Goran Augustin

Venomous snakebites in the Croatian North Dalmatia region

ZusammenfassungZIEL DER STUDIE: Analyse der epidemiologischen, klinischen und labormäßigen Attribute von giftigen Schlangenbissen mit dem Ziel, die rechtzeitige und wirksame Behandlung vor Ort oder im klinischen Setting zu ermitteln. METHODEN: Es wurden die epidemiologischen und klinischen Daten sowie die Laborergebnisse der Leute, die im Zeitraum von 11 Jahren (1999–2009) von giftigen Schlangen gebissen und im Allgemeinen Krankenhaus von Zadar behandelt worden waren, retrospektiv analysiert. ERGEBNISSE: Im untersuchten Zeitraum sind 93 Leute (57 (62 %) Männer und 36 (38 %) Frauen) von giftigen Schlangen gebissen worden. In 82 Fällen (90 %) war der Biss auf den Extremitäten der Patienten lokalisiert. Die restlichen 11 Patienten wurden an anderen Stellen gebissen. Bei 31 Patienten (33 %) erfolgte der Biss bei der Ausübung von Freizeitaktivität, bei 44 (47,3 %) während der Arbeit. Die häufigsten lokalen Zeichen des Schlangenbisses sind Schwellung und Schmerz an der Biss-Stelle (bei 100 %) sowie Hämatome und Ekchymosis (87 Patienten = 89 %). Acht der gebissenen Patienten erlitten ein Kompartment Syndrom und eine Person (0,97 %) verstarb. SCHLUSSFOLGERUNGEN: Die Gegengift-Behandlung zur Vorbeugung möglicher allergischer Reaktionen eines Schlangenbisses sollte in der medizinischen Institution, in die das Opfer gebracht wird, stattfinden. Wenn aber der Transport nicht gleich möglich ist oder das Opfer bereits Zeichen der Vergiftung zeigt, sollte die Gegengift-Behandlung sofort (vor Ort) erfolgen, da ihre Wirkung schwächer ist, wenn das Gift bereits wirkt.SummaryAIM: The aim of this research project is to analyze the epidemiological, clinical and laboratory attributes of venomous snakebites and to ascertain the timely and efficient treatment at the location where the incident took place or in varying clinical conditions. METHODS: Epidemiological, clinical and laboratory data were collected from people who were bitten by venomous snakes as well as treatments at Zadar General Hospital during a span of eleven years (1999–2009) which were analyzed retrospectively. RESULTS: During that period, 93 people were bitten by venomous snakes of which 57 patients (62%) were male and 36 (38%) were female. In 82 cases (90%), the bite area was localized on the limbs while in the remaining 11 cases the bite area was located elsewhere. At the time of the venomous snakebite, 31 (33%) patients were performing leisure activities and 44 (47.31%) of them were at work. The most common local snakebite signs are swelling and pain at the bite site (93 patients; 100%), hematomas and ecchymoses (87 patients; 89%). Of the affected patients, 8 suffered from compartment syndrome and one person (0.97%) expired. CONCLUSION: Antivenom treatment for preventing possible allergic reactions should take place at the medical institution where the victim was transported. However, when transport is not immediately available or in cases where the victim shows clear signs of envenomation, antivenom treatment should be used immediately because its effect is weaker if the venom is allowed to run its course.

Small bowel entrapment associated with pelvic fracture: a case report with review of the literature and differentiation of clinical picture.

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Raising concerns about the Sepsis-3 definitions

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

Thigh abscess as an extension of psoas abscess: the first manifestation of perforated appendiceal adenocarcinoma: case report

SummaryA 65-year-old woman presented with a painful, swollen, red right thigh and the mild pain in the right abdomen without nausea, vomiting or diarrhoea that lasted for 1 week. Laboratory findings revealed elevated inflammatory markers. Computed tomography of the right thigh, abdomen and pelvis showed an abscess formation in the adductor muscles draining from the abscess that completely occupied the right retroperitoneum up to the diaphragm, dissecting downward through the inguinal canal. Appendix was enlarged with an appendicolith. Emergent exploratory laparotomy revealed a perforated appendix with psoas abscess. Pathohistological diagnosis revealed adenocarcinoma of the appendix. Thigh abscess is an uncommon condition with insidious clinical presentation. Therefore, early recognition and setting of the correct diagnosis enables adequate treatment avoiding additional complications and in some cases potential life-threatening conditions. When upper leg abscess is suspected or proven abdominal examination is mandatory.ZusammenfassungEine 65-jährige Frau präsentierte sich mit einer seit einer Woche schmerzhaften, geschwollenen rechten Hüfte und geringen Schmerzen im rechten Abdomen ohne Nausea, Erbrechen oder Diarrhoe. Im Labor waren die Entzündungsmarker erhöht. Die Computertomographie der rechten Hüfte, des Abdomens und Beckens zeigte eine Abszessbildung in den Adduktoren als Drainage von einem Abszess, der das rechte Retroperitoneum bis zum Diaphragma ausfüllte und hinunter durch den Inguinalkanal dissezierte. Der Appendix war vergrößert mit einem Appendikolithen. Die explorative Not-Laparatomie ergab einen perforierten Appendix mit einem Psoasabszess. Pathohistologisch wurde ein Adenokarzinom des Appendix befundet. Hüftabszesse sind selten und präsentieren sich klinisch schleichend. Deshalb sind das frühe Erkennen und die frühe Erstellung der korrekten Diagnose wichtig. Nur so kann eine adäquate Therapie unter Vermeidung von zusätzlichen Komplikationen und manchmal sogar lebensbedrohenden Zuständen ermöglicht werden. Wenn der Verdacht eines Abszesses im Oberschenkel besteht oder dieser bestätigt ist, muss unbedingt eine Untersuchung des Abdomens durchgeführt werden.

Post-vaccination dermatolipomyonecrosis.

A 27-year-old woman with long standing aplastic anemia and paroxysmal nocturnal hemoglobinuria was vaccinated with N. meningitidis and H. Influenzae type b vaccine in the right deltoid region. The same evening the patient developed edema of the whole arm with progressive skin necrosis with blisters and surrounding inflammation (Fig. 1a). During vaccination the patient was on therapy with deferasirox 125 mg, prednisone 15 mg and enoxaparine 40 mg. After complete excision myonecrosis progressed urging further excision (Fig. 1b). The final defect was covered with split thickness skin graft, the further healing process was uneventful. Skin necrosis can develop after vaccination, medication, snake bites, ischemia, infection, autoimmune disease and surgery. Redness, swelling and tenderness are common, but dermatolipomyonecrosis is extremely rare after different types of vaccionations and has not been documented after vaccination with N. meningitidis and H. Influenzae type b vaccine. Progressive vaccinia (�accinia �ecrosum or �accinia �angrenosa), is a potential complication of smallpox vaccination with an incidence of 1.6 cases per million vaccinations, with a case fatality rate of almost 90% [1]. It occurs almost exclusively among persons with cellular immunodeficiency, presenting with local ulceration and central necrosis with little or no inflammation at the site initially. It should be differentiated from local infection due to contamination by the injection procedure or by the pharmaceutic product (if not sterile) or �icolau’s syndrome (embolia cutis medicamentosa) which represents painful, livid discoloration and sloughing of the skin with areas of necrosis after intramuscular injection due to to accidental intravascular or perivascular drug injection [2]. Dinko Bagatin, Goran Augustin, Tomica Bagatin