A case of otitis media complicated by intracranial infection with .

Introduction: Actinomycosis is a granulomatous suppurative infection caused by filamentous Gram-positive anaerobic bacteria from the family . To our knowledge, this is the first reported case of otogenic brain abscess associated with .

Case Presentation: We report the case of an immunocompetent 5-year-old boy with recurrent otitis media who re-presented to the emergency department with a 3-week history of otorrhoea, progressive anorexia, vomiting and lethargy.

Foreign body sexual assault complicated by rectovaginal fistula.

A case is discussed of an adolescent presenting with a rectovaginal fistula secondary to a sexual assault 2 years earlier. The fistula resulted from a retained foreign body (bottle cap) inserted into the vagina during the assault. The adolescent did not disclose the presence of the foreign body at the initial examination.

CT colonography in a rural New Zealand hospital.

Aim: Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. Most of the literature is based on data from urban centres. The purpose of this study is to evaluate the use of CTC in a rural New Zealand hospital.

Outpatient follow-up for patients with rheumatoid arthritis in relation to New Zealand Rheumatology Association guidelines at Dunedin Hospital.

Aim: Current treatment for rheumatoid arthritis (RA) involves the use of various disease-modifying anti-rheumatic drugs (DMARDs) and biologic response agents which require ongoing medical supervision. An audit was undertaken to assess the adequacy of outpatient specialist follow-up for supervision of treatment in patients with RA in the Otago region.

Methods: The Rheumatology Service database was used to assess time between follow-up for the penultimate and last visit to rheumatology outpatient clinic for all patients who made at least two visits between 1 October 2001 and 30 September 2006.

Successful treatment with low-dose thalidomide in a patient with both Behçet's disease and complex regional pain syndrome type I: case report.

Thalidomide is a recognized treatment of Behçet's disease. Low-dose thalidomide seems to be effective in the treatment of orogenital ulcers and is potentially safer with a lower incidence of adverse effects than higher doses. We wish to report a case of Behçet's disease in a 33-year-old woman who responded well to thalidomide 50 mg 2 to 4 times per week.

Back to the future: postoperative pain management beyond COX-2 inhibitors.

In the aftermath of the heated dispute on COX-2 selective nonsteroidal anti-inflammatory drugs (NSAID) that led to the national and international withdrawal of several of the recently introduced coxibs, a balanced discussion of pros and cons for their short term use is warranted. Further debate and research has highlighted risks with both classical NSAIDs and coxibs when administered to patients with cardiovascular disease. For several decades discussion about indications, risks and contraindications for the perioperative use of classical NSAIDs has been ongoing.

A randomized, placebo-controlled study of rofecoxib with paracetamol in early post-tonsillectomy pain in adults.

Background And Objective: Effective and early treatment of postoperative pain and nausea have become pivotal for the early discharge of patients after tonsillectomy. Opioid-based analgesia is standard practice but the use of non-steroidal anti-inflammatory drugs is discouraged due to their platelet inhibiting properties. The cyclo-oxygenase-2 selective non-steroidal anti-inflammatory drugs are effective analgesics and do not affect platelet function.

Sustained supraventricular tachycardia in Ebstein's anomaly.

A case is reported of a middle-aged female with congenital heart disease who presented with treatment-resistant supraventricular tachycardia. Supraventricular tachycardias (SVTs) in congenital heart disease (and their management) are discussed. The authors are not aware of any similar reports in the literature.

Physician job satisfaction in New Zealand versus the United Kingdom.

Aims: To compare and contrast levels of job satisfaction and job-related stress between doctors in New Zealand (NZ) and the United Kingdom (UK).

Methods: Self-administered questionnaire to 593 NZ doctors and 795 UK doctors. Job satisfaction was scored using the Warr, Cook, and Wall scale.

Right atrial myxoma mistaken for recurrent pulmonary thromboembolism.

A 69 year old man was admitted for investigation of right sided pleuritic chest pain and dyspnoea, both of which began suddenly four days before admission. Acute pulmonary embolism was diagnosed. Six months after discharge while on warfarin he died.

Swimming and grommets: a prospective survey.

Aim: To assess the incidence of otorrhoea after swimming in patients with grommets in situ, and discover whether protecting the ears from water affects this occurrence.

Methods: A group of children with bilateral patent grommets were allowed to swim with head under the water with one ear protected, and the other unprotected from water entry. Using a calendar system, each swim was recorded and each episode of otalgia or otorrhoea occasioning medical consultation was recorded with the outcome of the consultation.

Nonparticipation in mammography screening: apathy, anxiety or cost?

Aims: A survey was undertaken to find out why only 46% of eligible women had taken the opportunity to join the South Canterbury mammography screening programme in the first 22 months of operation.

Methods: One hundred and sixty seven randomly chosen women, aged between 40 and 65 years, who had not had a mammogram, were questioned about their knowledge of, and attitudes to, mammography screening.

Results: The answers showed that apathy, lack of concern and lack of perceived need were reasons quoted for nonattendance by almost half of respondents.

Ketotifen--a therapeutic agent of eosinophilic fasciitis?

A 30-year-old male with eosinophilic fasciitis (EF) associated with morphoea and vitiligo is described. The patient showed a partial response to prednisone, but did not respond to hydroxychloroquine, D-penicillamine and cimetidine. In the light of reports of increased plasma histamine levels, and a putative role of mast cells in the pathogenesis of EF, ketotifen (a mast cell stabilizer) was prescribed.

Treatment of posttraumatic nasal deformity.

This paper surveys 57 consecutive cases of posttraumatic rhinoplasty. The commonest cause of injury was sporting activities. Thirty-seven percent of patients had additional non traumatic nasal problems.

Auricular complication of acupuncture.

Auricular chondritis occurred in a patient following a course of auricular acupuncture administered to help the patient give up smoking. Despite immediate treatment the condition pursued a long course resulting in considerable morbidity and some deformity of the ear. Twenty months after presentation the ear is not completely stable.