1/31. Generalized peritonitis with pneumoperitoneum caused by the spontaneous perforation of pyometra without malignancy: report of a case.Spontaneous perforation is a very rare complication of pyometra. We report herein the case of an 88-year-old woman who presented with muscular rigidity and free air on abdominal X-ray films. Perforation of the gastrointestinal tract was diagnosed preoperatively, and an emergency laparotomy was performed. A total hysterectomy with bilateral salpingo-oophorectomy was carried out under the diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra. The culture of purulent fluid from the abdominal cavity showed only escherichia coli, with no anaerobic bacteria. Histological examination revealed pyometra with necrosis of the endometrium and no evidence of malignancy. The patient was discharged on postoperative day 68 without any major complications. pyometra is an unusual cause of peritonitis, but it must be considered as a possible diagnosis in elderly women presenting with an acute abdomen. Following this case report, we discuss the problems associated with establishing a correct preoperative diagnosis of generalized peritonitis caused by the spontaneous perforation of pyometra.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/31. Purulent pericarditis presenting as an extracardiac mass in a patient with untreated diabetes.A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
3/31. Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case.We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
4/31. Wegener's granulomatosis triggered by infection?Wegener's granulomatosis is a systemic disease of unknown origin, although recent studies suggest that auto-immune mechanisms and infection play a role in the pathogenesis of this disease. Wegener is characterized by a necrotizing vasculitis involving the lungs (pulmonary infiltrates), the upper airways and the kidneys (rapidly progressive glomerulonephritis). We present a case of a male patient admitted because of progressive deterioration of the general condition with weight loss, a unilateral neck mass, unilateral purulent rhinorrea and fever. CT-scan evaluation demonstrated a unilateral expanding mass in the sing-nasal cavity, obliterating the ethmoid complex. MRI revealed signs of intracranial inflammatory reaction and onset of absedation. A malignancy was suspected but a diagnosis of Wegener's granulomatosis was established based on histologic criteria (nasal biopsy) and a positive titer for anti-cytoplasmic antibodies (cANCA). During follow-up, nasal carriage of Staphyloccocus Aureus could be documented. An overview of Wegener's granulomatosis will be provided with emphasis on the potential role of acute infections as a trigger for Wegener's granulomatosis and the head and neck manifestations.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/31. The first-reported case of diffuse purulent peritonitis in a patient with retroperitoneal hodgkin disease (etiopathogenetic hypotheses).We report a case of purulent diffuse peritonitis in a patient who was affected by Hodgkin lymphoma, with no evidence of other abdominal diseases. This is a 54 y. old. white male who was admitted to our department with a history of asthenia, recurrent fever, dysphagia and abdominal pain. In the plain abdominal radiology pneumoperitoneum was evident. Duodenal perforation suspicion was confirmed by anamnesis and plain radiology which showed the presence of intra abdominal air. Emergency exploratory laparotomy showed a purulent diffuse peritonitis, which relapsed after multiple surgical toilettes and peritoneal lavage. A postoperative abdominal CT scan and histology of a biopsy taken during the second surgical operation showed a retroperitoneal Hodgkin lymphoma, which went to remission after chemotherapy. Considering the two simultaneous clinical manifestations (retroperitoneal Hodgkin lymphoma and peritonitis), we made two pathogenetic hypotheses: a) The retroperitoneal disease produced lymphatic stagnation and peritoneal transudation, which then was infected; b) The abnormal lymph nodes were infected and the abdominal cavity was contaminated from retroperitoneum from blood/lymphatic stream or by contiguity.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/31. Incomplete vaginal expulsion of pyoadenomyoma with sepsis and focal bladder necrosis after uterine artery embolization for symptomatic adenomyosis: case report.The major complications secondary to uterine artery embolization (UAE) are rare. We report a case involving a patient who underwent UAE for symptomatic adenomyosis, and experienced complications including incomplete vaginal expulsion of a large focal pyoadenomyosis, sepsis and focal bladder necrosis. The serial changes of uterine echogenicity reflected the intracavity sloughing tissue, and cystourethroscopy revealed a focal bladder necrosis. Administration of appropriate antibiotics and timely expulsion of the focal pyoadenomyosis vaginally resulted in successful preservation of the uterus and spontaneous recovery of focal bladder necrosis without surgical intervention. A review of the relevant literature was conducted to explore the mechanisms of bladder necrosis after UAE, summarize post-embolization intervention and the outcome of vaginally expelled myoma, and to discuss the value of UAE for adenomyosis.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/31. Pyostomatitis vegetans as an early sign of reactivation of Crohn's disease: a case report.BACKGROUND: The structures and lining of the oral cavity are an accessible mirror reflecting the health of an individual. They may play an important role in detecting and monitoring systemic diseases. Certain conditions that primarily affect other regions of the body may cause signs and symptoms in the mouth, either as the initial presenting symptom or in conjunction with other systemic manifestations. methods: Pyostomatitis vegetans, which occurred in a patient with a history of Crohn's disease, was diagnosed as an early sign of disease reactivation. RESULTS: The patient was treated with a topical fluorinated corticosteroid gel, which led to the improvement of the oral lesions. However, the oral lesions continued to recur over a period of several months until the underlying inflammatory bowel disease came under control. CONCLUSIONS: This report emphasizes the relationship of pyostomatitis vegetans to Inflammatory bowel disease and the importance of the oral lesions as initial presenting signs of systemic disease or activity.- - - - - - - - - - ranking = 3.4553611185253keywords = oral cavity, cavity, mouth (Clic here for more details about this article) |
8/31. Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization.OBJECTIVE: To report the detection of pyometra after ovum retrieval for IVF with the routine use of ultrasound-guided embryo transfer. DESIGN: Case report. SETTING: Tertiary fertility center. patients: A 29-year-old woman who developed pyometra after ovum retrieval for IVF detected at the time of ultrasound-guided embryo transfer. INTERVENTION(S): Cancellation of the embryo transfer, cryopreservation of the embryos, treatment of the pyometra, and a successful frozen-embryo transfer. MAIN OUTCOME MEASURE(S): Normal uterine cavity after treatment and a delivered twin pregnancy. RESULT(S): A successful delivered twin pregnancy. CONCLUSION(S): Routine use of ultrasound-guided embryo transfer resulted in the rescue of the patient's embryos for cryopreservation, with a resulting ongoing pregnancy.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/31. Nocardia infection in AIDS: a clinical and microbiological challenge.A case of nocardia asteroides pneumonia was diagnosed after death in a patient with AIDS. Six sputum cultures and one bronchoalveolar lavage fluid contained no pathogens, and no growth was obtained from one pleural fluid aspirate. None of these specimens was incubated for more than two days. Extended incubation for mycobacteria also failed to help in the diagnosis. N asteroides was isolated from pus taken from the lung cavity during the post mortem examination. It is suggested that if nocardiosis enters the differential diagnosis all specimens should be cultured for at least two weeks and the use of selective media be considered. This case highlights the need for clinicians to maintain a high index of suspicion for this pathogen.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
10/31. Unusual presentation of verrucous carcinoma of maxillary antrum.Verrucous carcinoma is a rare type of squamous cell carcinoma that is most often seen in the oral cavity and larynx. This paper describes a case report of a rare tumor with an unusual presentation. This patient presented with recurrent pyoceles and was diagnosed by chance. carcinoma of maxilla is rarely diagnosed until the bony walls are eroded. This condition should be kept in mind in patients presenting with recurrent pyocele and a biopsy carried out from the maxilla.- - - - - - - - - - ranking = 3.3060975800767keywords = oral cavity, cavity (Clic here for more details about this article) |
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