Thrombophlebitis Research Articles

Comparison of the Efficacy of Magnesium Sulphate and Cold Application for the Treatment of Thrombo Phlebitis in Patients Undergoing Intravenous Therapy at a Tertiary Care Hospital

Introduction: In hospitals, providing care for patients typically includes the utilization of various intravenous devices. The monitoring of a patient’s hemodynamic condition as well as the delivery of fluids, nutrition, medicines, and blood products are all accomplished with the assistance of these instruments. Up to eighty percent of hospitalized patients in contemporary medical practice are given intravenous therapy at some point during their hospitalization. This treatment can be given at any time during the patient’s stay. Even though peripheral IVs seldom cause serious difficulties, problems might arise, especially when they are used for an extended period of time. Because of this, different hospitals have developed different sets of rules about the suggested amount of time that a peripheral IV should be in place. Early detection, as well as clear and open communication between the patient and the healthcare provider, is essential in the event that a medical procedure results in a side effect or complication of any kind. Aims: The purpose of this study is to compare the efficacy of magnesium sulphate application and cold application for the treatment of thrombophlebitis in patients who are receiving intravenous therapy in a tertiary care hospital. Objectives to determine whether or not the application of cold can effectively treat thrombophlebitis. To determine whether or not magnesium sulphate is effective in treating thrombophlebitis. In order to evaluate the relative efficacy of magnesium sulphate and cold application in the treatment of thrombophlebitis. Material and Method: Techniques and Components Among the 32 patients who participated in the study, an evaluation was carried out using a method called straightforward random sampling. A total of 16 samples were allotted to the group that was to receive the cold treatment, and the same number of samples were given to the group that was to receive the magnesium sulphate application. The research approach known as the pre-experimental two-group design was utilised for the investigation. The medical and surgical wards of the tertiary care hospital located in Karad were chosen as the location for this particular research project. Patients who have acquired thrombophlebitis and are now being treated in medical and/or surgical wards at tertiary care hospitals make up the population of the current research study. Results: In order to determine whether or not there was an effect of cold treatment on thrombophlebitis in group A, a non-parametric repeated ANOVA was carried out using the Friedman test. It was discovered that, beginning on day 2 and continuing onwards, there was a significant decrease in the readings of score on the thrombophlebitis measuring chart when cold treatment was performed each time in group A (p 0.001). When performing a non-parametric repeated ANOVA, the Friedman test was utilised to determine whether or not there was an effect of magnesium sulphate treatment on thrombophlebitis in group B. It was shown that there was a substantial drop in the readings of score of thrombophlebitis measurement chart, beginning on day 1 and continuing onwards for magnesium sulphate application three times in group B (p less than 0.001) According to the findings of the Mann Whitney U test, there was a statistically significant difference between groups A and B regarding the thrombophlebitis assessment grading scale for the various therapies (p less than 0.05). The fact that the median score for magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that the magnesium sulphate paste application was more effective than the cold application. Conclusion: The findings of the study indicated that there was a significant difference between groups A and B with regard to the thrombophlebitis assessment grading scale for various therapies (p less than 0.05). The fact that the median score in magnesium sulphate application, group B was constantly reduced (meaning the level of pain decreased), demonstrates that magnesium sulphate application was more effective than the application of cold.

Chemical and mechanochemical catheter-directed sclerotherapy in varicose vein ablation

