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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-five patients under the age of 20 years with rhinogenic subdural empyema were treated at Groote Schuur Hospital and Red Cross War Memorial Children's Hospital between 1979 and 1991. Thirty-two were male and 13 female. The majority were between 13 and 19 years of age. Headache was the predominant symptom in 41 patients. Vomiting occurred in 15 and 21 presented with seizures, 2 in status epilepticus. Thirty had swinging pyrexias and 26 neck stiffness while only 14 had focal neurological signs. Swelling of the face or orbit was seen in 24. Twenty-two had depressed levels of consciousness and 7 had Glasgow Coma Scale (GCS) values below 11/15. White cell counts and erythrocyte sedimentation rates were raised in all cases. Twenty-three patients underwent lumbar punctures despite the inherent danger in this procedure. Cerebrospinal fluid analysis showed a pleocytosis in all cases; no organisms were cultured in any of the specimens. The diagnosis in all cases was made by contrast-enhanced computed tomography. Twenty-five patients underwent multiple burrholes, 9 small craniectomies and 11 craniotomies. Thirty-four patients made an excellent recovery. All of the 6 patients who died had GCS values below 11 at the time of their surgery.
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PMID:Rhinogenic subdural empyema in older children and teenagers. 757 Feb 36

Paranasal sinusitis complicated by subdural empyema (SDE) in a 14-year-old boy is described. He presented with fever, headache and vomiting. X-rays revealed left maxillary and bilateral frontal sinusitis. While in the emergency room he had seizures; CT-scan showed an air leak adjacent to the right frontal sinus. Despite intravenous antibiotics, left hemiparesis developed and repeat CT showed interhemispheric SDE. Frontal craniotomy was performed and a large amount of purulent material was drained. Recovery followed 4 weeks of intravenous antibiotic treatment without neurologic sequelae. SDE is a rare complication of paranasal sinusitis and constitutes approximately 20% of all localized intracranial infections. Clinical features include fever, headache, vomiting, convulsions and neurologic deficits. Modern imaging methods and combined surgical and antibiotic treatment have lowered mortality to 5-10%. A high index of suspicion is important for early diagnosis and successful treatment.
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PMID:[Subdural empyema complicating sinusitis]. 791 Nov 17

Subdural empyema, a collection of pus in the space between the dura and arachnoid, is a rare type of intracranial infection. We report on 23 patients, aged 8 months to 70 years, with subdural empyema who were treated in our clinic between 1989 and 1994. The sources of subdural empyemas were meningitis in five patients, middle ear in five, trauma in four, paranasal sinus in three, complications of surgery and subdural tap in four, and unknown in two patients. The common presentations were headache, focal neurologic deficit, fever, vomiting, seizures, and neck stiffness. Diagnosis was achieved by computerized tomography and neurologic examinations in all cases. Treatment was effected by burr hole or small craniotomy with catheter drainage, and antibiotics were administered to all patients. The mortality rate was 8.7%; the remaining patients made a good recovery without sequelae. We therefore recommend burr hole with catheter drainage plus antibiotics as a method of treating subdural empyema.
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PMID:Treatment of subdural empyema by burr hole. 875 81

Ten cases of Boerhaave's syndrome have been treated in this hospital from 1983-1998. Nine patients underwent surgery resulting in complete recovery in seven cases and two postoperative deaths. One was treated with a satisfactory outcome. Vomiting was considered to be the determinative factor for the illness in eight cases. The relationship between the rupture of the esophagus and vomiting and the mechanism of its occurrence based on anatomy and pathophysiology is discussed. It is believed that the most beneficial time to perform surgery is based on the general condition of the patient. The surgical procedure should consist of closure of the lacerated esophagus, a complete clearance of the fibrinous coating on the surface of the pleura, mobilization of a pedicled omentum pad and a gastrostomy. The chest should be entered from the side where the esophagus was lacerated or the X-ray examination showed hydrothorax or hydropneumothorax. The most important factor to guarantee a successful outcome for surgery is a complete clear off of the empyema and early expansion of the lung in addition to effective nutritional support.
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PMID:Surgical treatment of Boerhaave's syndrome: when, how and why? 1007 8

A previously healthy man aged 18 years suddenly developed a severe headache, followed by nausea, vomiting, fever. During the following weeks a left-sided hemiparesis developed. CT of the brain revealed a pansinusitis and a frontal epidural empyema. A few days after surgical drainage his condition deteriorated and subsequent CT showed a right-sided subdural empyema. This was surgically evacuated and followed by long-term high-dose intravenous antibiotic therapy. The patient made a complete recovery. A sudden severe headache can be caused by an intracranial infection and intracranial pus collections can occur in the subdural as well as in the epidural space. Epidural empyema is a limited disease with relatively mild symptoms and a favourable prognosis, whereas subdural empyema may rapidly spread and cause severe disease with a poor prognosis. Quick antibiotic treatment and surgical drainage are required.
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PMID:[Clinical thinking and decision making in practice. A student with sudden headache]. 1092 61

