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A 12-year-old boy presented with a swelling on the right eye along with high grade fever and headache for the past two days. On examination there was a diffuse erythematous swelling around the right eye along with purulent discharge (Fig [1][1]). Except for mild conjunctival congestion, the rest of

A 32-year-old male presented to us with the history of purulent discharge from scrotum since 5 months ago, with increased amount of discharge during sexual intercourse. Magnetic resonance imaging showed a fistula tract ending at the root of the penis. However, intraoperatively it was found to be communicating with the anal canal. Fistula in ano rarely presents with an external opening in the scrotum. We could not find any published literature in this regard. Complex fistula in ano therefore should be considered in cases of scrotal discharging sinus.

Pyoderma Gangrenosum (PG) genellikle orta yastaki eris- kinleri etkileyen, nadir gorulen, notrofilik inflamatuvar bir deri hastaligidir. Etyolojisi ve patogenezi net olarak bilin- memektedir. Behcet hastaligi (BH) ise multisistemik bir vaskulit olup, deri bulgulari arasinda nadiren PG da goru- lebilmektedir. On uc yildir BH oykusu olan, 29 yasindaki bir erkek hasta sol bacakta ulserle poliklinigimize basvurdu. Dermatolojik muayenesinde sol alt bacakta en buyugu 12x6 cm olan, fasyaya kadar uzanan derin, hafif purulan akinti ve kotu kokunun eslik ettigi 3 adet ulser saptanan hastadan yapi- lan histopatolojik inceleme PG ile uyumluydu. Burada agresif seyirli bir BH'da gorulen PG lezyonlarinin kontrolunun saglanmasi icin, sistemik tedavinin uzun sure ve kombine yapilmasi gerekebilecegini vurgulanmak ama- ciyla sunulmustur. Pyoderma gangrenosum (PG),is a rare neutrophilic inflam- matory skin disease, usually affecting middle-aged adults. The etiology and pathogenesis is not clear. Behcet's disease (BD) is a multisystem vasculitis, in which PG can rarely be seen among its cutaneous manifestations., A 29 -year-old male patient with a 13 years history of BH, was admitted to clinic with left leg ulcers. On dermatologi- cal examination 3 ulcers localized on the left lower leg, with the largest one being 12x6 cm, spreading to the deep fas- cia, accompanied by mild purulent discharge and bad smell. The histologically was compatible with PG. This report is presented to emphasize the necessity of long term and combined treatment of PG accompanying BD with agressive course

Botryomycosis is an uncommon chronic suppurative granulomatous bacterial infection that can affect the skin and viscera. Clinically, lesions typically consist of small tender nodules from which draining sinuses may develop to expel a purulent discharge. Histopathological features include characteristic aggregation of microorganisms (grain) within the inflammatory infiltrate. The commonest causative organisms are Staphylococcus aureus and Pseudomonas aeruginosa, of others. Botryomycosis resulting from Prevotella melaninogenica has not been reported previously. We report the case of a middle-aged patient with botryomycosis presenting as nasal cutaneous fistulas caused by P. melaninogenica, which was successfully treated with surgical intervention combined with systemic antibiotic treatment.

Deep mycosis of the scalp caused by Rhizopus oryzae mimicking kerion is rare. Herein, we report a case of such infection in a 5-year-old immunocompetent boy who presented with multiple painful boggy swellings with discharging sinuses on the scalp of 4 months’ duration. Purulent discharge from the swelling cultured on Sabouraud's dextrose agar yielded R. oryzae species which was confirmed by molecular analysis by polymerase chain reaction. The child was managed with parenteral liposomal amphotericin-B which helped in clearance of infection.

