Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jun 2007
Case Reports[Septic shock with purpura fulminans after a dog bite].
A 61-year-old man presented with a four-day history of back pain and nonspecific abdominal pain. His condition had significantly worsened since the day before admission with generalized weakness and dyspnea. His temperature was 39.1 C, he had tachycardia and was tachypneic. Peripheral cyanosis was noted. The abdomen was soft with mild epigastric tenderness. A diffuse skin rash developed with increasing petechial bleeding and central necrosis. It was revealed that he had been bitten by a dog several weeks before admission. ⋯ As a rare cause of septicemia, especially in immunocompromised patients, Capnocytophaga canimorsus infection should be considered after an animal bite. Given the slow growth of this bacterium in culture, Gram-staining of a peripheral blood smear may provide an early diagnosis and avoid delay before appropriate antibiotic therapy, which may favorably influence the potentially fatal course, is started.
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Dtsch. Med. Wochenschr. · Jun 2007
Review[Dual platelet aggregation inhibition in coronary artery stent implantation--what is evidence-based?].
Dual platelet inhibition (ASA and clopidogrel) is the generally accepted standard therapy to avoid stent thrombosis although clopidogrel is not approved for this indication in Germany. The duration of dual platelet inhibition depends on the complexity of the stenosis, plaque activity and the type of stent implanted. Recent analyses suggested that implantation of drug eluting stents is associated with a substantially higher rate of stent thrombosis when compared with bare metal stents. ⋯ When elective or urgent surgery is required the surgeon and practitioner must decide whether the procedure can be performed with reasonable safety without discontinuation of antiplatelet therapy posing a higher bleeding risk to the patient. Patients on chronic oral anticoaglation should be additionally treated with clopidogrel for 1 month after implantation of bare metal or 12 months after drug-eluting stents. Additional treatment with ASS is not generally recommended since the bleeding risk of this triple medication may overweigh the benefits of dual antiplatelet inhibition.