RESUMO
AIM: This report addresses the management of a large persistent discharging lesion in an 11-year-old boy. The report describes the use of aspiration-irrigation technique for the management of immature necrotic tooth with persistent discharge after a failed regenerative procedure. BACKGROUND: Regenerative endodontics aim to provide an increase in root canal width, length, and in apical closure. Alternative procedures, such as apexification, should be attempted when regeneration fails. If the canal cannot be dried to persistent discharge, the aspiration-irrigation technique can be used. The technique relies on using aspiration along with irrigation to remove pus from the periapical area. CASE DESCRIPTION: This is a case for an 11-year-old patient who had trauma to tooth #11, which resulted in the complicated crown fracture. He had an emergency management that included pulpectomy and intracanal medication at another clinic. Two years later, the patient was presented to our clinic. Upon examination, the diagnosis was previously initiated therapy with asymptomatic apical periodontitis in immature tooth #11. Regeneration was attempted first but failed. The mineral trioxide aggregate (MTA) plug was removed, and the canal had persistent pus discharge. The canal was filled with intracanal medication, and then 2 weeks later, the canal was filled with triple antibiotic paste (TAP). Next visit, and due to continuous discharge, tooth #11 was treated conservatively with an intracanal aspiration-irrigation technique. An IrriFlex needle attached to a high-volume suction was used to aspirate the cystic fluid. Mineral trioxide aggregate plug apexification was performed in a later visit and the tooth was restored. CONCLUSION: During the 3-month and 16-month follow-up, there was resolution of the symptoms, a decrease in the periapical lesion size, and soft tissues appeared within normal limits. CLINICAL SIGNIFICANCE: Regenerative procedures are a good option for immature necrotic teeth. These procedures may fail due to persistent pus discharge from the root canals. The aspiration-irrigation technique is a good treatment option in cases of consciously discharging canals. How to cite this article: Alsofi L, Almarzouki S. Failed Regenerative Endodontic Case Treated by Modified Aspiration-irrigation Technique and Apexification. J Contemp Dent Pract 2024;25(1):92-97.
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Endodontia Regenerativa , Materiais Restauradores do Canal Radicular , Masculino , Humanos , Criança , Apexificação/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Ápice Dentário/patologia , Compostos de Cálcio/uso terapêutico , Combinação de Medicamentos , Óxidos/uso terapêutico , Compostos de Alumínio/uso terapêutico , Silicatos/uso terapêutico , Supuração/tratamento farmacológico , Supuração/patologia , Necrose da Polpa Dentária/terapiaRESUMO
BACKGROUND: Hand infections are a common reason for presenting to hospital and can be associated with significant morbidity and prolonged antibiotic use. Factors recognized to influence patient outcomes include resistant organisms and delayed presentation. Surgeons working around Australia may assume that hand infections and appropriate treatment algorithms will be similar between sites. This is the first study to examine differences between hand infections presenting in Darwin (with its tropical climate) vs. those in a more temperate city (Adelaide). METHODS: This is a two-site retrospective study, where diagnostic discharge codes were used to identify cases for a 12-month period and patient age, sex and rurality, duration of hospital stay, microbiology results and subsequent trips to theatre were reviewed. RESULTS: Despite significant differences in rurality between FMC and RDH patients, there was no significant difference in length of hospital stay, duration of intravenous antibiotics or return trips to theatre across the two sites. RDH reported a 25% rate of MRSA, compared to 18% at FMC, as well as a statistically significant increase in uncommon microbes, with 30% compared to 12% of patients growing microbes that may not be covered by antibiotics routinely administered in metropolitan areas. A limitation of this study was that compliance with antibiotics and hospital stay were not accounted for. CONCLUSION: It is often our training years that determine our norms of everyday practice, but fewer Australian surgical training posts are located in tropical centres. The results of this study highlight the importance of not assuming that the spectrum of organisms causing hand infections are the same as that in the surgeons' state of origin.