Background Varicose vein, as well as the accompanied venous insufficiency, is a frequent disorder, affecting ∼30% of the Western population. Chronic venous insufficiency has a major effect on patients’ health-related quality of life, similar to different chronic disorders, including diabetes mellitus as well as cardiovascular diseases. Aim The aim of this study was to assess and compare the applicability, technique, and results of catheter-directed foam sclerotherapy in the management of varicose vein with and without mechanical injury to the vein wall. Patients and methods The study was conducted on 104 patients with primary varicose vein between November 2017 to October 2019. All patients were admitted to Vascular Surgery Department in Mansoura University hospitals. They were divided into two groups: group A (chemical ablation) included 79 patients, and group B (mechanochemical ablation) included 25 patients. Technique In chemical ablation group, catheter-directed foam sclerotherapy of great saphenous vein was done using Aethoxysklerol 3% by ureteric catheter. In mechanochemical ablation group, catheter-directed foam sclerotherapy of the great saphenous vein was done using Aethoxysklerol 3% through Flebogrif catheter. This was a nonrandomized prospective comparative study. Results Complete occlusion was reported at 3 months for all cases of group A (100%) and 19 (76%) of cases in group B, and after 6-month follow-up, occlusion occurred in 43 (54.43%) cases among group A and 22 (88%) of cases among group B and long-segment recanalization in 36 (45.56%) of cases among group A and three (12%) of cases among group B. Complications developed in 22 cases in group A and five cases in group B. In group A, 20 cases developed painful thrombophlebitis, one case reported DVT, and only one case reported respiratory distress. However, in group B, four cases developed painful thrombophlebitis and one case reported hyperpigmentation along the course of the vein. Patients in group B were more satisfied than group A patients, with significant difference, and also group B patients has less pain sensation than group A patients, with significant difference. Conclusions Catheter-directed foam sclerotherapy is accepted in the treatment of primary varicose vein with short-term and mid-term success in varicose vein ablation and has a low incidence of complications. Mechanochemical occlusion is preferred than catheter-directed foam sclerotherapy, with better results and fewer complications.

692: Septic Shock From Sore Throat? Presentation of Streptococcus anginosus Shock and Lemierre Syndrome

INTRODUCTION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein caused by oropharyngeal or head and neck infections The main causative organism is Fusobacterium necrophorum but rarely other organisms such as Staphylococcus aureus, E coli, streptococci, staphylococci, Klebsiella etc can cause the syndrome as well Members of the Streptococcus Anginosus group are rare causes of Lemierre syndrome with very few pediatric case reports in the literature METHODS: A previously healthy 15-year-old female presented with four days of fever, throat pain, abdominal pain and persistent vomiting and was admitted with septic shock requiring extensive fluid resuscitation and vasopressor support Initial labs included WBC 15 2 x 10 9/ L, CRP 34 9 mg/dL, ESR 78 mm/Hr Review of systems was negative for tampon use Rapid streptococcus probe test, respiratory viral panel, and SARS CoV-2 tests were all negative Clindamycin was added to empiric coverage with concern for toxic shock syndrome Within 24 hours of hospitalization, she developed ARDS requiring non-invasive positive pressure ventilation She continued to complain of worsening throat pain and headache CT scan of the neck revealed extensive thrombosis of the left internal jugular and initial blood culture grew Streptococcus constellatus, a member of the S Anginosus group Antibiotic coverage was switched to piperacillin-tazobactam to cover anaerobic organisms such as Fusobacterium as well as Streptococcus Anginosis Enoxaparin was started Lupus antibodies were transiently positive secondary to infection Following discharge, she received intravenous ceftriaxone via PICC line and oral metronidazole for 3 weeks and then oral levofloxacin and metronidazole for 2 weeks She was followed up regularly to assure clearance of septic thrombi from internal jugular vein after 6 weeks of antithrombotic therapy RESULTS: Lemierre syndrome should be considered a diagnosis for an adolescent with throat pain presenting with shock

Endovenous laser ablation vs conventional surgery in the management of superficial venous insufficiency

