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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 -
European Review For Medical and... Jan 2024The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection...
OBJECTIVE
The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy.
PATIENTS AND METHODS
A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates.
RESULTS
The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05).
CONCLUSIONS
Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.
Topics: Pregnancy; Humans; Female; Episiotomy; Rifampin; Subcutaneous Tissue; Prospective Studies; Cross-Sectional Studies; Surgical Wound Infection; Pain; Perineum
PubMed: 38235887
DOI: 10.26355/eurrev_202401_34924 -
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 -
Frontiers in Pediatrics 2023To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
OBJECTIVE
To report and review infantile orbital abscess caused by methicillin-resistant (MRSA).
METHODS
We report a case of MRSA-induced infantile orbital abscess accompanied by sepsis, pneumonia, and purulent meningitis. We systematically review cases of MRSA-induced infantile orbital abscess published in PubMed, Web of Science and ScienceDirect until April 2023.
RESULTS
We reviewed 14 patients [our patient + 13 patients (10 papers) identified via literature searches]. There were nine boys and five girls; nine neonates and five older infants; and 8 full-term births and 1 preterm birth. The gestational age at birth was unknown for five infants. The right and left orbits were affected in 10 and 4 patients, respectively. The clinical presentation included periorbital soft-tissue edema or redness (11 patients), fever (7 patients), exophthalmos (10 patients), limited eye movement (4 patients), purulent eye secretions (2 patients), and skin abscess and convulsion (1 patient each). The source of infection was sinusitis (8 patients), vertical transmission, gingivitis, dacryocystitis, upper respiratory tract infection (1 patient each), and unknown (2 patients). MRSA was detected in blood (6 patients) or pus culture (8 patients). Vancomycin or linezolid were used for 11 patients; corticosteroids were administered to only 1 patient. Surgical drainage was performed for 13 infants (external drainage, 11 patients; endoscopic drainage, 2 patients). Two patients initially had pulmonary and intracranial infections. Except for one patient with neurological dysfunction at discharge, all other infants had no sequelae or complications.
CONCLUSION
Early aggressive anti-infective treatment and timely drainage are essential for managing MRSA-induced infantile orbital abscess.
PubMed: 38188913
DOI: 10.3389/fped.2023.1272852 -
SAGE Open Medical Case Reports 2024Actinomycosis is a rare, chronic, and suppurative disease caused by species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of...
Actinomycosis is a rare, chronic, and suppurative disease caused by species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.
PubMed: 38187812
DOI: 10.1177/2050313X231222222 -
Veterinary Research Forum : An... 2023is a Gram-negative, facultative anaerobic bacillus of family, and it is an uncommon pathogen in domestic animals. To date, five cases were reported including two dogs,...
is a Gram-negative, facultative anaerobic bacillus of family, and it is an uncommon pathogen in domestic animals. To date, five cases were reported including two dogs, two cattle, and a goat. is the second common bacterial agent after the . subsp in equine pneumonia cases. The present report describes the isolation of . from lungs and spleen of a 10-year-old Arabian horse (May 08, 2022) at post-mortem examination being co-infected with Clinical and pathological findings included bilateral nasal discharge, conjunctivitis, sternal recumbency, severe diffuse necrosuppurative rhinitis, multi-focal fibrinopurulent pneumonia and purulent lymphadenitis. Polymerase chain reaction assays showed no viral nucleic acids of equid alphaherpesvirus (EHV) 1, EHV-4, equine arteritis virus and equine papilloma virus. The antibiogram test revealed that the isolate was sensitive to several antibiotics except colistin. Taken together, the present report documents the first isolation of . from lungs and spleen of a horse; hence, experimental studies are needed to clarify the pathogenity and pathogenesis of . .
PubMed: 38174095
DOI: 10.30466/vrf.2023.1987898.3760 -
The American Journal of Case Reports Jan 2024BACKGROUND Traditionally, penile implant infections have been treated by removal followed by immediate or delayed replacement. The use of antibiotics in conservative...
