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1.
Kyobu Geka ; 74(3): 217-219, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33831877

RESUMO

A 45-year-old man was diagnosed with active aortic valve endocarditis accompanied by massive aortic regurgitation, complete atrioventricular block, para-annular abscess and a mobile large vegetation. He underwent emergency resection of the aortic valve, direct closure of the abscess with an autologous pericardium patch and mechanical valve replacement. Acquired communication between the left ventricle and the right atrium was closed simultaneously. Then, adjacent mitral para-annular abscess and another vegetation were revealed by echocardiography, and treated surgically 20 days after the first operation. He underwent mitral valve replacement and closure of the annular abscess. Twenty-one days after the second operation, aortic annular false aneurysm was detected by echocardiography, and closure of the false aneurysm and aortic valve re-replacement were performed successfully.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
2.
Urologiia ; (1): 45-49, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33818934

RESUMO

OBJECTIVES: Demonstrate the treatment of prostatic abscess with a minimally invasive method - abscess puncture with aspiration of purulent fluid and injection of an antibiotic into abscess cavity. MATERIALS AND METHODS: Diagnosis of prostatic abscess of 23 patients using ultrasonography, computed tomography and magnetic resonance imaging of the pelvic region. 19 patients with the abscess within the prostatic capsule were treated with perineal percutaneous puncture method with aspiration of the abscess fluid and injection of antibiotics into cavity. For 4 patients with prostatic abscess and purulent paraprostatitis we performed incision and drainage of purulent cavity with open transperineal access. RESULTS: Single abscess puncture was enough to normalize health status of 15 patients. In 4 cases additional puncture was required in 4-5 days after the first manipulation. All the patients recovered and were discharged from the clinic in 7-8 days. Patients after abscess incision and drainage stayed in hospital for 10-14 days. In 1-3 months after the surgery, imaging methods revealed a high-density lesion in prostate whatever the method was used. DISCUSSION: Treatment response was controlled by imaging methods. 2 days after puncture 4 patients had a lesion with liquid content larger than 50% of the initial purulent lesion size. Repeated puncture was performed in this patients. CONCLUSION: Abscess puncture with aspiration of fluid is an effective method of treatment when prostatic abscess is within the capsule. In cases of purulent paraprostetitis incision and drainage of an abscess cavity is needed.


Assuntos
Abscesso , Doenças Prostáticas , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Drenagem , Humanos , Masculino , Doenças Prostáticas/diagnóstico por imagem , Doenças Prostáticas/cirurgia , Ultrassonografia
3.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541999

RESUMO

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.


Assuntos
Antibacterianos/uso terapêutico , Ceftazidima/uso terapêutico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Streptococcus salivarius/isolamento & purificação , Vancomicina/uso terapêutico , Vitrectomia , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Infecções Oculares Bacterianas/microbiologia , Humanos , Masculino , Ultrassonografia , Corpo Vítreo/microbiologia
4.
BMC Infect Dis ; 21(1): 196, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607951

RESUMO

BACKGROUND: Non-tuberculous mycobacterial (NTM) infections are increasing worldwide, making them an international public health problem. Surgical management is often indicated for localized infectious disease; however, most surgeons are unaware of the potential risks of transmission during surgery. CASE PRESENTATION: An 88-year-old Asian female was referred to our hospital for a tumor in the right lateral thoracic region. One month prior, she had a feeling of fullness and complained of localized pain and warmth in the right lateral thoracic wall. Pain and warmth gradually resolved without intervention; however, the fullness was getting worse. Computed tomography (CT) scan showed a mass of approximately 65 × 30 mm with an osteolytic change, involving the right 8th rib. Based on the rapid growth rate and CT findings, we strongly suspected a malignant chest wall tumor, and en bloc tumor resection with the 8th rib was performed. When the specimen was cut, a large amount of viscous pus was drained and its culture showed growth of Mycobacterium avium. Microscopically, the non-caseating epithelioid cell granuloma extended into the rib, infiltrating the bone cortex. On follow-up 1 month after discharge, there were no signs of infection or other adverse events associated with the surgery. CONCLUSIONS: Herein, we report about a patient with a mass diagnosed as an NTM abscess involving the rib cage, which was confused with a malignant tumor and eventually diagnosed following surgical excision. This report emphasizes the need to be aware of the possibility of NTM infection and take appropriate precautions if the patient has a rapidly growing mass in the chest wall.


Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Parede Torácica/microbiologia , Parede Torácica/patologia , Abscesso/diagnóstico por imagem , Abscesso/microbiologia , Abscesso/patologia , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Drenagem , Feminino , Granuloma/microbiologia , Granuloma/patologia , Granuloma/cirurgia , Humanos , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/cirurgia , Mycobacterium avium/isolamento & purificação , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia , Resultado do Tratamento
6.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431529

RESUMO

Abdominoperineal excision of rectum (APER) is one of the widely used surgical procedures to treat low rectal cancer, benign conditions like Crohn's proctitis with anal involvement and as a salvage procedure for anal cancer. Perineal wound infection is a well-recognised complication following such major surgery. Occurrence of appendicitis in a few weeks' time following such a major surgery is uncommon. However, here we present a rare case report of perforated appendicitis presenting as persistent perineal discharge in an elderly man, following laparoscopic APER for a low rectal tumour. To our knowledge, this is the first time such a rare clinical presentation of appendicitis is reported in the history of medical literature. Through this case report, we aim to highlight the importance of considering such an uncommon presentation in patients with perineal discharge, following APER.


Assuntos
Abscesso/diagnóstico , Apendicite/complicações , Infecções por Escherichia coli/diagnóstico , Perfuração Intestinal/diagnóstico , Infecção Pélvica/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Abscesso/etiologia , Abscesso/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Diagnóstico Diferencial , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Infecção Pélvica/etiologia , Infecção Pélvica/cirurgia , Períneo/microbiologia , Períneo/patologia , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1177-1181, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353273

RESUMO

Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) µg/L, 122.2 (55.8, 226.0) µg/L, 59.2 (29.0,203.5) µg/L and 64.1 (30.0,88.4) µg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.


Assuntos
Abscesso , Fístula do Sistema Digestório/complicações , Drenagem/métodos , Infecção Pélvica/cirurgia , Abscesso/etiologia , Abscesso/cirurgia , Adulto , Idoso , Nádegas/cirurgia , Cateterismo/métodos , Fístula do Sistema Digestório/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecção Pélvica/etiologia , Pelve/cirurgia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
8.
Zhonghua Nan Ke Xue ; 26(8): 731-735, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-33377736

RESUMO

Objective: To investigate the clinical effect and safety of transurethral decompression and drainage with holmium laser in the treatment of prostatic abscess. METHODS: We retrospectively analyzed the clinical data on 13 cases of prostatic abscess treated in our hospital from January 2015 to May 2019. One of the patients was cured by drug therapy while the other 12 underwent transurethral decompression and drainage with holmium laser after failure in medication. We recorded such postoperative symptoms as fever, frequent urination, urgent urination, painful urination, tenteria, dysuria and abdominal distension, obtained the dynamical indices of blood and urine routine and culture after surgery, and performed MRI during the follow-up for possible recurrence and complications. Those with disappearance of the clinical symptoms, negative results of urine leukocyte and pathogen examinations, and no recurrence revealed by MRI were considered to be cured. RESULTS: After operation, the clinical symptoms were improved significantly and the urinary catheters removed within 5-10 days in all the cases. At 3-5 days after removal of the catheters, all the patients experienced smooth urination, with no urinary retention or urethral stricture. The patients were followed up for 3-16 months, during which no recurrence was observed. CONCLUSIONS: Transurethral decompression and drainage with holmium laser can achieve a definite clinical effect in the treatment of prostatic abscess and therefore deserves to be promoted in clinical practice.


Assuntos
Abscesso/cirurgia , Descompressão Cirúrgica , Drenagem , Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318274

RESUMO

Splenic abscess is a rare entity, however if unrecognised or left untreated, it is invariably fatal. We herein report a case of splenic abscess in a 40-year-old man presenting with fever, left-sided abdominal pain, altered sensorium and vomiting. On clinical examination, hepatosplenomegaly was noted and the ultrasound of the abdomen showed multiple hypoechoic regions in the upper pole of spleen, and the diagnosis of splenic abscess was made. The patient received antimicrobial therapy and underwent an open splenectomy with full recovery. Pus aspirated from the splenic abscess grew an unusual organism named Parabacteroides distasonis In the literature, there are only a few recorded cases of P. distasonis causing splenic abscess. Through this case report, we would like to emphasise the pathogenic role of P. distasonis in causing clinical disease, as this organism is typically known to constitute a part of the normal flora.


