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https://www.readbyqxmd.com/read/28629607/post-operative-management-of-perforated-appendicitis-can-clinical-pathways-improve-outcomes
#1
Robert R Gerard, Barrett A Kielhorn, Laurence E McCahill, Brent Petersen, Andrew J Mullard
BACKGROUND: We sought to decrease organ space infection (OSI) following appendectomy for perforated acute appendicitis (PAA) by minimizing variation in clinical management. OBJECTIVE: A postoperative treatment pathway was developed and four recommendations were implemented: 1) clear documentation of post-operative diagnosis, 2) patients with unknown perforation status to be treated as perforated pending definitive diagnosis, 3) antibiotic therapy to be continued post operatively for 4-7 days after SIRS resolution, and 4) judicious use of abdominal computed tomography (CT) scanning prior to post-operative day 5...
June 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28620749/bundles-prevent-surgical-site-infections-after-colorectal-surgery-meta-analysis-and-systematic-review
#2
Aleksander Zywot, Christine S M Lau, H Stephen Fletcher, Subroto Paul
INTRODUCTION: Colorectal surgeries (CRS) have one of the highest rates of surgical site infections (SSIs) with rates 15 to >30%. Prevention "bundles" or sets of evidence-based interventions are structured ways to improve patient outcomes. The aim sof this study is to evaluate CRS SSI prevention bundles, bundle components, and implementation and compliance strategies. METHODS: A meta-analysis of studies with pre- and post-implementation data was conducted to assess the impact of bundles on SSI rates (superficial, deep, and organ/space)...
June 15, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28614043/antibiotics-vs-appendectomy-for-acute-uncomplicated-appendicitis-in-adults-review-of-the-evidence-and-future-directions
#3
Jared M Huston, Lillian S Kao, Phillip K Chang, James M Sanders, Sara Buckman, Charles A Adams, Christine S Cocanour, Sarah E Parli, Julia Grabowski, Jose Diaz, Jeffrey M Tessier, Therese M Duane
BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis. METHODS: Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial...
June 14, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28602900/multi-level-mycotic-aneurysms-due-to-salmonella-infection-case-report-and-review-of-the-literature
#4
E H Pasveer, R G Statius van Eps, J J Wever, H T C Veger
Infected or mycotic aneurysms (MA) of the aorta and adjacent arteries are rare and difficult to treat. We report a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic and iliac pseudoaneurysm during pre-operative work-up. Based on the presented case, we postulate that the agressive nature of Salmonella Enteritidis MA should not be underestimated. If postponed intervention is chosen and the patient is managed conservatively with antibiotic therapy to create a window of definitive diagnosis one should consider close follow-up imaging to observe progression of the pseudo aneurysm...
June 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28579135/urinary-tract-infection-after-voiding-cystourethrogram
#5
E K Johnson, N R Malhotra, R Shannon, D L Jacobson, J Green, C K Rigsby, J L Holl, E Y Cheng
BACKGROUND: Reported rates of post-procedural urinary tract infection (ppUTI) after voiding cystourethrogram (VCUG) are highly variable (0-42%). OBJECTIVE: This study aimed to determine the risk of ppUTI after cystogram, and evaluate predictors of ppUTI. STUDY DESIGN: A retrospective cohort study of children undergoing VCUG or radionuclide cystogram (henceforth 'cystogram') was conducted. Children with neurogenic bladder who underwent cystogram in the operating room and without follow-up at the study institution were excluded...
May 25, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28577723/postoperative-infections-after-limb-sparing-surgery-for-primary-bone-tumors-of-the-pelvis-incidence-characterization-and-functional-impact
#6
REVIEW
M Severyns, S Briand, D Waast, S Touchais, A Hamel, F Gouin
INTRODUCTION: Surgical site infections (SSI) represent the most common postoperative complication after limb sparing surgery for primary malignant bone tumors, with incidence ranging from 10 to 47%. There is no consensus concerning about the optimal surgical strategy, or the adequate antibiotic prophylaxis in pelvic resections. A greater knowledge of these infections and their surgical trajectories seem essential to obtain. MATERIALS AND METHODS: We retrospectively studied 45 cases of pelvic resection, including at least the periacetabular zone 2 of Enneking, performed between 1989 and 2013 in the same center...
