In a case of iliopsoas abscess treated by computed tomography (CT) guided percutaneous drainage, a 72-year-old woman admitted to our hospital presented with a high-grade fever and pain in the left hip. Laboratory examination showed leukocytosis (white blood cell count 12, 600/mm3) and elevated C-reactive protein (11.6mg/dl). Plain X-ray film revealed no apparent abnormalities, but CT scan clearly showed an abscess formed in the left iliopsoas muscle. For treatment, we chose CT-guided percutaneous drainage because the lesion was localized in the iliac fossa. A drain catheter (sump tube) was inserted in the abscess cavity and about 300cc of purulent effusion was drained. After drainage, laboratory findings and clinical sympton improved gradually and CT after 3 weeks of follow-up showed the abscess to have disappeared. We found that CT-guided percutaneous drainage is effective in treating iliopsoas abscess, especially in the early stage. This drainage is less invasive than conventional surgical treatment, and we suggest that CT-guided percutaneous drainage may be the treatment of first choice when iliopsoas abscess is diagnosed early enough.
This report describes 7 victims of sodium azide poisoning caused by drinking poisoned water. Ten employees at the poisoning site developed symptoms immediately after ingesting coffee or tea made from hot water contained in a thermos bottle. Symptoms included altered consciousness, faintness, blackout, palpitation, nausea, and paresthesia of both hands and feet. Seven patients were transferred to our institution by ambulance. We assumed symptoms were caused by acute poisoning but the causative agent was unknown. We could not rule out cyanide poisoning because of the rapid emergence of symptoms suggesting circulatory failure, so we administered amyl nitrate, sodium nitrate, and sodium thiosulfate. Symptoms rapidly subsided. The causative agent was identified the next day as sodium azide. While the victims were being treated at the emergency room, 2 doctors, 3 nurses, and 1 pharmacist complained of faintness, headache, nausea, sensations of dyspnea and eye pain. These medical staff members had all either conducted gastric lavage or treated gastric contents. This strongly suggests that symptoms were caused by hydrazoic acid formed in a chemical reaction between sodium azide and gastric acid. Our experience underscores the potential hazard from hydrazoic acid faced by medical staff treating patients with oral sodium azide intoxication.
A 63-year-old man began acting abnormally 2 days after development of a fever. He was admitted to a nearby hospital where a brain CT scan showed no abnormality. After experiencing a clonic convulsion the day following admission, he fell into a coma. Five days after admission, CT scans revealed low-density areas in the left temporal lobe, and acyclovir was administered based on a tentative diagnosis of herpes simplex encephalitis. Twelve days after admission, the patient was transferred to the Emergency Department of Kawasaki Medical School Hospital. MR imaging revealed bilateral expansion of the lesions, and his EEG showed periodic lateralized epileptform discharges (PLEDs) on both sides. HSV-DNA in his spinal fluid was positive as determined by PCR examination. Acyclovir 1, 500mg/day was continued for 3 weeks, and the patient's consciousness improved slightly. Although lesions improved, as indicated by MRI, SPECT showed high uptake on the left side at least up to 71 days after fever onset. The patient survived with apallic syndrome. Although pharmacological intervention improved the prognosis of this disease, treatment must be initiated promptly.
We treated 3 patients who developed respiratory disorders due to aluminum silicate, a principal component of “Kitty litter” (cat dirt). Case 1 was a 37-year-old woman with dyspnea treated for bronchial asthma for 3 months from about September 1995. Dyspnea was exacerbated after inhalation of powder from Kitty litter. On admission, disturbance of consciousness and marked hypoxemia were noted, but the patient recovered through respiratory management. Bronchoscopy showed white sputum in each segment of the bronchi. Case 2 was a 48-year-old woman with a cough exacerbated from about November 1998. Moist rales were present in expiration on chest auscultation. Symptoms were resolved by the administration of bronchodilators and expectorants. Case 3 was a 45-year-old woman with dyspnea treated for bronchial asthma since about March 1998 without improvement. Moist rales were present in bilateral lung fields during inspiration and expiration. A diagnosis of pneumonitis was made based on chest computed tomography (CT) findings recovered by bronchodilators and expectorants. From the information obtained by inquiry about the disorder, all 3 patients were considered have problems related to Kitty litter. Silica was present in the sputum of all 3 in analysis using an X-ray microanalyzer. Kitty litter causes severe symptoms on massive inhalation and respiratory disorders by inhalation of even a small amount over a long period. Precaution are thus required for indoor use.