Assuntos
Abscesso/microbiologia , Bacteroidetes/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Esplenopatias/microbiologia , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/cirurgia , Humanos , Masculino , Esplenectomia , Esplenopatias/tratamento farmacológico , Esplenopatias/cirurgia
10.
Hinyokika Kiyo ; 66(9): 323-326, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32988171

RESUMO

An 82-year-old man visited our department with a chief complaint of penile pain and swelling. He was receiving maintenance dialysis for chronic renal failure and was catheterized because of urinary retention associated with prostatic hypertrophy. The penis was reddened with swelling extending to the root and marked tenderness. Blood tests indicated inflammation and imaging revealed an abscess with emphysematous changes in the cavernous region of the penis. The diagnosis was purulent penile cavernitis. His symptoms improved after decompression with incision and drainage. There has been no recurrence of the abscess in the 4 months since treatment.


Assuntos
Enfisema , Hiperplasia Prostática , Retenção Urinária , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Humanos , Masculino , Pênis
11.
J Laryngol Otol ; 134(8): 721-726, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32787992

RESUMO

OBJECTIVE: Bibliographic data for the management of acute mastoiditis in infants aged six months or less are very limited. This study investigated the presenting symptomatology, diagnostic and treatment options, and final outcomes in this age group. METHOD: A retrospective review was conducted of all infants aged six months or less suffering from acute mastoiditis, admitted to our department between 2007 and 2017. RESULTS: Eleven infants were identified. All of them developed the typical symptomatology of acute mastoiditis, while a higher rate of subperiosteal abscess formation was observed. Imaging was necessary in three cases only. Parenteral antibiotics and myringotomy were applied in all infants. A drainage procedure was also included in the infants with a subperiosteal abscess. Antrotomy was reserved for non-responsive cases. No intracranial complications were observed. All infants were cured without further complications or sequelae. CONCLUSION: Acute mastoiditis in infants aged six months or less can be safely diagnosed and treated using a standardised algorithmic approach, similar to that used for older children.


Assuntos
Mastoidite/diagnóstico , Mastoidite/terapia , Periósteo/microbiologia , Abscesso/cirurgia , Doença Aguda , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Drenagem/métodos , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Mastoidite/complicações , Mastoidite/epidemiologia , Ventilação da Orelha Média/métodos , Otite Média , Estudos Retrospectivos , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
Rev. inf. cient ; 99(4): 386-397, jul.-ago. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1139199

RESUMO

RESUMEN Introducción: El absceso frío tuberculoso es la forma clínica más frecuente de tuberculosis cutánea. Objetivo: Familiarizar a los médicos generales con las características clínicas del absceso tuberculoso frío para asegurar su diagnóstico y tratamiento específico en la consulta de Cirugía del Hospital General N'gola Kimbanda en Namibe, Angola en 2018. Método: Se revisó la literatura sobre el tema en bases de datos científicas como Medline, PubMed, SciELO, Scopus, Clinical Key, LILACS con los descriptores: tuberculosis extrapulmonar y absceso frío tuberculoso. Resultados: Los pacientes, tres varones y dos hembras, tres adultos y dos infantes, todos desnutridos, con antecedentes de tuberculosis pulmonar y mal de Pott que fueron enviados a consulta con el diagnóstico de lipoma. En todos los casos se diagnosticó absceso frío tuberculoso, 3 de localización lumbar, 1 toracolumbar y 1 lumbosacra confirmados por microbiología y tratados según los protocolos de las especialidades de Cirugía y Neumología. Conclusiones: Es necesario que los estudiantes de Medicina, médicos generales y especialistas que en su desempeño enfrentan a dichos pacientes dentro y fuera de Cuba se empoderen de las características semiológicas del, también llamado, goma tuberculoso, a fin de identificarlo en los pacientes de riesgo y garantizar su tratamiento médico-quirúrgico específico para evitar la discapacidad y mortalidad asociada a esta temida infección que sigue constituyendo un azote social.


