Article

Indium-III white blood cell scan

January 1981
Orthopaedic Review 10(6):91-96

Authors:

It seems clear that the Indium-III white blood cell scan may very well be more specific and sensitive in the detection of inflammatory lesions than any other presently available noninvasive tool. To the orthopaedic surgeon, this offers improvement in his ability to diagnose and localize bone and soft tissue inflammatory (septic and aseptic) sites. Secondly, it may provide a more accurate, objective method of following the response of such lesions to treatment. Final determination of the utility of this procedure will depend upon its performance in clinical settings at other centers and in different patient populations. Full evaluation also awaits the results of controlled experimental studies which are now underway.

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Skin lesions and neutrophilic leukemoid reaction in a patient with angioimmunoblastic T-cell lymphom...

March 2015 · Clinical Case Reports

Key Clinical Message Here, we present a 53-year-old man with angioimmunoblastic T-cell lymphoma accompanied by skin lesions (vesicles, papulovesicles, and miliary papules symmetrically distributed on extremities and trunk, with more distal lesions increasing in severity). Routine blood tests showed a white blood cell count of 58.97 × 109/L (Neutrophils% 91.64%).

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Same-day discharge after incision and drainage of soft-tissue abscess in diaper-age children is safe...

May 2017 · Pediatric Surgery International

Purpose: Many pediatric centers admit patients following incision and drainage (I&D) of soft-tissue abscesses. The purpose of this study is to assess the safety and efficacy of the same-day discharge following I&D. Methods: Retrospective review was performed of children aged 3 months-4 years who underwent operative I&D of an abscess followed by same-day discharge. Patients receiving ... [Show full abstract] antibiotics within 2 weeks of presentation were excluded. Treatment failure was defined as readmission or repeat procedure related to the initial abscess. Statistical analysis was performed using Wilcoxon Rank-Sum and Fisher's Exact tests. Results: There were 442 procedures performed in 408 patients. Mean age was 1.8 years. Fever was noted in 25.8%. Of those who had a white blood cell (WBC) count drawn, 59.7% had leukocytosis. Mean time from procedure to discharge was 2.3 h, and 85.0% were discharged with oral antibiotics. Treatment failure occurred in four (0.9%) and ten (2.3%) patients at 14 and 30 days, respectively. Mean WBC count was higher in the 14-day treatment failure group (24.1 versus 16.3; p = 0.10). In patients with leukocytosis, there were 2 (1.4%) treatment failures compared to none in those without leukocytosis. Conclusion: Same-day discharge after I&D of abscess in diaper-age children is safe and effective.

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What are we waiting for? An argument for early surgery for spinal epidural abscesses

November 2015 · Surgical Neurology International

Nancy E Epstein

Background: In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA): A review, Epstein raises one major point; it is imperative that spinal surgeons "take back decision-making" from our medical cohorts and reinstitute early surgery (<24 h) to better treat SEAs. Methods: Spine surgeons recognize the clinical triad (e.g., fever [50%], spinal pain [92-100%], and ... [Show full abstract] neurological deficits [47%]) for establishing the diagnosis of an SEA. We also appreciate the multiple major risk factors for developing SEA; diabetes (15-30%), elevated white blood cell count (>12.5), high C-reactive protein (>115), positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 19-45%). Results: Recognizing these risk factors should prompt early open surgery (<24 h from the onset of a neurological deficit). Open surgery better defines the correct/multiple organisms present, and immediately provides adequate/thorough neurological decompression (with fusion if unstable). Although minimally invasive surgery may suffice in select cases, too often it provides insufficient biopsy/culture/irrigation/decompression. Most critically, nonsurgical options result in unacceptably high failure rates (e.g., 41-42.5-75% requiring delayed surgery), while risking permanent paralysis (up to 22%), and death (up to 25%). Conclusion: As spine surgeons, we need to "take back decision-making" from our medical cohorts and advocate for early surgery to achieve better outcomes for our patients. Why should anyone accept the >41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate?

Article

Clinical characteristics and risk factors analysis of amalgamative infection of liver cirrhosis with...

