Drainage Of Pus Research Articles

Comparison of Percutaneous Endoscopic Surgery and Traditional Anterior Open Surgery for Treating Lumbar Infectious Spondylitis.

Minimally invasive surgery is becoming popular for treating spinal disorders. The advantages of percutaneous endoscopic debridement and drainage (PEDD) for infectious spondylitis include direct observation of the lesion, direct pus drainage, and earlier pain relief. We retrospectively reviewed 37 patients who underwent PEDD and 31 who underwent traditional anterior open debridement and interbody fusion with bone grafting from 2004 to 2012. The causative organisms were isolated from 30 patients (81.1%) following PEDD, and from 25 patients (80.6%) following open surgery (p = 0.48). Staphylococcus aureus was the most common pathogen (38.2%). In the PEDD group, blood loss (<50 mL versus 585 ± 428 mL, p < 0.001) was significantly lesser and the duration of hospitalization (24.4 ± 12.5 days versus 31.5 ± 14.6 days, p = 0.03) was shorter than that in the open surgery group. Serologically, there were significantly faster C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) normalization rates in the PEDD group (p < 0.001, p = 0.009, respectively). In the two-year follow-up radiographs, 26 out of 30 (86.7%) open surgery patients showed bony fusions of the infected segments. On the contrary, sclerotic change of the destructive endplates was observed and the motion of infected spinal segments was still preserved in the PEDD group. There was no significant difference in the change of sagittal profile, including primary correction gain, correction loss, and actual correction gain/loss. PEDD is an effective alternative option and should be considered prior to traditional extensive spinal surgery—particularly for patients with early-stage spinal infection or serious complicated medical conditions.

Bacterial Pericarditis Causing Cardiac Tamponade in a Patient with No Primary Source of Infection

Introduction Bacterial Pericarditis is a rare entity accounting for Case Description 73 year old male with history of coronary artery disease presents with pleuritic chest pain and dyspnea since 2 days. On arrival, he was hemodynamically stable. EKG showed changes consistent with acute pericarditis. Echo showed moderate pericardial effusion without tamponade and normal systolic/diastolic function. Patient was treated with colchicine, NSAIDS could not be given due to acute kidney injury. His home dose of aspirin and clopidogrel were continued. Overnight, patient decompensated with persistent tachycardia, tachypnea and hypoxia. He started spiking fevers with worsening leucocytosis. Echo showed moderate pericardial effusion with signs of cardiac tamponade. Urgent pericardiocentesis was done and 250 mL of serosanguinous fluid was removed and a pigtail catheter was left in situ. His antiplatelet agents were discontinued to prevent hemorrhagic pericardial effusion. Methicillin sensitive Staphylococcus aureus was detected in cultures of pericardial fluid and blood. His antibiotic was deescalated to intravenous nafcillin. Echo post procedure showed small pericardial effusion with fibrinous echogenic material. His pericardial drain was not draining enough and was removed the next day. He started developing moderate left sided pleural effusion, likely an extension of pericardial inflammation. A small bore pleural catheter was placed in left pleural space for drainage. He had to undergo pericardectomy for definitive drainage and a chest tube was placed in right pleural cavity for drainage. Transesophageal echocardiogram demonstrated no further pathology. Repeat echo and CT-chest did not show any effusions, so pleural drains were removed on 6th day and patient was doing well. Discussion Purulent pericarditis presents as an acute illness characterized by fever in all patients, chest pain in 25-37% of patients. Bacterial pericarditis is usually not a primary infection, but occurs as a complication of underlying infection. Risk factors are immunosuppression, chest injuries, and chronic kidney disease with hemodialysis, diabetes mellitus and alcoholism. About 15% of patients with purulent pericarditis can develop cardiac tamponade. Typically small effusions accumulate quickly and develop tamponade. Large effusions can accumulate slowly allowing the pericardial sac to expand. Treatment is drainage of pus along with antibiotic therapy. Pericardiocentesis may be sufficient but in case of recurrent effusion or poor drainage of thick loculated fluid, pericardiotomy and pericardial window with manual lysis of adhesions and loculations allowing complete drainage is required. Survival in purulent pericarditis depends on early empiric antibiotic therapy and pericardial drainage.

