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Journal of Medical Cases Jan 2024Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be...
Regional anesthesia is being used more frequently in pediatric anesthesia practice, including the perioperative care of neonates and infants. Adverse effects may be encountered during epidural needle placement, with catheter advancement, or subsequently during infusion of local anesthetic agents. Despite applying standard practice of care regarding placement of epidural catheter, epidural catheter-related infections may still occur. We present the rare occurrence of an epidural abscess in a 4-month-old infant after placement and subsequent use of a tunneled caudal epidural catheter for postoperative pain management following abdominal surgery. Magnetic resonance imaging (MRI) was the gold standard diagnostic imaging modality and was used to identify the abscess. Management included intravenous antibiotic therapy as well as hemilaminectomy with evacuation of the epidural abscess and hematoma. The patient continued to progress well with no deficits noted on neurological examination. There were no other postoperative concerns. When there is a concern for epidural catheter-related infection, the catheter should be removed immediately. The epidural catheter tip as well as any purulent discharge from the insertion site should be sent for culture and sensitivity. Urgent neurosurgical and infectious disease consultation is suggested to provide opinions regarding surgical intervention and antibiotic therapy.
PubMed: 38328807
DOI: 10.14740/jmc4180 -
World Journal of Clinical Cases Jan 2024Marginal zone lymphoma (MZL) is an indolent subtype of non-Hodgkin lymphoma (NHL), which is rare clinically with severe rashes as the initial symptom.
BACKGROUND
Marginal zone lymphoma (MZL) is an indolent subtype of non-Hodgkin lymphoma (NHL), which is rare clinically with severe rashes as the initial symptom.
CASE SUMMARY
This study reports a case of MZL with generalized skin rashes accompanied by pruritus and purulent discharge. First-line treatment with rituximab combined with zanubrutinib had poor effects. However, after switching to obinutuzumab combined with zanubrutinib, the case was alleviated, and the rashes disappeared.
CONCLUSION
For patients with advanced stage MZL not benefiting from type I anti-CD20 monoclonal antibody (mAb) combination therapy, switching to a type II anti-CD20 mAb combination regimen may be considered. This approach may provide a new perspective in the treatment of MZL.
PubMed: 38322474
DOI: 10.12998/wjcc.v12.i3.565 -
BMC Ophthalmology Feb 2024To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent...
BACKGROUND
To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies.
METHODS
This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy.
RESULTS
The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of canaliculitis (53.3%) and chronic dacryocystitis (42.3%).
CONCLUSIONS
This study highlights the microbial spectrum of dacryocystitis and canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.
Topics: Male; Humans; Female; Canaliculitis; Prospective Studies; Dacryocystitis; Lacrimal Apparatus; Anti-Bacterial Agents; Hospitals, Teaching
PubMed: 38317063
DOI: 10.1186/s12886-024-03323-x -
Skin Health and Disease Feb 2024Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has...
BACKGROUND
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has significant physical, psychological and financial impact.
OBJECTIVES
This study plans to analyse patient costs associated with HS. Direct costs include prescription items. Indirect or out-of-pocket costs include dressings, analgesia, and healthcare-related travel costs. This study will also assess disease impact on quality-of-life (QOL).
METHODS
Patients with HS diagnosis attending dermatology OPD at our public tertiary centre were invited to participate. Ethical approval was secured, and informed consent was obtained. Participants completed an anonymous survey which was analysed to identify costs associated with HS as well as demographics and QOL impact.
RESULTS
A total of 25 patients completed the survey; median age was 29% and 80% were female. Median time from HS onset to diagnosis was 2 years, with 24% waiting >10 years to be diagnosed. In the past 3 months, 20% spent >€200 in both categories; prescription and non-prescription items. In the non-prescription category, 36% of patients reported expenditure >€100 in the past 3 months. Dressings were the most common out-of-pocket expense (in 15/25 patients), followed by analgesia and protective clothing. Attendance at medical appointments cost 24% of patients €50-€200. Four participants reported difficulty accessing HS treatments due to associated costs. Mean number of absence days from work/education as result of HS was 8.7 in the past 3 months. Two patients reported being on disability allowance, and two on unemployment benefit as result of their skin disorder. In the QOL question; 96% reported disease impact on QOL, and 11 participants reported that it affected their life 'very much'.
