1/26. Delayed cutaneous reaction to jellyfish.A 57-year-old woman presented with a widespread papulonodular eruption. The dermatitis had appeared about 1 week after her return from a trip to the Red Sea, where she had come into contact with a shoal of unidentified jellyfish; however, that contact had not been followed by cutaneous lesions and/or symptoms. The patient also stated that she had had previous contacts with jellyfish during other trips to exotic seaside resorts. The dermatitis was characterized by papulonodular lesions, round or oval in shape, of a few millimeters in diameter, with a color ranging from pink to red to brown, and with a smooth and regular surface. The lesions were grouped in an apparently random fashion (Fig. 1) or arranged linearly (Fig. 2). The patient complained of pruritus and burning. Histopathologic examination showed the presence of some necrotic keratinocytes; in the upper and mid dermis, edema and a predominantly perivascular and periadnexal lymphohistiocytic infiltrate, with numerous neutrophils and eosinophils, were observed (Fig. 3). The patient was treated with hydroxyzine (37.5 mg/day) and hydrocortisone butyrate, which resulted in the rapid disappearance of the symptoms; however, the cutaneous lesions persisted for about 3 weeks.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/26. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. Synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/26. Surgical management of strabismus after rupture of the inferior rectus muscle.BACKGROUND: rupture of an inferior rectus muscle is an uncommon problem. The resulting absence of infraduction and large hypertropia that result when the muscle cannot be repaired are challenging to manage surgically. methods: We treated 2 patients who had traumatic rupture of the inferior rectus muscle. Both patients underwent an inferior transposition of the inferior halves of the medial and lateral rectus muscles without disinsertion (modified Jensen transposition procedure). RESULTS: Both patients had a persistent small overcorrection in the primary gaze position. One patient was treated with a second strabismus surgery consisting of a recession of the contralateral superior rectus muscle; the other was treated with prism glasses. Both achieved restoration of depression to approximately 40 degrees and single binocular vision in the primary position at distance, near, and in the reading position. CONCLUSION: This modified Jensen transposition procedure of the horizontal rectus muscles appears to be highly effective in the treatment of the hypertropia and infraduction deficit produced by rupture of the inferior rectus muscle. It also appears to be suitable for use in situations when other rectus muscles are absent or unavailable for surgical manipulation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/26. Avian mite bites acquired from a new source--pet gerbils: report of 2 cases and review of the literature.BACKGROUND: Cutaneous manifestations of avian mite bites are not well recognized by physicians or patients. Clinical signs and symptoms are usually caused by bites from avian mites that have infested domestic poultry or birds nesting in or near human habitation. This report details 2 cases of pruritic papules acquired from avian mites that had infested pet gerbils and reviews the dermatologic literature about avian mites. OBSERVATIONS: An 11-year-old boy and an unrelated 10-year-old girl each had mysterious, pruritic papules for many months before their pet gerbils were found to be infested with Ornithonyssus sylviarum (the northern fowl mite) and Dermanyssus gallinae (the chicken mite), respectively. Symptoms resolved when the gerbils were removed from the home. CONCLUSIONS: Because infestation of pet gerbils with avian mites has never been reported, cases of avian mite bites and dermatitis may have gone unrecognized or misdiagnosed. Inquiry about ownership of pet gerbils may be helpful in patients with mysterious bites.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/26. A case of jellyfish sting.Jellyfish sting may result in a wide range of symptoms from common erythematous urticarial eruptions to the rare box-jelly induced acute respiratory failure. In taiwan, with the increasing frequency of international travel, cases of jellyfish sting to foreigners are on the rise. We report a case of jellyfish sting with the rare presentation of painless contact dermatitis. A 38-y-o man accidentally stepped on a sea urchin with his right foot during scuba diving in a beach in thailand. Traditional therapy with vinegar was applied on the lesion. However, when he returned to taiwan, erythematous patches on the left thigh with linear radiations to the leg were discovered. The skin lesions had bizzare shapes and showed progressive change. No pain or numbness was noticed. Jellyfish stingwas suspected, topical medications were applied, and the patient recovered without complication. Jellyfish stings usually result in a painful erythematous eruption. In this case, though the lesion involved a large surface, there was no pain. delayed diagnosis of jellyfish sting was due to the atypical presentation and the physician's unfamiliarity to the Thai jellyfish sting. awareness to the wide spectrum of jellyfish sting symptoms should be promoted.