scholarly journals Successful management of emphysematous gastritis with invasive gastric mucormycosis

2020 ◽  
Vol 13 (2) ◽  
pp. e231297 ◽  
Author(s):  
Digvijoy Sharma
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Favourable Outcome ◽  
Source Control ◽  
Successful Management ◽  
Emphysematous Gastritis ◽  
Prompt Diagnosis ◽  
Early Surgical Intervention

The present manuscript reports two extremely rare cases of coexisting emphysematous gastritis with gastric mucormycosis. The cases were managed successfully, considering the high mortality associated with both conditions independently. The aim of the manuscript is to elucidate the importance of prompt diagnosis, early surgical intervention for source control and concomitant application of antifungal therapy for a favourable outcome.

Invasive pulmonary aspergillosis/pseudomonas

2021 ◽  
Vol 14 (7) ◽  
pp. e236887
Author(s):  
Menaka Mahendran ◽  
Daniel Urbine
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Discomfort ◽  
Pulmonary Aspergillosis ◽  
Extensive Disease ◽  
Massive Haemoptysis ◽  
History Of

A 47-year-old Caucasian man on long-standing antifungal therapy for chronic necrotising aspergillosis and a history of recurrent pseudomonas pneumonias presented to the outpatient pulmonary clinic with dyspnoea and chest discomfort for 3 days. A CT angiography of the chest demonstrated angioinvasion from the previously noted left upper lobe cavitary lesion into the left main pulmonary artery, along with new consolidating lesions. Due to the high risk for massive haemoptysis, he was evaluated by thoracic surgery and underwent a successful left pneumonectomy. As invasive pulmonary aspergillosis is associated with high mortality, surgical intervention should always be considered, especially in those who develop extensive disease, despite being on aggressive antifungal therapy. Though minimally described in literature, invasive pulmonary pseudomonas also carries a high mortality risk. In our patient, cultures from the resected lung only demonstrated Pseudomonas aeruginosa.

scholarly journals Necrotising enterocolitis in an adult with anorexia nervosa

2020 ◽  
Vol 102 (8) ◽  
pp. 560-565
Author(s):  
B Schapira ◽  
S Nazarian ◽  
M Thanapal ◽  
C Parmar ◽  
H Mukhtar
Keyword(s):  
Anorexia Nervosa ◽  
Surgical Intervention ◽  
Case Reports ◽  
Mortality Rates ◽  
Necrotising Enterocolitis ◽  
Emergency Laparotomy ◽  
Good Recovery ◽  
Successful Management ◽  
Necrotic Bowel ◽  
Prompt Diagnosis

Necrotising enterocolitis (NEC) is a rare cause of the acute abdomen in adults and carries one of the highest mortality rates in gastroenterology. However, its rarity confines research to small case reports. Both its pathogenesis and aetiology remain enigmatic in adult patients, proving timely diagnosis and management a challenge. This paper reports on one case of NEC in an adult patient with underlying anorexia nervosa, following a seven-day period of starvation. She underwent emergency laparotomy for resection of necrotic bowel and subsequently made a good recovery. To date, there have only been eight reports linking NEC with anorexia nervosa. We review our patient in the context of plausible mechanisms hypothesised in these cases. Successful management depends on prompt diagnosis, resuscitation and surgical intervention.

Junctional Epidermolysis Bullosa with Pyloric Atresia: A Case with Favourable Outcome

1998 ◽  
Vol 3 (2) ◽  
pp. 102-104 ◽  
Author(s):  
Duc Ha ◽  
Halliday Idikio ◽  
Alfons Krol ◽  
Andrew N. Lin
Keyword(s):  
Early Childhood ◽  
Epidermolysis Bullosa ◽  
Surgical Intervention ◽  
Early Recognition ◽  
Favourable Outcome ◽  
Pyloric Atresia ◽  
Junctional Epidermolysis Bullosa ◽  
Favourable Prognosis ◽  
Early Surgical Intervention

Background: Pyloric atresia is a rare but serious condition that can occur with junctional epidermolysis bullosa (PA-JEB). Early recognition is necessary for timely intervention, but prognosis can be serious and mortality is high. Objective: We describe the case of a patient with PA-JEB who not only survived past infancy, but showed improvement in cutaneous blistering as she grew older. Conclusion: With early surgical intervention, some patients with PA-JEB can survive and look forward to a favourable prognosis, with improvement of cutaneous blistering by early childhood.

