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1.
Clin Imaging ; 81: 143-146, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34717236

RESUMO

A pyogenic hepatic abscess is an uncommon complication after laparoscopic sleeve gastrectomy (LSG) that can develop secondary to an infected hematoma or a staple line leak due to bacterial seeding. Appropriate screening for and management of a pyogenic hepatic abscess are essential in patients with clinical suspicion for complications after LSG. Early diagnosis is essential as pyogenic hepatic abscess can be fatal if not treated early. Only five cases have been reported in the literature so far. We present a case of pyogenic hepatic abscess that occurred two weeks after LSG in a 46-year-old female without immunosuppressive conditions or early postoperative leak. The abscess was diagnosed by computed tomography (CT) and was successfully treated with antibiotics and CT-guided drainage.


Assuntos
Laparoscopia , Abscesso Hepático Piogênico , Obesidade Mórbida , Fístula Anastomótica , Drenagem , Feminino , Gastrectomia/efeitos adversos , Humanos , Abscesso Hepático Piogênico/diagnóstico por imagem , Abscesso Hepático Piogênico/etiologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
2.
Oral Maxillofac Surg Clin North Am ; 34(1): 169-177, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34728145

RESUMO

This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.


Assuntos
Cárie Dentária , Doenças Periodontais , Cirurgia Bucal , Antibacterianos/uso terapêutico , Cárie Dentária/tratamento farmacológico , Drenagem , Humanos , Doenças Periodontais/tratamento farmacológico , Doenças Periodontais/cirurgia
3.
Urol Clin North Am ; 49(1): 185-196, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34776051

RESUMO

Ureteral stents are an indispensable part of any (endo-) urologic practice. Despite the widely demonstrated advantages of stents, they also carry a considerable risk of side effects and complications, such as urinary symptoms, pain, hematuria, decreased quality of life, stent-related infection, and encrustation. Multiple pathways in preventing or mitigating these side effects and complications and improving stent efficacy have been and are being investigated, including stent architecture and design, biomaterials, and coatings. This article provides an update on currently researched and available stents as well as future perspectives.


Assuntos
Biofilmes , Desenho de Equipamento , Stents , Implantes Absorvíveis , Materiais Biocompatíveis , Drenagem/instrumentação , Humanos , Silicones , Stents/efeitos adversos , Ureter , Ureteroscopia/efeitos adversos
4.
Neurosurg Focus ; 51(5): E4, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724637

RESUMO

OBJECTIVE: Timely ventriculostomy placement is critical in the management of neurosurgical emergencies. Prompt external ventricular drain (EVD) placement has been shown to improve long-term patient outcomes and decrease the length of ICU and hospital stays. Successful and efficient EVD placement requires seamless coordination among multiple healthcare teams. In this study, the authors sought to identify factors favoring delayed ventriculostomy via a quality improvement initiative and to implement changes to expedite EVD placement. METHODS: Through process mapping, root cause analysis, and interviews with staff, the authors identified the lack of a standardized mechanism for alerting necessary healthcare teams as a major contributor to delays in EVD placement. In December 2019, an EVD alert system was developed to automatically initiate an EVD placement protocol and to alert the neurosurgery department, pharmacy, core laboratory, and nursing staff to prepare for EVD placement. The time to EVD placement was tracked prospectively using time stamps in the electronic medical record. RESULTS: A total of 20 patients who underwent EVD placement between December 2019 and April 2021, during the EVD alert protocol initiation, and 18 preprotocol control patients (January 2018 to December 2019) met study inclusion criteria and were included in the analysis. The mean time to EVD placement in the control group was 71.88 minutes compared with 50.3 minutes in the EVD alert group (two-tailed t-test, p = 0.025). The median time to EVD placement was 64 minutes in the control group compared with 52 minutes in the EVD alert group (rank-sum test, p = 0.0184). All patients from each cohort exhibited behavior typical of stable processes, with no violation of Shewhart rules and no special cause variations on statistical process control charts. CONCLUSIONS: A quality improvement framework helped identify sources of delays to EVD placement in the emergency department. An automated EVD alert system was a simple intervention that significantly reduced the time to EVD placement in the emergency department and can be easily implemented at other institutions to improve patient care.