Background and objective Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is much more used as an alternative method of treatment instead of conventional surgery procedures. EVLA is thought to decrease postoperative morbidity with rapid recovery and early return to daily activity. The goal of this study was to compare the effectiveness, postoperative pain, complications, and patient satisfaction following either EVLA or conventional surgery for varicose veins of the lower limbs. Patients and methods This is a retrospective study that was conducted on 50 consecutive patients/60 limbs (10 bilateral and 40 unilateral) presented to Kasr Al Aini Hospitals, Cairo University and Asir Central Hospital Saudi Arabia from January 2015 to January 2018 with truncal varicose veins involving GSV. Patients were divided into two groups: group I (30 limbs) who underwent conventional surgery in the form of high ligation and striping and group II (30 limbs) who underwent EVLA. Results The EVLT group was associated with good patient satisfaction with early return to daily activities and work. Pain, paresthesia, ecchymosis, hematoma were significantly higher in group II (P Conclusion Both EVLT and conventional surgery techniques were performed well as regards efficacy with low rate of recurrence for incompetent GSV. Less postoperative pain and complications were observed with EVLT as compared with conventional surgery such as ecchymosis, hematoma, superficial thrombophlebitis, and paresthesia.

Erratum to: A Case of Thrombophlebitis Obliterans Managed with Homoeopathy

Erratum to: A Case of Thrombophlebitis Obliterans Managed with Homoeopathy

Management of primary uncomplicated varicose veins, endovenous laser ablation with sclerotherapy versus traditional surgery: which is the best option?

Aim To compare between endovenous laser treatment (EVLT) with ambulatory phlebectomy, EVLT with injection sclerotherapy, and the standard surgical procedure. Patients and methods A randomized prospective study was conducted on 60 (72 limbs) patients having primary uncomplicated varicose veins and was carried out at Minia University Hospital. Patients were divided into three groups (20 patients each), each with a different intervention for varicose veins. Group A underwent endovenous laser with injection sclerotherapy, group B underwent endovenous laser with ambulatory phlebotomy, whereas group C underwent traditional surgery. Results Operative time and hospital stay were significantly lower in group A. There was a significant decrease in complications in patients in group A (12.5%) compared with group C (37.5%). The most common complication in groups A and B was superficial thrombophlebitis, represented by 8.3 and 12.5%, respectively, and in group C was hematoma at 12.5%. After 1-month follow-up, residual varicose veins (VV) was 4.2, 16.7, and 8.3% in groups A, B, and C, respectively. Approximately 96% of patients in group A, 83.3% of patients in group B, and 66.7% of patients in group C were satisfied. Conclusion The combination technique of EVLT and injection sclerotherapy appears to be a safe and an efficient treatment method for the treatment of the great saphenous vein and small saphenous vein, achieving good short-term and long-term results.

A study of clinical profile of childhood tetanus in south Gujarat area

Introduction: Despite the availability of cheap, safe and effective vaccine, tetanus is still a serious health problem worldwide and rural India, and a common cause of death in the new born. Community surveys have shown that only a small proportion of neonatal tetanus (NT) cases are routinely reported and under – reporting is often highest in areas at highest risk of NT. So, the objective of the study was to find out the epidemiological factors, clinical profile and outcome of childhood tetanus. Also to find out the preventable factors and prognostic factors in childhood tetanus. Methods: It was a prospective observational study. Legal guardians of all children less than 12 years old including neonates with diagnosis of tetanus admitted in pediatric department were inquired for detailed history regarding the present complaint, history of sources of infection, history of antenatal care, immunization status and detailed labor history. Grading of tetanus was done after detailed general and systemic examination. Result: Total 35 cases were included in the study with Male: Female ratio of 1.7:1. Among them 28.57% were neonatal tetanus and 28.57% were traumatic case. Among 10 neonatal tetanus cases 9 mothers were not immunized and among 25 non-neonatal cases 19 were unimmunized. Mortality was 90% in NT cases and 36% in Non-Neonatal Tetanus (NNT) cases. Common complication were septicemia [9 (25.71%)], Disseminated Intravascular Coagulation (DIC) [8 (22.85%)], Hyperpyrexia [7 (17.14%)], Pneumonia [5 (14.28%)], Bed sore [3 (8.5%)], and thrombo phlebitis [1(2.8%)] of cases. Conclusion: Although incidence of childhood tetanus has been reduced over the years, but still tetanus is more common in rural population due to illiteracy, poor socioeconomic status, poor vaccination and superstitions. The mortality by tetanus can be reduced by improving routine immunization specifically in rural and low socioeconomic population, by recognition of disease severity and providing proper management with intensive care as early as possible.

