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Urology Case Reports May 2024We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal...
We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal swelling. Doppler ultrasound revealed normal testicles but an enlarged, echogenic left epididymis with pyocele. Despite initial therapy with amoxicillin and cefotaxime, a repeated ultrasound indicated compromised testicular vascularity, necessitating emergency surgical exploration. This revealed purulent discharge and inflammation, with as a causative agent. Post-surgery, the patient showed significant improvement and was discharged in good condition after a ten-day of hospitalization. The study emphasizes the significance of including EO in the possible diagnoses for neonatal scrotal swelling.
PubMed: 38516173
DOI: 10.1016/j.eucr.2024.102702 -
Cureus Feb 2024This case report explores the feasibility and efficacy of endoscopic retrograde appendicitis therapy (ERAT) in treating a 42-year-old female with subacute appendicitis...
This case report explores the feasibility and efficacy of endoscopic retrograde appendicitis therapy (ERAT) in treating a 42-year-old female with subacute appendicitis complicated by an abscess. The patient, initially presenting with abdominal pain, underwent an endoscopic intervention involving drainage, irrigation, and stent placement in the appendix. The study discusses the patient's successful outcome, emphasizing the role of ERAT in managing complicated appendicitis with abscesses. The report outlines the case presentation with the initial misdiagnosis of cecal intussusception. The endoscopic procedure involved identifying a partially prolapsed appendix, spontaneous drainage of purulent discharge, and subsequent stent placement to facilitate drainage while awaiting definitive surgery. The patient's positive response to ERAT was marked by pain reduction and a follow-up CT scan confirming the absence of an abscess and a normal appendix. The case report asserts that ERAT emerges as a promising alternative to immediate appendectomy for patients with subacute appendicitis complicated by abscesses, enhancing symptom relief and reducing major adverse events.
PubMed: 38487134
DOI: 10.7759/cureus.54087 -
Journal of Community Hospital Internal... 2024We present the case of a 19-year-old male with a history of sickle cell anemia who presented to the hospital with worsening lower extremity pain. Given his acute...
We present the case of a 19-year-old male with a history of sickle cell anemia who presented to the hospital with worsening lower extremity pain. Given his acute presentation and history of recurrent pain crises, he was admitted to the hospital for management of a suspected acute pain crisis. However, due to continued pain, imaging was obtained which revealed a different diagnosis for the cause of his symptoms. MRI of the left lower leg revealed heterogenous T1 and T2 hyperintense signals within the proximal tibial diaphysis measuring 6.6 × 1.6 × 2.2 cm with a thick rim of peripheral irregular enhancement with surrounding periosteal reaction and soft tissue edema, concerning for osteomyelitis and developing Brodie's abscess. The patient underwent tibia irrigation and debridement with the placement of vancomycin and tobramycin beads. Perioperatively, no purulence was noted within the soft tissues, and no organisms were grown on tissue cultures. The patient's pain improved and he was discharged home with a plan to complete six weeks of intravenous antibiotics. This case represents the need to differentiate Brodie's abscess from a sickle cell crisis. Clinicians should also be aware that patients with sick cell disease are prone to Brodie's abscess and it should be a differential for symptoms of relenting bone pain.
PubMed: 38482084
DOI: 10.55729/2000-9666.1299 -
Molecules (Basel, Switzerland) Mar 2024has a long history of medicinal and edible homology in China. It has the functions of clearing heat and detoxifying, reducing swelling and purulent discharge, diuresis,...
has a long history of medicinal and edible homology in China. It has the functions of clearing heat and detoxifying, reducing swelling and purulent discharge, diuresis, and relieving gonorrhea. It is mainly distributed in the central, southeastern, and southwestern provinces of China. has been designated by the National Ministry of Health of China as a dual-use plant for both food and medicine. Comprising volatile oils, flavonoids, and alkaloids as its primary constituents, harbors aristolactams, a prominent subclass of alkaloids. Notably, the structural affinity of aristolactams to aristolochic acids is discernible, the latter known for its explicit toxicological effects. Additionally, the safety study on mainly focused on the ethanol, methanol, or aqueous extract. In this study, both zebrafish and mice were used to evaluate the acute toxicity of the total alkaloids extracts from (HHTAE). The zebrafish experiment showed that a high concentration (0.1 mg/mL) of HHTAE had a lethal effect on zebrafish embryos. Furthermore, the mice experiment results showed that, even at a higher dose of 2000 mg/kg, HHTAE was not toxic. In conclusion, HHTAE was of low safety risk.
Topics: Mice; Animals; Zebrafish; Alkaloids; Plant Extracts; Drugs, Chinese Herbal; Oils, Volatile; Antineoplastic Agents
PubMed: 38474619
DOI: 10.3390/molecules29051107 -
Narra J Aug 2023Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation...
Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.
PubMed: 38450268
DOI: 10.52225/narra.v3i2.223 -
Zhongguo Dang Dai Er Ke Za Zhi =... Feb 2024To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of (SP) isolates in Chinese children.