June 2017: Surgical Oncology
https://www.readbyqxmd.com/read/28554816/a-pre-operative-clinical-scoring-system-to-distinguish-perforation-risk-with-pediatric-appendicitis
#7
William Bonadio, Syeda Shahid, Lior Vardi, Carly Buckingham, Allison Kornblatt, Chloe Free, Peter Homel
IMPORTANCE: Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present. OBJECTIVE: The objective was to determine efficacy of commonly assessed pre-operative variables in stratifying perforation risk in children with appendicitis. DESIGN: A retrospective analysis of consecutive cases was performed...
May 22, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28552099/bacteriology-and-treatment-of-infections-in-the-upper-and-lower-airways-in-patients-with-primary-ciliary-dyskinesia-adressing-the-paranasal-sinuses
#8
Mikkel Christian Alanin
The respiratory tract is lined with motile cilia that transport respiratory mucus. Primary ciliary dyskinesia (PCD) is a chronic genetic disease caused by mutations in genes responsible for ciliary structure and function. Non-functional airway cilia impair the mucociliary clearance (MCC), causing mucostasis, lung infections and destruction, chronic rhinosinusitis (CRS) and hearing impairment. It is of paramount importance to postpone chronic lung infection mainly with Gram-negative bacteria (GNB) in patients with an impaired MCC...
May 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28529869/septic-arthritis-of-the-shoulder-with-proximal-humerus-osteomyelitis-treated-by-ilizarov-shoulder-arthrodesis
#9
John Kendall, Martin McNally
Septic arthritis of the shoulder can destroy the glenohumeral joint resulting in significant pain, instability and poor function. Surgical treatment is notoriously difficult with significant risk of complications. Shoulder arthrodesis has been performed using both internal and external fixation but has high complication rates in the presence of infection. We present our experience of managing a patient with significant pain and loss of function as a result of septic arthritis of the shoulder following infected proximal humeral fracture fixation with associated proximal humeral osteomyelitis...
2017: Journal of bone and joint infection
https://www.readbyqxmd.com/read/28528282/management-options-in-the-treatment-of-femoral-pseudoaneurysms-secondary-to-intravenous-drug-abuse-a-case-series
#10
James Rammell, Nisheeth Kansal, Vish Bhattacharya
INTRODUCTION: Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28516223/two-stage-revision-hip-arthroplasty-in-periprosthetic-joint-infection-comparison-study-with-or-without-the-use-of-a-spacer
#11
Dariusz Marczak, Marek Synder, Marcin Sibiński, Michał Polguj, Julian Dudka, Jacek Kowalczewski
PURPOSE: The aim of this study was to compare two methods of two-stage surgery for PJI (periprosthetic joint infection) after THA (total hip arthroplasty): one with and one without the use of an antibiotic-loaded cement spacer. METHODS: This retrospective study was performed on 99 consecutive patients (99 hips) with a minimum follow-up of 24 months. Patients were divided into two groups: (1) in whom the operation was performed using a spacer, and (2) for whom a spacer was not used...
May 18, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28507783/periprosthetic-shoulder-infection-an-overview
#12
REVIEW
Nicolas Bonnevialle, Florence Dauzères, Julien Toulemonde, Fanny Elia, Jean-Michel Laffosse, Pierre Mansat
Periprosthetic shoulder infection (PSI) is rare but potentially devastating. The rate of PSI is increased in cases of revision procedures, reverse shoulder implants and co-morbidities. One specific type of PSI is the occurrence of low-grade infections caused by non-suppurative bacteria such as Propionibacterium acnes or Staphylococcus epidemermidis.Success of treatment depends on micro-organism identification, appropriate surgical procedures and antibiotic administration efficiency. Post-operative early PSI can be treated with simple debridement, while chronic PSI requires a one- or two-stage revision procedure...
April 2017: EFORT Open Rev
https://www.readbyqxmd.com/read/28472599/peri-prosthetic-knee-infection-management-spacers-loaded-with-two-or-three-antibiotic-agents
#13
David Joaquin Ortola, Domenico Fenga, Sandra Marcellino, Massimiliano Rosi, Francesco Centofanti, Michele Attilio Rosa
BACKGROUND: The purpose of this work was to compare pre-made antibiotic-loaded spacers with two commercially available antibiotic agents and custom-made cements with three antibiotic agents added. We evaluated: (a) the validity of our procedures, (b) the control of the rate of infection in the long term, (c) complications, and (d) quality of life and patient satisfaction. METHODS: A retrospective cohort study was performed on 112 consecutively treated patients between January 2010 and December 2013; 56 patients were treated with a pre-formed cement spacer (clindamycin + gentamicin), and 56 patients were treated with a spacer loaded with three antibiotic agents (clindamycin + gentamicin + vancomycin)...
