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PubMed2006

[Retropharingeal abscess in paediatrics].

Retropharingeal abscess is a potentially lethal but infrequent infection of the retropharyngeal space, thanks to the use of antibiotics. Caused by a suppurative lymphadenitis secondary to a locoregional infection of the head and neck, it is the most frequent abscess in Paediatric age. It must be present in our differential diagnosis when facing a torpid development of head and neck infectious processes accompanied by adenitis. A cervical lateral X-Ray should be done without delay and in case of doubt, a CAT--scan is mandatory. We protocolise its diagnosis and treatment in order to avoid its serious complications.

Amoxicillin-Potassium Clavulanate Combination↗

PubMed2006

Laparoscopic appendicectomy in children: A trainee's perspective.

INTRODUCTION: The emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee's point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure. MATERIALS AND METHODS: A retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done. RESULTS: A total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 +/- 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel's diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 +/- 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection. CONCLUSIONS: LA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.

Acute Disease↗

PubMed1991

Principles of traumatic surgery.1942.

Traumatic surgery is emergency surgery and the fundamental thing is "to do it now." The 6-hour period is the Golden Period. If we can take care of our wounds during that time we are very much less likely to get infections. After the 6-hour period there is a different type of treatment because the situation is different. Let us debride our wounds; let us use the sulfa drug on the outside as well as internally; but do not regard them as substitutes for the ordinary surgery asepsis of years back. In the infected cases, sulfa drugs are invaluable, but don't rely on sulfa drugs to carry you through; the sulfa drugs won't do it without giving the wound ordinary cleansing; and don't forget that the sulfa drugs are specific for infections of the erysipelas type and other cellulitis. Do not sew up a debrided case, and above all, do not sew it up in a compound fracture. In infections there are 3 indications for incision: local fluctuation, localized tenderness and local induration. Never for brawny induration; never for adenitis.

Clinical Protocols↗

PubMed1991

The re-emergence of scrofula with HIV infection: a review of epidemiology, pathogenesis, diagnosis and treatment.

Scrofula has been called "The Dangerous Masquerader" because of its propensity to mimic other diseases. Scrofula has been mistaken for metastatic carcinoma, regional neoplasms, thyroglossal duct cysts, fungal disease, toxoplasmosis, lymphoma, osteosarcoma, chondrosarcoma, bacterial adenitis, and collagen vascular disease. Because of the enormous number of infectious and neoplastic diseases acquired by the HIV positive population, the diagnosis of scrofula may be further delayed in some patients. In these patients the early diagnosis of scrofula might allow the early identification of HIV infection and the early institution of anti-retroviral therapy. The recommended duration of anti-tuberculosis therapy is also different in HIV positive patients. Therefore, to ensure the patient of the most beneficial therapy, the physician must always consider scrofula in the differential diagnosis of a neck mass, and particularly because of the increases incidence of intrapulmonary tuberculosis in AIDS patients, he must consider the possibility of HIV infection.

HIV Infections↗

PubMedDate not supplied

[Lymph node tuberculosis in Cameroon: clinical and anatomo-pathologic aspects; apropos of 333 cases].

For a period of 11 years and 7 months (1st January 78-31 July 89), 1950 lymph nodes were received in the pathology laboratory of Cameroon. 333 of these, that is 17% revealed typical lesions of tuberculosis. Analysing the information associated to these tuberculoid adenitis revealed that: 46% of the patients were less than 10 years of age; 83.8% of the specimens were taken from the cervical region. 78% of patients had fever, cough was complained of by 56% and 40% had polyadenopathies. Finally, 81% of the tuberculoid lymph nodes analyzed had a diameter less than 5cm while only 33% showed acid fast bacilli on direct examination (Ziehl-Neelsen staining method) on the histologic slides.

Adolescent↗

PubMed1991

Intra-abdominal abscesses in children.

