[Traumatic subcutaneous emphysema of the face: the hazard of holding a sneeze]. / L'image du mois. Emphysème sous-cutané traumatique de la face : le danger de retenir un éternuement.

In this period of pandemic, protective measures and social distancing, sneezing might not be well received and trying to suppress a sneeze is tempting. It's not always a good idea. We here report the case of a patient suffering from minor facial trauma. The next day after the accident, while trying to hold back a sneeze, the patient caused sudden swelling of the right cheek, associated with subcutaneous emphysema and disturbances in sensitivity, revealing an unrecognized fracture of the right maxillary sinus. Post-traumatic subcutaneous emphysema of the face, caused by suppressed sneezing, is rarely described.

En cette période de pandémie, de gestes barrières et de distanciation sociale, éternuer peut être mal perçu et chercher à réprimer un éternuement est tentant. Ce n'est pas toujours une bonne idée. Nous rapportons ici le cas d'un patient victime d'un traumatisme facial mineur. Le lendemain de l'accident, en essayant de retenir un éternuement, le patient provoqua un brusque gonflement de la joue droite, associé à un emphysème sous-cutané et à des troubles de la sensibilité, révélant ainsi une fracture méconnue du sinus maxillaire droit. L'emphysème sous-cutané post-traumatique de la face, provoqué par un éternuement réprimé, est rarement décrit.

[Exploring focal liver lesions with contrastenhanced ultrasonography]. / Comment j'explore... Une lésion hépatique focale par une échographie de contraste.

Noninvasive diagnosis of focal liver lesions is usually based on unenhanced ultrasonography, computed tomography, or magnetic resonance. Contrast-enhanced ultrasonography (CEUS) can be used among the other imaging modalities in evaluating these lesions. The technique requires the intravenous injection of contrast media. Ultrasound contrast agents are very safe and the technique doesn't involve any radiation. A large body of evidence supports and clarifies the role of CEUS in evaluating focal liver lesions. Hemangiomas, focal nodular hyperplasia, focal fatty change will be diagnosed in a majority of cases and CEUS is also helpful in distinguishing malignant from benign lesions.

Le diagnostic non invasif des lésions hépatiques focales repose habituellement sur l'échographie conventionnelle, la tomodensitométrie ou l'imagerie par résonance magnétique. L'échographie de contraste vient s'ajouter à l'arsenal des techniques d'imagerie disponibles et peut être utilisée dans la mise au point de ces lésions. Elle requiert l'utilisation de produits de contraste ultrasonores qui sont injectés en intraveineux. Ceux-ci présentent un excellent profil de sécurité et le caractère non irradiant de la technique est un avantage supplémentaire. De nombreuses publications illustrent la contribution et la place de l'échographie de contraste dans le bilan des lésions hépatiques focales. Elle est performante dans le diagnostic d'hémangiome, d'hyperplasie nodulaire focale et de stéatose hétérogène, et s'avère également contributive dans l'exploration des lésions malignes.

Cystic Fibrosis Foundation and European Cystic Fibrosis Society Survey of cystic fibrosis mental health care delivery.

BACKGROUND: Psychological morbidity in individuals with cystic fibrosis (CF) and their caregivers is common. The Cystic Fibrosis Foundation (CFF) and European Cystic Fibrosis Society (ECFS) Guidelines Committee on Mental Health sought the views of CF health care professionals concerning mental health care delivery. METHODS: An online survey which focused on the current provision and barriers to mental health care was distributed to CF health care professionals. RESULTS: Of the 1454 respondents, many did not have a colleague trained in mental health issues and 20% had no one on their team whose primary role was focused on assessing or treating these issues. Insufficient resources and a lack of competency were reported in relation to mental health referrals. Seventy-three percent of respondents had no experience with mental health screening. Of those who did, they utilized 48 different, validated scales. CONCLUSIONS: These data have informed the decision-making, dissemination and implementation strategies of the Mental Health Guidelines Committee sponsored by the CFF and ECFS.

Relationship between Helicobacter pylori seropositivity and hyperemesis gravidarum with the use of questionnaire.

