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BMJ Case Reports Mar 2021A patient presented to our unit with a long history of a discharging skin infection on his left cheek, which came and went. He had been seen by numerous healthcare...
A patient presented to our unit with a long history of a discharging skin infection on his left cheek, which came and went. He had been seen by numerous healthcare practitioners including his general practitioner, general dental practitioner and dermatologist, with no resolution. He was eventually diagnosed with an odontogenic cutaneous fistula (OCF), for which he underwent surgical management. The purpose of the study is to describe the diagnosis and surgical management of an OCF, from initial assessment through to postoperative review and discharge. Following surgical management of the OCF and treatment of the source of infection by dental extraction, the patient is no longer experiencing purulent discharge through his left cheek. The extraoral skin site of drainage at his left cheek has resolved completely, with minimal residual scarring. OCF can be managed by a number of different treatment modalities. The treatment of an OCF by surgical excision is presented.
Topics: Cheek; Cutaneous Fistula; Dentists; Humans; Male; Professional Role; Skin Diseases
PubMed: 33727295
DOI: 10.1136/bcr-2020-240306 -
European Journal of Obstetrics,... Nov 2020To describe post-operative outcomes following early re-suturing of obstetric perineal wound dehiscence.
OBJECTIVES
To describe post-operative outcomes following early re-suturing of obstetric perineal wound dehiscence.
STUDY DESIGN
This was a retrospective series of 72 women who underwent re- suturing of a dehisced perineal wound at a tertiary urogynaecology department during a 13-year period (December 2006 - December 2019).
RESULTS
Seventy-two women with complete perineal wound dehiscence opted for secondary re-suturing. Other accompanying symptoms included purulent discharge from the wound (22.2 %), perineal pain (23.6 %) and both purulent discharge and pain (26.4 %). The median time taken for the wound to heal completely following re-suturing was 28 days (IQR 14.0-52.0); 49.2 % had healed completely by four weeks, 63.5 % by six weeks and 76.2 % by eight weeks. The median number of out-patient follow-up appointments required was 2 (IQR 1.0-3.0). No post-operative complications were experienced in 63.6 % of women, one complication occurred in 25.8 % and two complications in 10.6 %. Complications included skin dehiscence (33.3 %), granuloma (33.3 %), scar tissue (17.6 %), perineal pain (5.9 %) and sinus formation (5.9 %). Of the women who developed two complications, four developed skin dehiscence with granulation tissue and one had skin sinus formation. One developed granulation tissue with perineal pain. All complications were managed conservatively in an outpatient setting or surgically under local anaesthetic, without further complication. There was no significant difference (p = 0.443) in complication rates between the group (n = 10) with dehisced wounds with signs of wound infection (purulent discharge or the presence of both purulent discharge and pain) pre-operatively versus the group (n = 14) without signs of infection.
CONCLUSIONS
This study demonstrates the positive outcomes of early re-suturing of perineal wound dehiscence with faster healing, reduced follow-up requirements and few major complications. It provides information to clinicians who are uncertain about the effects of early re-suturing of perineal wounds which can be used to help counsel mothers with wound dehiscence on their management options.
Topics: Female; Humans; Perineum; Pregnancy; Retrospective Studies; Sutures; Wound Healing
PubMed: 32942078
DOI: 10.1016/j.ejogrb.2020.09.013 -
Turkish Archives of Otorhinolaryngology Dec 2016A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the...
OBJECTIVE
A rhinolith is a rare entity affecting all people in all age groups. It is defined as a mineralized foreign body. The purpose of the present study was to reveal the distribution in age and gender and the localization, side, and prominent symptoms of rhinoliths to identify the risk groups and characteristics of the rhinoliths in a large case series.
METHODS
A retrospective review was performed from the medical charts of 28 patients who were diagnosed with rhinolith and underwent surgery between May 2011 and January 2015 in Ankara Research and Training Hospital. All data, including age, gender, duration of symptoms, localization of the lesion and accompanying pathologies, were documented.