May 4, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28471252/type-iv-hypersensitivity-to-gold-weight-upper-eyelid-implant-case-report-and-review-of-the-literature
#14
Caroline L S Kilduff, Edward J Casswell, Richard Imonikhe, Branka Marjanovic
PURPOSE: Complications associated with gold-weight insertion for lagophthalmos are uncommon, recent reports have provided evidence to suggest that type IV hypersensitivity to gold can cause a persistent inflammatory reaction. METHODS: We present a case of a 46-year-old man who experienced persistent post-operative inflammation, and summarize previously documented cases. This patient underwent uncomplicated insertion of an upper eyelid gold weight for right-sided facial nerve palsy...
May 4, 2017: Ocular Immunology and Inflammation
https://www.readbyqxmd.com/read/28462592/c-reactive-protein-and-erythrocyte-sedimentation-rate-predict-systemic-inflammatory-response-syndrome-after-percutaneous-nephrolithotomy
#15
Vishnu Ganesan, Robert D Brown, Juan Antonio Jiménez, Shubha De, Manoj Monga
OBJECTIVE: The aim of the study was to test the hypothesis that high levels of preoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are associated with an increased risk of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: This is a retrospective study of patients who underwent PCNL at our institution between October 2012 and October 2013 when ESR and CRP levels were part of our standard preoperative order set...
May 24, 2017: Journal of Endourology
https://www.readbyqxmd.com/read/28461965/total-knee-arthroplasty-and-infection-how-surgeons-can-reduce-the-risks
#16
REVIEW
Nicola Ratto, Chiara Arrigoni, Federica Rosso, Matteo Bruzzone, Federico Dettoni, Davide Edoardo Bonasia, Roberto Rossi
Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure.Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care.In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities...
September 2016: EFORT open reviews
https://www.readbyqxmd.com/read/28458967/improved-head-and-neck-free-flap-outcome-effects-of-a-treatment-protocol-adjustment-from-pre-to-postoperative-radiotherapy
#17
Martin Halle, Bjorn O Eriksson, Ann-Charlott Docherty Skogh, Pehr Sommar, Lalle Hammarstedt, Caroline Gahm
BACKGROUND: The impact of preoperative radiotherapy on microvascular reconstructive surgery outcome has been a subject of debate. However, data are conflicting and often dependent on local treatment protocols. We have studied the effects of radiotherapy in a unique, single-center setting where a treatment protocol change was undertaken from pre- to postoperative radiotherapy administration for microsurgical head and neck reconstructions. METHODS: A cohort study was conducted for 200 consecutive head and neck free flap cases, where 100 were operated on before and 100 after the treatment protocol adjustment in 2006...
March 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28448197/surgical-site-infections-and-associated-operative-characteristics
#18
Paul K Waltz, Brian S Zuckerbraun
Surgical site infection (SSI) contributes significantly to surgical morbidity. Patient factors and operative factors contribute to the risk of development of SSI. This review focuses on understanding operative characteristics that are associated with an increased risk of SSI. Much attention has been given to protocol care to reduce SSI, such as hair removal, skin preparation, and pre-operative antibiotic agents. Even with this, the appropriate antibiotic and re-dosing regimens often remain a challenge. Other operative factors such as blood loss/transfusion, emergency/urgent cases, duration of the operation, type of anesthesia, and resident involvement are also potentially modifiable to reduce the risk of SSI...
May 2017: Surgical Infections
https://www.readbyqxmd.com/read/28442206/change-the-habit-to-change-the-practice-do-audits-really-ever-change-anything
#19
D Bodansky, Y Oskrochi, G Judah, M Lewis, B Fischer, B Narayan
INTRODUCTION: Methicillin resistant staphylococcus aureus (MRSA) eradication by nurses and pre-op induction antibiotics are mandated for emergency surgery, where true status is unknown. We assessed adherence to local MRSA guidelines for patients undergoing emergency hip fracture surgery and employed point of decision prompts to influence clinicians' behaviour. METHODS: We undertook a retrospective record review for all patients undergoing emergency hip fracture surgery at a UK major trauma centre over 3-months...
April 17, 2017: Injury
https://www.readbyqxmd.com/read/28435560/humeral-supracondylar-fractures-in-children-a-novel-technique-of-lateral-external-fixation-and-kirschner-wiring
#20
R Y Kow, A R Zamri, J K Ruben, S Jamaluddin, M T Mohd-Nazir
Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture...
July 2016: Malaysian Orthopaedic Journal
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