AIM: The aim of the present study was to investigate the relationship between Helicobacter pylori (HP) infection and Hyperemesis gravidarum (HG) by using a questionnaire. METHODS: Twenty-five pregnant women with HG and 85 asymptomatic pregnant women (aged 14-40) of matching gestational age were enrolled between October 2004 and January 2006. Anti-HP immunoglobin G (IgG) serum antibody was tested to establish seropositivity. In our study we used a multi variable questionnaire (name, age, gravida, number of vomits daily etc.). The results were analyzed using chi squared and Mann-Whitney U- test. RESULTS: The prevalence of HP infection was 56% (14 of 25) among patients with Hyperemesis gravidarum and 48.2% (41 of 85) among control subjects (P>0.05, chi squared test). In the same study the HP seropositivity is not related to age of the woman (50%, 55 of 110 were HP positive, P>0.05 chi squared test) but there was a significantly association between number of deliveries and HP seropositivity (primigravida [+] 34.2% versus 65.8%, multigravida [+] 6.1% versus 38.9%, P<0.05 chi squared test). The history for gastrointestinal problems of the tested women and their husbands is not related to HP seropositivity(38.1% positive for HP and with gastrointestinal disorders she/he or both versus 61.8% positive and without problems both, P>0.05, Mann-Whitney U- test). Finally there was no relativity between the number of vomits daily and the HP seropositivity (48.2% with HP [+] and 0-3 vomits daily versus 56% with HP [+] and 4-8 vomits daily, P>0.05 chi squared). CONCLUSIONS: Our findings do not support any direct correlation between HP seropositivity and Hyperemesis gravidarum, number of vomits daily, age of woman, history for gastrointestinal problems but only with the number of deliveries.

Routine screening for postpartum depression.

BACKGROUND: Postpartum depression (PPD) is a common and often overlooked condition. Validated screening tools for PPD exist but are not commonly used. We present the 1-year outcome of a project to implement universal PPD screening at the 6-week postpartum visit. METHODS: Universal screening with the Edinburgh Postnatal Depression Scale (EPDS) was implemented in all community postnatal care sites. One-year outcome assessments (diagnosis and treatment of PPD) were completed for a sample of the women screened using medical record review of all care they received during the first year postpartum. RESULTS: Sixty-eight (20%) of the 342 women whose medical records were reviewed had been given a documented diagnosis of postpartum depression, resulting in an estimated population rate of 10.7%. Depression was diagnosed in 35% of the women with elevated EPDS scores (> or =10) compared with 5% of the women with low EPDS scores (<10) in the first year postpartum. Treatment was provided for all women diagnosed with depression, including drug therapy for 49% and counseling for 78%. Four women were hospitalized for depression. Some degree of suicidal ideation was noted on the EPDS by 48 women but acknowledged in the chart of only 10 women, including 1 with an immediate hospitalization. The rate of diagnosis of postpartum depression in this community increased from 3.7% before the routine use of EPDS screening to 10.7% following screening. CONCLUSIONS: A high EPDS score was predictive of a diagnosis of postpartum depression, and the implementation of routine EPDS screening at 6 weeks postpartum was associated with an increase in the rate of diagnosed postpartum depression in this community.

Incidence of postpartum depression in Olmsted County, Minnesota. A population-based, retrospective study.

OBJECTIVE: To provide population-based data on the recognition of postpartum depression by reviewing diagnostic and treatment practices of all physicians caring for pregnant and postpartum women in Olmsted County, Minnesota. STUDY DESIGN: We reviewed the medical charts of a random sample of 403 Olmsted County women who gave birth in 1993. Using outpatient and hospital medical records, we recorded all documented symptoms and diagnoses of depression, drug therapy for depression and variables that were previously associated with postpartum depression, during pregnancy and for one year postpartum. RESULTS: Fifteen (3.7%) of the women were identified as having postpartum depression during the year following delivery. Two (0.5%) other women had preexisting depression that did not remit before delivery. We found significant associations between postpartum depression and young maternal age, single marital status, hyperemesis gravidarum, tobacco or illegal drug use during pregnancy, history of substance abuse, high utilization of emergency department services and previous affective disorder. Using multivariate analysis with stepwise logistic regression, only single marital status, previous affective disorder and high utilization of emergency services remained associated with postpartum depression. CONCLUSION: The incidence of postpartum depression was significantly below incidences seen in prospective studies. Systematic screening for postpartum depression may be appropriate in this population.

Population-based screening for postpartum depression.

