scholarly journals Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

2021 ◽  
Vol 6 (7) ◽  
pp. 584-592
Author(s):  
Tamer El-Sobky ◽  
Shady Mahmoud
Keyword(s):  
Clinical Judgment ◽  
Surgical Techniques ◽  
Management Plan ◽  
Antibiotic Administration ◽  
Open Drainage ◽  
Acute Phase Reactants ◽  
Ample Evidence ◽  
Road Map ◽  
Osteoarticular Infections ◽  
Long Term Prognosis

Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art

2021 ◽  
pp. jisakos-2020-000496
Author(s):  
Gustavo Vinagre ◽  
Flávio Cruz ◽  
Khalid Alkhelaifi ◽  
Pieter D'Hooghe
Keyword(s):  
Children And Adolescents ◽  
State Of The Art ◽  
Surgical Techniques ◽  
Meniscal Repair ◽  
Management Plan ◽  
Anatomical Location ◽  
Return To Sports ◽  
Meniscal Tears ◽  
Geographical Differences ◽  
Meniscal Healing

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

scholarly journals Study on the Usefulness of APR Scores from the Viewpoint of Proinflammatory Cytokines

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
T. Nakamura ◽  
D. Hatanaka ◽  
T. Yoshioka ◽  
S. Yamada ◽  
H. Goto
Keyword(s):  
Inflammatory Response ◽  
Proinflammatory Cytokines ◽  
Proinflammatory Cytokine ◽  
Clinical Laboratory ◽  
Diagnosis And Treatment ◽  
Antibiotic Administration ◽  
Acute Phase Reactants ◽  
Group I ◽  
Cytokine Levels ◽  
Fetal Inflammatory Response

Background. Delayed diagnosis and treatment of newborn infection adversely impact outcomes. Clinical laboratory parameters have aimed to obtain the most correct and prompt diagnosis and treatment of this disease. This study simultaneously observed changes over time in APR as well as proinflammatory cytokines and anti-proinflammatory cytokines and aims to clarify usefulness of APR scores.Methods. We evaluated the usefulness of acute phase reactants (APR) in 46 newborns whose serum up to age 7 days had been stored, with comparison of three types (Group I: infection 15, Group F: fetal inflammatory response syndrome 17, and Group C: control 14) of APR-based scores, those of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP), and haptoglobin (Hp), with proinflammatory cytokine levels. APR scores for CRP, AGP, and Hp and the levels of the proinflammatory cytokines IL-1β, IL-6, IL-8, IL-10, and TNFαwere determined.Results. The cytokine levels started to increase from age 0 days and then decreased rapidly. The three APR scores, CRP, AG, and Hp, were elevated at age 0 days and then gradually decreased in infection (Group I) and fetal inflammatory response syndrome (Group F). The duration of antibiotic administration according to APR scores was significantly shorter in Group F than in Group I.Conclusion. This study demonstrated APR scores to be more useful for deciding whether antibiotics should be discontinued than proinflammatory cytokine levels.

scholarly journals Case Report: Management of Multiple Deep-Tissue Cellulitis Without Sling Removal After an Anti-incontinence Procedure in a Female With Diabetes Mellitus

2020 ◽  
Vol 7 ◽  
Author(s):  
Hai-Hong Jiang ◽  
Sheng-Ping Hu ◽  
Yasmeen Bano ◽  
Ling-Xiao Ji ◽  
Peng-Fei Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Perioperative Period ◽  
Urinary Continence ◽  
Antibiotic Administration ◽  
Open Drainage ◽  
Deep Tissue ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
Transobturator Suburethral Tape

The transobturator suburethral tape procedure is emerging as a preferred surgical option in the management of stress urinary incontinence. This procedure, also called tension-free vaginal tape transobturator (TVT-O) procedure, has fewer risks of injury to the bladder, similar effectiveness, and shorter surgery duration compared with the older tension-free vaginal tape (TVT) procedure. In this study, we report the case of a female patient with type 2 diabetes mellitus who developed emergency ketoacidosis and severe cellulitis after a TVT-O procedure, which was successfully managed without sling removal and open drainage of abscesses after multi-point puncture drainage, guided by ultrasound and appropriate antibiotic administration. The patient showed appropriate urinary continence with controlled diabetes mellitus 24 months after treatment. In conclusion, cellulitis from the pelvic floor to the associated thigh after TVT-O procedure in a diabetic patient can be managed conservatively if no sling exposure is confirmed. However, these patients should be closely observed and followed up during the perioperative period, especially for synthetic sling use.

scholarly journals Methylprednisolone in Pediatric Cardiac Surgery: Is There Enough Evidence?

