11/81. Synchronous pyomyositis and septic hip arthritis.The authors report a rare concomitant pyogenic infection of the iliopsoas, iliacus and external obturator muscles and of the hip joint in a 68-year-old woman. Because the patient showed the classic symptomatic triad of limping, hip pain and fever, in addition to positive hip arthrocentesis, the diagnosis of septic hip arthritis was routine, but the simultaneous pyomyositis was almost overlooked. Unusual localised heat and swelling on the front of the proximal thigh prompted a CT scan that identified remarkable muscle abscesses in addition to the septic arthritis. Surgical debridement and antibiotics resolved the infection relatively rapidly without sequelae. We noted that reaching a definitive diagnosis of such a concomitant infection requires a suspicion of the presence of pyomyositis, which can be definitively determined using advanced imaging studies.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
12/81. Wegener's granulomatosis triggered by infection?Wegener's granulomatosis is a systemic disease of unknown origin, although recent studies suggest that auto-immune mechanisms and infection play a role in the pathogenesis of this disease. Wegener is characterized by a necrotizing vasculitis involving the lungs (pulmonary infiltrates), the upper airways and the kidneys (rapidly progressive glomerulonephritis). We present a case of a male patient admitted because of progressive deterioration of the general condition with weight loss, a unilateral neck mass, unilateral purulent rhinorrea and fever. CT-scan evaluation demonstrated a unilateral expanding mass in the sing-nasal cavity, obliterating the ethmoid complex. MRI revealed signs of intracranial inflammatory reaction and onset of absedation. A malignancy was suspected but a diagnosis of Wegener's granulomatosis was established based on histologic criteria (nasal biopsy) and a positive titer for anti-cytoplasmic antibodies (cANCA). During follow-up, nasal carriage of Staphyloccocus Aureus could be documented. An overview of Wegener's granulomatosis will be provided with emphasis on the potential role of acute infections as a trigger for Wegener's granulomatosis and the head and neck manifestations.- - - - - - - - - - ranking = 0.04994974224581keywords = upper (Clic here for more details about this article) |
13/81. Acute (haematogenous) osteomyelitis of the skull in childhood.A 13-year old boy presented with a 2-week history of right frontotemporal headache, fever and progressive painful swelling in that region. There was no preceding trauma. Clinical and radiological evaluation confirmed osteomyelitis of the right frontal bone. staphylococcus aureus was found to be the causative organism. The affected bone was debrided and appropriate antibiotics administered. A subdural abscess developed requiring drainage. Hospital stay was 8 weeks. Haematogenous (pyogenic) osteomyelitis of the skull is rare in childhood and diagnosis may be missed or delayed. A high index of suspicion is necessary to make an early diagnosis and to avoid morbidity and mortality.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
14/81. Clinical applications for maggots in wound care.Maggot debridement therapy (MDT) was first introduced in the US in 1931 and was routinely used there until mid-1940s in over 300 hospitals. With the advent of antibacterials, maggot therapy became rare until the early 1990s, when it was re-introduced first in the US, and later in israel, the UK, germany, sweden, switzerland, ukraine and thailand. Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1000 maggots are introduced in the wound and left for 1 to 3 days. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80 to 95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT. The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20 to 25% of the patients with superficial, painful wounds, complain of increased pain during treatment with maggots, and are treated with analgesics. MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. It is a simple, efficient, well tolerated and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.- - - - - - - - - - ranking = 3keywords = pain (Clic here for more details about this article) |
15/81. delayed diagnosis of purulent pericarditis caused by esophagopericardial fistula by computed tomography scan and echocardiography.We report a case of esophagopericardial fistula with subsequent purulent pericarditis that was diagnosed with computed tomography and echocardiography. In a patient with non-specific chest pain and vague past history, serial echocardiography demonstrated rapid aggravation of pyopneumopericardium and chest CT scan showed a foreign body that caused the fistula in the esophageal wall. Removal of a piece of fish bone, closure of the fistula, and creation of a pericardial window for continuous drainage were performed through a low lateral thoracotomy.- - - - - - - - - - ranking = 1.4232758449367keywords = pain, chest (Clic here for more details about this article) |
