scholarly journals Conservative management of aortic arch injury following penetrating trauma

2015 ◽  
Vol 97 (3) ◽  
pp. 184-187
Author(s):  
RK Mohammed ◽  
S Cheung ◽  
SP Parikh ◽  
K Asgaria
Keyword(s):  
Aortic Arch ◽  
High Mortality ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Penetrating Trauma ◽  
Standard Of Care ◽  
Mortality Rates ◽  
Penetrating Injury ◽  
Stab Wounds ◽  
Left Chest

Aortic arch injuries following penetrating trauma are typically lethal events with high mortality rates. Traditionally, the standard of care for patients presenting with penetrating injury and aortic involvement has included surgical intervention. We report the case of a 31-year-old man who was managed non-operatively after sustaining multiple stab wounds to the left chest and presenting with mid aortic arch injury.

Diphtheria stenosis

1935 ◽  
Vol 31 (3-4) ◽  
pp. 381-385
Author(s):  
S. A. Egereva
Keyword(s):  
High Mortality ◽  
Surgical Intervention ◽  
Negative Attitude ◽  
Mortality Rates ◽  
Point Of View ◽  
Clinical Material ◽  
Comprehensive Data ◽  
Serum Therapy

Despite the success of serum therapy, laryngeal diphtheria is one of the most serious diseases of childhood and causes high mortality rates. Questions about surgical intervention in cereals, the use of intubation or tracheotomy are still unresolved, despite the numerous and seemingly comprehensive data on the benefits of intubation. The fact that some authors, while expressing their negative attitude towards intubation, do not stop at the assessment of the factual material adds a lot of ambiguity to the resolution of these issues. From this point of view, we did not feel it unnecessary to summarise our clinical material over 4 years.

scholarly journals Conservative management of penetrating abdominal trauma (stab wound)

2019 ◽  
Vol 6 (8) ◽  
pp. 2686
Author(s):  
Magdy Ahmed Loulah ◽  
Asem Fayed Mostafa ◽  
Osama Soliman El-Balky ◽  
Abdel-Rahman Mohamed Mohamed Mohamed El-Meligi
Keyword(s):  
Conservative Management ◽  
Penetrating Trauma ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
A Prospective Study ◽  
Abdominal Stab Wounds ◽  
Abdominal Penetration ◽  
Initial Classification

Background: The aim of the study is to study the reliability of selective conservative management of the penetrating stab abdominal wounds. Trauma is one of the most important reasons of mortality. The mechanism that underlies the penetrating trauma relates to the mode of injury. The early diagnosis of hollow viscus injuries is difficult and a delay in the diagnosis of such injuries may be associated with increased morbidity and mortality. Focused assessment with sonography for trauma (FAST) is an effective for screening and initial classification of stable patients and confirmed by CT scan. The management of stable patients was either surgical exploration or selective non-operative interference with the optimal management of patients is yet to be fully elucidated for abdominal stab wounds (ASW).Methods: A prospective study of 40 patients with penetrating abdominal stab wounds between June 2017 and February 2018, at Damanhour Medical National Institute.Results: The mean age of our patients was 51.9±13.3 years with predominance of males and without predominance of any side to be affected and non-significant deviation from the normal values of hemodynamic signs. The presence of air under diaphragm in X-ray films signify abdominal penetration and ultrasonographic examination (FAST) document the diagnosis and help in following up of cases. Most of hemodynamically stable patients passed conservatively with a little rate of laparotomy.Conclusions: We concluded that there is still a role for conservative management in managing stable cases of penetrating stab abdominal wound. 

scholarly journals An incidental finding of pneumatosis intestinalis: Conservative management without oxygen therapy

2018 ◽  
Vol 4 (2) ◽  
pp. 6
Author(s):  
Ranjeet S. Kalsi ◽  
Benjamin A. Raymond ◽  
Pablo Giuseppucci ◽  
Christopher Esper
Keyword(s):  
Conservative Management ◽  
Oxygen Therapy ◽  
Surgical Intervention ◽  
Incidental Finding ◽  
Oxygen Toxicity ◽  
Pneumatosis Intestinalis ◽  
Standard Of Care ◽  
Supplemental Oxygen ◽  
Antibiotic Administration ◽  
Vascular Compromise

Pneumatosis intestinalis can be identified radiographically incidentally in an asymptomatic patient, or it may be present in its fulminant form with peritonitis. Although multiple mechanisms have been postulated, most believe it arises from mechanical or infectious factors. Respiratory factors have also been described as possible causes for this condition. Clinically, it is important to differentiate among patients whom require surgical intervention from those who would benefit from conservative management, such as hyperbaric oxygen, changes in diet, and/or antibiotic administration. Although supplemental oxygen has become the standard of care for the treatment of benign pneumatosis intestinalis, we question whether all patients require oxygen therapy as a treatment. Although oxygen may be beneficial, the literature suggests there may be detrimental effects from oxygen toxicity and the free radicals formed during hyper-oxygenation. Furthermore, given the rising epidemic of antibiotic resistance and the various toxicities associated with usage of antibiotics, do all patients really require antibiotics? We present a case of a patient with complaints of hematuria, but no other gross abdominal complaints and was incidentally found to have pneumatosis intestinalis and pneumoperitoneum without any evidence of vascular compromise or ischemia. This patient was managed successfully with conservative treatment without oxygen therapy or antibiotics.