Polymicrobial Bacteremia With Actinomyces odontolyticus , Fusobacterium and Atopobium parvulum Secondary to Septic Thrombophlebitis in an Immunocompetent Patient

A 25-year-old immunocompetent man was found to have polymicrobial bacteremia secondary to a right arm septic thrombus. His blood cultures grew Actinomyces odontolyticus , Fusobacterium and Atopobium parvulum . Co-infections with these three bacteria are rarely documented and this is the first known reported case of thrombophlebitis associated with these bacteria. J Med Cases. 2016;7(11):515-517 doi: http://dx.doi.org/10.14740/jmc2685w

Clinical efficacy of complex splenectomy in 235 patients

Objective To explore the clinical efficacy and safety of complex splenectomy. Methods The retrospective cohort study was adopted. The clinical data of 235 patients including 135 from Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 67 from Shanghai Jiaotong University Affiliated First People's Hospital, 26 from Shanghai Jiaotong University Affiliated Sixth People's Hospital, 7 from 85 Hospital of PLA who underwent complex splenectomy from January 2005 to December 2015 were collected. All the patients received total splenectomy after splenic artery ligation. The observation indexes included: (1) surgical situations, (2) major complications including intraperitoneal hemorrhage, pulmonary complication, left subphrenic abscess and peritoneal effusion, (3) follow-up situations: portal vein (PV) complications (splenic venous thrombo-phlebitis, thrombosis of splenic vein and main portal vein thrombosis), survival of patients. The follow-up using outpatient examination and telephone interview was performed up to March 2016, and patients received regularly ultrasound reexamination, computed tomography (CT) rescan, routine blood retest and coagulation function. Measurement data with normal distribution were presented as ±s, and count data were analyzed using the chi-square test. Results (1) Surgical situations: of 235 patients, 200 patients underwent secondary spleen pedicle severance and 35 patients underwent non-secondary spleen pedicle severance. Volume of intraoperative blood loss and duration of splenic resection were (268±103)mL and (82±29)minutes. (2) Major complications: of 31 patients with postoperative complications, intraperitoneal hemorrhage was detected in 12 patients, pulmonary complication in 17 patients, left subphrenic abscess in 3 patients and massive peritoneal effusion in 21 patients. Some patients were combined with multiple symptoms. The patients with above complications were cured after reoperations and non-operative treatments. (3) Follow-up situations: PV complications: splenic venous thrombo-phlebitis was detected in 16 patients, thrombosis of splenic vein in 17 patients, thrombosis of splenic vein combined with main portal vein thrombosis in 7 patients, and they were improved after the treatments of anti-inflammation, anti-coagulation and thrombolysis. The thrombi rate after splenectomy was 32.4%(12/37) in patients with schistosoma-related cirrhosis and 8.1%(12/149) in patients with HBV-related cirrhosis, with a statistically significant difference (χ2=10.9, P<0.05). Survival of patients: of 235 patients, 228 were followed up for (7.9±4.2)years, with good survival. Conclusion Complex splenectomy is safe and effective, and the key procedure determining the safety of complex splenectomy includes careful preoperative evaluation, delicate surgical technique, proper splenic pedicle severance and peritoneal wounds. Key words: Portal hypertension; Complex splenectomy; Splenomegaly

Facial Cellulitis and Thrombosis With Pulmonary Septic Emboli Mimicking Lemierre's Syndrome