RESULTS
In total, 28 patients (18 females and 10 males) with a mean age of 26.2±16.6 (5-62) years who were diagnosed with rhinolithiasis were reviewed. Nasal obstruction (71.4%) and nasal discharge (64.3%) were the most common complaints. The rhinolith was located in the right nasal cavity in 24 patients and in the left in four; this difference was statistically significant (p<0.001). There were 11 accompanying pathologies including nasal septal deviation (n=6), nasal polyposis (n=2), concha bullosa (n=2), and adenoid vegetation (n=1). In 21 (75%) patients, the most common site was the nasal base of the cavity between the inferior turbinate and the nasal septum.
CONCLUSION
If unilateral right-sided nasal obstruction with foul-smelling purulent discharge is detected in a young adult and a nasal examination reveals a mass in the floor of the cavity, a rhinolith should be strongly considered in the differential diagnosis.
PubMed: 29392038
DOI: 10.5152/tao.2016.1773 -
Microbiology Spectrum Jun 2022Pet bite-related infections are commonly caused by the pet's oral flora transmitted to the animal handlers through the bite wounds. In this study, we isolated a...
Pet bite-related infections are commonly caused by the pet's oral flora transmitted to the animal handlers through the bite wounds. In this study, we isolated a streptococcus, HKU75, in pure culture from the purulent discharge collected from a guinea pig bite wound in a previously healthy young patient. HKU75 was alpha-hemolytic on sheep blood agar and agglutinated with Lancefield group D and group G antisera. API 20 STREP showed that the most likely identity for HKU75 was S. suis I with 85.4% confidence while Vitek 2 showed that HKU75 was unidentifiable. MALDI-TOF MS identified HKU75 as Streptococcus suis (score of 1.86 only). 16S rRNA gene sequencing showed that HKU75 was most closely related to (98.3% nucleotide identity), whereas partial and gene sequencing showed that it was most closely related to S. suis (81.8% and 89.8% nucleotide identity respectively). Whole genome sequencing and intergenomic distance determined by ANI revealed that there was <85% identity between the genome of HKU75 and those of all other known Streptococcus species. Genome classification using concatenated sequences of 92 bacterial core genes showed that HKU75 belonged to the Suis group. gene sequences identical to that of HKU75 could be directly amplified from the oral cavities of the two guinea pigs owned by the patient. HKU75 is a novel Streptococcus species, which we propose to be named . The oral cavity of guinea pigs is presumably a reservoir of . Some of the reported S. suis strains isolated from clinical specimens may be . We reported the discovery of a novel Streptococcus species, propose to be named Streptococcus oriscaviae, from the pus collected from a guinea pig bite wound in a healthy young patient. The bacterium was initially misidentified as S. suis/ by biochemical tests, mass spectrometry. and housekeeping genes sequencing. Its novelty was confirmed by whole genome sequencing. Comparative genomic studies showed that belongs to the Suis group. sequences were detected in the oral cavities of the two guinea pigs owned by the patient, suggesting that the oral cavity of guinea pigs could be a reservoir of . Some of the reported S. suis strains may be . Further studies are warranted to refine our knowledge on this novel Streptococcus species.
Topics: Animals; DNA, Bacterial; Genes, Bacterial; Guinea Pigs; Nucleotides; Phylogeny; RNA, Ribosomal, 16S; Streptococcus suis
PubMed: 35510851
DOI: 10.1128/spectrum.00014-22 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jul 2021To explore the risk factors of malignant transformation of sinonasal inverted papilloma (SNIP), and to improve the accuracy of preoperative diagnosis of tumor. The...
To explore the risk factors of malignant transformation of sinonasal inverted papilloma (SNIP), and to improve the accuracy of preoperative diagnosis of tumor. The clinical data of 89 patients with sinonasal inverted papilloma (SNIP group, n=60) and malignant transformation of sinonasal inverted papilloma (IP-SCC, =29) were analyzed retrospectively. Clinical symptoms, medical history, endoscopic examination, characteristic of sinonasal CT scan and MR imaging were collected and compared between two groups. Then the indicators with significant differences between the two groups were used for binary logistic regression analysis. The logistic regression model was established to predict the malignant transformation risk factors of inverted papilloma and the prediction ability of the regression model was estimated. The significant differences between the two groups were: symptoms, including nasal obstruction, purulent mucus, blood in the nasal discharge; long-term smoking history; tumor attached with purulent mucus; CT scan showing bone destruction of the orbital wall and skull base; MR Imaging showing convoluted cerebriform pattern (CCP) sign, intraorbital involvement, and dural enhancement of the skull base. The results of logistic regression analysis showed that the risk factors of malignant transformation of SNIP were blood in the nasal discharge, long-term smoking history, tumor with purulent discharge, orbital wall destruction on CT scan, disappearance of CCP and orbital involvement on MRI. The accuracy rate of regression model for predicting malignant transformation of IP is 75.0%, and the accuracy rate for benign inverted papilloma is 96.7%, and the overall accuracy of the model is 89.8%. The risk factors for predicting malignant transformation of SNIP are blood in the nasal discharge, long-term smoking history, tumor with purulent discharge, orbital wall destruction on CT scan, and disappearance of CCP sign and orbital involvement on MRI. It's necessary to analyze all of clinical factors in order to improve the accuracy of preoperative diagnosis of sinonasal inverted papilloma.