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Antibacterianos , Mãos , Humanos , Estudos Retrospectivos , Austrália/epidemiologia , Mãos/cirurgia , Antibacterianos/uso terapêutico , Supuração/tratamento farmacológicoRESUMO
BACKGROUND: Monkeypox is a zoonosis endemic in Africa caused by 3 orthopoxvirus clades. Knowledge of the disease is limited, but a worldwide outbreak involving a new route of transmission was declared in April 2022. OBJECTIVE: This study aimed to describe anal symptoms and outcomes in patients infected with Monkeypox virus presenting to an emergency proctology unit in Paris. DESIGN: This was an observational study. SETTING: We reported anal symptoms of all consecutive patients with monkeypox anal infection in a single proctology center between June 16, 2022, and July 26, 2022. Association with sexually transmitted infections and outcomes were also recorded. PATIENTS: Sixty-five men with a mean age of 39.6 (19.9-64.6) years with confirmed monkeypox anal infection were included in the study. MAIN OUTCOME MEASURES: Anal symptoms and their severity were clinically assessed. A favorable outcome consisted of a complete resolution of clinical manifestation. RESULTS: Sexual transmission was reported in 51 patients (78.4%), among whom 63 (97%) were men who have sex with men. Twenty-eight (43%) were living with HIV, and 24 (36.9%) were taking tenofovir/emtricitabine for HIV preexposure prophylaxis. Anal symptoms appeared first in 36 patients (55.4%) and skin rash or other general symptoms in 22 patients (33.8%). Incubation time was 6.9 (1-26) days. Symptoms included painful perianal (n = 42 patients; 64.6%), anal (n = 28, 43%), and rectal (n = 25; 38.4%) ulcerations and perianal vesicles (n = 24; 36.9%). Proctitis was observed in 49 patients (75.4%). It was mild in 20 (40.8%) and intense in 29 (59.2%), and severe proctitis mimicking high intersphincteric suppuration was found in 4 (8.2%). Fifteen patients (23.1%) had concurrent sexually transmitted infection and 3 were hospitalized. Complete symptom resolution occurred within 12 days. LIMITATIONS: We performed a single-center study during a short period of time. CONCLUSIONS: Proctological symptoms are frequent in the current outbreak of monkeypox disease, probably linked to the route of transmission. Rectal ulcerations mimicking high intersphincteric suppuration should be recognized to avoid unnecessary surgery. See Video Abstract . ENFERMEDAD ANAL DE LA VIRUELA DEL MONO DESCRIPCIN DE CASOS: ANTECEDENTES:La viruela del simio mono es una zoonosis endémica en África causada por tres clados de orthopoxvirus. El conocimiento de la enfermedad es limitado, pero en abril de 2022 se declaró un brote mundial que implica una nueva vía de transmisión.OBJETIVO:Describir los síntomas anales y los resultados en pacientes que sufren de infección por Monkeypox que asistieron a una unidad de proctología de emergencia en París.DISEÑO:Un estudio observacional.ESCENARIO:Informamos los síntomas anales de todos los pacientes consecutivos con infección anal por viruela del mono en un solo centro de proctología entre el 16/6/2022 y el 26/7/2022. También se registró la asociación con infecciones de transmisión sexual (ITS) y el resultado.PACIENTES:Sesenta y cinco hombres de 39,6 [19,9-64,6] años con infección anal confirmada.PRINCIPALES MEDIDAS DE RESULTADO:Los síntomas anales y su gravedad se evaluaron clínicamente. Un resultado favorable consistió en una resolución completa de la manifestación clínica.RESULTADOS:La transmisión sexual se informó en 51 (78,4%) pacientes, de los cuales 63 (97%) eran hombres que tuvieron sexo con hombres. Veintiocho (43%) vivían con el VIH y 24 (36,9%) tomaban Emtricitabina/Tenofovir para profilaxis previa por exposición al VIH. Los síntomas anales aparecieron primero en 36 (55,4%) pacientes y la erupción cutánea u otros síntomas generales en 22 (33,8%). El tiempo de incubación fue de 6,9 [1-26] días. Los síntomas incluyeron ulceraciones perianales dolorosas (n = 42 pacientes, 64,6%), anales (n = 28, 43%), rectales (n = 25, 38,4%) y vesículas perianales (n = 24, 36,9%). Se observó proctitis en 49 (75,4%) pacientes. Fue leve en 20 (40,8%) e intensa en 29 (59,2%) y proctitis severa simulando supuración interesfinteriana alta en 4 (8,2%). Quince (23,1%) pacientes presentaban ITS concurrentes y 3 fueron hospitalizados. La resolución completa de los síntomas ocurrió dentro de los 12 días.LIMITACIONES:Estudio de un solo centro y durante corto período de tiempo.CONCLUSIÓN:Los síntomas proctológicos son frecuentes en el brote actual de la enfermedad de la viruela del mono, probablemente relacionados con la vía de transmisión. Las ulceraciones rectales que simulan una supuración interesfinteriana alta deben reconocerse para evitar una cirugía innecesaria. (Traducción-Dr. Fidel Ruiz Healy ).