2021 ◽  
Vol 8 ◽  
Author(s):  
Annewil van Saet ◽  
Gerdien A. Zeilmaker-Roest ◽  
Robert J. Stolker ◽  
Ad J. J. C. Bogers ◽  
Dick Tibboel
Keyword(s):  
Cardiac Surgery ◽  
Inflammatory Mediators ◽  
Plasma Concentrations ◽  
Neurodevelopmental Outcome ◽  
Surgical Techniques ◽  
Pediatric Cardiac Surgery ◽  
Limited Information ◽  
Term Outcome ◽  
Ample Evidence ◽  
Long Term Outcome

Corticosteroids have been used to decrease the inflammatory response to cardiac surgery and cardiopulmonary bypass in children for decades. Sparse information is present concerning the pharmacokinetics and pharmacodynamics of corticosteroids in the context of pediatric cardiac surgery. There is large interindividual variability in plasma concentrations, with indications for a larger volume of distribution in neonates compared to other age groups. There is ample evidence that perioperative use of MP leads to a decrease in pro-inflammatory mediators and an increase in anti-inflammatory mediators, with no difference in effect between doses of 2 and 30 mg/kg. No differences in inflammatory mediators have been shown between different times of administration relative to the start of surgery in various studies. MP has been shown to have a beneficial effect in certain subgroups of patients but is also associated with side effects. In lower risk categories, the balance between risk and benefit may be shifted toward risk. There is limited information on short- to medium-term outcome (mortality, low cardiac output syndrome, duration of mechanical ventilation, length of stay in the intensive care unit or the hospital), mostly from underpowered studies. No information on long-term outcome, such as neurodevelopmental outcome, is available. MP may provide a small benefit that is easily abolished by patient characteristics, surgical techniques, and perfusion management. The lack of evidence leads to large differences in practice between and within countries, and even within hospitals, so there is a need for adequately powered randomized studies.

Administration of antibiotics to ewes at the beginning of the dry-period

2013 ◽  
Vol 81 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Ioannis G Petridis ◽  
George C Fthenakis
Keyword(s):  
Antimicrobial Agents ◽  
Health Management ◽  
Management Plan ◽  
Antibiotic Administration ◽  
Lactation Period ◽  
Dry Period ◽  
Coagulase Negative Staphylococci ◽  
Intramammary Infections ◽  
Cell Counts ◽  
Increased Risk

The objective of the present paper is to review the significance of administration of antibiotics at the end of a lactation period/beginning of the dry-period in ewes. During the stage of active involution, there is an increased risk of new mastitis cases and recrudescence of subclinical infections that had occurred during the previous lactation period. The main pathogens involved in the so-called ‘dry-period mastitis’ are coagulase-negative staphylococci. The principle of antibiotic administration at the end of a lactation period involves the intramammary infusion of a preparation to both mammary glands of ewes in the flock. Although a variety of products is licensed for administration in ewes, preferably the product for administration should be selected on the results of susceptibility testing of bacteria to be isolated from samples from ewes in the flock. In many clinical studies from around the world, performed in dairy- or mutton-production flocks, administration of antimicrobial agents at the end of a lactation period has been found beneficial in curing intramammary infections present at cessation of a lactation period, as well as in minimising the risk for intramammary infections during the dry-period. In dairy flocks, there are also benefits from increase in milk yield and decrease flock bulk milk mean somatic cell counts during the subsequent lactation period. Antibiotic administration at drying-off may be performed to all animals in a flock (‘complete’) or only to those considered to be infected (‘selective’). In all cases, after administration of the antibiotic, definite and complete cessation of the lactation period is essential for success of the procedure. Moreover, maintenance of the prescribed withdrawal periods is essential to safeguard public health. The procedure should always be applied as part of a strategic udder health management plan in a flock; implementation improves the welfare of animals and affords significant financial benefits to the farmer. A mastitis prevention scheme during lactation will minimise the incidence of the disease; effective treatment of cases of the disease during lactation will decrease the bacterial populations in the flock and limit risk of infection of other animals. Administration of antibiotics at the end of a lactation period will complement the above procedures and will contribute to improved mammary health for the forthcoming lactation period.

