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Mason AK, Adams L, Garner MM. Bacterial abscesses in whitespotted bamboo sharks (Chiloscyllium plagiosum) in managed care. J Fish Dis 2024; 47:e13917. [PMID: 38242861 DOI: 10.1111/jfd.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024]
Abstract
Sixteen whitespotted bamboo sharks (Chiloscyllium plagiosum) with histologically similar bacterial abscesses were submitted to Northwest ZooPath from nine zoo and aquarium institutions over a 17-year period. These abscesses were characterized by inflammatory cell infiltrates and necrosis with intralesional small, Gram-positive, acid-fast negative, cocci bacteria. The clinical presentation, histologic findings, and culture results indicate that Enterococcus faecalis is a relatively common cause of these lesions in whitespotted bamboo sharks. This organism also provides a treatment challenge due to its inherent antibiotic-resistant properties and ability to form biofilms, confounding the host's immune response. Enterococcus faecalis represents an important cause for abscess formation and cellulitis in captive whitespotted bamboo sharks.
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Affiliation(s)
| | - Lance Adams
- Aquarium of the Pacific, Long Beach, California, USA
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Urbón-sánchez P, Mendoza-Moreno F, Sánchez De Toca-Gómez S, Mañes-Jiménez F, Jiménez-Martín R, Bru-Aparicio M, Laguna-Hernández P, Allaoua-Moussaoui Y, Soto-Schutte S, Quiroga-Valcárcel A, Díez-Alonso M, Lasa Unzúe I, Gutiérrez-Calvo A. Thyroid abscess, an uncommon diagnosis: A case report and mini‑review of the literature. Med Int (Lond) 2024; 4:29. [PMID: 38660126 PMCID: PMC11040282 DOI: 10.3892/mi.2024.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/23/2024] [Indexed: 04/26/2024]
Abstract
Thyroid abscess is a rare entity, commonly experienced by immunocompromised patients, or those who have anatomical abnormalities or a pre-existing thyroid disease. An early diagnosis continued by treatment with antibiotics and drainage of the abscess is the recommended therapeutic strategy for such cases. The present study describes a clinical case of this rare event, and also provides a brief literature review. The present study describes the case of a 48-year-old healthy male with no medical antecedents, apart from acute prostatitis treated with antibiotics for 6 days prior, who visited the Emergency Department of the authors' hospital with neck pain and progressive swelling of the mass. Diagnostic imaging confirmed the authors' suspicion of an abscess and revealed the lesion displacing the airway to the contralateral side. This restricted the mobility of the neck of the patient. As an emergency measure, the patient was then taken to the operating room for a neck examination. A hemithyroidectomy was finally performed. Following a prolonged hospital duration, he was discharged from the hospital and his recovery was uneventful without any voice alterations, hypocalcemia or recurrence.
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Affiliation(s)
- Patricia Urbón-sánchez
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Fernando Mendoza-Moreno
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | | | - Félix Mañes-Jiménez
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Rubén Jiménez-Martín
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Marta Bru-Aparicio
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Pilar Laguna-Hernández
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Yousef Allaoua-Moussaoui
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Sonia Soto-Schutte
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Ana Quiroga-Valcárcel
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Manuel Díez-Alonso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Inmaculada Lasa Unzúe
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
| | - Alberto Gutiérrez-Calvo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, 28805 Madrid, Spain
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Danhel L, Fritz A, Havranek L, Kratzer T, Punkenhofer P, Punzengruber A, Rezaie D, Tatalovic S, Wurm M, Függer R, Biebl M, Kirchweger P. Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication-case report and review of the literature. Front Surg 2024; 11:1375502. [PMID: 38655209 PMCID: PMC11035747 DOI: 10.3389/fsurg.2024.1375502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC. Methods Case report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022. Case Report An 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation. Conclusion Intraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
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Affiliation(s)
- L. Danhel
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Fritz
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - L. Havranek
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - T. Kratzer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - P. Punkenhofer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Punzengruber
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - D. Rezaie
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - S. Tatalovic
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - M. Wurm
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - R. Függer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - M. Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - P. Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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Hibiya T, Nagahama K, Matsumoto Y, Saito K, Sasaki N, Kobayashi K, Otsu A, Shimasaki T, Takeuchi K, Shiokawa Y, Nagane M, Shibahara J. Epstein-Barr virus-positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report. Neuropathology 2024; 44:104-108. [PMID: 37424259 DOI: 10.1111/neup.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete bacterium Treponema pallidum. Neurosyphilis results from the infection of the nervous system with Treponema pallidum, which can occur at any stage of syphilis. Neurosyphilis is often overlooked because of its rarity. Early-stage neurosyphilis with brain mass formation is rare. We present a case of early-stage neurosyphilis with prominent Epstein-Barr virus (EBV)-positive monoclonal lymphoplasmacytic proliferation in an immunocompetent patient. A 36-year-old man presented with a chief complaint of a progressively worsening headache, a newly developed skin rash, and a fever. Magnetic resonance imaging showed a mass lesion, which measured 18 mm in diameter, in the left frontal lobe of the cerebrum. The patient underwent an emergency operation to remove the abscess. A pathological investigation revealed complex findings. There was an abscess in the cerebrum. Lymphoplasmacytic meningitis was also noted. In addition, a vaguely nodular lesion, which was composed of plasmacytoid and lymphoid cells, was observed around the abscess. Immunohistochemically, an anti-Treponema pallidum antibody revealed numerous Treponemas around the abscess. In situ hybridization revealed that the plasmacytoid and lymphoid cells were Epstein-Barr encoding region (EBER)-positive; κ-positive cells were significantly more prevalent than λ-positive cells, suggesting light-chain restriction. Postoperatively, parenteral antibiotics were administered for four weeks. The patient has been free of recurrence for two years since the surgery. No association between neurosyphilis and EBV-positive lymphoplasmacytic proliferation has ever been reported. Mass formation in early-stage neurosyphilis is an exceptionally rare event. The present case indicates that in syphilis patients, lymphoproliferative disorders that lead to mass formation may be caused by concomitant EBV reactivation. Furthermore, when treating patients with mass lesions of the central nervous system, it is important to check their medical history and perform laboratory screening for infectious diseases to avoid overlooking syphilis infections.
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Affiliation(s)
- Takashi Hibiya
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshie Matsumoto
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kuniaki Saito
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Kobayashi
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Akiyasu Otsu
- Department of Infectious Disease, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Teppei Shimasaki
- Department of Infectious Disease, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
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Yang PF, Builth-Snoad L, Ng KS, Gu E, Errington B, McBride KE, Lee PJ. Optimizing theatre utilization for abscess drainage: going beyond priority categories. ANZ J Surg 2024; 94:648-654. [PMID: 38426392 DOI: 10.1111/ans.18919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Day-only emergency surgery for abscess drainage is poorly implemented in Australia. This study assessed the feasibility, outcomes, cost, and impact of an acute day-only surgery (ADOS) program. METHOD A retrospective pre-post implementation study of patients requiring abscess drainage in theatre was performed. Following implementation of an ADOS program for abscess management, eligible patients were discharged from the emergency department and prioritized first on the following day's emergency list. Outcomes from the first 12 months of the ADOS era were compared with those of the preceding 6 months (pre-ADOS). Primary outcome was length of hospital stay (LOS). Secondary outcomes included 30-day complications, admission costs, and impact on overall emergency theatre workflow (measured by emergency appendicectomy metrics). RESULTS Overall, 266 patients during the ADOS era (including 95 eligible for the ADOS pathway) were compared with 115 patients during the pre-ADOS era. Baseline characteristics were comparable. Median LOS was shorter during the ADOS era (21.9 h (IQR 11.8-43.3) vs. 30.1 h (IQR 24.7-48.8), P < 0.001). Median LOS was 10.2 h (IQR 8.9-13.1) for patients on the ADOS pathway. There were no significant differences in 30-day complications (9.3% vs. 9.5%), emergency department re-presentations (7.4% vs. 5.1%), or abscess recurrence (5.6% vs. 5.7%). Average cost per patient was lower during the ADOS era ($4155 vs. $4916, p = 0.005). ADOS did not appear to materially impact other emergency procedures. CONCLUSION ADOS for abscess drainage is feasible, safe, and produces cost savings, while being implemented without significant additional resources.
