Abdominal Cellulitis Research Articles

Sinusoidal Atrial Fibrillation (Yasser’s Fibrillation) and Partial SAN Function in COVID-19 Pneumonia; a New Cardiovascular Discovery Change in Atrial Fibrillation Directory

Introduction: Atrial fibrillation (AF) is one of the most common and probable serious arrhythmias and a hallmark of an increasing risk of pathological thrombus formation. Interestingly, normal sinus rhythm (NSR) is the standard rhythm in a normal person. The sino-atrial node (SAN) is the heart's pacemaker and generator of the normal electrical conduction system of the heart which allows for the generating of electrical impulses. In AF, the normal regular electrical impulses generated by the sinoatrial node are overwhelmed by disorganized electrical waves, usually originating from the roots of the pulmonary veins. These disorganized waves conduct intermittently through the atrioventricular node (AVN) leading to irregular activation of the ventricles that generate the heartbeat. Cases presentation: Four different cases were described. 1. An elderly female patient presented to the ICU with metastatic complicated Mantle cell lymphoma, COVID-19 pneumonia, and irregular heart rate. 2. A senile male patient presented to the intensive care unit (ICU) with an aortic aneurysm, COVID-19 pneumonia, consumptive thrombocytopenia, lung fibrosis, and irregular heart rate. 3. A middle-aged female presented to the ICU with chronic renal failure (CRF) on regular hemodialysis, liver cell failure (LCF), pseudo-orange abdominal cellulitis, valvular heart replacement, and irregular heart rate. 4. An elderly female patient presented with cardiomyopathy, global cardiomegaly, irregular heart rate, diabetes, pseudo-orange abdominal cellulitis, liver cirrhosis, and COVID-19 pneumonia. Method of study and patients: Retrospective-Observational four case report series study was conducted in Kafr El-Bateekh Central Hospital staring from January 21, 2023 and ending on June 24, 2024 on COVID-19 pneumonia and atrial fibrillations. Conclusion: Sinusoidal atrial fibrillations (Yasser’s fibrillation) or mixed AF are a new cardiovascular discovery. The partial sino-atrial nodal function has essential role in the presence of Sinusoidal atrial fibrillations (Yasser’s fibrillation) or mixed AF and its interpretation. Sinusoidal atrial fibrillations (Yasser’s fibrillation) or mixed AF may be balanced between AF and normal sinus rhythm. The percentages of normal sinus beats to AF beats in the cases of Sinusoidal atrial fibrillations (Yasser’s fibrillation) may be a guide for approximate healthy or sick part of the sinoatrial node. Widening the research for the Sinusoidal atrial fibrillations (Yasser’s fibrillation) or mixed AF will be recommended.

148 - An odd presentation of abdominal cellulitis in the setting of clonal cytopenia of undetermined significance

148 - An odd presentation of abdominal cellulitis in the setting of clonal cytopenia of undetermined significance

Novel scoring system for early diagnosis of necrotizing enterocolitis: integrating clinical and laboratory data with urinary caveolin-1 levels.

Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data with urinary caveolin-1 levels. A single-center prospective cohort study was conducted at a tertiary hospital in East Java, Indonesia. NEC diagnosis was established by Bell's criteria and proven gut dysbiosis. Urinary levels of claudin-2, caveolin-1, and epidermal growth factor (EGF) were assessed as potential indicators of tight junction disruption. The selected urine biomarker cutoff value was determined using symbolic classification analysis and combined with clinical and laboratory parameters from Bell's criteria to create an NEC scoring system, validated with the Aiken index. Sensitivity and specificity analyses were performed. Thirty-four neonates, comprising NEC, preterm non-NEC, and term infants, were included. qPCR analysis highlighted elevated Klebsiella, Lactobacillus, Clostridium, and Bacteroides levels in NEC patients, indicating a gut dysbiosis trend. Among 3 biomarkers, caveolin-1 ≥ 17.81 ng/dl on day 3 demonstrated 72.86% negative predictive value and 87.50% positive predictive value. The combined scoring system which comprised abdominal cellulitis, distension, radiology, advanced resuscitation at birth, prematurity or low birthweight, platelet count, sepsis, orogastric retention, metabolic acidosis and caveolin-1 findings exhibited an AUC of 0.922 (95% CI: 0.81-1.00, p < 0.001), with ≥ 1.81 as the cutoff, offering 93% sensitivity and 94% specificity. Urine caveolin-1 on day 3 signifies enterocyte tight junction damage and the acute phase of NEC in premature infants. The proposed scoring system demonstrates good performance in predicting NEC incidence in preterm infants.

Predicting Areas with High Concentration of the Long-Term Uninsured and Their Association with Emergency Department Usage by Uninsured Patients in South Carolina.

