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Case Reports in Pediatrics 2022. Pott's puffy tumor is characterized by the osteomyelitis of the frontal bone with underlying subperiosteal abscess, mostly occurring secondary to recurrent sinusitis...
. Pott's puffy tumor is characterized by the osteomyelitis of the frontal bone with underlying subperiosteal abscess, mostly occurring secondary to recurrent sinusitis or head trauma. Though it is a rare clinical entity in this antibiotic era, its occurrence mostly in the adolescent age group has now shown increased reporting lately in all age groups. . We describe here a case of a 4½-month-old female baby who presented to our hospital's Emergency Room with clinical features of pyogenic meningitis following aspiration of a midline frontal swelling. The infant presented with high-grade fever, 3-4 episodes of projectile vomiting, increased irritability, and refusal to breastfeeding than usual. This was accompanied by a history of a gradually increasing midline fluctuant erythematous swelling on her forehead extending to the left eye. Aspiration of the swelling was done a day before by a local general practitioner, following which she developed the above-mentioned features of pyogenic meningitis and was brought to the hospital the next day. Examination revealed a conscious, febrile, irritable child with bulging anterior fontanel and 101.4°F axillary temperature. Vital signs were within normal limits. CSF analysis was suggestive of pyogenic meningitis, and appropriate antibiotics were given. MRI showed frontal bone osteomyelitis with erosion of the bony plate and focal cerebritis. The condition turned out to be Pott's puffy tumor with pyogenic meningitis after detailed investigations. The infant was treated with appropriate antibiotics and other supportive therapeutic measures and discharged with the advice for further management in collaboration with otorhinolaryngologist.
PubMed: 35371577
DOI: 10.1155/2022/4732287 -
BMJ Case Reports Mar 2022Hiccups are experienced by people of all ages. While acute hiccups are benign and self-limited, persistent and intractable hiccups can sometimes signal a serious...
Hiccups are experienced by people of all ages. While acute hiccups are benign and self-limited, persistent and intractable hiccups can sometimes signal a serious disease. We present a young previously healthy man who complained of only hiccups for 4 months and later developed a severe headache and projectile vomiting. His systemic examination was within normal limits. Brain imaging revealed a diffuse pontine glioma with mild hydrocephalus.
Topics: Brain; Glioma; Hiccup; Humans; Male; Pons
PubMed: 35292545
DOI: 10.1136/bcr-2021-247830 -
Annals of Medicine and Surgery (2012) Mar 2022and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain...
INTRODUCTION
and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain injury, which can form separate hematomas contralaterally or joint bilateral extradural hematomas commonly owing to superior sagittal sinus injury. In light of the above, this is the first case of such a condition to be reported from Sudan in the literature.
CASE PRESENTATION
A 31-years-old male presented with headache, confusion, and 4 episodes of non-projectile vomiting with a GCS score of 14, after being assaulted by direct blunt head trauma. CT brain showed acute extradural hematoma on the right frontotemporal part compared to a parietal extradural hematoma on the contralateral side. The patient underwent bilateral craniotomy with a wide question mark-like skin flap on the right temporoparietal side followed by 5 burr holes. On the left side, parietal craniotomy was made with an inverted U-shaped skin flap and 4 burr holes on the left parietal side, after that two surgical drains were inserted bilaterally. The patient was discharged on the third postoperative day with a GCS of 15.
DISCUSSION
Although bilateral extradural hematomas are rare and grave conditions, prompt surgical intervention has shown low morbidity and mortality rate with markedly favorable postoperative outcomes.
CONCLUSION
Bilateral extradural hematomas can be attributed to extended linear fracture caused by superior sagittal sinus injury. CT scan is the gold standard imaging. However, MRI and MRV can be used to demonstrate injury or occlusion of the Superior sagittal sinus.
PubMed: 35198197
DOI: 10.1016/j.amsu.2022.103377 -
Journal of Pharmacy Practice Jun 2023Contraction alkalosis is characterized by low serum sodium and chloride and high serum carbon dioxide and bicarbonate levels. A 28-year-old Caucasian active-duty male...