Assuntos
Doenças do Ânus , Infecções por HIV , Mpox , Proctite , Minorias Sexuais e de Gênero , Infecções Sexualmente Transmissíveis , Masculino , Humanos , Adulto , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Tenofovir/uso terapêutico , Emtricitabina/uso terapêutico , Doenças do Ânus/epidemiologia , Proctite/diagnóstico , Proctite/epidemiologia , Proctite/tratamento farmacológico , Supuração/tratamento farmacológicoRESUMO
Bronchiectasis is a pathologic state of conducting airways manifested radiographically by evidence of bronchial dilation and clinically by chronic productive cough. Considered an "orphan disease" for long, it remains a major contributor to morbidity and mortality in both developed and underdeveloped countries. With the advances in the medical field accompanied by widespread access to vaccines and antibiotics, improved health services and better access to nutrition, the incidences of bronchiectasis have markedly decreased, particularly in developed countries. This review summarizes the current knowledge pertaining to the clinical definition, etiology, clinical approach and management related to pediatric bronchiectasis.
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Bronquiectasia , Pneumopatias , Criança , Humanos , Doença Crônica , Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Pneumopatias/terapia , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/epidemiologia , Tosse/complicações , Antibacterianos/uso terapêutico , Supuração/complicações , Supuração/tratamento farmacológicoRESUMO
Background and Objectives: Phytotherapeutically, various herbal remedies, such as St. John's wort oil, have been introduced as wound care options. Recently, Neem oil has been considered a herbal option for the management of superficial wounds. Wound care is a complex process that involves several factors including the patient, caregiver, and medications. Herbal combinations could be an alternative to the chemical counterparts in the wound care area. This report includes an investigation of the possible supportive impacts of the St. John's wort and Neem oil containing ointment (W Cura G Plus ®) in the management of pressure ulcers (PUs) in three intensive care unit (ICU) patients. Materials and Methods: The ointment was administered to individuals once daily for 42 consecutive days. The status of individuals was macroscopically monitored by measuring the PU area and histopathological assessment of the tissue sections taken on the first and last days of wound treatment. Results: The outcomes of the macroscopic and histopathological techniques exhibited that St. John's wort and Neem oil containing ointment provided a remarkable supportive impact on the patients that suffered from PUs in the ICUs. Conclusions: The combination of St. John's wort and Neem oil could be suggested as an efficient active phytoconstituent for the management of PUs. The herbal ointments may be suggested as an alternative for the patients that have PUs in the ICUs.
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Hypericum , Úlcera por Pressão , Humanos , Úlcera por Pressão/tratamento farmacológico , Pomadas/uso terapêutico , Unidades de Terapia Intensiva , Supuração/tratamento farmacológico , Extratos Vegetais/uso terapêuticoRESUMO
An 84-year-old female with metastatic left breast cancer underwent a venous port insertion for chemotherapy. The port was inserted using standard techniques with image guidance under local anesthesia. She presented after 36 days with evidence of infection. A limited bedside ultrasound demonstrated free fluid surrounding the port. The port was subsequently removed the same day, at which time pus was expressed from the subcutaneous pocket. The culture from the pus grew Mycobacterium abscessus. She required removal of the port and wound debridement, wound dressings and a prolonged course of antibiotics. Mycobacterium abscessus is a group of rapidly growing, multidrug-resistant, non-tuberculous mycobacteria that are also relatively resistant to standard skin disinfectants. In recent years, this organism has been increasingly reported as the culprit in post-operative or post-procedural infections. Treatment is challenging due to multidrug resistance, and requires an extensive course of intravenous antimicrobial and macrolide-based combination therapy followed by oral antimicrobial therapy. Early treatment is essential as progression may result in disseminated infection. We discuss the peri-operative and post-operative care required in preventing and treating infection with this organism.
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Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Feminino , Humanos , Idoso de 80 Anos ou mais , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Antibacterianos/uso terapêutico , Macrolídeos/uso terapêutico , Supuração/tratamento farmacológicoRESUMO
Purpose: To determine the clinical efficacy of recombinant human epidermal growth factor (rh-EGF) combined with povidone-iodine (PVI) on patients with pressure ulcers (PUs). Methods: One hundred and five PU patients treated between January 2018 and January 2021 were enrolled and retrospectively analyzed. Of them, 50 patients who received conventional treatment were assigned to the control group (Con group), while 55 patients treated with rh-EGF combined with PVI were assigned to the observation group (Obs group). The two groups were compared in clinical efficacy, PU alleviation (total area reduction rate, total depth reduction rate, and total volume reduction rate), healing time, pain degree (Visual Analog Scale [VAS] score), inflammatory indexes (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitive C reactive protein [hs-CRP]), and hydroxyproline content in the wound. Results: The Obs group yielded a higher total effective rate than the Con group (P < 0.05). The Obs group also experienced statistically shorter healing time and milder pain, with better PU alleviation and lower levels of inflammation indexes compared with the Con group (all P < 0.05). In addition, a higher hydroxyproline content in the wound was found in the Obs group. Conclusions: All in all, rh-EGF combined with PVI has a definite curative effect on patients with PUs. It can promote PU alleviation and hydroxyproline secretion in the wound and inhibit pain and inflammatory reactions, which is worthy of clinical promotion.
