Retroperitoneoscopic drainage of cryptogenic psoas abscess

2020 ◽  
Vol 13 (7) ◽  
pp. e235579
Author(s):  
Caterina Froiio ◽  
Daniele Tiziano Bernardi ◽  
Emanuele Asti ◽  
Luigi Bonavina
Keyword(s):  
Antibiotic Therapy ◽  
Psoas Abscess ◽  
Secondary Infection ◽  
Ct Guided ◽  
Rehabilitation Care ◽  
The Past ◽  
Threatening Condition ◽  
Life Threatening ◽  
Spine Tuberculosis ◽  
Retroperitoneoscopic Approach

Psoas abscess is a rare and occasionally life-threatening condition. In the past, the major cause of psoas abscess was a descending infection originating from spine tuberculosis (Pott’s disease). Subsequently, secondary infection from spondylodiscitis or Crohn’s disease has become the prevalent aetiology. Conventional treatment ranges from antibiotic therapy alone to CT-guided and/or surgical drainage. We present the case of a 67-year-old man with a complex history, including pneumonia, sepsis and previous muscle-skeletal trauma. The patient subsequently developed a psoas abscess that was successfully treated with a minimally invasive retroperitoneoscopic approach and antibiotics. Blood cultures and pus yielded Gram-positive Streptococcus sp, and transesophageal echocardiography identified endocarditis as a possible source of sepsis. Postoperative clinical course was complicated by recurrent sepsis that required a change of antibiotic therapy. The patient was eventually discharged to rehabilitation care without further complications. The retroperitoneoscopic approach is safe and effective for the treatment of cryptogenic psoas abscess.

scholarly journals Targeting Neutrophils in Sepsis: From Mechanism to Translation

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaofei Shen ◽  
Ke Cao ◽  
Yang Zhao ◽  
Junfeng Du
Keyword(s):  
Therapeutic Strategy ◽  
Secondary Infection ◽  
Specific Treatment ◽  
Neutrophil Function ◽  
The Past ◽  
Extracellular Traps ◽  
Promising Strategy ◽  
Threatening Condition ◽  
Life Threatening

Sepsis is a life-threatening condition caused by a dysregulated host response to infection. Although our understanding in the pathophysiological features of sepsis has increased significantly during the past decades, there is still lack of specific treatment for sepsis. Neutrophils are important regulators against invading pathogens, and their role during sepsis has been studied extensively. It has been suggested that the migration, the antimicrobial activity, and the function of neutrophil extracellular traps (NETs) have all been impaired during sepsis, which results in an inappropriate response to primary infection and potentially increase the susceptibility to secondary infection. On the other hand, accumulating evidence has shown that the reversal or restoration of neutrophil function can promote bacterial clearance and improve sepsis outcome, supporting the idea that targeting neutrophils may be a promising strategy for sepsis treatment. In this review, we will give an overview of the role of neutrophils during sepsis and discuss the potential therapeutic strategy targeting neutrophils.

scholarly journals Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Medicines ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 16
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Luca Caneva ◽  
Sebastiano Gerosa ◽  
Giovanni Ricevuti
Keyword(s):  
Major Trauma ◽  
Management Strategies ◽  
Medical Problem ◽  
Current Evidence ◽  
Potential Drug ◽  
The Past ◽  
Trauma Induced Coagulopathy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Trauma Mortality

Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

(Un) conventional complicated pancreatitis

2021 ◽  
Vol 75 (1) ◽  
pp. 61-67
Author(s):  
Michal Rybár ◽  
Ivo Horný
Keyword(s):  
Acute Pancreatitis ◽  
Multidisciplinary Approach ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Secondary Infection ◽  
Abdominal Ultrasound ◽  
Stent Migration ◽  
Endoscopic Extraction ◽  
Threatening Condition ◽  
Life Threatening

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

Ossification of the Peritoneal Membrane

2004 ◽  
Vol 24 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Nicola Di Paolo ◽  
Giovanni Sacchi ◽  
Paola Lorenzoni ◽  
Enrico Sansoni ◽  
Enzo Gaggiotti
Keyword(s):  
Histopathological Examination ◽  
Giant Cells ◽  
Peritoneal Membrane ◽  
The Past ◽  
Biopsy Specimens ◽  
Dialysis Solution ◽  
Threatening Condition ◽  
Life Threatening ◽  
Great Availability ◽  
White Material

