Peritonsillar Abscess Treatment under Local Anaesthesia: Incision and Drainage versus Needle Aspiration

Background: Peritonsillar abscess is usually complication of acute tonsillitis which itself is prevalent in society. As a general surgical principle, abscess any were, has to be drained so same applies for quinsy but methodology for this drainage is not being agreed. Aim: To find best modality for drainage of this abscess and see its incidence in which age group and sex. Study design: Prospective study Place and duration of the study: Department of ENT, Rai Medical College, Sargodha from 1st Feb. 2017 to 31st Jan. 2019. Methodology: One hundred and thirty five patients above 15 years of age and those in need of hospital admission due to severity of symptoms were included. Paediatric, immunocompromised, requiring general anesthesia and acute tonsillitis patients were excluded. Results: There were 65.2% males and 34.8% females. Commonly affected age group was 21-40 years. Needle aspiration was found more effective for management of peritonsillar abscess. Conclusion: No consensus for single modality and both needle aspiration and incision/drainage is advocated and needle aspiration proved fruitful in management. Keywords: Quinsy, Peritonsillar abscess, needle aspiration

Facial Abscess due to Staphylococcus aureus in Patient with Type 2 Diabetes Mellitus: Case Report

Diabetes mellitus (DM) is a chronic disease with an increasing frequency over the last decade. DM patient has higher risk of infection than people without diabetes. Several literatures suggest a strong positive correlation between hyperglycemia and skin infections. Skin and soft tissue infections (SSTIs), including abscess which commonly caused by Staphylococcus aureus, could lead to severe and life-threatening infections. The correct diagnosis and effective management therapy should be needed to prevent further complications and reduce morbidity and mortality. We report a case about facial abscess caused by S. aureus in diabetic patient that healed after got incision drainage and antibiotics.

Arrodált gyomorgyűrűk kezelése – irodalmi áttekintés egy eset kapcsán

Összefoglaló. Bevezetés: 70 éves férfi beteg kóros kövérség (BMI: 50,1) miatt 2005-ben gyomorgyűrű beültetésben részesült. 2020 decemberében hasfali phlegmone hátterében igazolt port infekció miatt más intézetben subcutan incisió, lavage történt. CT-vizsgálattal, majd gasztroszkóppal a gyomorgyűrű arrosióját, intramurális elhelyezkedését igazoltuk. A műtét során laparoszkópos technikával a gyomor corpus nagygörbületén ejtett, kb. 2 cm nagyságú nyíláson keresztül távolítottuk el a gyűrűt. A beteg szövődménymentesen került emisszióra. Megbeszélés: Mintegy 20 évvel ezelőtt a laparoszkópos állítható gyomorgyűrű (LAGB) rendkívül népszerű volt. A LAGB azonban számtalan rövid és hosszú távú szövődménnyel jár, ezért egyre inkább kikerül a bariátriai sebészet tárházából. A gyűrű arrosiója ritka, súlyos szövődmény. Eltávolításának többféle módja lehet. A gyomorgyűrű eltávolítása általában a testsúly jelentős növekedésével jár. A betegeknél konverziós bariátriai műtétet, laparoszkópos gyomor sleeve reszekciót, vagy gyomor bypass műtétet lehet végezni. Summary. Introduction: Extreme obese (BMI: 50.1) 70 year old male patient after LAGB procedure in 2005, with abdominal wall and port infection underwent subcutaneous incision drainage of the area in December 2020. CT and Gastroscopy confirmed gastric penetration and intramural position of the Band. Using laparoscopic approach with incision of 2 cm of the stomach at the gastric greater curvature the band had been removed. Patient had been discharged without any complications. Discussion: LAGB was a very popular bariatric approach at the first decade of laparoscopic bariatric surgery. The increased incidence of short and long term complications reduced worldwide the number of LAGB procedures. Band penetration is a rare but dangerous complication. Laparoscopic removal is recommended. Usually, the intervention is followed by significant weight gain which can be treated with conversion of LAGB to Sleeve Gastrectomy or LGBP procedure.

Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”

Objectives Defects in human cognition commonly result in clinical reasoning failures that can lead to diagnostic errors. Case presentation A 43-year-old female was brought to the emergency department with 4–5 days of confusion, disequilibrium resulting in several falls, and hallucinations. Further investigation revealed tachycardia, diaphoresis, mydriatic pupils, incomprehensible speech and she was seen picking at the air. Given multiple recent medication changes, there was initial concern for serotonin syndrome vs. an anticholinergic toxidrome. She then developed a fever, marked leukocytosis, and worsening encephalopathy. She underwent lumbar puncture and aspiration of an identified left ankle effusion. Methicillin sensitive staph aureus (MSSA) grew from blood, joint, and cerebrospinal fluid cultures within 18 h. She improved with antibiotics and incision, drainage, and washout of her ankle by orthopedic surgery. Conclusions Through integrated commentary on the diagnostic reasoning process from clinical reasoning experts, this case underscores how multiple cognitive biases can cascade sequentially, skewing clinical reasoning toward erroneous conclusions and driving potentially inappropriate testing and treatment. A fishbone diagram is provided to visually demonstrate the major factors that contributed to the diagnostic error. A case discussant describes the importance of structured reflection, a tool to promote metacognitive analysis, and the application of knowledge organization tools such as illness scripts to navigate these cognitive biases.