This paper reviews the safety data for levofloxacin utilizing reports from clinical and post-marketing surveillance trials. The side effect incidence rates are 1.3% for nausea, 0.1% for anxiety, 0.3% for insomnia, and 0.1% for headache. No levofloxacin-related adverse events were reported at a rate higher than 1.3%, and most were lower. Four clinical trials were reported. Levofloxacin achieved superior clinical and microbiological results compared to ceftriaxone/macrolide combination, and was better tolerated. Results comparing IV azithromycin plus ceftriaxone versus 500 mg levofloxacin in hospitalised CAP demonstrated that levofloxacin performed better, with more adverse events associated with the comparators (levofloxacin 5.3%, comparators 9.3%). High-dose levofloxacin (750 mg) was also evaluated and found to be well tolerated. Surveillance data reported low ADR rates for levofloxacin: nausea 0.8%, rash 0.5%, abdominal pain 0.4%, and diarrhoea, dizziness, and vomiting 0.3%. Worldwide and US surveillance data confirmed that tendon rupture occurred in less than 4 per million prescriptions, taste perversion in less than 3 per million, convulsions in 2 per million, and photosensitivity, hepatitis, hepatic failure, QT prolongation, torsade de pointes or empyema all in less than 1 per million.
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PMID:Latest industry information on the safety profile of levofloxacin in the US. 1154 87

Aspiration of oro-pharyngeal secretions and gastric content is the most frequent cause of formation of primary lung abscess. A compromised mental status (e.g. alcoholism, sedatives, stroke) and esophageal dysfunction (e.g. herniation, vomiting) are important risk factors. Aspiration pneumonia presents as a subacute disease and is usually not distinguishable from other causes of pneumonia, until typical radiological signs of cavitation and putrid sputum appear 8 to 14 days after the initial event of aspiration. Anaerobic bacteria play a pivotal role in an almost exclusively mixed spectrum of causative organisms. Aerobic pathogens are also frequently isolated, but whether they are an active part of infection or merely represent colonizers remains unclear in many instances. Differential diagnosis includes bronchial neoplasms, either as necrotizing carcinoma or as the cause of poststenotic cavernous pneumonia, other infectious diseases like tuberculosis, Pneumocystis carinii pneumonia or endocarditis with septic metastases, and lung artery embolism or vasculitis (M. Wegener). Fiberoptic bronchoscopy is extremely helpful in determining cause and etiology of the disease and should be carried out in all patients presenting with cavernous lung lesions. Bacteriological sampling should be performed using protected specimen brushing (PSB) technique. Broncho-alveolar lavage might serve as a less expensive but also less sensitive alternative measure. Since anaerobic bacteria resemble ubiquitous commensals of the oral cavity, sputum is of no use in anaerobic culture. Principal therapeutic strategy is antibiotic therapy for an extended period, usually four weeks to four months, unless radiologic changes and as well laboratory as clinical indicators of infection are completely resolved. Clindamycin, optionally supplemented with a second or third generation cephalosporin and Ampicillin/Sulbactam proved equally effective in treating aspiration pneumonia and primary lung abscess. The role of Moxifloxacin and other new flouroquinolones with their favorable pharmacodynamics is currently evaluated. Provided that antibiotics are prescribed for a sufficient period of time and patients' compliance is ensured, surgical procedures are limited to a negligible number of complications, e.g. recurrent severe hemoptysis, empyema or broncho-pleural fistula.
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PMID:[Diagnosis and therapy of abscess forming pneumonia]. 1169 90

A rare case of otogenic massive intra-falx empyema is reported. The patient presented with headache, vomiting and left lower limb weakness of 8 months duration. C.T. scan revealed two cavities in the falx. Right fronto-parietal craniectomy and drainage of massive empyema was undertaken through interhemispheric approach with wide opening of the falx, evacuation of voluminous amount of thick pus and marsupalization of flax with dura. The patient showed complete recovery. The relevant literature is briefly reviewed.
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PMID:Massive falx cerebri empyema. 1286 20

Acute frontal sinusitis can be a serious condition because of its potential life-threatening complications. These complications, including spread of infection to the frontal bone and intracranially, require prompt diagnosis and intervention to avoid morbidity and mortality. We report a case of acute frontal sinusitis in a 16-year-old girl who presented with fever, severe headache, and vomiting of 3 days' duration. Generalized fluctuant swelling of the nasal root, and bilateral supraorbital and frontoparietal regions was noted. Computed tomography (CT) demonstrated left pansinusitis, extensive subgaleal abscess and epidural empyema with osteomyelitis of the frontal bone. External frontoethmoidectomy with mucoperiostectomy were performed. Endoscopic sinus surgery was then conducted for intranasal ethmoidectomy. Intraoperative cultures grew viridans streptococci, coagulase-negative staphylococci and Peptostreptococcus micros. The patient received 3 weeks of treatment with intravenous antibiotics (penicillin 3 MU 4-hourly, ceftriaxone 500 mg 12-hourly, metronidazole 500 mg 6-hourly) and was discharged uneventfully and prescribed additional oral antibiotics for 5 weeks (clindamycin 150 mg 6-hourly and chloramphenicol 250 mg 6-hourly). CT revealed complete resolution of the abscess and clear maxillary and ethmoid sinuses at 7 weeks posttreatment. The patient was free of sinus infection at 4-years follow-up, without noticeable cosmetic deformity.
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PMID:Extensive subgaleal abscess and epidural empyema in a patient with acute frontal sinusitis. 1287 74

A 14 year old male developed a subdural empyema with a leptomeningeal infection of sinogenic origin. Initially, there were none of the expected neurological symptoms such as worsening headaches, vomiting, alteration in the level of consciousness and neck stiffness. Later, focal neurological deficits and seizures occurred. An endonasal sinus drainage was performed simultaneously with a neurosurgical exploration. We started an antibiotic therapy. All neurological deficits disappeared rapidly.
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PMID:[An endocranial complication of sinogenic origin without initial classical neurological symptoms]. 1530 55


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