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Fator de Crescimento Epidérmico , Úlcera por Pressão , Citocinas , Fator de Crescimento Epidérmico/uso terapêutico , Humanos , Hidroxiprolina , Fatores Imunológicos , Inflamação/tratamento farmacológico , Dor/tratamento farmacológico , Povidona-Iodo/uso terapêutico , Úlcera por Pressão/tratamento farmacológico , Estudos Retrospectivos , Supuração/tratamento farmacológicoRESUMO
BACKGROUND: Few studies have investigated the differences in clinical features of patients with mastitis following Corynebacterium kroppenstedtii infection, and most focused on the bacterial antimicrobial susceptibility, detection methods and therapy. METHODOLOGY: There were 133 patients with mastitis infected by C. kroppenstedtii between August 2016 and September 2019. C. kroppenstedtii was identified using mass spectrometry. The demographics, clinical diagnosis, laboratory test results of different types of mastitis combined with bacillus infection, and the effects of different treatments in reducing recurrence were compared. RESULTS: The incidence of pus following C. kroppenstedtii infection was higher in patients with non-granulomatous lobular mastitis (NGLM; 56.6%) than in those with granulomatous lobular mastitis (GLM; 33.3%; χ2 = 7.072, p = 0.008). While C-reactive protein (CRP) was higher in the GLM group (12.50 mg/L) than in the NGLM group (6.05 mg/L; Z = - 2.187, p = 0.029). Treatment with local lavage (triamcinolone acetonide) and antibiotics (cefuroxime) showed a recurrent rate of 25.9% in C. kroppenstedtii infection. CONCLUSION: Increased pus, large masses, and an elevated CRP level may occur in patients with mastitis infected by C.kroppenstedtii. These clinical features may guide the determination of the bacterial infection in patients with mastitis. Combining an antibiotic with a triamcinolone acetonide lavage, preferably cefuroxime, may reduce the recurrence.
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Infecções por Corynebacterium , Mastite Granulomatosa , Antibacterianos/uso terapêutico , Cefuroxima/uso terapêutico , Corynebacterium , Infecções por Corynebacterium/diagnóstico , Infecções por Corynebacterium/tratamento farmacológico , Infecções por Corynebacterium/microbiologia , Feminino , Mastite Granulomatosa/tratamento farmacológico , Humanos , Supuração/tratamento farmacológico , Triancinolona Acetonida/uso terapêuticoRESUMO
OBJECTIVES: The aim of our study was to describe clinical presentations, bacteriological results, and therapeutic management in a pediatric population presenting with acute pharyngeal suppuration. A further aim was to identify clinical, bacteriological, and radiological predictors of success associated with exclusive medical treatment. METHOD: A retrospective study was carried out including patients under 18 years of age hospitalized between January 1, 2015 and December 31, 2017 in our center for acute pharyngeal suppuration. We identified three groups of patients: group A, treated with exclusive intravenous antibiotics; group B, surgically treated after 48 h of appropriate antibiotic therapy, due to persistent fever and/or clinical worsening and/or persistence of a collection on follow-up imaging; group C, surgically treated as first-line therapy in association with intravenous antibiotics. A total of 83 patients were included: 36 in group A, 12 in group B, and 35 in group C. These three groups were compared for several variables: age of the patients, polynuclear neutrophil counts, diameter of the collections (the largest diameter found on imaging), duration of antibiotic therapy, delay before return to apyrexia, and hospitalization duration. RESULTS: A neck mass and torticollis were present, respectively, in 48.8 and 47.6% of cases. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism. The average diameter of the collections from patients treated surgically as first-line therapy (group C) was significantly larger than that of the patients treated with antibiotics (group A) (27.89 mm vs. 18.73 mm, respectively, p = 0.0006). All the patients who required surgery despite 48 h of appropriate antibiotic therapy (group B) had collections with diameters greater than or equal to 15 mm. There was no significant difference between the groups concerning hospitalization duration. CONCLUSION: Exclusive medical treatment is associated with a high cure rate, mainly for collections with small diameter. We recommend special attention to patients treated with first-line exclusive intravenous antibiotic therapy and with a collection diameter greater than or equal to 15 mm.