Lemierre’s syndrome is characterized by thrombophlebitis of the internal jugular vein and bacteremia, typically caused by anerobic microorganisms following a recent pharyngeal infection, first described by Andre Lemierre as a clinical finding of “anerobic post-anginal sepsis” in 1936. Diagnosis is made by identifying thrombosis of the internal jugular vein; although variants of the disease with facial vein thrombosis have been reported, in addition to positive anerobic blood cultures, the most common causative organism remains Fusobacterium necrophorum . The mainstay of treatment remains prolonged antibiotic therapy. J Med Cases. 2016;7(3):87-89 doi: http://dx.doi.org/10.14740/jmc2422w

Clinical characteristics and treatments of Klebsiella pneumoniae infections

Klebsiella pneumoniae is one of the most important gram-negative bacteria clinically.Klebsiella infections are seen mostly in people with a weakened immune system.Klebsiella can cause infections in the respiratory tract, urinary tract, lower biliary tract, and surgical wound sites.The range of clinical diseases includes pneumonia, thrombophlebitis, urinary tract infection, pyogenic liver abscess, cholecystitis, diarrhea, upper respiratory tract infection, wound infection, osteomyelitis, meningitis, and bacteremia and septicemia.The most common condition caused by Klebsiella bacteria is pneumonia, and the worst condition is septic shock.Klebsiella organisms are often resistant to multiple antibiotics.Klebsiella with the ability to produce extended-spectrum beta-lactamases is resistant to many classes of antibiotics.Therefore, prevent spreading Klebsiella infections and give effective treatment to patients are most important task for us. Key words: Klebsiella pneumoniae; Infection; Treatment,

A case of sudden death due to septic pulmonary embolism

<strong>Introduction: </strong>Sudden deaths in hospital following a short duration of seemingly improving illness arouse suspicion of medical maltreatment. It is mandatory to have a medico-legal investigation in to such deaths. Facts, explanations, and opinions made by the forensic pathologists at the end of an autopsy examination are of crucial importance to eliminate or confirm such doubts. We report how a thorough autopsy examination including ancillary testing can lead to effective administration of justice in such cases. <strong>Case History: </strong>A 42 year woman with diabetes mellitus was admitted to hospital with fever and right knee joint swelling and tenderness of one week’s duration. There was cellulitis over the right knee joint and underlying septic arthritis. Surgical drainage of the joint was done and intra venous antibiotics were given and the condition seemed to be improving. On the 4th day of admission, she developed sudden onset of shortness of breath and central chest pain resulting in death 12 hours later. At autopsy she was pale and icteric. There was evidence of septic arthritis with surrounding necrotizing fasciitis and deep venous thrombosis of the right calf. There was consolidation of the right lung with patchy focal pale yellow areas with surrounding erythema, and evidence of multi-organ sepsis. Microscopy confirmed multi organ involvement and revealed pneumonia of the right lung with early abscess formation and multiple bilateral peripheral septic thrombo emboli. There was septic thrombosis of the calf veins with associated thrombo phlebitis. <strong>Conclusion: </strong>Facts revealed at autopsy explained the sudden death and the possibility of such death was scientifically clarified. The cause of death was concluded as septic pulmonary thrombo embolism due to deep venous septic thrombosis and thrombophlebitis due to septic arthritis and necrotizing fasciitis. <em>Medico-Legal Journal of Sri Lanka </em>2013; 1(2) : 46-50

Diagnosis and treatment of cavernous sinus syndrome caused by fungal infection to sphenoid sinus

To discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus. The clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time. After treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications. Cavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.

