scholarly journals Early Sonographic Diagnosis of Emphysematous Cholecystitis Successfully Treated With Antibiotics

2016 ◽  
Vol 33 (1) ◽  
pp. 43-46
Author(s):  
Joseph James Tseng ◽  
R. Brooke Jeffrey
Keyword(s):  
Surgical Intervention ◽  
Early Stage ◽  
Secondary Infection ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Gallbladder Perforation ◽  
Emphysematous Cholecystitis ◽  
Pericholecystic Abscess ◽  
Emergency Surgical Intervention

Emphysematous cholecystitis (EC) is an uncommon form of acute cholecystitis, caused by secondary infection of the gallbladder wall with gas-forming organisms. The mortality rate of EC is as high as 25% due to complications such as gangrene, gallbladder perforation, pericholecystic abscess, and bile peritonitis. Traditionally, prompt emergency surgical intervention with open cholecystectomy is recommended for EC treatment. This case study of EC was diagnosed at an early stage with sonography and computed tomography and successfully treated by antibiotic treatment alone without surgery. With characteristic findings on sonography such as echogenic reflectors with posterior shadowing, EC is an important entity for sonographers to be able to identify. In the future as imaging with sonography and CT affords earlier diagnosis of EC, antibiotic therapy might be considered for some patients, but more evidence is needed to obtain the same outcome as this particular case.

scholarly journals Successful treatment of emphysematous cholecystitis by laparoscopic surgery

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Hitoshi Funahashi ◽  
Tetsuya Komori ◽  
Naoki Sumita
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Cholecystitis ◽  
Rare Variant ◽  
Successful Treatment ◽  
Gold Standard ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Emphysematous Cholecystitis ◽  
Bacterial Proliferation ◽  
Calot’S Triangle

Abstract Emphysematous cholecystitis (EC) is a severe and rare variant of acute cholecystitis characterized by ischemia of the gallbladder wall with gas-forming bacterial proliferation. Open cholecystectomy is traditionally the gold standard approach to treatment due to difficulty in isolating Calot’s triangle in the setting of intense inflammation. We present a case of EC successfully and safely treated by laparoscopic surgery.

scholarly journals Emphysematous cholecystitis

2009 ◽  
Vol 22 (4) ◽  
pp. 235-236
Author(s):  
Renato Micelli Lupinacci ◽  
Najim Chafai ◽  
Emmanuel Tiret
Keyword(s):  
Open Cholecystectomy ◽  
Clinical Signs ◽  
Vascular Diseases ◽  
Gallbladder Wall ◽  
White Blood Count ◽  
Emphysematous Cholecystitis ◽  
Reactive Protein ◽  
Threatening Condition ◽  
Life Threatening ◽  
Male Patients

BACKGROUND: Emphysematous cholecystitis is life-threatening condition characterized by gas-forming infection of the gallbladder. It is mostly seems in old male patients with systemic, specially diabetes and vascular diseases. CASE REPORT: - A 30-year-old man without previous diseases was admitted because of right upper quadrant pain and nausea. On admission the patient was febrile (38.7o) with normal bilirubin levels. The white blood count was 26700/µl and reactive protein C was 470. Axial sections of single slice computed tomography imaging (section thickness 5 mm), revealed gallbladder wall enhancement after i.v. contrast, as well as dilatation of the gallbladder with intraluminal air. The patient underwent open cholecystectomy. The culture of the bile showed clostridium perfringes. The postoperative course of the patient was uneventful. CONCLUSION: This is a rare form of cholecystitis that carries a high mortality and usually present insidious clinical signs. CT is the most accurate imaging technique. Antibiotic therapy should begin quickly and include coverage of common pathogens, particularly Clostridia. Surgical intervention should take place as early as possible.

scholarly journals Current experience with emphysematous cholecystitis

2021 ◽  
Vol 8 (2) ◽  
pp. 463
Author(s):  
Ramiz Iqbal ◽  
Elvina Wiadji
Keyword(s):  
Mortality Rate ◽  
Open Cholecystectomy ◽  
Major Complication ◽  
Gallbladder Wall ◽  
Clinical Event ◽  
Emphysematous Cholecystitis ◽  
Open Conversion ◽  
Adverse Clinical Event ◽  
Co Morbidity ◽  
Laparoscopic Techniques

