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Cureus Dec 2023Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or...
Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.
PubMed: 38249182
DOI: 10.7759/cureus.50934 -
Clinical Case Reports Jul 2023can cause infection in healthy people. As this bacterium is slow-growing, special attention should be paid to the timely diagnosis and control of its antibiotic...
KEY CLINICAL MESSAGE
can cause infection in healthy people. As this bacterium is slow-growing, special attention should be paid to the timely diagnosis and control of its antibiotic resistance to prevent the spread of resistant strains.
ABSTRACT
This study reports a case of ocular infection caused by and its treatment with various antibiotics. A middle-aged woman with prolonged purulent eye discharge was admitted to an ophthalmology clinic in Qazvin, Iran. A strain of was isolated from the patient. The sample was identified by Sanger sequencing of the 16s rRNA gene, and an antibiogram test was performed to determine its resistance profile. The patient was treated with ceftazidime and levofloxacin eye drops. The bacterial culture was negative 18 days after starting ceftazidime and levofloxacin treatment. The antibiogram results showed that the isolated bacterium was resistant to aminoglycosides and colistin. This study highlights that can cause disease even in immunocompetent individuals. Due to the different resistance profiles of this bacterium, treatment should be based on antibiogram results.
PubMed: 37476596
DOI: 10.1002/ccr3.7715 -
Zhongguo Dang Dai Er Ke Za Zhi =... Apr 2024The patient, a male newborn, was admitted to the hospital 2 hours after birth due to prematurity (gestational age 27 weeks) and respiratory distress occurring 2 hours...
The patient, a male newborn, was admitted to the hospital 2 hours after birth due to prematurity (gestational age 27 weeks) and respiratory distress occurring 2 hours postnatally. After admission, the infant developed fever and elevated C-reactive protein levels. On the fourth day after birth, metagenomic next-generation sequencing of cerebrospinal fluid indicated a positive result for (9 898 reads). On the eighth day, a retest of cerebrospinal fluid metagenomics confirmed (56 806 reads). The diagnosis of purulent meningitis caused by was established, and the antibiotic treatment was switched to moxifloxacin [5 mg/(kg·day)] administered intravenously for a total of 4 weeks. After treatment, the patient's cerebrospinal fluid tests returned to normal, and he was discharged as cured on the 76th day after birth. This article focuses on the diagnosis and treatment of neonatal purulent meningitis, introducing the multidisciplinary diagnosis and treatment of the condition in extremely preterm infants.
Topics: Humans; Mycoplasma hominis; Infant, Newborn; Male; Infant, Extremely Premature; Moxifloxacin; Meningitis, Bacterial; Mycoplasma Infections; Anti-Bacterial Agents
PubMed: 38660910
DOI: 10.7499/j.issn.1008-8830.2312016 -
International Journal of Surgery Case... May 2024Cutaneous Tuberculosis (CTB), elicited by the Mycobacterium tuberculosis complex, manifests dermatologically. The scarcity of bacilli within CTB lesions renders their...
INTRODUCTION AND IMPORTANCE
Cutaneous Tuberculosis (CTB), elicited by the Mycobacterium tuberculosis complex, manifests dermatologically. The scarcity of bacilli within CTB lesions renders their detection challenging. This study presents a case of CTB, underscoring its rarity and the potential for severe complications that can deteriorate patient quality of life. It aims to highlight the importance of CTB identification in dermatological diagnoses due to its capacity to cause considerable morbidity and affect patients' psychosocial health.
CASE PRESENTATION
An 18-year-old patient presented with a painful, well-defined reddish plaque on the right palm, originating five years prior, accompanied by contractures of the middle finger. The tender lesion, characterized by an irregular surface, exhibited purulent discharge upon light touch through fissures along its periphery. Management involved necrotomy, debridement, and tissue biopsy for diagnostic and reconstructive purposes.
CLINICAL DISCUSSION
CTB exhibits a wide range of clinical presentations, often resembling other dermatological infections, which complicates its diagnosis. Accurate diagnosis necessitates an integrated approach involving clinical assessment, the tuberculin skin test, histopathological analysis, and bacteriological investigations. The therapeutic regimen includes multidrug anti-tuberculosis treatment, with surgical intervention reserved for specific cases.
CONCLUSION
Long-term complications of untreated CTB encompass significant contractures, scarring, and the onset of carcinomas and sarcomas. Prompt diagnosis facilitates timely and effective treatment, averting these sequelae and yielding high patient satisfaction.
PubMed: 38608519
DOI: 10.1016/j.ijscr.2024.109631 -
Annals of Vascular Surgery Jul 2024Skill and experience of surgeons are likely to influence the incidence of surgical wound complications (SWC) after open lower limb revascularization. Differences in SWC... (Comparative Study)
Comparative Study
BACKGROUND
Skill and experience of surgeons are likely to influence the incidence of surgical wound complications (SWC) after open lower limb revascularization. Differences in SWC between surgeons with predominantly endovascular or open vascular surgical profiles could be expected. The aim of this study was to compare SWC rates after elective open vascular surgery between primarily endovascular and primarily open vascular surgeons.
