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Management of surgical site infection

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https://www.readbyqxmd.com/read/29649397/management-of-a-cancer-patient-with-an-intrathecal-drug-delivery-system-and-an-acute-brain-abscess
#1
David R Walega, Marc Korn
Surgical-site infection, spinal cord abscess, and catheter tip granuloma are known but rare complications of intrathecal drug delivery systems (IDDS). To date, there are no published cases of brain abscess in a patient with an IDDS. In this study, we report a case of a cancer patient with an IDDS for management of cancer pain who developed a brain abscess with profound mental status changes and clinical management challenges.
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649026/evidence-review-conducted-for-the-agency-for-healthcare-research-and-quality-safety-program-for-improving-surgical-care-and-recovery-focus-on-anesthesiology-for-colorectal-surgery
#2
Kristen A Ban, Melinda M Gibbons, Clifford Y Ko, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Michael C Grant, Christopher L Wu
The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29627850/clinical-outcomes-with-the-corticotomy-first-technique-associated-with-the-ilizarov-method-for-the-management-of-the-septic-long-bones-non-union
#3
Gamal Ahmed Hosny, Abdel-Salam Abdel-Aleem Ahmed, Mohamed Abd-Elaal Hussein
PURPOSE: Corticotomy is an integral part of the Ilizarov method on management of infected nonunited fractures that are challenging orthopaedic surgeons. However, the presence of active draining sinuses may contaminate the operative field with the potential of developing corticotomy site infection. The authors present a surgical technique aiming at minimizing or avoiding the risk of surgical site infection (SSI) in the corticotomy zone. PATIENTS AND METHODS: A total of 144 cases of draining infected nonunions were treated by Ilizarov fixator using the corticotomy-first technique...
April 7, 2018: International Orthopaedics
https://www.readbyqxmd.com/read/29626286/multidetector-ct-of-expected-findings-and-complications-after-hysterectomy
#4
REVIEW
Massimo Tonolini
Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal impairment and malpractice claims...
April 6, 2018: Insights Into Imaging
https://www.readbyqxmd.com/read/29623470/laparoscopy-in-management-of-appendicitis-in-high-middle-and-low-income-countries-a-multicenter-prospective-cohort-study
#5
(no author information available yet)
BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study...
April 5, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29620609/the-use-of-closed-incision-negative-pressure-wound-therapy-in-orthopaedic-surgery
#6
Denis Nam, Robert A Sershon, Brett R Levine, Craig J Della Valle
Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a decade ago, and the benefits of this treatment modality include wound contraction with diminished tensile forces, stabilization of the wound environment, decreased edema and improved removal of exudate, and increased blood and lymphatic flow...
April 3, 2018: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29618877/infection-alveolar-osteitis-and-adverse-effects-using-metronidazole-in-healthy-patients-undergoing-third-molar-surgery-a-meta-analysis
#7
REVIEW
Mario Alberto Isiordia-Espinoza, Othoniel H Aragon-Martinez, Ronell E Bollogna-Molina, Ángel J Alonso-Castro
Purpose: The aim of this systematic review and meta-analysis was to evaluate the risk of surgical infection, alveolar osteitis, and adverse effects using systemic metronidazole in comparison with placebo in healthy patients undergoing third molar surgery. Materials and Methods: The eligible reports were identified from diverse science sources. Clinical trials meeting the inclusion and exclusion criteria and an acceptable Oxford Quality Score were included in this study...