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Febre/etiologia , Cervicalgia/etiologia , Espaço Parafaríngeo/microbiologia , Abscesso Retrofaríngeo/microbiologia , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Supuração/microbiologia , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Criança , Humanos , Pescoço , Abscesso Peritonsilar , Abscesso Retrofaríngeo/terapia , Estudos Retrospectivos , Supuração/tratamento farmacológico , Resultado do TratamentoRESUMO
PURPOSE: The significant pathogens associated with paediatric cervical suppurative lymphadenitis (CSL) are unclarified, and there is a lack of clinical evaluations of antibiotic regimens in paediatric CSL. We aimed to (1) explore the bacterial findings and the associated primary sites of infection in paediatric cases of CSL and (2) evaluate the clinical outcomes in patients treated with different antibiotic regimens. METHODS: All children (< 18 years) treated for non-mycobacterium CSL at the Department of Otorhinolaryngology, Aarhus University Hospital, from 2001 to 2018 were retrospectively evaluated. RESULTS: Eighty-five patients were included in the study. The prevalent isolates were S. aureus (57%), S. pyogenes (17%), non-haemolytic streptococci (11%), and F. necrophorum (3%). The primary sites of infection were identified in 30 (35%) patients. The most common sites were the oropharynx (n = 15), the middle ear (n = 10), and the skin (n = 5). All patients were treated with surgical incision and antibiotics. No statistically significant differences were found between patients treated with antibiotics covering streptococci (n = 60) versus antibiotics covering streptococci and S. aureus (n = 25) in terms of duration of hospitalisation (median 4 vs 4 days, p = 0.26), altered antibiotic treatment because of insufficient clinical or biochemical progress (7% vs 12%, p = 0.41), and abscess recurrence (8% vs 12%, p = 0.69). CONCLUSION: S. aureus was the predominant pathogen in paediatric CSL at all cervical levels, and even in cases with evidence of primary site infection not normally associated with S. aureus. We were unable to underscore the importance of antibiotic treatment covering S. aureus based on evaluation of the clinical outcomes.
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Infecções , Linfadenite , Antibacterianos/uso terapêutico , Criança , Humanos , Infecções/complicações , Linfadenite/tratamento farmacológico , Linfadenite/microbiologia , Estudos Retrospectivos , Staphylococcus aureus , Streptococcus pyogenes , Supuração/tratamento farmacológicoRESUMO
INTRODUCTION: Idiopathic granulomatous mastitis (IGM) often mimics breast cancer. Presentation includes pain, palpable mass, suppuration or suspicious imaging. Widely reported in Asia and the Middle East, IGM is diagnosed after excluding specific granulomatous mastitis (SGM). Aetiology remains unknown. Lactation, prolactinaemia, ethnicity, autoimmune disease and Corynebacteria are associated. Treatment is controversial and the prevalence rising. Surgery and non-operative treatments including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), steroids, methotrexate and observation have advocates. METHODS: A retrospective chart review of 63 patients with IGM from 2008 to 2018 was undertaken focusing on birthplace, age, clinical presentation, wound cultures, imaging, treatments and outcomes. RESULTS: Sixty-one of 63 patients were Hispanic; 53 were Mexican-born women aged 23-46. Clinical presentation included pain, painful mass, painless mass, suppuration and abnormal imaging. Some 31/61 ultrasound examinations and 17/33 mammograms were deemed Breast Imaging Reporting and Data System (BI-RADS) score 4 or 5. Management included antibiotics (43), incision and drainage (24), NSAIDs (29), steroids (8), lumpectomy (18) and observation (12). Some 12/20 patients with painless masses resolved with observation, 3 received NSAIDs, 2 received steroids and 3 underwent lumpectomies. Antibiotics resolved 8/43 cases, 5 needed incision and drainage, 26 received NSAIDs, 6 received steroids and 5 underwent lumpectomies. Nineteen patients had indolent disease or recurrence. CONCLUSIONS: Excluding malignancy is critical, treatment challenging and recurrence common in IGM. A preponderance of patients were Mexican-born, similar to other reports from the USA. Over 50% of IGM cases had suspicious BI-RADS scores. Best management remains a challenge and ranges from observation to lumpectomy.