ABSTRACT Introduction: Tuberculous cold abscess is the most common clinical form of skin tuberculosis. Objective: To familiarize general physicians with the clinical characteristics of tuberculous cold abscesses to ensure their diagnosis and specific treatment at the Surgery Department of the N'gola Kimbanda General Hospital in Namibe, Angola in 2018. Method: Literature on the subject was reviewed in scientific databases such as Medline, PubMed, SciELO, Scopus, Clinical Key and LILACS with the following descriptors: extrapulmonary tuberculosis and tuberculous cold abscess. Results: The patients, three males and two females, three adults and two infants, all of them malnourished, with a history of pulmonary tuberculosis and Pott's Disease, who were sent for consultation with a diagnosis of lipoma. In all cases, tuberculous cold abscesses were diagnosed, 3 of them in lumbar location, 1 in thoracolumbar and 1 in lumbosacral locations, confirmed by microbiology and treated according to the protocols of the specialties of Surgery and Pneumology. Conclusions: It is necessary that students of Medicine, general physicians and specialists who face these patients inside and outside of Cuba to gain in knowledge with the semiological characteristics of the tuberculous cold abscess, also known as tuberculous gum, in order to identify it in the patients in risk groups, and to guarantee their specific medical-surgical treatment to avoid the disability and mortality associated to this infection that still constitutes a major issue.


Assuntos
Humanos , Tuberculose Cutânea/cirurgia , Abscesso/cirurgia , Angola
14.
Int J Surg ; 80: 157-161, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32679205

RESUMO

BACKGROUND: during the COVID-19 pandemic, the number of Acute Care Surgery procedures performed in Spanish hospitals decreased significantly. The aim of this study was to compare Acute Care Surgery activity during the COVID-19 pandemic and during a control period. MATERIAL AND METHODS: a multicenter retrospective cohort study was performed including patients who underwent Acute Care Surgery in three tertiary care hospitals in Spain during a control (11th March 2019 to 21st April 2019) and a pandemic (16th March 2020 to 26th April 2020) period. Type of surgical procedures, patients' features and postoperative complications were compared. RESULTS: two hundred and eighty-five and 117 patients were included in each group. Mean number of patients who underwent Acute Care Surgery during the control and pandemic periods was 2.3 and 0.9 patients per day and hospital (p < 0.001), representing a 58.9% decrease in Acute Care Surgery activity. Time from symptoms onset to patient arrival at the Emergency Department was longer during the pandemic (44.6 vs. 71.0 h, p < 0.001). Surgeries due to acute cholecystitis and complications from previous elective procedures decreased (26.7% vs. 9.4%) during the pandemic, while bowel obstructions and abdominal wall hernia surgeries increased (12.3% vs. 22.2%) (p = 0.001). Morbidity was higher during pandemic period (34.7% vs. 47.1%, p = 0.022), although this difference was not statistically significant in the multivariate analysis. Reoperation rate (17.9% vs. 12.8%, p = 0.212) and mortality (6.7% vs. 4.3%, p = 0.358) were similar in both groups. CONCLUSION: during the COVID-19 pandemic, a significant reduction in the performance of Acute Care Surgery procedures was observed. Moreso, a longer time from symptoms onset to patient arrival at the Emergency Department was noted. Higher morbidity was observed in patients undergoing Acute Care Surgery during the pandemic period, although there was not any difference in mortality or reoperation rate.


Assuntos
Abscesso/cirurgia , Apendicite/cirurgia , Colecistite Aguda/cirurgia , Infecções por Coronavirus/epidemiologia , Obstrução Intestinal/cirurgia , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Parede Abdominal , Abscesso/epidemiologia , Doença Aguda , Apendicectomia/estatística & dados numéricos , Apendicite/epidemiologia , Betacoronavirus , Colecistite Aguda/epidemiologia , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Emergências , Feminino , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/cirurgia , Herniorrafia/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Obstrução Intestinal/epidemiologia , Laparoscopia/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Pandemias , Doenças Retais/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Espanha/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos
15.
Med Glas (Zenica) ; 17(2): 275-278, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32662615

