Objective To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two ...systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient.
Study Design A 21‐year‐old man presented with a scalp swelling and epidural abscess. Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess.
Methods A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess.
Results Cultures returned as Streptococcus intermedius from all three sites. The patient was free of disease at the 3‐month follow‐up.
Conclusions Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease. The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin. Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.
The lagoons that border the east coast of the Florida peninsula provide an opportunity to study water chemistry and phytoplankton characteristics over a wide range of water residence and nutrient ...load conditions. This article includes the results of a 2-year study of eight study sites. The northern half of the sampling range included four sampling sites within the newly established Guana Tolomato Matanzas National Estuarine Research Reserve. The southern half of the sampling range consisted of four study sites distributed in ecologically distinct sub-basins of the Indian River Lagoon. The Guana Tolomato Matanzas National Estuarine Research Reserve and Indian River Lagoon include estuaries with water residence times ranging from days to months and watersheds with widely differing nutrient load characteristics. The results of this study revealed wide temporal and spatial variability of physical and chemical characteristics. Mean salinities for the study period ranged from 9.7 to 31.5‰ over the eight sites. Mean orthophosphate and total phosphorus concentrations ranged from 0.26 to 1.55 μM and 1.45 to 3.00 μM, respectively. Mean dissolved inorganic nitrogen and total nitrogen concentrations ranged from 3.14 to 9.77 μM and 26.43 to 71.14 μM, respectively. Individual phytoplankton standing crops, in terms of chlorophyll a concentrations, ranged from less than 1 μg L−1 to more than 60 μg L−1. Comparisons of the relationships between nutrient and phytoplankton standing crops at the eight study sites indicated that water residence times and nutrient loads provided important insights into the basis for observed temporal and spatial patterns of variability. Indices for water residence time and nutrient load were determined for each site. A combination of the character of watershed inputs and residence time was most useful in interpreting patterns of nutrient concentrations, whereas water residence time appeared to be the pre-eminent factor dictating phytoplankton standing crop potential among the eight study sites.
Acute fatty liver of pregnancy is an uncommon, potentially fatal disorder. Between 1998 and 2000, two patients with acute fatty liver of pregnancy presented at the Christian Medical College Hospital, ...Vellore. Both patients were in the thirty-sixth week of pregnancy. jaundice and encephalopathy were the predominant symptoms. Both the mothers died after they delivered a stillborn Infant each. The maternal deaths were due to multiorgan failure and/or postpartum haemorrhage and sepsis. The route of delivery was vaginal in both the patients. Extrahepatic and metabolic complications in both cases Included renal failure, sepsis, hypoglycaemia, disseminated intravascular coagulation and gastrointestinal bleeding. Liver biopsy done in both patients was consistent with the diagnosis of acute fatty liver of pregnancy. To the best of our knowledge, this is the first report from India on acute fatty liver of pregnancy.
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