BACKGROUND Traditionally, penile implant infections have been treated by removal followed by immediate or delayed replacement. The use of antibiotics in conservative therapy has recently attracted attention. CASE REPORT We report our experience with 4 cases of infected penile implants managed conservatively. Case 1 was a 41-year-old with sickle cell anemia who presented with low-grade fever and purulent discharge that started 1 month postoperatively and lasted for 3 weeks. He had left graft after fibrotic tissue excision with 14-mm collection in the left corpus cavernosum. He was managed with IV pipracillin/tazobactam and vancomycin for 13 days. Follow-up after 23 weeks showed complete wound healing. Case 2 was a 62-year-old with diabetes who had purulent discharge that started 41 days postoperatively and lasted for 1 week. He received 5 days of IV vancomycin and gentamycin. Follow-up after 4 weeks showed marked improvement of the wound. Case 3 was a 61-year-old with diabetes and ischemic heart disease. He presented 30 days postoperatively with fever, purulent discharge for 5 days. He received a total of 10 days of IV vancomycin and gentamycin. Follow-up 3 weeks after discharge showed complete wound healing. Case 4 was a 61-year-old with diabetes and ischemic heart disease. He presented 1 month postoperatively with fever and pus discharge for 1 week. He completed 10 days of IV vancomycin and gentamycin. Follow-up after 1 week showed marked wound healing. CONCLUSIONS Choosing patients with early superficial infected penile prosthesis for conservative management should be tailored to selected patients who does not have leukocytosis, signs of sepsis, high-grade fever, or an exposed device.
Topics: Male; Humans; Adult; Middle Aged; Vancomycin; Penile Prosthesis; Conservative Treatment; Prosthesis-Related Infections; Gentamicins; Diabetes Mellitus; Myocardial Ischemia
PubMed: 38167227
DOI: 10.12659/AJCR.941806 -
Cureus Dec 2023The presence of sinonasal ectopic teeth is a rare entity that is usually asymptomatic. In some cases, the presence of foreign bodies in the maxillary sinus, such as...
The presence of sinonasal ectopic teeth is a rare entity that is usually asymptomatic. In some cases, the presence of foreign bodies in the maxillary sinus, such as ectopic teeth, can lead to chronic maxillary sinusitis. We report a case of chronic sinusitis because of an ectopic tooth in the roof of the left maxillary sinus in a 50-year-old female who presented with complaints of facial pain in the left maxillary region and purulent nasal discharge. The treatment of ectopic teeth usually consists of the removal of the previous, taking into account its location and possible risks. In this case, the close proximity to the orbit could have led to a greater risk of complications involving the infraorbital bundle. CT scan evaluation is frequently required to identify the exact location and is useful for treatment planning. The traditional surgical approaches to maxillary sinus pathology are transoral Caldwell-Luc approaches or transnasal endoscopic surgery. The method used in this case was the Caldwell-Luc approach. Although more invasive, it allows visualization into the maxillary sinus and superior access for instrumentation of the posterolateral region while permitting manipulation and removal of larger objects. Despite maxillary sinus ectopic teeth being uncommon, it is important for clinicians to become aware and to consider this entity to provide early adequate treatment.
PubMed: 38164311
DOI: 10.7759/cureus.49765 -
Antimicrobial Stewardship & Healthcare... 2023To evaluate rates of and outcomes associated with antibiotic overuse at hospital discharge for patients with common infectious diseases states.
OBJECTIVE
To evaluate rates of and outcomes associated with antibiotic overuse at hospital discharge for patients with common infectious diseases states.
DESIGN
Single-center, respective cohort study.
SETTING
A large, academic medical center in the Midwest United States.
PATIENTS
Adult patients who received antibiotics for community-acquired pneumonia (CAP), uncomplicated cystitis, or mild, non-purulent cellulitis. Patients were excluded if they did not receive antibiotic(s) upon hospital discharge, were pregnant, severely immunocompromised, had concomitant infections, died during hospitalization, or were transferred to another hospital or to an intensive care unit.
METHODS
Data were abstracted from the electronic medical record of ambulatory antibiotic orders for included patients based on inpatient encounters from August 1, 2021 through July 31, 2022.
RESULTS
Of the 182 patients included in the study, antibiotic overuse was common for all three infectious disease states: CAP ( = 87/125, 69.6%), uncomplicated cystitis ( = 21/28, 75.0%), mild, non-purulent cellulitis ( = 28/29, 96.6%). The prevailing reason for overuse was excessive antibiotic duration ( = 127/182, 69.8%; mean antibiotic duration 5.39 vs. 8.32 days, = 0.001). Antibiotic overuse was associated with approximately one additional day in the hospital (2.48 vs. 3.32 days, = 0.001), and an increase in emergency department visits within 30 days after discharge (1 vs. 31, = 0.001) compared to patients without antibiotic overuse at discharge.
CONCLUSION
Antibiotic overuse was prevalent upon hospital discharge for these three common infectious disease states. Transitions of care should be prioritized as an area for antimicrobial stewardship intervention.
PubMed: 38156229
DOI: 10.1017/ash.2023.497