Topics: Humans; Nose Neoplasms; Papilloma, Inverted; Paranasal Sinus Neoplasms; Retrospective Studies; Risk Factors
PubMed: 34304493
DOI: 10.13201/j.issn.2096-7993.2021.07.011 -
Case Reports in Dentistry 2018This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth...
This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor.
PubMed: 29888011
DOI: 10.1155/2018/7478236 -
Annals of Medicine and Surgery (2012) Aug 2021Cardiac implantable electronic devices (CIEDs), including implantable cardiac defibrillators, pacemakers, and cardiac resynchronization therapy devices, are lifesaving....
BACKGROUND
Cardiac implantable electronic devices (CIEDs), including implantable cardiac defibrillators, pacemakers, and cardiac resynchronization therapy devices, are lifesaving. However, device infections can lead to morbidity and mortality. of this study was to describe the outcome of CIED infections treated at our center, and to identify risk factors for infection in patients with CIEDs. : Single-center study, Prince Sultan Military Medical City, Riyadh, KSA.
METHODS
This case series included all -related CIED infections treated at a tertiary care center between 2009 and 2020. Data on patient demographics, clinical manifestations, predisposing factors, microbiology, treatment regimens, and outcomes were reviewed.
RESULTS
Fifteen patients met the CIED infection criteria. The mean age was 62.2 years, and 80% were males. Common comorbidities included hypertension (73%), diabetes mellitus (67%), ischemic heart disease (47%), and chronic kidney disease (60%). The mean time to infection following the device implantation was 4.8 years (range: 5 months to 13 years). Fever was detected in 53% of patients, device site swelling in 47%, purulent discharge in 33%, and pain in 27%. The blood culture and serology results were positive in 73% and 80% of patients, respectively. All patients were treated with antibiotics, and the infected device was removed. Seven (46.6%) patients underwent reimplantation with a new device. One patient with dual and methicillin-sensitive infection died, and the other 14 patients recovered, with no recurrent infections reported to date.
CONCLUSION
should be considered in CIED infections, particularly in endemic areas. Proper treatment and device removal are essential for good outcomes.
PubMed: 34367635
DOI: 10.1016/j.amsu.2021.102568 -
International Journal of Burns and... 2021Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) surgeries and prompt diagnosis and treatment are vital; however, no study...
BACKGROUND
Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) surgeries and prompt diagnosis and treatment are vital; however, no study has been conducted to determine the relationship between characteristics and duration of surgical site discharge and PJI.
METHODS
This is a longitudinal observational study that was performed at Al-Zahra and Kashani and Sadi university hospitals from 2017 until 2019. A total of 961 elective TKA were performed on 850 consecutive patients. Patients were followed up for two years after surgery. Data regarding the occurrence of discharges, types of discharges, duration of discharges, the incidence of PJI and superficial infections were collected.
RESULTS
The rate of superficial and prosthetic joint infection was 0.3% and 0.3%. Patients with infections (either PJI or superficial) had a longer duration of discharge (14.6 days and 13.3 days in PJI and superficial infections respectively, compared to 7.7 days in all of the study population); Bloody-purulent discharge was associated with the development of prosthetic and superficial infections.
CONCLUSION
Bloody purulent discharge reaching seven days postsurgical in TKA patients is highly suggestive of an underlying infection (PJI or superficial infection) but type and duration of discharge could not be used to differentiate between PJI and superficial infection. Other risk factors for PJI or superficial infection include women's gender, longer surgical duration, longer hospitalization and longer discharge duration.