OBJECTIVE: To estimate the community prevalence in Olmsted County, Minnesota of elevated scores on the Edinburgh Postnatal Depression Scale, a self-report screening tool for postpartum depression. METHODS: At the 6-week postpartum visit, the Edinburgh Postnatal Depression Scale was administered to women who gave birth in Olmsted County between July 28, 1997 and March 28, 1998. Study sites included all ambulatory clinics that provide pregnancy care in the county, and women who missed postpartum visits were contacted by mail. A threshold of 12 or more points on the scale was selected for clinical use; data for scores of ten and above were also examined. RESULTS: Of the 909 Olmsted County women studied (response rate 83.2%), 11.4% (n = 104) had scores of 12 or greater, with a 95% confidence interval (CI) of 9.4%, 13.5%. The percentage of women with a positive screen increased to 19.8% (n = 180; 95% CI 17.2%, 22.4%) when scores of 10 or higher were included, as has been recommended for screening in primary care settings. Forty-eight or 5.3% of the subjects (95% CI 3.8%, 6.7%) indicated experiencing suicidal ideation during the previous week. CONCLUSION: More than 11% of women had elevated scores on the Edinburgh Postnatal Depression Scale, indicating a high likelihood of postpartum depression and the need for further assessment. The screening process required little extra time and was acceptable to the subjects and clinicians. Screening for postpartum depression is appropriate and feasible for clinical practice and increases the identification of women suffering from this serious, common, and highly treatable disorder.

Treatment of acute pyelonephritis in women with intramuscular ceftriaxone: an out-patient study.

Ceftriaxone, a third-generation cephalosporin with a long half-life, was administered intramuscularly to 30 adult women suffering from acute pyelonephritis. Standard bacteriologic methods were used to identify the pathogens and their susceptibilities before treatment and at intervals during and after treatment. Overall cure was achieved in 25 (85%) of the patients 6 weeks after completion of therapy. The results demonstrate that ceftriaxone is an effective drug when given once a day intramuscularly to out-patients with acute pyelonephritis.

Value of single-dose ciprofloxacin in the treatment of acute uncomplicated urinary tract infection in women.

Single-dose antibiotic therapy for uncomplicated infection of the lower urinary tract (UTI) in women has resulted in high success rates. Ciprofloxacin, like other new quinolones, has shown good in vitro activity against the pathogens most frequently encountered in UTI, high concentrations in the urine and is well tolerated. The present report describes a randomized, double-blind, controlled trial of two single-dose regimens of ciprofloxacin in women with lower UTI. Thirty-six women received 250 mg and forty-two received 500 mg of ciprofloxacin as a single dose. Escherichia coli was the most frequently isolated pathogen in both groups (forty-eight patients). Clinical and bacteriological cures were attained in 81% and 93% of the 250 mg and 500 mg dose groups, respectively, 7 days after treatment. Follow-up at 4 weeks after completion of treatment disclosed that the clinical cure rate was 62% and 79% respectively. Ciprofloxacin was well tolerated. This study shows that a single dose of ciprofloxacin is an effective and safe treatment of uncomplicated UTI. Although the cure rates were higher with a single dose of 500 mg, further studies are needed for assessment to determine the optimal dose.

Treatment of various infections in an outpatient practice by intramuscular ceftriaxone: home parenteral therapy.

Ceftriaxone, a broad-spectrum third-generation cephalosporin with a long half-life, was administered intramuscularly to 23 outpatients who had a variety of infectious diseases. Cure was achieved in 21 of the patients (91%). The results of this study indicate that ceftriaxone is an effective and well-tolerated antimicrobial agent when administered intramuscularly to outpatients with various infections.

Norfloxacin versus nalidixic acid in the treatment of urinary tract infections.

Norfloxacin (MK-0366), a new oral quinoline antimicrobial agent, was shown to have much wider spectrum than nalidixic acid which includes Pseudomonas aeruginosa and gram-positive cocci. Many studies have been undertaken to determine the clinical effectiveness of norfloxacin in patients with urinary tract infections. Seventy-two patients with urinary tract infections caused by sensitivity strains were treated with either 400 mg norfloxacin per 12 hours or nalidixic acid 500 mg every 8 hours for 7 days. Follow-up examinations showed that norfloxacin is more effective than nalidixic acid, 93% and 83%, respectively, for the eradication of bacteriuria and symptoms. Adverse reactions due to norfloxacin were fewer and minor, and the tolerability seemed to be better than that of nalidixic acid.

Acute renal failure in acute pancreatitis.

Nine patients who developed acute renal failure in the course of acute pancreatitis are described. All patients developed acute renal failure in the absence of hypotension. Acute renal failure developed within 24 to 72 hours after admission. They were treated conservatively except for one, who was treated with peritoneal dialysis. The duration of the oliguric phase of acute renal failure subsided between 4 to 14 days, and all patients recovered from both acute pancreatitis and acute renal failure.