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Tampon toxic shock syndrome

Usually caused by staphylococcal exotoxin associated with high-absorbency tampon use. Strep. pyogenes can also cause it. The rare syndrome usually begins within 5 days of the onset of the period.

Clinical features include sudden onset fever, vomiting and diarrhoea, muscle aches and pains, skin erythema, hypotension progressing to confusion, stupor and sometimes death.


Active treatment depends on the severity of the illness. Cultures should be taken from the vagina, cervix, perineum and nasopharynx. The patient should be referred to a major centre if ‘shock’ develops. Otherwise the vagina must be emptied, ensuring there is not a forgotten tampon, cleaned with a povidone–iodine solution tds for 2 d, and di(flu)cloxacillin or vancomycin antibiotics administered for 8–12 d.

Tearduct (nasolacrimal duct) blockage in child

  • If conjunctivitis present: neosporin or chloramphenicol eye drops

  • Perform regular massage from inner canthus to base of nose (teach mother) at least twice daily

  • If persistent in infant: requires nasolacrimal probing at 4–6 mths—otherwise leave to 6 mths or more as it may resolve


Babies usually cut their teeth from 6 mths until 2–3 yrs with discomfort usually caused by the molars (ages 1–3).

Precautions: exclude other possible causes of irritability in a teething child (e.g. UTI, meningitis, otitis media). Teething doesn't cause fever.


  • Reassure parents that the problem will soon settle.


Chewing soothing methods

  • Teething ring (kept cold in the refrigerator) or

  • Baby can chew on a clean, cold, lightly moistened facewasher (a piece of apple can be placed in the facewasher) or

  • Parent can massage gum with forefinger wrapped in a soft cloth or gauze pad (Oro-Sed gel can be massaged into gums every 3 h if extremely troublesome)

Temporomandibular joint dysfunction

Refer to the techniques on image treatment of TMJ dysfunction. Most effective and simplest method is placing a piece of soft wood (e.g. carpenter's pencil) firmly against back molars and biting rhythmically on the object with a grinding movement for 2–3 mins at least 3 times a day.

Testicular tumours

A mass that is part of the testis, and solid, is likely to be a tumour.

Table T1

Comparison of the common testicular cancers

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