Background: Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis with a reported 15-25% mortality rate. Conventionally, EC is managed with an early open cholecystectomy. However, recent advancement in percutaneous intervention and laparoscopic techniques have influenced our management of this biliary pathology. This study reviews the management and outcomes of EC in a regional centre.Methods: Retrospective analysis of a clinical database constituting all patients diagnosed with EC at a regional Australian hospital in NSW from Jan 2010 to July 2019. Inclusion criteria: sepsis, abdominal pain and radiological evidence of gas in the gallbladder wall, lumen, and pericholecystic tissue in the absence of an abnormal connection between the gallbladder and gastrointestinal tract. We investigated patient risk factors, management and outcomes.Results: 16 patients with EC were identified. The mean age of the cohort was 73 years old. The majority of patients had co-morbidity including type 2 diabetes and ischemic heart disease (56 and 62% respectively). Laparoscopic cholecystectomies were performed in 9 patients during their index admissions and 7 patients were managed with PTC. 5 patients required ICU admission for septic shock, and all were managed with PTC drain placement. The overall mortality rate was 6%.Conclusions: Laparoscopic cholecystectomy on index admission is the treatment of choice for EC. Although more technically challenging, adverse clinical event including major complication and open conversion was avoided in our cohort while percutaneous cholecystostomy was reserved for unstable and poor surgical candidate.

A Proof for the Possibility of Ce-Oxide from CMP Residuals in Si-Wafers by Analytical TEM

2012 ◽  
Author(s):  
Wayne Zhao ◽  
Liem Do Thanh ◽  
Michael Gribelyuk ◽  
Mary-Ann Zaitz ◽  
Wing Lai
Keyword(s):  
Technology Development ◽  
Early Stage ◽  
Chemical Mechanical Planarization ◽  
Particle Cluster ◽  
Limited Region ◽  
Physical Evidence ◽  
Analytical Tem ◽  
Transmission Electron ◽  
Oxide Particles

Abstract Inclusion of cerium (Ce) oxide particles as an abrasive into chemical mechanical planarization (CMP) slurries has become popular for wafer fabs below the 45nm technology node due to better polishing quality and improved CMP selectivity. Transmission electron microscopy (TEM) has difficulties finding and identifying Ce-oxide residuals due to the limited region of analysis unless dedicated efforts to search for them are employed. This article presents a case study that proved the concept in which physical evidence of Ce-rich particles was directly identified by analytical TEM during a CMP tool qualification in the early stage of 20nm node technology development. This justifies the need to setup in-fab monitoring for trace amounts of CMP residuals in Si-based wafer foundries. The fact that Cr resided right above the Ce-O particle cluster, further proved that the Ce-O particles were from the wafer and not introduced during the sample preparation.

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

scholarly journals Surgical Intervention of Early Stage Primary Acquired Cholesteatoma

2016 ◽  
Vol 130 (S3) ◽  
pp. S218-S219
Author(s):  
Tao Pan ◽  
Furong Ma ◽  
Yu Wang ◽  
Ke Zhang ◽  
Jia Ke
Keyword(s):  
Surgical Intervention ◽  
Early Stage ◽  
Acquired Cholesteatoma

scholarly journals Neighborhood Energy Modeling and Monitoring: A Case Study

Energies ◽  
2021 ◽  
Vol 14 (12) ◽  
pp. 3716
Author(s):  
Francesco Causone ◽  
Rossano Scoccia ◽  
Martina Pelle ◽  
Paola Colombo ◽  
Mario Motta ◽  
...  
Keyword(s):  
High Performance ◽  
High Efficiency ◽  
Early Stage ◽  
Energy Performance ◽  
Monitoring Plan ◽  
Performance Targets ◽  
Carrier Energy ◽  
Zero Carbon ◽  
Energy Grid

Cities and nations worldwide are pledging to energy and carbon neutral objectives that imply a huge contribution from buildings. High-performance targets, either zero energy or zero carbon, are typically difficult to be reached by single buildings, but groups of properly-managed buildings might reach these ambitious goals. For this purpose we need tools and experiences to model, monitor, manage and optimize buildings and their neighborhood-level systems. The paper describes the activities pursued for the deployment of an advanced energy management system for a multi-carrier energy grid of an existing neighborhood in the area of Milan. The activities included: (i) development of a detailed monitoring plan, (ii) deployment of the monitoring plan, (iii) development of a virtual model of the neighborhood and simulation of the energy performance. Comparisons against early-stage energy monitoring data proved promising and the generation system showed high efficiency (EER equal to 5.84), to be further exploited.

scholarly journals Traumatic Gallbladder Perforation in Children – Case Report and Review

2021 ◽  
Author(s):  
Melanie Thanh Phuong Le ◽  
Jochen Herrmann ◽  
Michael Groth ◽  
Konrad Reinshagen ◽  
Michael Boettcher
Keyword(s):  
Case Report ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Recent Literature ◽  
Signs And Symptoms ◽  
Gallbladder Wall ◽  
Gallbladder Perforation ◽  
Free Fluid ◽  
Key Points ◽  
Magnetic Resonance Imaging Mri

Background Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases. Methods We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using “gallbladder injury in children”, “gallbladder perforation children”, “blunt abdominal trauma children” as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000–2020 was taken into account to review the state of the art in diagnosis and management. Results and Conclusion Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed. Key Points:  Citation Format

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