scholarly journals Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study

2021 ◽  
Author(s):  
Christopher Radcliffe ◽  
Savanah Gisriel ◽  
Yu Si Niu ◽  
David Peaper ◽  
Santiago Delgado ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Percutaneous Drainage ◽  
Treatment Success ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Altered Mental Status ◽  
Gram Positive Bacteria ◽  
Tertiary Care Institution ◽  
The Mean ◽  
Days Open

Abstract Background Pyomyositis is a bacterial infection of skeletal muscle which classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one-third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Roughly half of all patients received >1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies which prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.

scholarly journals The Pattern of Day Case (Ambulatory) Percutaneous (PCNL): A Descriptive Retrospective Study from a Tertiary Care Hospital

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Rehan Fareed ◽  
Huma Shamim
Keyword(s):  
Retrospective Study ◽  
Tertiary Care ◽  
Ureteral Stones ◽  
Transfusion Rate ◽  
Care Hospital ◽  
High Grade ◽  
High Grade Fever ◽  
Access Methods ◽  
The Mean ◽  
Staghorn Stones

Background: Percutaneous nephrolithotomy (PCNL) has experienced remarkable development and alteration since it was first described in 1976 by Fernstorm et al. It has also experienced miniaturization of equipment, improvement in operative systems, and refining renal access methods leading to the achievement of maximum clearance of stone while causing minimal morbidity. For example, in endourological practice, when the patient is subjected to PCNL, he traditionally needs programmed inpatient admission, as part of their recovery, it is applicable as an outpatient method in properly selected cases. Objectives: We aimed at evaluating the safety and applicability of the outpatient PCNL procedure. Methods: This retrospective study was done on 210 cases of tubeless PCNL performed by a single urologist at our institute from January 2016 to January 2019. Patients’ mean age (134 males and 76 females) was 57 ± 11.8 years, and 7 patients aged 8 - 12 years. There were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn stones, 17 ureteral stones, 32 renal + ureteric stones (simultaneous renal and ureteral stones) , and 28 complete staghorn stones. The average stone size was 3.5 ± 2.8 (range: 0.7 to 11.8 cm). Results: The mean operation duration was 85.0 ± 29.4 min, and the mean hospital stay was 21.7 ± 3.4 h. Out of 210 patients, 6 patients had longer stay due to high-grade fever and 3 patients due to severe pain, and also 7 patients refused discharge due to personal and social reasons. Our ambulatory PCNL rate was 97 % ( 194 out of 210). Within 72 h, 5 patients were readmitted due to high-grade fever, 3 patients due to haematuria, and 4 patients due to pain and dysuria, and all patients were discharged 2 - 4 days after conservative treatment. Thus, the readmission rate was 6.18% (12 cases were readmitted out of 194 cases). Patients showed a blood transfusion rate of 1.4 %. Also, 19 cases (9.02%) were found with post-operative fever, and no urosepsis was reported. No pulmonary complications and mortality were noted. No re-exploration was done, and no major leak was noted. The angio-embolization rate was 0.59%. We did not use HEMO-SEAL technology, cautery, or suture in the tracks. Conclusions: In conclusion, the outpatient PCNL procedure is an applicable and feasible procedure under selected criteria; however, more investigations using a larger sample size are needed.

scholarly journals Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

2020 ◽  
Vol 27 (4) ◽  
pp. E202043
Author(s):  
Aamir Hussain Hela ◽  
Haseeb Mohammad Khandwaw ◽  
Rahul Kumar ◽  
Mir Adnan Samad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Surgical Site Infection ◽  
Tertiary Care Hospital ◽  
Open Cholecystectomy ◽  
Tertiary Care ◽  
Care Hospital ◽  
Site Infection ◽  
The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder.  It is estimated that approximately 90% of cholecystectomies in the  United States are performed using a laparoscopic approach.  The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital.  Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%).  Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

scholarly journals DECISION MAKING FOR DEVICE CLOSURE IN ADULTS WITH ‘HYPERTENSIVE PDA’–NON-INVASIVE CRITERIA: IMMEDIATE RESULTS

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S762-67
Author(s):  
Ahsan Beg ◽  
Abdul Malik ◽  
Amjad Mahmood ◽  
M Younas ◽  
Fakher -e- Fayaz
Keyword(s):  
Pulmonary Hypertension ◽  
Retrospective Study ◽  
Pulmonary Artery ◽  
Main Pulmonary Artery ◽  
Tertiary Care ◽  
Referral Hospital ◽  
Device Closure ◽  
X Ray ◽  
Non Invasive ◽  
The Mean

