Acute Suppuration Research Articles

Higher Efficacy of Shufeng Tongqiao Decoction in Treating Acute Suppurative Otitis Media with Tobramycin Compared to Levofloxacinor Drops

We have evaluated the effects of Shufeng Tongqiao decoction on the efficacy of tobramycin drops and levofloxacin drops in treating acute suppurative otitis media. To this end, 200 patients with acute suppurative otitis media were divided into 4 treatment groups (A, B, C, and D) of 50 patients per group. Patients in groups A and B received a combination of Shufeng Tongqiao decoction plus levofloxacinor and tobramycin drops, respectively. Patients in groups C and D received only levofloxacinor and tobramycin drops, respectively. Among these four groups, group B (Shufeng Tongqiao decoction + tobramycin) was the most effective in decreasing the time of tinnitus and ear pain, discharge of pus and hearing loss (P < 0.05), and serum levels of proinflammatory cytokines. Also, this group promoted the quality of life as well as the clearance rate of pathogenic bacteria much faster relative to other groups. In conclusion, Shufeng Tongqiao decoction in combination with tobramycin drops has a significant curative effect in treating acute suppurative otitis media, which can improve the clearance rate of pathogenic bacteria, shorten the recovery time of patients, and promote the quality of life of patients.

Melioidosis

Melioidosis is a disorder caused by Gram-negative bacillus Berkholderia pseudomallei. The condition is endemic in Far East Southeastern Asia Northern Australia and India. It presents with recurrent or prolonged febrile illness. There may be a variety of manifestations in the form of septicemia acute localized suppuration acute pulmonary infection chronic suppuration or as a pulmonary mass lesion. It is associated with high mortality. It is treated with third generation cephalosporins.

Clinical Significance of Repeat Fine-Needle Aspiration in Managing Patients with Suppurative Lesion

Background: Fine-needle aspiration (FNA) has been challenged about its role in the management of patients with clinical suspicion of infective or neoplastic etiology but cytological picture showing features of acute suppuration. This study emphasizes the need to perform repeat FNA cytology (FNAC), especially if the mass lesion is indicating suppuration and has not responded to the initial course of antibiotics. Materials and Methods: All patients with a previously diagnosed suppurative lesion on cytology smears who have undergone repeat FNA were included in the study. Insufficient material on FNA and the nonavailability of slides were excluded from this study. Results: Repeat FNA assisted in the detection of malignant lesions (3), tubercular lesions (20), fungal lesions (9), and benign lesions (9) out of the 123 cases of previously diagnosed acute suppurative lesions. Comparison of FNAC findings with histopathological specimens was available for 52 cases, following which repeat FNA had a sensitivity of 66.67% (95% confidence interval 34.89%-90.08%) in detecting neoplastic, specificity was 100%, positive predictive value was 100%, negative predictive value was 90.91%, and the total diagnostic accuracy was 92.31%. Conclusion: Patients with acute suppurative lesions should be followed by repeat FNA, especially if the lesion is not responded to initial antibiotic therapy. Repeat FNA will enhance the diagnostic accuracy of malignant lesions and many other lesions, such as fungal or tubercular infections. It will reduce the need for surgical interventions and molecular detection of infectious diseases.

Acute Suppurative Otitis Media in Children with Risk Factors of Recurrent Upper Respiratory Tract Infection, Non-Exclusive Breastfeeding, and Working Mothers

Background: Many factors influence Children's health, including the mother's employment status and exclusive breastfeeding. Purpose: To present cases of children with ASOM (Acute Suppurative Otitis Media) with risk factors for recurrent Acute Respiratory Tract Infection, not getting exclusive breastfeeding and working mothers. Case: A boy aged one year and four months came with his mother to the family doctor's clinic with complaints of discharge from his right ear. This fluid has been coming out of the right ear since seven days ago and does not smell. Previously the patient had a cold that often recurred. The patient only gets exclusive breastfeeding for two months, and the mother is busy working. On examination, there was a central perforation of the tympanic membrane of the right ear. The patient was treated with antibiotics and decongestants, then turned to an ENT specialist. After a home visit at two weeks of therapy, the tympanic membrane was closed. Conclusion: The importance of controlling risk factors to prevent recurring ASOM.