Omphalitis contributes significantly to morbidity and mortality in neonatal calves. Diagnosis of omphalitis is based on the local signs of inflammation-pain, swelling, local heat and purulent discharge. An abattoir trial identified an optimal, sign-based, scoring system for diagnosis of omphalitis. A sample of 187 calves aged between 7 and 15 days old were clinically examined for signs of umbilical inflammation and compared with postmortem examination of navels. On postmortem findings, 64 calves (34.2 per cent) had omphalitis. In the examined omphalitis cases, the most commonly affected umbilical structure was the urachus (78.1 per cent). Multivariable logistic regression revealed that thickening of the umbilical stump over 1.3 cm (P0.001), discharge (P0.001), raised local temperature (P=0.003) and the presence of umbilical hernia (P=0.024) were correlated and positive predictors of omphalitis. Discharge from the umbilical stump was associated with intra-abdominal inflammation (P=0.004). Assigning weights based on the multivariable logistic regression coefficients, a clinical scoring algorithm was developed. The cumulative score ranged from 0 to 9. Using this scoring system, calves were categorised as positive if their total score was ≥2. This scoring method had a sensitivity of 85.9 per cent, specificity of 74.8 per cent and correctly classified 78.6 per cent of all calves.

Caso de uma paciente com 62 anos, apresentando lesão na região posterior da coxa direita de aproximadamente 7 cm, com áreas de eritema, edema e no centro sinais de necrose e coleção purulenta amarelo-esverdeada, acompanhada de dor excruciante. Lesão ocasionada por uma picada de aranha do gênero loxoceles, com bases nessas evidências clínicas a paciente foi submetida a um desbridamento e a uma drenagem da coleção purulenta com excisão completa da área e remissão total dos sintomas.

Acute otitis media (AOM) continues to be a common infection in young children. Milder disease, usually due to viruses or less virulent bacteria, resolves equally quickly with or without antibiotics. A bulging tympanic membrane, especially if yellow or hemorrhagic, has a high sensitivity for AOM that is likely to be bacterial in origin and is a major diagnostic criterion for AOM. Perforation of the tympanic membrane with purulent discharge similarly indicates a bacterial cause. Immediate antibiotic treatment is recommended for children who are highly febrile (≥39°C), moderately to severely systemically ill or who have very severe otalgia, or have already been significantly ill for 48 h. For all other cases, parents can be provided with a prescription for antibiotics to fill if the child does not improve in 48 h or the child can be reassessed if this occurs. Amoxicillin remains the clear drug of choice. Ten days of therapy is appropriate for children2 years of age, whereas older children can be treated for five days.L’otite moyenne aiguë (OMA) continue d’être une infection courante chez les jeunes enfants. Les maladies plus bénignes, qui sont généralement causées par des bactéries ou des virus moins virulents, guérissent tout aussi rapidement avec ou sans la prise d’antibiotiques. Un tympan bombé, particulièrement s’il est jaunâtre ou hémorragique, est un signe très sensible d’OMA d’origine bactérienne et un critère diagnostique important d’OMA. La perforation du tympan accompagnée d’un écoulement purulent est également indicatrice d’une cause bactérienne. Une antibiothérapie immédiate est recommandée pour les enfants qui font une forte fièvre (39 °C ou plus), qui présentent des signes systémiques modérés ou majeurs, qui souffrent d’otalgie importante ou qui sont très malades depuis 48 heures. Dans tous les autres cas, les parents peuvent recevoir une prescription d’antibiotiques qu’ils pourront faire remplir si l’état de l’enfant ne s’améliore pas dans les 48 heures. Dans une telle situation, on peut également réévaluer l’enfant. De toute évidence, l’amoxicilline demeure le médicament de choix. Un traitement de dix jours convient pour les enfants de moins de deux ans, tandis que cinq jours suffisent pour les enfants plus âgés.

In this report the authors consider the advantages and methods of wound treatment under the bandage. This significantly speeds up the elimination of purulent discharge on the wound surface, terminates the inflammatory process and granulation growth. In some cases it is recommended to use napkins, impregnated with herb saps mix. Clinical observations have discovered the therapeutic efficiency of fresh sap not only at the initial stage of treatment, but also during the later treatment of wounds of any origin, which haven’t been closing up for a long time.

We report on a 51-year-old man with some glass fragments as foreign bodies in the submental region. Five months after injury, he complained of swelling in the mental region, accompanied by purulent discharge and fistula formation in the submental region. Radiographic examination showed part of a glass fragment in the submental region. Detection of glass by conventional radiographic techniques is challenging because glass has a low radiopaque appearance and is usually obscured by overlying bony structures in the maxillofacial region. CT examination showed multiple radiopaque images in the submental region. We measured the CT values of these foreign bodies. The CT value was useful for establishing the diagnosis of glass fragments as foreign bodies in this patient.