August 2016

Objectives: This study is to characterize the clinic symptoms and analyze the risk factors of amalgamative infection for LCHD. Methods: 224 LCHD cases were divided into infection group and non-infection group according to their infection history. SPSS l6 statistical software was utilized to analyze the possible risk factors by uncondi-tioned Logistic regression analysis, and calculate the odds ... [Show full abstract] ratio (OR). Results: Among these 224 LCHD patients, 105 cases had infection (46.88%) mainly from community infection. Infection occurred mainly in the respiratory tract and abdominal cavity, followed by urinary tract, digestive tract, biliary tract, skin and soft tissue infections. The major nosocomial infection is intraperitoneal infection and the main community infection is respiratory tract infection. 19 cases of 41 patients with hospital infection had fever (46.34%). Routine blood white blood cells analysis revealed that fever was not significantly associated with leukocyte count. Conclusion: Liver cirrhosis with hepatic de-compensation was mainly from community infection. Infection occurred mainly in the respiratory tract and abdominal cavity. Age, gastrointestinal bleeding, liver function grade C and hospital time all contributed to the infection of LCHD. Therefore, early detection and timely treatment of LCHD can reduce the incidence of infection and mortality.

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White blood cell sister chromatid exchange among a sample of Thai subjects exposed to lead: Lead-ind...

July 2008 · Toxicological and Environmental Chemistry

Epidemiological and experimental studies indicated that inorganic lead compounds are associated with increased risks of tumorigenesis. This study was aimed at determination for sister chromatid exchange (SCE), a marker for genotoxicity with correlation to lead blood levels in Thai exposed subjects. A total of 32 police (all males) were included into this study. The average (mean ± SD) blood lead ... [Show full abstract] in these police was 2.1 ± 1 µmol L. The average SCE among the police with high blood lead was significant higher than those with low metal exposure. Data suggest that cytogenetic response to Pb is significantly different between the subjects with high versus low lead exposure. High exposure to lead seems related to high chromosome aberrations.

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Hydroxyurea treatment for chronic myeloid leukaemia during pregnancy

January 1994 · British Journal of Haematology

A patient being treated for chronic myeloid leukaemia with hydroxyurea became pregnant. Despite an increase in the dose of hydroxyurea (to 3 g per day) during the pregnancy, her white blood cell count could only be controlled at about 150 x 10(9)/l. A healthy baby girl was born at 37 weeks with normal blood counts and no evidence of congenital abnormality. There are now five reports of the use of ... [Show full abstract] hydroxyurea in pregnancy, and where leukapheresis is not available it may be the treatment of choice.

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Third day laboratory follow-up: mandatory for surgical site infections of tibial plateau fractures

April 2021 · European Journal of Trauma and Emergency Surgery

Introduction Tibial plateau fractures are common fractures in adults and can be extremely challenging for surgeons. State-of-the-art therapy is open reduction and internal fixation (ORIF), although major complications of ORIF are surgical site infections (SSIs). This is especially critical on the proximal tibia, which is only sparsely covered by soft tissue and has a close relation to the knee ... [Show full abstract] joint. We analyzed SSIs after ORIF to correlate established laboratory parameters to the occurrence of SSIs. Methods A monocentric case–control study in a Level 1 Trauma Center was conducted. Data were acquired from electronic medical records from 2011 until 2016. White blood cell count (WBC) and C-reactive protein (CRP) were used as laboratory parameters and statistically analyzed. Results In total, 97 patients were included, with four patients suffering from SSIs. Patients with SSIs had a significantly increased WBC count and CRP levels on the third postoperative day. Infection was diagnosed after rehospitalization, 12 ± 4 weeks after initial surgery. Furthermore, a large bony destruction through trauma coincides with a rise of WBC count with no influence on CRP level. Conclusion We highly recommend a laboratory analysis with WBC count and CRP on the third day after ORIF. Patients with a CRP level above 100 mg/l should be closely watched, even if laboratory parameters few days later are adequate—since a one-time increase above this landmark might be a hint regarding the development of a SSI.

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Fever, white blood cell count, and culture and sensitivity: Their value in the evaluation of the eme...

January 1989 · Topics in Emergency Medicine

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Computed-tomography-guided biopsy in suspected spondylodiscitis: Single-center experience including...