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/26. Facial fractures from dog bite injuries.Dog bites are commonly associated with soft-tissue injury to the face but rarely result in facial fractures. This article reports six new cases of facial fractures associated with dog bites and reviews additional cases reported in the literature. The demographics of the patients attacked, the location of facial fractures, and the characteristics of associated soft-tissue injuries or complications developing from the dog bite are described. With six new cases and 10 from the literature, this article reviewed a total of 16 cases involving 27 facial fractures. Eighty-seven percent of the cases involved children less than 16 years of age. The periorbital or nasal bones were involved in 69 percent of the cases. lacerations were the most frequently associated soft-tissue injury. Additional injuries included facial nerve damage, lacrimal duct damage requiring stenting and reconstruction, ptosis from levator transection, and blood loss requiring transfusion. Although facial fractures are not commonly considered to be associated with dog bite injuries, the index of suspicion for a fracture should be raised when the injury occurs in a child, particularly when injury occurs near the orbit, nose, and cheek.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/26. Cryptogenic rabies, bats, and the question of aerosol transmission.Human rabies is rare in the united states; however, an estimated 40,000 patients receive rabies postexposure prophylaxis each year. Misconceptions about the transmission of rabies are plentiful, particularly regarding bats. Most cases of human rabies caused by bat variants have no definitive history of animal bite. Three hypotheses are proposed and reviewed for the transmission of rabies from bats to human beings. They include nonbite transmission (including aerosol transmission), the alternate host hypothesis (an intermediate animal host that acquires rabies from a bat and then transmits rabies to human beings), and minimized or unrecognized bat bites. Nonbite transmission of rabies is very rare, and aerosol transmission has never been well documented in the natural environment. The known pathogenesis of rabies and available data suggest that all or nearly all cases of human rabies attributable to bats were transmitted by bat bites that were minimized or unrecognized by the patients.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/26. Cat bite transmission of yersinia pestis infection to man.The transmission of bubonic plague from the kitten of a domestic cat to a man by means of a bite on a finger is described. The human case was complicated by the development of a secondary meningitis, followed, after specific therapy, by protracted recovery. The kitten showed swollen lymph nodes of the head and neck, frothing at the mouth and nostrils, and signs of an acute infectious disease which had a fatal termination. yersinia pestis was isolated on about the 8th day from the cerebrospinal fluid of the man. The foster mother of the kitten exhibited signs of spinal and cerebral meningitis but recovered following treatment; her serum contained plague antibody levels of 1:512 and 1:1024 on the 22nd and 34th days respectively after the first evidence of illness. Three litter mates of the kitten also died. The outbreak occurred on a farm in the Graaff-Reinet district of the eastern Cape Province, which is situated about 160 km from the nearest known natural plague focus.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/26. tenosynovitis caused by mycobacterium kansasii associated with a dog bite.A 68-year-old man with adult-onset diabetes mellitus suffered an accidental puncture wound to the palm of his hand while playing with his pet dog. He received cephalosporin prophylaxis for 1 week. No inflammation occurred. Six months later, a mass developed near his elbow. It was removed. Histopathology revealed granulomas containing acid-fast bacilli (AFB). No culture was done. Swelling and decreased motion of the wrist and fingers developed. magnetic resonance imaging revealed inflammation of the flexor compartment of the hand, wrist, and forearm. Surgical incision and drainage yielded purulent material, granulomatous inflammation, with AFB. Cultures yielded mycobacterium kansasii. Several surgical procedures were required; M kansasii was recovered. He received isoniazid and rifampin for 1 year and prolonged rehabilitation. After 4 years, he was relatively asymptomatic, with good function of wrist and fingers. We believe this to be the first report of tenosynovitis caused by M kansasii in association with a dog bite.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/26. Successful treatment of a chronic atrophic dog-bite scar with the 1450-nm diode laser.BACKGROUND: Atrophic scars can be revised with surgical methods and more recently with newer ablative and nonablative laser techniques. Nonablative laser technology offers the advantage of improving the appearance of atrophic scars without the risks associated with traditional surgery or ablative lasers. methods: A case of a large linear atrophic dog-bite scar on the chin of greater than 2-year duration treated for three sessions at 4- to 6-week intervals with the 1450-nm diode laser is presented. RESULTS: Fifty to seventy-five percent improvement in the appearance of the scar resulted after three treatments with the 1450-nm diode laser. No adverse effects were noted from the treatment. The patient subjective rating of scar improvement was more than 50%. CONCLUSION: The 1450-nm diode laser may provide a noninvasive and effective alternative for the treatment of atrophic traumatic scars. This method appears to be potentially effective even for treatment of very mature scars and warrants additional studies.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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