Lemierre syndrome associated with 12th cranial nerve palsy--a case report and review

Since the widespread availability and use of antibiotics the prevalence of Lemierre syndrome (L.S.) has decreased. It is a well-described entity, consisting of postanginal septicaemia with thrombophlebitis of the internal jugular vein with metastatic infection, most commonly in the lungs. The most common causative agent is a gram-negative, non-spore-forming obligate anaerobic bacterium, Fusobacterium necrophorum (F.n.). We describe the unusual clinical features of a 12-year-old boy with Lemierre syndrome with isolated hypoglossal nerve palsy - the latter symptom is an extremely rare manifestation of this disease.

Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment

CONCLUSIONS

Early diagnosis and aggressive antimicrobial and surgical treatment are essential to successfully treat extensive cervico-mediastinal abscesses of odontogenic origin. Patient management should be performed by experienced clinicians well trained in managing possible complications. We recommend close clinical and radiological postoperative follow-up investigations with early surgical re-intervention if necessary.

OBJECTIVES

While neck infections affecting the perimandibular space have a high prevalence and their clinical aspects have repeatedly been discussed, further spread of the inflammation and life-threatening situations have rarely been described. The objective was to determine clinical, diagnostic, and therapeutic aspects of severe neck infections of odontogenic origin. Emphasis was placed on grave descending deep neck space infections, sometimes resulting in mediastinitis as a life-threatening complication.

PATIENTS AND METHODS

We reviewed 10 patients with severe odontogenic abscesses treated during an 8-year interval in a single center.

RESULTS

The submandibular space was the most frequently encountered location of deep neck space infections. Mediastinitis was found in five patients. The most frequent causative bacteria were Streptococcus and Bacteroides species. All patients underwent intravenous antibiotic treatment and surgical therapy. Mediastinotomy was inevitable in five cases and thoracotomy in one case. All patients survived.

Peritonsillarabszess mit tödlichem Verlauf - Diagnostische und therapeutische Aspekte

BACKGROUND

Acute tonsillitis is an extremely common infection seen in children and adults. In most cases, the family doctor is initially consulted. Intratonsillar, peritonsillar and retrotonsillar abscesses are frequent complications in the course of tonsillitis. In those cases, oropharyngeal infection may lead to a descending process with consecutive mediastinitis as a life-threatening condition.

PATIENTS AND METHODS

We report the case of a 67-year old man who died of a mediastinitis resulting from a peritonsillar abscess. Clinical findings, radiological diagnostics and antibiotic as well as surgical therapy are illustrated.

RESULTS

The patient died due to a septic multi-organic failure despite aggressive antibiotic and surgical therapy by a combined enoral and cervical approach with thoracic drainage.

DISCUSSION

Peritonsillar abscess is a potentially life-threatening complication of acute tonsillitis. This must be kept in mind and should therefore lead to an adequate and directed management of this pathology. We discuss the stepwise diagnosis and therapy within the framework of scientific literature.

[Diagnostic and therapeutic management of a big cyst at the floor of the mouth--a case report]

BACKGROUND

The growth of dysontogenetic cysts at the floor of the mouth is considered as a rare condition. Cysts of the floor of the mouth may be differentiated depending on location or on histopathologic-embryological criteria into dermoids, epidermoids and teratomas.

PATIENTS AND METHODS

We report a case of a large cyst at the floor of the mouth and present the results of clinical examination, preoperative diagnostics and surgical approach.

RESULTS

The tumour was resected by an enoral operation. Histological findings confirmed a large sublingual epidermoid cyst. There were no complication or relaps during postoperative course. The case is discussed within the framework of scientific literature.

CONCLUSIONS

Dysontogenetic cysts should be considered in differential diagnosis of tumours of the floor of the mouth. Diagnostic and surgical management depends first of all on size and location of dysontogenetic cysts.

Changes in ripening-related processes in tomato conditioned by the alc mutant

The alc mutation affects the ripening and storability of tomato fruit. The alteration of fruit color in alc lines is due to a reduction in total pigment and a reduction in lycopene relative to total carotinoids. Polygalacturonase (PG) activity is reduced to less than 5% of normal, and the isozymes PG2a and PG2b are absent in alc fruit. The level of anti-PG precipitable proteins is also reduced to less than 5% of normal. Total polyA + mRNA is not significantly reduced in ripening alc fruit, but hybridization of polyA + mRNA to different ripening-related cDNA clones showed that specific mRNAs are present at reduced levels in the mutant. Specific mRNA levels were reduced to 10%-80% of normal levels, depending on the cDNA clone used as the probe. PG mRNA was present at 5%-10% of the normal level.All effects of alc on fruit ripening are relived in the line Alcobaca-red, which arose spontaneously from the original alc line, Alcobaca. The Alcobaca-red trait segregates as a single dominant trait at or very near the alc locus, and it is probably the result of a reverse mutation at the alc locus.The chromosomal locations of regions homologous to 5 ripening-related cDNA probes were determined. Regions homologous to 4 of these probes map to chromosomes other than chromosome 10, indicating that the effects of alc are transactive. A cDNA clone for PG was homologous to only one chromosomal region. This region is located on chromosome 10, which is also the chromosome on which alc and nor are located.