Primary Iliopsoas Abscess in a Neonate

Iliopsoas abscess (IPA) is rare in children but exceptional in neonates. Fewer than 30 cases have been reported in literature. We present a case of 11-day neonate who was brought with left inguinal swelling along with significantly raised white cell count and positive C-reactive protein (CRP). Ultrasound and CT scan confirmed the diagnosis of IPA. Drainage of abscess was done by open method through extraperitoneal approach. Systemic antibiotics, according to culture and sensitivity, were given and the neonate recovered well and was sent home. IPA can be primary or secondary. Primary IPA is more common in neonates unlike adults, who have secondary IPA in majority of the cases. Primary IPA spreads by hematogenous route from distant occult source in the body. Staphylococcus aureus is the causative organism in most cases of primary IPA. Septic arthritis of hip joint is among important differentials. Ultrasound and CT scan are helpful in diagnosis in the presence of raised white cell count and positive CRP. Drainage of pus by open method and through extraperitoneal approach is preferred method although ultrasound-guided percutaneous drainage has also been done with successful outcome. In conclusion, neonatal IPA is extremely rare entity and can easily be overlooked. High index of suspicion is required for its diagnosis in cases where a neonate presents with groin swelling, limited or painful motion of leg and fever.

Antibiotic Prophylaxis in Clean Head and Neck Surgery: An Observational Retrospective Single-Centre Study.

Surgical site infection (SSI) is a common complication in surgery. In head and neck surgeries, different rates are reported in the indexed literature. Nowadays, this indiscriminate use of antibiotics is associated with increased cost and risks for patients. Antimicrobial misuse has also contributed to the development of antibiotic-resistant bacteria. A total of 204 patients were included in this observational retrospective cohort study. The primary outcome of this study was to describe the rate of SSI. Wound infection was considered as SSI and was defined as any cellulitis or pus drainage requiring treatment with antibiotics. Of all, 127 were included in group A (not antibiotic) and 77 in group B (antibiotic prophylaxis); 109 (53.5%) patients were male, and 97 (47.5%) were female. Four (3.14%) patients developed SSI in group A and 3 (3,89%) developed SSI in group B, being not statistically significant (P = .592). In group A, 2 patients suffered SSI after a submandibular gland resection (SGR), 1 patient after a parotid gland resection (PGR), and another one after a branchial cleft cyst resection. In group B, 1 patient suffered SSI after an SGR and 2 after a PGR. On univariate and multivariate analyses, we did not find any variable associated with the development of SSI. According to our results, the prophylactic antibiotic in clean, benign head and neck surgery is not necessary. Nevertheless, physicians and surgeons should be aware that severe or even fatal SSIs might be developed, and it needs to be explained to our patient before any surgery.

Ballooning technique for orbital floor fracture reduction in neglected midfacial fracture: a case report

Objective: Midfacial fracture is a fracture that separates maxilla from the middle part of face. Orbital floor fracture includes in midfacial fracture that difficult to treat. The aggravating factor of the treatment are depressed fractures and infection. We use ballooning technique which is inflated in the maxillary sinus to lift fracture segment of orbital floor and to prevent the orbital floor displaced to the maxillary sinus.Methods: There were multiple lacerations at left eye and nose region, post suturing at left zygoma and left cheek region. Intraoral findings there were multiple laceration, then the patient was examined a complete blood count, chest xray, cervical lateral examination, and 3D CT-Scan examination.Results: Examination of head and panoramic xray was performed and showed there was no bone discontinuity, contact and stable fracture segments. Examination of the 5th day post operative showed minimal pus drainage, leukocytes were within normal limits and other lab results were normal. Physical examination showed minimum scar, there was no dehiscence, symmetrical face and drain was performed at left zygoma region, symmetrical orbital, intact and stable occlusion.Conclusion: In this case, ballooning technique was successfully reduced the ruptured orbital floor and obtained good result.Keywords: Ballooning, Fixation, Open fracture, Orbital floor fracture.