Wound infection can complicate all kinds of cutaneous surgery. We report the results of two prospective, non-randomised, single-centre audits on wound infection rates following cutaneous skin cancer surgery performed as day cases. The intention of the first audit was to determine the wound infection rates and compare these with the published literature. The second audit was completed after changes were introduced to some of the extrinsic factors that may influence the risk of developing wound infection. The results of the two audits were compared to complete the audit loop. A total of 54 patients (30 male, 24 female, range 39–95 years) were included in this study, with 27 patients for each of the two audits. Wounds were termed ‘infected’ if there was purulent discharge, or erythema with seros-anguinous discharge (with a positive bacteriological culture) or spreading cellulitis. The wound infection rate from the first audit was 33.3%. This prompted a change in practice, which resulted in reducing the wound infection rate to 3.7%. Although the risk of developing postoperative wound infection is multifactorial, this study shows that concentrating on extrinsic risk factors for wound infection alone can affect the overall wound infection rate.

BACKGROUND: Infection arising from the use of epidural catheters for postoperative analgesia is a major source of anxiety. METHODS: The routine culture of epidural catheter tips were studied in 100 consecutive children aged 1 day to 15 years. Epidural catheters were inserted aseptically in accordance with an agreed protocol. The catheter site was inspected regularly and the tip sent for microbiological culture following removal. RESULTS: Local signs of inflammation at the epidural site were seen in 16% of children, and bacteria were isolated from catheter tip culture in 32%. Positive catheter tip culture was found in 43% of children with local signs of inflammation and of the remaining children with no local signs, organisms were isolated from the catheter tip in 30%. Culture of skin swabs and catheter tips in two patients with purulent discharge at the epidural site yielded the same organism. No correlation between the number of attempts at catheter insertion and either local signs of inflammation or positive catheter tip cultures were found. CONCLUSIONS: Minor local signs of inflammation and infection are common in pediatric patients during continuous epidural infusion. Epidural catheter tips are also frequently culture positive in patients with and without local signs and who may not go on to develop further signs or symptoms of infection. Routine culture of catheter tips is unnecessary as it is not a good predictor of epidural space infection.

In otorhinolaryngologic fields, Lyodura had been used mainly in otological procedures, such as tympanoplasty, myringoplasty, and mastoidectomy. However, so far in rhinologic area, there is only 1 report that Lyodura was used for closure of cerebrospinal fluid leaks. This report describes a 54-year-old woman presented with recurrent purulent discharge for 4-month duration because of Lyodura extrusion from the septum. On the basis of authors' experience, the authors highlight that the complete removal of exposed Lyodura from the nasal septum may be difficult because of adhesion to the surrounding septal mucosal flap. So, the authors suggest unilaterally wide mucosal incision using mucosal defect site may be necessary for completely removing Lyodura.

We describe a rare case of extraocular inflammation secondary to scleral buckle infection with Alcaligenes xylosoxidans. A 60-year-old female with a history of retinal detachment repair with open-book technique of scleral buckling presented with purulent discharge and irritation in the right eye that had begun 4 weeks earlier and had been treated ineffectively at another hospital. Conjunctival erosion with exposure of the scleral buckle was noted. The scleral buckle was removed and cultured. The explanted material grew gram-negative rod later identified as A. xylosoxidans. On the basis of the susceptibility test results, the patient was treated by subconjunctival injection and fortified topical ceftazidime. After 4 weeks of treatment, the infection resolved.