Ear Diseases in Children Presenting at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh

Introduction: Ear diseases have been found to be important health problems among children. Nearly one third of Otorhinolaryngology outdoor attendance in the hospital comprised of paediatric age group. The problem is compounded by the fact that the children are economically dependent on their parents who are largely poor. However, the cause of hearing loss in children is more varied, including the etiologies. Objective: To find out ear diseases in children presenting at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Materials and Methods: This hospital-based prospective study was carried at Department of ENT & Head-Neck Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh from January to December 2021. 985 patients below sixteen years of age presented to the ENT OPD during the study period. Of them, 450 had ear disease. All patients aged 16 years or younger presenting with ear diseases to the ENT clinic of the hospital and seen by ENT surgeons were enrolled into the study. The diagnoses were made on the basis of history and clinical examination. Results were expressed in numbers and percentages. Results: Out of 985 patients below sixteen years of age presented to the ENT OPD during the study period. Of them, 450 had ear disease. Five hundred and sixty one (64.4%) were males. The male to female sex ratio was 1.8:1. Table 2 the various types of ear disease were as CSOM (Chronic Suppurative Ottitis Media), ASOM (Acute Suppurative Ottitis Media) and OME (Ottitis Media with Effusion). Wax (33.6%) followed by CSOM (18.7%) and ASOM (13.8%) were the most common ear diseases in paediatric patients in tertiary care centre. Ear diseases commonly found in this study were in the age group of 6-10 years and most ear diseases were more common in boys. It was found that wax (33.6%) was the most common diagnosed ear disease. Conclusion: Ear diseases are most common condition in ENT OPD among paediatric age group. Wax, CSOM and ASOM were the three most common ear diseases. Improvement of health care facilities and awareness amongst health care providers would definitely be helpful in reducing the prevalence of ear diseases in developing countries.

LBODP102 A Case of Unexpected Thyroid Storm Due To Acute Suppurative Thyroiditis From Klebsiella Pneumoniae

Abstract Introduction Thyroid storm is a life-threatening endocrinological emergency. It creates a hypermetabolic state caused by excessive release of thyroid hormones, causing adrenergic hyperactivity following a precipitant(s). An uncommon precipitant of thyroid storm is a thyroid abscess. Clinical Case A 48-year-old man with a PMHx of COPD on home oxygen, OSA, HTN, left thyroid lobe nodule and recent treatment for community-acquired pneumonia the prior week presented to the ED with complaints of right neck pain and swelling of 5 days duration. Patient had associated diarrhea, fever, nausea, vomiting and palpitations. VS: Temp 101.9 F, BP 164/120, RR 20 and HR 160. Physical examination revealed a right non-mobile tender neck mass, rales on the lower lobe of the left lung, and drenching sweats. CT of the neck showed a prominent soft tissue mass on the right side of the neck with irregular margins abutting the right thyroid lobe, suggesting possible abscess. A subsequent thyroid US revealed a large heterogeneous nonvascular right thyroid mass measuring approximately 12×7×7 cm. Initial labs: TSH < 0. 005 mU/L (normal range 0.45-5. 0 mU/L), FT4 2.54 mU/L (normal range 0.9 to 2.3 mU/L); TSHrAB, TSI and TPO were negative. Thyroid storm was diagnosed using the Burch Wartofsky score (45 points). He was treated with propythiouracil, hydrocortisone, propranolol and antibiotics. FT4 normalized after 2 days on admission at which time he was taken for surgical drainage of his right thyroid abscess. 80 cc of pus was aspirated and cultured with isolation of Klebsiella Pneumoniae. Blood cultures also revealed K. Pneumoniae. Repeat Thyroid US showed resolution of abscess. Patient remained in hospital for ongoing treatment of his pneumonia. Clinical Lesson: Acute suppurative thyroiditis (AST) is a rare, life-threatening infection of the thyroid gland. Thyroid gland is rich in iodine, blood supply and lymphatics with a thick capsule which is relatively resistant to infection from neighboring sites. AST is more common in women and affects the left lobe of thyroid. Our patient is a man and his thyroid abscess was on the right lobe. The most common route of infection in AST is a congenital pyriform sinus fistula which was ruled out in our patient with direct laryngoscopy. Common presenting symptoms include fever, neck pain, and dysphagia. Pathogens commonly found to cause AST include Streptococcus and Staphylococcus. Our patient presents as an interesting case of AST from K. Pneumoniae with hematogenous spread that precipitated a thyroid storm. Thyroid storm incidence is noted to be <10%; however, to our knowledge AST is a rare cause of thyroid storm resulting from a thyroid abscess. For patients presenting with thyroid storm and a neck abscess, AST should be kept in mind as a possible etiology. Reference: https://www.ncbi. nlm. nih.gov/pmc/articles/PMC5667251, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587896/ Presentation: No date and time listed

