Presence Of Pus Research Articles

Video assisted thoracoscopic surgery in the management of acute fibrinopurulent empyema in paediatric patients

Background: Empyema is the presence of pus in the pleural space that usually follows an episode of pneumonia in pediatric age group. The aim of this study was to assess the efficacy of management of acute fibrinopurulent stage of empyema by early video assisted thoracoscopic surgery (VATS) in paediatric patients.Methods: The study was carried out at a tertiary care hospital in India. It was a prospective interventional observational study. The study included 40 children between age group 0-12 years attending the surgery in-patient department referred for further management of parapneumonic effusions who had clinical and radiological evidence of empyema and thoracocentesis confirmed purulent exudate in pleural cavity, were subjected to early VATS after thorough pre-operative workup.Results: The mean age was 7.22 years. Average operative time was 135.5 minutes. The mean duration of hospital stay was 7.5 days. Few complications were bleeding, superficial wound infection, bronchopleural fistula, pneumothorax, recurrence of empyema and incomplete expansion of lung.Conclusions: VATS facilitates the management of fibrinopurulent and organised pyogenic pleural empyema with less post-operative discomfort and complications and reduced hospital stay. However larger sample size study is required to come to a definitive conclusion.

Endoscopic retrograde cholangiopancreatography (ERCP) findings to predict survival in patients with metastatic pancreatic adenocarcinoma.

e16734 Background: Chemotherapy is the primary therapy for patients with metastatic pancreatic ductal adenocarcinoma (PDAC), but response to therapy is variable. Patients with PDAC often develop jaundice and cholangitis and require endoscopic biliary stenting. Here, we investigate the association between ERCP findings, cholangitis, chemotherapy use, and survival in PDAC patients. Methods: We conducted a retrospective chart review of all patients who received metal stents for biliary obstruction with PDAC over a five-year period at the Massachusetts General Hospital. Only patients with metastatic cancer were included. Patients were stratified by whether or not they received chemotherapy, as well as the presence or absence of cholangitis. Associations between chemotherapy use and ERCP findings were investigated. Survival analyses were performed to compare patients by chemotherapy use, presence of cholangitis, and findings at ERCP. Results: A total of 126 patients were included; the average age of patients in our study was 69.9 ± 11.8. The average size of the primary lesion was 38.7 ± 14.4 mm. Sixty-nine percent of patients completed chemotherapy. The average number of stents for all patients was 2.5 ± 2.5, but was significantly higher in patients who experienced cholangitis (3.3 ± 2.8) as expected (p < 0.001). The majority of ERCP reports noted debris or sludge (44%), followed by presence of infiltrating or obstructing tumor (27%), stone (13%), pus or purulence (11%), and blood clot (5%). Patients who did not receive chemotherapy were more likely to have tumor obstruction noted on ERCP compared to those who received chemotherapy (p = 0.024). Patients undergoing chemotherapy were also more likely to have sludge noted on ERCP (p = 0.009) compared to those who did not have chemotherapy. There was no association between chemotherapy use and presence of stones (p = 0.94) or presence of purulence (p = 0.44) noted on ERCP. Among patients who received chemotherapy, those who had sludge or debris noted on their ERCP tended to have better survival compared to those where sludge was not noted on endoscopy (p = 0.038). Conversely, among patients who received chemotherapy, identification of an obstructing tumor on ERCP was prognostic of poorer survival (p = 0.037). Among patients who did not get chemotherapy, there was no survival difference between patients who had sludge or tumor and those who did not. Conclusions: Findings on ERCP may serve as a surrogate for chemotherapy response and be prognostic of survival in metastatic PDAC.

3:45 PM Abstract No. 360 Predictors of catheter-related infections of tunneled lines in the inpatient setting