RESUMO

Aim The outbreak of the COVID-19 pandemic has had a major impact on the delivery of elective, as well as emergency surgery on a world-wide scale. Up to date few studies have actually assessed the impact of COVID-19 on the postoperative morbidity and mortality following emergency gastrointestinal surgery. Herein, we present our relevant experience over a 3-month period of uninterrupted provision of emergency general surgery services in George Eliot Hospital NHS Trust, the United Kingdom. Methods We performed a retrospective analysis of a prospective institutional database, which included the operation types, paraclinical investigations and postoperative complications of all patients undergoing emergency general surgery operations between March - May 2020. Results The occurrence of a 5% overall respiratory complication rate postoperatively, with 3% infection rate for COVID-19 was found; no patient had unplanned return to intensive care for ventilator support and there was no mortality related to COVID-19 infection. Conclusion When indicated, emergency surgery should not be delayed in favour of expectant/conservative management in fear of COVID-19-related morbidity or mortality risks.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório , Emergências , Mortalidade , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Infecções Respiratórias/epidemiologia , Abscesso/cirurgia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Betacoronavirus , Colecistectomia Laparoscópica , Comorbidade , Infecções por Coronavirus/terapia , Surtos de Doenças , Drenagem , Feminino , Herniorrafia , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/epidemiologia , Insuficiência Respiratória/terapia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Reino Unido/epidemiologia , Adulto Jovem
16.
Arch Gynecol Obstet ; 302(3): 679-683, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32535665

RESUMO

PURPOSE: Management of tubo-ovarian abscesses (TOA) is often complex and may include antibiotics, image-guided drainage via interventional radiology (IR) or surgery. We aim to (i) identify clinical factors that prognosticate primary drainage and (ii) compare outcomes of each treatment regimen. METHODS: This is a retrospective analysis on patients with TOA, admitted to KK Hospital, a tertiary women's hospital in Singapore from June 2016 to June 2017. Pregnant patients or patients who were discharged against medical advice were excluded. 102 patients were included in this study. RESULTS: 85.3% patients received antibiotics only, while 14.7% patients received antibiotics with IR drainage or surgery (primary drainage) as initial treatment. Subsequently, 20.7% failed antibiotic treatment and required IR drainage or surgery (secondary drainage). Patients aged above 40 years, TOA diameter of larger than 7 cm and presence of fever were found to be predictive of antibiotic failure, requiring secondary drainage. However, patients with primary drainage had a longer length of stay by 2.69 days (95% CI 1.44-3.94, p value < 0.001), compared to patients successfully managed conservatively. CONCLUSION: Patients who are above 40 years, febrile and have a larger TOA are at a higher risk of medical treatment failure, and should, therefore, be recommended for primary drainage at presentation. Further prospective studies should be conducted with a larger sample size to compare the outcomes of conservative management versus drainage of TOA.


Assuntos
Abscesso/cirurgia , Tratamento Conservador/métodos , Drenagem/métodos , Doenças Ovarianas/cirurgia , Adulto , Feminino , Humanos , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
17.
Khirurgiia (Mosk) ; (5): 81-86, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500694

RESUMO

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 terapêutico
19.
Acta Orthop Traumatol Turc ; 54(3): 344-347, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32442124

RESUMO

Brodie's abscess of the calcaneus is an uncommon benign lesion that has rarely been reported in the literature. This study presents a rare case of a Brodie's abscess of the calcaneus caused by Staphylococcus aureus in an adult patient. A 46-year-old immunocompetent man had undergone nonsurgical treatment since childhood owing to the diagnosis of a heel spur. Radiological evaluation revealed a benign radiolucent cystic lesion of the calcaneus surrounded by a sclerotic rim. This condition was accompanied by perilesional bone marrow edema. Thereafter, surgical treatment was planned. During surgery, the content of the lesion was observed to be purulent. Meticulous intralesional debridement was performed, and antibiotic-loaded bone cement beads were placed. Subsequent to microbiological and pathological examinations, the cystic lesion was confirmed to be a Brodie abscess; however, direct clinical evidence of an intraosseous infection was lacking. The patient was followed up for 14 months with no complications until recovery. A Brodie abscess may mimic bone tumors. The onset of a Brodie abscess is insidious, and the clinical findings of such lesions may be obscure. A Brodie abscess of the calcaneus should be considered in the differential diagnosis of patients with chronic heel pain when suspicious radiological findings are evident.


Assuntos
Calcâneo , Desbridamento/métodos , Esporão do Calcâneo/diagnóstico , Abscesso/diagnóstico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Cimentos para Ossos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Calcâneo/diagnóstico por imagem , Calcâneo/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
20.
BMC Infect Dis ; 20(1): 354, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429852

RESUMO

BACKGROUND: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA). CASE PRESENTATION: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics. CONCLUSIONS: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.


Assuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/diagnóstico , Exotoxinas/análise , Imunocompetência , Leucocidinas/análise , Mediastinite/diagnóstico , Mediastinite/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/metabolismo , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Clindamicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Drenagem , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/imunologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
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