Objective: To find the mean pulmonary artery pressures (PAP) in adults (>12 years) Patent Ductus Arteriosus (PDA) with ‘reversible pulmonary hypertension’ after the device closure. Residual PDA and immediate complications (embolization, pulse loss, obstruction in the aorta or pulmonary artery) are to be reported. Study Design: Retrospective study. Place and Duration of Study: Tertiary Care Referral Hospital, from Aug 2007 to Jun 2020. Methodology: This retrospective study is descriptive. Data collected by convenience sampling from 3 tertiary care referral hospital. 981 patients were undergone PDA device closure during the period from Aug 2007 to June 2020. After informed consent, an initial assessment was done by history, clinical examination, x-ray chest PA view, electrocardiography (ECG), and transthoracic echocardiography (TTE). Reversible pulmonary hypertension was labeled based on non-invasive criteria including room air saturation >93% and cardiomegaly on x-ray chest. Patients who had <93% and normal heart size on x-ray chest were excluded. The lower limit for age was 12 years. Results: Nine Hundred Eighty One patients had undergone PDA device closure. 32 (n=32/981 3.3%) had fulfilled our inclusion criteria. The mean age was 22 ± 9 (13–45) years. Mean weight was 41 ± 11 (25-66) kg. Successful device closure was done in 30 patients (93.7%). Mean diameter of PDA was 7 ± 0.1 (4.5-13 mm. Mean PAP decreased from 59 ± 13 mmHg to 38 ± 19 mmHg (p<0.05). Commonest device used was Shasma duct occluder (n=16/32 50%) followed by Occlutech Duct Occluder (n=7/32 21.9%), while 2 had muscular VSD device (n=5/32 15.6%). In 2 patients, there was an underestimation of the size of PDA so the device was retrieved and replaced with another larger one successfully. Two patients had the device fully dropped into the main pulmonary artery before it was released. Larger size device was not available at that time so the patients were referred for surgery. None of our patients had device embolization or residual shunt on echo performed next day to the procedure. Neither any patient had residual pulmonary hypertension on echocardiography. There was no significant obstruction in the aorta in any patients. Two patients had mild left pulmonary artery obstruction. There was no significant obstruction in the aorta in any of our patients. There was pulse loss in 3 patients which were treated successfully with heparin infusion with no residual damage. Conclusion: Device closure is a feasible option in adults with hypertensive PDA while the decision of reversibility is based on non-invasive criteria.

A retrospective study of chromomycosis in a tertiary care institution in South India

2014 ◽  
Vol 34 (2) ◽  
pp. 126 ◽  
Author(s):  
Asha Ramayivadakayil ◽  
MK Srinath ◽  
D Sukumar ◽  
RameshM Bhat ◽  
Rochelle Monteiro
Keyword(s):  
Retrospective Study ◽  
South India ◽  
Tertiary Care ◽  
Care Institution ◽  
Tertiary Care Institution

Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

2020 ◽  
pp. 1-4
Author(s):  
Haijun Zhong ◽  
Yunli Bi
Keyword(s):  
Testicular Torsion ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Delayed Diagnosis ◽  
Retrospective Chart Review ◽  
Duration Of Symptoms ◽  
Testicular Trauma ◽  
Genital Trauma ◽  
Tertiary Care Institution ◽  
The Mean

<b><i>Objective:</i></b> To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). <b><i>Methods:</i></b> This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. <b><i>Results:</i></b> Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. <b><i>Conclusions:</i></b> TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.

Once-Daily Intraperitoneal Gentamicin is Effective Therapy for Gram-Negative Capd Peritonitis

1999 ◽  
Vol 19 (4) ◽  
pp. 357-360 ◽  
Author(s):  
Wai-Choong Lye ◽  
Jane C. Van Der Straaten ◽  
See-Odd Leong ◽  
Pary Sivaraman ◽  
Seng-Ho Tan ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Treatment Success ◽  
Tertiary Care ◽  
Empirical Therapy ◽  
Success Rates ◽  
Once Daily ◽  
Gram Negative ◽  
Tertiary Care Institution ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms

Objective To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Design A prospective cohort study in prevalent CAPD patients. Setting A tertiary care institution. Patients All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis. Main Outcome Measures Results of microbiological cultures and clinical outcomes of peritonitis were analyzed. Results Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded. Conclusions Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.

scholarly journals Endoscopic Repair of Spontaneous CSF Rhinorrhoea: Results from 21 Cases

2020 ◽  
Vol 28 (1) ◽  
pp. 71-75
Author(s):  
Swapan Kumar Ghosh ◽  
Indranath Kundu ◽  
Mukesh Kumar Singh ◽  
Rajarshi Chakraborty ◽  
Suyash Banerjee
Keyword(s):  
Tertiary Care ◽  
Treatment Strategies ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Endoscopic Endonasal ◽  
Prospective Longitudinal Study ◽  
Tertiary Care Institution ◽  
Csf Rhinorrhoea ◽  
Skull Base Defect ◽  
Prospective Longitudinal

