Peter Stride

A case of Aggregatibacter actinomycetemcomitans endocarditis presenting as quadriceps myositis.

An 80 year old female was admitted with an eight week history of fever associated with painful swelling of her right thigh, and a long history of poor dentition. Culture of blood stained fluid aspirated from the abscess grew Aggregatibacter actinomycetemcomitans (Aa) sensitive to ampicillin and cephalosporins. Transoesophageal echocardiography indicated endocarditis. Four weeks treatment with intravenous ceftriaxone and appropriate dental care was followed by full recovery.

Staphylococcal Sepsis with Multiple Abscesses, Urinary Tract Infection, and Bilateral Renal Vein Thrombosis in a Patient with Uncontrolled Diabetes Mellitus

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

Right ventricular inflow tract obstruction secondary to metastatic cutaneous squamous cell carcinoma

We report the case of an immunocompetent 83-year-old man with metastatic neoplastic infiltration of the heart from primary squamous cell carcinoma (SCC) of the skin. Death was from cardiopulmonary collapse due to left ventricular failure with features of right ventricular inflow tract obstruction. Metastatic tumours involving the heart rarely originate from cutaneous SCC though have been reported in the literature in both immunocompetent and postrenal-transplant recipient patients. Most involve the pericardium and only rarely the endocardium or the myocardium. While the prognosis is generally poor, palliative radiotherapy may provide significant symptom relief. Cardiac metastases should be considered in patients with advanced cancer, especially when they show cardiac symptoms and signs.

Integration of patient safety systems in a suburban hospital

Public awareness of hospital misadventure is now common. In response, we describe our integrated hospital safety system, which is dependent on the linkage of multiple individual safety committees, and the presence on each committee of senior and junior multidisciplinary healthcare professionals to provide feedback to their peer groups on required improvements.

A case of cephalothin-associated urolithiasis

We present a case of osteomyelitis requiring prolonged intravenous cephalothin complicated by symptomatic calcium oxalate urocalculi formation. Patients on long-term β-lactam antibiotics with lower urinary tract symptoms may have urolithiasis rather than a urinary tract infection.

Extensive Bilateral Extraluminal Perivascular Pulmonary Haemorrhage Associated with Stanford Type A Aortic Dissection

We present the case of an 80-year old man with a Stanford Type A dissecting thoracic aortic aneurysm plus the unusual CT finding of extramural haemorrhage along the pulmonary vessels. The clinical and radiological picture has an extremely high mortality

The i-patient or the eyeball patient?

A 44-year-old woman presented to the emergency department complaining of severe central chest pain for 2 weeks. Sequential electrocardiograms and cardiac enzymes were normal; however, an anteroposterior chest X-ray revealed bilateral pulmonary opacities both with air-fluid levels (Fig. 1), and the white cell count was raised at 19.9 ¥ 10, with 82% neutrophils. A review of the website-du-jour favoured by trainee physicians offers the following list of likely microorganisms as causative agents of pulmonary abscesses, with the more exotic likely to be found in immunocompromised patients. Most frequently cultured are anaerobes, particularly Peptostreptococcus, Prevotella, Bacteroides (usually not Bacteroides fragilis) and Fusobacterium spp., less frequently cultured are non-anaerobes, particularly Streptococcus milleri and other microaerophilic streptococci. Other possibilities include Staphylococcus aureus, Klebsiella pneumoniae, other Gram-negative bacilli, Streptococcus pyogenes, Burkholderia pseudomallei, Haemophilus influenzae type b, Legionella, Nocardia and Actinomyces. Transthoracic needle aspiration is suggested particularly for identification of the microorganism in resistant cases. However, returning to the patient to clarify some issues, she gave a history of bilateral breast duct excision for duct ectasia confirmed on histology 18 days previously. A review of the lateral chest X-ray shows the larger air-fluid level to be in the breast, not in the lungs (Fig. 2). A computed tomography pulmonary angiogram was performed to exclude postoperative pulmonary emboli, revealing clear lung fields, but a small amount of gas in the right breast (Fig. 3).

The nuts and bolts of pills and potions: the functions of a drug safety working group

Hospitalised patients commonly experience adverse drug events (ADEs) and medication errors. Runciman reported that ADEs in hospitals account for 20% of reported adverse events and contribute to 27% of deaths where death followed an adverse event. Hughes recommends multidisciplinary hospital drug committees to assess performance and raise standards. The new Code of Conduct of the Medical Board of Australia recommends participation in systems for surveillance and monitoring of adverse events, and to improve patient safety. We describe the functions and role of a Drug Safety Working Group (DSWG) in a suburban hospital, which aims to audit and promote a culture of prescribing and medication administration that is prudent and cautious to minimise the risk of harm to patients. We believe that regular prescription monitoring and feedback to Resident Medical Officers (RMOs) improves medication management in our hospital.