Inpatients with central venous catheters (CVCs) that show signs of local or systemic infection may undergo CVC removal followed by catheter tip culture for confirmation of catheter-related infections (CRI) and catheter-related bloodstream infections (CRBSI), as defined by positive catheter tip culture with a congruent positive blood culture. The use of this test has dwindled over the past decade, owing to factors including reimbursement penalties, poor predictive value, and increased reliance on blood cultures (BCx). We aim to develop a clinical risk calculator to reduce unnecessary removal and catheter tip culture. This IRB-approved retrospective study examined 151 patients in the inpatient setting who underwent tunneled CVC removal and tip culture. The primary outcome was the presence of CRI as defined by a positive catheter tip culture. Subgroup analysis was performed to determine which clinical factors results influenced the presence of CRI. All analyses were performed using χ2 analysis, and binary logistic regression with backward elimination. In this cohort, the median age at placement was 52 years, and median catheter-days was 98 days. Of the 151 lines removed, 32 patients (21%) had CRBSI and 43(29%) of catheter tips were culture positive. Variables predictive of CRI were gram-positive BCx prior to line removal and access site purulence (OR = 2.2 and OR = 4.0, P < 0.05). Variables that were not predictive of CRI included: fungal BCx, access site and laterality, CVC type, white count, placement indication, catheter tip location, signs of systemic infection, tenderness, and erythema. While not in the final model, CVC cultures with gram-negative organisms were related to the absence of CRIs (χ2 value = 3.6, P < 0.05). In this population, it is important to discern high-risk patients. Our model demonstrates feasibility of a risk calculator in the setting of possible CRI. When choosing a course of action, clinicians may consider removing CVCs in the presence of purulence or gram-positive BCx, and conversely, treating through non-gram positive BCx infections. Limitations of the study include cohort size and antibiotics given before cultures.

Female Cat Intravesical Sequestration after Ovariosalpingohisterectomy Using Nylon Clamp

Background: The nylon clamp, marketed as an accessory of electrical devices, has been used as an alternative method for definitive surgical hemostasis by ligature of arteriovenous vessels in ovariosalpingohisterectomy (OSH) in bitches and female cats. However, since May 2015, the Brazilian Veterinary Statutory Body (CFMV - Conselho Federal de Medicina Veterinária) banned its application, once it is a material still not regulated to be used in animals, in addition to the numerous reports of postoperative complications. This paper reports the migration of the clamp used in the OSH to the urinary bladder of the cat and the implications of the presence of the foreign body, in addition to discussing the use of this device in surgeries.Case: A 1-year-old Persian female cat, which, three months after an elective OSH in a private veterinary clinic, presented polyuria and hematuria. The patient presented pain at abdominal palpation; in the WBC were observed leucopenia and eosinophilia, indicating a chronic inflammatory process installed; the urinalysis showed the presence of crystals, increased urinary density, milky aspect indicating presence of pus, proteinuria and hematuria; on ultrasound were observed the presence of two amorphous mobile structures inside the bladder, producing acoustic shadow, measuring approximately 0.4 and 0.6 cm in diameter, suggesting the presence of bladder urolithiasis. Considering the results, the patient was sent for a cystotomy. The association of acepromazine (0.02 mg/kg), midazolam (0.2 mg/kg), morphine (0.2 mg/kg) and ketamine (10 mg/kg) was used intramuscularly as preanesthetic medication. For anesthetic induction, 5 mg/kg of propofol was applied intravenously, in addition to epidural anesthesia with 1 mL/4 kg of lidocaine along 0.1 mg/kg of morphine and, for maintenance, isoflurane in oxygen at 100% was used. Then, a four-centimeter retro-umbilical incision was performed to exhibit the bladder. After the incision on the ventral aspect of the bladder wall, a nylon clamp with approximately 0.8 cm, present in the lumen was found and removed. The seromuscular synthesis of the bladder was with a 3-0 mononylon simple continuous suture, the muscle with a 2-0 mononylon sultan pattern, and in the skin an interrupted simple suture using 2-0 nylon was performed. Postoperative care comprised by amoxicillin with potassium clavulanate (15 mg/kg, orally, 8/8 h, 7 d), meloxican (0.15 mg/kg, orally, 24/24 h, 4 d) and tramadol (12 mg/kg, orally, 12/12 h, 4 d). After ten days, surgical stitches were removed, with good healing and clinical improvement, as well as remission of the symptomatology reported on anamnesis and physical examination.Discussion: The pathophysiology of the nylon clip migration probably occurred in a similar way to the intravesical migration of intrauterine devices (IUDs) to the abdominal cavity, bladder and intestine, in women. According to reports, it is a progressive event, in which several factors may be involved, mainly: inadequate implantation of devices, uterine infections, use of contaminated medical instruments, among others, followed by an inflammatory process, perforation of the uterine wall by the device, adhesions and migration to adjacent structures. In the present report, it is believed that the clamp lock failed in the procedure performed by the veterinarian responsible for OSH, with subsequent loosening and detachment, and migration to the urinary bladder, an organ located ventrally to the uterine body. However, the following hypotheses can also be raised: pregnancy at the moment of castration, followed by uterine stump retraction and release of the clamp; contamination of surgical instruments; postoperative infections and adhesions involving the bladder.

Melanoma del conducto auditivo externo. Presentación de un caso

Los melanomas cutáneos son neoplasias malignas cuya incidencia ha aumentado marcadamente en las últimas cinco décadas. En cuanto a los melanomas cutáneos primarios, la localización en cabeza y cuello representa el 17%. De estos, entre el 7% y el 16% se asientan en el oído externo, de los cuales, aproximadamente el 60% ocurren en el hélix y el antihélix (1, 2). El compromiso del conducto auditivo externo rara vez es informado y cuando ocurre, tiene lugar en el meato.&#x0D; Reportamos el caso de un paciente campesino con exposición a la luz solar de larga data. El paciente presentó una lesión de 1×1,5 cm, aproximadamente, de color pardo oscuro, en el conducto auditivo externo, con otalgia, otorrea con presencia de pus, sangre e hipoacusia y adenopatía preauricular y cervical. El diagnóstico se confirmó con punción por aspiración fina (PAFF) del tumor y, además, con el estudio de la pieza postoperatoria, que confirmó el resultado de la PAFF.

European multicenter survey on approaches in pediatric laparoscopic appendectomy

This survey reviewed the practice of laparoscopic appendectomy in pediatric surgical centers across Europe. An online survey questionnaire was created and data obtained analyzed. There were 58 responders (52 Consultants and 6 trainees), of them n = 24 performed > 100 laparoscopic procedures per year. Procedures were performed by trainee with scrubbed consultant supervision n = 30, trainee with unscrubbed consultant n = 14, independent trainees n = 8 and consultants n = 6. Optic port preferences were 10 mm (n = 29), 5 mm (n = 24) and 12 mm (n = 3). Working port placement preference was sectorization n = 32, triangulation n = 16 and n = 10 decided based on intraoperative findings. Mesoappendix was dissected by monopolar hook n = 26, bipolar forceps n = 20, harmonic devices n = 8, and bipolar scissors n = 4. Appendix ligation was done with 3 vicryl endoloops (n = 36), 2 vicryl endoloops (n = 13), 3 polydioxanone (PDS) endoloops (n = 7) and endostaplers (n = 2). Appendix was removed through optic 10–12 mm port (n = 27), exchanging 5 mm for 10–12 mm port (n = 9), endobag (n = 8), sterile glove digit endobag (n = 7), through 5 mm ports (n = 5) and along 5 mm port (n = 2). In complicated appendicitis, n = 48/58 would proceed with laparoscopy on prior confirmed perforation and n = 53/58 would continue with laparoscopy when intraoperative findings showed complicated appendicitis. In the presence of pus, n = 52/58 would perform peritoneal lavage and n = 4/58 would only suction pus. Complicated appendices were removed via endobag n = 30, through 10–12 mm port n = 10, sterile glove digit n = 10, exchange 5 mm for 10–12 mm port n = 7 and along with work port n = 1. Opinions were divided with regards to approach in performing various steps of pediatric laparoscopic appendectomy in institutions throughout Europe.

2631 A New Uterine Suspension Technique May Fasten Patient Recovery After Laparoscopic Radical Hysterectomy

Study Objective Postoperative fever may delay the patient recovery after laparoscopic radical hysterectomy (LRH). The use of traditional uterine manipulator could be one of the reasons behind this issue. The aim of this study is to evaluate the feasibility and surgical outcomes of a new method of manipulating the uterus during LRH. Design A retrospective cohort study. Setting A university-based tertiary obstetrics and gynecology hospital. Patients or Participants Patients with early stage of cervical cancer and treated by the same surgical team were enrolled. Between January 2015 to February 2019, 40 patients (Group S) have undergone LRH with this new technique described as uterine suspension followed by a modified cervical holder (Fig.1), and 40 patients (Group T) underwent LRH with traditional uterine manipulator. Interventions Variables such as age, histological result, International Federation of Gynecology and Obstetrics (FIGO) stage and surgical outcomes were analyzed by student-t test and Wilcoxon rank sum between above two groups. Measurements and Main Results As shown in Table 1 and Table 2, postoperative fever was shorter in Group S compared with that in Group T (2 days vs 4 days,P=0.004). Lower blood loss (188ml vs 249ml,P=0.018) and shorter operation time (211 min vs 242 min, P=0.004) was shown in Group S, No statistical significance were found in the number of positive lymph nodes (7/40 vs 5/40,P=0.422) or lymphovascular invasion(16/40 vs 17/40,P=0.465) between these two groups. Conclusion The use of this simple uterine suspension technique may decrease the incidence of post operation fever, allowing patients with early-stage cervical cancers for faster recovery after operation. It is recommended for every LRH especially with the presence of pus inside the uterus. Postoperative fever may delay the patient recovery after laparoscopic radical hysterectomy (LRH). The use of traditional uterine manipulator could be one of the reasons behind this issue. The aim of this study is to evaluate the feasibility and surgical outcomes of a new method of manipulating the uterus during LRH. A retrospective cohort study. A university-based tertiary obstetrics and gynecology hospital. Patients with early stage of cervical cancer and treated by the same surgical team were enrolled. Between January 2015 to February 2019, 40 patients (Group S) have undergone LRH with this new technique described as uterine suspension followed by a modified cervical holder (Fig.1), and 40 patients (Group T) underwent LRH with traditional uterine manipulator. Variables such as age, histological result, International Federation of Gynecology and Obstetrics (FIGO) stage and surgical outcomes were analyzed by student-t test and Wilcoxon rank sum between above two groups. As shown in Table 1 and Table 2, postoperative fever was shorter in Group S compared with that in Group T (2 days vs 4 days,P=0.004). Lower blood loss (188ml vs 249ml,P=0.018) and shorter operation time (211 min vs 242 min, P=0.004) was shown in Group S, No statistical significance were found in the number of positive lymph nodes (7/40 vs 5/40,P=0.422) or lymphovascular invasion(16/40 vs 17/40,P=0.465) between these two groups. The use of this simple uterine suspension technique may decrease the incidence of post operation fever, allowing patients with early-stage cervical cancers for faster recovery after operation. It is recommended for every LRH especially with the presence of pus inside the uterus.

Chinese expert consensus on diagnosis and treatment of infection after fracture fixation

Currently, accurate diagnosis and successful treatment of infection after fracture fixation (IAFF) still impose great challenges. According to the onset of infection symptoms after implantation, IAFF is classified as early infection (<2 weeks), delayed infection (2∼10 weeks) and late infection (>10 weeks). Confirmation of IAFF should be supported by histopathological tests of intraoperative specimens which confirm infection, cultures from at least two suspected infection sites which reveal the same pathogen, a definite sinus or fistula which connects directly the bone or the implant, and purulent drainage from the wound or presence of pus during surgery. Diagnosis of IAFF is built on comprehensive assessment of medical history, clinical signs and symptoms of the patient, and imaging and laboratory tests. The gold standard of diagnosis is histopathological tests. Treatment of IAFF consists of radical debridement, adequate irrigation, implant handling, systematic and local antibiotics, reconstruction of osseous and/or soft tissue defects, and functional rehabilitation of an affected limb. Early accurate diagnosis and appropriate treatment of IAFF play a key role in increasing the cure rate, reducing infection recurrence and disability risk, restoring limb function and improving quality of life of the patient.

Associations Between Inflammatory Endotypes and Clinical Presentations in Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by mucosal inflammation in the nose and paranasal sinuses. Inflammation in CRS is also heterogeneous and is mainly characterized by type 2 (T2) inflammation, but subsets of patients show type 1 (T1) and type 3 (T3) inflammation. Whether inflammatory endotypes are associated with clinical phenotypes has yet to be explored in detail. To identify associations between inflammatory endotypes and clinical presentations in CRS. We compared 121 patients with nonpolypoid CRS (CRSsNP) and 134 patients with polypoid CRS (CRSwNP) and identified inflammatory endotypes using markers including IFN-γ (T1), eosinophil cationic protein (T2), Charcot-Leyden crystal galectin (T2), and IL-17A (T3). We collected clinical parameters from medical and surgical records and examined whether there were any associations between endotype and clinical features. The presence of nasal polyps, asthma comorbidity, smell loss, and allergic mucin was significantly associated with the presence of T2 endotype in all patients with CRS. The T1 endotype was significantly more common in females, and the presence of pus was significantly associated with T3 endotype in all patients with CRS. We further analyzed these associations in CRSsNP and CRSwNP separately and found that smell loss was still associated with T2 endotype and pus with the T3 endotype in both CRSsNP and CRSwNP. Importantly, patients with CRS with T2 and T3 mixed endotype tended to have clinical presentations shared by both T2 and T3 endotypes. Clinical presentations are directly associated with inflammatory endotypes in CRS. Identification of inflammatory endotypes may allow for more precise and personalized medical treatments in CRS.

A Proposal of a Clinically Based Classification for Idiopathic Granulomatous Mastitis

Objectives:There is no consensus regarding the surgical or immunosuppressive treatment of idiopathic granulomatous mastitis (IGM). This study aimed to introduce a clinical classification system for IGM that might facilitate its treatment and predict recurrence.Methods:We analyzed the management of 68 patients with IGM at (Princess Basma Teaching Hospital and King Abdulla University Hospital (1994-2016) to find out if distinct patterns of presentation exist according to the following parameters: presence of a painful or painless breast mass, local inflammation, abscess formation, communication to the skin, and extra-mammary manifestation.Results:We identified four distinct patterns of IGM: A: (13.23 %) A hard, painless breast mass. B: (52.94 %) A hard, painful breast mass with gross inflammation. C: (26.47 %) A breast abscess-like presentation. D: (7. 35 %) A subacute presentation with ulceration, sinus, or fistula formation. Erythema nodosum might complicate any of these patterns. Wide local excision in pattern A was curative with zero recurrence rate. The recurrence rates in patterns B and C were 22.20 % and 50.00 %. Patterns B, C, and D were treated by a combination of surgery and prednisolone. In keeping with this, recent literature is in favor of a wider use of immunosuppression especially in the presence of pus and extra-mammary findings.Conclusion:IGM could be classified into 4 distinct patterns according to the presenting signs and symptoms. These patterns correlated with treatment, recurrence rate, and the gross operative findings. This is the first step toward a classification for IGM. Multicenter and Meta-analysis studies are essential for a comprehensive prognostic classification. Treatment of IGM in any institution should be the responsibility of a multidisciplinary team.

Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk Factor.

Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD). We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens. There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds ratio 3.67; 95% confidence interval 2.22-6.06; p < 0.001) was the only significant factor associated with IAA. No significant factor was found to analyze variables associated with mortality. ERBD, but not PTCD, is associated with an increased risk of IAA in patients undergoing PD, which suggests that ERBD should be avoided whenever possible to prevent IAA. Further randomized clinical trials should be conducted to validate this relationship.

Diagnosis of Periimplant Disease.

The aim of this review is to describe the current guidelines for the differential diagnosis of periimplant diseases. Synopsis reviews were conducted to define the differential diagnosis of periimplant disease through an electronic literature search in MEDLINE up to February 2018. Periimplant mucositis is defined by the presence of bleeding and/or suppuration on gentle probing with or without an increased probing depth compared with previous examinations and by the absence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Periimplantitis is defined by the presence of bleeding and/or suppuration on gentle probing with an increased probing depth compared with previous examinations and by the presence of bone loss beyond crestal bone-level changes resulting from initial bone remodeling. Thus, a combination of clinical registrations (probing pocket depth, bleeding on probing, and presence of pus) combined with radiographic signs of possible bone loss is needed for differential diagnosis. An accurate baseline registration at the time of placement of the prosthesis (probing pocket depth and bone level) with ongoing yearly monitoring is essential for diagnosis and appropriate disease management.

Comparing the efficacy of cefixime versus amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women

Objective To evaluate efficacy of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria (ASB) in pregnant women. Background ASB can cause progressive and severe infections and endanger maternal as well as fetal health. Bacteriuria is usually associated with low birth weight, high blood pressure during pregnancy, maternal anemia, and fetal death. Patients and methods A prospective randomized study was conducted on 100 pregnant women having ASB in the first and early second trimester attending the pregnancy follow-up clinic in Galaa Teaching Hospital. Detailed history, laboratory investigations, obstetric, and ultrasound follow-up study were done. Results Maternal age (year) of patients ranged from 20 to 35 years, with a mean of 26.06 ± 4.91 years. The presence of pus and serial assessments of fetal growth were significant differences among the studied patients. Overall, 25% of patients had Intrauterine growth retardation (IUGR), 13% had premature rupture of membranes, and 13% had preterm labor. Adverse effects of drug such as presence of Gastrointestinal (GIT) upset, diarrhea, and vaginal candida infection were significantly increased in group 1 (18, 22, and 22%, respectively) than group 2 (4, 6, and 6%, respectively). Conclusion The use of amoxicillin/clavulanate is significantly more often accompanied by the development of adverse reactions compared with cefixime. Amoxicillin/clavulanate shows higher incidence of GIT manifestation, diarrhea, and vaginal candida infection. So, further larger studies could provide cost-benefit data necessary to inform a national screening program.

Предварительные результаты Российской национальной программы «Хронический тонзиллит»

The article is devoted to the results of the 1st stage of the National program «Chronic tonsillitis». The program was approved by the Council of Experts of NMAO at the end of 2017. Within the framework of the Program, in 20 cities of the Russian Federation 620 out-patient otolaryngologists performed a prospective observational study, which involved 6250 patients aged 5 years to 86 years. Epidemiological data were collected and the results of inter-relapse treatment of chronic tonsillitis (HT) were evaluated. Participants with compensated form of CT received 2 courses of inter-relapse therapy and 5 times visited a doctor, patients with decompensated form of CT were observed during 7 visits and received 3 courses of therapy. Female patients predominated among all participants. The age group of patients older than 60 years was the smallest. Among the noted complaints, throat tickling was most often recorded (93% of patients), of the local signs of HT – looseness and scarring of the Palatine tonsils (92%). For the examined patients prevailed compensated form CT (86%). Among the types of decompensation were the leaders of recurrent angina is 53%. The degree of examination of patients before inclusion in the study did not exceed 30%, regardless of the form of CT. There were 6 groups in composition of inter-relapse treatment: a combination of local anaesthetics and immunomodulators herbal drugs (group 2, 11%), with Tonsilotren (group 1, 66%), local anaesthetics and immunomodulators without the use of these drugs (group 5, 2%), Tonsilotren monotherapy (group 3, 18%) or herbs (group 4, 1%). 6% was conducted lavage of lacunas of the tonsils without pharmacotherapy. After the end of the 1st course of therapy, the greatest clinical effect was achieved in groups 1, 3 and 6 (p &lt; 0.01). A more pronounced positive trend was observed with respect to the presence of pus and caseous masses in lacunas, as well as edema and hyperemia of Palatine arches. Addition to standard therapy, herbal remedies, and especially Tonsilotren achieve the best therapeutic result. The average number of drugs in the scheme of anti-relapse therapy in groups 1, 2, and 5 was, respectively, 2.8±0.6; 3.6±0.5 and 3.8±0.8, with differences between groups 1 and 2 and groups 1 and 5 reached statistical significance, U-test, p &lt; 0.01. The efficacy (IMOS), treatment satisfaction (IMPSS), and tolerability assessments for the 1st course of anti-relapse therapy were positive in all groups, with a prevalence of higher scores in groups 1, 2, 3, and 6.

IMPROVING PLEURAL MICROBIOLOGY YIELD WITH BLOOD CULTURE BOTTLES

SESSION TITLE: Chest Infections 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Pleural infection, a complication of pneumonia, is a major cause of morbidity and mortality. To maximize the success in treatment, identification of the infectious agent is of utmost importance. When performing thoracenteses, fluid samples are typically collected in sterile containers, and are then sent for gram stain and culture. The yield using this method, however, is low, with previous reports hovering around 40%. This often leads to excessive use of broad-spectrum antibiotics, or potentially increased antibiotic resistance. Using blood culture bottles has been shown to significantly increase the yield of positive microbiology results (in one study, from 37.7% to 58.5%). Implementing this into common practice may therefore lead to more specific antibiotic targets and improve patient outcome. METHODS: In this retrospective study, we reviewed patients in three New York hospitals who had undergone small bore chest tube placement by pulmonary physicians over a nine-month period (June 2017 - February 2018). Of these, we identified eight cases of empyema, based on pleural fluid analysis (pH < 7.2, glucose < 5, presence of pus, positive gram stain or culture), and clinical presentation. Through chart review, we looked at the microbiology results and the antibiotic regimen each patient received. RESULTS: In each case, a pleural fluid sample was sent for microbiology analysis using standard sterile thoracentesis containers. Three out of the 8 cases had positive microbiology results (37.5%), which was similar to the percentage seen in prior reports. There was no statistically significant difference regarding hospital length of stay or mortality between patients with positive and negative results. CONCLUSIONS: Using standard techniques, the yield of microbiology testing of pleural fluid is relatively low at these three academic institutions. Sampling pleural fluid with blood culture bottles may improve the yield of microbiology testing. An increase in positive results will enable the pulmonary team to more effectively treat pleural infections, although it is unclear if this will affect patient length of stay or mortality. CLINICAL IMPLICATIONS: With this data, we plan to implement a quality improvement project wherein all patients with pleural infections who undergo small bore chest tube placement will have microbiology testing of the pleural fluid analysis utilizing blood culture bottles in place of the standard sterile vials. DISCLOSURES: No relevant relationships by Young Im Lee, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Gorav Sharma, source=Web Response

Postoperative infections after dental implant placement: Variables associated with increased risk of failure.

Wound infections after dental implant placement are a rare finding that might lead to early implant failure. However, the available information on this topic is scarce. This retrospective cohort study was conducted to determine factors that may increase the failure rate of dental implants that presented a postoperative infection during the osseointegration period. Postoperative infections were defined as the presence of pus or fistula in the surgical area, with pain or tenderness, swelling, redness, and heat or fever, before prosthetic loading. A bivariate and multivariate analysis of the data using Cox proportional-hazards regression was performed to detect prognostic factors for implant failure in patients that suffer infections. The patient-based prevalence of postoperative infections after implant placement was 2.80% (95% confidence interval (95%CI): 2.04% to 3.83%). Thirty-three out of 37 (89.19%) patients with infections had to be surgically retreated because of antibiotic failure and 65% of the infected implants were removed. The bivariate analysis showed a significant association between implant failure and the collar surface (HR: 3.12; 95% CI: 1.16 to 8.41; P=0.014). Cox proportional-hazards regression indicated that rough-surfaced collars increased 2.35 times the likelihood of failure (95% CI: 0.87 to 6.37; P=0.071). The survival of implants placed in the maxilla, with smooth collar, and late-onset of infection was higher than those placed in the mandible, with a rough collar and early onset of infection. In general, signs of infection after dental implant placement compromises the survival rate of the affected fixtures.

Dental Follicle Stem Cells as a Biomaterial for Periodontal Regeneration A proof-of-concept study

The goal of periodontal therapy is to regenerate the periodontal structures: cement, periodontal ligament and alveolar bone. Stem cell-based tissue engineering raised novel therapeutic strategies for periodontal repair. In vivo dental follicle stem (DFSC) cells give rise to cementoblasts, osteoblasts and fibroblasts. Based on this idea, we have assessed DFSC potential to regenerate the periodontal structures, and by that to elaborate a new biomaterial. An experimental study was performed on male Wistar rats which were subjected to a procedure of periodontitis induction through placing silk thread ligatures around the lower incisors, under general anesthesia. Clinically, the changes of the periodontal tissue (bleeding on probing, dental mobility, dental plaque, presence of pus) induced by the periodontitis progression were daily assessed. The subjects were divided in two groups: a control and a study group. After 7 days from placing silk thread ligatures, subjects from the study group received an injection in the gingival sulcus. The injected biomaterial contained dental follicle stem cells seeded on fibrinogen. Bleeding on probing at the end of the treatment period was significantly reduced in the study group (study vs control group - 0% vs 100%, p=0.01.). In terms of dental mobility statistical significant results were obtained (p=0.04): for 20% from the subjects from the study group dental mobility was absent, while in the control group all subjects presented different degrees of mobility (33.3% degree II- v-o/m-d, 66.6% degree III-v-o/m-d/ax). In the control group pus was present in 66.7% from the subjects, and absent in the study group (p=0.10). Dental plaque was present in 40% of the subjects from the study group and in 100% in the control group. The clinical and histological results of our study demonstrate that dental follicle stem cells are a valuable cell source for tissue engineering the periodontal tissue.