Our goal was to characterize the dynamics and bacterial interaction of the aerobic and anaerobic flora of nasal discharge of children at different stages of uncomplicated nasopharyngitis.Serial semiquantitative nasopharyngeal (NP) and quantitative nasal discharge (ND) cultures were taken every 3 to 5 days from 20 children in whom purulent discharge eventually developed (group 1), and a single culture was obtained from a group of 20 who had only clear discharge (group 2).Aerobic and anaerobic bacteria were isolated from all NP cultures. Bacterial growth was present in 8 (40%) NDs of group 2. Only 7 (35%) of the clear NDs of group 1 showed bacterial growth; the number increased to 14 (70%) at the mucoid stage and 20 (100%) at the purulent stage. It declined to 6 (30%) at the final clear stage. The number of species and total number of organisms increased in the NDs of group 1. Group 1 patients had higher recovery rates of Streptococcus pneumoniae and Haemophilus influenzae in their NP cultures than group 2 patients (P0.05). During the purulent stage, Peptostreptococcus species were isolated in 15 (75%), Fusobacterium species in 10 (50%), Prevotella species in 9 (45%), H influenzae in 8 (40%), S pneumoniae in 6 (30%), and beta-hemolytic streptococci in 5 (25%) of group 1 NDs. This was higher than their recovery in the clear stages of both groups and the mucoid stage of group 1. A total of 8 organisms capable of interfering with the growth of potential pathogens were isolated from the NPs of group 1, as compared with 35 from group 2 (P0.001).The development of purulent nasopharyngitis is associated with the pre-existing presence of potential pathogens and the absence of interfering organisms.

Staphylococcus aureus and some other bacteria are known to cause botryomycosis. These bacteria are known to produce yellowish-white soft grains. Only Actinomadura pelletieri is known to produce red grains. We report here a case of an intensely inflammatory type of botryomycosis. A 35-year-old male labourer presented with swelling, redness and multiple sinuses on his foot, of eight months duration. The purulent discharge contained bright red coloured grains, 0.5 to 1 mm in size, which were round to oval in shape. Gram-positive cocci were demonstrated in crushed granules and tissue sections. Culture yielded pure and heavy growth of Staphylococcus aureus . He responded very well to cefazolin. There is no other report of such red grain botryomycosis due to Staphylococcus aureus , available in literature. This is first case report of its kind in world literature.

Introduction To evaluate the utility of the exit site scoring system in diagnosing exit site infections, we compared its scores to the well established exit site categories outlined by Twardowski and Prowant. Methods We examined the exit sites of 50 patients on peritoneal dialysis. Each exit site was given a score ranging from "zero" to "≥ 4" according to the exit site scoring system. Exit sites were simultaneously classified into one of the exit site diagnostic categories outlined by Twardowski and Prowant. The sensitivity and specifity of the exit site scoring system in diagnosing exit site infection was then calculated in reference to the exit sites classified as infected according to Twardowski criteria. Results The proportions of perfect, good, equivocal, and infected exit sites were 24%, 22%, 32%, and 22%, respectively. 21 exit sites had an exit site score of zero. Of those, 12 (57.1%) were perfect, 7 (33.3%) were good, 1 (4.8%) was equivocal, and 1 (4.8%) was actually infected. 21 exit sites had an exit site score ranging from 1 to 3 without purulent discharge. Of those, 4 (18.2%) were good, 15 (68.2%) were equivocal, and 3 (13.6%) were infected. The specifity of the exit site scoring system in diagnosing exit site infection was 100%, but its sensitivity was only 63.6%. Conclusion The exit site scoring system is not a sensitive tool for diagnosing exit site infection mainly because it ignores evaluation of the sinus for granulation tissue. Exuberant granulation tissue in the sinus tract is not always accompanied by purulent drainage.

A chest wall abscess is a very rare presentation of extranodal Hodgkin's lymphoma (HL); only one case has been reported to date. Here, we describe a case of a 38-yr-old man with HL whose initial presentation was a chest wall abscess. The diagnosis of HL was suggested by cytological examination of the purulent discharge and was confirmed subsequently by excisional biopsy of cervical lymph node. Diagn. Cytopathol. 2005;33:33–35. © 2005 Wiley-Liss, Inc.