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Affiliation(s)
- Phillip F Yang
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- South West Sydney Clinical Campus, UNSW Sydney, New South Wales, Australia
| | - Lily Builth-Snoad
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Eva Gu
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Belinda Errington
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate E McBride
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Peter J Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Surgical Outcomes Research Centre (SOuRCe), Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Adapa AR, Linzey JR, Moriguchi F, Daou BJ, Khalsa SSS, Ponnaluri-Wears S, Thompson BG, Park P, Pandey AS. Risk factors and morbidity associated with surgical site infection subtypes following adult neurosurgical procedures. Br J Neurosurg 2024; 38:503-509. [PMID: 33779461 DOI: 10.1080/02688697.2021.1905773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype. METHODS A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis. RESULTS 9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, p < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, p = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, p = 0.022). CONCLUSION Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
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Affiliation(s)
- Arjun R Adapa
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Badih J Daou
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Paul Park
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
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Hosokawa T, Kuntaro D, Takei H, Arakawa Y, Kambe T, Kurihara J, Mochizuki N, Sato Y, Tanami Y, Oguma E. Assessing the Usefulness of Ultrasonography for the Diagnosis and Evaluation of Intra-Orbital Lesions in Pediatric Patients: A Retrospective Analysis. J Ultrasound Med 2024; 43:573-585. [PMID: 38124268 DOI: 10.1002/jum.16391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/26/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To assess the usefulness of ultrasonography in the diagnosis and evaluation of extraocular intra-orbital lesions in pediatric patients. METHODS Twenty-three pediatric patients with intra-orbital lesions who underwent both ultrasound and computed tomography/magnetic resonance imaging (CT/MRI) were included. The following parameters were evaluated using ultrasound: 1) lesion detection rate (presence or absence of lesions), 2) lesion characteristics, 3) lesion location (extraconal or intraconal), and 4) the lesion longest linear dimensions, and these were compared using Fisher's exact test and Mann-Whitney U test. RESULTS Two lesions could not be detected using ultrasound; in the other 21 cases, the lesion characteristics diagnosed by ultrasound were correct. Diagnostic accuracy of detection and characteristics assessment using ultrasound were 91.3% and 91.3%, respectively. The lesion location was not significantly different between the two groups (intraconal/extraconal in those detected using ultrasound versus those in the absence on ultrasound = 7/14 versus 0/2, P > .999); however, in two cases that were not detected on ultrasound, the lesions were located at extraconal. Lesions that were small in longest linear dimensions on CT/MRI were not detected using ultrasound (the longest linear dimensions in lesions detected using ultrasound versus that in the absence of ultrasound: 29.5 ± 8.2 [range, 13-46] versus 10 and 11 mm, P = .043). CONCLUSIONS Ultrasonography proved to be useful for visualizing and evaluating intra-orbital lesions except for lesions that were relatively small in size. Therefore, although ultrasound could not detect lesions located behind bone and bone invasion, it could be used for diagnosing and selecting treatment strategies for intra-orbital lesions.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Deguchi Kuntaro
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Haruka Takei
- Department of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuki Arakawa
- Department of Hematology and Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoka Kambe
- Division of Ophthalmology, Saitama Children's Medical Center, Saitama, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naoto Mochizuki
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Tan KX, Aukes J. Large malignant tracheo-oesophageal fistula with lung abscesses. Respirol Case Rep 2024; 12:e01328. [PMID: 38504768 PMCID: PMC10950391 DOI: 10.1002/rcr2.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
Tracheo-oesophageal fistula (TOF) can arise as a rare complication of malignancy (especially oesophageal or lung cancers) and pose difficult diagnostic and management dilemmas. We explore a challenging case of large malignant TOF below.
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Affiliation(s)
- Kang Xiang Tan
- Department of Respiratory & Sleep MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - John Aukes
- Department of Respiratory & Sleep MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
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Alkoheji HK, Alharbi WM, Abulfateh FN, Nasser M, Alshehabi M. Challenges in Diagnosis and Management of Infantile Deep Neck Abscess: A Case Report and Literature Review. Cureus 2024; 16:e55543. [PMID: 38576697 PMCID: PMC10993194 DOI: 10.7759/cureus.55543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
A deep neck abscess is a relatively rare bacterial infection in infants that can rapidly progress to life-threatening complications. Mostly, the patients present with fever and neck pain. Some may present with dysphonia, sore throat, torticollis, trismus, or neck swelling. Early diagnosis and management can prevent life-threatening complications, such as airway obstruction, mediastinitis, and tracheitis. In this report, we present a case of a six-month-old infant presenting with retropharyngeal and parapharyngeal abscesses with prompt diagnosis leading to complete recovery of the patient.
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Affiliation(s)
- Heba K Alkoheji
- Otolaryngology - Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
| | - Wasan M Alharbi
- Otolaryngology - Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
| | - Fatima N Abulfateh
- Otolaryngology - Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
| | - Mai Nasser
- Otolaryngology - Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
| | - Mohamed Alshehabi
- Otolaryngology - Head and Neck Surgery, The Royal Medical Services, Riffa, BHR
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10
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Lee HK, Walls G, Anderson G, Sullivan C, Wong CA. Prolonged Bacteroides pyogenes infection in a patient with multiple lung abscesses. Respirol Case Rep 2024; 12:e01314. [PMID: 38455503 PMCID: PMC10918597 DOI: 10.1002/rcr2.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
Bacteroides pyogenes is naturally found in the oral microbiome of cats and dogs and hence exposure, especially bites from these animals, is a major risk factor for human infections. B pyogenes is known to cause infections that persist despite antibiotic treatment and can have serious clinical outcomes. We present a novel case of complex lung abscesses associated with B pyogenes infection. A 55 year old man presents with a 3-month history of productive cough, night sweats, and 5 kg weight loss. An initial chest radiograph revealed mass-like opacities in the right upper lobe (RUL), right middle lobe (RML), and left lower lobe (LLL). Over the next 4 years the patient underwent multiple investigations and antimicrobial treatments until resolution of the abscesses. We believe that metronidazole in combination with moxifloxacin was a key component in the clinical cure of this patient.
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Affiliation(s)
- Hyun Kyoung Lee
- Department of MedicineTe Whatu Ora Counties ManukauAucklandNew Zealand
| | - Genevieve Walls
- Department of Infectious DiseaseTe Whatu Ora Counties ManukauAucklandNew Zealand
| | - Graeme Anderson
- Department of RadiologyTe Whatu Ora Counties ManukauAucklandNew Zealand
| | - Cameron Sullivan
- Department of Respiratory MedicineTe Whatu Ora Counties ManukauAucklandNew Zealand
| | - Conroy A. Wong
- Department of Respiratory MedicineTe Whatu Ora Counties Manukau and University of AucklandAucklandNew Zealand
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11
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Gbegli E, Miremadi A, Serrao EM, Sadler TJ. Perforated Amyand hernia with an adenocarcinoma tumour presenting as a groin abscess. BJR Case Rep 2024; 10:uaae008. [PMID: 38529105 PMCID: PMC10962930 DOI: 10.1093/bjrcr/uaae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/27/2024] Open
Abstract
An Amyand hernia is an incarcerated inguinal hernia containing the appendix with or without appendicitis. This is a rare form of inguinal hernia, making up approximately 0.4%-1% of all cases. As with any hernia, this may become strangulated at any time, leading to the loss of blood supply and further development of gangrene and complications. Clinically, this can present in a manner indistinguishable from other types of inguinal hernias. In addition, the appendix can be affected by its own set of pathological processes, such as infection, inflammation, and malignancy. Not uncommonly both hernial and appendiceal complications coexist. The clinical diagnosis of an Amyand hernia remains challenging due to its low incidence and indistinct clinical presentation. At present, surgery is usually diagnostic and therapeutic. However, there is a growing number of recent reports showing the invaluable role of imaging on the diagnosis of Amyand hernias and associated complications. The correct and timely recognition of their imaging features including complications can optimize and expedite patient care by guiding diagnosis, treatment, and prognosis. Here, we report for the first time the radiological and pathological findings of a patient with a unique complicated Amyand hernia, which posed a diagnostic challenge for the clinical and radiological teams.
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Affiliation(s)
- Emmanuel Gbegli
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Ahmad Miremadi
- Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Eva Mendes Serrao
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
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12
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Boudriiya T, Zouaoui I, Lachkar S, El Mamoune M, Aoufi S. A Rare Case of a Retroperitoneal Abscess Due to Trichosporon spp. in an Immunocompetent Patient. Cureus 2024; 16:e55656. [PMID: 38586770 PMCID: PMC10997153 DOI: 10.7759/cureus.55656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
This report discusses a rare case of retroperitoneal infection caused by Trichosporon spp. in a 68-year-old immunocompetent woman following a nephrectomy. Trichosporon spp. was identified through meticulous mycological examination. This case challenges the typical association of Trichosporon infections with immunocompromised patients, emphasizing its potential pathogenicity in immunocompetent individuals. The importance of accurate identification, especially in postoperative infections and broad-spectrum antibiotic contexts, is highlighted, emphasizing the need for a thorough diagnostic approach in such cases.
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Affiliation(s)
- Tamer Boudriiya
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Imane Zouaoui
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Salim Lachkar
- Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Mostaine El Mamoune
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
| | - Sarra Aoufi
- Central Laboratory of Parasitology and Mycology, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, MAR
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13
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Maldonado-Pérez A, Estronza S, Maldonado HJ, Pastrana EA, De Jesus O. Cervical Intramedullary Spinal Cord Abscess Secondary to Discitis and Osteomyelitis in an Immunocompromised Patient. Cureus 2024; 16:e56477. [PMID: 38638746 PMCID: PMC11025874 DOI: 10.7759/cureus.56477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Intramedullary spinal cord abscess is a rare neurological condition, not commonly suspected and often misdiagnosed. Even after a prompt diagnosis and treatment, most patients persist with permanent neurological deficits. In adults, factors such as immunocompromised, intravenous drug use, endocarditis, and sepsis could be associated with its development. In this study, we present the case of a 63-year-old male patient who developed a chronic cervical intramedullary spinal cord abscess after being treated for multiple abscesses in the paravertebral and psoas muscles. A diagnosis of cervical intramedullary spinal cord abscess secondary to osteomyelitis and discitis was made. He underwent a two-stage cervical surgery, with drainage of the abscess, spinal stabilization, and intravenous antibiotics. Although rare, vertebral osteomyelitis and discitis may be related to its development. Early diagnosis, prompt abscess drainage, and appropriate antibiotic therapy are of utmost importance to improve prognosis and minimize the long-term sequelae and complications of permanent neurological deficits.
