Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

Abstract Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

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Severe mammary fibroepithelial hyperplasia due to single injection of medroxyprogesterone acetate in two male cats

Ciência Rural ◽

10.1590/0103-8478cr20200171 ◽

2021 ◽

Vol 51 (4) ◽

Author(s):

Fabiana Azevedo Voorwald ◽

Carlize Lopes ◽

Gabriel Coutinho Silveira ◽

Daniela Tavares Lima ◽

Maria de Fátima Cotta da Silva ◽

...

Keyword(s):

Surgical Treatment ◽

Antibiotic Therapy ◽

Treatment Failure ◽

Medroxyprogesterone Acetate ◽

Single Injection ◽

Mammary Glands ◽

Bilateral Mastectomy ◽

Mixed Breed ◽

Thoracic And Abdominal ◽

Entire Male

ABSTRACT: Thirty and forty days after a 50 mg medroxyprogesterone acetate injection, respectively, two mixed-breed, 7 and 8-month-old entire male cats presented diffuse enlargement of thoracic and abdominal mammary glands, with ulceration, abscessation and necrosis. One patient was treated with 10 mg/kg aglepristone, antibiotic therapy, analgesic and non-steroidal anti-inflammatory compound; however a worse enlargement of mammary glands, necrosis and clinical condition was noted two days after antiprogestin injection. The second patient was submitted to surgical procedure without previous medical treatment. A partial bilateral mastectomy and conventional orchiectomy were performed, and both patients presented no clinical abnormalities 10 days after surgical treatment. In the male cat, the interruption of progesterone associated mammary fibroepithelial hyperplasia cannot be based in gonadectomy, being antiprogestin treatment the primary approach. Mastectomy can be a treatment option in selected cases, such as the two cases presented here, in case of antiprogestin treatment failure or in case of extensive ulceration, necrosis and risk of sepsis.

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Application of the BP Nerve Network Model in the Analysis of Factors Affecting Hospitalization Expenses

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.50-51.968 ◽

2011 ◽

Vol 50-51 ◽

pp. 968-972

Author(s):

Guo Li Wang ◽

Jian Hui Wu ◽

Ting Li ◽

Xiao Ming Li

Keyword(s):

Medical Treatment ◽

Influencing Factors ◽

Network Model ◽

Therapeutic Result ◽

Factors Affecting ◽

Nerve Network ◽

Factors Analysis ◽

Emergency Medical ◽

Powerful Analytical Tool ◽

Major Factors

Collected 2218 medical records of cerebral infarction patients from 2007 to 2008 in a third-class hospital in Tang Shan as sample. A statistical analysis was made of the hospitalization expenses and its influencing factors by BP nerve network model to identify the factors affecting hospitalization expense by using BP nerve network model. The results showed that the major factors impacting the hospitalization expense included age, hospitalization day, therapeutic result and emergency medical treatment. The sensitivity were: age is 0.91426, hospitalization day is 0.32131, therapeutic result is 0.19722, emergency medical treatment is 0.27564. BP nerve network model is a powerful analytical tool for hospitalization expenses and its influencing factors analysis.

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Medical treatment of nasal squamous papilloma with imiquimod cream

The Journal of Laryngology & Otology ◽

10.1258/002221503322334576 ◽

2003 ◽

Vol 117 (9) ◽

pp. 720-722 ◽

Cited By ~ 3

Author(s):

Marco Caversaccio ◽

Stefan Aebi

Keyword(s):

Surgical Treatment ◽

Medical Treatment ◽

The Body ◽

Treatment Modalities ◽

Imiquimod Cream ◽

Skin Tumours ◽

Squamous Papilloma ◽

Human Papilloma Viruses

Warts are common lesions. The prevalence and incidence of squamous papilloma of the nasal vestibulum are not known, and it is not certain how often human papilloma viruses are involved. Numerous medical or surgical treatment modalities have been reported in the literature with variable, sometimes unsatisfactory results. Imiquimod cream is a topically applied immunomodulator. It is used for warts and other skin tumours on different locations of the body. We report results of six patients treated with imiquimod five per cent cream for nasal squamous papilloma.

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Treatment of subdural empyema

Journal of Neurosurgery ◽

10.3171/jns.1981.55.1.0082 ◽

1981 ◽

Vol 55 (1) ◽

pp. 82-88 ◽

Cited By ~ 87

Author(s):

Gordon Bannister ◽

Bernard Williams ◽

Simon Smith

Keyword(s):

Surgical Treatment ◽

Antibiotic Therapy ◽

Survival Rates ◽

Subdural Empyema ◽

Content Type ◽

Factors Affecting ◽

Drug Of Choice ◽

Interhemispheric Fissure ◽

Burr Holes ◽

Fine Print

✓ A review of 66 cases and a survey of the literature indicates that survival rates of around 90% should now be expected from patients with subdural empyema. Factors affecting the outcome are discussed. In addition to prompt surgical treatment and appropriate antibiotic therapy, the most important step seems to be extensive craniotomy and direct removal of subdural pus, particularly from the interhemispheric fissure. Treatment through burr holes is not acceptable. In the absence of a culture of the organisms and known antibiotic sensitivities, chloramphenicol is recommended as the drug of choice.