Forty-one intra-abdominal abscesses in 30 Nigerian children seen over a 2-year period at the Obafemi Awolowo University Teaching Hospital were studied prospectively to determine their location, aetiology, microbiology and clinical course. Thirty-four abscesses (83%) were intraperitoneal with the subphrenic spaces and pelvis being the commonly involved intraperitoneal sites. Six abscesses (15%) were retroperitoneal while there was only one visceral abscess (2%). Diseases of the gastrointestinal tract occurring in 20 patients (67%) were responsible for the majority of intraperitoneal abscesses, while suppurating external iliac adenitis was the major cause of retroperitoneal abscesses. There were 62 microbiological isolates, with 52% being anaerobic bacteria and 47% aerobic bacteria. A fungus, Candida, was isolated once (2%). Escherichia coli and Staphylococcus aureus were the commonest aerobic bacteria, while Bacteroides and anaerobic streptococci were the commonest anaerobes. Sixteen patients (53%) had a mixed flora of aerobic and anaerobic bacteria, while in seven patients each (23%) only aerobic or anaerobic bacteria were isolated. The mortality rate in this series was 23%. Association of an intra-abdominal abscess with remote organ failure, postoperative anastomotic leakage, non-localization of the abscess within the peritoneal cavity and gastrointestinal perforation due to typhoid enteritis was found to portend poor prognosis.

Abscess↗

PubMed1991

[Pulmonary sarcoidosis or intrathoracic malignant lymphoma--the significance of a histological diagnosis].

The clinical appearance of sarcoidosis and the changes seen on x-ray of the thorax are often typical. However, several other conditions may present the same symptoms and identical x-ray findings. The present case report emphasizes the importance of an invasive approach and of histological investigation in patients in whom carcoidosis is suspected. For almost one year, a man aged 29 years was considered to be suffering from sarcoidosis on account of the clinical symptoms and bilateral hilar adenitis on x-ray op the thorax. He was treated with steroid for several months with clinical and radiological response. After the illness has lasted for one year, bronchoscopy was performed and bronchial biopsies revealed the diagnosis of malignant lymphoma.

Adult↗

PubMed1990

[Clinical aspects, diagnosis and therapy of Yersinia enterocolitica infections].

The predominant form (65% of all patients) of yersiniosis is mesenteric adenitis, resulting in enteritis, pseudo-appendicular syndromes, ileitis or colitis. The severity of this form depends to some degree on the age. Extra-mesenteric forms (in 20-25%), focal infections by dissemination, the septic form and the lymphadenopathy syndrome may occur after or without previous enteritis. Persistence of Y. enterocolitica in lymphnodes and the GALT is responsible for chronic and recurrent forms. Secondary immunological complications (25%) are arthritis and Erythema nodosum. Diagnosis is made by culture, serology, of which demonstration of specific antibodies against released proteins is more reliable than demonstration of agglutinins and antigen detection by indirect immunofluorescence in biopsies. Antibiotic treatment of mild enteric forms is questionable, extra-mesenteric forms should be treated. Appropriate antibiotics are trimethoprim, chloramphenicol, tetracycline and the new fluoroquinolones. Studies are in progress (Leeuwarden and Hanover, MHH) to elucidate the indication of antibiotic treatment of Yersinia-arthritis patients.

Anti-Bacterial Agents↗

PubMed1990

The diagnosis of Thornwaldt's cyst.

Thornwaldt's cyst is an uncommon nasopharyngeal lesion which develops from the remnant of the primitive notochord. A case report of a patient with a Thornwaldt's cyst and cervical adenitis is presented. Though computed tomography of the head and neck was unremarkable, magnetic resonance imaging of the nasopharynx revealed the Thornwaldt's cyst, suggesting that this modality may be more sensitive in detecting and evaluating cystic lesions of the nasopharynx. The differential diagnosis of cystic nasopharyngeal masses is discussed.

Adult↗

PubMed1990

[Adult T-cell leukemia and non-malignant adenopathies associated with HTLV I virus. Apropos of 17 patients born in the Caribbean region and Africa].