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Affiliation(s)
| | - Samuel Estronza
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Hiram J Maldonado
- Neurosurgery/Critical Care Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Emil A Pastrana
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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14
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Kinay T, Akay A, Aksoy M, Celik Balkan F, Engin Ustun Y. Risk factors for antibiotic therapy failure in women with tubo-ovarian abscess: A systematic review and meta-analysis. J Obstet Gynaecol Res 2024; 50:298-312. [PMID: 38184888 DOI: 10.1111/jog.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
AIM Medical therapy with antibiotics only and surgical drainage are the treatment options of tubo-ovarian abscess (TOA). It is not yet known exactly which cases need surgical treatment. The aim of this systematic review and meta-analysis was to evaluate the risk factors leading antibiotic therapy failure in women with TOA. METHODS We searched the following databases from inception to June 1, 2022: PubMed, Ovid MEDLINE, The Cochrane Library, and Scopus. We also searched reference lists of eligible articles and related review articles. The observational cohort, cross-sectional, and case-control studies were included in the meta-analysis. At least four review authors independently selected eligible articles, assessed risk of bias, and extracted data. The random effect model was used in the meta-analysis. RESULTS A total of 29 studies, including 2890 women, were included in the study. The age, abscess size, history of intrauterine device use, postmenopausal status, history of diabetes mellitus, fever, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, and history of pelvic inflammatory disease were found as significant risk factors for antibiotic therapy failure in women with TOA. CONCLUSIONS The findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.
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Affiliation(s)
- Tugba Kinay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Arife Akay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Munevver Aksoy
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Fatma Celik Balkan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
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15
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Li X, Zeng D, Shi J. Effect of angiogenesis inhibitors on wound healing in patients with ovarian cancer: A meta-analysis. Int Wound J 2024; 21:e14737. [PMID: 38468423 PMCID: PMC10928245 DOI: 10.1111/iwj.14737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/21/2024] [Indexed: 03/13/2024] Open
Abstract
Angiogenic inhibitors have been demonstrated to inhibit tumour cells in ovarian carcinoma, but the initial data are not accurate enough to indicate the influence of these drugs on the post-therapy wound healing. In order to assess the effect of angiogenic inhibitors on the treatment of wound healing in ovarian carcinoma, we performed a meta-analysis of related literature. For this meta-analysis, we looked up the data from 4 databases: PubMed, EMBASE, Web of Science and the Cochrane Library. All literature searches were performed up to October 2023. The ROBINS-I tool was applied to evaluate the risk of bias in the inclusion trials, and statistical analysis was performed with RevMan 5.3. In this research, 971 related research were chosen, and 9 of them were selected. These studies were published between 2013 and 2023. In all 9 trials, a total of 3902 patients were enrolled. There was a significant reduction in the risk of wound infection in the control group than in those who received angiogenesis inhibitors (OR, 0.66; 95% CI, 0.49-0.89 p = 0.007). The risk of developing an abscess was not significantly different from that of those who received angiogenesis inhibitors (OR, 0.80; 95% CI, 0.20-3.12 p = 0.74). The risk of perforation in the control group was smaller than that in those receiving angiogenic inhibitors (OR, 0.25; 95% CI, 0.11-0.56 p = 0.0006). There was a significant increase in the risk of injury and GI perforation in women who received angiogenic inhibitors than in the control group. But the incidence of abscess did not differ significantly among the two groups.
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Affiliation(s)
- Xin Li
- School of medicineWuhan University of Science and TechnologyWuhanChina
| | - Deyang Zeng
- School of medicineWuhan University of Science and TechnologyWuhanChina
| | - Jing Shi
- Department of PharmacyPeking University Third HospitalBeijingChina
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16
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Bomphrey L, Hayden A, Plant AJ. Isolated Fusobacterium nucleatum Growth in the Blood Culture of a Middle-Aged Man With Lumbar Discitis, Surrounding Psoas Abscesses, and an Inferior Vena Cava Thrombus. Cureus 2024; 16:e55306. [PMID: 38562315 PMCID: PMC10982156 DOI: 10.7759/cureus.55306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Pyogenic spinal infections (PSI) have an incidence of 0.5-2.2 cases per 100,000 population, though diagnosis can be delayed by up to three months. The incidence of Fusobacterium nucleatum bacteremia is rare, occurring in 0.22-0.34 cases per 100,000 population, whilst its implication in spinal infections is rarer still. A man in his 60s with a background of chronic lower back pain presented to the emergency department with a two-week history of worsening back pain associated with fever and difficulty voiding. He was initially managed as pyelonephritis due to the recent history of urinary tract infection (UTI) with fever and flank pain. However, there were radiculopathy and bilateral pain on hip flexion with reduced power on the right side. The light-touch sensation was reduced over the right hallux and distal L4 dermatome. These neurological deficits associated with deranged infective markers made a diagnosis of discitis plausible. Discitis and native vertebral osteomyelitis (NVO) should be suspected in patients reporting a fever and back pain of recent onset or increasing in severity. Once discitis was confirmed, the patient was subsequently tested for tuberculosis (TB) using a T-SPOT, human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus, with no positive findings, but in the days following, blood cultures yielded F. nucleatum. Guided by knowing the natural reservoirs in the body, establishing the source of F. nucleatum could be achieved through head and neck imaging and investigating the gastrointestinal tract for malignant or inflammatory processes.
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Affiliation(s)
| | | | - Aiden J Plant
- Microbiology, Black Country Pathology Services, Wolverhampton, GBR
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17
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Kawataki M, Oda Y. Low attenuation areas in necrotizing soft tissue infection. Clin Case Rep 2024; 12:e8566. [PMID: 38435504 PMCID: PMC10907342 DOI: 10.1002/ccr3.8566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Necrotizing Soft Tissue Infection can be challenging to differentiate from abscesses based on computed tomography imaging findings only, so it is crucial to perform surgical debridement as early as possible.
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Affiliation(s)
- Masanori Kawataki
- Department of Respiratory Medicine, Ohara Healthcare FoundationKurashiki Central HospitalOkayamaJapan
| | - Yuta Oda
- Department of Critical Care Medicine, Ohara Healthcare FoundationKurashiki Central HospitalOkayamaJapan
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18
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Nakabayashi A, Tsujii A, Kim D, Tamada T, Yoshimura M, Isoda K, Ohshima S. Ultrasound and magnetic resonance image findings in a patient with a subungual abscess: A case report. Clin Case Rep 2024; 12:e8593. [PMID: 38444921 PMCID: PMC10912096 DOI: 10.1002/ccr3.8593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/04/2023] [Accepted: 01/04/2024] [Indexed: 03/07/2024] Open
Abstract
Subungual abscesses are rare, and information about them through imaging findings is lacking. Carbon dioxide laser drainage and antibiotics are effective treatment strategies for subungual abscesses. We report a case of a 47-year-old male healthcare worker with a subungual abscess that improved after manual drainage alone. Ultrasound and magnetic resonance images showed a tumor (with blood flow) between the nail plate and distal phalanx. Culture tests revealed Staphylococcus aureus. The patient's symptoms resolved quickly and the nail returned to normal after 4 months. This is possibly the first report of a subungual abscess with ultrasound and magnetic resonance imaging findings.
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Affiliation(s)
- Akihiko Nakabayashi
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Atsuko Tsujii
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Dong‐seop Kim
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Tatsuya Tamada
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Maiko Yoshimura
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Kentaro Isoda
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
| | - Shiro Ohshima
- Department of RheumatologyNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
- Department of Clinical ResearchNational Hospital Organization Osaka Minami Medical CenterOsakaJapan
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19
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Fontes CAP, Bedran Ananias ML, Garcia Alves da Trindade J. Pulmonary abscess with atypical topography - computed tomography assessment before and after treatment. J Infect Dev Ctries 2024; 18:315-317. [PMID: 38484348 DOI: 10.3855/jidc.17685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/26/2023] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION We present a clinical case of a patient with neurological sequelae, dementia, gastrostomy and tracheostomy with a metal canula, who developed a lung abscess in an atypical topography, in the anterior segment of the left upper lobe, being attended to in the emergency department. CASE PRESENTATION A 79-year-old man who was bedridden and with neurological sequelae resulting from a hemorrhagic stroke, with gastrostomy and tracheostomy with a metal canula, was attended for daily fever and increased secretion trough the canula, and a diagnosis of bronchoaspiration pneumonia was made. The chest X-ray was unremarkable with an evaluation impaired by the patient's posture. The chest CT showed a characteristic image of an abscess in the topography of the anterior segment of the upper lobe. Improvement in the patient`s clinical condition was accompanied by an improvement in the CT imaging results. And the other exams carried out did not show any other associated lung disease. DISCUSSION Chest X-ray is still the initial method for studying infectious lung lesions, and CT is indicated in cases where the appearance of the lesion is not well defined, if doubts persist, whether the patient is immunosuppressed or oncological. CT can provide better definition of abscess imaging findings and is particularly useful for visualizing cavities not well delineated by X-ray, especially when a malignant neoplastic tumor lesion is suspected or when there is an associated pleural collection.
