Treatment Including Bed Rest Research Articles

Avulsion fracture of the anterior inferior iliac spine in an uncommon way: A rare case

Apophyseal anterior inferior iliac spine fractures are rare injuries. They most commonly occur in athletes in adolescence period. Because the ossification of pelvis is not completed, apophyses are the weakest part of musculotendinous unit during this period, thus avulsion fractures are more frequent than muscle ruptures. The fracture occurs as a result of the pull of the straight head of the rectus femoris muscle. Patients feel a severe pain localized in groin, and cannot bear weight. With conservative treatment including bed rest, analgesia, using crutches and toe-touch weight bearing, progressing to full weight bearing as tolerated, satisfactory results could be obtained. We present a 14-year old boy with anterior inferior iliac spine fracture occurred in an uncommon manner. J Clin Exp Invest 2012; 3(2): 267-269

Pneumomédiastin spontané chez un nourrisson de 4 mois

Spontaneous pneumomediastinum is a rare entity in children, especially in young infants. We report the case of a 4-month-old infant with a massive spontaneous pneumomediastinum caused by acute viral bronchiolitis. Treatment including bed rest, codeine for its antitussive action, and nitrogen washout resolved the pneumomediastinum within 3 days. In the literature, cases of pneumomediastinum in very young infants are exceptional. To our knowledge, codeine has never been used in this situation. Nitrogen washout is also rarely used because of poorly demonstrated efficacy.

A Case of Long-Term Dysbasia Due to Sacroiliitis During the First Trimester of Pregnancy

We present a case of pregnancy complicated by sacroiliitis. The patient complained of lumbar pain, dysbasia, and fever of 37.8°C at 14 weeks' gestation. Sacroiliitis was diagnosed on the basis of magnetic resonance imaging. Treatment included bed rest, antibiotics, and analgesic medications. Complete recovery required 2 months.

The Effect of Corticosteroid in Conservative Treatment of Patients with Hemoptysis

Background: This study examined the effect of corticosteroids as a short-term treatment for patients with hemoptysis that requires conservative treatment including bed rest, antitussives and antibiotics. Methods: From February 2005 to August 2006, 78 consecutive patients who visited the emergency room because of hemoptysis were enrolled in the study. Patients with hemoptysis due to lung cancer, active pulmonary tuberculosis, and pneumonia were excluded. The 78 patients were divided randomly into a corticosteroid medication group (n=37) and a control group (n=41). The mean control time of hemoptysis, mean in-hospital days, and complications of treatment were investigated prospectively. Results: For the etiology of hemoptysis, inactive pulmonary tuberculosis alone or its associated complications (bronchiectasis and/or aspergilloma) were the most common causes (51%); bronchiectasis alone and bronchitis were the next most common causative diseases (15%, respectively). The patients' characteristics and symptoms in the corticosteroid medication and control groups were similar. The steroid medication group showed a significantly lower mean control time of hemoptysis than the control group ( days, days, respectively) (p=0.022) and had a lower mean number of in-hospital days ( days, days, respectively) (p=0.036). There were no significant complications, such as hospital-acquired pneumonia or gastrointestinal bleeding, related to the use of corticosteroids. Conclusion: The use of corticosteroids as a conservative treatment for hemoptysis due to bronchitis, bronchiectasis, inactive pulmonary tuberculosis and its related complications safely reduces the control time of hemoptysis as well as the number of in-hospital days.