June 2018: Journal of Maxillofacial and Oral Surgery
https://www.readbyqxmd.com/read/29613955/influence-of-postoperative-hepatic-angiography-on-mortality-after-laparotomy-in-grade-iv-v-hepatic-injuries
#8
Shokei Matsumoto, Emily Cantrell, Kyoungwon Jung, Alan Smith, Raul Coimbra
BACKGROUND: Mortality rate for severe liver injuries remains high. As an adjunct to surgery, postoperative hepatic angiography (PHA) may have a positive impact on outcomes. This study sought to compare outcomes following surgical management of severe liver injuries with and without PHA using propensity score matching analysis. METHODS: Data from the National Trauma Data Bank from 2007 - 2014 was analyzed. The study population consisted of patients greater than 18 years of age sustaining severe liver injuries (ie AAST-OIS grade IV or V) who underwent surgery...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29596598/a-survey-of-practice-and-opinions-on-the-use-of-topical-antibiotics-to-prevent-surgical-site-infection-more-confusion-than-consensus
#9
Charlotte Cooper, Carolyne Horner, Gavin Barlow, Jan Stryja, Kylie Sandy-Hodgetts, Tracey Guise, Hilary Humphreys
Background: Surgical site infection (SSI) is one of the most common causes of healthcare-associated infection. Although the use of topical antibiotics to prevent SSI is not recommended by current guidelines, published studies document conflicting results and conclusions. Objectives: The objectives of this survey were to: (i) determine the extent of the use of topical antibiotics to prevent SSI in clinical practice; and (ii) gather the opinions of healthcare professionals most likely to be involved in their use...
March 27, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29595725/plastic-surgery-complications-from-medical-tourism-treated-in-a-u-s-academic-medical-center
#10
Kimberly M Ross, Andrea V Moscoso, Lauren R Bayer, Liliana Rosselli-Risal, Dennis P Orgill
BACKGROUND: Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. METHODS: A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29595706/large-sliding-inguino-scrotal-hernia-of-the-urinary-bladder-a-case-report-and-literature-review
#11
Ping Wang, Yonggang Huang, Jing Ye, Guodong Gao, Fangjie Zhang, Hao Wu
RATIONALE: Sliding inguinal hernias of the urinary bladder are protrusions of the bladder through the internal inguinal ring, most of which are insignificant and diagnosed intra-operatively. Large inguino-scrotal bladder hernias commonly present with lower urinary tract symptoms and may cause severe complications, including bladder incarceration or necrosis, bladder hemorrhage, obstructive or neurogenic bladder dysfunction, and even renal failure. PATIENT CONCERNS: We describe and discuss the clinical findings and management of a 59-year-old man who complained of a decrease in scrotal size after voiding and 2-stage voiding requiring pressure to the scrotum...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29589116/early-closure-of-defunctioning-loop-ileostomy-is-it-beneficial-for-the-patient-a-meta-analysis
#12
REVIEW
Benjamin Menahem, Jean Lubrano, Antoine Vallois, Arnaud Alves
OBJECTIVE: To perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity. DESIGN: Medline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as ≤14 days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery...
March 27, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29587603/fractures-at-the-junction-of-diaphysis-and-metaphysis-of-the-proximal-phalanges-in-adults
#13
David J Shewring, Ryan W Trickett, Adam Smith
We describe the treatment of 101 patients with 113 fractures of the proximal phalanx at the junction of the diaphysis with the proximal metaphysis. Fractures were stabilized using a single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the base of the phalanx base and across the fracture to engage the lateral cortex. Patients were treated semi-electively on a day surgery unit. The metacarpophalangeal joint was splinted in flexion with mobilization of the proximal inter-phalangeal joints, until the wire was removed at 24 days and the hand then freely mobilized...
January 1, 2018: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/29578875/strategies-for-the-prevention-and-treatment-of-surgical-site-infection-in-the-lumbar-spine
#14
Joseph S Butler, Scott C Wagner, Patrick B Morrissey, Ian D Kaye, Arjun S Sebastian, Gregory D Schroeder, Kristen Radcliff, Alexander R Vaccaro
Surgical site infection (SSI) following spine surgery can be devastating for both the patient and the surgeon. It leads to significant morbidity and associated health care costs, from readmissions, reoperations, and subsequent poor clinical outcomes. Complications associated with SSI following spine surgery include pseudarthrosis, neurological deterioration, sepsis, and death. Its management can be very challenging. The diagnosis of SSI involves the interpretation of combined clinical, laboratory, and occasionally radiologic findings...
