1/34. Descending suppurative mediastinitis: nonsurgical approach to this unusual complication of retropharyngeal abscesses in childhood.OBJECTIVE: To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases. methods: We describe a case of suppurative mediastinitis secondary to a retropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology, diagnosis, and treatment of this disease. RESULTS: Prompt diagnosis, based on clinical, radiographic, and CT findings, followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14. CONCLUSIONS: When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/34. Primary haematogenous osteomyelitis of the patella: a rare cause for anterior knee pain in an adult.Acute osteomyelitis of the patella is a very rare condition, which commonly affects children between the ages of 5-15 years. Primary haematogenous osteomyelitis in an adult usually occurs in patients with associated risk factors like intravenous drug abuse, hiv infection, and trauma. This report discusses a similar condition in a 46 year old women with no associated predisposing risk factors. The rarity of this condition and its atypical presentation should be borne in mind while treating an adult patient with anterior knee pain. Point tenderness over the patella should alert a physician to the possibility of osteomyelitis of the patella. The value of bone scan and computed tomography in the early stages to help diagnose this condition has been stressed. The literature has been reviewed and discussed briefly.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/34. A craniocerebral infectious disease: case report on the traces of Hippocrates.A modern case of complicated sinusitis, with osteitis of the cranium and intraorbital-intracranial empyema, closely corresponds to descriptions reported in the Hippocratic treatise Diseases II. The therapeutic measures suggested in that work can be regarded as suitable according to modern practice. An ancient physician who followed the Hippocratic doctrine probably would have been able to recognize this complicated disease and possibly save the patient.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/34. Primary psoas abscess. Report of three cases.BACKGROUND: Primary psoas abscesses are a rare clinical entity with subtle and non specific symptoms, most commonly seen in patients predisposed to infections. early diagnosis and appropriate management are therefore challenging aspects for physicians. patients AND methods: We present three patients with primary pyogenic psoas abscess, treated at the Heraklion University Hospital, during a 5-year period. The two male and one female patient, aged 36-51 years were admitted with fever, abdominal pain and a palpable tender mass. RESULTS: The classical sign of limping was absent in all cases. Positive psoas symptoms were detected in only two patients. CT scan accurately confirmed the diagnosis in all cases. The patients were successfully treated with antibiotics and prolonged surgical drainage. Staphylococcus aureus was the causative microorganism in the first two and bacteroides fragilis in the third patient. This is the first reported case resulting from this specific bacteria. None of our patients had any predisposing risk factor. CONCLUSIONS: A high index of suspicion is mandatory to enable early recognition of this rare clinical disease. CT scan is the standard diagnostic tool to confirm diagnosis. Prolonged drainage and appropriate antibiotics are essential for the successful treatment of primary psoas abscesses.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/34. Acute hematogenous osteomyelitis of the pelvis in childhood: Diagnostic clues and pitfalls.Acute hematogenous osteomyelitis (AHOM) of the pelvis is a rare form of childhood osteomyelitis. Prompted by a recent case, we reviewed the 146 reported cases of pelvic AHOM published since 1966. Classical childhood AHOM of tubular bones usually occurs in older children (mean age, 8.1 y) as opposed to younger children (aged 2-5 y). It is more common in boys than in girls (male to female ratio = 1.5:1). The most common site is the ilium (40%), followed by the ischium (28%) and the pubis (15%). In contrast to AHOM of the long bones, trauma is an uncommon antecedent event in pelvic AHOM. The pain in pelvic AHOM may be referred to the hip, thigh, or abdomen, often leading to misdiagnosis. On average, the correct diagnosis is delayed for 12 days. Such delays have resulted in a permanent disability in 3.4% of the cases. If diagnosed and treated promptly, uneventful recovery can be anticipated in all patients. This case history and review of the literature may facilitate early recognition of pelvic AHOM by primary care physicians, as well as by pediatric or orthopedic specialists.