The American journal of emergency medicine
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Review Case Reports
Aortic dissection presenting as superior vena cava syndrome.
Aortic dissection usually presents with chest pain, abnormal pulses, and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome (SVCS), which more commonly occurs in the setting of malignant disease. A patient who had SVCS as a result of a painless aortic dissection is presented and compared with other previously reported cases of simultaneous SVCS and aortic dissection.
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Eikenella corrodens, a fastidious, slow-growing, gram-negative, facultative anaerobic bacillus may be encountered in wounds exposed to human saliva, especially human bites and head and neck infections. An unusual case of a mixed flora E corrodens and Streptococcus septic arthritis with adjacent osteomyelitis secondary to saliva contamination from licking an intravenous (i.v.) needle is presented. A literature search showed 53 previous cases of E corrodens infections in i.v. drug users. ⋯ Recommendations for treatment include penicillin or ampicillin. Tetracycline is recommended in the penicillin-allergic patient. This is the first case that draws attention to the connection between E corrodens, i.v. drug use, and septic arthritis and osteomyelitis.
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Various treatment strategies are currently used in the management of acute pyelonephritis, with some patients being treated as inpatients and others as outpatients. To better describe the clinical course of patients with this condition and the management strategies of physicians treating these patients, a retrospective cohort study of febrile nonpregnant women presenting to the emergency department with clinical evidence of acute pyelonephritis was conducted. Acute pyelonephritis was defined as infected urine (> or = 7 white blood cells/high-power field and/or urine culture with > or = 10(4) colony-forming units [CFU]/mL) and fewer (> or = 37.8 degrees C) without other source. ⋯ Nine (12%) of the 75 returned because of symptoms of acute pyelonephritis, with 8 returning within 1 day of the initial visit. Seven of those returning were admitted. All responded to additional antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)