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Streptococcus Intermedius Empyema Following Acute Pulmonary Embolism: Case Report

Pulmonary embolism is and has been an established medical dia gnosis. The complications, however, seem to awe physicians and healthcare workers across the globe. The purpose of this report is to bring to awareness a case involving a 37-year-old female with pulmonary embolism which was complicated by develop ment of right-sided empyema. This patient initially presented with shortness of breath, heart rate/pulse of 109 beats per minute and right sided pleuritic chest pain and was diagnosed with pulmona ry embolism and started on apixaban. Upon discharge after three days, she continued to have persistent progressively worse right sided chest pain. She was readmitted five weeks later, and further investigation resulted in the diagnosis of right sided pleural effu sion. CT guided drainage of the effusion was consistent with em pyema with cultures growing streptococcus intermedius. The aim of this report is to present a readmission of a 37-year-old woman patient who developed streptococcus intermedius empyema after initial diagnosis and management for acute pulmonary embolism. 2. Introduction Acute pulmonary embolism results in pulmonary infarct at a rate of approximately 16% to 31% [5]. The predisposing risk factors for pulmonary infarct are active smoking and increase body height. Patients are often of younger age groups without cardiopulmonary comorbidities [10, 11]. 4% to 7% of patients with pulmonary in farction develop cavitary lesions due to necrosis or superinfection of the necrotic tissue [8, 12]. Pulmonary infarction is a wedge shaped area that usually extends to the pleural surface and causes pleural effusion due to increase pulmonary capillaries permeabi lity from ischemia or release of vasoactive cytokines [6, 9]. 23% to 52% of patients with Pulmonary embolism have pleural effusion on computed tomography [2]. The pleural effusion is usually exu dative and hemorrhagic [2, 9]. Delayed onset of pleural effusion or late enlargement in the course are associated with either recurrent pulmonary embolism or superinfection [1]. Empyema is a collection of pus [fluid filled with immune cells, dead cells, and bacteria] in the pleural cavity [14]. The risk factors for empyema include pneumonia, chronic lung disease, diabetes mellitus, prolonged corticosteroid use, illicit drug use, alcohol abuse, aspiration, thoracic or esophageal surgery or trauma [3]. Empyema had rarely been associated with pulmonary embolism [3, 7]. The implicated pathogens in empyema include gram po sitive bacteria especially viridans strep species in community ac q

A Case of Tendon Saving Stapedotomy with Postoperative Recovery of Acoustic Reflex

Tendon saving stapedotomy is a delicate surgical technique which saves stapedius tendon while removing anterior and posterior crua of stapes. Preserving the incus-stapes tendon alignment during op eration might give a chance to human’s protective mechanism to recover acoustic reflex, which has a protective effect from baro trauma. Also, there are few more known benifits for tendon sav ing, such as improvement in noise filtering, stabilization of incus during prosthesis insertion and preservation of blood supply to distal incus.

Multi-traumatized patient with a dehiscent fistulized abdomen and a central venous line-associated infection successfully treated with a new medical device II

We present the case of a patient involved in a multiple-vehicle ac cident with massive thoracoabdominal trauma who was admitted to a Social Security specialized trauma center in Mexico City. He went through a very complicated postoperative course, including abdominal burst with evisceration, two low-output enterocutane ous fistulas (ECFs) and a central venous line-associated infection. Daily application of C.P.Z.O was carried out in the sites of infec tion. A substantial improvement of the abdominal septic ECF was achieved with the daily application of C.P.Z.O and strict wound care measures.

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