Status of the mastoid antrum and the eustachian tube function in cases of chronic otitis media

Introduction: Chronic otitis media (COM) is now synonymous with chronic suppurative otitis media, which is not actively used since COM is seldom associated with “the collection of pus.” Acute suppuration of the ear which transcends 6 weeks is considered to be COM which suggests an abnormality of the ear drum. With a prevalence incidence of 1%, Eustachian tube (ET) dysfunction is among the most important factors in the development of COM. Recently, mastoid air cells have been acknowledged as an essential compounding factor for the pathogenesis of middle ear disease. Since ET, mastoid air cell system, and nasopharyngeal mass like adenoids can play a pivotal role in the causation and persistence of COM, the current study will be taken to observe the status of ET, mastoid air cells system, nasopharynx in general, and adenoids in particular in patients of COM. Aim: This study aims to study the status of the mastoid antrum on surgical exploration, the status of ET, and nasopharynx for adenoids in patients of large, subtotal perforation, and posterosuperior retraction pockets (PSRPs). Study Design: This study was an observational, cross-sectional study. Study Setting: All the patients with large, subtotal perforation, and PSRPs visiting the Outpatient Department and Inpatient Department of ENT in Acharya Vinoba Bhave Rural Hospital (AVBRH) between 2022 and 2023 will be studied. Methods: All the selected patients of large, subtotal perforation, and posterosuperior retraction pocket (PSRP) in the age bracket of 15–65 years and satisfying the inclusion criteria will be considered and accrued in this study. We plan to look at a sample size of 50 patients (50 ears). Diagnostic nasal video endoscopy to get insight into ET function, size, and grade of adenoids by grading system given by Cassano et al. and pure-tone audiometry by ALPS AD2000 to know the type and amount of hearing loss will be carried out. Status of the mastoid antrum, the extent of the disease, status of ossicles, and associated abnormalities of temporal bone along with any other incidental findings will be noted intraoperatively. Expected Results: The data will be tabulated, analyzed statistically, and will be discussed in the context of existing research. Conclusion: The purpose of the present study is to help the surgeon have a better insight into the status of the mastoid antrum, ET in cases of large and subtotal perforation, and PSRP and nasopharynx in general with significance to adenoids in patients of COM in rural area.

Pediatric deep neck infections: Clinical description and analysis of therapeutic management