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Affiliation(s)
| | - Mary Lúcia Bedran Ananias
- Department of Radiology, Faculty of Medicine, Antônio Pedro University Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brasil
| | - Juliana Garcia Alves da Trindade
- Department of Radiology, Faculty of Medicine, Antônio Pedro University Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brasil
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20
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Li Z, Hannan MN, Sharma AK, Baran TM. Treatment planning for photodynamic therapy of abscess cavities using patient-specific optical properties measured prior to illumination. Phys Med Biol 2024; 69:055031. [PMID: 38316055 PMCID: PMC10900070 DOI: 10.1088/1361-6560/ad2635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
Photodynamic therapy (PDT) is an effective antimicrobial therapy that we used to treat human abscess cavities in a Phase 1 clinical trial. This trial included pre-PDT measurements of abscess optical properties, which affect light dose (light fluence) at the abscess wall and PDT response. This study simulated PDT treatment planning for 13 subjects that received optical spectroscopy prior to clinical PDT, to determine the impact of measured optical properties on ability to achieve fluence rate targets in 95% of the abscess wall. Retrospective treatment plans were evaluated for 3 conditions: (1) clinically delivered laser power and assumed, homogeneous optical properties, (2) clinically delivered laser power and measured, homogeneous optical properties, and (3) with patient-specific treatment planning using measured, homogeneous optical properties. Treatment plans modified delivered laser power, intra-cavity Intralipid (scatterer) concentration, and laser fiber type. Using flat-cleaved laser fibers, the proportion of subjects achieving 95% abscess wall coverage decreased significantly relative to assumed optical properties when using measured values for 4 mW cm-2(92% versus 38%,p= 0.01) and 20 mW cm-2(62% versus 15%,p= 0.04) thresholds. When measured optical properties were incorporated into treatment planning, the 4 mW cm-2target was achieved for all cases. After treatment planning, optimal Intralipid concentration across subjects was 0.14 ± 0.09%, whereas 1% was used clinically. Required laser power to achieve the 4 mW cm-2target was significantly correlated with measured abscess wall absorption (ρ= 0.7,p= 0.008), but not abscess surface area (ρ= 0.2,p= 0.53). When using spherical diffuser fibers for illumination, both optimal Intralipid concentration (p= 0.0005) and required laser power (p= 0.0002) decreased compared to flat cleaved fibers. At 0% Intralipid concentration, the 4 mW cm-2target could only be achieved for 69% of subjects for flat-cleaved fibers, compared to 100% for spherical diffusers. Based on large inter-subject variations in optical properties, individualized treatment planning is essential for abscess photodynamic therapy. (Clinical Trial Registration: The parent clinical trial from which these data were acquired is registered on ClinicalTrials.gov as 'Safety and Feasibility Study of Methylene Blue Photodynamic Therapy to Sterilize Deep Tissue Abscess Cavities,' with ClinicalTrials.gov identifier NCT02240498).
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Affiliation(s)
- Zihao Li
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Md Nafiz Hannan
- Department of Physics and Astronomy, University of Rochester, Rochester, NY, United States of America
| | - Ashwani K Sharma
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Timothy M Baran
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States of America
- The Institute of Optics, University of Rochester, Rochester, NY, United States of America
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21
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Grande-Moreillo C, Fuentes-Carretero S, Corella-Vicente F, Margarit-Mallol J. Unexpected location of a pilonidal sinus. Pediatr Dermatol 2024. [PMID: 38413127 DOI: 10.1111/pde.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on the scalp and its management.
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Affiliation(s)
- Carme Grande-Moreillo
- Pediatric Surgery Department Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Pediatric Surgery Unit, Consorci Sanitari Alt Penedès i Garraf, Barcelona, Spain
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22
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Kami W, Baba M, Chinen T, Fujita J. Lung Hepatization to Lung Abscess with Pneumococcal Pneumonia. Intern Med 2024:3226-23. [PMID: 38403758 DOI: 10.2169/internalmedicine.3226-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Affiliation(s)
- Wakaki Kami
- Department of Respiratory Medicine, Ohama Dai-ichi Hospital, Japan
- Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Motoo Baba
- Department of Respiratory Medicine, Ohama Dai-ichi Hospital, Japan
| | - Tetsu Chinen
- Department of Respiratory Medicine, Ohama Dai-ichi Hospital, Japan
| | - Jiro Fujita
- Department of Respiratory Medicine, Ohama Dai-ichi Hospital, Japan
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23
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Tosunoğlu Z, Doğan S, Turan Bektaş C, Çermik TF, Arslan E. Detection of Rare Gallbladder Microperforation by 18F-FDG PET/CT in a Patient with Maxillary Sinus Cancer. Mol Imaging Radionucl Ther 2024; 33:47-49. [PMID: 38390789 PMCID: PMC10899745 DOI: 10.4274/mirt.galenos.2023.27576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Gallbladder perforation is one of the most serious complications of cholecystitis and is rarely seen in 2-11% of cases. Pericholecystic abscesses secondary to gallbladder perforation are rare. Rapid diagnosis is important because of high morbidity and mortalityrates. A subcapsular abscess secondary to gallbladder microperforation is presented on 18F-fluorodeoxyglucose positron emission tomography/computed tomography performed for restaging in a patient with maxillary sinus cancer.
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Affiliation(s)
- Zehranur Tosunoğlu
- University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Türkiye
| | - Selim Doğan
- University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Clinic of Surgery, İstanbul, Türkiye
| | - Ceyda Turan Bektaş
- University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Clinic of Radiology, İstanbul, Türkiye
| | - Tevfik Fikret Çermik
- University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Türkiye
| | - Esra Arslan
- University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Türkiye
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24
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Goonetilleke A, Nandasena M, Fernandopulle N, Matthias AT. Coeliac lymph node abscess: A case report of a rare manifestation of extrapulmonary tuberculosis. SAGE Open Med Case Rep 2024; 12:2050313X241229640. [PMID: 38333519 PMCID: PMC10851757 DOI: 10.1177/2050313x241229640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
Tuberculosis is a leading cause of death worldwide, especially in developing countries. It can affect any site in the body and have a myriad of presentations making diagnosis challenging. Tuberculous lymphadenitis in the abdomen is rare. We present a case of a 42-year-old man who presented with non-specific abdominal symptoms and was found to have an intraabdominal abscess on computed tomography scan of the abdomen. Endoscopic ultrasound-guided aspiration was performed, and tuberculosis was confirmed. This case highlights the importance of having a high clinical suspicion of tuberculosis even with vague symptoms in tuberculosis endemic countries. This would prevent unnecessary surgery as tuberculosis is responsive to anti-tuberculosis drugs.
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Affiliation(s)
- Asitha Goonetilleke
- University Medical Unit, Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - Malith Nandasena
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Anne Thushara Matthias
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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25
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Zhao Y, Zhang JY, Ullah S, Zheng QF, Liu D, Wang M, Zhao LX, Shi M, Li DL, Liu BR. Massive continuous irrigation (MCI) and endoscopic debridement as an alternative treatment strategy for refractory abscess-fistula complexes. J Dig Dis 2024; 25:133-139. [PMID: 38511408 DOI: 10.1111/1751-2980.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the feasibility, safety, and efficacy of massive continuous irrigation (MCI) and endoscopic debridement for the treatment of refractory abscess-fistula complexes. METHODS This was a retrospective single-center observational study involving 12 patients with refractory abscess-fistula complexes. All patients had experienced long-term treatment failure or had failed multiple treatment modalities. We used over two catheters and inserted them via the gastrointestinal (GI) tract or percutaneously to form a circulation pathway to achieve MCI of normal saline, endoscopic debridement was then performed. The treatment success rate, irrigation volume and treatment duration, time to abscess-fistula complex closure, intra-treatment complications, and recurrence rate were recorded. RESULTS The treatment success rates were 100%. The median time of previous treatment was 32 days (range 7-912 days). The mean time from the use of the novel treatment strategy to abscess-fistula complex healing was 18.8 ± 11.0 days. The mean volume of irrigation was 10 804 ± 1669 mL/24 h. The mean irrigation time was 16.5 ± 9.2 days, and a median of two irrigation tubes (range 2-5) were used. No complications occurred either during or after the procedure. During the follow-up of 23.1 ± 18.1 months, no recurrence or adverse events were noted. CONCLUSIONS MCI and endoscopic debridement may be a feasible, safe, and effective alternative treatment for refractory abscess-fistula complexes. Large prospective studies are needed to validate our results.
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Affiliation(s)
- Yue Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ji Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qing Fen Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Dan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Meng Wang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Li Xia Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Miao Shi
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - De Liang Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bing Rong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Yang F, Malavia M, Chali A, Keeler J. Labial Necrotizing Fasciitis Caused by Pelvic Eggerthia catenaformis Infection. Cureus 2024; 16:e53625. [PMID: 38449955 PMCID: PMC10916910 DOI: 10.7759/cureus.53625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
A patient with comorbid diabetes mellitus, obesity, and hypertension acutely presented to the ED due to labial cellulitis with rapidly progressing symptoms of systemic inflammation. Clinical examination revealed fever and groin pain that was tender to palpation. Initial contrast-enhanced CT scans showed labial cellulitis extending to the inguinal canal, with later CT imaging findings of subcutaneous air indicative of necrotizing fasciitis (NF). Antimicrobial therapy was initiated empirically and later tailored to culture antibiogram. The patient underwent acute surgical abscess drainage and tissue debridement but was transferred to the surgical intensive care unit (SICU) due to postoperative blood loss and hypotension. Two additional surgical procedures were needed before sufficient drainage was achieved, and Eggerthia catenaformis (E. catenaformis) was isolated from all samples. Due to the extent of the infection, the patient was admitted for a total of 16 days, with five days spent in the SICU. They recovered completely due to adequate surgery and antimicrobial therapy for a total of 24 days. Here, we present the third reported case of NF due to E. catenaformiswhile emphasizing timely treatment with empiric antibiotics and surgical intervention.
