1/40. Childhood actinomycosis. Report of 3 recent cases.Three cases of childhood actinomycosis are reported, 2 with the commonest presentation of cervicofacial abscess and the third with a rarely reported superficial chest wall abscess. The importance of prompt bacteriological diagnosis and adequate treatment with surgical drainage and chemotherapy is stressed. Though in adults males are affected more frequently than females, the sexes are probably equally affected in childhood.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/40. 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 = 2keywords = chest (Clic here for more details about this article) |
3/40. A man with fever, rigors, and poor oral hygiene.A 62-year-old man presented to the emergency department with a one-week history of subjective fever and rigors. He had had epigastric pain for three weeks, for which he was taking ranitidine, and in the past two to three months had experienced night sweats, a nonproductive cough, nausea, vomiting, and a 30-lb weight loss. He denied dsypnea, chest pain, hematochezia, melena, or any change in bowel habits.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/40. steatocystoma multiplex suppurativum: oral isotretinoin treatment combined with cryotherapy.A 30-year-old man presented with numerous papules, nodules and inflamed cysts. The lesions were located all over the body, including the scalp, except the palms and soles. His mother and one sister had had similar but less extensive lesions. Histopathology of the biopsy specimens obtained from the anterior chest wall, axillae and the back region was consistent with steatocystoma multiplex (SM). A diagnosis of steatocystoma multiplex suppurativum was made. The inflamed lesions were treated with oral isotretinoin (1 mg/kg per daily) for 6 months. At the same time, cryotherapy was used for non-suppurating lesions smaller than 2 cm. When the patient was evaluated 6 months later, cosmetic results were good. No new lesions have appeared in the subsequent 12-month follow up.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/40. Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case.We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.- - - - - - - - - - ranking = 6.1309769044381keywords = abdominal pain (Clic here for more details about this article) |
6/40. 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 = 7.7367908687516keywords = discomfort (Clic here for more details about this article) |
7/40. 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 = 2keywords = chest (Clic here for more details about this article) |
8/40. 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 = 6.1309769044381keywords = abdominal pain (Clic here for more details about this article) |
9/40. Pyogenic lumbar facet joint arthritis with intradural extension: a case report.There have been 40 previously reported cases of lumbar facet joint pyogenic infection. These have been well characterized earlier. Intradural pyogenic extension has never been reported from a facet joint origin. This case demonstrates an elderly diabetic man with acute onset of nontraumatic back pain with no other source of infectious pathology. Surgical exploration identified a purulent left L4-L5 facet joint with epidural and intradural extension. Minimal spinal fluid leak was present. Wound cultures were positive for Group B beta Full resolution occurred with appropriate intravenous vancomycin antibiotic therapy.- - - - - - - - - - ranking = 5.9097744185909keywords = back pain (Clic here for more details about this article) |
10/40. The urgency of diagnosis and surgical treatment of acute suppurative cholangitis.Twenty patients with suppurative cholangitis were seen at the massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.- - - - - - - - - - ranking = 6.1309769044381keywords = abdominal pain (Clic here for more details about this article) |
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