1/7. Venous sinus thrombosis after proteus vulgaris meningitis and concomitant clostridium abscess formation.A 19-y-old woman presented with proteus vulgaris meningitis as a complication of chronic otitis media. Despite treatment with ceftazidime and amikacin no clinical improvement was observed. Cranial MRI revealed right-sided mastoiditis/otitis media and venous sinus thrombosis. After mastoidectomy, repeat cranial MRI demonstrated abscess formation in the venous sinuses. The abscess was drained. clostridium spp. was isolated from the abscess culture.- - - - - - - - - - ranking = 1keywords = otitis (Clic here for more details about this article) |
2/7. Modern presentations of Bezold's abscess.The use of antibiotics in suppurative otitis media has greatly diminished the incidence of complications. Deep neck abscess arising from acute mastoiditis, a disease thoroughly described by Frederick Bezold early in this century, has become rare. In the last three years we have treated five cases of deep neck abscess of otogenic origin at our hospital. These cases exemplify Bezold's classic description in their site of origin in the mastoid process and route of spread in the neck. However, our contemporary examples differed in clinical setting, latency of onset, and bacterial cause. In four of the cases, delay in diagnosis occurred because of failure to recognize the disorder. Computed tomography has proved valuable in the anatomic diagnosis and surgical planning. Renewed familiarity with the clinical presentations and pathogenesis of this now uncommon condition may prevent delay in diagnosis and initiation of therapy.- - - - - - - - - - ranking = 0.5keywords = otitis (Clic here for more details about this article) |
3/7. Subperiosteal and Bezold's abscesses complicating cholesteatoma: a case report.A case of subperiosteal and Bezold's abscesses that occurred in a 60-year-old man with cholesteatoma has been described and the literature reviewed. Bezold's abscess is rarely seen in the current era of antibiotics. The simultaneous occurrence of a subperiosteal abscess in association with cholesteatoma, particularly in an adult, makes this case even more unusual. Although antibiotics have reduced the complications associated with acute otitis media, rare complications still occur and should be recognized by the otolaryngologist.- - - - - - - - - - ranking = 0.5keywords = otitis (Clic here for more details about this article) |
4/7. Septic thrombosis of the dural venous sinuses.From 1940 to 1984, 19 cases of septic dural-sinus thrombosis have been diagnosed at the massachusetts General Hospital, and some 136 cases have been reported from other institutions. Septic thrombosis most frequently involves the cavernous sinuses (96 cases). Facial or sphenoid air sinus infection often precede cavernous-sinus disease. In addition to the classical signs of proptosis, chemosis, and oculomotor paralysis, isolated sixth-nerve palsy and hypo- or hyperesthesia of the fifth nerve may be found. The major pathogens associated with cavernous-sinus infection include staphylococcus aureus, other gram-positive organisms, and anaerobes. Septic lateral-sinus thrombosis (64 cases) is almost exclusively a complication of otitis media and/or mastoid infection. Organisms causing this infection include Proteus species, escherichia coli, S. aureus, and anaerobes. Septic thrombosis of the superior sagittal sinus (23 cases) most frequently accompanies bacterial meningitis or air sinus infection. Causative organisms include streptococcus pneumoniae, S. aureus, other streptococci, and klebsiella species. Because septic dural-sinus thrombosis is rare, this disease is frequently misdiagnosed. Evaluation should include lumbar puncture, air sinus films, and computed tomographic scan with contrast. Other helpful diagnostic tests may include carotid angiography, and dynamic brain scan. Orbital venography is the most definitive study in cases of chronic cavernous-sinus thrombosis. Therapy should include intravenous antibiotics and early surgical drainage of purulent exudate in the air sinuses or mastoid regions. Retrospective analysis suggests that treatment with heparin may reduce mortality in carefully selected cases of septic cavernous-sinus thrombosis. Anticoagulation is not recommended in other forms of septic dural-sinus thrombosis. mortality in the antibiotic-era remains high, particularly in patients with septic thrombosis of the cavernous (30%) and superior sagittal (78%) sinuses.- - - - - - - - - - ranking = 0.5keywords = otitis (Clic here for more details about this article) |
5/7. Parenteral trimethoprim/sulfamethoxazole for gram-negative bacillary meningitis.Three adults with gram-negative bacillary meningitis were treated with an intravenous preparation of trimethoprim and sulfamethoxazole. This therapy sterilized the cerebrospinal fluid in each case. The infections occurred as complications of neurosurgery, trauma and chronic otitis media. serratia marcescens was the causative organism in two patients and proteus vulgaris in the third. The infecting organism was eradicated within three to 17 days of beginning intravenous trimethoprim/sulfamethoxazole. Followup CSF cultures after completing therapy were sterile. These cases suggest intravenous trimethoprim/sulfamethoxazole may be effective treatment for some cases of gram negative bacillary meningitis.- - - - - - - - - - ranking = 0.5keywords = otitis (Clic here for more details about this article) |
6/7. Malignant external otitis in infants.The authors report two cases of malignant external otitis in infant boys, 5 and 6 months old respectively, caused by different etiologic agents (pseudomonas aeruginosa and proteus mirabilis). Both of them were in very poor general health, but neither developed complications such as facial paralysis because of the intensive treatment that was employed from the beginning.- - - - - - - - - - ranking = 2.5keywords = otitis (Clic here for more details about this article) |
7/7. Post-keratoplasty endophthalmitis caused by proteus mirabilis.A diabetic patient who underwent a triple procedure (penetrating keratoplasty, cataract extraction and posterior chamber intraocular lens implantation), developed endophthalmitis caused by proteus mirabilis. The source of infection was the infected donor cornea, which was imported from sri lanka. The organism was resistant to gentamicin, which was the only antibiotic present in the storage medium. On top of an aggressive antibiotic treatment regime (topical, systemic and intravitreal), exchange of the infected with a fresh corneal graft and pars plana vitrectomy were performed. The patient had a speedy recovery and the visual outcome was 20/40 two and a half years after the incident. To our knowledge, post-keratoplasty endophthalmitis caused by P. mirabilis has never been reported in the literature. We report herein such a case with good visual outcome. Newer storage medium, such as Optisol GS, might have a role in preventing keratoplasty-related infection.- - - - - - - - - - ranking = 0.074808574773727keywords = medium (Clic here for more details about this article) |