Calcified abdominal aortic aneurysm in a 12-year-old boy.

The authors report a case of an idiopathic, isolated infrarenal abdominal aortic aneurysm with dense intramural calcification and sterile mesenteric lymphadenopathy in a 12-year-old boy. Aneurysmal disease in the pediatric population is very uncommon. The majority of previously reported cases have clear associated causes, such as connective tissue disorders, infectious processes, inflammatory states, or trauma. A minority of cases have no distinguishable cause and are classified as idiopathic. Isolated abdominal aortic aneurysms are very uncommon in children, and those with densely calcified walls are rare, with only 2 case reports in the literature. The authors found no previous reports of abdominal aortic aneurysm with associated sterile mesenteric lymphadenopathy. The etiology of this patient's aneurysm remains unknown.

Surgical management of tracheocutaneous fistula.

Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of > or = 4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since the closure technique was adopted.

Submandibular abscess caused by Eikenella corrodens.

Eikenella corrodens is a slow-growing, facultative, anaerobic, gram-negative bacillus that is part of the normal oral flora and is found in dental plaque. It has become increasingly recognized as a pathogen in nonimmunocompromised and immunocompromised hosts. A case of a submandibular abscess due to Eikenella corrodens, which was successfully treated by administration of cefuroxime accompanied by incision and drainage, is presented. Dermatologists need to be aware of this pathogen is the evaluation of suppurative lesions of the head and neck.

Thermoplastic splint for use after nasal fracture.

I have used this splint on 16 patients between November 1992 and July 1993. The device works as well as or better than other similarly designed thermoplastic nasal splints that are commercially available, and it is significantly less expensive. Commercially available splints run about 5 to 10 dollars per unit. This device as described costs approximately 50 cents per unit. This method of external splinting of the nose is extremely reliable and satisfactory to both myself and the patient. No splint is unobtrusive, and I have found that my patients like these bright and colorful splints.

Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis?

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.