Invasive salmonella enteritidis infection complicated by colonic perforations and pancytopenia: A case report

Salmonellosis caused by bacterial genus Salmonella is associated with a high morbidity and mortality rate. Salmonellae can be divided into typhoidal serotypes (S. enterica ser. Typhi and S. enterica ser. Paratyphi A) and nontyphoidal Salmonella (NTS) serotypes. The two most common NTS serotypes isolated from human sources were S. enterica ser. Typhimurium and S. enterica ser. Enteritidis. NTS infection can present with diverse clinical manifestations, including gastroenteritis, bacteraemia, septic arthritis, osteomyelitis, and endovascular infection. Intestinal perforation is an extremely rare and potentially fatal complication of severe salmonella infection. Herein, we report a case of invasive S. Enteritidis infection complicated by colonic perforation and pancytopenia. Following a colonic resection, the patient received a prolonged course of antimicrobial therapy and eventually recovered.

The efficacy of percutaneous transluminal angioplasty in the treatment of failing vascular access in chronic hemodialysis patients

BACKGROUND

Failure of vascular access leading to inefficient hemodialysis is the most common cause of morbidity in uremic patients. Careful observation of clinical signs and hemodynamic monitoring are vitally important to prevent complete fistula thrombosis. This study was undertaken to evaluate approaches for early detection and the application of percutaneous transluminal angioplasty in the treatment of failing vascular access.

METHODS

From August 1994 to August 1995, 32 uremic patients with failing vascular access (26 native arteriovenous fistulas, 6 polytetrafluroethlene (PTFE) grafts), presented signs of poor arterial flow, high venous pressure, significant recirculation, acute fistula thrombosis and persistent swelling of the access arm. These patients underwent fistulography and subsequent angioplasty in the confirmed obstructed sites.

RESULTS

Thirty-seven angioplasty procedures were performed including 32 de novo lesions and 5 restenotic lesions; of the total, 32 (86.5%) were successful. In native arteriovenous (AV) fistulas, the most common problem was inadequate flow with the lesion located within 5 cm from the AV junction (63.6%). In PTFE grafts, the most common presentation was high venous pressure with the lesion located at the PTFE-venous junction (57.1%).

CONCLUSIONS

Through clinical surveillance and hemodynamic monitoring during hemodialysis, failing vascular access can be detected early and treated effectively with percutaneous transluminal angioplasty.