A 42-year-old female Testudo graeca was referred with a five-month history of a non-healing carapacial wound. Previous treatment had involved long-term antibiotic therapy and conscious debridement of necrotic tissue. On presentation an extensive deep wound with purulent discharge was visible on the right side of the carapace. A computed tomographic scan was performed to assess the extent of the wound. This revealed a large carapacial deficit with two underlying soft tissue masses. Surgical debridement was performed under general anaesthesia resulting in an even larger defect. Because of the extensive nature of the deficit, negative pressure wound therapy was applied to aid wound healing. A negative pressure of approximately 120 mmHg was maintained and bandages were changed every third day. Wound healing progressed rapidly and a healthy granulation bed was formed within 16 days.

Our patient suffered a left buccal lesion in a fall. A fragment of a leaf was removed by her family doctor. However, a trismus continued. Ten days after the injury, she was referred to our hospital. There was fistula formation with purulent discharge from the wound. No foreign bodies were reliably detected by a CTscan. We then used MRI for the diagnosis of a foreign body. A wooden foreign body with a high signal was found in the masseteric muscle on T2-weighted imaging. After the removal of the foreign object, the trismus recovered quickly.MRI is not necessarily recommended as a routine examination in the diagnosis of a foreign body. However, if a wooden foreign body is suspected and cannot be detected by CT scan, then MRI should be applied.

Ocular nocardiosis is an opportunistic infection and is believed to be a rare entity. We describe a rare case report of a patient with culture-positive Nocardia asteroides canaliculitis who presented with complaints of watering, purulent discharge and painful swelling of left lower eye lid. A purulent tenacious material was expressed from the punctum of lower eye lid and subjected to microbiological investigations such as smears and cultures. Smears and culture proved the presence of Nocardia asteroides in the sample collected from punctum.

A 60-year-old female patient was seen for a four-year evolving painless paronychia with purulent discharge on the lateral aspect of the third toe, on the left (figure 1). The culture of pus and mycological examination were negative. Previous treatments with topical and systemic antifungals were ineffective.What is your diagnosis?Subungual squamous cell carcinoma (SSCC)Based on the clinical findings, negative culture of pus, negative mycological examination and histopathology, the diagnosis of SSCC [...]

We read with interest the recent NeuroImage presented by Ye et al.1 as an example of calcified otogenic brain abscess. The authors described a patient with a 2-year history of recurrent episodes of purulent discharge from the left ear and an incidental calcified brain mass in the ipsilateral temporal lobe.1 In the largest case series of calcifying pseudoneoplasm of the neuraxis (CAPNON), all …

Long-forgotten vaginal pessaries get incarcerated in the vagina and their removal poses problems. A 60-year-old postmenopausal woman presented with foul smelling purulent discharge per vaginum and stress incontinence. Speculum examination revealed foul smelling white discharge per vaginum and a friable vaginal wall which bled on touch. The anterior portion of a metal ring deeply embedded in the vagina was seen. The cervix appeared normal. Attempts of removal by traction under local infiltration failed and resulted in bleeding. Biopsy from the tissue covering the ring reported no evidence of malignancy. She was treated with broad-spectrum antibiotics for 1 week and the metallic ring was removed without any complications under general anaesthesia using electrocautery. It was found to be a metallic bangle with design. It is essential to gently cauterise and release the fibrosis over the incarcerated foreign body to achieve safe removal.

This manuscript reports an uncommon case of inferior third molar facial abscess with purulent secretion drainage through the left external acoustic meatus. The patient's left external acoustic meatus was filled with a purulent secretion observed on a CT scan. He underwent surgery to drain the facial abscess. Despite facial abscesses being routine occurrences, the literature does not contain many case reports of odontogenic facial abscesses with drainage via the external acoustic meatus. These situations occur in two possible ways: multiple fissures in the anterior wall of the cartilaginous portion of the external acoustic meatus; and congenital defects that are occasionally present in the anterior-superior aspect of the external acoustic meatus, known as the foramen of Huschke, which allow communication between the external acoustic meatus and mandibular fossa. These defects may also predispose the patient to the spread of the infection or tumour from the external auditory canal to the infratemporal fossa and vice versa. No otological sequelae were observed in this case. The authors conclude that the hypothesis of bone malformation cannot be excluded, and affirm that any facial abscess requires appropriate and immediate treatment for adequate resolution, by removing the causal factor and providing systemic support.