ObjectivesThe aim of our study was to describe clinical presentations, bacteriological results, and therapeutic management in a pediatric population presenting with acute pharyngeal suppuration. A further aim was to identify clinical, bacteriological, and radiological predictors of success associated with exclusive medical treatment. MethodA retrospective study was carried out including patients under 18 years of age hospitalized between January 1, 2015 and December 31, 2017 in our center for acute pharyngeal suppuration. We identified three groups of patients: group A, treated with exclusive intravenous antibiotics; group B, surgically treated after 48 h of appropriate antibiotic therapy, due to persistent fever and/or clinical worsening and/or persistence of a collection on follow-up imaging; group C, surgically treated as first-line therapy in association with intravenous antibiotics. A total of 83 patients were included: 36 in group A, 12 in group B, and 35 in group C. These three groups were compared for several variables: age of the patients, polynuclear neutrophil counts, diameter of the collections (the largest diameter found on imaging), duration of antibiotic therapy, delay before return to apyrexia, and hospitalization duration. ResultsA neck mass and torticollis were present, respectively, in 48.8 and 47.6% of cases. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism. The average diameter of the collections from patients treated surgically as first-line therapy (group C) was significantly larger than that of the patients treated with antibiotics (group A) (27.89 mm vs. 18.73 mm, respectively, p = 0.0006). All the patients who required surgery despite 48 h of appropriate antibiotic therapy (group B) had collections with diameters greater than or equal to 15 mm. There was no significant difference between the groups concerning hospitalization duration. ConclusionExclusive medical treatment is associated with a high cure rate, mainly for collections with small diameter. We recommend special attention to patients treated with first-line exclusive intravenous antibiotic therapy and with a collection diameter greater than or equal to 15 mm.

Needle aspiration of lateral neck abscess in children: A simple and effective treatment

BackgroundCervical abscesses frequently occurred in pediatric patients. Surgical drainage is currently recommended in the cases not responding to medical therapy. Needle aspiration may represent a simple, effective and minimally invasive treatment for acute neck suppuration in selected cases. ObjectiveTo evaluate the effectiveness of needle aspiration in the treatment of cervical abscesses in pediatric age as an alternative to surgical drainage. MethodsFrom November 2013 to November 2019, at the ENT Department of the “Bambino Gesù" Pediatric Hospital, Rome, we treated 47 children with cervical abscess by performing aspiration with a 19 G needle in wakefulness after applying local anesthetic. Parenteral antibiotic treatment was associated with all patients both before and after treatment. ResultsComplete regression of the abscess occurred in 46 children with no evidence of recurrence in the follow-up period. Surgical drainage was required in only one patient due to the lack of resolution of the abscess episode. No complications such as hematomas or hypertrophic scars were found in any patient. ConclusionsOur results confirm the effectiveness of needle aspiration in the treatment of cervical abscesses in children as an alternative to surgical drainage.

Acute Mastoiditis - Beginning of COVID-19 Infection - Case Report

Abstract Particular onset of Sars-Cov-2 infection, by acute mastoiditis without symptoms specific to the case definition. Mastoiditis is part of inflammatory diseases of the middle ear and is important because of its frequency and life-threatening complications due to the close relationship between the middle ear and the cranial cavity. An acute middle ear inflammation may follow a serious course even if the tympanic membrane does not perforate. In the pathogenesis of acute suppurations of the middle ear, the Eustachian tube plays a major role in the appearance of inflammation and the development of the disease. The most common germ can be - a virus whose initial effect is congestion of mucosa and reduce resistance to biological defence by promoting rapid superinfection with Hemophilus Pneumococcus, Staphylococcus, and others. Sars-Cov-2 infection begins with respiratory phenomena and clinical and biological inflammatory syndrome. This article presents a case of Sars-Cov-2 infection with atypical onset of acute mastoiditis. The clinical importance lies in the fact that the virus can migrate from the nose and nasopharynx through its Eustachian tube into the middle ear and from here to the mastoid. The presence of the virus in the middle ear is almost constant even if the patient is asymptomatic. This requires precautions in all surgical maneuvers at this level in patients with Sars-Cov-2 infection.

The First Case of Acute Neonatal Suppurative Parotitis Caused by Escherichia coli in Korea

The First Case of Acute Neonatal Suppurative Parotitis Caused by Escherichia coli in Korea

Rare causes of acute purulent-inflammatory lesions of pararectal tissue and Fournier's gangrene

National and foreign literature devoted to acute non-cryptogenic suppurations of pararectal tissue was analyzed. Own clinical observations are given. The unsolved questions of terminology and treatment strategy for this rare disease are discussed.