Background: To predict areas with a high concentration of long-term uninsured (LTU) and Emergency Department (ED) usage by uninsured patients in South Carolina. Methods: American Community Survey data was used to predict the concentration of LTU at the ZIP Code Tabulation Area (ZCTA) level. In a multivariate regression model, the LTU concentration was then modeled to predict ED visits by uninsured patients. ED data came from the restricted South Carolina Patient Encounter data with patients’ billing zip codes. A simulation was conducted to predict changes in the ED visit numbers and rates by uninsured patients if the LTU concentration was reduced to a lower level. Results: Overall, there was a positive relationship between ED visit rates by the uninsured patients and areas with higher concentrations of LTU. Our simulation model predicted that if the LTU concentration for each ZCTA was reduced to the lowest quintile, the ED visit rates by the uninsured would decrease significantly. The greatest reduction in the number of ED visits by the uninsured over a two-year period was for the following primary diagnoses: abdominal pain (15,751 visits), cellulitis and abscess (11,260 visits) and diseases for the teeth and supporting structures (10,525 visits). Conclusions: The provision of primary healthcare services to the LTU could help cut back inappropriate uses of ED resources and healthcare costs.

Management of Diffuse Abdominal Cellulitis After Cesarean Section

Management of Diffuse Abdominal Cellulitis After Cesarean Section

A Case of Abdominal Cellulitis Induced by a Continuous Subcutaneous Injection of Oxycodone in a Patient with Gastric Cancer

【緒言】オピオイドの投与経路は経口投与が基本であるが，嚥下障害，悪心・嘔吐などの理由から皮下投与などに変更する場合がある．皮下投与の稀な合併症として，腹部蜂窩織炎の症例を報告する．【症例】44歳の男性．2017年2月に胃がんの多発転移の診断で痛みの緩和ならびに化学療法目的で入院した．オキシコドン持続皮下注射で痛みの緩和を図り，化学療法を継続していたが，皮下注射部位に腹部蜂窩織炎を併発した．穿刺を変更し，血液培養検査提出後，セファゾリン2 g/日を1週間投与し，臨床症状，血液検査共に軽快し，化学療法が継続できた．【考察】オキシコドン持続皮下注射により蜂窩織炎を併発した報告は認められなかった．終末期がん患者や化学療法中の患者は免疫力が低下しており，オキシコドン持続皮下注射などのオピオイド持続皮下注射を行う場合，穿刺部位を注意深く観察し，感染徴候に留意する必要性があると考えられた．

Management of Diffuse Abdominal Cellulitis After Cesarean Section

Management of Diffuse Abdominal Cellulitis After Cesarean Section

Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?

to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life.

Abdominal cellulitis: dreadful clinical consequence after skin branding.

Abdominal cellulitis: dreadful clinical consequence after skin branding.

Molecular characteristics of the Taiwanese multiple drug-resistant ST59 clone of Panton-Valentine leucocidin-positive community-acquired methicillin-resistant Staphylococcus aureus from pediatric cellulitis

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which often produces Panton-Valentine leucocidin (PVL), has emerged worldwide as a life-threatening pathogen. Herein, we describe molecular characteristics of MRSA isolated from abdominal cellulitis in a 7-year-old Japanese boy. This MRSA was PVL-positive and belonged to the Taiwanese multiple drug-resistant CA-MRSA clone with the genotype of ST59, staphylococcal cassette chromosome mec (SCCmec) VII (SCCmecV, according to recent reclassification), agr1a (a novel agr1 subtype), and SaPI (which carried seb1, a newly designated variant seb gene). This study demonstrates the first isolation of the Taiwanese PVL-positive ST59 MRSA clone in Japan. The data also demonstrate novel subtypes in agr1 and seb and suggest that a combination of agr1a, seb1, and PVL could contribute to cellulitis (and its recurrence). Recently, a variety of PVL-positive MRSA clones are accumulating in Japan.

Diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction.

Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary. Key words: Choledocho-pancreatico-duodenal junction; Injury; Diagnosis; Treatment

Emergency Department Usage by Uninsured Patients in Galveston County, Texas

The number of uninsured Texas residents who rely on the medical emergency department as their primary health care provider continues to increase. Unfortunately, little information about the characteristics of this group of emergency department users is available. Using an administrative billing database, we conducted a descriptive study to examine the demographic and clinical features of 17,110 consecutive patients without medical insurance who presented to the emergency department of the University of Texas Medical Branch in Galveston over a 12-month period. We also analyzed the risk of multiple emergency department visits or hospitalization according to demographic characteristics. Twenty percent of the study population made two or more emergency department visits during the study period; 19% of the population was admitted to the hospital via the emergency department. The risk of multiple emergency department visits was significantly elevated among African Americans and increased in a stepwise fashion according to age. The risk of being hospitalized was significantly reduced among females, African Americans, and Hispanics. There was an age-related monotonic increase in the risk of hospitalization. Abdominal pain, cellulitis, and spinal disorders were the most common primary diagnoses in patients who made multiple emergency department visits. Hospitalization occurred most frequently in patients with a primary diagnosis of chest pain, nonischemic heart disease, or an affective disorder. Additional studies of emergency department usage by uninsured patients from other regions of Texas are warranted. Such data may prove helpful in developing effective community-based alternatives to the emergency department for this growing segment of our population. Local policymakers who are responsible for the development of safety net programs throughout the state should find this information particularly useful.