Assuntos
Drenagem , Ventriculostomia , Ventrículos Cerebrais , Serviço Hospitalar de Emergência , Humanos , Tempo de Internação , Estudos Retrospectivos
5.
Ann Palliat Med ; 10(10): 11129-11140, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763473

RESUMO

BACKGROUND: Lumbar continuous drainage of fluid (LCDF) has become more widely used in the diagnosis and treatment of neurological diseases in recent years. The use of LCDF can enable a better understanding of the patient's condition and reduce the incidence of related complications. LCDF can also affect complications of perforation surgery, including mortality during hospitalization, cerebral vasospasm (CVS), bleeding, and aneurysmal subarachnoid hemorrhage (aSAH). METHODS: Articles published from library construction to April 2021 were searched for in the English-language databases PubMed, Cochrane Library, and Embase. All randomized controlled trials (RCTs) with LCDF and hole locking surgery were meta-analyzed using the Cochrane Collaboration's RevMan 5.3 software. RESULTS: Ten RCTs involving 1,092 patients (continuous drainage group, n=585; control group, n=507) were included in the meta-analysis. For the statistical different in incidence of perioperative cerebral infarction in the two groups, the odds ratio (OR) was 5.42 [95% confidence interval (CI): (2.71, 10.83); P<0.00001], and for the statistical difference in the incidence of cerebral hemorrhage, the OR was 4.76 [95% CI: (2.11, 10.76); P=0.0002]. Perioperative complications were fewer in the LCDF-treated drainage group than in the conventional group. DISCUSSION: This meta-analysis of 10 RCTs confirmed that LCDF compared with other treatments is associated with a lower incidence of perioperative complications, such as cerebral hemorrhage, hydrocephalus, and cerebral infarction, as well as increased Glasgow Outcome Scale (GOS).


Assuntos
Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Vazamento de Líquido Cefalorraquidiano/etiologia , Drenagem , Humanos , Período Perioperatório , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
6.
Kyobu Geka ; 74(12): 992-995, 2021 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-34795140

RESUMO

A 73 years old male patient with the past history of kidney transplantation was admitted to our hospital for treatment of coronavirus disease 2019 (COVID-19) pneumonia. On the 25th day after the onset of symptoms when his condition was improving, he suddenly developed pneumothorax. Chest tube drainage was performed and connected the tube to the drainage device using a high efficiency particulate air (HEPA) filter. Because of the improvement of infection, the HEPA filter was removed from the drainage device on day 28. Chest tube drainage was continued by day 35, and he was discharged and introduced home oxygen therapy on day 51.


Assuntos
COVID-19 , Pneumotórax , Idoso , Tubos Torácicos , Drenagem , Humanos , Masculino , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , SARS-CoV-2
7.
Wounds ; 33(9): 226-230, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34734841

RESUMO

INTRODUCTION: Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. OBJECTIVE: This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. MATERIALS AND METHODS: The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. RESULTS: All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. CONCLUSIONS: Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.


Assuntos
Abscesso Abdominal , Fasciite Necrosante , Abscesso/complicações , Abscesso/terapia , Desbridamento , Drenagem , Fasciite Necrosante/complicações , Fasciite Necrosante/terapia , Humanos , Coxa da Perna
8.
Sao Paulo Med J ; 139(6): 556-563, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34787294

RESUMO

BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.


Assuntos
Procedimentos Cirúrgicos Eletivos , Modalidades de Fisioterapia , Drenagem , Gases , Humanos , Tempo de Internação , Complicações Pós-Operatórias/prevenção & controle
9.
J Wound Ostomy Continence Nurs ; 48(6): 568-572, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34781314