Introduction Surgery to close the skull base defect is the treatment of choice in persistent spontaneous cerebrospinal fluid rhinorrhoea with endoscopic endonasal repair being the method of choice.  This study analysed the demographics of presentation, optimal diagnostic and localisation strategies and the effectiveness of transnasal endoscopic treatment strategies  with post-operative follow-up of CSF rhinorrhoea patients in a tertiary care institution   . Materials and Methods  A prospective longitudinal study was conducted on 21 CSF rhinorrhoea patients operated on between August 2014 and August 2018 and results documented. Results CSF rhinorrhoea was found most commonly in middle aged female patients in our study. HRCT PNS was capable of identifying a leak site in 66% of the cases. All patients were operated endoscopically with no major intra-operative or post-operative complications. Resolution of CSF leak occurred in 85% of cases. Conclusion CSF rhinorrhoea can be diagnosed and endoscopic repair can be effectively performed in our existing tertiary care set-ups with good results.

scholarly journals Anastomotic leakage with abscess after laparoscopic sleeve gastrectomy for obesity: report of a series and review of literature

2020 ◽  
Vol 13 ◽  
pp. 263177452092596
Author(s):  
Yang Liu ◽  
Ning-Ning Yang ◽  
Yong-Song Guan ◽  
Qing He
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Abdominal Pain ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Percutaneous Drainage ◽  
Treatment Strategies ◽  
Postoperative Hospital Stay ◽  
Severe Complication ◽  
The Mean

Anastomotic leakage with abscess is a rare but severe complication of bariatric surgery. However, there is currently a lack of attention regarding this complication. This study aimed to investigate the risk factors for this complication and relevant treatment strategies to call attention to this severe complication. We retrospectively reviewed the patients who were rehospitalized for anastomotic leakage with abscess after bariatric surgeries in West China Hospital of Sichuan University from November 2017 to November 2018. The clinical profiles analyzed included body mass index, body weight before and after surgery, postoperative hospital stay, diet prescriptions, treatment strategies, and outcomes. A total of six patients (two men and four women) were included. The mean baseline body mass index was 37.52 (29.84–43.37), and the mean weight was 104.95 kg (74.5–127.5). The chief complaints leading to rehospitalization were fever and dull abdominal pain. The average postoperative hospital stay was 3.3 (3–4) days, and the onset time ranged from 7 to 15 days. Finally, revision surgeries were performed in two of the six patients (33%), and they were all cured by percutaneous drainage-based treatments. The postoperative fever and abdominal pain were the signs of leakage and abscess. Similar patients should be followed up once a week for 3 weeks after bariatric surgery to facilitate the early recognition of this complication. A longer hospital stay and sufficient parenteral nutrition plus a later implementation of diet should be helpful to minimize this severe complication. Percutaneous drainage played a significant role in the treatment of these patients.

scholarly journals Anaesthesia-related complications and side-effects in TAVI: a retrospective study in Germany

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025825
Author(s):  
Sophia Goldfuss ◽  
Sigrid Wittmann ◽  
Fabian Würschinger ◽  
Diane Bitzinger ◽  
Timo Seyfried ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
General Anaesthesia ◽  
Tertiary Care ◽  
Postoperative Nausea And Vomiting ◽  
Secondary Outcome ◽  
Transcatheter Aortic Valve ◽  
Single Centre Study ◽  
The Mean ◽  
Valve Implantation

ObjectivesThis study was performed to analyse anaesthesia-related complications and side effects in patients undergoing transcatheter aortic valve implantation (TAVI) under general anaesthesia.DesignRetrospective study.SettingThe study was performed as a single-centre study in a hospital of tertiary care in Germany.ParticipantsAll 853 patients, who underwent TAVI at the Universitätsklinikum Regensburg between January 2009 and July 2015, were included. 52.5% were female patients.Primary and secondary outcome measuresWe gathered information, such as recent illness, vital parameters and medication administered during the intervention and postoperatively for 12 hours. We analysed all anaesthesia-related complications and anaesthesia-related side effects that occurred during the intervention and entire hospital stay.ResultsWe analysed all 853 TAVI procedures. The mean patient age was 79 ± 6 years. In 99.5% of cases, we used volatile-based anaesthesia. 2.8% (n=24; transfemoral (TF): n=19 [3.8%]; transapical (TA): n=5 [1.4%]) of all cases suffered from anaesthesia-related complications. 819 (TF: n=447; TA: n=372) anaesthesia-related side effects occurred in 586 (68.7%, TF: n=325 [64.2%], TA: n=261 [75.2%]) patients. Neither the complications nor the side effects had any serious consequences. Intraoperative hypothermia in 44% of cases (TF: n=202 [39.9%]; TA: n=173 [49.9%]) and postoperative nausea and vomiting in 27% (n=232; TF: n=131 [25.9%], TA: n=101 [29.1%]) of cases were the most common anaesthesia-related side effects.ConclusionIn this study, serious anaesthesia-related complications were rarely seen, and non-critical anaesthesia-related side effects could have been avoided through consistent prophylaxis and management. Therefore, despite their high anaesthetic risk, general anaesthesia is justifiable in patients who underwent TAVI.

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