The clinical significance of the presence of Clostridium difficile in children's faeces remains uncertain using current diagnostic procedures. Clostridium difficile is a relatively common finding in infants with no symptoms of gastrointestinal disease, suggesting it may be an incidental finding and form part of the normal gut micro-flora in this age group. On the other hand, particularly in older children or those with significant co-morbidity, there are examples where C. difficile causes disease and exerts considerable morbidity and even mortality (C. difficile infection, CDI). Between these extremes lie a substantial group of children who have both diarrhoea and C. difficile in their stools but where the nature of the association is not clear: Clostridium difficile associated disease (CDAD). We review the significance of C. difficile in children presenting recently uncovered paediatric data from a large UK epidemiological study that informs some key unanswered questions.
We report a case of polymethylmethacrylate cement pulmonary embolism (PE) that occurred two days following a minimally invasive kyphoplasty procedure. Our patient developed non-specific rib pain postoperatively followed by dyspnea, prompting presentation to the emergency department. The polymethylmetacrylate cement was visualized on initial chest radiograph and further characterized using computed tomography. The patient was admitted and anticoagulation started, later having an uncomplicated hospital course. The polymethylmethacrylate cement has a well-documented history of leakage and other postoperative complications. Cement PE, while rare, can present similarly to a thrombotic PE and requires adequate long-term anticoagulation with close follow-up.
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