RESUMO

BACKGROUND: Tuberculosis (TB) is a leading infectious disease worldwide. It rarely occurs in the scapula and toe joints and is easily misdiagnosed. Without prompt treatment, the associated lesions can spread to surrounding soft tissues such as joint capsules, muscles, tendons, and fascia. In severe cases, the bones and articular surfaces can become significantly damaged; it is not uncommon for deep skeletal TB wounds with sinus tracts to form, which are very difficult to treat. We report our successful wound care management approach for one patient with multiple skeletal TB complicated with multiple deep sinus tracts. CASE: The patient was treated with anti-TB medications, and wound and bone debridement (sharps, surgical) combined with vacuum-shielded drainage (VSD) (Kula, CG Bio Co Ltd, Gyeonggi-do, South Korea) to fill the sinus tract. We removed the caseous (cheese-like) necrotic tissue, purulent drainage, and necrotic tissue at the base of the wound to ensure optimal wound care. Throughout the course of treatment, we selected different types of dressings to maintain moist wound healing and absorb excessive drainage. After 144 days of treatment, the wound and deep sinus tracts completely healed. CONCLUSIONS: Wounds related to skeletal TB with multiple sinus tracts are difficult to manage and heal. We found our wound protocol that included timely debridement and use of VSD was effective for the management of these complex wounds. Specifically, our approach filled the dead space in the sinus tract, removed excessive drainage, promoted the growth of granulation tissue, and overall promoted tissue healing.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Tuberculose , Desbridamento , Drenagem , Humanos , Transplante de Pele , Resultado do Tratamento , Cicatrização
10.
Am J Case Rep ; 22: e933618, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758004

RESUMO

BACKGROUND Penile abscesses were traditionally regarded as an infectious disease; however, idiopathic cases in which prednisolone was effective have been reported. CASE REPORT A 64-year-old man was admitted to the hospital with symptoms of penile induration and dysuria. He was diagnosed with a penile abscess, which was punctured and then relapsed. An incision and drainage were performed on the abscess, and the pus and tissue samples were cultured and examined histologically. There was no evidence of malignancy or bacterial infection, and he was diagnosed with an idiopathic penile abscess. As pus continuously drained from the incision, prednisolone 40 mg was initiated, which resulted in a decreased amount of pus and eventual wound closure. Over 15 months, prednisolone was gradually tapered to 5 mg, and the abscess continued to decrease in size. CONCLUSIONS Idiopathic penile abscesses are rare but often lead to penectomy. Prednisolone is a new treatment method for such patients. This is the third case of an idiopathic penile abscess that was successfully treated with prednisolone. The causative agent of the idiopathic penile abscess was suggested to be pyoderma gangrenosum; however, this case did not exhibit the typical characteristics of pyoderma gangrenosum. Therefore, further investigation was needed. A differential diagnosis of an infectious abscess is required before initiating steroid treatment. Open drainage is useful, but the size of the incision should be minimized for the purpose of preserving penile function. The prednisolone dose should be started at 20 to 40 mg and reduced gradually to avoid relapse.


Assuntos
Abscesso , Pioderma Gangrenoso , Abscesso/tratamento farmacológico , Diagnóstico Diferencial , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Pioderma Gangrenoso/diagnóstico
12.
Pan Afr Med J ; 39: 198, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603579

RESUMO

A mucocele is a cystic and expansive lesion of the sinus cavities. It is uncommon in the sphenoid sinus and its management is quite challenging especially in low to middle income countries like Cameroon. A 43-years-old female was referred to us by a neurologist for chronic headache and visual disturbances. The pain was unresponsive to analgesics. Physical examination was non-remarkable and a head CT scan realized showed a cyst-like lesion in the sphenoid sinus cavity. Surgical endoscopic treatment was proposed and realized with basic endoscopic instruments, consisting of opening the cavity with drainage of the mucocele. A large opening was made on the anterior wall of the sphenoid sinus, in order to ensure continuous drainage and prevent a recurrence. Sphenoid sinus mucocele is a rare condition, and its diagnosis can be difficult. Confirmation requires specific imaging and treatment is presently well established, but it can be managed with basic tools.


Assuntos
Mucocele/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Adulto , Camarões , Drenagem , Endoscopia , Feminino , Transtornos da Cefaleia/etiologia , Humanos , Mucocele/cirurgia , Doenças dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
13.
Georgian Med News ; (318): 28-34, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628374