March 2019 · Orthopedic Reviews

Our propose is to evaluate CT-guided biopsies in suspected spondylodiscitis with respect to puncture site, microbiology findings, histopathology findings and impact on antibiotic therapy. 86 CT-guided spine interventions in suspected spondylodiscitis comprising 201 biopsy procedures were analyzed. Medical records of all patients were screened for microbiology and histopathology reports as well as ... [Show full abstract] date, duration and kind of antibiotic therapy. Statistical analyses included calculation of Chi2-tests and logistic regression analyses. Locations of biopsies were intervertebral disc (48.3%), paravertebral soft-tissue (38.3%) and vertebral body (10.9%). Positive microbiological findings were found altogether in 33.8% of cases, positive histopathological findings in 53.6%. Significant associations between positive microbiological findings, positive histopathological findings and antibiotic therapy, respectively, were found. Location of biopsies did not significantly influence rate of positive findings. From the variables age, white blood cell count, serum creatinine and puncture site, none were found to be an independent predictor for a positive microbiological result. We concluded that CT-guided biopsy of intervertebral disc and paravertebral soft tissue yields positive microbiologic findings in a significant proportion of cases. Puncture site is not associated with positive results of microbiology or histopathology.

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Discrepancy between serum C-reactive protein and white blood cell count suggests unfavorable prognos...

January 2013

Even though suitable strategies of wound treatment and management are performed, some patients with severe soft tissue infection show poor improvements or fatal outcome. In this article, we studied patients with progressive soft tissue infection, considering factors indicating a poor prognosis. We examined 39 patients with soft tissue infection whose CRP levels were above 200 mg/l. Among these ... [Show full abstract] patients, 31 showed a favorable improvement of inflammation, whereas 8 showed poor improvement or a fatal outcome. We investigated the associations of laboratory data, including WBC, neutrophil, lymphocyte, serum protein, albumin, hemoglobin, platelet, AST, ALT, and creatinine levels between these groups. The mean WBC count in patients showing delayed improvement or a fatal outcome was 12,500, and that with early improvement was 15,400, revealing a significant difference between the groups. There was no significant difference between these groups regarding to other factors. We conclude that about 80% of patients with aggressive soft tissue infection show successful inflammatory resolution within 3 weeks of immediate radical debridement. However, some patients with lower WBC counts may show a much slower improvement or a fatal course. A discrepancy between serum CRP and WBC suggests a poor prognosis in patients with severe soft tissue infection.

Article

Low sensitivity of physical examination findings in necrotizing soft tissue infection is improved wi...

January 2009 · The American Journal of Surgery

When clinical "hard signs" of necrotizing soft tissue infection (NSTI) are present, establishing the diagnosis of NSTI is not difficult. However, hard signs of NSTIs are often absent on presentation, thus potentially delaying diagnosis and surgical intervention. A prior retrospective study performed at our institution demonstrated that admission white blood cell (WBC) count >15,400/microL x ... [Show full abstract] 10(9)/L and/or serum sodium (Na) <135 mEq/L could help differentiate NSTI from non-NSTI. The purpose of this study was to prospectively determine how often "hard signs" of NSTI are present and to evaluate how knowledge of laboratory parameters influence our surgeons' abilities to diagnose and manage NSTI. Prospective observational data collection to determine the sensitivity of NSTI "hard signs" and administration of a questionnaire in which the surgeon was asked whether he believed the patient had an NSTI based on physical examination (PE) alone, and then after being informed of the Na level and WBC count. Twenty-one patients with a mean age of 41 years had NSTI. Mean admission WBC count and Na level were 31,500/microL and 127 mEq/L, respectively. Only 9 (43%) had hard signs of NSTI. Suspicion for NSTI increased from 9 to 18 (86%) after evaluating laboratory criteria (P = .008). Fewer than half of the patients presented with hard clinical signs of NSTI. Admission WBC count >15,400/microL or serum Na <135 mEq/L significantly increased suspicion for NSTI and aided early diagnosis.

Article

Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study

September 2015 · International Journal of Colorectal Disease

Daniel Isacson

Abstract Purpose The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period. Methods A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without ... [Show full abstract] antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months. Results In total, 155 patients were included, of which 54 were men; the mean age of the patients was 57.4 years. At the time of diagnosis, the mean C-reactive protein and white blood cell count were 73 mg/l and 10.5 × 109, respectively, and normalized in the vast majority of patients within the first week. The majority of the patients (97.4 %) were managed successfully as outpatients without antibiotics, admissions, or complications. In only four (2.6 %) patients, the management failed because of complications in three and deterioration in one. These patients were all treated successfully as inpatients without surgery. Five patients had recurrences and were treated as outpatients without antibiotics. Follow-up colonic investigations revealed cancer in two patients and polyps in 13 patients. Conclusion Previous results of low complication rates with the non-antibiotic policy were confirmed. The new policy of outpatient management without antibiotics in acute uncomplicated diverticulitis is now shown to be feasible, well functioning, and safe.

Last Updated: 22 Oct 2024