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Affiliation(s)
- Felix Yang
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mira Malavia
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Ashna Chali
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Jared Keeler
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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Dhayhi NS, Mahnashi MA, Mokhasha AI, Ahmed LF, Shamakhi AE, Ageel AA, Tohary MA, Alhazmi AH. Case report of congenital neutropenia type 4 with glucose-6-phosphatase catalytic subunit 3 (G6PC3) deficiency. Clin Case Rep 2024; 12:e8540. [PMID: 38385051 PMCID: PMC10879636 DOI: 10.1002/ccr3.8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
Congenital neutropenia syndromes encompass a group of genetic disorders characterized by persistent neutropenia and recurrent infections inherited in an autosomal recessive, dominant, or X-linked manner. These syndromes arise from mutations in various genes, and one of the significant genes involved is glucose-6-phosphatase catalytic subunit 3 (G6PC3), giving rise to a condition known as Dursun syndrome. As per existing knowledge, a total of 92 cases of Dursun syndrome have been reported globally, including eight cases from Saudi Arabia. Our study identified two additional cases exhibiting neutropenia since the early postnatal period and recurrent admissions due to infections. Additionally, these patients presented with oral ulcers, chronic diarrhea, and anomalies affecting the cardiac and genitourinary systems. The rising incidence of congenital neutropenia on a global scale necessitates heightened vigilance among clinicians to ensure thorough follow-up of patients with neutropenia. This proactive approach can lead to early detection and appropriate management of associated complications, ultimately improving patient outcomes.
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Affiliation(s)
- Nabil S Dhayhi
- Pediatric Infectious Disease Unit King Fahad Central Hospital Jazan Saudi Arabia
| | - Mohammed A Mahnashi
- Pediatric Genetic Diseases Unit King Fahad Central Hospital Jazan Saudi Arabia
| | | | - Lana F Ahmed
- Pediatric Department King Fahad Central Hospital Jazan Saudi Arabia
| | - Ahmed E Shamakhi
- Pediatric Allergy/Immunology Unit King Fahad Central Hospital Jazan Saudi Arabia
| | - Adeeb A Ageel
- Pediatric Hematology Unit Kung Fahad Central Hospital Jazan Saudi Arabia
| | - Mohammed A Tohary
- Pediatric Hematology Unit Kung Fahad Central Hospital Jazan Saudi Arabia
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Greenfield-Feig MR, Tarpley RJ, Traversi JP, Meegan JM, Jensen ED. Pre-anal gland abscess in a male Atlantic bottlenose dolphin (Tursiops truncatus). J Am Vet Med Assoc 2024; 262:1-4. [PMID: 38016286 DOI: 10.2460/javma.23.09.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Anal glands have been identified in a variety of terrestrial and aquatic mammalian species, but there are few accounts describing their presence in cetaceans. To our knowledge, this report describes the first documented case of a pre-anal gland abscess in an Atlantic bottlenose dolphin (Tursiops truncatus). ANIMAL A 9-year-old male bottlenose dolphin (T truncatus) part of the US Navy Marine Mammal Program in San Diego Bay, California. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The patient presented for a 3-day history of lethargy, failure to perform voluntary behaviors, and an elevated respiratory rate. Complete blood count and serum biochemistry results showed an inflammatory hemogram. Physical examination revealed a 4-cm circular swelling at the right pre-anal gland pore. The swelling was warm and erythematous, with multifocal pinpoint ulcerations. An abscess of the pre-anal gland was diagnosed using cytology, culture, and ultrasound. TREATMENT AND OUTCOME Treatment included systemic oral antibiotic and antifungal therapy, along with daily lavage and warm compress of the gland. Treatment was successful, and the abscess resolved. CLINICAL RELEVANCE This case provides insight into a previously unreported disease process in bottlenose dolphins and encourages veterinarians to evaluate the pre-anal gland during routine physical examinations and complete further work-up if swelling or clinical signs associated with this region are present.
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Affiliation(s)
| | - Raymond J Tarpley
- 2College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | | | | | - Eric D Jensen
- 4United States Navy Marine Mammal Program, Naval Information Warfare Center Pacific, San Diego, CA
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Raxwal B, Payappagoudar J, Patel S. Endoscopic Retrograde Appendicitis Therapy in Subacute Appendicitis With Abscess: A Comprehensive Case Study and Innovative Insights. Cureus 2024; 16:e54087. [PMID: 38487134 PMCID: PMC10937217 DOI: 10.7759/cureus.54087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
This case report explores the feasibility and efficacy of endoscopic retrograde appendicitis therapy (ERAT) in treating a 42-year-old female with subacute appendicitis complicated by an abscess. The patient, initially presenting with abdominal pain, underwent an endoscopic intervention involving drainage, irrigation, and stent placement in the appendix. The study discusses the patient's successful outcome, emphasizing the role of ERAT in managing complicated appendicitis with abscesses. The report outlines the case presentation with the initial misdiagnosis of cecal intussusception. The endoscopic procedure involved identifying a partially prolapsed appendix, spontaneous drainage of purulent discharge, and subsequent stent placement to facilitate drainage while awaiting definitive surgery. The patient's positive response to ERAT was marked by pain reduction and a follow-up CT scan confirming the absence of an abscess and a normal appendix. The case report asserts that ERAT emerges as a promising alternative to immediate appendectomy for patients with subacute appendicitis complicated by abscesses, enhancing symptom relief and reducing major adverse events.
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Affiliation(s)
- Bhuvi Raxwal
- Medicine, Access Health Care Physicians, Zephyrhills, USA
| | | | - Satish Patel
- Gastroenterology, HCA Florida Trinity Hospital, New Port Richey, USA
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Dualim DM, Wong MPK, Rusli SM, Elnaim Ali ALK, Sagap I. Ligation of the Intersphincteric Fistula Tract as an Emergency Treatment for Cryptoglandular Anal Fistula. Malays J Med Sci 2024; 31:62-70. [PMID: 38456116 PMCID: PMC10917591 DOI: 10.21315/mjms2024.31.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/06/2023] [Indexed: 03/09/2024] Open
Abstract
Introduction Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treating anal fistula of cryptoglandular origin. Our prospective study aimed to determine the postoperative outcomes of patients undergoing LIFT in emergency and elective settings. Methods This was a single-centre prospective observational study of the LIFT procedure for the treatment of anal fistulas. The differences in the 6-month postoperative outcomes between the emergency and elective procedures were analysed, including the healing rate, healing time, recurrence rate, recurrence time, postoperative complications and length of hospital stay. Results Twenty-two patients were recruited for this study: 11 patients underwent LIFT as an emergency procedure (EM-LIFT), while the others underwent LIFT as an elective procedure (EL-LIFT). The healing rate for the EM-LIFT group was 90.9% (n = 10), with a median healing time of 2 months (range 0.5-4). For the EL-LIFT group, the healing rate was 100% (n = 11), with the same median healing time of 2 months (range 0.5-4). Two of the patients in the EM-LIFT group developed recurrence, with a median recurrence time of 5 months (range 4-6) and three developed recurrence in the EL-LIFT group, with the same median recurrence time of 5 months (range 4-6). There were minor postoperative complications of pain and subcutaneous infection, with no faecal incontinence. There was no statistically significant difference in postoperative outcomes between the groups. Conclusion EM-LIFT is a feasible and safe primary procedure for active cryptoglandular-type anal fistulas.
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Affiliation(s)
- Diana Melissa Dualim
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Michael Pak-Kai Wong
- School of Medical Sciences and Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Siti Mayuha Rusli
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Ismail Sagap
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Nanu C, Ciocan LA, Radu G, Sumedrea L, Popescu GA, Borcan AM. Fusobacterium necrophorum intratonsillar abscess as a source of bacteremia in a patient with a history of substance abuse. J Infect Dev Ctries 2024; 18:158-161. [PMID: 38377084 DOI: 10.3855/jidc.18268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 02/22/2024] Open
Abstract
A 22-year-old male, with a history of recreational drug use, was admitted with a 24-hour history of sore throat, bilateral otalgia, fever, chills, sweats, and pain in the upper chest. The blood cultures were positive for Fusobacterium necrophorum. A thoracic and neck soft tissue computed tomography (CT) scan revealed an intratonsillar abscess and pulmonary septic emboli. Initial treatment with Piperacillin-tazobactam and Clindamycin was de-escalated after 5 days. The patient made a complete recovery after 22 days of antibiotic treatment.
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Affiliation(s)
- Claudiu Nanu
- University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu 37, 020022, Bucharest, Romania
| | - Liana Adela Ciocan
- University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu 37, 020022, Bucharest, Romania
| | - Georgiana Radu
- University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu 37, 020022, Bucharest, Romania
| | - Liliana Sumedrea
- University of Medicine and Pharmacy "Carol Davila", Dionisie Lupu 37, 020022, Bucharest, Romania
| | - Gabriel Adrian Popescu
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Grozovici 1, 021105, Bucharest, Romania
| | - Alina Maria Borcan
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Grozovici 1, 021105, Bucharest, Romania
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Ciuntu BM, Tanevski A, Buescu DO, Lutenco V, Mihailov R, Ciuntu MS, Zuzu MM, Vintila D, Zabara M, Trofin A, Cadar R, Nastase A, Lupascu Ursulescu C, Lupascu CD. Endoscopic Vacuum-Assisted Closure (E-VAC) in Septic Shock from Perforated Duodenal Ulcers with Abscess Formations. J Clin Med 2024; 13:470. [PMID: 38256604 PMCID: PMC10816729 DOI: 10.3390/jcm13020470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This case report underscores the importance of utilizing E-VAC (endoscopic vacuum-assisted closure) in the treatment of a perforated duodenal ulcer complicated by the formation of a subphrenic abscess and septic shock. It showcases how E-VAC can effectively mitigate the risk of further complications, such as leakage, bleeding, or rupture, which are more commonly associated with traditional methods like stents, clips, or sutures. As a result, there is a significant reduction in mortality rates. A perforated duodenal ulcer accompanied by abscess formation represents a critical medical condition that demands prompt surgical intervention. The choice of the method for abscess drainage and perforation closure plays a pivotal role in determining the patient's chances of survival. Notably, in patients with a high ASA (American Association of Anesthesiologists) score of IV-V, the mortality rate following conventional surgical intervention is considerably elevated. The management of perforated duodenal ulcers has evolved from open abdominal surgical procedures, which were associated with high mortality rates and risk of suture repair leakage, to minimally invasive techniques like laparoscopy and ingestible robots. Previously, complications arising from peptic ulcers, such as perforations, leaks, and fistulas, were primarily addressed through surgical and conservative treatments. However, over the past two decades, the medical community has shifted towards employing endoscopic closure techniques, including stents, clips, and E-VAC. E-VAC, in particular, has shown promising outcomes by promoting rapid and consistent healing. This case report presents the clinical scenario of a patient diagnosed with septic shock due to a perforated duodenal ulcer with abscess formation. Following an exploratory laparotomy that confirmed the presence of a subphrenic abscess, three drainage tubes were utilized to evacuate it. Subsequently, E-VAC therapy was initiated, with the kit being replaced three times during the recovery period. The patient exhibited favorable progress, including weight gain, and was ultimately discharged as fully recovered. In the treatment of patients with duodenal perforated ulcers and associated abscess formation, the successful and comprehensive drainage of the abscess, coupled with the closure of the perforation, emerges as a pivotal factor influencing the patient's healing process. The positive outcomes observed in these patients underscore the efficacy of employing a negative pressure E-VAC kit, resulting in thorough drainage, rapid patient recovery, and low mortality rates.