MUMPS ORCHITIS: REPORT OF A MINI-EPIDEMIC

Purpose The incidence of mumps orchitis has declined dramatically since the introduction of vaccination. While in the past cases of mumps have only been seen occasionally at our institution, recently there has been a sharp increase in the number of confirmed cases. Materials and Methods Between June 1995 and April 1996, 11 patients with severe mumps orchitis were hospitalized at our clinic. Medical history, therapeutic measures and clinical outcome were recorded for each patient. Results All patients showed marked scrotal swelling with a temperature above 38.5C. Serum C-reactive protein was significantly elevated (mean 140 mg./l.). The vaccination status of 1 of the 11 patients (9%) was unknown. Medical records from the remaining 10 patients indicated that they had not been vaccinated. Nine patients (82%) had a typical mumps parotitis preceding the orchitis. In 2 patients the clinical diagnosis of parotitis was uncertain but mumps serology was positive. None of the patients showed other manifestations of mumps. Antibodies to the mumps virus (IgG and IgM) were determined in 6 patients and positive in all cases. The average interval between parotitis and onset of orchitis was 10 days. All patients were hospitalized for an average of 6 days. Treatment included bed rest with local cooling, scrotal support and systemic treatment with nonsteroidal anti-inflammatory drugs. Ciprofloxacin or clavulanic acid/amoxicillin was administered as bacterial orchitis could not be excluded at initial presentation. The mean time to cessation of fever was 3.6 days (range 3 to 5). Antibiotics were administered for an average of 8.8 days (range 7 to 13) and anti-inflammatory drugs were given an average of 8.6 days (range 7 to 11). One patient required scrotal exploration. Conclusions Since the introduction of a vaccine against the mumps virus there is a diminished risk for mumps and its complications. However, in case of scrotal swelling mumps orchitis should still be considered. Despite vaccination mumps has not been erradicated. Therefore, continued vaccination should be considered an important step in minimizing clinical outbreaks and working towards a possible eradication of this disease in the future.

Persistent post-dural-puncture headache treated with epidural infusion of dextran.

A retrospective review was done on medical records of 13 patients with persistent post-dural-puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post-laminectomy syndrome after "wet taps" while performing epidural blocks. In two patients post-dural-puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran-40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD +/- 0.79). In five patients headache ceased in less than five hours. Nausea and photo-phobia subsided earlier. Patients with post-dural-puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran-40.

Bone and joint infections in intravenous drug abusers.

An analysis of data on 45 intravenous drug abusers treated for skeletal infection in 1982-1983 is presented. Eighty percent of patients were younger than 40 years old. None had any serious underlying illnesses. Septic arthritis was noted in 33 patients, osteomyelitis in seven, and both in five. Bone or joint infection involved the extremities in 78% of patients. The knee joint (left, 11 patients; right, four) was most commonly affected, and the left groin was the most frequent site of drug injections, a finding that suggests a relationship between the sites of injection and infection. Fever was absent in 16 (36%) of 45 patients. The predominant pathogens isolated were methicillin-resistant Staphylococcus aureus and groups A and G streptococci. Pseudomonas aeruginosa was much less common (11% of patients). Treatment included bed rest, intravenous antibiotics, and arthrocentesis when needed. Surgery was required in only seven (16%) of 45 patients. The immediate prognosis for intravenous drug abusers with skeletal infection was excellent. Attempts to obtain follow-up information from most patients, however, were unsuccessful.

Inhalation Therapy in Chronic Bronchial Infections

SUMMARY 1.A study has been made to determine the efficacy of inhalation therapy in bronchial infection. To rule out spontaneous remission, improvement by medical treatment, and the production of the effect by a blood level of penicillin the following criteria were used in selection of cases: a.There must be definite bronchographic evidence of bronchiectasis. b.There must be a history which is definitely of this type of infection for a long period of time. c.All of the patients should have been previously treated by all other methods of medical treatment including bed rest, postural drainage, sulfonamides by mouth and penicillin by injection. 2.Forty-two patients satisfying these criteria were treated over a period of two years. All of the patients have been followed for at least 1 year. 3.Of the 42 patients there were 19 cases of complete disappearance of symptoms; 14 cases of marked improvement in symptoms and general condition, although some symptoms remained; and 8 cases in which no clinical improvement could be found. Recurrence of symptoms with an entirely new bacterial flora as indication of new infection was the rule rather than the exception. 4.The concentration of penicillin per c.c. in the nebulized solution did not appear to be an important factor per se. The sensitivity of the organism to penicillin was the most important factor in the determination of the result. 5.Inhalation therapy appears to be a definite method of treatment with a definite effect upon bronchial disease. Its efficacy is limited by the effectiveness of the chemotherapeutic agent used. 6.Continued medical supervision and customary means of treatment including postural drainage remains an essential element in the treatment of chronic bronchial infections.