Adult T-cell leukaemia is the first blood disease caused by a retrovirus: HTLV-1. The authors report the first French series of 15 patients, of whom 9 came from the classical endemic areas--the Antilles and outer Caribbean Islands--and 6 from Africa where the serological prevalence of HTLV-1 is high but few cases of adult T-cell leukaemia have been reported. Emphasis is laid on the importance of immunodeficiency (refractory strongyloidiasis, Pneumocystis carinii pneumonia, polyclonal B lymphoproliferative syndrome) and of other pathologies associated with the retrovirus (polyarthritis, lymphocytic interstitial pneumonia). The authors also describe the presence of adenopathy in healthy carriers: either adenitis suggestive of retroviral infection, or Castelman's disease adenopathy. These clinical presentations are similar to those described in lymphadenopathy syndromes due to the human immunodeficiency viruses. Aggressive lymphomas require chemotherapy, but sooner or later resistance develops, and the prognosis is very poor. The indications for allogeneic bone marrow transplantation are still to be determined. The diagnosis of adult T-cell leukaemia must be considered in all patients with blood disease coming from the endemic areas.

Adult↗

PubMed1990

Interferon for vulvar vestibulitis.

Eight women with human papillomavirus-associated vestibular adenitis were treated with locally administered alpha interferon, 1 million units, three times weekly for four consecutive weeks. Five patients had a complete remission, and one had a slight, transient improvement, with a relapse after the therapy ceased.

Adult↗

PubMed1990

Yersinia pseudotuberculosis: report of a case with endoscopic findings.

Yersinia pseudotuberculosis is an uncommon gastrointestinal pathogen, recognized as a causative agent in some cases of mesenteric adenitis. We report the clinical and endoscopic features of a case of a 6-year-old girl with abdominal pain and bloody diarrhea. Colonoscopic examination revealed aphthous ulcers in the right colon, and mucosal biopsy culture grew Yersinia pseudotuberculosis. This case documents right colonic ulcers and bloody diarrhea with Yersinia pseudotuberculosis.

Child↗

PubMed1990

[Pathologico-morphologic changes in the digestive system in rabid foxes].

Pathologico-morphological changes in the digestive tract were investigated in fifty naturally infected common foxes (Vulpes vulpes crucigera). Nineteen animals were found to suffer from mild cachexia, 31 animals suffered from complete cachexia. Erosions were observed in the mucosa of oral cavities of 21 foxes. Traumatic injuries appeared in the teeth of 11 animals. One case of swollen and hyperaemic tongue was described; in three cases there occurred sialo-adenitis. A mild degree of inflammation was recorded in the gullet in three animals. Fifteen animals had empty stomachs, thirty-five animals had atypical food or foreign bodies in the stomach contents; simple hyperaemia was recorded 18 times, acute catarrhal gastritis 19 times and haemorrhagic gastritis was observed in two cases. Acute catarrhal enteritis was found in six cases, haemorrhagic enteritis in one case.

Animals↗

PubMed1990

[Effects of alpha tocopherol and free fatty acids on physical properties of lipid matrix and adenylate cyclase activity in rat brain synaptosomes].

Using modification of physical state of synaptosome lipid matrix by free fatty acids and alpha-tocopherol it was shown that fluidity of lipid matrix isn't limiting regulating factor for the activity of alpha-adrenergic aden late cyclase. From the point of view that state of annular lipids is different from the state of lipid bilayer in synaptosomes we suggest that composition of annular lipids regulates alpha-adrenergic adenylate cyclase system in rat neuronal membranes.

Adenylyl Cyclases↗

PubMed1990

[The fight against diarrheal disease in Yemen: introduction of oral rehydration therapy].

