CROHN’S DISEASE IN CHILDREN: THE CURRENT STATE OF THE PROBLEM

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

Local and Systemic Complications of Local Testosterone Patches and Gels

In recent decades, testosterone therapy has gained the attention of many researchers due to the increased demand for this modality worldwide, the increased average age of the different populations, and increased awareness of the potential uses of the modality in clinical settings. Using testosterone therapy aims to treat erectile dysfunction, libido disorders, and potentially enhance physical strength and general body functions. It should be noted that the administration of this treatment modality has been reported with various adverse outcomes despite the remarkable efficacy and wide rates of administration among the different populations. In the present literature review, we have discussed the potential local and systemic complications of applying local testosterone patches and gel. The main advesre events that were reported for both formulas have been skin reactions at the site of application. However, these reactions are not usually serious, and only a few patients discontinued the therapy due to these reactions. In general, evidence indicates that the exogenous administration of testosterone has been associated with many systemic complications as cardiovascular diseases, prostate cancer, obstructive sleep apnea, and elevated hematocrite value. However, evidence regarding this association is still controversial, and additional studies are needed for verfication.

EP.FRI.537 Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in Clinical Practice or lack of guidelines

Aims Acute cutaneous abscess is a common surgical condition which mostly require incision and drainage. Despite this, there is no standardised national or international guidance on the post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice of the post-operative antibiotics prescription for cutaneous abscesses in a University teaching hospital in London. Methods A retrospective data collection of emergency general surgical admissions for a period of six months from July to December 2020 was carried out. All patients with superficial skin abscess were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients’ demographics, Co-morbidities, local and systemic complications were studied. Results A total of 149 patients presented during this period. Mean age was 40 (54% were male). Most common site of abscess was perianal (24%), followed by pilonidal, axilla, back, gluteal, neck, abdominal wall and groin. At total of 108 (72.5%) were managed surgically with incision and drainage, 70 (65%) got antibiotics and only 23 (33%) had indications for it (i.e. diabetic, immunocompromised, sepsis, cellulitis, MRSA carriage) = (χ2[1] =22.03, p<.0001). Co-amoxiclav was the most common post-operative empirical antibiotic prescribed in 61% of the patients. Conclusions This study has identified significant variation in clinical practice regarding post-operative antibiotic usage in superficial abscesses. Further research is required in cooperation with microbiologists to develop standardised evidence-based treatment protocol for management of such common surgical condition.

EP.FRI.535 A clinical audit of post-operative antibiotics prescription in uncomplicated perianal abscesses

Aims Management of perianal abscesses continues to revolve around prompt surgical drainage. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines state that all patients should have incision and drainage within 24 hours and antibiotics are not indicated in routine uncomplicated perianal abscesses. We aimed to study the antibiotics prescription after surgical drainage in a London university teaching hospital against the national standard. Methods A single-centred retrospective analysis of all emergency surgical admissions for incision and drainage of perianal abscess was carried out for a 6 month period. Patients’ demographics, Co-morbidities, local and systemic complications and readmissions were studied. Results A total of 36 patients, (mean age 43, 64% males) were included in this study, 21 received incision and drainage without antibiotics prescription, while 15 received empirical post-operative antibiotics. Indications for antibiotic therapy in this group included diabetes, immunocompromise, local complications (necrosis, cellulitis) and recurrence. There was no clear indication for antibiotics in 60% of patients who received them. 86% of patients had surgical drainage within 24 hours of presentation. One patient was readmitted for a second drainage 3 months later. Most common empirical agent used was co-amoxiclav (53%), followed by (33%) combination of co-amoxiclav and metronidazole. Conclusion Although surgical drainage was generally carried out in timely manner according to guidance, there was excessive post-operative antibiotic prescriptions. Increase awareness of guidelines is required to improve antibiotic stewardship in these surgical patients in order to avoid unnecessary drugs’ prescription.

The open abdomen

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

Periprosthetic fractures in the hip joint – own study by the Department of Orthopedics and Traumatology in Kalisz

Every year, the number of total hip replacement treatments increases and along with it, so does the number of local and systemic complications, including periprosthetic fractures. These fractures usually occur among elderly people with deteriorated bone quality and other general and neurological disorders. Treatment of periprosthetic femoral fractures imposes a difficult and complex medical problem, which requires adequate experience and a rational combination of traumatological and orthopedical knowledge from the surgeon. In this article we review management of periprosthetic femoral fractures in the Department of Orthopedics and Traumatology in Kalisz.

Complications, readmission and reoperation rates in one-stage bilateral versus unilateral total hip arthroplasty: a high-volume single center case–control study

The study aimed to assess the safety of one-stage bilateral total hip arthroplasty (THA) compared with unilateral THA. In this retrospective observational case–control study were included patients undergoing unilateral (group 1) and one-stage bilateral (group 2) THA in a high-volume center. The groups were matched for gender, age at surgery, and pre-operative American Society of Anesthesiology score. The following variables were assessed: local and systemic complications, postoperative anemia, 30-day and 1-year readmission and reoperation rates, length of hospital stay, and ambulation time. Group 1 reported a significantly higher rate of local and systemic complications compared with group 2 (5.4% versus 3.9% and 29.6% versus 4.7%, respectively). Postoperative anemia was significantly lower in group 1 compared with group 2 (8.1% versus 30%). There was no significant difference in terms of 30-day and 1-year readmission rates between the two groups. The average length of hospital stay was 5.1 ± 2.3 days in group 1, and 5.3 ± 1.9 days in group 2 (p = 0.78). Ambulation time was significantly lower for group 1 (day 0.9 ± 0.9 in group 1, and day 1 ± 0.8 in group 2, p = 0.03). In a high-volume center, one-stage bilateral THA is a safe procedure compared with unilateral THA in terms of postoperative local and systemic complications, 30-day readmission and 1-year reoperation rates, and length of hospital stay.

Piomiosite del cingolo scapolare con focolai polmonari multipli e sepsi da MRSA

The paper describes the case of a 14-year-old girl with intense right shoulder pain and severe signs of local and systemic inflammation. Magnetic resonance imaging revealed a pyomyositis of right shoulder girdle muscles. Blood culture was found positive for methicillin-resistant Staphylococcus aureus (MRSA) and the chest computed tomography scan revealed nodular infiltrates in both pulmonary fields resulting from septic embolism. A prolonged antibiotic therapy according to antibiogram allowed the complete recovery. Pyomyositis is a deep pyogenic infection of the skeletal muscle tissue and is most commonly caused by Staphylococcus aureus species. In the described case, repetitive trauma due to karate may have caused the initial muscle cell damage with subsequent haematoma, which subsequently becomes colonised by bacteria during a transient bacteraemia. There is an increasing prevalence of pyomyositis in temperate climates and in the last few years MRSA has emerged as a pathogen within the community (CA-MRSA) also in healthy people. An early diagnosis is important to avoid local and systemic complications.

Methicillin Resistant Staphylococcus Aureus Shoulder Pyomyositis with Multifocal Lung Infiltrations

Pyomyositis is a rare condition in temperate climates. We present a case of Methicillin Resistant Staphylococcus aureus pyomyositis of the shoulder complicated by multifocal lung infiltrations, treated successfully with antibiotic therapy. After excluding shoulder septic arthritis, a low threshold of suspicion for the diagnosis of shoulder pyomyositis should be applied to patients with persistent fever, pain, and decreased range of shoulder motion. A prompt diagnosis and a rapid rise in antibiotic therapy are important to avoid local and systemic complications.