A Case of Thrombophlebitis Caused by Carbamazepine

Objective: To present a male patient with focal epilepsy and Glanzmann’s thrombasthenia who experienced Thrombophlebitis (TP) after oral administration of Carbamazepine (CBZ). Methods: In an epileptic patient with malacia from intracerebral hemorrhage in left parietal and occipital lobes due to thrombasthenia, TP occurred following treatment of antiepileptic drug CBZ. Based on the dynamic changes of clinical manifestation and dosage of CBZ, in combination with the test results of D-Dimer, fibrinogen, prothrombin degradation products, and other laboratory tests, especially of Adenosine Diphosphate (ADP) and Arachidonic Acid (AA) evoked platelet aggregation tests, the etiology and pathophysiology of TP was explored. Results: Six months after CBZ application with 200 mg bid, TP in the right lower extremity appeared. TP occurred in the left leg after another 3 months. The comfortlessness lightened when CBZ dosage was decreased to 100 mg bid. Furthermore, the inflammation disappeared after 4 months of cutting CBZ to 50 mg bid. However, inflammation emerged again in both legs following 100 mg bid of CBZ. D-Dimer, fibrinogen and prothrombin degradation products were 2357 ng/mL, 100 mg/dL, and 34.2 μg/mL, respectively. ADP and AA evoked platelet aggregation tests showed 4% and 26% (normal range: 71%-88%), respectively. These results demonstrated that there may be definite correlation between TP in lower extremity and CBZ administration. Conclusion: CBZ might result in reversible peripheral TP which was associated with its dosage, but the mechanism is still not clear. Practice implications: This case report reminds of physicians to pay more attention to the rare side effect of CBZ.

Thrombophlebitis Resembling Mondor’s Disease: A Case Report

INTRODUCTION: Mondor’s disease (MD) is a rare benign breast condition characterized by thrombophlebitis of the superficial veins in the subcutaneous fat of the breast or anterior chest wall. The etiopathogenesis of MD remains controversial and, in the absence of a proven pathophysiological mechanism, a multifactorial phenomenon has been postulated. Various authors have associated the disease with local trauma, including biopsy or surgery, cancer, muscular strain, tight clothing, radiation and large pendulous breasts. Inflammatory and infectious agents have also been proposed as etiologic factors. The thoracoepigastric, superior epigastric and lateral thoracic veins are the most commonly involved, especially the last of these. Although the internal mammary vein receives drainage from the medial aspect of the breast, it is rarely affected. Bilateral involvement is unusual too. We report a case of bilateral thrombophlebitis resembling Mondor’s disease involving the lateral thoracic veins and the internal mammary veins, with multiple simultaneous or separate recurrences in both breasts. CASE REPORT: A 44-year-old Brazilian woman presented at the outpatient clinic of the Fortaleza General Hospital (HGF). On physical examination, the patient presented very large pendular breasts and a 35 cm long subcutaneous, ulcerated cord-like induration in the inner quadrants of the right breast. Several old scars were observed bilaterally in the topography of the thoracic lateral veins and internal veins. Dilated superficial veins were observed in both breasts. The patient was submitted to mammography and sonography, but no lesions were detected. DISCUSSION: The classical form of MD is lateral, unilateral and self-limited thrombophlebitis of the mammary veins. In contrast, in our patient MD affected the lateral thoracic veins and the internal mammary veins bilaterally, with multiple recurrences. Despite all efforts, the main cause was not identified, as with many other cases reported in the literature. In fact, other case reports have associated large and pendular breasts with MD. The major clinical significance of MD is that the condition can mask malignant lesions. No specific treatment is needed in most cases and and follow-up is strongly recommended.

Review: Fondaparinux reduces VTE and recurrence in superficial thrombophlebitis of the leg

Source Citation Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. 2012(3):CD004982. 22419302

