1/6. Posttraumatic cholothorax in a child: case report and review of the literature.OBJECTIVE: Thoracobiliary fistula, subsequent to a combined thoracic and hepatic blunt trauma, is a rare complication, which calls for a high index of suspicion during diagnostic workup. Due to its uncommon nature, especially in children, and hence the paucity of reports in literature, no consensus has been reached on its optimal management. patients AND methods: We report on a 4-yr-old girl, who developed a cholothorax after a blunt thoracoabdominal trauma. She was successfully treated through conservative management with drainage, antibiotics, and a low-fat diet. The cases previously described in the English literature are reviewed, and management is discussed. CONCLUSION: The recent tendency to observe rather than explore abdominal trauma and the absence of a definitive diagnostic test for diaphragmatic injury may contribute to a delayed diagnosis of the components that may result in the development of a fistula. literature review substantiates endoscopic retrograde cholangiopancreatography as the imaging modality of choice, because it has the potential of therapeutic intervention by sphincterotomy or stent placement. A nonoperative approach was successful in this case.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. Pancreaticopleural fistula. Report of 7 patients and review of the literature.Pancreaticopleural fistula is an uncommon clinical condition. Its presentation is often confusing because of the paucity of clues suggestive of pancreatic disease and the preponderance of pulmonary symptoms and signs. Most patients are alcoholics but only one-half will have a clinical history of previous pancreatitis. Pleural effusions are large, recurrent, and highly exudative in nature. Many patients go through extensive pulmonary evaluation before the pancreas is identified as the site of primary pathology. An elevated serum amylase may be the first clue to the diagnosis. However, the key to the diagnosis is a dramatically elevated pleural fluid amylase. Effusions in association with acute pancreatitis, esophageal perforation, and thoracic malignancy are important to consider in the differential diagnosis of an elevated pleural fluid amylase but are usually easy to exclude. Computed tomography is excellent in defining pancreatic abnormalities and should be the first abdominal imaging study in suspected cases. Endoscopic retrograde cholangiopancreatography (ERCP) is used as a diagnostic tool only in confusing cases. Although no systematic study evaluates medical versus surgical therapy, we recommend an initial 2 to 4-week trial of medical therapy, including allowance of no oral intake, total parenteral nutrition, chest tube thoracostomy, and possibly a regimen of somatostatin or its analogs. The major complication in these patients is superinfection, which results in significant morbidity and mortality. Failure of medical therapy should be considered failure of pleural effusion(s) to clear, recurrence after reinstatement of oral intake, or superinfection. For those patients who fail to benefit from medical therapy, surgery is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/6. Infections due to Lancefield group C streptococci.Our experience with group C streptococcal infection over the past 15 years demonstrates an important and emerging role for this hemolytic organism as an opportunistic and nosocomial pathogen. Significant risk factors in this predominantly male population included chronic cardiopulmonary disease, diabetes, malignancy, and alcoholism. bacteremia occurred in 74% of cases seen in our series. Nosocomial acquisition of infection was observed in 26%, and infection was frequently polymicrobial in nature with gram-negative enteric bacilli isolated most commonly along with group C streptococci. We observed a broad spectrum of infections including puerperal sepsis, pleuropulmonary infections, skin and soft-tissue infection, central nervous system infection, endocarditis, urinary tract infection, and pharyngeal infections. Several cases of bacteremia of unknown source were observed in neutropenic patients with underlying leukemia. New syndromes of infection due to group C streptococci observed in our series included intra-abdominal abscess, epidural abscess, and dialysis-associated infection. Response to therapy and outcome was related to the underlying disease. While the literature suggests that patients with group C endocarditis respond better to synergistic penicillin-aminoglycoside regimens, patient numbers are too small to draw definite conclusions. The clinical significance of antibiotic tolerant group C streptococci remains uncertain. In patients with serious group C infections including endocarditis, meningitis, septic arthritis, or bacteremia in neutropenic hosts, we advocate the initial use of cell-wall-acting agents in combination with an aminoglycoside.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/6. Differentiation of pulmonary parenchymal consolidation from pleural disease using the sonographic fluid bronchogram.The nature of pleural-based thoracic collections may be sonographically confusing. To help lessen this confusion, the fluid bronchogram, a useful sonographic sign of pulmonary parenchymal consolidation, is described. bronchi containing fluid in consolidated lung can be identified using ultrasound.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/6. Lymphaticopleural fistula: diagnosis by computed tomography.A case of lymphaticopleural fistula demonstrated by CT following lymphography is presented. Computed tomography can depict the course and location of the fistula as well as the chylous nature of the effusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/6. Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia.Resection of superior sulcus neoplasms is associated with a number of complications resulting from the extensive nature of the resection and the necessity to sacrifice certain adjacent structures. One of the complications of resection is the development of subarachnoid-pleural fistula, with the subsequent appearance of air in the cerebrospinal fluid circulation. We report a case in which a subarachnoid-pleural fistula led to persistent pneumocephaly in a patient who exhibited postoperative hyponatremia, confusion, and gait disturbance.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |