Ensuring the welfare of cattle is an important factor in the optimal management of intensive production. Important components of the well-being of cows are ensuring proper conditions of detention, including high-quality stall floors in the premises, since the improper condition of the latter leads to the emergence and development of diseases of the limbs in animals, decrease in milk productivity and even their premature culling. The article reflects the results of an examination of a dairy farm, on which a significant number of primiparous cows developed various diseases of the proximal pelvic limbs during the first 2–4 weeks after calving, in particular purulent lesions of the lateral bursa of the hock joint (48.5% of animals), including 55.1% of them with phlegmon of the lower leg and 5.9% with a thigh abscess. The diseases occurred after the heifers were transferred from loose housing on deep bedding to the maternity ward for tethered housing. In cows of older age groups (2–5 lactations), the disease was recorded in only 8.9% of cases, of which 22.2% were complicated by shin phlegmon and hip abscess (in 8.3% of animals). When examining the livestock, bedsores and ulcers were found on the lateral surface of the hock, knee and hip joints (in 94.6% of cows), lateral hock bursitis (in 28.1%), redness and coarsening of the skin of the outer surface of the shin, thigh and posterior lower abdominal wall (12.1%), shins phleg mon (0.8%) and hips abscess (0.4%). It was found that the cows were kept tied on a concrete floor, the surface of which was constantly in an unsatisfactory sanitary and hygienic condition, as well as an insufficient amount or complete absence of chopped straw bedding. In most animals, lying on a dirty and hard concrete floor during rest led to the appearance of bedsores in the places of bone protrusions of the joints with their subsequent maceration, infection and development of ulcers, lateral bursitis of the hock joint, phlegmon of the shin and abscess of the thigh. Key words: cows, stall floor, bedding, bedsore, ulcer, lateral bursitis of the hock joint, phlegmon of the shin, abscess of the thigh.

Acute pancreatitis (AP) is one of the most common gastrointestinal-related causes of hospitalization in the USA, accounting for more than 200,000 admissions annually. Although mild and moderate cases usually improve within a week, severe AP conditions could lead to life-threatening pancreatic necrosis, multiple-organ dysfunction, and be fatal in some cases. Excessive alcohol use and gallstones are the two leading causes, nonetheless other systemic complication could also lead to AP. Hypertriglyceridemia is an important, yet uncommon, cause/risk factor of AP, especially when associated with heavy alcohol use. Additionally, the level of triglycerides (TGs) was found to be an important factor of determining the method and duration of treatment. Here we present a case of 38-year-old obese and active smoker male with hypertension and alcohol use disorder presented with a chief complaint of 2 weeks of progressive sharp epigastric pain. His medical history was significant of opioid use disorder that is maintained on methadone therapy. Computed tomography (CT) scan of the abdomen and pelvis revealed infiltration of the fat along the pancreatic tail and distal body with focus of decreased enhancement in the very distal pancreatic tail, which could represent a small infarct or phlegmon. In addition, laboratory data was significant of elevated lipase level (> 1,000 mg/dL), which together with the CT result confirmed the diagnosis of AP. Additional laboratory workup revealed extremely high level of TGs of > 2,000 mg/dL. The patient was subsequently transferred to the intensive care unit for management of hypertriglyceridemia. He was started on insulin therapy along with supportive treatment for the management of pancreatitis. Hypertriglyceridemia and pancreatitis rapidly improved over the course of hospitalization period and no additional intervention was needed. He was successfully discharged on fenofibrate. J Med Cases. 2021;12(1):23-26 doi: https://doi.org/10.14740/jmc3595

Лечение гнойно-некротических флегмон стопы с использованием бактерициднолимфотропных технологий

To analyze the clinical features, possible reasons and management of anastomotic leakage after laparoscopic-assisted radical right hemicolectomy. Clinical data of 546 patients undergoing laparoscopic-assisted radical right hemicolectomy in Peking Union Medical College Hospital from October 2010 to September 2016 were retrospectively analyzed. The occurrence of anastomotic leakage and its countermeasures were evaluated. Among 546 patients, 8(1.5%) cases developed anastomotic leakage, including 7 males and 1 female with mean age of (54.3±10.3) years. Six cases of ascending colon cancer, 1 case of phlegmon and 1 case of arterior-venous malformation were confirmed after operation. The incidence of anastomotic leakage after D3 and D2 lymphadenectomy was 2.1%(6/290) and 0.8%(2/256). The time from operation to the diagnosis of anastomotic leakage was (6.6±3.6) days. The clinical manifestation of anastomotic leakage were stool-like drainage in 7 patients, fever in 4 and abdominal pain in 3. Amylase and bilirubin in drainage of 4 patients increased obviously. All the 8 patients underwent secondary ileostomy, including 4 with laparoscopy and 4 with laparotomy. One patient suffered from respiratory failure after re-operation because of severe abdominal infection and was cured by ventilator support treatment. Another one had pelvic encapsulated effusion and was treated by puncture drainage. All the patients discharged from hospital smoothly. Anastomotic leakage after laparoscopic-assisted right hemicolectomy is a quite rare but serious complication, which may be associated with over-cleaning of lymph fatty tissues. Ileostomy should be the first choice of anastomotic leakage after laparoscopy-assisted right hemicolectomy and its efficacy is satisfactory.

Флегмона желудка у ребенка 10 лет

Is an Ileal Phlegmon Always Crohnʼs Disease?

To discuss the diagnostic value of Crohn's disease activity with multi-slice CT enterography. MSCTE examination data of 88 cases of CD patients by clinical, endoscopy, pathology confirmed in Sir Run Run Shaw Hospital from January 2013 to June 2014 were analysed. According to the Harvey-Bradshaw index, all of CD patients were divided into the active phase group and remission phase group. Imaging findings of two groups were compared. To explore the relationship between MSCTE findings and CRP/ESR of CD patients. The wall thickness (8.2 ± 2.6) mm and enhancement degree (112 ± 16) HU in active phase group were higher than the wall thickness (5.4 ± 1.6) mm and enhancement degree (93 ± 17) HU in the remission phase group (P < 0.01). The incidences of intestinal wall stratification enhancement, comb sign, swollen lymph nodes, phlegmon, intestinal fistula, intestinal stenosis in active phase group (88.5%, 72.1%, 77%, 45.9%, 26.2%, 65.6%) were significantly higher than those in remission phase group (29.6%, 18.5%, 25.9%, 0, 3.7%, 37%) (P < 0.05). The incidences of intestinal wall homogeneous enhancement in remission phase group (70.4%) were higher than those in active phase group (11.5%) (P < 0.01). There was no significant difference in the incidences of abscesse in two groups (P > 0.05). CRP was correlated with the wall thickness and enhancement degree, abnornlal mesentery vascularity, lymph node enlargement, phlegmon, intestinal fistula (r > 0.2, P < 0.05). ESR was correlated with the wall enhancement degree, abnormal mesentery vascularity, lymph node enlargement and phlegmon (r > 0.2, P < 0.05). CT enterography can adequately demonstrate mural abnormalities and assess the presence of extramural complications, which are helpful in evaluating the activity of Crohn's disease.

Random regression threshold animal models were applied to binary longitudinal claw disorder data for studying genetic parameters of all claw disorders (ACD), as well as to claw disorders divided into different categories: non-purulent claw disorders (NPCD), purulent claw disorders (PCD), dermatitis digitalis (DD), sole ulcer (SU), phlegmona (PH), laminitis (LAM) and interdigital hyperplasia (IH) in the course of lactation. Claw disorder data were obtained from 26,651 Holstein cows kept in 15 large-scale contract herds in the region of Thuringia over a period of 5 years from 2007 to 2012. If a cow had one or more entries of the same disorder, for example, sole ulcer, within an interval of 30 days, she was scored with a '1', and otherwise, she received a score of '0' for healthy. Heritabilities for the same disorder were relatively stable between DIM 50 and DIM 300, but they tended to increase in early and late lactation. Highest heritabilities in the range from 0.20 to 0.34 were estimated for IH, and lowest heritabilities were realized for LAM (~ 0.05). Genetic correlations for same traits between different DIMs were high for adjacent test days, but close to zero for distant test days. The relationship between the sire EBVs for claw disorders and official sire EBVs for the type traits 'foot angle' was slightly antagonistic with correlation coefficients in the range from 0.05 (DD) to 0.33 (PH). Correlations between lactation EBVs for hock quality, rear leg rear view and the feet and leg index with EBVs for claw disorders were slightly favourable and ranged between -0.01 (rear leg rear view correlated with SU) and -0.43 (hock quality correlated with PH). Regarding daily EBVs for claw disorders, the strongest correlation coefficient was of value -0.46 (LAM early in lactation correlated with the feet and leg index). Genetic parameters from the random regression model were verified by applying a single-trait repeatability model. Correlation coefficients between lactation EBVs from the random regression model and lactation EBVs from the repeatability model for the same claw disorder were close to 1. Correlations were lower between EBVs from single test days and lactation EBVs from the repeatability models, with a minimal value of 0.58 for PCD measured at day 20.

To investigate the value of CT and X-ray enterography in the diagnosis of small intestinal Crohn disease(CD). Data of 39 CD cases confirmed by surgery and pathology who underwent CT and X-ray enterography were analyzed retrospectively. All the patients had complete CT data, 28 cases had X-ray intestinal barium meal data, and 18 had sinus tract enterography. CT enterography showed mural thickening(>4 mm) in 34(87.2%) patients, mural gas in 7(17.9%), mural edema in 7(17.9%), mural fat in 4(10.3%), increased enhancement of bowel wall(>10 HU) in 37(94.9%), multiple segmental lesions in 33(84.6%), single segmental lesions in 6(15.4%), mesenteric lymphadenopathy(>5 mm) in 13(33.3%), vascular bundle thickening in 9(23.1%), cellulitis in 12(30.8%), peritoneal abscess in 10(25.6%), phlegmon in 8(20.5%), incomplete intestinal obstruction in 14(35.9%), seroperitoneum in 22(56.4%), and fistulization in 4(10.3%). CT enterography did not demonstrate the change of mucosa such as strip ulcer or cobblestone. Among the 28 cases of small bowel X-ray enterography, 23 cases(82.1%) presented with multiple segmental lesions, 5(17.9%) with single segmental lesions, 18(64.3%) with strip ulcer, 16(57.1%) with cobblestones, 4(14.3%) with intestinal fistula, while no bowel wall and extraintestinal complication of CD disease was observed. Among the 18 cases of sinus tract enterography, 13 cases (72.2%) presented with intestinal fistula, 12(66.7%) with peritoneal abscess, 8(44.4%) with sinus tract. CT enterography can demonstrate exactly the diseased bowel wall and extraintestinal complication of CD disease, which is important to evaluate the extent of CD and guide the treatment, however strip ulcer and cobblestone sign cannot be demonstrated. The X-ray enterography is available to demonstrate the characteristic changes of CD such as trip ulcers and cobblestones, but is difficult to show the bowel wall and extraintestinal inflammatory mass and abscesses. The sinus tract enterography is easy to demonstrate the intestinal fistula and intra-abdominal abscess. Combination of these methods is more beneficial to guild the diagnosis and treatment.

Objective To investigate the diagnostic value of computed tomography,X ray enterography and digestive endoscopy for intestinal Crohn's disease in active and chronic phase.Methods The clinical data of 39 patients with Crohn's disease who were admitted to the Subei People's Hospital from June 2008 to August 2011 were retrospectively analyzed.All patients were divided into the active phase group (28 patients) and the chronic phase group (11 patients).The results of computed tomography,X ray enterography and digestive endoscopy of the 2 groups were compared.The accuracy of the 3 diagnostic methods was assessed by consulting the operative findings.The enumeration data were analyzed using the chi-square test.Results The incidences of intestinal wall stratification,intesitnal edema strap,severe enhancement,ulcers,intestinal stenosis,intestinal fistula,phlegmon,swollen lymph nodes and comb sign in patients with active phase of Crohn's disease were significantly higher than those with chronic phase of Crohn's disease (x2 =10.700,3.954,22.025,7.661,10.700,7.661,6.810,7.661,4.592,P＜0.05).The incidences of intestinal wall thickening,intramural fat,mild enhancement,unenhancement,inflammatory polyps,abscesses and inflammatory masses in patients with chronic phase of Crohn's disease were significantly higher than those with active phase of Chrohn's disease (x2=17.475,11.345,18.050,5.366,22.856,12.662,5.846,P ＜ 0.05).Computed tomography was effective in detecting intestinal wall thickening and extraintestinal complications of Crohn's disease,but it was difficult in demonstrating ulcers and inflammatory polyps.X ray enterography and digestive endoscopy were effective in detecting ulcers and inflammatory polyps,but they were difficult in detecting intestinal wall thickening and extraintestinal complications of Crohn's disease.Conclusion Computed tomography combined with X ray enterography and digestive endoscopy is helpful in demonstrating the presentations of Crohn's disease in active and chronic phase. Key words: Crohn's disease; Imaging examination; Diagnosis

Background: Appendectomy is the most common emergency operation performed in the world. This study aimed to compare complication of simple legation of the appendix with purse string diving appendectomy. Methods: Randomized clinical trial designed 361 patients who had underwent appendectomy during 2008 and 2009 in Imam Reza and Taleghani hospitals, Kermanshah, Iran, were included. Those patients with normal appendix, peritonitis, appendicular abscess and phlegmon were excluded. 184 simple legation subjects in the group A and 177 purse string of the stump of the appendix subjects in the group B was carried out. The postoperative complications including wound infection wound dehiscence, abdominal abscess formation, fecal fistula, illus and duration of hospital staying was recorded for two months follow up period. Data was analyzed using statistical tests. Results: Mean age in the group A and B was 27.1±13.8 and 25.7±13.1 year, respectively. 70 percent of patients were male in both groups. Rate of wound infection was 4.2% in the group A and 4% in group B (P=0.852). 1.6% of patients in the group A and 4.6% in group B suffered from post operation illus. Mean hospital stay was 3.63±1.43 days in the group A and 3.79±1.48 days in group B (P=0.279). No case with abdominal abscess formation, wound dehiscence and focal fistula was seen in both groups. Conclusions: No difference was seen between two groups. Therefore, with considering the point that simple legation takes less time compared to purse string to perform it can be considered as the preferred method for appendectomy.

The pathology of the skin in felines is extremely varied and complex. The determination of the etiology may be sometimes difficult. The mycological diagnosis is difficult, especially in our country, where the number of the field specialties is extremely small. The various clinical aspects and the complexity of the diagnosis methods determine the medical practitioners to give up the specialty examination. Atypical developing forms, which are quite frequent, were characterised by a severe diffuse alopecia on large areas, cutaneous erythema, intense itching and suppurative Kerion Celsi phlegmon, depilation, and moderate itching and were based on other parasitical deseases of the cats: fleas, notoedric mange, auricular mange, and cheyletiellosis

To examine the influence of previous episodes of uncomplicated diverticulitis on the prognosis of patients who subsequently develop complicated diverticulitis. One hundred and fifty patients with previous episodes of diverticulitis who were admitted to the Mayo Clinic (Rochester, MN, USA) with complicated diverticulitis (perforation, abscess, obstruction, phlegmon, fistula, or bleeding). The retrospective analysis was based on two groups of patients: group A had one or two prior episodes of diverticulitis (n = 118) and group B had more than two prior episodes of diverticulitis (n = 32). MEASUREMENT OF OUTCOME: The following criteria were used: phlegmon was a symptomatic inflammatory mass separate from and not associated with a purulent fluid collection; pericolic abscess was a collection of purulent material localized near the colon or in the pelvis; obstruction was characterized by obstructive symptoms and a stricture or stenosis diagnosed by radiographic studies or pathological evaluation; fistulas included colovaginal and colovesicular connections; perforation was either a collection of contained air outside the bowel wall or a large amount of free intra-abdominal air; and patients who required a transfusion for a lower gastrointestinal haemorrhage associated with symptoms and signs of diverticulitis were placed in the bleeding category. Perforated diverticulitis occurred more often in patients from group A; because of this, patients in group A underwent more surgical diversions. There were no appreciable differences in operative complications, morbidity or mortality rates. Patients with more than two episodes of uncomplicated diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis.