Bacterial biofilm in salivary stones

PurposeTo assess the susceptibility of salivary stones to bacterial biofilm formation, which may be involved in the development of salivary gland infection, and to investigate a relation between microbiological aspects and patient characteristics.MethodsThis prospective study comprises of 54 patients with sialolithiasis attended in Helsinki University Hospital during 2014–2016. A total of 55 salivary stones were removed, and studied for biofilm formation using fluorescence microscopy and sonication. The isolated organisms were quantified and identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry.ResultsBiofilm formation was confirmed on the surface of 39 (70.9%) stones. A total of 96 microorganisms were isolated from 45 salivary stones (81.8%). Two or more organisms were isolated in 33 (73.3%) cases. The main isolates were Streptococcus mitis/oralis (n = 27; 28.1%), followed by Streptococcus anginosus (n = 10; 9.6%), Rothia spp. (n = 8; 8.3%), Streptococcus constellatus (n = 7; 7.3%), and Streptococcus gordonii (n = 6; 6.2%). In all patients showing pre-operative (12 cases) or peri-operative (three cases) drainage of pus, the presence of biofilm was detected in microscopy (p = 0.004). Four patients showed post-operative infection, and in three of them (75.0%), the presence of biofilm was detected. Increased number of pus drainage was found among patients with reflux symptoms or use of proton-pump inhibitors.ConclusionsSalivary stones are susceptible to bacterial biofilm formation, which could be related with the development and severity of the inflammation and the refractory nature of the disease. Sonication of salivary gland stones could be a useful method for finding the etiology of the chronic infection.

Effect of alcohol skin cleansing on vaccination-associated infections and local skin reactions: a randomized controlled trial

ABSTRACT Objectives: Recommendations regarding the need to use alcohol prior to vaccine injections are inconsistent and based on low-level evidence. The objective was to assess the effectiveness of alcohol in reducing local skin reactions and infection post-vaccination. Methods: Randomized controlled trial in a pediatric clinic. A research assistant cleansed the skin with alcohol at (swab group) or adjacent to (control group) the pre-defined injection site(s). Clinicians, parents and children were blinded to group allocation. Parents reported local skin reactions using paper diaries for 15 days post-vaccination (Day 0–14). Telephone interviews were conducted Day 1, 5, and 14. The Brighton Collaboration criteria were used to diagnose cellulitis and infectious abscess Day 5 and afterward. Results: 170 children participated (May-November 2017). Baseline characteristics did not differ (p > 0.05) between groups. Children received 1–4 separate injections. There were no differences between swab and control groups in the incidence of any local skin reactions (58% vs. 54%), and specifically, pain (45% vs. 40%), redness (26% vs. 21%), swelling (20% vs. 13%), warmth (19% vs. 27%), and spontaneous drainage of pus (0% in both groups) over the post-vaccination follow-up period. Day 5 data was available for 99% of participants from diaries and telephone surveys; there were no cases of cellulitis or infectious abscess. Conclusion: These findings are the first direct evidence for vaccine injections demonstrating that cleansing the skin with alcohol may not be needed. Our study is underpowered; however, to detect a difference in incidence of skin infection, future research is recommended.

Orbital complications of acute rhinosinusitis: a study on clinical profile, surgical management and outcome

Objectives1. Evaluate the clinical signs and their correlation to Computed Tomography(CT) findings2. Assess the correlation between CT and intra-operative findings.3. To identify implicated micro-organisms.4. Evaluate the current practice in surgical management. MethodologyA descriptive retrospective study conducted at Lady Ridgeway Hospital (LRH) on 19 patients who underwent endoscopic sinus surgery, drainage of pus and orbital decompression for radiologically suspected orbital complications of acute rhinosinusitis from 01/01/2015 to 31/12/2018. ResultsClinical features were fever (73.7%), peri-orbital swelling (100%), chemosis(68.4%), proptosis(57.9%) and ophthalmoplegia(42.1%). Chemosis and ophthalmoplegia were found in 62% and 37% of the patients with intra-orbital abscesses, with only chemosis showing a statistically significant association. CT was suggestive of subperiosteal abscess or inflammation in all. Intra-operatively abscesses were found in 16 (84.2%). Of these 6 had both subperiosteal and intra-orbital abscesses. Eight had subperiosteal abscesses. Two had only intra-orbital abscesses. The CT scan failed to predict the presence of abscess within the orbital fat in 3 out of 8. The positive predictive value was 89.4% for CT to detect orbital abscesses. An Intra-operative bony defect was noted in 15.8%. The mean surgery duration was 2.04 hours. Cultures revealed MRSA(21.1%), MSSA(15.8%), Pseudomonas(10.5%), mixed growth(10.6%) and Streptococcus viridans(5.3%). ConclusionThe commonest presentations were peri-orbital swelling, fever, chemosis. MRSA and pseudomonas being the commonest organism, the appropriate empirical therapy needs further discussion. Endoscopic surgery is safe, reliable and cosmetic. As patients with intra-orbital abscesses may not be detected clinically or radiologically, we recommend routine incision of the orbital periosteum for suspected orbital complications of acute rhinosinusitis when undergoing endoscopic surgery.

Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports

BackgroundWe report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon.Case presentationThe clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day.ConclusionsThe possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.

Spontaneous perforated pyometra presenting as an acute abdomen: appraisal of three consecutive cases

Introduction: Pyometra is the accumulation of purulent fluid in the uterine cavity caused by impaired drainage of pus due to benign or malignant conditions; rarely with resultant spontaneous uterine perforation brought about by uterine distension.&#x0D; Cases: We report three consecutive cases of spontaneous perforated pyometra in postmenopausal elderly women aged 60 to 70 years who presented with acute abdomen, initially diagnosed as hollow viscus perforation, demonstrated of having significant uterine perforation at laparotomy for which hysterectomy with bilateral salpingo-oophorectomy were done. Histopathological examination revealed features of necrosis of stroma with chronic endometritis without any evidence of malignancy in all the three cases.&#x0D; Conclusion: Spontaneous perforated pyometra, a grave complication necessitating prompt intervention, should always be kept as a possibility in all cases of suspected pyoperitoneum and acute abdomen in elderly postmenopausal women.

Diagnosis and Treatment of Peritonsillar Abscess with Single Enhanced Computed Tomography

Background and Objectives Diagnostic features of peritonsillar abscess are an asymmetrically enlarged palatine tonsil with peripheral rim enhancement and central low density in the post-contrast computed tomography (CT). Although it is necessary to differentiate tumorous conditions of tonsils to compare pre- and post-contrast CT, pre-contrast CT may be less useful in the diagnosis of peritonsillar abscess. This study aims to evaluate of the efficacy of single post-contrast CT for diagnosis and treatment of peritonsillar abscess. Subjects and Method We retrospectively compared 29 patients with peritonsillar abscess, who were diagnosed by single post-contrast CT, with 36 patients diagnosed by pre- and post-contrast CT to determine the success rates of pus drainage and hospital days. Additionally, two otorhinolaryngologists made a judgment of abscess presence for sixty randomly mixed CT images of peritonsillar abscess or tonsillitis with pre- and post-contrast CT or single post-contrast CT. Results There were no significant differences in the success rate of drainage (p=0.622) and hospital days (p=0.504) between groups with/without pre-contrast CT. Abscess presence was judged by raters with/without pre-contrast CT. Inter-rater agreement value (Cohen’s kappa) was 0.825 (p＜0.01). Conclusion Single post-contrast CT of peritonsillar abscess may be a good alternative for diagnosis and treatment and may reduce unnecessary exposure to radiation. Key words: Computed tomography ㆍ Contrast media ㆍ Peritonsillar abscess ㆍ Sensitivity ㆍ Specificity

A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei

BackgroundMelioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis.Case presentationA 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient.ConclusionBurkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome.

Long-term outcome of anterior decompression and instrumentation in tuberculosis of spine