Intracranial dermoid tumors constitute a rare entity. Their association with Klippel-Feil anomaly is all the more rare. These lesions, if associated with dermal sinuses, receive attention when a patient presents with features of central nervous system infection. We describe a 5-year-old girl who presented with purulent discharge from an occipital dermal sinus with an infected posterior fossa dermoid associated with cerebellar abscesses and characteristic Klippel-Feil anomaly.

A 39-year-old otherwise healthy barber presented to our clinic complaining of frequent periods of swelling and purulent discharge in his second and third right web spaces. An excision was performed after administration of methylene blue to visualize the extent of both cysts located in his second and third web spaces. A distally based dorsal metacarpal artery perforator flap was chosen to close the defect on his second web space. Interdigital pilonidal sinus is a rare disease caused by repeated implantation of foreign hair to the interdigital web space. In secondary cases or in cases where an extensive resection has to be done in order to completely remove the cysts, closure with a skin flap can become compulsory. Dorsal metacarpal artery perforator flap is a good choice with minimal donor site morbidity and this flap might provide robust skin coverage which can possibly avoid further penetration of hair in to web space.

Osteonecrosis of the jaw associated to biphosphonate use is more common in cancer patients with bone metastases, that are using intravenous diphosphonates. When these drugs are used orally the risk of the complication is lower. We report 3 diabetic women aged 69, 76 and 82 years, receiving alendronate 70 mg every one week. The unveiling event was the extraction of several teeth without the use of antibiotics. All had bone pain, purulent discharge, loss of bone and halitosis. All improved five months after discontinuing alendronate.

A 6-year-old castrated male Maltese weighing 4.8 kg was presented with a non-healing wound exhibiting purulent discharge after surgery on scar tissue of a chronic twelve-month-old bite wound on the left caudal abdominal region. The dog had previously undergone four surgeries and had been on continuous antibiotic therapy for eight months. Following radiographic and ultrasonographic examinations, the problem was diagnosed as an enterocutaneous fistula of a herniated bowel loop under the skin. Surgical resection of the fistula involving the bowel loop resolved all symptoms.

The identification of different bacterial strains and the occurrence of antibiotic resistance were investigated in several infection processes of pets as skin abscess with purulent discharge, bronco alveolar fluid, earwax, urine, mammary, and eye fluid. Streptococcus spp. and Staphylococcus spp. were the most detected in the different samples. A high frequency of antimicrobial resistance has been observed and this could reflect the wide use of antimicrobials in pets, making the effectiveness of antibiotic treatment to become more complicated.

A 41-year-old male presented with purulent discharge and pain in the perianal region. There was no history of fever or weight loss. The patient gave a history of being operated 14 times earlier for the same complaints. Perioperative discharge showed acid-fast bacilli on Ziehl-Neelsen (ZN) stain. No pulmonary focus of tuberculosis (TB) was found. The patient was started on antitubercular treatment and has not reported any pain or discharge from the perianal region for the last 1 year. A high index of suspicion of TB should be kept in mind in perianal lesions, especially recurrent lesions, even when no primary focus is found. Surgery and medical treatment combined may be needed in such cases.

A 13-year-old boy was brought to the emergency department (ED) with a generalized itchy rash of 2 days' duration. For the past 3 days, he had dry, itchy eyes with a purulent discharge (Figure 1) and nonbilious emesis 2 or 3 times per day, with some blood streaks in the vomitus on the third day of illness.

The clinical results of photodynamic therapy of maxillary sinusitis have been presented. 0.1%-Methylene Blue aqueous solution in combination with He-Ne laser irradiation (632.8 nm) has been used for treatment of patients with acute and chronic maxillary sinusitis. Efficacy of the photodynamic therapy was estimated with the use of the following criteria: the state of respiration, olfaction, duration of purulent discharge, reconstruction of transport function of ciliary epithelium, etc. The obtained results have shown that the photodynamic therapy is effective in comparison with conservative methods of treatment of the diseases.

An 81-year-old woman was seen with a suture granuloma 7 years after medial canthal tendon tightening. One end of the suture extended through the inferior punctum. Excision of the granuloma and suture without retightening the canthal tendon resulted in relief of the purulent discharge and foreign-body sensation and no recurrence of epiphora.