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/34. Subacute necrotizing fasciitis caused by gas-producing Staphylococcus aureus.Presented here is a case of necrotizing fasciitis that developed bilaterally on the thighs of a 54-year-old diabetic woman following subcutaneous insulin injection. Severe localized pain was the presenting symptom; later, soft-tissue gas appeared. Incisional biopsy, performed on day 10 following admission, confirmed the diagnosis. Staphylococcus aureus was the only pathogen isolated. The disease had a slowly progressive course despite appropriate medical treatment, and recovery of the patient was achieved only after fasciotomy, drainage, and debridement of necrotic tissue was undertaken 4 weeks following admission. Staphylococcus aureus may cause subacute necrotizing fasciitis, and infection with this organism should be considered in cases of soft-tissue infection with gas formation in diabetics. The development of soft-tissue infection at the site of insulin injection should alert physicians to the possibility of infection with Staphylococcus aureus.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/34. A case of delayed brain abscess due to a retained intracranial wooden foreign body: a case report and review of the last 20 years.A 13-year-old female is presented. When she was six years old, she had fallen, holding wooden chopsticks and got stuck with a chopstick in the right upper eyelid. She was brought to a physician immediately, but a residual foreign body was missed and no particular symptom had developed during 7 years. She visited our department with fever and headache, and a brain abscess and an intracranial foreign body were found on computed tomography (CT) and magnetic resonance image (MRI) 7 years after the penetrating injury. She underwent removal of the object and abscess by craniotomy and recovered without neurological abnormalities. Since intracranial retained wooden foreign bodies frequently cause delayed complications of severe central nervous system infection, surgical removal is necessary even in the absence of symptoms.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/34. Parapneumonic empyema. A pitfall in diagnosis.Two patients eventually shown to have empyema were encountered in which the initial thoracentesis revealed fluid compatible with either a simple or a complicated parapneumonic effusion. In both cases, the diagnosis of empyema was made by a second thoracentesis done at a close interval of time from a different site. Therefore, the physician should approach parapneumonic effusions systematically, and remember that in some cases, multiple thoracenteses may be required to make the correct diagnosis of an empyema.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/34. Necrotizing fasciitis during de novo minimal change nephrotic syndrome in a kidney transplant recipient.skin infections and particularly necrotizing fasciitis (NF) represent a rare but serious complication after transplantation. Optimal management depends on prompt diagnosis with identification of the causative organisms to allow appropriate antibiotic therapy in association with surgical debridement. We report a case of a methicillin-resistant staphylococcus aureus (MRSA) NF as the single pathogen in a renal transplant recipient, during the course of a de novo minimal-change nephrotic syndrome, treated with high-dose steroids. Antibiotic therapy together with surgical debridement and discontinuation of immunosuppressive treatment led to a complete recovery, despite persistence of the nephrotic syndrome. The development of de novo minimal-change nephrotic syndrome after renal allograft transplantation should alert physicians to the possibility of MRSA NF during an increase in the immunosuppressive regimen.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/34. Hematogenous patellar osteomyelitis associated with human immunodeficiency virus.The case of a 37-year-old man with hematogenous osteomyelitis associated with the human immunodeficiency virus (hiv) is presented, with a review of the literature. Hematogenous osteomyelitis is a relatively rare entity in the patella; most cases have involved adolescents and immunocompromised patients. There have been no previous reports of hematogenous osteomyelitis in hiv-positive patients. The diagnosis requires clinical suspicion and roentgenographic evidence. Point tenderness over the patella and a painful, swollen knee joint are signs that should alert a physician to the possibility of hematogenous osteomyelitis. Laboratory studies are often of little value, and systemic symptoms are often absent. Treatment requires appropriately directed intravenous antibiotics and open drainage and curettage of the patella. Patellectomy may be required for large lesions and in instances of articular involvement. Computed tomography is a helpful diagnostic tool. The patient in this presentation had osteomyelitis of the patella with a knee pyarthrosis. He had open debridement of the extensor mechanism and knee joint, but ultimately required amputation because of repeat pyarthroses.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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