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The odor emitted by a patient may be one of the first major clues leading to an early diagnosis. Certain conditions produce a characteristic smell and several diseases are associated with a specific odor. We report an illustrative case and review olfactory physiology, the value of smell in physical examination, and finally discuss several illnesses associated with unusual odors.
Subcutaneous manifestations (Grey Turner's sign and Cullen's sign) of severe acute pancreatitis (SAP) are often discussed but rarely observed in a daily clinic setting. This paper will demonstrate the anatomic pathways followed by the extravasated pancreatic enzymes and how their effects lead to these ecchymoses by multiplanar reformation (MPR) images obtained by helical computed tomography (hCT). A 34-year-old female was admitted with SAP. A hCT scan revealed a swollen pancreas and cholecystolithiasis. The fluid collection around the pancreas extended to the pelvic cavity, infiltrating subcutaneous tissue in the left anterior and lateral abdominal wall. She was treated with interventional endoscopy (IVE) and continuous arterial infusion (CAI) therapy immediately following admission, she survived the SAP and these ecchymoses resolved within 7 days of presentation. MPR images obtained by hCT revealed that, the infiltration of the extra-pancreatic fluid collection between the leaves of the anterior renal fascia through the anterior and posterior pararenal space had reached into a relationship with the subcutaneous tissues in the left flank at the clinical site of discoloration as the pathway of extension to Grey Turner's sign, and also revealed anterior extension from the inflamed gastrohepatic ligament and across the falciform ligament to Cullen's sign.
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Under rigorously controlled laboratory conditions, mechanically induced simulated human bite marks were made on pig skin to enable the clinical and histopatholgical study of experimental bite marks in-vivo. A series of bite marks were created on the abdomen and thorax of live anaesthetized juvenile pigs at specific times just prior to and after death. Following the release of the biting force clinical observations of antemortem wounds revealed slow diminishment of the bite indentations presumably due to dermal elastic recovery. Minutes after euthanasia of the animals, the indentations of the teeth from the postmortem bite marks faded rapidly. After the biting process the animals were placed on either the right or left side and this side was maintained until necropsy to examine for dependant and non-dependent side differences. All bite mark injuries located on the non-dependent side revealed specific pattern characteristics. However, on the dependent side whether the bite mark was antemortem or postmortem in areas of livor mortis, no clear pattern was visible. Histologically, the observations for each bite mark specimen were categorised by the presence or absence of extravasated red blood cells in the fatty or muscle layers. The histopathological findings correlate with the clinical observations of antemortem and postmortem bite marks located on the non-dependent side in regard to muscular erythema and extravasated red blood cells. It is clinically difficult to comment on temporal relationship of a bite mark in relation to time of death in areas affected by blood-pooling seen on the dependent side. In these situations, histopathological studies could be a reliable alternative to provide information regarding antemortem or postmortem injuries.
A young man with bleeding symptoms, mild thrombocytopenia and abundant marrow megakaryocytes was classified as having idiopathic thrombocytopenic purpura. Neither prednisone therapy nor splenectomy modified the clinical picture. Subsequently, a severe defect of platelet aggregation and release reaction was demonstrated. Fifteen months after the onset of bleeding symptoms, fever and hepatomegaly appeared and the diagnosis of T cell non Hodgkin lymphoma was made on the basis of a histologic review of paraffin sections of the spleen. Chemotherapy induced remission of the lymphoma, disappearance of bleeding symptoms and normalization of the platelet count and function.
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This article describes the facial complications of adult leukemia, as derived from a study of more than 3,000 patients treated at the University of Texas M.D. Anderson Hospital during the past 25 years. Facial leukemia cutis, leukemia-associated facial hemorrhages, leukemia-induced cranial nerve facial palsies, and leukemia-provoked pure and mixed facial infections are discussed.
The clinical and laboratory findings in 176 patients hospitalized with suspected systemic meningococcal disease (MCd) are presented. All except nine patients were prospectively included in the MenOPP study. One hundred and fifteen patients were most likely to have meningococcal disease, of these 71 were confirmed with growth of meningococci in blood and/or cerebrospinal fluid (CSF). The remaining sixty-one patients served as the control group. Both petechiae, reduced general condition, and reduced consciousness proved valuable in the diagnosis of MCd. Petechiae was the clinical sign best discriminating between MCd and the control group. Ecchymoses were specific for meningococcal disease. Among the laboratory tests C-reactive protein (CRP) and Thrombotest (TT) were the tests which most frequently were found to be abnormal in patients with meningococcal disease. A diagnostic score is computed by the aid of a multiple regression analysis. This score includes the variables skin hemorrhages, body pain, CSF cell count, TT, CRP and white blood cell count. For a patient hospitalized with suspected MCd a score of three or more supports the diagnosis and should indicate the need for rapid antibiotic therapy.
Failure of osseointegration and mechanical accidents are the most common complications of dental implants. The functional prognosis is preserved in any case. Most of these complications can be avoided by a careful patient selection, a strict surgical phase and restorative procedures realized by competent practitioners.
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We describe a 7-years boy by with a meningococcal sepsis due to Neisseria Meningitidis, with very serious evolution of cutaneous necrosis, initial D.I.C. and heart failure. The clinical picture do not improve with antibiotic therapy (CAF-penicillin), but the association ceftriaxone + tobramycin results in rapid improvement. The cutaneous necrosis, especially evident on gluteus, arms and legs, were treated locally with AgNO3 and penicillin-solution. After 4 weeks of treatment, also this cutaneous involvement improved and now the boy is healthy, without residual signs neither systemic nor cutaneous.
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