Background: Treatment of tuberculosis of spine has various modalities ranging from medical to various surgical forms including just drainage of pus to only decompression and decompression with instrumentation. The goals of surgery include radical debridement of the infective focus. In some cases, when surgery causes mechanical spinal instability, the question arises whether the risk of recurrent infection outweighs the benefits of spinal instrumentation and stabilization. Instrumentation helps in preventing progression of kyphosis and helps in maintaining the achieved correction. Materials and Methods: Forty-three cases of both sexes with spinal tuberculosis treated with anterior decompression with instrumentation were reviewed retrospectively. Patients with medically managed disease and those who did not receive instrumentation were eliminated from this review. The mean age of patients was 42.3 years (20–72). The mean follow-up duration was 31.6 months (72 to 12 months). Results: Result was analyzed clinically and radiologically in the form of neurological improvement, correction of kyphosis, and maintenance of correction. All patients with wet lesion showed neurological improvement and showed no or very minimal progression of kyphosis. The mean preoperative kyphosis was 27.2° (50 to 16). The mean postoperative kyphosis was 9.0° (20 to 0) and the mean kyphosis at follow-up was 10.3°. None of the patients showed hardware failure, deep infection, and wound infection, and no patient required hardware revision. Conclusion: Instrumentation of the spine is safe and has an important role in stabilization of the tuberculosis of the spine. Despite the presence of active infection, instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing and avoids progression of kyphosis. Level of Evidence: 2

Transimplant antral lavage as minimally invasive treatment of chronic rhinosinusitis: Preliminary report of 11 consecutive cases.

The present article reports how a dental implant with an internal port dental implant valve approach (DIVA) can be utilized as oroantral port to treat chronic rhinosinusitis (CRS) in a minimally invasive manner. Eleven patients (age mean 68.1 years) with CRS were subjected to the transimplant lavage technique. For three patients the CRS treatment was performed via previously installed dental implants, and for another eight patients the implantation procedure was combined with the CRS treatment. The moment the implant was fully installed, the sinus membrane was punctured via the implant channel. Upon completion of the pus drainage the sinus was irrigated with normal saline, followed by the injection of a steroid solution (100 mg hydrocortisone). Patients began to report symptomatic improvement from the first day after the first-session procedure. Nine patients had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) at day 30. The follow- up nasal endoscopy demonstrated no evidence of active sinus disease. All the implants used were found to be well-osseointegrated and still in use for prosthetic purposes. Clinical and radiologic results showed stability and no recurrence in the follow-up period. The dental implant with an internal central port and integral dedicated sealing screw may be used for irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.

Deep neck infections in children.

Deep neck infections (DNIs) often have a rapid onset and can progress to life-threatening complications. There are only a few reports on pediatric DNIs' clinical manifestations, diagnostic clues, and etiology in Taiwan. A retrospective chart review of patients (aged≤18 years) diagnosed with DNI from January 2005 to December 2014 was performed. DNIs were classified into retropharyngeal, parapharyngeal, peritonsillar, submandibular, and multispace abscesses. A total of 52 patients with DNI were identified. The most common site of DNI was the parapharyngeal space (n=22, 42.3%). The most commonly associated antecedent illness was preceding upper respiratory tract infection (30.8%). The most common clinical presentation was neck mass or swelling (82.7%) and fever (75%). Pus drainage or needle aspiration was performed to obtain pus samples from the infection site for pus culture (n=31). The most commonly isolated pathogen was Staphylococcus aureus (n=7). Amoxicillin-clavulanic acid (56.6%) was the most commonly used antibiotics, followed by penicillin (15.1%). There was no long-term morbidity or mortality. When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis. The low culture rate in Taiwan and previous partial treatment of infections may have affected identification of pathogens in cultures. Performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial. The recurrence of DNI should alert the physician to the possibility of an underlying bronchogenic cyst. Excision surgery is required to cure recurrent infections.

Urethral calculi with a urethral fistula: a case report and review of the literature

BackgroundTo explore and summarize the reasons why urethral calculi cause a urethral fistula.Case presentationWe retrospectively studied 1 patient in Xiangya hospital and all relevant literature published in English between 1989 and 2015. The patients (including those reported in the literature) were characterized by age, origin, location of calculus, size of calculus, fistulous track, and etiological factors. Most of urethral calculi associated with a urethral fistula were native generated. Urethral calculi can be formed in various locations of the urethra, and the size of the calculus ranged from small (multiple) calculi to giant stones. The fistula external orifice located at the root of the penis was relatively common, and there were various etiological factors, such as urethral strictures, urethral trauma induced by long-term catheterization, lumbar fractures, and congenital anomaly factors. They were managed by the excision of the fistulous tract, retrieval of the urethral stones, and/or debridement and pus drainage operations.ConclusionSome elements, such as trauma, recurrent urinary tract infections, abscess formation induced by long-term catheterization, and urethral calculus, may be the risk factors for a urethral fistula.