scholarly journals Cardiac myxoma: The influence of surgical technique on long-term prognosis

2012 ◽  
Vol 64 (1) ◽  
pp. 1-6
Author(s):  
A. Mikic ◽  
P. Djukic ◽  
Biljana Obrenovic-Kircanski ◽  
Z. Gluvic ◽  
S. Putnik ◽  
...  
Keyword(s):  
Left Atrial ◽  
Cardiac Myxoma ◽  
Surgical Techniques ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Functional Improvement ◽  
Aortic Cross Clamp Time ◽  
Left Atrial Myxoma ◽  
Right Atrial Myxoma ◽  
Long Term Prognosis

The aim of our study was to analyze the influence of different surgical techniques (left atriotomy, right atriotomy, biatrial approach and tumor basis solving) on early and late outcomes of patients operated on for cardiac myxoma. We evaluated 74 patients operated on for cardiac myxoma from 1982 through 2011. Sixty-six patients (89.19%) had left atrial myxoma and 8 (10.81%) right atrial myxoma. Histopathologic examination confirmed the diagnosis of atrial myxoma in all patients. In analyzing different surgical techniques we found that they had no influence on the duration of extracorporeal circulation and aortic cross-clamp time. Mortality analysis revealed: no intraoperative mortality; early mortality in 2 patients; late mortality in 12 patients. Survival after 29 years was 81.08%. There were no myxoma recurrences. 83.78% of the patients had functional improvement. In our opinion the best approach for right atrial myxoma is through right atriotomy, for left atrial myxoma through left atriotomy, with a biatrial approach for large tumors of the left atrium or when exploration of all 4 chambers is necessary. Subendocardial excision or thermocauterization was used for small tumors with bases less than 5 mm. Myxoma with a wider basis, depending on the localization, were partially resected at the atrial septum in the whole thickness or subendocardial excision of the tumor basis.

scholarly journals Management of necrotizing pancreatitis and its outcome in a secondary healthcare institution

2017 ◽  
Vol 4 (3) ◽  
pp. 1049 ◽  
Author(s):  
Tanweer Karim ◽  
Vinod Kumar ◽  
Vivek Kumar Katiyar ◽  
Subhash K.
Keyword(s):  
Clinical Judgment ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Operating Time ◽  
Surgical Techniques ◽  
Infected Pancreatic Necrosis ◽  
Minimal Access ◽  
Significant Difference ◽  
Surgical Conditions ◽  
Laparoscopic Techniques

Background: Surgical debridement is the “gold standard” for infected pancreatic necrosis. Advances in imaging methods and minimal access techniques have changed the management of many surgical conditions and even infected pancreatic necrosis has successfully been treated in selected patients. However, technical advances don’t obviate sound clinical judgment. Aim was to consider recent advances in minimal access surgery, this article retrospectively analyses the role of open surgery and laparoscopic techniques in the management of necrotizing pancreatitis.Methods: A retrospective study of 30 cases of pancreatic necrosectomy admitted and managed during 2012-2016 was carried out and compared with results available in the existing literature.Results: Out of 30 cases, 20 were men and 10 were women. Patients' age ranged from 23 to 70 years (mean age - 49.8 years). The mean operating time was 103.8 min (range, 60-120 min). Timing of necrosectomy was 21-32 days (average - 25.5 days). The average duration of hospital stay after the procedure was 17.4 days (range, 10-21 days).Conclusions: Comparative analysis of results of different surgical techniques reveals that there is no significant difference in terms of mortality. However, overall rate of complications and failure (inadequate debridement and drainage) are still higher with minimally invasive techniques.

scholarly journals SMART CLASS;