RESUMO

Esophageal perforation (EP) is a devastating condition. In modern times it is still associated with substantial morbidity and mortality. 62-year-old male patient came to Surgical Department of the First University Clinic of Tbilisi State Medical University on 17.10.2018 15:00. The patient complained of pain in the chest cavity, especially after eating, shortness of breath, fever, chills, weakness. The patient felt pain in the chest cavity after eating 4 days before hospitalization. CT scan revealed pneumomediastinum, extravasation of contrast medium at the level of the 8th thoracic vertebra. Esophagogastroduodenoscopy revealed a defect in the esophagus at the level of 32 cm from the incisors. Dimensions of defect were 2.0 - 3.0 cm. An urgent operation was performed. Left-sided posterolateral thoracotomy, mediastinotomy, suturing of the defect, buttressing of the sutures with the mediastinal pleura, washing and drainage of the mediastinum and left pleural cavity were performed. A Witzel gastrostomy was performed. After the operation, the patient's treatment continued in the intensive care unit. Since leakage was noted, it was decided to place an esophageal stent in the area of the defect. Stenting was performed on 05.11.2018. A complication in the form of bleeding was noted on 01.12.2018. Bleeding was controlled conservatively. Finally, stent was removed and the patient was discharged from the clinic in good condition on 07.12.2018. New interventional endoscopic techniques, including endoscopic clips, covered metal stents, and endoluminal vacuum therapy, have been developed over the last several years to manage esophageal perforation. Surgery should be undertaken in all patients who do not meet non-operative management criteria. Buttressing the esophageal repair with surrounding viable tissue has been recommended to decrease the risk of leakage. If direct repair of thoracic EP is not feasible esophageal exclusion, diversion, or resection should be performed. Repair over a large size T-tube can be used to create a controlled esophago-cutaneous fistula and minimize mediastinal and pleural contamination. Thus, esophageal perforation continues to present a diagnostic and therapeutic challenge despite decades of clinical experience and innovation in surgical technique.


Assuntos
Perfuração Esofágica , Drenagem , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Vértebras Torácicas
14.
Ann Palliat Med ; 10(9): 9830-9840, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628909

RESUMO

BACKGROUND: Surgery is the clinically preferred treatment for high perianal abscesses. Incision and seton drainage improve the cure rate and reduce recurrence. We aimed to systematically evaluate the clinical effect and safety of incision and seton drainage in the treatment of high perianal abscess. METHODS: China Knowledge Network (CNKI), WanFang database, VIP database, PubMed, and Cochrane Library were searched and all relevant Chinese and English language documents until July 2021were retrieved. All records that described randomized clinical trials (RCTs) of incision and seton drainage for the treatment of high perianal abscess were eligible. Documents that met the inclusion criteria were evaluated for bias using the Cochrane Collaboration Risk Evaluation Standard, and Revman5.4 software was used to analyze the data. RESULTS: Fourteen RCTs were included. The results of nine studies showed that the clinical cure rate of the incision-seton group was higher than that of the incision-drainage group (P<0.05). Seven studies showed that the wound healing time of the incision-seton group was shorter than that of the incision-drainage group (P<0.05). Four studies showed that the visual analogue scale (VAS) score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Five studies showed that the Wexner score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Six studies demonstrated that the recurrence rate of abscess in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Seven studies showed that the incidence of adverse events in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Five studies demonstrated that the length of stay in the incision-seton group was shorter than that of the incision-drainage group (P<0.05). DISCUSSION: The choice of surgical methods in clinical research has always been controversial. The incision-seton method can effectively and safely treat high perianal abscess. However, the results of this meta-analysis still leave some gaps in the evidence. More large-sample, high-quality, and multi-center RCTs are needed.


Assuntos
Doenças do Ânus , Fístula Retal , Abscesso/cirurgia , Doenças do Ânus/cirurgia , Drenagem , Humanos , Recidiva
15.
Ann Palliat Med ; 10(9): 10091-10094, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628928

RESUMO

Emphysematous splenic infection is a rare disease. In this case, a 33-year-old woman presented to the emergency department with a 10-day history of left-upper-quadrant abdominal pain and intermittent fever. She positively denied any previous history of illness or trauma. On admission to the hospital, her white-cell count, neutrophil percentage, C-reactive protein level, blood glucose, and urine glucose were higher than normal. Computed tomography (CT) revealed gas-fluid levels and infection in the spleen. After multidisciplinary consultation and discussions, the patient was diagnosed with emphysema spleen infection and diabetes, and the infection was most likely related to the diabetes. The patient was treated with antibiotics, hypoglycemic therapy, and transabdominal spleen infection puncture and drainage. Finally, the patient's infection and blood sugar were controlled, and the drainage fluid was unobstructed. To the best of our knowledge, emphysematous spleen infection has only been reported once previously in a super obese female patient in 2007. Interestingly, the patient in the present case was also an obese and diabetic middle-aged woman. Similar to other documented emphysematous infection cases, the disease onset of our patient was indistinct and insidious. Due to advances in imaging tools and knowledge of emphysematous nephritis, the patient was successfully diagnosed and treated in time.