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Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases

Medical Science and Discovery ◽

10.36472/msd.v6i10.309 ◽

2019 ◽

Vol 6 (10) ◽

pp. 235-240

Author(s):

Bora Çoşkun ◽

Coşkun Şimşir

Keyword(s):

Medical Treatment ◽

Predictive Factors ◽

Success Rates ◽

Laboratory Findings ◽

Factors Affecting ◽

Neutrophil Lymphocyte Ratio ◽

Treatment Regimens ◽

Tuboovarian Abscess ◽

Retrospective Clinical Study ◽

Wbc Count

Objective: The main outcome measure of the present study was to find out the predictive factors affecting the need for surgery in patients diagnosed with tuboovarian abscess (TOA). We also examined the success of different medical treatment regimens in those patients. Material and Methods: This was a retrospective clinical study performed on 96 TOA patients who were treated in the current hospital between August 2015 and August 2019. All patients underwent physical examination and ultrasonographic imaging with some laboratory tests to investigate the presence of TOA. Two different medical treatment regimens were administered as recommended by the international guidelines after the initial diagnoses. Patients with worsening clinical and/or laboratory findings and/or who did not respond to medical treatment were taken to surgery. Predictive factors for surgical intervention and success rates of medical treatment regimens were evaluated. Results: White blood cell (WBC) levels≥ 16000 and abscess size≥ 7 cm was strongly correlated with the requirement for surgery. The 94 patients received the Regimen 1. Six patients underwent surgery urgently when they were under medical treatment. Regimen 1 failed in 21 (22.34 %) patients out of 94, Regimen 2 was shifted to. Six patients (28.5%) out of 21 underwent surgery because of treatment failure with Regimen 2. Recovery was achieved in the remaining 15 (71.4%) patients. Conclusion: The success of medical TOA treatment was found to be high. Therefore, medical treatment can be applied first, except in case of acute abdomen. It was found that WBC and abscess diameter in patients with TOA in admission were the most important factors affecting the need for surgery. The factors affecting the duration of medical treatment were found to be age, WBC count, CRP (C-Reactive Protein), ESR (Erythrocyte Sedimentation Rate) and NLR (Neutrophil/Lymphocyte Ratio) levels.

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Epistaxis: Etiology and management

Annals of King Edward Medical University ◽

10.21649/akemu.v9i4.1364 ◽

2016 ◽

Vol 9 (4) ◽

Author(s):

Shahid Ali ◽

Sami Mumtaz ◽

Mohammad Saeed

Keyword(s):

Surgical Treatment ◽

Prospective Study ◽

Medical Treatment ◽

General Hospital ◽

Medical Condition ◽

Nonsurgical Treatment ◽

Treatment Modalities ◽

Common Cause ◽

Surgical Methods ◽

Common Medical Condition

This prospective study was conducted in ENT department at Lahore General Hospital Lahore with objectives to evaluate the patients for various etiological factors and to study the effects of various treatment modalities. The most common cause of epistaxis was trauma and bleeding usually stopped by conservative measures. The most common medical condition associated with epistaxis was hypertension, which responded well to medical treatment. Nonsurgical treatment was effective in majority of our patients; surgical treatment was considered in cases of failure of non-surgical methods.

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Outcome of Debridement and Retention in Prosthetic Joint Infections by Methicillin-Resistant Staphylococci, with Special Reference to Rifampin and Fusidic Acid Combination Therapy

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02061-12 ◽

2012 ◽

Vol 57 (1) ◽

pp. 350-355 ◽

Cited By ~ 54

Author(s):

T. N. Peel ◽

K. L. Buising ◽

M. M. Dowsey ◽

C. A. Aboltins ◽

J. R. Daffy ◽

...

Keyword(s):