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Affiliation(s)
- Bogdan Mihnea Ciuntu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Adelina Tanevski
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - David Ovidiu Buescu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Valerii Lutenco
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Raul Mihailov
- Department of General Surgery, Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800010 Galati, Romania; (V.L.); (R.M.)
- General Surgery Clinic, “St. Apostol Andrei” County Emergency Clinical Hospital, Strada Brăilei 177, 800578 Galati, Romania
| | - Madalina Stefana Ciuntu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Mihai Marius Zuzu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Dan Vintila
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Mihai Zabara
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Trofin
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ramona Cadar
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Alexandru Nastase
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Cristian Dumitru Lupascu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania; (D.O.B.); (M.M.Z.); (D.V.); (M.Z.); (A.T.); (R.C.); (A.N.); (C.D.L.)
- General Surgery Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Pruijt MJ, de Voogd FAE, Montazeri NSM, van Etten-Jamaludin FS, D'Haens GR, Gecse KB. DIAGNOSTIC ACCURACY OF INTESTINAL ULTRASOUND IN THE DETECTION OF INTRA-ABDOMINAL COMPLICATIONS IN CROHN'S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Crohns Colitis 2024:jjad215. [PMID: 38173288 DOI: 10.1093/ecco-jcc/jjad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Crohn's disease (CD) is frequently associated with the development of strictures and penetrating complications. Intestinal ultrasound (IUS) is a non-invasive imaging modality ideal for point-of-care assessment. In this systematic review and meta-analysis we provide a current overview on the diagnostic accuracy of IUS and its advanced modalities in the detection of intra-abdominal complications in CD compared to endoscopy, cross-sectional imaging, surgery and pathology. METHOD We conducted a literature search for studies describing diagnostic accuracy of IUS in adult patients with CD related intra-abdominal complications. Quality of the included studies was assessed with the QUADAS-2 tool. Meta-analysis was performed for both conventional IUS (B-mode) and oral contrast IUS (SICUS). RESULTS Of the 1498 studies we identified, 68 were included in this review and 23 studies (3863 patients) were used for the meta-analysis. Pooled sensitivities and specificities for strictures, inflammatory masses and fistulas by B-mode IUS were 0.81 and 0.90, 0.87 (sensitivities) and 0.95, and 0.67 and 0.97 (specificities), respectively. Pooled overall log diagnostic odds ratios were 3.56, 3.97 and 3.84 respectively. Pooled sensitivity and specificity of SICUS were 0.94 and 0.95, 0.91 and 0.97 (sensitivities), and 0.90 and 0.94 (specificities), respectively. Pooled overall log diagnostic odds ratio of SICUS were 4.51, 5.46 and 4.80, respectively. CONCLUSION IUS is accurate for the diagnosis of intra-abdominal complications in CD. As a non-invasive, point-of-care modality, IUS is recommended as the first-line imaging tool if there is a suspicion of CD-related intra-abdominal complications.
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Affiliation(s)
- Maarten J Pruijt
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Floris A E de Voogd
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Nahid S M Montazeri
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | | | - Geert R D'Haens
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
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Alfehaid M, Aljohani M, Salati SA, Alaodah S, Alresheedi W, Almarshud R. Practices and Attitudes of Surgeons With Regard to Spilled Gallstones During Laparoscopic Cholecystectomy: A Cross-Sectional Study From Saudi Arabia. Cureus 2024; 16:e53115. [PMID: 38283781 PMCID: PMC10822716 DOI: 10.7759/cureus.53115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Gallbladder perforation and gallstone leakage are frequent complications following laparoscopic cholecystectomy (LC). Failure to remove gallstones may result in several issues that manifest immediately or years later. The goal of this study was to evaluate the attitudes of surgeons and the procedures used by them to deal with gallstone spillage during LC. METHODS A cross-sectional design was followed. Surgeons in nine healthcare facilities in the Qassim region of Saudi Arabia were approached through non-probability convivence sampling and the survey was distributed in each of the general surgery divisions. The study included general surgeons who currently performed LC and incomplete responses and interns were excluded. A self-administered questionnaire was developed with 18 questions regarding demographics, center, and designation at the hospital, surgeons' experience of LC, and exposure to gallstone spillage. Furthermore, items regarding knowledge, attitude, and self-reported practices related to gallstone spillage such as incidence, complications, and intervention taken to prevent gallstone spillage were also included. The level of significance was set at P <0.05. RESULTS There were 82 participants of both genders, including consultants, specialists, and residents. While only 23 (28%) participants had actually observed patients with complications from spilled stones, 46 (56.1%) participants were aware of this possibility, 53 (64.6%) deemed it inappropriate to bring up gallstone spillage when securing consent for LC, and 67 (81.7%) believed that such an incident needed to be documented in the operation notes. Only 11 (13.4%) thought that the complications arising out of the unretrieved gallstones should fall under the legal purview of the operative surgeon. There were very few complications of spilled gallstones that the participants were aware of, and none of them anticipated problems to arise more than three years after LC. CONCLUSIONS Awareness of the risks associated with gallstone spillage during LC needs to be raised, and it is imperative to standardize the practices related to their management.
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Affiliation(s)
- Mohammed Alfehaid
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Moath Aljohani
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Sajad A Salati
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Shoug Alaodah
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Wejdan Alresheedi
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Raghad Almarshud
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
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Kakkad J, Jain S, Reddy V, Saboo K, Naseri S. Post-burn Cervicofacial Necrotizing Fasciitis With Diabetic Ketoacidosis: A Report of a Case With a Favorable Outcome. Cureus 2024; 16:e53219. [PMID: 38425638 PMCID: PMC10902738 DOI: 10.7759/cureus.53219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Post-burn necrotizing fasciitis (PBNF) is a serious and potentially life-threatening infection that occurs after a burn injury. It is characterized by rapid destruction of soft tissue and muscle and is usually caused by a bacterial infection. Diabetic ketoacidosis (DKA) is another serious complication of diabetes, which can occur when the body does not have enough insulin to break down glucose for energy. This causes the body to start breaking down fat for energy instead, leading to various complications. The present study discusses the association between PBNF and DKA in a patient with diabetes. Here is a case of a post-auricular abscess and a precipitated DKA. The abscess was located near the site of the previous burn injury that happened 20 years ago and was believed to have developed as a result of thick scar tissue. The patient was given adequate hydration, intravenous antibiotics, and insulin therapy. However, the abscess continued to grow with increasing insulin requirements and the patient underwent incision and drainage to remove the infected tissue, and an aggressive debridement was carried out. Thus, this case highlights the importance of closely monitoring blood sugar levels in patients with a history of burn injury and diabetes, as well as the potential for infections to precipitate DKA. Timely intervention, including incision and drainage, can lead to successful resolution of symptoms and improved outcomes.
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Affiliation(s)
- Jasleen Kakkad
- Otolaryngology - Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha Jain
- Otolaryngology - Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Venkat Reddy
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhit Naseri
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Koo Y, Yun T, Chae Y, Lee D, Yu H, Cha S, Kim H, Yang M, Kang B. Serratia marcescens-associated subcutaneous abscess in a dog. Vet Med Sci 2024; 10:e1312. [PMID: 37904649 PMCID: PMC10766026 DOI: 10.1002/vms3.1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023] Open
Abstract
This report describes the clinical presentation and progression of a Serratia marcescens-associated subcutaneous abscess in a dog with hypothyroidism, hyperadrenocorticism and diabetes mellitus. The S. marcescens isolate was resistant to several antibiotics. Treatment with antibiotics and topical antiseptics was not successful.