Assuntos
Diabetes Mellitus , Enfisema , Adulto , Antibacterianos/uso terapêutico , Drenagem , Enfisema/tratamento farmacológico , Enfisema/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
West Afr J Med ; 38(9): 835-838, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34675209

RESUMO

BACKGROUND: Chronic subdural hematoma (CSDH) is achronic inflammatory and angiogenic condition that is potentially fatal and common among the elderly with a probability of gender, racial and ethnic differences. As our population ages due to increase in our life expectancy, a closer look at this disease in our environment is therefore justified. OBJECTIVES: Our objective is to evaluate the epidemiology, relationship of demography, procedure type and mode of anaesthesia on outcome in the patients. METHODS: Retrospective analyses of patients with CSDHs treated by single burrhole, over a 9-year period was performed. Patients' biodata, type of surgery, mode of anaesthesia and discharge outcome were noted. Data were analysed with chisquare, independent t test and multivariate binary regression. Values of p < 0.05 were considered statistical significance. RESULTS: Two hundred and sixty-four patients were managed during the study period. The male-to-female ratio was 2:1 with mean age of 61.4 years. The peak age range was in the seventh decade. Recurrence and mortality rates were 2.7% and 6.8% respectively. Age was significantly associated with mortality. CONCLUSION: The study showed a male preponderance. Age was significantly associated with mortality. Recurrence of CSDH was not related to patients' age, gender or mode of anaesthesia.


Assuntos
Hematoma Subdural Crônico , Idoso , Demografia , Drenagem , Feminino , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
17.
J Cardiothorac Surg ; 16(1): 292, 2021 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-34629078

RESUMO

BACKGROUND: Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. CASE PRESENTATION: This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient's wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. CONCLUSIONS: The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tratamento de Ferimentos com Pressão Negativa , Antibacterianos/uso terapêutico , Cimentos Ósseos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Desbridamento , Drenagem , Humanos , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento , Cicatrização
18.
N Engl J Med ; 385(15): 1372-1381, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34614330

RESUMO

BACKGROUND: Infected necrotizing pancreatitis is a potentially lethal disease that is treated with the use of a step-up approach, with catheter drainage often delayed until the infected necrosis is encapsulated. Whether outcomes could be improved by earlier catheter drainage is unknown. METHODS: We conducted a multicenter, randomized superiority trial involving patients with infected necrotizing pancreatitis, in which we compared immediate drainage within 24 hours after randomization once infected necrosis was diagnosed with drainage that was postponed until the stage of walled-off necrosis was reached. The primary end point was the score on the Comprehensive Complication Index, which incorporates all complications over the course of 6 months of follow-up. RESULTS: A total of 104 patients were randomly assigned to immediate drainage (55 patients) or postponed drainage (49 patients). The mean score on the Comprehensive Complication Index (scores range from 0 to 100, with higher scores indicating more severe complications) was 57 in the immediate-drainage group and 58 in the postponed-drainage group (mean difference, -1; 95% confidence interval [CI], -12 to 10; P = 0.90). Mortality was 13% in the immediate-drainage group and 10% in the postponed-drainage group (relative risk, 1.25; 95% CI, 0.42 to 3.68). The mean number of interventions (catheter drainage and necrosectomy) was 4.4 in the immediate-drainage group and 2.6 in the postponed-drainage group (mean difference, 1.8; 95% CI, 0.6 to 3.0). In the postponed-drainage group, 19 patients (39%) were treated conservatively with antibiotics and did not require drainage; 17 of these patients survived. The incidence of adverse events was similar in the two groups. CONCLUSIONS: This trial did not show the superiority of immediate drainage over postponed drainage with regard to complications in patients with infected necrotizing pancreatitis. Patients randomly assigned to the postponed-drainage strategy received fewer invasive interventions. (Funded by Fonds NutsOhra and Amsterdam UMC; POINTER ISRCTN Registry number, ISRCTN33682933.).