Contraction alkalosis is characterized by low serum sodium and chloride and high serum carbon dioxide and bicarbonate levels. A 28-year-old Caucasian active-duty male with a history of autosomal dominant polycystic kidney disease and diarrhea-predominant Irritable Bowel Syndrome (D-IBS) presented to his primary care provider (PCP) with elevated blood pressure (136/96 mmHg), was diagnosed with stage-2 hypertension, and started oral HCTZ (25 mg/day). His medications included dicyclomine (10 mg oral three times daily). Subsequently, (Visit 1), his blood pressure was 130/91 mmHg and he was started on telmisartan (20 mg/day). At Visit 2, 4 weeks later, his blood pressure improved (121/73 mmHg); however, blood chemistry revealed elevated serum CO2 (32 mEq/L) and chloride (94 mmol/L). Four days later, the patient presented to the Emergency Department with dyspnea and swallowing difficulty. The patient returned to his PCP 3 days later complaining of cough, congestion, vomiting, and mild dyspnea, blood pressure of 124/84 mmHg. Two months later, sudden onset of projectile vomiting and abdominal pain while running was reported, resolved by rehydration and a single oral dose of prochlorperazine 25 mg. Three months later, (Visit 3), he complained of lightheadedness and cloudy judgment, suggesting contraction alkalosis. HCTZ was discontinued and telmisartan was increased to 20 mg twice daily. A follow-up blood chemistry panel 2 weeks later revealed serum chloride and CO2 levels within normal limits and blood pressure under 130/80 mmHg. This is the first known report of contraction alkalosis driven by drug-drug interaction between dicyclomine and HCTZ.
Topics: Humans; Male; Adult; Telmisartan; Hydrochlorothiazide; Dicyclomine; Chlorides; Carbon Dioxide; Hypertension; Blood Pressure; Alkalosis; Antihypertensive Agents; Drug Therapy, Combination
PubMed: 34670427
DOI: 10.1177/08971900211052829 -
Pediatrics in Review Oct 2021Hypertrophic pyloric stenosis is a common condition seen in the first 1 to 3 months after birth. Patients typically present with nonbilious projectile emesis after feeds...
Hypertrophic pyloric stenosis is a common condition seen in the first 1 to 3 months after birth. Patients typically present with nonbilious projectile emesis after feeds that may result in hypokalemic, hypochloremic metabolic alkalosis. Although inability to tolerate feeds is frequently seen with self-limited conditions such as reflux, a low threshold to obtain an ultrasonographic image is important to prevent a delay in diagnosis. Although operative intervention is the treatment, it is imperative that patients are hydrated and serum electrolyte concentrations normalized before the induction of anesthesia. Laparoscopic pyloromyotomy is safe and effective. Postoperative emesis is normal, and reassurance to parents is appropriate. There is no significant long-term physiologic impairment from pyloric stenosis after successful surgical intervention.
Topics: Alkalosis; Humans; Infant; Pyloric Stenosis, Hypertrophic; Vomiting
PubMed: 34599053
DOI: 10.1542/pir.2020-003277 -
Sisli Etfal Hastanesi Tip Bulteni 2021Smith-Lemli-Opitz syndrome (SLOS) is caused by a deficiency in the enzyme 7-dehydrocholesterol reductase (DHCR7) that results in an abnormality in cholesterol...
Smith-Lemli-Opitz syndrome (SLOS) is caused by a deficiency in the enzyme 7-dehydrocholesterol reductase (DHCR7) that results in an abnormality in cholesterol metabolism. SLOS is inherited as an autosomal recessive genetic disorder. In this case, we describe a 34-day-old patient with postnatal progressive projectile vomiting, diagnosed with hypertrophic pyloric stenosis, who was suspected to have SLOS during treatment clinical and biochemical profile. A 34-day-old patient with progressively worsening vomiting and abdominal distention, diagnosed as hypertrophic pyloric stenosis, was operated by pediatric surgery department. After operation, the patient required pediatric intensive care unit admission due to respiratory distress, anemia, hypoalbuminemia, and generalized edema. Physical examination of our patient revealed dysmorphic facial features, finger anomalies, sacral dimple, and ambiguous genitalia, with chromosomal determination as XY. Molecular genetic testing was performed, and mutations in the DHCR7 gene of homozygous c.1342G>A/p.Glu448Lys (rs80338864) were detected. Infants with progressive projectile vomiting, feeding problems, and multiple anomalies with dysmorphic facial anomalies may be suspected to have SLOS and their families should be advised to have genetic testing and genetic counseling.