Role of Surgical Interventions and Outcomes in Septic Abortion Cases: A Prospective Hospital Based Study

Background: Aim of this study was to evaluate the maternal morbidity & mortality, clinical features, management and role of surgical interventions in cases of septic abortion in a tertiary Centre. Methods: This study was conducted on 25 cases of septic abortion in the Department of obstetrics & Gynaecology in Himalayan Institute of Medical Sciences, Dehradun. All patients were evaluated with special reference to incidence, etiological factors, clinical features, surgery & maternal morbidity & mortality. Results: Common age group was between 26-30 years. Most of the cases were from lower socioeconomic status. Septic abortion following spontaneous abortion was present in 5 cases. Unwanted pregnancy was the indication for termination of pregnancy in majority of the cases. 8 cases required laparotomy for drainage of pus, 1 patient had hysterectomy. Conclusion: The incidence of illegal and septic abortion can be reduced by increasing awareness about family planning services and making legal abortion services easily available to the women and that too at a cheaper cost.

Clinical study of necrotizing fasciitis and its management

Background: Necrotizing fasciitis is a severe flesh-eating disease of soft tissue infection. It is characterized by widespread infection of the fascia with necrosis. It may lead to MODS and shock in a very short period of time. In this study we have evaluated the predisposing factors, clinical manifestation and different modalities of investigation which helps in management of this near fatal disease.Methods: This study was conducted in Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India for 3 years (October 2013-September 2016). A total of 107 patients having necrotising fasciitis were admitted in this period. The diagnosis was confirmed by detailed history and physical examination followed by haematological, microbiological and radiological investigations priority wise. After initial resuscitation patients were taken to OT where debridement of dead necrotic tissue was done, laying open of deeper planes with proper and effective drainage of pus. Most of the dressings used were silver sulfadiazine or iodine depending upon the sensitivity to sulpha group.Results: Diabetes mellitus was the most common predisposing factor (65.4%) followed by trauma (28%). Perineum and thigh were the most commonly affected site (70%). Most of the patients (84%) presented with skin erythema and blistering. Fever and tachycardia were seen in almost all the patients (95%). Leukocytosis and neutrophilia were seen in 91.5%. Most common organisms isolated were E. coli and proteus. Mortality rate was 24.29%.Conclusions: Necrotizing fasciitis is a flesh eating, highly lethal disease. Early diagnosis, early and radical surgical debridement supported by appropriate antibiotic and correction of metabolic disorder are the cornerstones of successful management.

Surgical management of necrotizing fasciitis due to odontogenic infection with sepsis: a case report

Objective:To perform surgical operation on necrotizing fasciitis due to odontegenic infection with sepsis.Methods: In this case an odontogenic infection was accompanied by a large open wound on the face and sepsis. Patient was hospitalized in the Dr.HasanSadikin General Hospital. Management of this patient in the emergency room were administration of appropriate broad-spectrum empiric antibiotic, incision and pus drainage, and extraction of the infected tooth, followed by fluid resuscitation with strict observation. Surgical debridement was then performed.Results:After being treated for 12 days the patient’s condition improved. We planned closure of defects of the facial area, but the patient refused.Conclusion: Necrotizing fasciitis is an uncommon but potentially lethal condition associated with high rates of morbidity and mortality. Early diagnosis coupled with emergent surgical debridement, appropriate broad-spectrum empiric antibiotic treatment, and a multidisciplinary team approach is essential for successful treatment.

Gas-Containing Cervical Epidural Abscess Accompanying Bacterial Meningitis in an Adult.

Gas-containing spinal epidural abscesses are uncommon. Moreover, acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. Here, we report a rare case of a gas-containing cervical epidural abscess accompanying bacterial meningitis. In spite of aggressive fluid and continuous antibiotic therapy after the isolation of Streptococcus anginosus and Streptococcus constellatus in the cerebrospinal fluid cultures, the patient showed remaining motor dysfunction and bladder involvement. Our experience suggests that the effort to prevent neurologic deterioration by emergent surgical decompression and drainage of pus is mandatory to avoid additional spinal cord dysfunction in patients with spinal epidural abscesses accompanying bacterial meningitis.