METHODS
Prospective data from patients undergoing elective surgery for peripheral artery disease (PAD) was collected between 2013 and 2019. Senior surgeons were assigned to the open-surgeon or the endo-surgeon group based on the percentage of their open surgical case load during the 6 year study period. SWC was measured by their clinical impact scale (grade 1-outpatient treatment to grade 6-death). Surgical site infection was defined by Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, and Stay (ASEPSIS) criteria. Propensity score adjusted analysis (PSAA) was used to account for differences in baseline and perioperative characteristics and expressed as odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS
The proportion of chronic limb-threatening ischemia (P = 0.001), ipsilateral foot wound (P = 0.012) and femoro-popliteal bypass procedures (P < 0.001) were higher in the open-surgeon group. A lower incidence of SWC according to ASEPSIS criteria (25.6% vs. 38.6%, respectively, P = 0.042) and SWC grade ≥1 (33.7% vs. 51.0%, respectively, P = 0.010) was found in the endo-surgeon group (n = 86) compared to the open-surgeon group (n = 153). These differences disappeared after PSAA (OR 0.63, 95% CI 0.27-1.44, and OR 0.60, 95% CI 0.27-1.33, respectively).
CONCLUSIONS
Patients operated by endo-surgeons had less advanced PAD and lower incidence of SWC compared to those treated by open-surgeons. No difference in SWC remained after PSAA.
Topics: Humans; Male; Female; Aged; Surgical Wound Infection; Peripheral Arterial Disease; Elective Surgical Procedures; Endovascular Procedures; Prospective Studies; Risk Factors; Middle Aged; Treatment Outcome; Vascular Surgical Procedures; Time Factors; Risk Assessment; Clinical Competence; Aged, 80 and over; Surgeons; Incidence
PubMed: 37473836
DOI: 10.1016/j.avsg.2023.07.090 -
Journal of Inflammation Research 2024The increasing popularity of tattoo art, including facial cosmetic tattoos, has led to a growing societal acceptance of tattoos. However, complications such as lip...
The increasing popularity of tattoo art, including facial cosmetic tattoos, has led to a growing societal acceptance of tattoos. However, complications such as lip inflammation following cosmetic lip tattoos remain a concern. This article presents the case of a 47-year-old Asian woman who experienced recurrent lip swelling, purulent discharge, and scarring after receiving lip tattoos. Despite previous treatment with corticosteroid injections yielding unsatisfactory results, the patient showed significant improvement with topical application of 2% Crisaborole, a phosphodiesterase-4 inhibitor. Crisaborole modulates intracellular cyclic adenosine monophosphate levels, thereby reducing tissue inflammation and swelling associated with chronic cheilitis. Additionally, pulse laser therapy was effective in addressing residual tattoo pigment and scar tissue. This case highlights the therapeutic challenges of managing chronic inflammatory diseases of the lips secondary to cosmetic tattoos and introduces Crisaborole as a promising treatment option, offering insights for managing similar conditions in the future.
PubMed: 38828051
DOI: 10.2147/JIR.S465630 -
International Medical Case Reports... 2024Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically challenging to diagnose and has a poor prognosis. It is characterized by symmetric...
BACKGROUND
Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically challenging to diagnose and has a poor prognosis. It is characterized by symmetric proximal muscle weakness, muscle tenderness, dysphagia, characteristic skin rash (heliotrope rash, Gottron's sign), elevated muscle enzyme levels, abnormal electromyography, and muscle biopsy findings. DM with positive anti-MDA5 antibodies is mainly characterized by Gottron's sign, skin ulcers, facial erythema, mechanic's hands, and V-sign. In this case, the patient presented with the rare manifestation of severe necrotic skin ulcers in association with Gottron's sign, prompting us to report this case.
CASE PRESENTATION
A 45-year-old female was admitted to the hospital with systemic joint pain, fatigue, multiple ulcers, and purulent discharge on both hands. Her myositis-specific antibody profile revealed positive anti-MDA5 and anti-SSA/RO52 antibodies. Treatment included a combination of glucocorticoids, immunosuppressants, gastric and liver protection, infection control, and wound care. After two weeks of treatment, the patient showed improvement in symptoms. However, on the 24th day of hospitalization, the wound at the right elbow joint ruptured and became infected, requiring debridement and skin grafting in the appropriate department.