Background Peritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP. Objective To investigate etiopathogenetic correlations between PO and SP by histopathological examination. Method We examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy. Results Ossification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite. Conclusions Calcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.

scholarly journals Familial polyposis coli: the management of desmoid tumor bleeding

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 572-576 ◽  
Author(s):  
Armando Calogero ◽  
Caterina Sagnelli ◽  
Nicola Carlomagno ◽  
Vincenzo Tammaro ◽  
Maria Candida ◽  
...  
Keyword(s):  
Familial Polyposis ◽  
Local Relapse ◽  
Familial Polyposis Coli ◽  
Polyposis Coli ◽  
Abdominal Tumor ◽  
Ct Guided ◽  
Post Surgery ◽  
Threatening Condition ◽  
Life Threatening ◽  
Tumor Bleeding

AbstractBackgroundThere is currently no standard treatment for desmoid tumors (DTs) associated with familial polyposis coli (FAP). Familial adenomatous polyposis in DT patients is sometimes a life-threatening condition.MethodsWe enrolled all consecutive patients with FAP treated at Unit of General Surgery and Transplant, University of Naples Federico II and evaluated the incidence of DTs on FAP between 1996 and 2016.ResultsWe observed 45 consecutive patients with FAP; of these 5 were DT-FAP-associated. All 5 cases with FAP were young women, age 25 to 65 years, previously treated by colectomy. Of these, 4 patients presented a parietal localization and had been treated with a wide surgical exeresis; one patient had an intra-abdominal, mesenteric tumor that was unresectable at laparotomy. We performed CT-guided drainage, ureteral stenting, medical therapy (sulindac+tamoxifene), and chemotherapy (dacarba-zine+doxorubicine).All patients were alive and underwent follow-ups for 5 years post-surgery; only 1 patient with parietal localization showed a local relapse after 2 years.ConclusionsWe propose a modulated approach to the single patient with FAP, with surgery as treatment of choice for parietal localization disease and integrating different kinds of therapies (surgery alone or associated with RT, CT) for the intra-abdominal tumor.

scholarly journals Repeated Sepsis in an 83-Year-Old Man With Cancer With Long-Lasting Invasive Treatments

2020 ◽  
Author(s):  
Masoomeh Imanipour ◽  
Nasrin Rasoulzadeh ◽  
Amin Hosseini
Keyword(s):  
Risk Factors ◽  
Immune Response ◽  
Immune System ◽  
Antibiotic Therapy ◽  
Major Trauma ◽  
Fluid Replacement ◽  
Underlying Condition ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inflammatory Immune Response

Sepsis is a life-threatening condition that arises when the body's response to infection damages its own tissues and organs. Sepsis is caused by an inflammatory immune response triggered by an infection. Its risk factors include aging, weak immune system, major trauma, or burns. Treatment of sepsis is often based on fluid replacement and antibiotic therapy. In this study, an 83-year-old man is reported with two times of diagnosis of sepsis during three years. The first sepsis was due to an infection of the colostomy and the second one followed an infection at tracheostomy site. It seems that the disease and the underlying condition of the patient contribute to the occurrence of sepsis. The patient each time was discharged from the hospital after successful response to the treatment

scholarly journals Intramedullary abscess associated with acute bacterial meningitis: a case report and review of the literature

2020 ◽  
Vol 10 (3) ◽  
pp. 120-123
Author(s):  
Marouane Hammoud ◽  
Fayçal Lakhdar ◽  
Mohammed Benzagmout ◽  
Khalid Chakour, ◽  
Mohammed El Faiz Chaou
Keyword(s):  
Spinal Cord ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Contralateral Side ◽  
Acute Bacterial Meningitis ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Central Nervous System

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. Untreated, it may result in significant morbidity and mortality. We describe the case of a 34-year-old man, who initially was admitted for bacterial meningitis. 3 days after initiation of antibiotic therapy, a gradually and progressive weakness appeared on the left side of his body with numbness on the contralateral side. MRI of the spine demonstrated an ISCA at level of C4. A myelotomy and surgical drainage was performed. Postoperatively, the patient had improved significantly his neurological deficit. ISCA is still a life-threatening condition, we point out that the diagnosis should be highly suspected, if a cystic spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, especially in a context of sepsis or acuate meningitis. Prompt surgical evacuation followed by adequate antibiotic therapy, are the mainstays of treatment.

