1/97. liver abscess secondary to fish bone penetration of the gastric wall: a case report.An unusual case of liver abscess caused by fish bone perforation of the stomach is presented in this report. A 65-year-old woman was admitted to the Far Eastern Memorial Hospital for abdominal pain, fever and chills. physical examination revealed anemia and tenderness in the epigastrium. Laboratory data showed leukocytosis and abnormal liver function. Computerized tomography of the abdomen disclosed a huge abscess in the left lobe of the liver. Exploratory laparotomy was performed and a fish bone, 3.7 cm in length, was found perforating the stomach with penetration into the left lobe of the liver, resulting in a hepatic abscess. drainage of the liver abscess with removal of the fish bone and simple closure of the gastric perforation were performed. The patient recovered uneventfully.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/97. Odontogenic sinusitis causing orbital cellulitis.BACKGROUND: Odontogenic sinusitis is a well-recognized condition that usually is responsive to standard medical and surgical treatment. Current antibiotic therapy recommendations are directed against the usual odontogenic and sinus flora. CASE DESCRIPTION: The authors present a case of a patient with acute sinusitis initiated by a complicated tooth extraction that did not yield readily to standard treatment. The case was complicated by orbital extension of the sinusitis. The authors isolated methicillin-resistant staphylococcus aureus, or MRSA, species from the affected sinus that usually is not encountered in uncomplicated acute nonnosocomial or odontogenic sinusitis. CLINICAL IMPLICATIONS: Though such forms of resistant microbial flora as MRSA are rare, they may be seen in patients who have a history of intravenous, or i.v., drug use and in immunocompromised patients. Management of patients with orbital extension of sinusitis requires hospitalization and i.v. antibiotic treatment.- - - - - - - - - - ranking = 2.4052421563232keywords = drug (Clic here for more details about this article) |
3/97. Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.PURPOSE: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. CLINICAL FEATURES: A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination. CONCLUSION: The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/97. Unusual fatal mechanisms in nonasphyxial autoerotic death.The diagnosis of autoerotic death is most often made when there has been accidental asphyxia from ropes or ligatures used by the deceased as a part of his or her autoerotic ritual. Three cases of probable autoerotic death are reported in which the mechanisms of death involved hyperthermia, sepsis, and hemorrhage, respectively. Case 1: A 46-year-old man was found dead in bushland clothed in a dress, female undergarments, and seven pairs of stockings/pantyhose. The underwear had been cut to enable exposure of the genitals. The recorded daily maximum temperature was 39 degrees C, and the deceased had been taking the drug benztropine. death was attributed to hyperthermia due to a combination of excessive clothing, high ambient temperature, and prescription drug side effect. Case 2: A 40-year-old man was found dead in his boarding house. At autopsy, a pencil was found within his abdominal cavity with perforation of the bladder and peritonitis. death was attributed to peritonitis/sepsis following intraurethral introduction of a pencil. Case 3: A 56-year-old man was found dead lying on his bed following massive rectal hemorrhage. A blood stained shoe horn was found nearby. death was attributed to hemorrhage following laceration of the anal canal with a shoe horn. The diagnosis of autoerotic death may be difficult when typical features are absent, however, any unusual injury associated with genitourinary manipulation must raise this possibility.- - - - - - - - - - ranking = 4.8104843126463keywords = drug (Clic here for more details about this article) |
5/97. Retrieval of an IV catheter fragment from the pulmonary artery 11 years after embolization.The use of a peripherally inserted central catheter (PICC) is occasionally complicated by intravascular fracture and central embolization of the catheter fragment. We present a patient in whom a PICC fragment was retrieved from the pulmonary artery 11 years after embolization following its incidental detection. Despite a history of IV drug abuse and mitral regurgitation, this patient remained asymptomatic and without complications. The catheter fragment was retrieved since the patient was believed to be at risk for endocarditis. This may be the longest duration reported of an embolized catheter fragment that was successfully removed. As the natural history of asymptomatic-retained central venous foreign bodies remains unclear, the decision to remove them should be individualized. In selected cases, these foreign bodies may be retrieved without complications even several years after embolization.- - - - - - - - - - ranking = 2.4052421563232keywords = drug (Clic here for more details about this article) |
6/97. Suspected foreign body aspiration in a child with endobronchial tuberculosis.Endobronchial tuberculosis is a form of pulmonary tuberculosis, thought to result from rupture of an infected node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. With the presence of multidrug resistant isolates of TB, and its incidence in an increasing number of foreign-born persons immigrating to the US, otolaryngologists must be aware of its often subtle presentation. The following case is an unusual presentation of endobronchial tuberculosis initially diagnosed as an airway foreign body.- - - - - - - - - - ranking = 2.4052421563232keywords = drug (Clic here for more details about this article) |
7/97. An unexpected benefit of pre-emptive rectal analgesic administration: the "key" to postoperative analgesia.Analgesic and anti-inflammatory drugs are frequently administered intraoperatively by the rectal route to provide pre-emptive postoperative analgesia. We report the case of an inmate of a federal penitentiary who underwent orthopedic surgery in a public hospital. After induction of general anesthesia, indomethacin and acetaminophen were administered rectally. This led to the incidental discovery of a handcuff key hidden in the rectum and, thereby, the prevention of a planned escape. A review of data regarding escapes by prisoners from public hospitals is provided, as well as a description of cases of patients presenting with foreign rectal objects. A number of benefits have been described for the use of pre-emptive analgesia. This is the first reported description of an incidental benefit: the prevention of a planned escape by a prison inmate.- - - - - - - - - - ranking = 2.4052421563232keywords = drug (Clic here for more details about this article) |
8/97. neck needle foreign bodies: an added risk for autopsy pathologists.The risk to pathologists of contracting diseases due to cuts or needles punctures while performing autopsies is well known. An additional risk is an accidental needle puncture due to retained needle fragments within the subcutaneous tissues or internal organs of intravenous drug addicts. We report 4 cases of drug addicted patients infected with human immunodeficiency virus who came to autopsy and had retained needle fragments within their cervical-clavicular soft tissues. The presence of retained needle fragments increases the risk to the autopsy pathologist of accidental needle puncture and exposure to disease. Because of this phenomenon, the pathologist should take precautions in addition to those currently prescribed when performing autopsies on possible drug abusers.- - - - - - - - - - ranking = 7.2157264689695keywords = drug (Clic here for more details about this article) |
9/97. Intravenous drug abuse mimicking vasculitis."Mimickers" of vasculitis are well-documented in the literature. We report a case of intravenous drug abuse manifesting with signs and symptoms suggestive of vasculitis. This case highlights the need for diagnostic precision in the evaluation of suspected vasculitis.- - - - - - - - - - ranking = 12.026210781616keywords = drug (Clic here for more details about this article) |
10/97. Right ventricular needle embolus in an injecting drug user: the need for early removal.This case report describes an unusual cardiac complication in a 22 year old, female injecting drug user. The retention of two fractured injection needles at the site of intravenous injection in the groin, and the subsequent embolisation of one to the right ventricle, predisposed to recurrent local and systemic infections, and endocarditis. Two years later, the needle was completely embedded in the wall of the right ventricle and not suitable for transvenous removal. Removal of the retained and/or embolised needle at an earlier stage would have precluded these complications.- - - - - - - - - - ranking = 12.026210781616keywords = drug (Clic here for more details about this article) |
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