CONCLUSION
There has been limited research and reported cases of dermatomyositis with coexistence of positive anti-MDA5 and anti-SSA/RO52 antibodies combined with severe skin ulcers. Therefore, we present this rare case and emphasize the need for close follow-up on pulmonary involvement and skin ulcer progression, as well as timely implementation of new treatment strategies to actively improve the prognosis.
PubMed: 38205150
DOI: 10.2147/IMCRJ.S441691 -
Cureus May 2024As implant dentistry expands, the number of implants being placed increases, and so does the prevalence of associated complications, resulting in implant failure if not...
As implant dentistry expands, the number of implants being placed increases, and so does the prevalence of associated complications, resulting in implant failure if not timely attended. The present case report aims to discuss the successful regenerative management of peri-implantitis by both hard and soft tissue augmentation with a five-year follow-up. A 60-year-old male reported a chief complaint of purulent discharge, 7 mm peri-implant probing depth, and radiographic bone loss with no pathologic mobility of the dental implant. The reflection of the full-thickness flap revealed a circumferential defect. Guided bone regeneration (GBR) was performed using a combination of autogenous and alloplastic bone grafts around the implant site. To maintain the peri-implant marginal bone level, soft tissue augmentation was done using the vestibular incision subperiosteal tunnel access (VISTA) approach, after six months. A five-year follow-up showed a significant bone fill and stable soft tissue around the implant clinically and radiographically.
PubMed: 38882948
DOI: 10.7759/cureus.60307 -
International Journal of Surgery Case... Jan 2024For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high...
INTRODUCTION
For patients with large and deep-seated recurrent complex pilonidal sinuses, the use of traditional open excision or flap reconstruction surgery may lead to high surgical difficulty, significant local damage, numerous complications, slow healing, and a high risk of recurrence. This article reports a case of recurrent complex pilonidal sinus and discusses the advantages of Bascom II combined with VSD treatment involving the preservation of tissue bridges.
CASE PRESENTATION
The patient, a 31-year-old male, presented with recurrent swelling, pain, and purulent discharge from the sacrococcygeal region for over a year. Upon physical examination, extensive lumps and sinus tracts were observed in the lumbosacral tail area, with the lesion extending from L4 to the tip of the coccyx. Under general anesthesia, a segmental resection was performed, and the lumbosacral mass lesion was excised, preserving normal tissue bridges. The mature sinus tract at the upper part of the coccyx was removed, and Bascom II reconstruction surgery was performed. In the late stage at the site of lumbar sacral lesion excision, VSD was applied to promote wound healing.
DISCUSSION
The combination of Bascom II with lesion tunnel-like removal can reduce the damage, elevate gluteal cleft, and lower the recurrence rate. Subsequently, with the addition of VSD, it can accelerate the elimination of necrotic tissue, reduce infection risk, and expedite wound healing.
CONCLUSION
This case explores the advantages and characteristics of combining various techniques in the treatment of recurrent complex pilonidal sinuses, emphasizes the utility of VSD as an adjunctive therapy for large lesions.
PubMed: 38064859
DOI: 10.1016/j.ijscr.2023.109108 -
International Journal of Surgery Case... May 2024Oesophageal fistula is a severe complication that may occasionally develop after chemoradiotherapy (CRT) for oesophageal cancer and is difficult to treat.
INTRODUCTION AND IMPORTANCE
Oesophageal fistula is a severe complication that may occasionally develop after chemoradiotherapy (CRT) for oesophageal cancer and is difficult to treat.
CASE PRESENTATION
A 51-year-old man who had undergone CRT for oesophageal cancer presented with haematemesis and was diagnosed with a descending aortic aneurysm and an oesophageal fistula. Thoracic endovascular aneurysm repair was performed to achieve haemostasis. After 3 days, the patient underwent subtotal oesophagectomy and cervical oesophagostomy with delivery of a pedicled omental flap to the exposed aortic stent. Six months later, ileocecal reconstruction was performed. The second patient was a 49-year-old woman who had undergone CRT 1 year previously. She complained of leg weakness and gait disorder. After a workup, she was diagnosed with perforation of the posterior wall of the cervical oesophagus with abscess formation and purulent spondylitis. After two spinal fusion surgeries, we performed tracheotomy and drained the cervical region to reduce local infection. After 7 days, she underwent pharyngolaryngoesophagectomy and reconstruction using a gastric conduit, to which a large section of the omental flap was attached. After the multi-stage surgery, oral intake became possible, and both patients were discharged.
CLINICAL DISCUSSION
The optimal treatment strategy for post-CRT oesophageal fistula remains controversial. Radical surgery, including oesophagectomy, is the treatment of choice, although it is associated with high mortality rates. Multi-stage surgery may be useful for reducing surgical stress in moribund patients.
CONCLUSION
We reported two cases involving radiation-induced oesophageal fistula successfully treated by multi-stage surgery without major complications.
PubMed: 38653166
DOI: 10.1016/j.ijscr.2024.109460