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Affiliation(s)
- Yoonhoi Koo
- College of Veterinary MedicineKyungpook National UniversityDaeguRepublic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Hogeun Yu
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Sijin Cha
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Mhan‐Pyo Yang
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
| | - Byeong‐Teck Kang
- Laboratory of Veterinary Internal MedicineCollege of Veterinary MedicineChungbuk National UniversityCheongjuChungbukRepublic of Korea
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KV A, Arunachalam VK, Sherene H, Ethiraju V, Ranganathan R, SM G, Rajasekaran S, Mehta P, Cherian M. Comparison of Contrast-Enhanced 3D Imaging with 2D Imaging in the Evaluation of Perianal Fistula at 3T: A Prospective Observational Study. Indian J Radiol Imaging 2024; 34:95-102. [PMID: 38106872 PMCID: PMC10723969 DOI: 10.1055/s-0043-1775738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences. Materials and Methods Forty-four patients (mean age, 38.8 ± 15.3 [standard deviation]; 32 males, 12 females) with perianal fistula were included in this prospective study. The patients underwent conventional noncontrast, 2D sequences, diffusion-weighted imaging, followed by postcontrast, 2D T1 images in both axial and coronal planes, and 3D sequences at 3T. Acquisition times were recorded for each sequence. Each postcontrast sequence was evaluated in terms of image quality, presence of artifacts, fistula type, presence of an abscess, visibility, and number of internal orifices. The surgical findings were considered the gold standard. The imaging findings were compared with the surgical findings. Results In all three sequences, the fistula type and abscess were identified correctly in all patients. The sensitivity value for identification of ramifications utilizing CE 3D T1 VIBE sequence, CE 3D T1 SPACE, and CE 2D T1 images was 100, 86, and 36%, respectively. The number of internal orifices was identified by the CE 3D T1 VIBE and CE 3D T1 SPACE sequences in 100 and 92% of patients, respectively. CE 2D T1 images correctly identified internal orifices in 80% of patients. The overall scan time for each 3D sequence was shorter than for the combined postcontrast 2D sequences. Conclusion CE 3D T1 SPACE and CE 3D T1 VIBE sequences outperformed conventional CE 2D sequences in the evaluation of perianal fistulas in terms of visibility and the number of internal orifices with a shorter scanning time. Among the 3D sequences, CE 3D T1 VIBE is slightly superior to CE 3D T1 SPACE sequence.
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Affiliation(s)
- Abdulla KV
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | | | - Haleema Sherene
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Vijayakumaran Ethiraju
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Rupa Ranganathan
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Gowtham SM
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Sriman Rajasekaran
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Pankaj Mehta
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Mathew Cherian
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
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Turner GA, Tham N, Chandra R, Read DJ, Chittleborough TJ, McCormick JJ, Hayes IP. Management of acute perianal abscess: is surgeon specialization associated with improved outcomes? ANZ J Surg 2023. [PMID: 38131396 DOI: 10.1111/ans.18836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non-colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess. METHODS Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed. RESULTS Four-hundred and eight patients were included (150 CR, 258 non-CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69-2.01, P = 0.539). CONCLUSION Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment.
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Affiliation(s)
- Gregory A Turner
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nicole Tham
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Timothy J Chittleborough
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jacob J McCormick
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Unit, Department of Surgical Specialties, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Casillas-Berumen SS, Kasanga S, Salik A, Briski N, Alreqi MDA, Ali A, Kashan A, Garsondiya B. Does That Go There? A Rare Occurrence of Spontaneous Sternocleidomastoid Abscess without Trauma in a Diabetic Individual. Am J Case Rep 2023; 24:e942265. [PMID: 38113193 PMCID: PMC10750220 DOI: 10.12659/ajcr.942265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/17/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Spontaneous abscesses are generally typical in patients with significant risk factors and have been linked to numerous muscle groups. The sternocleidomastoid muscle, however, piqued our interest as an unusual location, especially in this patient who, other than diabetes mellitus, had no associated risk factors or signs of trauma. CASE REPORT A 61-year-old man appeared with neck pain, erythema, and swelling that had been present for 9 days and for which he had previously been examined in the Emergency Department. He was discharged on oral doxycycline after initial computed tomography (CT) of the neck revealed infiltration without collection. He returned with worsening symptoms and new-onset fever and chills. Vital signs were normal on assessment, with no evidence of trauma. Swelling was observed near the right sternocleidomastoid muscle insertion. A repeat CT scan of the neck revealed an abscess 2.5 cm in diameter. He was originally treated with empiric antibiotics before being moved to targeted medications. Incision and drainage were completed without complication. The patient was given a 6-week course of oral antibiotics. CONCLUSIONS Spontaneous intramuscular abscesses are uncommon in people who have had no previous trauma or other known risk factors, but could be encountered in diabetic patients with non-optimal blood glucose levels, due to bacteremia. As a result, these cases require a high level of suspicion to be recognized and treated early. The scarcity of literature on this illness makes determining the cause challenging. However, by highlighting this case, we intend to raise awareness and facilitate early diagnosis and treatment.
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40
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Chen J, Wen Y. Incomplete Kawasaki Disease Presenting as Retropharyngeal Abscess: A Case Report and Review of the Literature. Ear Nose Throat J 2023:1455613231218140. [PMID: 38083854 DOI: 10.1177/01455613231218140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Kawasaki disease (KD) is a cryptic and self-limiting vasculitis predominantly seen in children, often posing a diagnostic challenge due to its varied clinical presentations. Among these, the emergence of deep neck infections, particularly retropharyngeal abscesses, stands out as an extremely rare manifestation. Herein, we present a case of a 10-year-old girl who was hospitalized for fever, neck pain, swollen cervical lymph nodes, and increased inflammation markers. Although anti-infective treatment was initiated, her condition remained unchanged. A cervical computed tomography scan revealed an abscess in the retropharyngeal space. Remarkably, on the third day post-admission, the patient developed symptoms synonymous with KD, such as conjunctival redness, reddened lips, and a strawberry tongue. Subsequent treatment with high-dose intravenous immunoglobulins (IVIG) and oral aspirin led to swift symptom relief, including complete abscess resolution verified by a follow-up neck magnetic resonance imaging. This unique co-presentation of KD and a retropharyngeal abscess, possibly linked to infections like Streptococcus or Staphylococcus aureus, underscores the importance of quick diagnosis and KD management, especially when conventional treatments prove ineffective.
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Affiliation(s)
- Jun Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics, Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
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Oh CH. Clinical efficacy and safety of percutaneous drainage for post-operative fluid collection in patients with bladder cancer undergoing radical cystectomy and urinary diversion. Medicine (Baltimore) 2023; 102:e36488. [PMID: 38065871 PMCID: PMC10713095 DOI: 10.1097/md.0000000000036488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
To evaluate the success rates of percutaneous drainage for fluid collection after radical cystectomy, with emphasis on factors affecting the clinical success, including lesion, patient, and procedure characteristics. In this retrospective study, 31 percutaneous drainage catheters were placed in 29 consecutive patients between January 2021 and September 2023. Most fluid collections formed near the uretero-ileal anastomosis site in the right pelvic cavity (80.6%). The technical success rate was 100%. The primary and final clinical success was 80.6% and 96.9%, respectively. Lymphoceles notably increased the primary clinical failure risk (odds ratio and 95% confidential interval: 22.667 (1.839-279.366), P = .015). Significant differences were observed between transabdominal and transgluteal approaches in terms of fluoroscopic time, dose, and location. Leakage indications on computed tomography prompted differing interventions, but all achieved final clinical success. Percutaneous drainage for post-operative fluid collection is safe and effective in patients with radical cystectomy and urinary diversion.
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Affiliation(s)
- Chang Hoon Oh
- Department of Radiology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Tiralongo F, Di Pietro S, Milazzo D, Galioto S, Castiglione DG, Ini’ C, Foti PV, Mosconi C, Giurazza F, Venturini M, Zanghi’ GN, Palmucci S, Basile A. Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template. Diagnostics (Basel) 2023; 13:3628. [PMID: 38132212 PMCID: PMC10742435 DOI: 10.3390/diagnostics13243628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey's modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Stefano Di Pietro
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Dario Milazzo
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Sebastiano Galioto
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Corrado Ini’
- Radiology Unit 1, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (D.G.C.); (C.I.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | | | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.D.P.); (D.M.); (S.G.); (P.V.F.); (S.P.); (A.B.)
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Ledo GN, Artese D, Álvarez NP, Lorenzo MN, Perdíz M, Romero JI, Cohen MV. Brodie abscess in the clavicle: an uncommon presentation. ARCH ARGENT PEDIATR 2023; 121:e202202937. [PMID: 36971508 DOI: 10.5546/aap.2022-02937.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Osteomyelitis is defined as an inflammation of the bone caused by infection. Acute osteomyelitis is common in pediatrics. A Brodie abscess is a type of subacute osteomyelitis, with a historically low incidence; however, its incidence is currently increasing. Given its little clinical impact, with non-specific laboratory tests and radiological studies of difficult interpretation, diagnostic suspicion is crucial. It resembles neoplasms, either benign or malignant. An adequate diagnosis falls on the health care provider's experience. Treatment consists of antibiotics, both parenteral and oral, with potential surgical drainage. Here we describe the case of a healthy female patient with a tumor found in the topography of the left clavicle 3 months before. She was diagnosed with Brodie abscess; treatment was started with a good response. A high index of suspicion of Brodie abscess is critical to avoid invasive tests and studies or inadequate treatments, and to prevent future sequelae.
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Affiliation(s)
- Guillermo N Ledo
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Dolores Artese
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Natalia P Álvarez
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Mariano N Lorenzo
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Melina Perdíz
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Juana I Romero
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María V Cohen
- Hospital Nacional de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Al-Thawwab NI, Alhashim MJ, Alharbi GS, Alharbi KM, Abdultawab AA. Pediatric Neck Swelling: A Case Report of Fourth Branchial Cleft Cyst. Cureus 2023; 15:e50149. [PMID: 38186420 PMCID: PMC10771579 DOI: 10.7759/cureus.50149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Pediatric neck masses present a diagnostic challenge, encompassing various etiologies, including rare entities like branchial cleft anomalies. Branchial cleft cysts, resulting from incomplete embryonic cleft obliteration, may become symptomatic. This case report describes a seven-year-old boy who presented with a week-long history of fever and progressively enlarging left anterior cervical swelling. Physical examination revealed a fluctuant, non-tender mass, prompting diagnostic investigations. Laboratory results indicated an elevated white blood cell count and inflammatory markers. Computed tomography identified a hypodense, rim-enhancing mass consistent with an abscess secondary to a fourth branchial cleft cyst. Ultrasound-guided aspiration yielded purulent material, confirming Staphylococcus aureus infection. This case highlights the clinical significance of fourth branchial cleft cysts as rare inflammatory neck masses in pediatric patients. The embryological context informs their diverse anatomical manifestations. Surgical excision remains the primary treatment, demanding consideration of anatomical complexities.