PubMed: 34349606
DOI: 10.14744/SEMB.2020.34651 -
Emerging Infectious Diseases Aug 2021A typical clinical symptom of human norovirus infection is projectile vomiting. Although norovirus RNA and viral particles have been detected in vomitus, infectivity has...
A typical clinical symptom of human norovirus infection is projectile vomiting. Although norovirus RNA and viral particles have been detected in vomitus, infectivity has not yet been reported. We detected replication-competent norovirus in 25% of vomit samples with a 13-fold to 714-fold increase in genomic equivalents, confirming infectious norovirus.
Topics: Caliciviridae Infections; Humans; Intestines; Norovirus
PubMed: 34287131
DOI: 10.3201/eid2708.210011 -
The Pediatric Infectious Disease Journal Oct 2021Raoultella ornithinolytica is an opportunistic, aquaphilic and Gram-negative bacterium. Immune deficiency states and indwelling catheters provide a basis for most of the... (Review)
Review
Raoultella ornithinolytica is an opportunistic, aquaphilic and Gram-negative bacterium. Immune deficiency states and indwelling catheters provide a basis for most of the infections arising. R. ornithinolytica septicemia (ROS) is extremely rare in neonates but can be life threatening. Community-acquired ROS has not been described in neonates before. The diagnosis of neonatal septicemia is occasionally complicated by unusual clinical presentations. Pyloric stenosis is manifested by projectile, nonbilious vomiting and late findings, including weight loss, dehydration and electrolyte abnormalities beyond 4-6 weeks old. Community-acquired neonatal septicemia symptoms can sometimes be confused with symptoms of gastrointestinal obstructions in patients without risk factors for sepsis. Early diagnosis and appropriate antibiotics are essentials for a good prognosis in neonatal septicemia. Herein, we present a novel case of community-acquired ROS with an unusual presentation in a term infant and a review of the literature about ROS in the neonatal period.
Topics: Anti-Bacterial Agents; Community-Acquired Infections; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Infant, Newborn; Male; Neonatal Sepsis
PubMed: 34260488
DOI: 10.1097/INF.0000000000003197 -
Jornal Vascular Brasileiro Mar 2021The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of...
The purpose of this article is to report the case of a 53-year-old black man, with no previous comorbidities, who presented 48 days after a confirmed diagnosis of COVID-19, complaining of an initially insidious epigastric pain that had progressed to severe pain radiating to the interscapular vertebral region, with hyporexia and episodes of projectile vomiting, with no nausea or fever. Laboratory tests revealed no signs of acute infection or pancreatic injury. Abdominal computed tomography showed dilated, fluid-filled small bowel loops with thickened walls. After clinical treatment, the patient developed persistent abdominal pain. An exploratory laparotomy was performed, finding two sites of small bowel stenosis, with no extrinsic cause, and signs of local ischemia and considerable distension of jejunal and ileal loops. After enterectomy and side-to-side enteroanastomosis, the patient recovered satisfactorily and was discharged with a prescription for oral anticoagulants for outpatient use.
PubMed: 34093678
DOI: 10.1590/1677-5449.200105 -
Journal of Electrocardiology 2021Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential...
Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential diagnosis essential in not delaying crucial intervention. We here describe the case of an undetected PSVT in an infant performing repeated abdominal contractions, thus presenting with projectile vomiting. At an early stage of tachycardia, infants are probably able to unconsciously attempt and succeed to terminate acute episodes by strengthening vagal stimulation in the form of Valsalva-like abdominal contractions, but only up to a point. As PSVT progresses, heart failure may develop. Early recognition and treatment are therefore required to minimize negative outcomes.
Topics: Child; Electrocardiography; Humans; Infant; Infant, Newborn; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Tachycardia, Ventricular; Vomiting
PubMed: 33957501
DOI: 10.1016/j.jelectrocard.2021.04.010