Assuntos
Neoplasias da Mama , Mastite Granulomatosa , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Neoplasias da Mama/diagnóstico , Feminino , Mastite Granulomatosa/diagnóstico , Mastite Granulomatosa/epidemiologia , Mastite Granulomatosa/terapia , Hospitais , Humanos , Imunoglobulina M/uso terapêutico , New York , Dor , Estudos Retrospectivos , Esteroides/uso terapêutico , Supuração/tratamento farmacológicoRESUMO
BACKGROUND: Acquiring sputum cultures from infants is considered challenging. We describe their yield in infants with cystic fibrosis (CF) and other chronic suppurative lung diseases (CSLDs). METHODS: Retrospective medical record review over a 4-year period, for infants aged 0-2 years with ≥2 airway bacterial cultures acquired by deep suction or induced sputum ≥4 weeks apart. Data included demographics, culture results, and clinical status. RESULTS: A total of 98 infants (16 CF) were evaluated and 534 sputum cultures acquired, 201 in CF and 333 in CSLD. There were 12 (2-23), median (range) cultures/CF infant, and 3 (2-21)/CSLD infant. Age at first culture was 3.8 (1-19.5) months for CF and 10.4 (0.5-22) months for CSLD; p = .016. In total, 360 cultures (67%) were positive for any bacteria, with 170/234 (73%) positive during exacerbations, compared with 190/300 (63%) during routine visits; p = .05. More infants with CF than CSLD had cultures positive for Staphylococcus aureus (SA; 75% vs. 34%; p = .004) throughout the period. Pseudomonas aeruginosa (PA) was common in both CF and CSLD (56% and 44%, respectively; p = .42) and increased over time for CF but was high throughout for CSLD. The number of hospital days before PA acquisition was 6 (10.2) for CF and 28.8 (38.7) for CSLD (p = .003). No CF but 6/82 (7%) CSLD infants had chronic PA (p = .56). CONCLUSIONS: Sputum cultures showed that infection, in particular PA, is common in CF and CSLD whereas SA is more common in CF. Prospective studies are warranted to elucidate the role of active surveillance in guiding antibiotic therapy.
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Pneumopatias/diagnóstico , Escarro/microbiologia , Antibacterianos/uso terapêutico , Bactérias , Criança , Pré-Escolar , Fibrose Cística/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Pneumopatias/microbiologia , Masculino , Estudos Prospectivos , Pseudomonas aeruginosa , Estudos Retrospectivos , Supuração/tratamento farmacológicoAssuntos
Neoplasias Oculares/diagnóstico , Dor Ocular/diagnóstico , Doenças da Íris/diagnóstico , Transtornos da Pigmentação/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Supuração/diagnóstico , Pré-Escolar , Neoplasias Oculares/tratamento farmacológico , Dor Ocular/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pressão Intraocular/fisiologia , Doenças da Íris/tratamento farmacológico , Transtornos da Pigmentação/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Microscopia com Lâmpada de Fenda , Supuração/tratamento farmacológicoRESUMO
Increase of the frequency of soft tissues pyoinflammatory diseases and purulent-septic complications against the background the antibiotic-resistance of organism dictates the necessity of search of rational new surgical technologies and preparations with the intense bactericidal effect. Period of the connective tissue (cicatrix) formation on a place of wound defect of the operated purulent abscess of soft tissue (PAST) is defined by the speed of the granulations and epithelial tissue formation. Therefore, one of the task of experimental surgery is search of new methods of the effective postoperative influence on terms of the regeneration and complete obliteration of the PAST cavity. The perspective direction in treatment of surgical infection is application of metals nanoparticles. In treatment of pyoinflammatory processes it is applied the preparation Eplan and also zinc oxide nanoparticles which have bactericidal, antiinflammatory and regenerative effects. However, till now it was not carried out experimental works on modelling and surgical treatment of PAST with local application of the laser technologies in combinations with Eplan and metals nanoparticles.
Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Nanopartículas Metálicas/uso terapêutico , Infecções dos Tecidos Moles/terapia , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Antibacterianos/administração & dosagem , Combinação de Medicamentos , Humanos , Terapia a Laser , Nanopartículas Metálicas/administração & dosagem , Pomadas/administração & dosagem , Pomadas/uso terapêutico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/cirurgia , Supuração/tratamento farmacológico , Supuração/cirurgia , Supuração/terapia , Óxido de Zinco/administração & dosagem , Óxido de Zinco/uso terapêuticoRESUMO
BACKGROUND AND AIMS:: Appendicitis is a common presentation to hospital with appendectomy being the treatment of choice. Pre-operative administration of broad-spectrum antibiotics is common, but obtaining intra-abdominal pus samples is not. After an initial 6-month retrospective audit and departmental teaching on the importance of intra-peritoneal pus sampling, we aimed to determine whether intra-operative pus samples changed antibiotic management. MATERIALS AND METHODS:: Following the initial audit cycle, a 6-month prospective cohort study was conducted. Clinical data were collected on a predetermined proforma to assess the effectiveness of the intervention and antibiotic prescribing practice. The data collected during the whole 1-year period was analyzed. RESULTS:: During the 1-year period, 440 patients were identified as undergoing a laparoscopic procedure. After exclusion, 261 patients were identified as undergoing laparoscopic appendectomies, of which 141 (54%) were classified as complicated laparoscopic appendectomies. A total of 35 out of 141 (25%) pus samples were sent of which 24 (17%) resulted in positive cultures, with only nine of these positive cultures reported prior to the patient being discharged. No patient had their antibiotic regimen changed as a result of the culture results. There were three cases of cultures resistant to local antibiotics, but without significant clinical outcome. One of these patients developed a post-operative complication, but the antibiotic regimen was changed to broad spectrum rather than a specific antibiotic based on culture sensitivity. Of the 141 patients with complicated laparoscopic appendectomies, five (3.5%) developed post-operative complications: one readmission requiring a laparoscopic washout for pelvic collection, three (2%) cases of pelvic collections managed conservatively, and one case of prolonged paralytic ileus managed non-operatively. CONCLUSION:: Overall, none of the patients with positive cultures had a change in prescribed antibiotics based on culture results. Hence, the routine practice of intra-peritoneal pus sampling following complicated appendicitis remains of little clinical value.
Assuntos
Apendicite/cirurgia , Supuração/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/complicações , Apendicite/tratamento farmacológico , Apendicite/microbiologia , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Feminino , Humanos , Laparoscopia , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Supuração/tratamento farmacológico , Adulto JovemRESUMO
Bronchiectasis is a structural airway disease characterized by dilated bronchi and bronchioles due to severe or recurrent lower airways inflammation. Bronchiectasis can occur as a result of chronic pulmonary aspiration. Bronchiectasis may also be associated with a wide variety of systemic diseases, which should be considered in the differential diagnosis. Children with bronchiectasis typically have a chronic or recurrent productive cough and carry a significant burden of disease with a considerable impact on quality of life. The diagnosis of bronchiectasis is made by high-resolution chest computerized tomography. Aggressive management of bronchiectasis is necessary to reduce the daily symptom burden and frequency of exacerbations. Chronic suppurative lung disease may be a precursor to bronchiectasis, only lacking the defining radiographic features of bronchiectasis. Children with chronic suppurative lung disease may have the same symptoms as children with bronchiectasis and should be treated similarly. Protracted bacterial bronchitis is defined as a cough lasting at least four weeks that responds to antibiotic therapy. Protracted bacterial bronchitis may occur following a viral respiratory tract infection. Protracted bacterial bronchitis can be treated with a prolonged course of empiric antibiotics. Further evaluation is necessary if a child with suspected protracted bacterial bronchitis does not adequately respond to antibiotics as chronic suppurative lung disease or bronchiectasis must be considered.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Bronquiectasia/diagnóstico , Bronquite/diagnóstico , Pneumopatias/diagnóstico , Supuração/diagnóstico , Infecções Bacterianas/complicações , Bronquiectasia/tratamento farmacológico , Bronquiectasia/fisiopatologia , Bronquite/tratamento farmacológico , Bronquite/fisiopatologia , Broncoscopia , Criança , Doença Crônica , Tosse/etiologia , Humanos , Pneumopatias/tratamento farmacológico , Pneumopatias/fisiopatologia , Guias de Prática Clínica como Assunto , Supuração/tratamento farmacológico , Supuração/fisiopatologiaRESUMO
CONTEXT: Acute suppurative sialadenitis (hereafter referred to as sialadenitis) is accompanied by pain and fever and can diminish the quality of life in end-stage cancer patients; however, its incidence is not clear. OBJECTIVES: We conducted this study to elucidate the incidence of sialadenitis in end-stage cancer patients. METHODS: Retrospective review and observational study based on patients' medical records. SUBJECTS: About 726 consecutive cancer patients who died on the palliative care unit of our hospital between April 2012 and November 2016 were included. MEASUREMENTS: Median duration between sialadenitis onset and death, concomitant treatment, average infusion volume per day, site of onset, symptoms, effectiveness of antibiotic treatment, and mean duration until symptomatic relief. RESULTS: The incidence of sialadenitis was 2.9% (21 of 726 cases). The median duration from onset to death was 20 days (range 2-112); concomitant treatment included opioids in 11 patients (55%), anticholinergic drugs in six patients (28%), steroids in three patients (14%), and oxygen inhalation in five patients (23%); average infusion volume per day was 588 ± 307 mL; site of onset was submandibular gland in 12 patients (57%) and parotid gland in nine patients (42%); and symptoms were pain in 18 patients (85%) and fever in 13 patients (61%). Antibiotic treatment was administered in 18 patients (85%), and the mean duration until symptomatic relief was 4.0 ± 1.5 days. CONCLUSION: Sialadenitis is a rare complication in end-stage cancer patients; however, it is important to recognize that it can be associated with severe symptoms, including fever and pain.