To study the technique of endoscopic axillary lymph node dissection by liposuction. Endoscopic axillary lymph node dissection (E-ALND) after liposuction (group A) were performed on 45 patients with breast cancer from Dec. 2004 to Oct. 2005. It was compared with traditional ALND (group B). The average operation time of E-ALND was 108 min (60 - 190 min), it was longer than that in group B (P < 0.05). The total blood loss in group A was 152.82 ml (80 - 220 ml), it was less than that in group B significantly (P < 0.01). In group A, the mean lymph nodes harvested by endoscopy were 18 (8 - 34), the total postoperative lymph flow was 140.38 ml (60 - 180 ml), the duration of drainage was 6.91 d (6 - 15 d). The postoperation complication included axillary seromas 7 cases, epidermic blister 5 cases, operation area phlegmon 2 cases were found in group A. There was no significant difference between two groups in the total postoperative lymph flow, the duration of drainage and the number of dissected lymph nodes and postoperation complication. The incision of chest wall was smaller in group A, and patients by this surgery were satisfied with the cosmetic results. Endoscopic axillary lymph node dissection by liposuction could match the traditional lymphadenectomy. The technique should be further standardized.

Ureteral obstruction caused by L-asparaginase-induced pancreatitis in a child with acute lymphoblastic leukemia.

深頚部蜂か織炎からｄｅｘｓｅｎｄｉｎｇ ｎｅｃｒｏｔｉｚｉｎｇ ｍｅｄｉａｓｔｉｎｉｔｉｓへの進展過程の判定に対する超音波検査の有用性

Groups A, B, C and G streptococci were cultured from 63 consecutive in-patients recruited between November 1987 and April 1988 and monitored until the end of July 1988. Chronic leg ulcers were present in 34 patients. Group G was found in 34 patients, 25 of whom had pyoderma and 3 had sepsis. Six of the patients had no signs of clinical infection, and treatment with antibiotics was therefore withheld. Recurrent phlegmon or erysipelas developed in 2 of 28 patients with clinical Group G infections. Erysipelas developed some 1-7 months later in 3 of the 6 patients who were not initially treated. No significant difference in severity or additional medical conditions was found between the patients with either Group G or Group A streptococci. In comparison, data on all streptococcal cultures at the Department indicated that Group G was isolated 2.6 times as often as Group A streptococci for the in-patients, compared with 1.1 for all patients seen. It is concluded that Group G streptococcal skin infections must be regarded with the same clinical vigilance as Group A infections.

Bacteriological and clinical studies have been performed on meropenem (MEPM, SM-7338), a newly developed carbapenem antibiotic, in the pediatric field. 1. Antibacterial activities of MEPM against 24 clinical isolates were determined. MEPM showed excellent activity against Gram-positive bacteria including Staphylococcus aureus and Gram-negative bacteria, especially Escherichia coli and Branhamella catarrhalis. Against Haemophilus influenzae, MEPM had a higher activity than imipenem and flomoxef, but had a lower activity than piperacillin and cefoperazone. 2. Clinical efficacies of MEPM were evaluated in 32 cases with bacterial infections. A poor efficacy was observed in 1 patient with phlegmon but excellent or good efficacies were obtained in other 31 patients with tonsillitis (1), pneumonia (17), UTI (12), or SSSS (1). The overall efficacy rate was 96.9%. All strains except 1 of S. aureus were eradicated by the administration of MEPM, and a high eradication rate of 95.8% (23 out of 24 strains) was obtained. 3. No side effects were observed in 35 evaluated cases. As abnormal laboratory test results, elevated GOT, elevated GPT, eosinophilia and neutropenia were noted in 4, 4, 4 and 2 patients, respectively. 4. Influences on blood coagulation parameters were studied. PIVKA II was elevated upon administration of MEPM in some cases, but no changes in ATT, TT, HPT or Fbg were observed during the treatment. Based on the above results, it has been concluded that MEPM is a safe and effective drug to use in the treatment of pediatric infections. The usual recommended dosage and administration should be 10 to 20 mg/kg of MEPM at a time, using intravenous drip infusion, 3 times a day.

Gangrene of the Genitalia as seen in Advanced Periurethral Extravasation with Phlegmon

Cases of woody phlegmon: A. J. Held. Schweiz. Monatschr. f. Zahnh. 59: 546, 1949