Incidence and case-control study of delayed-onset infection after lower third molar surgery

Delayed-onset infection was defined as an infectious swelling and trismus accompained by pain or the presence of suppuration starting after the discharge of the patient, generally a week after surgery. Our aim was to describe incidence and possible risk factors of delayed-onset infection after lower wisdoom tooth removal. Retrospective study of 851 lower third molar surgeries, performed between January 2013 and August 2017 at Semmelweis University Faculty of Dentistry, Department of Oro-Maxillofacial Surgery and Stomatology, has been done. The teeth were removed by 2 surgeons. Under age of 26, a case-control study comprising a total of 150 lower third molar surgeries were done to indentify possible risk factors. 10 delayed-onset wound infections were recorded after suture removal (1.17% of the patients). The mean time elapsing from surgery to delayed-onset infection was 30 days. Lower third molars with total soft tissue coverage, a bigger amount of bone coverage, a lack of distal space (Pell-Gregory class III), deeper impaction (Pell-Gregory classes B, C) or mesioangular tilt are associated with the development of this complication (p<0.05). Female sex and young age seem to be risk factors, too. Patients with risk factors should be warned that infection may still occur several weeks after surgery. The clinicians should observe these patients longer and emphasize keeping their wound clean for a prolonged period. Orv Hetil. 2018; 159(31): 1278-1283.

Can community health workers identify omphalitis? A validation study from Southern Province, Zambia.

Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low-resource settings. We tested an algorithm that task-shifts omphalitis diagnosis to community-level workers in sub-Saharan Africa. Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis. Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%. Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub-Saharan African setting.

The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria

BackgroundThe introduction of the Musculoskeletal Infection Society (MSIS) criteria for periprosthetic joint infection (PJI) in 2011 resulted in improvements in diagnostic confidence and research collaboration. The emergence of new diagnostic tests and the lessons we have learned from the past 7 years using the MSIS definition, prompted us to develop an evidence-based and validated updated version of the criteria. MethodsThis multi-institutional study of patients undergoing revision total joint arthroplasty was conducted at 3 academic centers. For the development of the new diagnostic criteria, PJI and aseptic patient cohorts were stringently defined: PJI cases were defined using only major criteria from the MSIS definition (n = 684) and aseptic cases underwent one-stage revision for a noninfective indication and did not fail within 2 years (n = 820). Serum C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate were investigated, as well as synovial white blood cell count, polymorphonuclear percentage, leukocyte esterase, alpha-defensin, and synovial CRP. Intraoperative findings included frozen section, presence of purulence, and isolation of a pathogen by culture. A stepwise approach using random forest analysis and multivariate regression was used to generate relative weights for each diagnostic marker. Preoperative and intraoperative definitions were created based on beta coefficients. The new definition was then validated on an external cohort of 222 patients with PJI who subsequently failed with reinfection and 200 aseptic patients. The performance of the new criteria was compared to the established MSIS and the prior International Consensus Meeting definitions. ResultsTwo positive cultures or the presence of a sinus tract were considered as major criteria and diagnostic of PJI. The calculated weights of an elevated serum CRP (>1 mg/dL), D-dimer (>860 ng/mL), and erythrocyte sedimentation rate (>30 mm/h) were 2, 2, and 1 points, respectively. Furthermore, elevated synovial fluid white blood cell count (>3000 cells/μL), alpha-defensin (signal-to-cutoff ratio >1), leukocyte esterase (++), polymorphonuclear percentage (>80%), and synovial CRP (>6.9 mg/L) received 3, 3, 3, 2, and 1 points, respectively. Patients with an aggregate score of greater than or equal to 6 were considered infected, while a score between 2 and 5 required the inclusion of intraoperative findings for confirming or refuting the diagnosis. Intraoperative findings of positive histology, purulence, and single positive culture were assigned 3, 3, and 2 points, respectively. Combined with the preoperative score, a total of greater than or equal to 6 was considered infected, a score between 4 and 5 was inconclusive, and a score of 3 or less was not infected. The new criteria demonstrated a higher sensitivity of 97.7% compared to the MSIS (79.3%) and International Consensus Meeting definition (86.9%), with a similar specificity of 99.5%. ConclusionThis study offers an evidence-based definition for diagnosing hip and knee PJI, which has shown excellent performance on formal external validation.