Abnormal tracheal bronchus in a patient with pulmonary tuberculosis

Tracheal bronchus is a congenital anomaly of the structure of the trachea and bronchial tree, in which the additional, lobar or segmental bronchus departs from the trachea above its bifurcation site (or above the main bronchus). The clinical significance of this pathology is that in some cases, ventilation and drainage of the corresponding portion of the pulmonary parenchyma is incomplete, due to the abnormal bronchus moving at right angles from the trachea or its too narrow orifice. This contributes to the occurrence in the corresponding zone of processes such as pneumonia, acute suppuration, tuberculosis, etc.A young woman with limited first diagnosed tuberculosis in the upper lobe of the right lung without destruction and bacterial excretion had a torpid course of the disease, and 4 months after completion of the main course of chemotherapy, an early relapse.In addition, an abnormal tracheal bronchus was found in the patient, which departs from the right wall of the trachea 1 cm above the bifurcation site. According to the classification, it can be attributed to the option «B» — «true» or «piq tracheal bronchus». The horizontal location of the tracheal bronchus is a cause of impaired drainage of the affected area of the lung with tuberculosis. As a result, the patient did not secrete sputum, and the detection of MBT in the washings of the bronchi was unsuccessful, therefore, it was not possible to determine their drug sensitivity. In addition, in the lobe of the lung ventilated by the tracheal bronchus, already at the first admission to the hospital, bullous and fibrotic changes were detected on CT, which may accompany the abnormal structure of the bronchial tree. All this is the basis for the attachment of inflammatory (including tuberculosis) complications and inhibition of reparative processes.The diagnosis of tuberculosis is confirmed bacterioscopically and histologically after surgery.

Isolation and Characterization of Bacteria Causing Acute Suppurative Otitis Media in Egypt

Isolation and Characterization of Bacteria Causing Acute Suppurative Otitis Media in Egypt

Emphysematous pyelonephritis - Is surgery necessary?

Introduction Emphysematous pyelonephritis is a rare, life threatening acute suppuration of the kidney, characterised by the presence of air in the renal parenchyma, sometimes extending to the surrounding tissue. E. Coli and Klebsiella are the most common causative organisms, but the exact pathogenesis is poorly understood. It carries a high mortality, cited up to 50% and therefore requires prompt diagnosis and management. Case description A 52-year old woman presented to A&E with a two day history of severe left-sided abdominal pain, rigors, vomiting and increased urinary frequency. Her past medical history was significant for non-insulin dependent Type 2 diabetes mellitus, a well-established risk factor that is present in 90% of cases. On examination, she had marked left flank tenderness, tachycardia and pyrexia. Bloods showed raised inflammatory markers with a severe AKI. Results and Conclusions A CT KUB carried out in A&E showed air bubbles in the parenchyma and calyceal system of the left kidney, which confirmed emphysematous pyelonephritis. As there was no obstruction, the decision was made to manage conservatively. She was started on intravenous empiric metronidazole and tazocin, aggressive fluid resuscitation and close monitoring of her blood glucose. On day 3, initial blood cultures grew ESBL and tazocin was switched to meropenem and amikacin. A repeat CT scan on day 4 showed complete resolution of the parenchymal gas. Nonetheless, she continued to have recurrent pain and pyrexia. She stayed in hospital for a total of 16 days, with conservative management alone significantly improving her AKI and pyelonephritis. She was discharged with analgesia for residual loin tenderness. Take home message As portrayed in this case, young diabetic women are predisposed to developing emphysematous pyelonephritis. Nephrectomy remains the treatment of choice in most patients, whilst nephrostomy drainage is required in patients with urinary obstruction. Systematic reviews have indicated that antibiotic therapy with nephrostomy carries a reduced mortality risk in comparison to antibiotic therapy with emergency nephrectomy, though there are currently no guidelines available to optimally manage the condition. Prompt CT diagnosis and targeted antibiotic therapy in the initial assessment of this patient were crucial in preventing her from having to undergo an invasive surgical procedure.