Assuntos
Antibacterianos/uso terapêutico , Drenagem , Pâncreas/patologia , Pancreatite Necrosante Aguda/terapia , Tempo para o Tratamento , Idoso , Terapia Combinada , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia
19.
Ther Umsch ; 78(9): 547-558, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34704480

RESUMO

Symptoms, diagnostic and therapy of perianal disease in patients with inflammatory bowel diseases Abstract. Inflammatory bowel diseases (IBD) frequently affect the perianal region. Due to the great functional importance of the anorectum, this frequently results in a significant burden of disease for the patient. For assessment of perianal IBD symptoms, the clinical history is of great importance. Often, anorectal symptoms are not reported spontaneously by patients, and a respectful direct conversation remains crucial. More than 30 % of patients with Crohn's disease (CD) will develop perianal fistulas. Perianal fistulas can be further characterized by endoscopic ultrasound, MRI, and investigation under anesthesia. These investigations provide complementary information. Fistula therapy is based on symptoms; the short-term goal is improvement of pain and secretion; the long-term goal of treatment remains fistula closure. However, preservation of the anal sphincter is of utmost importance and incontinence needs to be avoided. Antibiotics and/ or seton drainage are the mainstay for acute fistula treatment. The anti-tumor necrosis factor antibody infliximab can improve fistula symptoms, as demonstrated in a randomized controlled study. Surgical fistula closure is only possible in a clinically stable situation without rectal inflammation or other symptoms of active CD. Several surgical strategies exist including 1) fistulotomy, 2) disconnection of the fistula, 3) filling of the fistula tract and 4) fistula ablation. The optimal strategy needs to be decided on an individual basis. Intraoperative application of mesenchymal donor stem cells into the fistula tract and surrounding tissue is possibly the most effective fistula therapy. Due to the significant logistic effort, this therapy is only available in a few selected centers. Currently, stem cell therapy for CD fistulas is limited to patients with no more than two external fistula openings. The therapy of fissures and hemorrhoids in IBD patients is similar to patients without intestinal inflammation; however, due to a high rate of complications, surgery should be avoided whenever possible in CD patients. Incontinence is a frequent problem in IBD patients leading to highly relevant restrictions in daily life. Therapy is directed against intestinal inflammation but also comprises measures for normalization of stool consistency and intestinal motility. However, there are no IBD-specific concepts for the treatment of incontinence. Functional intestinal diseases are frequent in IBD patients and can contribute to urge and incontinence. Some IBD patients might benefit from anorectal physiotherapy. IBD patients have an increased risk for colorectal carcinoma, fistula carcinoma and possibly also anal carcinoma. Therefore, malignancy needs to be excluded at reasonable intervals.


Assuntos
Doença de Crohn , Fístula Retal , Terapia Combinada , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Drenagem , Endossonografia , Humanos , Fístula Retal/diagnóstico , Fístula Retal/terapia , Resultado do Tratamento
20.
Z Gastroenterol ; 59(10): 1053-1058, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34638153

RESUMO

BACKGROUND: Drainage is essential for source control of the infection in a pelvic abscess. The purpose of this study was to report 2 cases of endoscopic ultrasound (EUS)-guided drainage of the pelvic abscess and review the literature of different modalities of EUS-guided drainage of pelvic abscess. CASE PRESENTATION: A 60-year-old male developed a pelvic abscess 1 month after laparoscopic complete tumor resection. An abdominal CT showed a mass shadow (about 7.1 cm × 5.1 cm) in the right pelvic region. Another case was an 85-year-old male who developed a pelvic abscess 3 days after recurrent tumor resection of multiple organs. The CT showed pelvic effusion and gas accumulation (approximately 6.5 cm × 4.2 cm), and the intestinal tube above the small intestinal anastomosis was dilated with effusion. A 19G-A puncture needle was used to puncture the abscess. An 8-mm cylindrical balloon was inserted, followed by a 10 Fr-3 cm double pigtail stent and an 8.5 Fr drainage tube. After EUS-guided drainage of pelvic abscess, the symptoms disappeared without recurrence. CONCLUSIONS: EUS-guided drainage is an effective and safe method for treating pelvic abscesses as long as the drainage modality is appropriately selected based on the etiology, size, and mucus viscosity of the abscess.


Assuntos
Abscesso , Endossonografia , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/cirurgia , Ultrassonografia de Intervenção
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