March 23, 2018: Clinical Spine Surgery
https://www.readbyqxmd.com/read/29564375/a-nonsurgical-protocol-for-management-of-postarthroplasty-wound-drainage
#15
Michael S Reich, Kace A Ezzet
Persistent wound drainage after total joint arthroplasty can potentiate periprosthetic joint infection. Although current recommendations are to treat persistent wound drainage with surgical debridement, we believe nonoperative treatment may be successful in selected patients. We performed a retrospective analysis of 25 persistently draining hip and knee arthroplasty wounds treated with a protocol consisting of a combination of surgical site aspiration, closure of open wound edges, cessation of anticoagulants, activity modification, and antibiotics (in select patients)...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29561679/selecting-appropriate-postoperative-dressings-to-support-wound-healing-and-reduce-surgical-site-infection
#16
Melanie Lumbers
The appropriate choice of postoperative dressing supports effective wound healing by providing a moist wound environment and reducing the risk of surgical site infection and blistering. Wound management is complex and practitioners need to consider the location of the wound, method of wound closure, expected exudate level and length of time the dressing needs to remain in place when selecting a product. The correct dressing selection will have a positive impact wound healing and the patient's quality of life...
March 22, 2018: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/29557862/does-vancomycin-powder-decrease-surgical-site-infections-in-growing-spine-surgery-a-preliminary-study
#17
George H Thompson, Connie Poe-Kochert, Christina K Hardesty, Jochen Son-Hing, R Justin Mistovich
BACKGROUND: Vancomycin powder has been demonstrated to be safe in children, and yet there are no data on its use to reduce surgical site infections (SSIs) in surgery for early-onset scoliosis. METHODS: We performed a retrospective study of our patients treated for early-onset scoliosis in the period of 2010 to 2016. In 2010, we updated our standardized perioperative growing spine care path. The only later change was the gradual introduction of intrawound vancomycin powder...
March 21, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29554316/concurrent-placement-of-bilateral-suboccipital-and-supraorbital-nerve-stimulators-using-on-q-tunneler-technical-note
#18
Lara Massie, Rushna Ali, Konstantin V Slavin, Jason M Schwalb
BACKGROUND: Stimulation of the occipital and supraorbital nerves is used to treat chronic migraine refractory to medical management. Placement of cranial leads is often challenging due to the rigid Touhy needle included in the kit for its placement. OBJECTIVE: To report the first case of concurrent placement of bilateral supraorbital (SNS) and occipital nerve stimulators (ONS) from a unilateral approach using the On-Q* Tunneler, (Halyard Health, Alpharetta, Georgia) a flexible, blunt tipped plastic tunneler with a tear-away sheath...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29537981/hyperinsulinemic-normoglycemia-during-cardiac-surgery-reduces-a-composite-of-30-day-mortality-and-serious-in-hospital-complications-a-randomized-clinical-trial
#19
Andra E Duncan, Daniel I Sessler, Hiroaki Sato, Tamaki Sato, Keisuke Nakazawa, George Carvalho, Roupen Hatzakorzian, Takumi Codere-Maruyama, Alaa Abd-Elsayed, Somnath Bose, Tamer Said, Maria Mendoza-Cuartas, Hyndhavi Chowdary, Edward J Mascha, Dongsheng Yang, A Marc Gillinov, Thomas Schricker
BACKGROUND: Hyperinsulinemic normoglycemia augments myocardial glucose uptake and utilization. We tested the hypothesis that hyperinsulinemic normoglycemia reduces 30-day mortality and morbidity after cardiac surgery. METHODS: This dual-center, parallel-group, superiority trial randomized cardiac surgical patients between August 2007 and March 2015 at the Cleveland Clinic, Cleveland, Ohio, and Royal Victoria Hospital, Montreal, Canada, to intraoperative glycemic management with (1) hyperinsulinemic normoglycemia, a fixed high-dose insulin and concomitant variable glucose infusion titrated to glucose concentrations of 80 to 110 mg · dl; or (2) standard glycemic management, low-dose insulin infusion targeting glucose greater than 150 mg · dl...
March 14, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29531643/concurrent-umbilical-hernia-repair-at-the-time-of-liver-transplantation-a-six-year-experience-from-a-single-institution
#20
A J Perez, I N Haskins, A S Prabhu, D M Krpata, C Tu, S Rosenblatt, K Hashimoto, T Diago, B Eghtesad, M L J Rosen
Background: Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define. Objective: To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution. Methods: Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016...
2018: International Journal of Organ Transplantation Medicine
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