Patients leaving against medical advice from the emergency department: How many of them actually return to continue their evaluation and what are the reasons the others do not?

Study objectives: There is little information about how many patients who leave against medical advice (AMA) return to the emergency department (ED) in the days immediately after their abrupt departure. We seek to determine the number of patients who leave AMA who actually return to the ED for resumption of further diagnostics and treatment and the reasons why they do not. Methods: A retrospective cohort analysis of patients leaving AMA during two 6-month periods in consecutive calendar years was performed at an urban academic ED. Patients leaving AMA were identified by treating staff, as well as daily medical record reviews. The study was conducted from May through October 2002 and July through December 2003. All patients were telephoned within 72 hours of their AMA departure and queried about their clinical status and their intent to return to the ED regardless of persistence, resolution, or worsening of symptoms. Data are reported as proportions and 95% confidence intervals (CIs). Approval was granted by the institutional review board. Results: A total of 199 patients were identified as having left the ED AMA. The predominant AMA discharge diagnoses, in order of predominance, included cardiovascular (acute coronary syndrome, rule out myocardial infarction, rule out pulmonary embolism, atrial fibrillation/flutter, and syncope), undifferentiated abdominal pain, respiratory (chronic obstructive pulmonary disease, asthma), and cellulitis. One hundred ninety-four patients could be reached by telephone within 72 hours. One hundred twenty-six of 194 patients (64.9%, 95% CI 57.6% to 71.5%) stated that their symptoms had either improved or were no longer present. Of these 126 patients, 109 (86.5%, 95% CI 78.9% to 91.7%) had original AMA discharge diagnoses referable to a potential cardiovascular pathology. Ninety-five patients (75.3%, 95% CI 66.7% to 82.4%) of the group whose symptoms had improved or abated stated they had no plans to seek further evaluation because their symptoms no longer existed. Of the remaining 31 patients in this group (24.6%, 95% CI 17.6% to 33.2%), 20 had returned in the intervening 72 hours, with 15 patients having significant clinical findings with further evaluation. Of the remaining 68 patients with continued symptoms, 36 (52.9%, 95% CI 40.5% to 64.9%) had returned for further evaluation. Nineteen of these 36 patients had significant findings on further evaluation. A total of 138 patients had not returned or sought follow-up care as instructed. In addition to the 95 patients expressing symptom improvement, 31 patients (22.4%, 95% CI 15.9% to 30.4%) opined that they had somewhat of a reluctance to return to the same ED for fear of possibly being made to feel embarrassed by staff about their original decision to disregard medical advice. The other 12 patients (8.7%, 95% CI 4.8% to 15.0%) who had not sought care, although still having symptoms, did not do so because of job and family commitments or because they would follow up with their personal physician. Conclusion: A number of patients who return to continue their care after having left AMA are found to have clinically significant pathology. A significant number of patients, particularly those who were believed to have cardiovascular maladies at their initial ED visit days earlier, do not plan to seek further evaluation and treatment as counseled because of the belief that the resolution or attenuation of their symptoms negates the need for further medical evaluation. Other patients express reticence about returning because they anticipate being met with derision by staff members and chastised for their original decision to leave.

ABDOMINAL WALL URINOMA:: A COMPLICATION OF ANTERIOR URETHRAL INJURY

Abdominal wall urinoma is a rare complication of anterior urethral injury because most patients present shortly after the traumatic event. 1 Therefore, to our knowledge this particular complication of anterior urethral injury has not been previously addressed in the literature. We discuss the management of a large abdominal wall urinoma after anterior urethral injury. CASE REPORT T. B., an 11-year-old boy, sustained a straddle injury on playground equipment and did not initially report the injury. However, the following day massive scrotal swelling was noticed and he presented to the emergency room with complaints of severe suprapubic pain and the inability to urinate. Abdominal cellulitis extended to the umbilicus. The genitalia, including the penis and scrotum, were massively edematous. The perineal area demonstrated classic butterfly hematoma, suggesting anterior urethral injury. Retrograde urethrography confirmed anterior urethral injury and no contrast material entered the bladder. Broad-spectrum intravenous antibiotics were started. The patient underwent open suprapubic cystotomy. A large urinoma was identified between Scarpa’s fascia and the external oblique fascial layers. Portions of this urinoma were not adequately drained by the cystotomy incision due to the extent of urinary extravasation. To drain the whole urine collection 2 additional incisions were made in the anterior abdominal wall through Scarpa’s fascia (see figure). Two small Penrose drains were placed to facilitate drainage postoperatively. Bilateral scrotal incisions were also made to drain a large scrotal urinoma but the perineal collection was not drained due to small size. Abdominal wall cellulitis resolved by postoperative day 2 and all drains were removed by postoperative day 3. The small perineal collection required operative drainage on postoperative day 12 due to abscess formation. The suprapubic tube remained in place for 8 weeks. Voiding cystourethrography before suprapubic tube removal revealed a normal urethra without stricture. At 6 months of followup the patient continues to void normally. DISCUSSION