Introduction Otorrhea is a common symptom and sign of patients seeking examination in an ENT Department of a General Hospital. The objective of this review is to assess the cause of otorrhea according to the type of it. Methods Retrospective review of 306 ears discharging some kind of fluid of 296 patients, who appeared in the ENT Department of our Hospital over a 58-month period. Results The most common type of otorrhea was the purulent one: 276 ears among 306 discharging ears (90%). The most common cause of purulent otorrhea was otitis externa: 156 ears among 276 ears discharging purulent fluid (56%). The germ most commonly isolated in the cultures of purulent aural discharge was Pseudomonas aeruginosa: 67 isolations of P. aeruginosa among 256 cultures (26%). Conclusions Otomicroscopic examination and accurate culture of purulent discharge are mandatory for the clinician to establish a correct diagnosis and suggest a proper therapy in every case of otorrhea.

A full-term infant was born with a swollen left conjunctival sac. Ophthalmia neonatorum developed within 5 d after birth. Examination of the purulent discharge showed Group B Streptococcus. The CRP level was found to be elevated and parenteral and topical therapy was started. Ophthalmia neonatorum resolved after 7 d of treatment.

We report a case of acute suppurative parotitis in a 16-day old infant presenting to an Emergency Department. Only 32 cases have been reported in English literature in the last 35 years. This is the first documented case in the United Kingdom. Clinical diagnosis was made on the basis of parotid swelling with purulent discharge from Stensen's duct. Samples sent for culture grew methicillin-resistant Staphylococcus aureus . The aetiology, pathogenesis and management of this infection are discussed.

Background: Synthetic mid-urethral sling (MUS) is a commonly used procedure to relieve stress urinary incontinence. Excellent cure rates make it a surgery of choice, but bothersome mesh-related symptoms can be distressing to the patient. Case: Retropubic synthetic MUS combined with laparoscopic-assisted vaginal hysterectomy in a 46-year-old woman resulted in postoperative chronic purulent discharge from the suprapubic sinus at the exit site of the sling, and profuse vaginal discharge from mesh exposure, of 5 years' duration. Her symptoms persisted in spite of repeated abdominal surgical explorations of the sinus tract and excision of the vaginally exposed mesh. Finally, exploration with complete removal of the infected mesh gave her relief. Conclusions: Relief from chronic suprapubic sinus and vaginal mesh exposure caused by infected synthetic MUS can be achieved only with complete removal of the sling. (J GYNECOL SURG 28:288)

Introdução: Fístula de mastóide é uma complicação que pode ocorrer após timpanomastoidectomia. Vários métodos para obliteração desta cavidade têm sido propostos, mas os resultados a longo prazo são, geralmente, desapontadores. O retalho de gálea aponeurótica, tanto com pedículo temporal quanto occipital, é maleável e bem vascularizado, sendo uma forma simples e confiável de se solucionar este problema. Forma de estudo: Retrospectivo clínico. Material e método: O Serviço de Cirurgia Plástica do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro utilizou esta técnica em 5 pacientes, no período de 1991 a 1995. A técnica operatória e a evolução são apresentados. O acompanhamento pós-operatório variou de 3 a 5 anos e os resultados foram encorajadores. Todos os pacientes evoluíram com boa cicatrização e sem fístula. No pós-operatório tardio 2 pacientes apresentaram pequena quantidade de drenagem purulenta pelo conduto externo que regrediu com o tratamento clínico. Introduction: Retroauricular mastoid fistula is a complication that may appear after tympanomastoidec-tomy. Many obliteration methods of the troublesome mastoid cavity have been proposed but the long-term results are often disappointing. Study design: Retrospective clinical. Material e method: The subtle and pliable galeal flap, either temporal or occipital with pedicle, is a simple and reliable way of solving the problem. It has been used in five patients with encouraging results. After at least 3 years of follow-up all patients had good scaring and no fistulae. At late post-op, two patients presented purulent discharge through the external canal, which disappeared after clinical treatment.