CONCLUSIONS
HS is a chronic inflammatory skin condition with significant financial burden alongside the well-analysed biopsychosocial disease impact. Financial burden can be divided into direct prescription costs and indirect costs such as non-prescription items, protective clothing and travel costs which we have explored in this study. Further research is needed in this area to identify and optimise both the financial and QOL implications of HS in acute flares and chronic disease management.
PubMed: 38312251
DOI: 10.1002/ski2.306 -
Case Reports in Ophthalmology 2024Osteopetrosis is a rare heritable disorder characterized by increased bone density resulting from osteoclast dysfunction. Major complications include bone fracture,...
INTRODUCTION
Osteopetrosis is a rare heritable disorder characterized by increased bone density resulting from osteoclast dysfunction. Major complications include bone fracture, osteomyelitis, anemia, and cranial nerve compression. Optic atrophy can occur due to compression of the optic nerve. Although osteomyelitis of the jaw is a common complication, it rarely occurs in the maxilla. Here, we report a case of a 74-year-old female with osteopetrosis who developed maxillary osteomyelitis, leading to orbital inflammation.
CASE PRESENTATION
She was referred to our clinic for 2 months of ptosis and swelling of the left eyelid and temporal region. Previous imaging revealed a left intraorbital occupying lesion, but a biopsy of the temporal subcutaneous tissue did not provide a definitive diagnosis. After 7 months, she presented with severe temporal swelling and purulent discharge. Upon examination, maxillary osteomyelitis resulting from caries of the upper jaw was observed. Treatment with oral antibiotics, drainage of the temporal skin fistula, and regular cleaning of the maxillary drainage improved her symptoms.
CONCLUSION
This is a rare case of maxillary osteomyelitis associated with osteopetrosis, causing orbital inflammation.
PubMed: 38288029
DOI: 10.1159/000536140 -
Cureus Dec 2023Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves...
Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus. Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain, allowing for same-day surgery discharge. Horseshoe abscess is a rare but known complication of anorectal surgery, characterized by an abscess that extends around the anal canal, often involving the ischiorectal fossa and adjacent structures. Although horseshoe abscesses have been reported after various anorectal surgeries, including hemorrhoidectomy, their occurrence following THD has not been well-documented in the literature. A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids and presented to the hospital on postoperative day 6 with severe rectal pain. A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening. A rectal examination under anesthesia confirmed the presence of purulent drainage from the anus, and surgical drainage of the abscess was performed. The patient received antibiotics and analgesics and experienced a favorable recovery. The exact pathophysiology of a horseshoe abscess following THD remains unclear, and the incidence and risk factors associated with this complication are not well-established. Moreover, there has yet to be a consensus on the optimal management of horseshoe abscesses after THD, whether through surgical or medical approaches. This case emphasizes the importance of considering horseshoe abscess as a potential complication of THD and highlights the need for further research to understand better its incidence, risk factors, and optimal management strategies.
PubMed: 38283447
DOI: 10.7759/cureus.51195 -
Microorganisms Jan 2024Purulent vulvar discharge is a clinical sign of genitourinary tract infections, which are a significant concern in swine facilities, leading to sow culling and...
Purulent vulvar discharge is a clinical sign of genitourinary tract infections, which are a significant concern in swine facilities, leading to sow culling and mortality. is one of the main agents involved in these diseases. This study aimed to characterize the virulence and antimicrobial resistance profiles as well as the phylotype of strains isolated from sows with purulent vulvar discharge. The results showed that at least 2 of the 29 tested virulence genes related to extraintestinal pathogenic were present in all strains tested. The most frequent gene was , present in all strains, followed by the genes , , , and . Associations between iron uptake genes, genes related to adhesion, attachment, and serum resistance, as well as genes related to toxin release and bacteriocin, were frequent. The most prevalent phylotype was B1 (40.0%), followed by A (18.5%), D (11.9%), C (9.6%), B2 (7.4%), E (4.4%), F (1.5%), and Clade I (0.7%), with B2 being related to highly virulent traits. The strains presented elevated resistance to antimicrobials such as ciprofloxacin, streptomycin, cephalexin, florfenicol, and ampicillin. More than 90% of the strains were identified as multidrug-resistant, indicating the selection that is induced by the high use of antimicrobials in swine farming.
