Toxic shock syndrome following functional endonasal sinus surgery: a case report

Toxic shock syndrome (TSS) is a serious multisystem disease that was first described in 1978 by Todd. It occurs most often in menstruating women using superabsorbent tampons. The exact pathogenesis is not well understood, but it is felt to be due to the effects of an enterotoxin produced by certain strains of Staphylococcus aureus. The reported incidence of TSS following nasal surgery is 16/100,000. We report a case of TSS following endonasal sinus surgery in which minimal packing was used. The nasal surgeon should be aware of this rare and possibly fatal entity, as TSS may occur following any nasal/sinus surgery, even where packing is minimal and of short duration and when the patient is receiving antibiotic therapy.     

Functional endonasal sinus surgery in adults and children

Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic and recurrent sinusitis in adults and children. Retrospective analysis of the charts of 513 adult and 260 pediatric patients who underwent FESS after failing to respond to optimal medical treatment revealed an improvement rate of approximately 80% for both age groups. Although high response rates and low complication rates were found for both groups, there were significant differences in indications, preoperative evaluation, operative technique, and methods of postoperative follow-up for children.     

Hallux valgus in children: A 5-14-year follow-up study of 30 feet treated with a modified Mitchell osteotomy

Between 1985 and 1995, 30 modified Mitchell osteotomies were performed in 18 children with hallux valgus, 12 bilateral and 6 unilateral. The mean age at surgery was 15 (10-18) years. The surgical modification consisted of diverging trapezoidal cuts, plantar displacement of the head, release of the lateral collateral ligament and the adductor insertion and Kirschner wire fixation of the osteotomy. At an average follow-up of 8 (5-14) years there were no nonunions, avascular necroses or recurrences. All the patients were satisfied with the cosmetic results, could use regular shoes and had no physical restrictions. Only 2 complained of occasional pain, thought to be secondary to transfer metatarsalgia. The presence of an open physis at the time of surgery did not affect the results.     

Therapeutic implications of phlebographic obstruction in chronic venous stasis

The purpose of this work was to evaluate the functional characteristics of the venous system of patients with chronic obstruction of their deep veins proved by phlebography. Sixty-eight extremities in 34 normal volunteers and 21 extremities in 17 patients with chronic venous stasis and phlebographically demonstrated obstruction of their deep veins (popliteal-superficial femoral in 33.3%, common femoral in 23.8%, iliac in 33.3% and inferior vena cava in 9.5%) were evaluated using mercury in silastic strain gauges on the feet to measure venous volume changes on elevation and exercise. Regurgitant flow, corrected for arterial foot blood flow, was calculated. In the control group, the apparent regurgitation range was 0 to 2.3 ml %/min (mean +/- 2 SD). Sixty-two percent of extremities with obstructed deep veins had significant functional regurgitation. Regurgitation was detected by phlebography in only 14.3% of cases. From these results we conclude that obstruction of the deep venous system by phlebography may or may not signify functional obstruction and, in itself, therefore, does not indicate that bypass surgery is an appropriate method of treatment. Selection for surgical correction requires quantitative determination of insufficiency since higher grades of regurgitation probably contraindicate venous bypass.     

A study of depression among Alexandria preparatory school adolescents.

Using a constructed Arabic version of Children Depression Inventory (CDI), screening of a stratified random sample of 1% (1561) of Alexandria Preparatory school adolescents was carried out. The prevalence of depressive scorers was 10.25% of total sample. A sub-sample of depressed scorers (111 pupils) were compared with controls (non-depressed scorers) matched on age and sex to study a variety of personal, familial, medical and scholastic ecological variables. Pupils neuroticism scorers were most predictive of depressive scorers where they explained 59.79% of the variance. Other ecological factors including peer and sibling relationships, introversive and lie scale scorers and scholastic performance explained an additional 14.87% of the variance. Using Beck Depression Inventory (BDI) and Mother-Father relationship check list, a sub-sample of depressed pupils' mothers were compared with controls of non-depressed pupils' mothers (42 mothers for each). Results indicated a strong positive correlation between pupils, CDI scores and their mothers BDI scores. On the other hand poor mother-father relationship was significantly associated with depressive scores of pupils. Findings, pointed to the need for reconsideration of school mental health program, since the presented medical and social services to depressed pupils were very poor.     

Hospital in-patients with diabetes: increasing prevalence and management problems.

AIMS: To re-assess the prevalence, management problems, clinical outcomes and discharge summaries of hospital in-patients with diabetes. METHODS: Case records of all patients occupying in-patient beds were audited on a single weekday in 2003 in a large urban hospital and repeated after 3 months. Data was compared with an identical audit 12 years previously. RESULTS: Over 12 years the number of beds available for admission (1191) had reduced by 25% with a bed occupancy of 97%. Diabetes prevalence had increased from 7.0% to 11.1% (P < 0.01) (97% Type 2). Diabetes management was considered inappropriate in 29%, more than in 1991 (20%). After 3 months, discharge summaries had been completed on 75% of patients but diabetes was mentioned in only 53%. CONCLUSION: The prevalence of in-patient diabetes (11.1%) was over 50% greater and diabetes management was suboptimal in more patients than in 1991. In many length of stay was prolonged and almost half of the discharge summaries did not mention diabetes. These findings have major implications for service delivery and resource planning.