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Journal of Visceral Surgery Dec 2023Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its... (Review)
Review
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
Topics: Humans; Hidradenitis Suppurativa; Abscess; Surgeons
PubMed: 37722942
DOI: 10.1016/j.jviscsurg.2023.07.008 -
Vestnik Otorinolaringologii 2023The number of cases of children's sinogenic orbital complications does not reduce in spite of the advanced methods of paranasal sinuses visualization, wide use of...
The number of cases of children's sinogenic orbital complications does not reduce in spite of the advanced methods of paranasal sinuses visualization, wide use of antibacterial therapy against sinusitis, and preventive vaccination against pneumococcal disease. Orbital complications are more common with children than with adults, the basic reason of their development being ethmoiditis. The prevailing classification of orbital complications proposed by J. Chandler et al. divides these into preceptal and postceptal forms and gives description to 5 development stages of orbital complications in the order of their increasing severity. At an early age preceptal and orbital cellulites prevail, and these commonly need conservative treatment only. In case of orbital cellulitis, the major treatment method is endovenous antibiotic therapy in which the chosen antibiotic is to cover the whole spectrum of aerobic and anaerobic microbes often extracted in such cases. At small subperiostal abscesses (<0.5-1 ml), conservative treatment during 24-48 hours is possible. If there is no positive dynamics, or abscess grows in size, or eye symptoms progress, abscess and affected sinuses drain is recommended. Orbital abscess is to be given surgical treatment; at the same time endoscopic management of paranasal sinuses might by complemented with external surgical approaches (lateral and medial orbitotomy).
Topics: Adult; Humans; Child; Abscess; Orbital Diseases; Retrospective Studies; Sinusitis; Paranasal Sinuses; Anti-Bacterial Agents
PubMed: 37184558
DOI: 10.17116/otorino20228802174 -
Survey of Ophthalmology 2016Numerous long-standing controversies influence the management of lacrimal sac abscesses, canalicular lacerations, and obstruction of the nasolacrimal duct. We examined... (Review)
Review
Numerous long-standing controversies influence the management of lacrimal sac abscesses, canalicular lacerations, and obstruction of the nasolacrimal duct. We examined the debatable beliefs that underline these controversies and concluded the following: drainage of a pointing lacrimal sac abscess can be well tolerated under local anesthesia, is associated with few adverse events, and should be performed regardless of whether systemic antibiotics have been administered. Reconstruction of monocanalicular lacerations should be considered in all cases, without distinction to whether the injury involves the upper or lower canaliculus. Finally, no firm evidence currently exists supporting intubation with routine dacryocystorhinostomy.
Topics: Abscess; Dacryocystorhinostomy; Drainage; Eye Injuries; Humans; Intubation; Lacerations; Lacrimal Apparatus; Lacrimal Apparatus Diseases; Lacrimal Duct Obstruction; Stents
PubMed: 26700821
DOI: 10.1016/j.survophthal.2015.12.003 -
The Journal of Invasive Cardiology Oct 2020Sterile inflammatory reactions at vascular access sites have rarely been reported in the literature. Simple conservative treatment, as in this case, can lead to...
Sterile inflammatory reactions at vascular access sites have rarely been reported in the literature. Simple conservative treatment, as in this case, can lead to resolution of even extensive sterile abscesses.
Topics: Abscess; Acute Coronary Syndrome; Conservative Treatment; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Vascular Surgical Procedures
PubMed: 32999099
DOI: No ID Found -
Surgery Sep 2023To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery.
BACKGROUND
To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery.
METHODS
This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed.
RESULTS
Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85).
CONCLUSION
Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
Topics: Humans; Abscess; Retrospective Studies; Abdominal Abscess; Nomograms; Diverticulitis; Drainage
PubMed: 37385866
DOI: 10.1016/j.surg.2023.05.016 -
Journal of Hepato-biliary-pancreatic... Jan 2015Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)-guided drainage provides a safe and effective minimally invasive... (Review)
Review
Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)-guided drainage provides a safe and effective minimally invasive treatment option. The likelihood of a successful outcome is dependent on appropriate patient selection, drainage technique and postoperative management. This review outlines the evidence behind and procedural steps required for EUS-guided pelvic abscess drainage.
Topics: Abscess; Drainage; Endosonography; Humans; Pelvis; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 25159523
DOI: 10.1002/jhbp.150 -
Ugeskrift For Laeger Jul 2017Simple subcutaneous abscesses are common, and we have examined the literature concerning the ideal treatment of subcutaneous abscesses. We recommend radical debridement... (Review)
Review
Simple subcutaneous abscesses are common, and we have examined the literature concerning the ideal treatment of subcutaneous abscesses. We recommend radical debridement with removal of all pus, the abscess wall and any necrosis. If primary suture is chosen, preoperative antibiotics should be administered, and the cavity should be closed without dead space. Antibiotics should not routinely be given, but always be considered in immunocompromised patients or patients with septicaemia. Routine examination of the microbiology has no influence on the treatment and is not recommended.
Topics: Abscess; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drainage; Humans; Skin Diseases
PubMed: 28689542
DOI: No ID Found -
International Journal of Environmental... May 2022(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics,... (Observational Study)
Observational Study
(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding.
Topics: Abscess; Anti-Bacterial Agents; Breast Diseases; Breast Feeding; Female; Humans; Mastitis; Pregnancy; Retrospective Studies; Staphylococcus aureus
PubMed: 35565158
DOI: 10.3390/ijerph19095762 -
Advanced Emergency Nursing Journal 2018Skin and soft tissue infections are a common complaint seen in the emergency setting, with diagnosis traditionally made by history and physical examination alone.... (Review)
Review
Skin and soft tissue infections are a common complaint seen in the emergency setting, with diagnosis traditionally made by history and physical examination alone. Cellulitis and cutaneous abscesses are often misdiagnosed. Because cellulitis and cutaneous abscesses can appear similar in presentation, they are often misdiagnosed and thus treated inappropriately. To improve accuracy of diagnosis and thus treatment, evidence now supports the use of point-of-care ultrasound for diagnosis of skin and soft tissue infections. This article reviews the difference in the 2 most common skin and soft tissue infections and discusses implications for point-of-care ultrasound in the emergency care setting to aid in diagnosis.
Topics: Abscess; Cellulitis; Drainage; Emergency Service, Hospital; Humans; Point-of-Care Systems; Skin Diseases; Ultrasonography
PubMed: 30365444
DOI: 10.1097/TME.0000000000000208 -
American Journal of Surgery Feb 2024Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based... (Review)
Review
Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based on provider or institution and no central treatment guidelines exist to direct the management of breast infections. This article provides a summary of the current trends in management of breast infections. The etiology, epidemiology, risk factors, presentation, diagnosis, and treatment of mastitis and breast abscesses (and their relative subdivisions) are explored based on the current literature. Trends in microbiology are reviewed and an approach to antibiotic coverage is proposed. Overall, there is a lack of randomized-controlled trials focused on the treatment of breast infections. This has resulted in an absence of clinical practice guidelines for the management of breast abscesses and variable practice patterns. The development of best-care protocols or pathways could provide more uniformity in care of breast infections.
Topics: Female; Humans; Anti-Bacterial Agents; Abscess; Mastitis; Breast; Antibiotic Prophylaxis
PubMed: 37949727
DOI: 10.1016/j.amjsurg.2023.10.040