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KPLA is an entity that should be sought for especially in poorly controlled diabetic patients when they present with clinical features of liver abscess. Blood culture must always be done especially when aspiration or drainage proves difficult.


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Use of appropriate antibiotics alone may be successful in treating them if surgical drainage is unsuccessful. Users Online: Community-acquired primary liver abscess due to klebsiella pneumoniae in a type 2 diabetic patient. Sub-Saharan Afr J Med ; Figure 1: Ultrasound: Hepatic abscess before treatment with gentamicin Click here to view. Figure 2: Ultrasound: Hepatic abscess after treatment with gentamicin Click here to view.

Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis ; Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med ; Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non- K. J Formos Med Assoc ; Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect ; Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: An emerging disease with unique clinical characteristics.


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  6. Am J Gastroenterol ; Invasive Klebsiella pneumonia syndrome in North America. Clin Infect Dis ; Pyogenic liver abscess caused by hypermucoviscous Klebsiella pneumoniae. Scand J Infect Dis ; Pyogenic liver abscess: Clinical manifestations and value of percutaneous catheter drainage treatment.


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      Burger v. We have reviewed the issues raised on appeal as they relate to Welte's informed consent claim against Dr. Bello and the specific negligence claim against Mercy and find no reversible error. We reverse and remand the cases for trial on the general negligence claim. The majority has ignored our law and has effectively expanded the application of the res ipsa loquitur doctrine well beyond its recognized purpose.

      Ever closer does the goal appear that any unexpected bad result from surgery must have been due to a surgeon's negligence. The "thing speaking for itself" has taken on a life of its own multiplying into the field of medicine with the self assurance of a crusader. Because the inference of negligence is without specific proof, we have said the doctrine of res ipsa loquitur should be used sparingly. Mogensen v.

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      Hicks, Iowa , , N. This is especially true in medical malpractice cases.

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      See Lagerpusch v. Lindley, Iowa , , N. Curtis, Iowa , , 66 N.

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      The doctrine is most often applied to medical injuries occurring when a surgeon either leaves an object in a patient's body or damages a portion of the body wholly unrelated to the surgery. See generally, 1 D. Louisell and H. Neither is the case here. We have held that the mere fact that an occurrence is rare does not alone warrant an application of res ipsa loquitur.

      Hagen, N. Further, the common experience exception to the expert testimony rule applies only where the injury suffered is an obvious violation of accepted medical standards. See, e. LeGrand, N.

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      Martin, Iowa 75, 91 N. In Perin, we decided that experts will be required to establish res ipsa's second foundational factthat the injury would not have occurred in the ordinary course of events if reasonable care had been usedwhere the injury sustained lies outside the common knowledge of laypersons.

      The common knowledge of laypersons hardly includes an understanding of the nature of sodium pentothal or what would happen if the sedative escaped from a vein to surrounding tissue. Nor is it commonly known how a needle is inserted into a vein, or how far it should be thrust. The majority's analysis is that the common knowledge exception is satisfied because people know that intravenous injections are often done.

      The misapprehension here is that knowledge of the frequency of an operative procedure equals knowledge that an unfavorable medical result must have been due to negligence. These two spheres of knowledge are not correlatives. With the standard applied by the majority, will every appendicitis operation involve an inference of negligence whenever a perfect result is not achieved? How soon will the res ipsa loquitur doctrine be applied to heart surgery cases? There are certainly many cases where a superb surgeon has performed the best operation possible and, nevertheless, experienced a tragic result.

      The fact that his skills were not enough to save the patient should not translate to an inference of negligence.

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      It is for the jury to decide whether the evidence shows a negligent surgeon or not. But the surgeon hasn't promised perfection to the patient and should not have it hung like an albatross about his neck, as the inference of negligence truly does, in the courtroom. When none was proffered by the plaintiff, Dr. Bello was entitled to summary judgment on this issue. Bello supplied the expert testimony to skewer himself is unrealistically technical.

      Phlebotomy: Syringe Draw Procedure - Blood Collection (Rx-TN)

      His statement in response to an interrogatory was one of scientific fact that sodium pentothal has caustic and burning effects. Maxwell's was similar. Both fell far short of supplying the expert testimony that plaintiff's injury would not occur absent negligence. The majority's reversal of the jury's absolution of Mercy Hospital again elevates "common experience" to lofty heights. Plaintiff Welte did receive the benefit of the res ipsa loquitur doctrine in the case against Mercy Hospital.

      Even so, the majority decides that the jury must infer negligence without judging the resulting injury against the standard of care recognized by those most knowledgeable in the fieldthe health care professionals. Thus, to the majority, the jurors'"common knowledge" of negligence, even if totally erroneous, is adequate to find liability since no expert testimony is required.

      This construction misuses the res ipsa loquitur principle. I concur in division IV of the majority opinion and would reverse and remand for a new trial as to defendant Mercy Hospital.