Combination Therapy ◽

Antibiotic Therapy ◽

Treatment Failure ◽

Fusidic Acid ◽

Treatment Success ◽

Treatment Modalities ◽

Methicillin Resistant ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

ABSTRACTThe management of prosthetic joint infections remains a clinical challenge, particularly infections due to methicillin-resistant staphylococci. Previously, this infection was considered a contraindication to debridement and retention strategies. This retrospective cohort study examined the treatment and outcomes of patients with arthroplasty infection by methicillin-resistant staphylococci managed by debridement and retention in conjunction with rifampin-fusidic acid combination therapy. Over an 11-year period, there were 43 patients with infection by methicillin-resistant staphylococci managed with debridement and retention. This consisted of close-interval repeated arthrotomies with pulsatile lavage. Rifampin was combined with fusidic acid for the majority of patients (88%). Patients were monitored for a median of 33.5 months (interquartile range, 20 to 54 months). Overall, 9 patients experienced treatment failure, with 12- and 24-month estimates of infection-free survival of 86% (95% confidence interval [CI], 71 to 93%) and 77% (95% CI, 60 to 87%), respectively. The following factors were associated with treatment failure: methicillin-resistantStaphylococcus aureus(MRSA) arthroplasty infection, a single surgical debridement or ≥4 debridements, and the receipt of less than 90 days of antibiotic therapy. Patients with infection by methicillin-resistant coagulase-negative staphylococci (MR-CNS) were less likely to fail treatment. The overall treatment success rate reported in this study is comparable to those of other treatment modalities for prosthetic joint infections by methicillin-resistant staphylococci. Therefore, the debridement and retention of the prosthesis and rifampin-based antibiotic therapy are a valid treatment option for carefully selected patients.

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Treatment Outcomes for Osteoradionecrosis of the Central Skull Base: A Systematic Review

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1733973 ◽

2021 ◽

Author(s):

Noah Shaikh ◽

Chadi A. Makary ◽

Lindsey Ryan ◽

Camilo Reyes

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Medical Treatment ◽

Skull Base ◽

Success Rate ◽

Study Design ◽

Case Reports ◽

Treatment Success ◽

Treatment Modalities ◽

Cochrane Library

Abstract Objective Osteoradionecrosis (ORN) of the skull base can have catastrophic consequences if not detected early and managed appropriately. This is a systematic review of the different treatment modalities for skull base ORN and their outcomes. Study Design This study is a systematic review. Materials and Methods Two researchers extracted information including patient population, surgical technique, outcomes of interest, and study design. A computerized search of Medline, Embase, and the Cochrane library (January 1990–June 2020) looked for several papers on the subject of skull base ORN. Results A total of 29 studies had met inclusion criteria, including data from 333 patients. Nasopharyngeal carcinoma was the most common primary tumor (85%). Average age at diagnosis of ORN was 55.9 years (range = 15–80 years) and 72.3% of patients were males. The average time to diagnosis of ORN after radiation therapy was 77 months with an average radiation dose of 76.2 Gy (range = 46–202 Gy). Nighty-eight patients (29.4%) also had chemotherapy as part of their treatment regimen. Although all parts of the central skull base were reported to be involved, the clivus and sphenoid bone were the most commonly reported subsites. Trial of medical treatment had a success rate of 41.1%. About 66% of patients needed surgical treatment, either primarily or after failing medical treatment. Success rate was 77.3%. Overall, the surgical treatment was superior to medical treatment (p < 0.0001). Conclusion ORN is a rare complication of the treatment of skull base tumors. Most cases require surgical treatment, including endoscopic debridement or free flap reconstruction, which has a high success rate. Level of Evidence Level 3 evidence as a systematic review of case studies, case reports, retrospective, and prospective trials with no blinding or controls.

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Survival patterns of COVID-19 pneumonia patients with false-negative PCR results transferred to the intensive care unit from the emergency department

10.21203/rs.3.rs-652047/v1 ◽

2021 ◽

Author(s):

Meltem Songur Kodik

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

False Negative ◽

Survival Rates ◽

Length Of Hospital Stay ◽

Treatment Modalities ◽

Laboratory Findings

Abstract ObjectiveThis study aimed to analyze factors associated with patient mortality in COVID-19 patients hospitalized in the intensive care unit (ICU) and provide data to help prioritize the most critical patients.DesignRetrospective cohort studySetting and participantsData for 289 patients were analyzed by the XXX hospital’s IT department.MethodsA clinical retrospective cohort study was conducted in a tertiary hospital. Patients (n=289) with negative reverse transcription-polymerase chain reaction (RT-PCR) and positive chest computed tomography (CT) scan indicating COVID-19 were included in the research. Demographics, clinical characteristics, treatment modalities, and length of hospital stay were analyzed in relation to 30-day survival outcomes.ResultsThe mean age of the patients was 69.04±15.10 years (range 19-100), and 41.2% (n=119) were female. The mortality rate was 48.1% (n=139). There were statistically significant differences in laboratory findings, such as hemoglobin (p=0.021), lymphocyte counts (p=0.046), d-dimer (p=0.009), and lactate (<0.001) regarding one-month survival. Additionally, those hospitalized for more than 5 days had higher one-month survival rates (hazard ratio (HR)= 0.003, CI= 10.264-155.972). Moreover, intubated patients had a higher mortality risk during this period (HR=4.15, CI=1.53-11.20).Conclusions and implicationsThe first five days of patients hospitalized in intensive care units due to COVID-19 pneumonia are critical. Besides, the need for intubation was another factor independently affecting survival. Clinicians should be alerted about the significance of these factors.

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