Stab Wounds of the Kidney: Conservative Management in Flank Penetration

1983 ◽  
Vol 129 (3) ◽  
pp. 468-470 ◽  
Author(s):  
Alexander S. Bernath ◽  
Heinrich Schutte ◽  
Rafael R.D. Fernandez ◽  
Joseph C. Addonizio
Keyword(s):  
Conservative Management ◽  
Stab Wounds

scholarly journals Antibiotic-Resistant Bacteria in Green Turtle (Chelonia mydas) Rearing Seawater

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1841
Author(s):  
Thanaporn Chuen-Im ◽  
Korapan Sawetsuwannakun ◽  
Pimmnapar Neesanant ◽  
Nakarin Kitkumthorn
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infection ◽  
High Mortality ◽  
Mortality Rates ◽  
Sea Turtle ◽  
Resistant Isolate ◽  
Resistant Bacteria ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant ◽  
Increased Risk

Antibiotic resistance of microorganisms is a serious health problem for both humans and animals. Infection of these bacteria may result in therapy failure, leading to high mortality rates. During an early intervention program process, the Sea Turtle Conservation Center of Thailand (STCCT) has faced high mortality rates due to bacterial infection. Previously, investigation of juvenile turtle carcasses found etiological agents in tissue lesions. Further determination of sea water in the turtle holding tanks revealed a prevalence of these causative agents in water samples, implying association of bacterial isolates in rearing water and infection in captive turtles. In this study, we examined the antibiotic resistance of bacteria in seawater from the turtle holding tank for a management plan of juvenile turtles with bacterial infection. The examination was carried out in three periods: 2015 to 2016, 2018, and 2019. The highest isolate numbers were resistant to beta-lactam, whilst low aminoglycoside resistance rates were observed. No gentamicin-resistant isolate was detected. Seventy-nine isolates (71.17%) were resistant to at least one antibiotic. Consideration of resistant bacterial and antibiotic numbers over three sampling periods indicated increased risk of antibiotic-resistant bacteria to sea turtle health. Essentially, this study emphasizes the importance of antibiotic-resistant bacterial assessment in rearing seawater for sea turtle husbandry.

scholarly journals Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0021
Author(s):  
Mauricio Drummond ◽  
Caroline Ayinon ◽  
Albert Lin ◽  
Robin Dunn
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Ultrasound Guided ◽  
Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

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 Molecular Insights into the Fungus-Specific Serine/Threonine Protein Phosphatase Z1 in Candida albicans

mBio ◽  
2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Emily Chen ◽  
Meng S. Choy ◽  
Katalin Petrényi ◽  
Zoltán Kónya ◽  
Ferenc Erdődi ◽  
...  
Keyword(s):  
Candida Albicans ◽  
High Mortality ◽  
Protein Phosphatase ◽  
Cyclic Peptide ◽  
Fungal Infections ◽  
The United States ◽  
Mortality Rates ◽  
Regulatory Proteins ◽  
Structural Elements ◽  
Novel Targets

ABSTRACT The opportunistic pathogen Candida is one of the most common causes of nosocomial bloodstream infections. Because candidemia is associated with high mortality rates and because the incidences of multidrug-resistant Candida are increasing, efforts to identify novel targets for the development of potent antifungals are warranted. Here, we describe the structure and function of the first member of a family of protein phosphatases that is specific to fungi, protein phosphatase Z1 (PPZ1) from Candida albicans . We show that PPZ1 not only is active but also is as susceptible to inhibition by the cyclic peptide inhibitor microcystin-LR as its most similar human homolog, protein phosphatase 1α (PP1α [GLC7 in the yeast Saccharomyces cerevisiae ]). Unexpectedly, we also discovered that, despite its 66% sequence identity to PP1α, the catalytic domain of PPZ1 contains novel structural elements that are not present in PP1α. We then used activity and pulldown assays to show that these structural differences block a large subset of PP1/GLC7 regulatory proteins from effectively binding PPZ1, demonstrating that PPZ1 does not compete with GLC7 for its regulatory proteins. Equally important, these unique structural elements provide new pockets suitable for the development of PPZ1-specific inhibitors. Together, these studies not only reveal why PPZ1 does not negatively impact GLC7 activity in vivo but also demonstrate that the family of fungus-specific phosphatases—especially PPZ1 from C. albicans —are highly suitable targets for the development of novel drugs that specifically target C. albicans without cross-reacting with human phosphatases. IMPORTANCE Candida albicans is a medically important human pathogen that is the most common cause of fungal infections in humans. In particular, approximately 46,000 cases of health care-associated candidiasis occur each year in the United States. Because these infections are associated with high mortality rates and because multiple species of Candida are becoming increasingly resistant to antifungals, there are increasing efforts to identify novel targets that are essential for C. albicans virulence. Here we use structural and biochemical approaches to elucidate how a member of a fungus-specific family of enzymes, serine/threonine phosphatase PPZ1, functions in C. albicans . We discovered multiple unique features of PPZ1 that explain why it does not cross-react with, and in turn compete for, PP1-specific regulators, a long-standing question in the field. Most importantly, however, these unique features identified PPZ1 as a potential target for the development of novel antifungal therapeutics that will provide new, safe, and potent treatments for candidiasis in humans.

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