OBJECTIVES
To investigate the clinical characteristics and prognosis of pneumococcal meningitis (PM), and drug sensitivity of (SP) isolates in Chinese children.
METHODS
A retrospective analysis was conducted on clinical information, laboratory data, and microbiological data of 160 hospitalized children under 15 years old with PM from January 2019 to December 2020 in 33 tertiary hospitals across the country.
RESULTS
Among the 160 children with PM, there were 103 males and 57 females. The age ranged from 15 days to 15 years, with 109 cases (68.1%) aged 3 months to under 3 years. SP strains were isolated from 95 cases (59.4%) in cerebrospinal fluid cultures and from 57 cases (35.6%) in blood cultures. The positive rates of SP detection by cerebrospinal fluid metagenomic next-generation sequencing and cerebrospinal fluid SP antigen testing were 40% (35/87) and 27% (21/78), respectively. Fifty-five cases (34.4%) had one or more risk factors for purulent meningitis, 113 cases (70.6%) had one or more extra-cranial infectious foci, and 18 cases (11.3%) had underlying diseases. The most common clinical symptoms were fever (147 cases, 91.9%), followed by lethargy (98 cases, 61.3%) and vomiting (61 cases, 38.1%). Sixty-nine cases (43.1%) experienced intracranial complications during hospitalization, with subdural effusion and/or empyema being the most common complication [43 cases (26.9%)], followed by hydrocephalus in 24 cases (15.0%), brain abscess in 23 cases (14.4%), and cerebral hemorrhage in 8 cases (5.0%). Subdural effusion and/or empyema and hydrocephalus mainly occurred in children under 1 year old, with rates of 91% (39/43) and 83% (20/24), respectively. SP strains exhibited complete sensitivity to vancomycin (100%, 75/75), linezolid (100%, 56/56), and meropenem (100%, 6/6). High sensitivity rates were also observed for levofloxacin (81%, 22/27), moxifloxacin (82%, 14/17), rifampicin (96%, 25/26), and chloramphenicol (91%, 21/23). However, low sensitivity rates were found for penicillin (16%, 11/68) and clindamycin (6%, 1/17), and SP strains were completely resistant to erythromycin (100%, 31/31). The rates of discharge with cure and improvement were 22.5% (36/160) and 66.2% (106/160), respectively, while 18 cases (11.3%) had adverse outcomes.
CONCLUSIONS
Pediatric PM is more common in children aged 3 months to under 3 years. Intracranial complications are more frequently observed in children under 1 year old. Fever is the most common clinical manifestation of PM, and subdural effusion/emphysema and hydrocephalus are the most frequent complications. Non-culture detection methods for cerebrospinal fluid can improve pathogen detection rates. Adverse outcomes can be noted in more than 10% of PM cases. SP strains are high sensitivity to vancomycin, linezolid, meropenem, levofloxacin, moxifloxacin, rifampicin, and chloramphenicol.
Topics: Infant; Female; Male; Humans; Child; Infant, Newborn; Adolescent; Meningitis, Pneumococcal; Meropenem; Vancomycin; Levofloxacin; Linezolid; Moxifloxacin; Retrospective Studies; Rifampin; Subdural Effusion; Streptococcus pneumoniae; Chloramphenicol; Empyema; Hydrocephalus
PubMed: 38436309
DOI: 10.7499/j.issn.1008-8830.2308090 -
Internal Medicine (Tokyo, Japan) Feb 2024A 70-year-old woman presented with stage III pancreatic head cancer. After endoscopic sphincterotomy, a fully covered self-expandable metallic stent (FCSEMS) was placed...
A 70-year-old woman presented with stage III pancreatic head cancer. After endoscopic sphincterotomy, a fully covered self-expandable metallic stent (FCSEMS) was placed in the common bile duct to manage jaundice. The patient developed a fever and abdominal pain 40 days after stent placement, with a suspected diagnosis of infected pancreatic pseudocyst. Purulent discharge from the papilla was observed during FCSEMS removal, and pancreatography revealed a pseudocyst connected to the main pancreatic duct. The pancreatic pseudocyst resolved after transpapillary drainage. Pancreatic pseudocysts should be suspected after biliary FCSEMS placement, and prompt removal and endoscopic drainage of the FCSEMS should be considered.
PubMed: 38403761
DOI: 10.2169/internalmedicine.3178-23 -
Medicine Feb 2024Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic... (Review)
Review
RATIONALE
Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial.
PATIENT CONCERNS
A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture.
DIAGNOSIS
The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization.
INTERVENTIONS
During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained.
OUTCOMES
The patient was discharged with optimal evolution.
LESSONS
LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
Topics: Female; Humans; Adult; Lemierre Syndrome; Methicillin-Resistant Staphylococcus aureus; Soft Tissue Infections; Thrombophlebitis; Staphylococcus aureus; Anti-Bacterial Agents
PubMed: 38363930
DOI: 10.1097/MD.0000000000037006