16/81. Pyometria after hemostatic square suture technique.BACKGROUND: The square suture technique to achieve hemostasis for postpartum hemorrhage has been described in the medical literature. In a prior report of 23 cases, there were no complications from the technique. CASE: A young woman with an gravida 1 para 0 with an uncomplicated prenatal course presented at 40 weeks' estimated gestational age in active labor. Cesarean delivery was performed for arrest of dilatation and was complicated by postpartum hemorrhage unresponsive to medical therapy and uterine artery ligation. Several hemostatic square sutures were placed, obtaining hemostasis. The patient presented 4 weeks postpartum with pain and mucopurulent discharge. Pyometrium was discovered at the time of dilation and curettage. CONCLUSION: Pyometrium may result from the use of hemostatic square suture technique for control of postpartum hemorrhage.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
17/81. Acute suppurative thyroiditis caused by an infected piriform sinus fistula with thyrotoxicosis.We report herein an unusual case of thyrotoxicosis caused by acute suppurative thyroiditis (AST) infected through a piriform sinus fistula (PSF). A 28-year-old man presented with pain over the thyroid gland and elevated serum thyroid hormone levels, a picture similar to subacute thyroiditis. A fine-needle aspiration biopsy from the left lobe showed neutrophil infiltration, and culture from the aspirate grew anaerobic peptostreptococcus. A neck computed tomography (CT) scan showed an abscess in the thyroid gland, and barium swallow revealed the presence of PSF. Appropriate antibiotic treatment ameliorated his symptoms of infection, followed by normalization of thyroid function. Three months later, he underwent fistulectomy and partial left lobectomy. The end of the PSF track was found in the left thyroid lobe. Thus infection of the thyroid gland through the infected PSF was likely the cause of supprative thyroiditis. The unusual clinical features of AST in this patient include the presence of severe thyrotoxicosis, relatively late onset (28-years-old) of infection despite the presence of congenital PSF, and the lack of acute inflammatory signs on the overlying skin of the thyroid gland. It is important to recognize this type of AST, since fistulectomy is required to prevent recurrent AST.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
18/81. Pneumococcal purulent genual arthritis after allogeneic bone marrow transplantation.A 21-year-old male patient with non-Hodgkin's lymphoma (diffuse large T-cell type, clinical stage IV) received allogeneic bone marrow transplantation (BMT) from a partially HLA-mismatched unrelated donor in July 1998 and achieved complete remission. Thereafter, he suffered from chronic graft-versus-host disease (GVHD) and was continuously administered immunosuppressive drugs for a long time. Two years after the BMT, he complained of severe pain in the right knee, which was swollen, and was diagnosed as having pneumococcal purulent genual arthritis. He underwent arthroscopic synovectomy and was administered systemic and intra-articular antibiotics, leading to a gradual improvement. Streptococcal infections are often seen in patients in the late phase after allogeneic BMT because of immunodeficiency associated with chronic GVHD and hyposplenism. Most streptococcal infections are respiratory tract infections and septicemia, and there have been very few reports on cases of purulent genual arthritis. Administration of prophylactic antibiotics and control of chronic GVHD, which is a risk factor of pneumococcal infection, seem to be important to prevent purulent genual arthritis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
19/81. An unusual form of actinomycosis of the mandible with a resultant gross sequester in a 4-year-old child: a case report.Mandibular osteomyelitis due to actinomyces group is considered rare in the pediatric population. The initial complaint of the 4-year-old child described here was increased swelling of his cheek and pain. The patient was managed successfully by surgical treatment with antibiotic therapy.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
20/81. The first-reported case of diffuse purulent peritonitis in a patient with retroperitoneal hodgkin disease (etiopathogenetic hypotheses).We report a case of purulent diffuse peritonitis in a patient who was affected by Hodgkin lymphoma, with no evidence of other abdominal diseases. This is a 54 y. old. white male who was admitted to our department with a history of asthenia, recurrent fever, dysphagia and abdominal pain. In the plain abdominal radiology pneumoperitoneum was evident. Duodenal perforation suspicion was confirmed by anamnesis and plain radiology which showed the presence of intra abdominal air. Emergency exploratory laparotomy showed a purulent diffuse peritonitis, which relapsed after multiple surgical toilettes and peritoneal lavage. A postoperative abdominal CT scan and histology of a biopsy taken during the second surgical operation showed a retroperitoneal Hodgkin lymphoma, which went to remission after chemotherapy. Considering the two simultaneous clinical manifestations (retroperitoneal Hodgkin lymphoma and peritonitis), we made two pathogenetic hypotheses: a) The retroperitoneal disease produced lymphatic stagnation and peritoneal transudation, which then was infected; b) The abnormal lymph nodes were infected and the abdominal cavity was contaminated from retroperitoneum from blood/lymphatic stream or by contiguity.- - - - - - - - - - ranking = 3.0838479406801keywords = abdominal pain, pain (Clic here for more details about this article) |
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