Compare the Outcome of Percutaneous Aspiration with Incision Drainage for Management of Breast Abscess

Objective: The aim of this study is to compare the outcome of percutaneous aspiration with incision drainage for management of breast abscess. Study Design: Comparative Study Place and Duration: The study was conducted at Surgery departments of Lady Reading hospital, Peshawar during the period of six months from August 2020 to January 2021. Methods: Total 110 women were presented in this study. Patients were aged between 20-45 years. Patients’ detailed demographics including age, weight, height and body mass index were recorded after taking informed written consent. Women had breast abscess were included. Patients were equally divided into two groups, I and II. Group I had 55 patients and received percutaneous aspiration while in group II 55 patients were underwent for incision drainage. Outcomes among both groups were compared in terms of early restoration of breast feeding, pain score by using VAS and time of healing. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 30.11±8.56 years with mean BMI 26.9±3.77 kg/m2 while mean age in group II was 29.17±9.44 years with mean BMI 26.08±3.27 kg/m2. Mean weight of patients in group I was 72.19±17.44 kg and in group II mean weight was 74.35±19.78 kg. Mean height in group I was 154.12±9.55 cm and in group II was 156.08±8.71 cm. Restoration of breast feeding among group I was 47 (85.45%) and in group II 32 (58.2%) patients restored breast feeding. Satisfaction among patients in group I was higher than that of 45 (81.82%) as compared to group II 31 (56.4%). Conclusion: We concluded in this study that percutaneous aspiration in breast abscess was successful and affective as compared to incision drainage with less complications and high satisfaction rate among the women. Keywords: Breast abscess, Percutaneous aspiration, Incision drainage,

Compare the Outcome of Percutaneous Aspiration with Incisional Drainage for Management of Breast Abscess

Objective: To compare the outcome of percutaneous aspiration with incision drainage for management of breast abscess. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit-1, Sandeman Provincial Hospital Quetta from 1st October 2020 to 31st March 2021. Methodology: One hundred and ten women age aged between 18-65 years of age were enrolled. Patients details demographics age, weight, height and body mass index were recorded after taking informed written consent. Women had breast abscess were included. Patients were equally divided into two groups, I and II. Group I had 55 patients and received percutaneous aspiration while in group II had 55 patients underwent for incision drainage. Results: Mean age of the patients in group I was 30.11±8.56 years with mean BMI 27.9±18.77kg/m2 while mean age in group II was29.17±9.44 years with mean BMI 28.9±55.27kg/m2. Mean weight of patients in group I was 72.19±17.44 kg and in group II mean weight was 74.35+19.78 kg. Mean height in group I was 154.12±9.55 cm and in group II was 156.08+8.71 cm. Restoration of breast feeding among group I was 47 (85.45%) and in group II 32 (58.2%) patients restored breast feeding. Satisfaction among patients in group I was higher than that of 45 (81.82%) as compared to group II, 31 (56.4%). Conclusion: Percutaneous aspiration in breast abscess was successful and affective as compared to incision drainage with less complications and high satisfaction rate among the women. Keywords: Breast abscess, percutaneous aspiration, Incision drainage

Case Report Series: Clinical Analysis of Severe Deep Neck Space Infection

BackgroundSevere deep neck space infection is rare and critical.The objective is to deepen the understanding of severe deep neck space infection and improve the level of clinical diagnosis and treatment. Case presentationA retrospective analysis of the diagnosis and treatment of 5 cases of serious deep neck infections admitted to our department. The 5 patients were all diagnosed by cervical CT and surgical exploration. 3 patients with diabetes, 2 patients with diabetic ketoacidosis, 3 patients with mediastinal infection; 3 patients underwent tracheotomy and 2 patients with tracheal intubation; All patients were treated by neck incision, drainage, dressing change and targeted antibiotics. ConclusionsSevere deep neck infections are prone to occur in patients with diabetes and other systemic basic diseases. Early diagnosis, timely neck incision exploration, drainage to maintain airway patency and targeted antibiotic treatment are the keys to diagnosis and treatment.

Post-traumatic Late Presentation of Morel–Lavallée: Case Report and Review of Literature

Introduction: Morel–Lavallée (MLL) is an uncommon entity that is missed by many physicians, it is the result of a shearing force that leads to degloving of the subcutaneous fat from the underlying deep fascia. Case Report: We present a case of a 15-year-old male patient who presented 3 months after the initial crush injury with a large MLL lesion at the lateral aspect of the right proximal thigh. He was treated with incision and drainage with compressive dressing and a negative pressure drain. Conclusion: Diagnosis of MLL is usually clinical and can be aided with radiological tools like MRI that is the gold standard of imaging in this lesion. Several treatment options are available, ranging from conservative treatment with compressive bandages to percutaneous drainage, injection of sclerotic agents, and surgical treatment with incision, drainage, and debridement. Diagnosis and treatment should be familiar to all caregivers to prevent further complications that could be life or organ-threatening. Keywords: Morel–Lavallée, thigh trauma, chronic Morel–Lavallée, thigh mass.