Intra-abdominal sepsis in the critically ill

2016 ◽  
Author(s):  
Jeffrey D. Doyle ◽  
John C. Marshall
Keyword(s):  
Critically Ill ◽  
Anaerobic Bacteria ◽  
Abdominal Sepsis ◽  
Source Control ◽  
Successful Management ◽  
Abdominal Infection ◽  
Infectious Disease Specialists ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Prompt Diagnosis

Intra-abdominal infection encompasses a broad group of infections arising both within the peritoneal cavity and the retroperitoneum. The probable bacteriology reflects patterns of normal and pathological colonization of the gastrointestinal tract. Anaerobic bacteria are found in the distal small bowel and colon. The abdomen is the second most common site of infection leading to sepsis in critically-ill patients. Intra-abdominal infections can be complex to manage and require excellent collaboration between intensivists, diagnostic and interventional radiologists, surgeons, and sometimes gastroenterologists and infectious disease specialists. Prompt diagnosis, appropriate antimicrobial coverage and timely source control are the cornerstones of successful management. The spectrum of pathologic conditions responsible for intra-abdominal infection is broad, although some common biological features facilitate an understanding of their diagnosis and management.

scholarly journals Fulminant necrotising amoebic colitis after corticosteroid therapy for severe COVID-19

2021 ◽  
Vol 14 (10) ◽  
pp. e246110
Author(s):  
Renu Saini ◽  
Vivek Kumar Bhagat ◽  
Balamurugan Thirunavukkarasu ◽  
Aditya Baksi
Keyword(s):  
Corticosteroid Therapy ◽  
High Mortality ◽  
Successful Management ◽  
Delay In Diagnosis ◽  
Diagnosis And Management ◽  
Uncommon Presentation ◽  
Amoebic Colitis ◽  
Prompt Diagnosis

Acute fulminant necrotising colitis is an uncommon presentation of amoebiasis, which can be precipitated after corticosteroid therapy. Clinicians treating patients with COVID-19 with corticosteroid therapy should be familiar with this condition to avoid delay in diagnosis. The disease is associated with high mortality, and prompt diagnosis and management are essential for salvaging patients. We report successful management of a patient who developed this complication following administration of steroids for COVID-19.

scholarly journals Renal allograft aspergilloma after renal transplantation treated with antifungal therapy with a favorable outcome: a case report.

2021 ◽  
Author(s):  
MOHAMMED ALSAEED ◽  
Kiran Kalam ◽  
ABEER ALBADANI
Keyword(s):  
Case Report ◽  
Renal Transplantation ◽  
Antifungal Therapy ◽  
High Mortality ◽  
Renal Allograft ◽  
Surgical Intervention ◽  
Obstructive Uropathy ◽  
Favorable Outcome ◽  
Rare Entity ◽  
Life Threatening

Renal allograft aspergillus is a rare entity with a high mortality due to life-threatening complications. We report a case of renal aspergilloma causing obstructive uropathy after two months of transplantation in a 64 -year- old patient who was managed successfully with antifungal therapy without surgical intervention.

scholarly journals 778 Management of Colorectal Anastomotic leaks: The East of England Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Aker ◽  
A Askari ◽  
M Rabie ◽  
M Aly ◽  
S Adegbola ◽  
...  
Keyword(s):  
High Mortality ◽  
Initial Treatment ◽  
Surgical Intervention ◽  
Management Strategies ◽  
Treatment Modalities ◽  
Anastomotic Leaks ◽  
Consensus Approach ◽  
Multi Centre Study ◽  
Population Mortality ◽  
Radiological Intervention

Abstract Introduction Colorectal anastomotic leaks (AL) are an unfortunate occurrence and are associated with a high mortality. The aim of this multi-centre study is to explore the different management strategies used and compare outcomes in the management of AL. Method All patients who had an AL were included at seven hospitals across the East of England. Morbidity, mortality, and survival were compared across the different management strategies. Results A total of 247 consecutive patients were included of which 60.3% were male and the median age was 68 (IQR 57-77). Half of patients were initially managed conservatively, a further 10.5% had a radiological procedure. 39.7% required surgery as an initial treatment. Of those who initially did not have a surgical intervention (n = 149), 10.7% (n = 16/149) eventually required laparotomy. Ultimately, 42.7% (n = 106/248) required a laparotomy. The 30- and 90-day across the entire population mortality were 3.6% and 4.9% respectively. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities. Conclusions Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy. A consensus approach is required to standardise management in these difficult scenarios.

scholarly journals Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
The Mean ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

Early Surgical Intervention for Infective Endocarditis

2002 ◽  
Vol 10 (4) ◽  
pp. 298-301 ◽  
Author(s):  
Hong Sheng Zhu ◽  
Pei Yan Yao ◽  
Jia Hao Zheng ◽  
A Thomas Pezzella
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Complex Disease ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

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