Acute Obstructive Suppuration of the Pancreatic Duct Causing Sepsis

Objective: We report a rare case of acute obstructive suppuration of the pancreatic duct causing sepsis, which was successfully treated with emergent endoscopic retrograde cholangiopancreatography (ERCP). Methods: We describe the patient’s clinical presentation, laboratory test results, and imaging used for diagnosis and treatment. Results: A 33-year-old female with a history of recurrent acute pancreatitis was admitted during an episode of acute pancreatitis. Computed tomography (CT) scan of the abdomen revealed acute pancreatitis, diffuse pancreatic atrophy and pancreatic ductal dilatation with obstruction due to a soft tissue lesion within the distal duct. Shortly after admission she developed symptoms and signs of sepsis. Urgent ERCP was performed to further assess the suspected cholangitis. “Clean” bile emanated from the common bile duct, while copious purulent fluid was detected at the dilated pancreatic duct orifice, confirming suppuration of the pancreatic duct. A plastic single pigtail stent was placed traversing the ampulla and pancreatic duct stones that were causing the obstruction, which were later removed. After endoscopic decompression, the patient rapidly improved over the following 24 hours and had no subsequent admissions for pancreatitis.Conclusion: Acute suppuration of the pancreatic duct (ASPD) is a rare and potentially fatal infectious complication of pancreatic ductal obstruction with few cases reported in the English literature. It would be of interest to further investigate the exact pathophysiology leading to development of ASPD. The endoscopic methods of urgent ERCP and pancreatic duct decompression utilized in our case proved effective in successfully treating ASPD. This unusual condition should be considered in patients with acute pancreatitis who develop early clinical decompensation.

English

INTRODUCTION: Right iliac fossa mass may arise from parietal wall or intraperitoneum or retroperitoneum. Mass may arise from right iliac regional structures or extended from adjacent structures. Appendicular pathology is commonest cause for right iliac fossa mass (either appendicular mass or abscess). Other common causes are ileo-caecal tuberculosis and carcinoma caecum. Appendicular mass is formed by inflamed appendix adherent with dilated ileum, greater omentum and caecum. Appendicular abscess due to suppuration in an acute appendicitis or suppuration in an already formed appendicular mass. Abdominal tuberculosis is common in developing countries like India. It is sixth most common type of extra pulmonary tuberculosis. Its incidence is high in HIV infected patients. Ileo-caecal tuberculosis is commonest type of abdominal tuberculosis due to presence of Peyer's patches and stasis of luminal contents favoured by ileo-caecal valve. Commonest type of carcinoma in caecum is adenocarcinoma. Third common site in large bowel carcinoma (12%). Diet with lack of fibres and high fat increases risk. Dietary vitamins A, C, E (antioxidants) and Zinc and high fibre diet reduce the risk. Diagnosis of right iliac fossa mass mainly depends on complete clinical examination, radiological, biochemical, microbiological and pathological investigations. Commonest cause of right iliac fossa mass in our country is appendicular mass or abscess, ileo-caecal tuberculosis and carcinoma caecum. OBJECTIVES: To study the aetiology, pattern of presentation, management and complications in patients with right iliac fossa mass in our institution. MATERIALS AND METHODS: This retrospective study was carried out in our institution over a period of two years from October 2010 to October 2012. All patients who are provisionally diagnosed to have mass in the right iliac fossa by clinical evaluation are included in the study. All data including age, gender, relevant history, investigations (complete blood count, Blood grouping and Rh typing, HIV I & II, Chest radiograph, Ultrasound abdomen and pelvis, CT Scan abdomen and pelvis, IVP and barium follow through and enema, FNAC, BIOPSY) were done to conclude the final diagnosis and appropriate treatment and postoperative complications and final histopathological reports were recorded in the standard forms. Cases are selected by following Inclusion and exclusion criteria; Inclusion criteria: All the cases admitted with Right iliac fossa mass in our institution. Exclusion criteria: Female patients with gynaecological diseases. Paediatric age group (<12 years) patients with right iliac fossa mass. CONCLUSION: Right iliac fossa mass was common in 20 to 50 years of age group. Overall incidence was more common in males as compared to females (1.1:1).Appendicular pathology and Carcinoma caecum was more common in males as compared to females. Ileo-caecal tuberculosis was more common in females. The diseases were more in people from low socio –economic status and the commonest symptom was pain in abdomen. Appendicular pathology (60%) either in the form of appendicular mass (32.5%) or appendicular abscess (27.5%) were the commonest cause of mass in the right iliac fossa. Ileo-caecal tuberculosis (20%), carcinoma caecum (12.5%) was the other common causes of mass in the right iliac fossa. Ultrasound abdomen was the essential investigation and it had a sensitivity of greater than 95%. Normal levels of serum CRP titer essentially ruled out appendicular pathology. Serial titers were helpful in assessing the treatment response of ileo-caecal tuberculosis and in prognosis of carcinoma caecum. In patients with appendicular mass, initial conservative management followed by interval appendicectomy had better results with minimal complications. In patients with appendicular abscess, abscess drainage combined with appendicectomy in the same procedure, had high morbidity compared to patients who underwent interval appendicectomy following abscess drainage. 44% of the patients with ileo-caecal tuberculosis were managed conservatively with anti-tubercular therapy (DOTS-I). Surgery was required in another 56 % of the patients, of which 25 % of the patients presented with acute complications needing immediate surgery. 31 % of the patients presented with sub-acute intestinal obstruction due to adhesions and strictures following the initiation of anti-tubercular therapy, which later required surgical intervention. 80 % of the patients with carcinoma caecum underwent successful surgical resection. 20 % of the patients presented with acute surgical problem requiring immediate surgery. 10 % of the patients presented with advanced disease. Most of the parietal wall and retroperitoneal conditions were treated surgically. Early evaluation and intervention is needed to improve the patients’ outcome and to reduce the morbidity and mortality.