2019 ◽  
Vol 26 (02) ◽  
Author(s):  
Imran Ali Shaikh ◽  
Naila Masood ◽  
Khalida Shaikh
Keyword(s):  
Data Collection ◽  
Observational Study ◽  
Clinical Judgment ◽  
Management Plan ◽  
Health Sciences ◽  
University Hospital ◽  
Medical Unit ◽  
Study Methodology ◽  
Convenience Sampling ◽  
Judgment Data

Objectives: To apply SMART class in ward posting of final year MBBS. Setting: Ward 6 medical unit 4 Liaquat university hospital Jamshoro Sindh. Duration of Study: May 2014 to November 2016. Study Design: Observational study. Methodology: 255 students of final year M. B. B. S. of Liaquat University of medical and health sciences Jamshoro Sindh, Pakistan were selected by convenience sampling for this study. All students were assessed for clinical judgment. Data collection tools included a 4 items assessment. The assessment was categorized in 4 grades;1-clinical judgment done independently, 2-partially got supervision for clinical judgment, 3-full supervised , 4-unable to perform any clinical judgment. Results: 255 students from three batches of final year MBBS assessed by 4 grades of performance. Out of which 39 % students were done patient judgment independently, 41.4% were partially or fully supervised, while 19.6% were unable to judge patient clinically. Conclusion: Smart class is better methods for interacting, clinical judgment and management plan for final year MBBS students.

scholarly journals Interventricular septal rupture after myocardial infarction despite early percutaneous coronary intervention

2011 ◽  
Vol 1 (3) ◽  
pp. 63
Author(s):  
Davran Cicek ◽  
Seher Gokay ◽  
Tonguc Saba ◽  
Ismail Sapmaz ◽  
Haldun Muderrisoglu
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Coronary Intervention ◽  
Anterior Myocardial Infarction ◽  
Hemodynamic Compromise ◽  
Percutaneous Coronary ◽  
Long Term Prognosis ◽  
Early Primary

Ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) is a serious clinical problem with high mortality rate due to cardiogenic shock or prolonged hemodynamic compromise. Despite multiple improvements in medical, interventional and surgical techniques, early and long-term prognosis after AMI related VSR still remain unpromising. We report a patient in whom an acute VSR was diagnosed 7 days after an anterior myocardial infarction treated with early primary percutaneous coronary intervention (pPCI).

scholarly journals Surgical Techniques for operating on Large Adherent Cervical Nodal Metastases from Thyroid Cancer causing Severe Neck Pain and Compression Effects and encasing Major Vessels

2016 ◽  
Vol 8 (3) ◽  
pp. 217-219
Author(s):  
Kul R Singh ◽  
Chanchal Rana
Keyword(s):  
Thyroid Cancer ◽  
Carotid Artery ◽  
Neck Pain ◽  
Surgical Planning ◽  
Surgical Techniques ◽  
Nodal Metastases ◽  
Carotid Sheath ◽  
Road Map ◽  
Adjacent Structures ◽  
Compression Effects

ABSTRACT Aim We aim to refine and define surgical techniques for doing difficult adherent bulky cervical nodal metastases from thyroid cancer to help surgeons do dissections with better curability and lesser morbidity. Background Patients with thyroid cancer with large nodal metastases presenting with severe neck pain due to compression effects and encasing carotid artery and other major vessels pose a challenge to surgeons to do complete resections while preserving important structures in the neck. Materials and methods We define surgical planning and road map to dissect difficult bulky adherent cervical nodes encasing carotid artery and jugular vein by splaying the plane over carotid sheath by doing adventitial level dissection and dissecting medial and lateral to carotid sheath the large nodal mass adherent to adjacent structures preserving the major vessels and nerve plexus. Conclusion By appropriate surgical planning and meticulous dissection techniques, we can do major neck dissections with complete resections and same time preserving important structures in the neck minimizing morbidity. Clinical significance: By doing neck dissections with complete oncological resections and saving vital structures in the neck, we aim to offer best possible chance of cure to the patient along with reduced morbidity at same time. How to cite this article Ramakant P, Singh KR, Rana C, Mishra AK. Surgical Techniques for operating on Large Adherent Cervical Nodal Metastases from Thyroid Cancer causing Severe Neck Pain and Compression Effects and encasing Major Vessels. World J Endoc Surg 2016;8(3):217-219.

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