Within the National Diarhoeal Diseases Control Programme formulated in 1982, the first oral rehydration centre was established in the Children's Hospital in Aden in 1983. 2898 diarrhoea patients were admitted to this hospital from 1980 to 1984, 360 (12.4%) of them died. Three periods were compacted for the evaluation of the Three periods were compacted for the evaluation of the impact of oral rehydration therapy: 12 months before the centre was established, 12 months when the centre was open 8 hours a day and 9 months when the centre functioned on a 24-hour basis. Total numbers of diarrhoea patients in the three periods were: 4631, 6406 and 9444 respectively. Admission rates were 12.2%, 9.1% and 4.3% resp., overall case fatality rates were 1.55%, 1.31% and 0.51% resp., inpatient case fatality rates 12.7%, 14.4% and 11.9% resp. Substantial reduction of diarrhoea admission and overall case fatality rates were considered to be the impact of oral rehydration therapy.

Diarrhea, Infantile↗

PubMed1975

[The calorigenic effect of glucagon].

The calorigenic action of glucagon was studied in several species by measuring its effect on the oxygen comsumption. The calorigenic effect was most pronounced in the quail and also evident in young adult rats of two different strains but not in mice and guinea pigs. The influence of various drugs on the calorigenic effect of glucagon was investigated in rats. Ganglionic blocking agents (hexamethonium, mecamylamine, chlorisondamine) as well as adrenergic blocking drugs (propranolol, butoxamine, phentolamine) greatly reduced the glucagon-induced calorigenesis but after pretreatment with reserpine, guanethidine or chemical sympathectomy with 6-hydroxydopamine the calorigenic effect of glucagon was exaggerated. It was somewhat diminished by nicotinic acid but not by chlorpromazine or lithium and potentiated by cocaine but not by theophylline.--These results are not indicative for an involvement of adenly cyclase--cyclic AMP--system in glucagon-induced calorigenesis but they are compatible with the assumption that the hormone enhances the metabolic rate by releasing catecholamines from the adrenal medulla.

Animals↗

PubMed1989

Screening of serum antibodies against Mycobacterium tuberculosis by enzyme-linked immunosorbent assay (ELISA) in healthy population.

Serum samples of venous blood of healthy individuals, chosen at random from two areas of the People's Democratic republic of Yemen, were examined for the presence of IgG antibodies against mycobacterial antigen by ELISA. From the district of Aden, the capital (A), there were 214 samples (72% vaccinated by BCG, 108 men and 106 women), other 235 ones originated from mountain area Laudar Muhairas (H) (66% vaccinated, 115 men and 120 women). The overall average of acquired titres was 1:81.4 in area A, and an average of 1:102.2 was recorded in area H. There was no substantial difference in the titres level in men of the two areas (1:86.9 and 1:90 resp.), however, a significant difference was observed in women: 1:75.7 in area A and 1:114.7 in area H. In area A the titres were ranging in all age groups from 1:61 to 1:83 and the differences between age groups and between vaccinated and unvaccinated individuals were not significant. In area H the titres were generally higher (1:72 to 1:164) in the unvaccinated and 1:79 to 1:204 in the vaccinated. The differences in the unvaccinated were not of a statistical importance: in the vaccinated, the titres of the 20-29 years old (1:204.5) substantially differed from the titres obtained in other groups. The differences in titres level between the two studied areas are explained by a different epidemiological situation, namely by a higher tuberculosis infestation of some age groups in area H.

Adolescent↗

PubMed1989

[The value of sialography in the differential diagnosis of parotid masses].

Sialographic manifestations of 82 patients with parotid masses were studied to determine the value of sialography in the differential diagnosis. Multiple filling defects indicate metastatic tumor, tuberculosis and sarcoidosis. The occurrence of calcification suggests tuberculosis or sarcoidosis. The parotid cyst may show the sialographic appearance similar to that of adenolymphoma. The appearance of adenitis of parotid lymph nodes may be similar to that of malignant tumor when the inflammation extends into the parenchyma. Sometimes the appearance of eosinophilic lymphatic granuloma may be similar to that of malignant tumor, but the former is more extensive. The displacement of entire gland suggests extrinsic lesion. Although the displacement of branch ducts may occur in the hypertrophy of parotid, there is no defect in acinar filling. At times it is not easy to differentiate the parotid masses by sialography alone Case histories, results of laboratory and other examines, such as gray scale ultrasound, should be combined to improve the diagnosis.

Adolescent↗