Spinal cord infarction as a severe complication of meningococcal meningitis.

Spinal cord infarction is a rare complication of bacterial meningitis and is, therefore, generally unknown. We describe a patient who developed a flaccid paraparesis 2 weeks after being diagnosed with meningococcal meningitis. The etiology of spinal cord infarction is multifactorial, but vascular mechanisms and coagulation abnormalities play an important role. Epidural hemorrhage and spinal abscess should be considered in the differential diagnosis.

[Bacterial ileocecitis, a "new" disease]. / Bacteriële ileocaecitis, een 'nieuwe' ziekte.

786 patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish appendicitis from bacterial enteritis. 533 of these patients were described before. In 91 (11.6%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region-enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of an inflamed appendix. In 64 of these a bacterial infection was confirmed (Yersinia enterocolitica in 28, Campylobacter jejuni in 24, Salmonella enteritidis in 11, Yersinia pseudotuberculosis in one). In the other 27, bacteriological tests were negative (17) or not performed (10). Only 34 of 91 had diarrhoea. Six of the 91 patients underwent surgery, in all of them the removed appendix was normal. The other 85 patients recovered with conservative treatment. In 38 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocecitis) appears to be responsible for an appreciable number of unnecessary appendicectomies. It has characteristic sonographic features which distinguish it from appendicitis.

Ultrasound in detection of portal venous gas in adults.

Three patients with sonographically demonstrated portal venous gas are presented. Two patients were also studied using computed tomography (CT). Both techniques had superior sensitivity compared to plain radiographs. Scattered echogenic patches in the liver parenchyma, and centrifugal flow of echogenic patches in the portal vein and its branches, are typical ultrasound findings of portal vein gas. Evaluation of ultrasound findings and coordination with clinical history differentiate portal vein gas from biliary gas.