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Affiliation(s)
- Noor I Al-Thawwab
- General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Maryam J Alhashim
- General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Kawkab M Alharbi
- General Practice, Princess Nourah Bint Abdul Rahman University, Riyadh, SAU
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Chadha A, Joshi S, Ghumman JK. Conservative Management of a Rare Contiguously Spread Splenic Abscess. Cureus 2023; 15:e50747. [PMID: 38239539 PMCID: PMC10794161 DOI: 10.7759/cureus.50747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Splenic abscess is a rare condition that generally results from hematogenous spread and affects individuals with hemoglobinopathies or immunocompromising conditions. Although optimal management has recently been under contention, this condition was traditionally managed with splenectomy. We present a rare case of a 58-year-old male with chronic pancreatitis that developed a splenic abscess via a contiguous spread of a pancreatic pseudocyst. His condition was complicated by septic shock. The splenic abscess was managed with antibiotics, image-guided percutaneous drainage, and notably without surgical intervention.
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Affiliation(s)
- Arjun Chadha
- Internal Medicine, McLaren Macomb Medical Center, Mount Clemens, USA
| | - Saakshi Joshi
- Internal Medicine, McLaren Macomb Medical Center, Mount Clemens, USA
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Azhar U, Lin J, Sayed R, Masoud Z, Zamarud A, Kaler R. Perineal Abscess Following SpaceOAR Insertion. Cureus 2023; 15:e51050. [PMID: 38146336 PMCID: PMC10749505 DOI: 10.7759/cureus.51050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 12/27/2023] Open
Abstract
This case report discusses a 64-year-old male who presented with a perineal abscess following the insertion of the SpaceOAR hydrogel, highlighting a rare but potentially serious complication of the hydrogel. Hydrogel spacers have become integral in prostate cancer radiotherapy by reducing rectal toxicity. Ensuring proper technique, prophylactic antibiotics, and vigilant post-insertion monitoring are crucial for averting complications. This case underscores the significance of early diagnosis and management in preventing severe consequences and emphasizes the need for a high index of clinical suspicion when patients present with post-insertion symptoms.
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Affiliation(s)
- Umair Azhar
- Department of Radiology, Albert Einstein College of Medicine, New York, USA
| | - Justin Lin
- Internal Medicine, Northwell Health, New York, USA
| | - Rahman Sayed
- Department of Neurosurgery, Albert Einstein College of Medicine, New York, USA
| | - Zaki Masoud
- Internal Medicine, Albert Einstein College of Medicine, New York, USA
| | - Aroosa Zamarud
- Department of Neurosurgery, Stanford Health Care, Palo Alto, USA
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Datta D, Chatterjee D, Tiwari M. Lingual Abscess after Posterior Fossa Surgery: An Unusual Complication of the Concorde Position. Asian J Neurosurg 2023; 18:810-812. [PMID: 38161605 PMCID: PMC10756768 DOI: 10.1055/s-0043-1776299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Posterior fossa tumors are one of the most common tumors occurring in children. These tumors are often operated in the Concorde or prone position. Venous congestion can occur due to neck flexion during the positioning causing macroglossia. We report a case of a lingual abscess in a child after surgery in the Concorde position. There was no preoperative evidence of any lingual and dental complaints or injury during intubation. We hypothesize that the lingual abscess in the immediate postoperative period was secondary to venous stasis during the positioning for surgery.
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Affiliation(s)
- Debajyoti Datta
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Debarshi Chatterjee
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Mona Tiwari
- Department of Radiology, Institute of Neurosciences, Kolkata, West Bengal, India
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48
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Li H, Zhang T. A case report of Mycobacterium fortuitum infection after muscle injection. Medicine (Baltimore) 2023; 102:e36060. [PMID: 38050215 PMCID: PMC10695593 DOI: 10.1097/md.0000000000036060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Injection-related abscesses are a common complication in clinical practice, but the identification of infected bacteria might be difficult. PATIENT CONCERNS A 51-year-old female patient was admitted to the hospital due to a lump on her right buttock that emerged after receiving intramuscular injections to treat left shoulder joint pain. The lump gradually enlarged into a 3.0 to 4.5 cm mass at the time of admission with symptoms such as skin redness, itching, and pain. DIAGNOSES The patient received ultrasonic and other laboratory examinations. Laboratory results from the drainage indicated that the infection was caused by a rapidly growing mycobacteria and was confirmed as Mycobacterium fortuitum by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. INTERVENTIONS The patient was treated with antibiotics for 12 days after incision and drainage of the abscess in the right buttock. Local dressings were changed regularly. A migration lesion that appeared 3 days after treatment was drained and cleaned when it matured. OUTCOMES The lesion substantially decreased in size and the patient was discharged after 2 months of treatment. LESSONS Rapidly growing mycobacteria are rare but important pathogens that should be considered in patients with injection-related abscesses. Early identification and appropriate treatment can result in a favorable prognosis.
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Affiliation(s)
- Hao Li
- Clinical laboratory medicine in Pingdingshan Medical District, 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
| | - Tao Zhang
- Clinical laboratory medicine in Pingdingshan Medical District, 989 Hospital of PLA Joint Logistic Support Force, Pingdingshan, Henan, China
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Jekl V, Jeklova E, Hauptman K. Radical debridement guided by advanced imaging and frequent monitoring is an effective approach for the treatment of odontogenic abscesses and jaw osteomyelitis in rabbits: a review of 200 cases (2018-2023). J Am Vet Med Assoc 2023; 261:S52-S61. [PMID: 37793634 DOI: 10.2460/javma.23.06.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To report the prevalence and document the treatment and outcome of odontogenic abscesses and associated jaw osteomyelitis in pet rabbits. ANIMALS 200 client-owned rabbits. METHODS Pet rabbits surgically treated using extraoral teeth extraction with marsupialization for abscesses of dental origin and jaw osteomyelitis were included in the study (February 2018 to February 2023). A case must have had pre- and postoperative computed tomographic study and a follow-up period of at least 4 months. RESULTS In total, 113 male and 87 female rabbits were treated surgically. The mean age at the time of the diagnosis at the authors' clinic was 3 years and 11 months. Male rabbits suffered from odontogenic abscesses significantly more often than females. The mean surgical time varied from 25 to 95 minutes, based on the severity of the pathology and location. The wound healed completely in an average of 39.7 days (range, 14 to 145 days; 95% CI, 36.9 to 42.5 days). Major complications detected in 18.5% (37/200) cases were associated with prolonged healing time mostly due to the formation of a bone sequestrum and gingival suture failure. The disease-free time following abscess resolution was on average 29 months (range, 4 to 60 months). The recurrence of the odontogenic infection was 8% (16/200 cases). CLINICAL RELEVANCE The radical surgical technique with the extraction of all the infected teeth with the removal of all affected tissue and osteomyelitic bone and regular follow-up wound management is an effective method for the treatment of odontogenic abscesses with jaw osteomyelitis.
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Affiliation(s)
- Vladimir Jekl
- Jekl & Hauptman Veterinary Clinic - Focused on Exotic Companion Mammal Care, Brno, Czech Republic
- Department of Pharmacology and Pharmacy, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - Edita Jeklova
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, Brno, Czech Republic
| | - Karel Hauptman
- Jekl & Hauptman Veterinary Clinic - Focused on Exotic Companion Mammal Care, Brno, Czech Republic
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50
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Liang F, Cao J, Qin L, Zhang X. Giant Prostate Abscess: A Case Report and Literature Review. Am J Mens Health 2023; 17:15579883231219570. [PMID: 38130088 DOI: 10.1177/15579883231219570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Prostate abscess, a rare condition often associated with prostate bacterial infections, often occurs in immunosuppressive individuals and manifests as fever and lower urinary tract symptoms. Clinical practice lacks standardized diagnostic and treatment protocols for prostate abscesses, resulting in predominantly empirical approaches with uncertain outcomes. This study presents a case of a giant prostate abscess, diagnosed in a patient exhibiting fever, lower urinary tract symptoms (including dysuria, urinary frequency, urgency, and weakness), and anal pain. The diagnosis was confirmed through prostate magnetic resonance imaging and transrectal color ultrasound examinations. Treatment included targeted anti-infective therapy (based on the urine culture results), urine flow diversion (suprapubic bladder puncture stomy), ultrasound-guided perineal puncture drainage of the prostatic abscess, intermittent abscess cavity irrigation, and urethral electroprostatectomy. The patient experienced a complete recovery and significantly improved quality of life. This successful case underscores several key points: (1) the importance of targeted anti-infective therapy based on etiological findings in prostate abscess treatment; (2) early urine flow diversion, precise puncture drainage, and intermittent abscess cavity irrigation may be one of crucial elements in abscess management; (3) the potential significance of transurethral prostate resection following abscess resolution in preventing recurrence. It is hoped that this case report offers new valuable insights for diagnosing and treating prostate abscesses. Slightly different from previous treatment experience, we extra used early urine diversion, intermittent abscess cavity irrigation, and etiological electroprostatectomy, which might also hold promise as potential therapies.
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Affiliation(s)
- Fuchao Liang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Jun Cao
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Linghui Qin
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Xuejun Zhang
- Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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