Acute symptomatic seizures as a complication of rhinosinusitis in children

When an otorhinolaryngologist thinks of acute seizures in children, what comes to mind are intracranial complications of infection within the sinuses or the temporal bone. Complications of rhinosinusitis, both in children and adults, may involve the orbit, soft tissues surrounding the nose and sinuses, and intracranial spread of the infection. Intracranial complications secondary to rhinosinusitis, intracranial abscesses and/or thrombophlebitis, occur sporadically and, although it appears that they cannot be prevented, early recognition and treatment are essential to reduce any subsequent morbidity or mortality [1]. The commonest presenting symptoms of intracranial complications are headaches (80%) followed by vomiting (45%) and swelling of the forehead (45%), an altered mental state, fever, seizure, unilateral weakness or hemiparesis, or a cranial nerve sign [1,2]. Exact pathogenesis of intracranial abscesses remains unclear [3]. Apart from rhinosinusitis, congenital cyanotic heart disease was identified as a predisposing factor, likewise otitis media or mastoiditis, dental abscesses and immunodeficiency [3]. The diagnosis of cerebral abscess is often difficult. The classical intracranial hypertension associated to high fever is usually incomplete and sometimes absent [4]. In most cases (60%), it is from the frontal sinus that the infection spreads intracranially [2]. In patients with intracranial complications of rhinosinusitis, frequency of seizures reaches 10–25% [1,3,5]. Epilepsy caused by intracranial complications is usually a long-term morbidity [1]. Above enumerated presenting symptoms justify an urgent magnetic resonance imaging (MRI) or computed tomography (CT) scan. The importance of imaging before a lumbar puncture cannot be overemphasized [1,6]. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8 to 3 days, andmortality from 25% to almost 0% [3]. In patients with intracranial complications, acute symptomatic seizures are usually accompanied by other neurological symptoms: fever in 50% of cases, headache in 75% of cases, and intracranial hypertension syndrome in 25% of cases [4]. The condition requires sinus surgery in order to drain the primary focus of the infection [2,7]. At the same time, prompt and aggressive medical and neurosurgical intervention is required, aiming tominimize the morbidity and mortality and to maximize the favorable outcome in those children [2]. The neurosurgical procedures aim to drain the abscess and include burr whole drainage or aspiration of abscess, craniotomy and evacuation of empyema, or craniotomy [2]. Central nervous system scars with subsequent seizures can be sequels of intracranial abscess therapy and are more common after excision of the brain abscess when compared to patients treated by aspiration and/or antibiotics alone [2,3,7]. Therefore, excision of brain abscess should be avoided *Address for correspondence: Olaf Zagolski, ENT, St. John Grande’s Hospital, Krakow, Poland. Tel.: +48 12 3797377; Fax: +48 12 4305491; E-mail: olafzag@poczta.onet.pl. Journal of Pediatric Epilepsy 1 (2012) 73–74 DOI 10.3233/PEP-2012-012 IOS Press 73

A new reliable tool (PVCassess) for assessment of peripheral venous catheters

To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n=3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n=3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa=0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.

Superficial Venous Thrombosis

Superficial thrombophlebitis — thrombosis and inflammation usually involving the saphenous veins — generally has been considered an annoyance rather

A case of Fusobacterium necroforum sepsis

A 26-year-old man was admitted to our hospital with a 10-day history of sore throat, high fever, and right knee joint pain. On physical examination, the pharynx was considerably inflamed, and the right knee joint was swollen and extremely tender. Chest radiography showed multiple, bilateral nodules and masses with pleural effusions. Fusobacterium necorforum grew from samples of blood, pleural effusion, and pus taken from the knee joint. The patient was treated with intravenous clindamycin, ventilatory support, and continuous chest and knee joint drainage. His condition progressively improved and he was discharged on the 66th hospital day. A disease caused by an oropharyngeal infection with secondary suppurative thrombophlebitis of the internal jugular vein, and complicated by multiple metastatic infections is called postanginal septicemia, or Lemierre syndrome. Before the discovery of antibiotics, this disease usually was fatal. The widespread use of antibiotics for treat oropharyngeal infections may have caused a number of reported cases. Lemierre syndrome is an uncommon complication of oropharyngeal infection, and it may be fatal if diagnosis is delayed. Careful attention must be directed to patients with oropharyngeal infection who have signs and symptoms that suggest metastatic infection.