9/23 PVG
ӷ|ШD
Dear doctor:
This 47-year-old female is a patient of right ankle ceelulitis. She received internal fixation of right ankle in 2008/02(due to traffic accident). Current antibiotis is Oxacillin and her condition improved. Blood culture on 9/18 yielded Stenotrophomonas maltophilia, which is resitent to TMP/SMZ. We need your expertise for evaluating this patient. Thank you very much!

ӷ|^
stenotrophomona maltophilia is rare in contamination, GNB bacteremia is most frequently associated with endogenous focus  
impression: 
1. suspect chronic osteomyelitis secondary to foreign body 

suggestion
1. please repeat blood cu;ture to exclude persistent bacteremia after treatment 
2. shift antibioitcs to moxifloxacin 
3. arrnage 3 phase bone scan 
4. consult orthopedics to see if removal of internal fixation is adequate \

thanks for your consulation 




9/23  
ӷ|ШD  G
Dear doctor:
This 47-year-old female is a patient of right ankle ceelulitis. She received internal fixation of right ankle at Hospital in 2008/02 (due to traffic accident). Current antibiotis is Oxacillin and her condition improved. Blood culture on 9/18 yielded Stenotrophomonas maltophilia, which is resitent to TMP/SMZ. We are not sure if this is related to the prostheses. We need your expertise for evaluating this patient. Thank you very much!

ӷ|^
A case of right lower leg cellulitis.



9/29  G
ӷ|ШD
Dear doctor:

This 47-year-old female was admitted to cellulitis. She claimed that she have no menstrual cycles in recent 6 months(after her Orthopedic surgery in this Febuary). She said that her menstrual cycles were irregular since that year. Sex hormone levels were checked in this hospitalization. 
FSH = 67.3 mIU/ml   
Right ankle fracture s/p ORIF in 2008/02.
x-ray showed right ankle fracture union
no local heat or tenderness over right ankle area.
impression: right lower leg cellulitis
            osteomyelitis is not likely
plan: continue antibiotic treatment
      if the condition gets progresion, please contact us again
   thanks for your consultation.


ӷ|^СG
Dear Dr:

This 47 y/o female is menopause.

FSH:67.3(>30)

LH:15.3

E2:23.1

Imp: postmenopause


                                R4βQ0966200129