PubMed: 38257950
DOI: 10.3390/microorganisms12010123 -
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 -
Cureus Dec 2023While definitions may vary, infected non-union is generally described as a condition where a fracture fails to heal due to infection, typically persisting for a duration...
While definitions may vary, infected non-union is generally described as a condition where a fracture fails to heal due to infection, typically persisting for a duration of six to eight months. Infected non-unions occurring in the shaft of the femur are infrequent and typically result from severe open fractures with deep fragmentation and segmental bone loss or following internal fixation of a severely fragmented closed fracture. Some associated factors contributing to non-union include positive bacterial cultures from deep wounds, histological evidence of bone necrosis, exposed bone without a vascularized periosteum for more than six weeks, and the presence of purulent discharge. Osteomyelitis, stiffness in adjacent joints, smoking, loss of soft tissue resulting in multiple sinus tracts, osteopenia, and deformities leading to limb length discrepancies are all complicating factors that impact treatment and prognosis. Infected non-union of bones, although rare, presents a significant challenge for physiotherapists striving to provide appropriate treatment. The level of stabilization at the fracture site is the most critical factor influencing whether a fracture progresses to non-union or successfully heals. Infection, such as osteomyelitis, also contributes to the development of non-union. Additionally, issues like tissue atrophy, joint stiffness, and muscle contractures can further complicate the non-union of a bone, posing a considerable challenge for physical therapists in helping patients achieve their recovery goals. Top of form this case report reviews the case of a 35-year-old male who was reported to Acharya Vinoba Bhave Rural Hospital (AVBRH) with an infective non-union of the shaft of the femur fracture after two months of repair. This case report highlights the recovery of patients from post-operative complications like non-union, stiffness, and reduced range of motion through tailored physiotherapy rehabilitation and improved quality of life.
PubMed: 38239531
DOI: 10.7759/cureus.50786 -
International Journal of Surgery Case... Feb 2024Intraductal papillary neoplasm of the bile duct (IPNB) is a rare neoplasm, mostly found in patients from far Eastern areas where hepatolithiasis and clonorchiasis are...
INTRODUCTION AND IMPORTANCE
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare neoplasm, mostly found in patients from far Eastern areas where hepatolithiasis and clonorchiasis are endemic. Very few cases are reported from India.
CASE PRESENTATION
We present a case of recurrent cholangitis in a 59-year-old male, initially suspected to have IPNB based on preoperative imaging. Confirmation occurred intraoperatively, with mucin-filled bile ducts and papillary lesions in the resected hepatic duct. Treatment included left hepatectomy, extrahepatic bile duct excision, and Roux-en-Y hepaticojejunostomy. Histopathology indicated invasive pancreatobiliary-type IPNB with clear margins. The patient experienced post-hepatectomy hepatic insufficiency and superficial incisional surgical site wound infection, managed conservatively. Discharge occurred on postoperative day 21, with satisfactory recovery at the 16-month follow-up.
CLINICAL DISCUSSION
IPNB is recognized as the biliary equivalent of intraductal papillary mucinous neoplasm, as these two conditions exhibit multiple commonalities in terms of clinical and histopathological characteristics. The unique aspect of our case lies in the intricacies associated with its diagnosis. Initially, imaging modalities did not yield a definitive characterization of the lesion. Notably, the endoscopist misinterpreted mucin expression emanating from the papilla as purulent material, primarily due to the patient's concurrent cholangitis. Subsequent repetitions of both CT scan and MRI provided some valuable insights that contributed to the diagnostic clarity of the IPNB.
CONCLUSION
In cases of symptoms like biliary obstruction with bile duct dilation, wall nodules, papillary/solid-cystic masses, and upstream-downstream dilation, IPNB should be considered. Striving for R0 resection is crucial for enhanced long-term patient survival.
PubMed: 38237412
DOI: 10.1016/j.ijscr.2024.109243