Systemic Upset Research Articles

Chronic Clostridium septicum infection of a tibial fracture: a case report

An open transverse fracture of the mid-shaft of the tibia of a professional footballer became infected by Clostridium septicum and, after early compression plating, required surgical intervention on three further occasions and extensive antibiotic treatment before healing occurred. Clostridial infection is a recognized complication of open fractures contaminated with soil, and the necrotizing toxins produced by the C. septicum were probably responsible for the persistence of this infection. Infection occurred in less than 1 per cent of our series of 215 operations of compression plating of fresh fractures of the tibial shaft. Infection by clostridium species is a serious complication of open fractures. This patient did not show the spreading inflammation and necrosis, or the marked systemic upset, characteristic of acute clostridial infection, but persistent local infection necessitated prolonged surgical and antibiotic treatment.

The effect of para-influenza type 1 (Sendai) virus infection on early pregnancy in the rat.

Summary. Infection of rats, 4 to 5 days pregnant, with aerosols of Sendai virus induced resorption of all embryos in nine out of the twelve animals examined. Virus was recovered from the conceptus of only one of fourteen additional rats, although each was shown to have the agent in the lungs. It is concluded that the observed termination of pregnancy is not due to virus growth within the cells of the conceptus, but is likely to be caused indirectly by the systemic upset in the pregnant animal induced by the respiratory disease.

Upper respiratory infection due to Entomophthora coronata. Rhino-entomophthoromycosis.

Rhino-entomophthoromycosis is a granulomatous lesion of the upper respiratory tract caused by a Phycomycete Entomophthora coronata (Costantin Kevorkian, 1935). The condition was initially described in Nigeria by Martinson in 1963 (1) under the designation of rhinophy-comycosis on the basis of its histological resemblance to subcutaneous phycomy-cosis but its somewhat different clinical behavior. Subsequently, in six further cases from the same hospital, the etiologic agent, E. coronata, was isolated (2). This paper analyses the radiological features found in 14 patients with this disease who were studied at the University College Hospital, Ibadan, in Western Nigeria. Pathology The mode of infection is probably traumatic implantation of the fungus or inhalation of spores, which germinate and produce infection when local conditions are suitable. A granulomatous lesion commences in the submucosa usually in or close to the anterior end of the inferior turbinate. This inflammatory process may then extend into the nasal cavity to cause nasal obstruction; invade the paranasal sinuses, filling them with submucosal masses; or spread on to the face by way of naturally occurring bony foraminae or spaces between two adjacent bones while remaining below the facial muscles, though these may become invaded in long-standing cases. This mode of extension gives rise to firm facial swellings over the nose which may progressively spread to the cheek and upper lip (Fig. 1). The swellings are firm with palpably discrete borders and are fixed to deeper tissues, but in rhino-entomophthoromycosis, unlike subcutaneous phycomycosis, the overlying skin is moveable over the swellings unless there is secondary infection or invasion of the facial muscles has occurred. The condition differs further from subcutaneous phycomycosis in that its downward spread is limited outward to the lateral border of the facial muscles of expression and downward to the upper lip. Histological examination of the affected tissue has disclosed a similar appearance in all cases. There is a chronic granulomatous reaction in which eosinophils are prominent and giant cells containing hyphae and lying in microabscesses may be seen; the degree of fibrosis varies with the age and maturity of the portion of the lesion examined. Large, nonseptate hyphal elements surrounded by eosinophilic material are demonstrated by periodic acid Schiff stain (Fig.2). Clinical Features All the patients were adults who were well nourished and fit, apart from their fungal infection. None of the patients had any evidence of systemic upset, anemia, or diabetes. The age range was between twenty and forty years, and 12 of the 14 patients were males. All patients had varying degrees of unilateral nasal obstruction, but none had fetor. There was a swelling over the nose, cheek, or upper lip in 13 of the cases; in the fourteenth the lesion was confined to the nasal cavity and there was no external swelling.

A nasal and systemic upset of possible thymic origin: Oaks, W., and Allen, W.: Eye, Ear, Nose, and Throat Monthly 18: 231, 1939

A nasal and systemic upset of possible thymic origin: Oaks, W., and Allen, W.: Eye, Ear, Nose, and Throat Monthly 18: 231, 1939