PubMed: 33824787
DOI: No ID Found -
Orbit (Amsterdam, Netherlands) Dec 2017Acute dacryoadenitis with abscess formation has been rarely described. We describe four cases that resolved with incision and drainage. This includes a retrospective... (Review)
Review
Acute dacryoadenitis with abscess formation has been rarely described. We describe four cases that resolved with incision and drainage. This includes a retrospective case series of four patients with radiologically confirmed lacrimal gland abscesses and a review of the reported cases in the literature. Computed tomography showed characteristic rim enhancing collections with central attenuation in all four cases. All patients presented with ptosis, upper eyelid erythema, and severe pain similar to scleritis. Injection of the conjunctiva and sclera was present in two patients, and a third patient presented with expression of purulent discharge onto the ocular surface upon palpation of the lacrimal gland. All patients were treated with intravenous antibiotics and underwent incision and drainage with subsequent improvement. All were monitored for 24 to 48 hours and discharged on oral antibiotics. There were no complications or recurrences. Lacrimal gland abscess formation is a rare complication of dacryoadenitis, and in our experience these patients respond well to incision and drainage in combination with systemic antibiotics.
Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; Child; Dacryocystitis; Drainage; Eye Infections, Bacterial; Female; Haemophilus Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Ophthalmologic Surgical Procedures; Retrospective Studies; Staphylococcal Infections; Streptococcal Infections; Tomography, X-Ray Computed
PubMed: 28812417
DOI: 10.1080/01676830.2017.1337205 -
The Journal of Sexual Medicine Dec 2018Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients,...
INTRODUCTION
Historically, contra-indications for immediate salvage of an infected penile prosthesis have included purulence on the device, purulent infections in diabetic patients, and severe diabetes. These clinical principles are from the 1990s to early 2000s and based on limited retrospective series or expert opinion. Since the publication of these contra-indications there have been improvements in device design, surgical technique, corporal washout protocols, and perioperative antibiotic prophylaxis that allow us to re-evaluate whether we can broaden the criteria for immediate salvage of an infected penile prosthesis.
AIM
To report whether patients with severe diabetes can safely have a purulent inflatable penile prosthesis (IPP) immediately salvaged.
METHODS
We considered a "severe diabetic" as a patient whose disease has progressed past diet control and oral medications and, therefore, has insulin-dependent type 2 diabetes mellitus (IDDM II). We retrospectively reviewed 6 consecutive patients with IDDM II and a purulent IPP who had been immediately salvaged from July 2011 to November 2017. In addition to immediate exchange, each received catheter-directed anti-microbial intracorporal irrigation and device culture. All patients were discharged home the next day with oral antibiotics.
MAIN OUTCOME MEASURE
Outcomes included repeat penile prosthesis infection or any other complication following immediate salvage.
RESULTS
All 6 patients have healed well and remained infection free at their 6- to 8-week post-operative follow-up appointment. 15-39 months after salvage, no patients have had a repeat infection or any other complication. 5 patients received a malleable replacement device and 1 patient was electively converted to an IPP 7 months after his salvage procedure. 1 patient received an IPP during salvage per patient preference. All patients are currently pleased with either their malleable penile prosthesis or IPP.
CLINICAL IMPLICATIONS
Immediate salvage attenuates the morbidity associated with an infected penile prosthesis such as irreversible penile shortening and corporal fibrosis. Our findings suggest that more patients than originally thought may be a candidate for immediate salvage.
STRENGTH & LIMITATIONS
To our knowledge, this is the first study evaluating outcomes after immediate salvage of a purulent IPP in patients with advanced diabetes. Limitations of the study include the small sample size and retrospective nature.
CONCLUSION
Our results suggest that those with IDDM II who have a purulent penile prosthesis may be candidates for safe and effective immediate salvage. Peters CE, Carlos EC, Lentz AC. Purulent Inflatable Penile Prostheses Can Be Safely Immediately Salvaged in Insulin-Dependent Diabetics. J Sex Med 2018;15:1673-1677.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Diabetes Mellitus, Type 2; Humans; Insulins; Male; Middle Aged; Penile Diseases; Penile Prosthesis; Prosthesis Implantation; Prosthesis-Related Infections; Retrospective Studies; Salvage Therapy
PubMed: 30446468
DOI: 10.1016/j.jsxm.2018.10.002