Expanded Dengue Syndrome: A Case of Subarachnoid Haemorrhage, Cranial Diabetes Insipidus, and Haemophagocytic Lymphohistiosis.

Dengue fever is a mosquito-borne viral infection common in tropical countries with increasing incidence. The clinical manifestations can range from asymptomatic or mild infection to multiorgan failure. The latter is also called "Expanded dengue syndrome," and it carries a high rate of mortality and morbidity. Intensive care management of such complicated cases is a challenging task for the treating physician, which requires intense monitoring and a multidisciplinary approach for decision making. We report an atypical case of an expanded dengue syndrome presented with subarachnoid haemorrhage associated with moderate thrombocytopenia, cranial diabetes insipidus, and haemophagocytic lymphohistiosis in a young healthy female patient.

Spontaneous Free Peritoneal Perforation of an Infected Pancreatic Fluid Collection Managed with Laparoscopic Drainage and Necrosectomy.

INTRODUCTION: Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient. Case Presentation. A 28-year-old patient presented with worsening generalized abdominal pain with increased inflammatory markers. She required persistent inotropic support despite adequate fluid resuscitation. She had transient acute renal impairment and acute respiratory distress, which improved with noninvasive support. CECT (contrast-enhanced computed tomography) showed an infected pancreatic fluid collection with peritoneal free fluid. Aspiration of pelvic collection showed purulent fluid. Based on these clinical and imaging findings, she was diagnosed with a free peritoneal perforation of an infected pancreatic fluid collection. She underwent a laparoscopic drainage and necrosectomy of the infected pancreatic collection and peritoneal washout. She had a gradual recovery. All inotropes were omitted on the second day following surgery. She was sent to the ward from the ICU (intensive care unit) on the 4th postoperative day. CONCLUSION: The laparoscopic approach is a viable option in managing ruptured pancreatic fluid collections when patient and technical factors are supportive. It reduces surgical morbidity, thereby reducing the overall strain on physiological reserves. When opted for laparoscopic drainage, the procedure must be guided by imaging findings. Multidisciplinary participation is critical in the overall management.

[Diagnostic criteria of occupational hearing damage according to current regulations]. / Kryteria zawodowego uszkodzenia sluchu w swietle obowiazujacych przepisów.

Problems connected with the hearing damage occur also among soldiers during military service. We discuss Polish current obligatory regulations describing types, and permissible noise values in labour environment together with requirements for performing measurements, and compare them with such regulations in other countries. We consider general principles for hearing protection currently in force in the army, and practical problems connected with them.

[Post-traumatic deafness in the materials of the ENT department CCH MMA in 1989-1994]. / Gluchoty pourazowe w materiale Kliniki Otolaryngologicznej CSK WAM w latach 1989-1994.

In the period of 1989-1994 in our ENT Department 22 patients with injury deafness were treated. In 8 patients the cause of the deafness was acoustic trauma and in 14 patients mechanical injury. In 6 patients we recognized temporal bone fracture. The authors compared their results with results of other authors published in period of 1963-1968. There was statistically significant increase in the quantity of mechanical injury deafness.

[A rare case of injury of the external auditory meatus]. / Rzadki przypadek urazu przewodu sluchowego zewnetrznego.

The authors present difficulties in the diagnosis and the treatment of rare case of external ear injury. 41-year-old woman with acute inflammation of external ear was observed in our Department. The cause of this inflammation was a foreign body which obliterated the external auditory meatus.

[A case of hemorrhagic inflammation of an external acoustic duct]. / Przypadek krwotocznego zapalenia przewodów sluchowych zewnetrznych.

We report a case a twenty-year-old male with purpura of his limbs, and acute, diffused inflammation of the skin of the external acoustic duct. Complaints occur in the course of upper respiratory tract infection treated with antibiotic. Administered treatment resulted in quick subsidence of general symptoms with prolonged healing of external acoustic duct requiring surgical debridement (incision, and evaluation of bloody contents).