Assuntos
Neoplasias/epidemiologia , Sialadenite/epidemiologia , Doença Aguda , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Neoplasias/terapia , Estudos Retrospectivos , Sialadenite/tratamento farmacológico , Supuração/tratamento farmacológico , Supuração/epidemiologiaRESUMO
The authors assessed efficacy of regional intraosseous administration of urokinase medac in comprehensive treatment of patients with complicated forms of diabetic foot syndrome by means of analysing therapeutic results in a total of 65 patients presenting with pyonecrotic complications of diabetic foot. The patients were subdivided into 2 groups. The control group was composed of 35 patients receiving basic therapy. The study group comprised 30 patients subjected to comprehensive treatment including regional intraosseous (into the heel bone of the affected limb) administration of urokinase medac at a dose of 100 thousand IU for 5 days. Efficacy of treatment was evaluated by the course of the wound process, indices of haemostasis, free radical oxidation, results of surgical treatment. In patients of the Study Group the terms of wound purification from pyonecrotic masses amounted to 9.8±0.3 days, which was by 4.7 days less than in the Control Group patients (p<0.01), marginal epithelialization of wounds also occurred averagely by 6.4 days faster. On day 22 of using the basic therapy alone, the haemostasis system preserved the condition of coagulation activity. The Study Group patients as early as on day 5 of treatment demonstrated shifts towards normocoagulation. In the Control Group by day 22 of treatment, the level of malonic dialdehyde decreased by 18.5%, the index of catalase activity increased by 24.6% (p<0.05); in the Study Group the level of malonic dialdehyde decreased by 42.6% and catalase activity increased by 69.4% (p<0.01). On the background of using urokinase the number of high amputations decreased by 18% and the number of operations with the supporting function preserved decreased by 12% as compared with basic therapy alone. A conclusion was made that additional use of regional intraosseous administration of urokinase medac as compared with basic therapy alone promoted a more significant decrease in the coagulation activity of blood and the level of free-radical lipid oxidation, stimulation of regenerative processes, as well as improvement of outcomes of surgical treatment.
Assuntos
Amputação Cirúrgica , Pé Diabético , Necrose , Supuração , Ativador de Plasminogênio Tipo Uroquinase , Amputação Cirúrgica/métodos , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/metabolismo , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Hemostasia/efeitos dos fármacos , Humanos , Infusões Intraósseas/métodos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Necrose/tratamento farmacológico , Necrose/etiologia , Necrose/fisiopatologia , Oxirredução/efeitos dos fármacos , Estudos Retrospectivos , Federação Russa , Supuração/tratamento farmacológico , Supuração/etiologia , Supuração/fisiopatologia , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Cicatrização/efeitos dos fármacosAssuntos
Linfoma Intraocular/diagnóstico , Supuração/diagnóstico , Antimetabólitos Antineoplásicos/uso terapêutico , Citometria de Fluxo , Humanos , Hifema/diagnóstico , Linfoma Intraocular/tratamento farmacológico , Injeções Intravítreas , Doenças da Íris/diagnóstico , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Biópsia de Linfonodo Sentinela , Supuração/tratamento farmacológico , Uveíte Anterior/diagnósticoRESUMO
We present the case of a healthy young man who developed pyogenic myositis, an infection that is rare in the USA. He had no prior medical conditions except for an obsessive-compulsive disorder and skin picking disorder resulting in multiple superficial skin infections. He presented to our hospital with acute back pain. He was found to be septic with fever, tachycardia and elevated white cell counts. Imaging revealed evidence of myositis in the gluteal region. He was treated with antibiotics and fully recovered. It is likely that the skin picking disorder and the recurrent superficial skin infections are responsible for the development of this infection.