scholarly journals Acute respiratory distress syndrome: An update and review

2018 ◽  
Vol 6 (2) ◽  
pp. 74-77 ◽  
Author(s):  
Gautam Rawal ◽  
Sankalp Yadav ◽  
Raj Kumar
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Severe Hypoxemia ◽  
Low Tidal Volume ◽  
The Past ◽  
Threatening Condition ◽  
Life Threatening

Abstract Acute respiratory distress syndrome (ARDS) is a life threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure and was first recognized in 1960s.Since its first description, it has undergone intensive research in the past few decades to understand its pathogenesis and therapies. Despite this, the recommended therapies to decrease mortality in ARDS remain limited and include low-tidal volume mechanical ventilation, prone ventilation and recently, the ECMO rescue therapy in extreme cases. This review article will summarize the key features of ARDS with a brief overview of the therapeutic options in the management of ARDS.

Pulmonary embolism as a potential side effect of olanzapine and the possible beneficiary side effect of duloxetine: A case study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1222-1222
Author(s):  
O. Andrioti ◽  
N. Nikolaidis ◽  
S. Ntonias
Keyword(s):  
Pulmonary Embolism ◽  
Side Effect ◽  
Potential Effect ◽  
Protective Role ◽  
Psychiatric Medication ◽  
Male Smoker ◽  
The Past ◽  
Threatening Condition ◽  
Life Threatening

IntroductionPulmonary embolism is a very serious, life threatening condition. It has been associated with the use of antipsychotic drugs, both typical and atypical, thus consisting a rare but potentially lethal side effect of this drug category. SSRIs/SNRIs on the other hand, are associated with bleeding, increased INR results and platelet dysfunction.Objective and methodA clinical case was followed and reviewed to illustrate the possible connection between the withdrawal of duloxetine and the ongoing use of olanzapine with pulmonary embolism.ResultsA 36-year- old male, smoker of 30 cigarettes/day had been under treatment with olanzapine 30 mg/day and aripiprazole 30 mg/day for the past year. Duloxetine 90 mg/day had also been added for the past nine months and withdrawn after the improvement of depressive symptoms. Approximately one month after its withdrawal the man suffered pulmonary embolism and was hospitalised. During hospitalisation tests found no other factors predisposing to emboli creation. He was discharged with acenocumarol (Sintrom). His psychiatric medication was therefore adjusted to omit olanzapine and SSRIs /SNRIs because of their potential effect on coagulation.ConclusionsCan it be that olanzapine played a role in promoting pulmonary embolism in this patient ?Can it be that duloxetine was playing a protective role and its withdrawal facilitated the onset of pulmonary embolism? There is no certain way to tell but, to our knowledge, there has not been a similar case before and the time sequence of the events might not be coincidental.

scholarly journals Convulsive syndrome. Part 1

2021 ◽  
pp. 98-105
Author(s):  
P.V. Moskaleva ◽  
◽  
N.A. Shnayder ◽  
M.M. Petrova ◽  
R.F. Nasyrova ◽  
...  
Keyword(s):  
Medical Education ◽  
General Practice ◽  
Continuing Medical Education ◽  
Postgraduate Training ◽  
Medicinal Products ◽  
The Past ◽  
Epileptic Syndromes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Convulsive Seizures

Convulsive syndrome is an urgent, potentially life-threatening condition in neurological, paediatric and general practice. Over the past decade, reconsideration has been committed in relation to the defi nition of epilepsy, epileptic syndromes, including convulsive syndrome with simultaneous expansion of the arsenal of medicinal products for cessation of convulsive seizures in children and adults. In this connection, we have prepared this lecture comprising two parts: the first part considers the defi nition, pathogenesis, aetiology and diagnosis of the convulsive syndrome. The lecture is designed for neurologists, paediatricians, general practitioners, ambulance physicians and anaesthesiologists-reanimatologists. Th e system of continuing medical education (CME) considers convulsive syndrome within the framework of the programme for postgraduate training of physicians in these specialities.

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