1/10. Spontaneously infected cephalohematoma: case report and review of the literature.Spontaneously infected cephalohematomas are rare occurrences; only five cases have been reported previously. Uninfected cephalohematomas are common and usually resolve without treatment. However, physicians should be aware that cephalohematomas are potential sites for infection and may require aspiration for diagnosis and treatment. Untreated infected cephalohematomas may lead to osteomyelitis, epidural abscess, or subdural empyema. We present a case of a spontaneously infected cephalohematoma with an associated osteomyelitis which was successfully managed with drainage and long-term antibiotics. A review of the literature is also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. epididymitis after prostate brachytherapy.OBJECTIVES: To analyze the incidence, time-course, and potential predisposing factors for what was clinically diagnosed as postimplant epididymitis. methods: Of 517 patients randomized and treated on two treatment protocols, with a planned total accrual of 1200, 5 patients were identified who developed clinically diagnosed epididymitis after iodine-125 or pallidium-103 prostate brachytherapy. Implants were performed by standard techniques, using a modified peripheral loading pattern. Perioperative antibiotics (cefazolin and ciprofloxacin) were given to 258 patients, according to physician preference. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological association (AUA) and radiation Therapy Oncology Group criteria at 1, 3, 6, 12, and 24 months. patients who did not respond to the mailed questionnaires were interviewed by telephone. Although the patients were not queried specifically regarding epididymitis, its occurrence was noted when discovered in the course of follow-up examinations. RESULTS: Postimplant epididymitis occurred in 5 (1%) of 517 consecutive brachytherapy patients. None of the 5 patients had had a prior history of orchitis, epididymitis, vasectomy, or preimplant catheterization. The symptoms of epididymitis first appeared at 4, 7, 10, 150, and 300 days after implantation. patients with epididymitis had prostate volumes, preimplant AUA scores, and ages typical of other implant patients. No association was apparent between postimplant epididymitis and the degree of implant-related prostate swelling or the number of seeds implanted. Only the preimplant AUA score predicted for epididymitis, but 2 of the 5 patients had low scores. Only 1 (0.4%) of the 258 patients who received perioperative antibiotics developed epididymitis, and 4 (1.5%) of the 259 patients with prophylactic antibiotics developed epididymitis. CONCLUSIONS: epididymitis is an uncommon postimplant complication occurring in 1% of a large patient cohort. That epididymitis patients had greater preimplant AUA scores is consistent with a retrograde infection route, at least in some cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Infection in total joint arthroplasty from distal intravenous lines. A case report.Prevention of late hematogenous infection of a total joint arthroplasty is of great importance because of the catastrophic consequences. Any situation that can lead to a bacteremia should be avoided and appropriate prophylactic antibiotics given in anticipation of a bacteremic episode. This report documents a bacteremia and total joint infection secondary to a routine intravenous line placed in an extremity distal to a total knee arthroplasty. Routine intravenous infusion lines should not be placed in extremities with proximal total joint arthroplasties. Educating both patients and physicians about the risks to a prosthetic joint is important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. rhabdomyolysis associated with Escherichia coli septicemia.rhabdomyolysis resulting from septicemia (and endotoxemia) is not generally appreciated. In the present case, rhabdomyolysis and renal insufficiency followed documented E coli septicemia. Other causes of rhabdomyolysis were not identified in this patient. Thus, physicians should be alerted to this potentially serious complication of gram-negative septicemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Case study: abscess of the labia.A 68 year old female with no history of perianal abscess was examined in the Emergency Department of the hospital verbalizing complaints of swelling and tenderness in the left inguinal area. physical examination revealed redness and swelling of the left labial area. The patient was admitted to the hospital and, following surgical incision and drainage by the physician, wound exploration revealed tunneling extending into the perirectal and vaginal areas. ET Nurse consultation was requested to establish a wound treatment regimen. The system of dressing used were a sterile, rayon/polyester dressing impregnated with 15 percent crystalline sodium chloride to cleanse the wound of slough and debris, in a ribbon form to facilitate packing of tunneling; a sterile 0.9 percent sodium chloride solution in gel form to protect the wound bed and keep it moist during granulation and reepithelialization; and an absorbent pad to collect drainage. This system of dressings addressed the patient's specific needs, was easy to use and proved easy to teach to a family member managing the patient's wound care at home. During the 10 1/2 weeks of treatment, wound healing progressed steadily, odor diminished rapidly and granulation of the wound bed progressed to healing with no maceration of the surrounding skin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Sternoclavicular septic arthritis: a rare but serious complication of subclavian venous catheterization.Sternoclavicular septic arthritis is a rare complication of subclavian venous catheterization. We estimate that septic involvement of this joint may be as common as one in 500 catheterizations. We report two patients with insidious onset of shoulder pain, chest discomfort, low-grade fever and slight but painful swelling of a sternoclavicular joint four weeks following subclavian venous catheterization. Positive blood cultures in the presence of abnormal bone scan and abnormal conventional X-ray examination or computed tomography of the sternoclavicular joint led to the diagnosis of septic arthritis. Both patients responded well to antibiotic treatment. Based on our observations and that reported in the literature, the earliest changes of sternoclavicular septic arthritis may be detected by bone scan while plain X-ray studies and CT become abnormal during advanced stages of this type of arthritis. We would like to alert physicians to this cause of fever and joint pain in patients who previously underwent subclavian venous catheterization.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Lessons learned from a patient. Changing concepts rather than facts.Many concepts pertaining to urinary tract infections and considered to be established or dogma are, in fact, incorrect or subject to modification. The physician should not be too rigid in his thinking regarding this disorder, as new knowledge constantly becomes available, disproving previously cherished beliefs. The case described appears to underscore this better than any hypothetical situation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Hemolytic uremic syndrome: just another case of gastroenteritis?Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in north america is increasing. Several studies have shown that escherichia coli o157:H7 is associated with HUS. Although this pathogen was first recognized more than 10 years ago and is relatively common, many physicians are not aware of this diagnosis let alone the spectrum of illness associated with the bacteria. This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Infected urachal remnants in the adult: case report and review.Abnormalities of the urachus in adults are uncommon. Urachal tract remnants that abnormally remain patent are subject to infection. Urachal infection is frequently confused with a wide spectrum of midline intraabdominal or pelvic inflammatory disorders. Because the literature on urachal infection is primarily limited to articles in urology and surgical specialty journals, many physicians may not be familiar with the varied clinical manifestations. We describe a case of infection of a patent urachus in an adult and review the embryology and anatomy of the urachus as it relates to clinical presentation, evaluation, and management. Infection of a urachal remnant should be included in the broad differential diagnosis of omphalitis and midline abdominal or pelvic infections. Rarely, it may be a cause of recurrent urinary tract infection. Definitive management consists of surgical excision after the institution of antimicrobial therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Treatment of a patient with an infected hepatic cyst.Symptomatic hepatic cysts are infrequently seen by family physicians. We review the literature and describe the diagnosis and management of a patient with cystic liver disease and a dominant infected hepatic cyst. The treatment included percutaneous drainage, intravenous antibiotic therapy, and sclerotherapy infusion using sterile alcohol (95% ethanol).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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