Unusual Cause of Fever and Abdominal Pain: Acute Suppuration of the Pancreas Duct and Endoscopic Management

Unusual Cause of Fever and Abdominal Pain: Acute Suppuration of the Pancreas Duct and Endoscopic Management

The challenges of Otologic Practice in an emerging Otorhinolaryngological Unit at Federal Medical Centre, Makurdi

Otological cases abound world over, our Centre inclusive. But the challenges of setting up an Ear, Nose, Throat, Head and Neck Surgery unit in an emerging Tertiary Centre are enormous. These include lack of basic practicing tools despite the high volume of patients seen. This study was to give an audit and management of otological cases seen despite the challenges of not having basic working implement, at the Federal Medical Centre, Makurdi. This was a three year retrospective study carried out between April 2009 and March 2012. Medical records of 1786 patients who had one form of ear related pathology were examined. Data retrieved were Age, Sex, Investigations, Diagnosis, and Treatment received with its outcome. A total of 3768 patients were attended to in this period. Of these, 1786(47.4%) patients had ear related problems. Chronic Suppurative Otitis Media accounted for 620(34.7%), Hearing loss (conductive, sensorineural, and mixed) 306(17.1%), Cerumen auris 254(14.2%), Tinnitus 230(12.9%), Acute Suppurative Otitis Media 122(6.8%), Otomycosis 106(5.9%), Otitis Externa 50(2.8%), Otitis Media with Effusion 18(1.0%). Others included foreign bodies 48(2.7%), and traumatic tympanic membrane perforation 32(1.8%). Otological cases still remain a significant problem in ear, nose and throat practice, so efforts should be made to train more personnel and equip the unit for better service delivery.

Juvenile Central Serous Retinopathy an Atypical Presentation of ASOM (Acute Suppurative Otitis Media) - A Case Report

Central serous retinopathy (CSR) is a visual impairment, often temporary, usually in one eye mostly affecting males. The disorder is characterized by leakage of fluid in the central macula, which results in blurred or distorted vision (metamorphopsia). We report an atypical Presentation of ASOM in a girl aged 11 yrs who presented with serous discharge in right ear, pyrexia and ipsilateral sudden decrease in vision along with micropsia.