Surgery For Abscess Research Articles

Breaking Barriers in Fistula Management: The Power of DLPL Laser and Ayurveda Harmony

Background: Anal fistula is a tract between anal canal and perianal skin which often arises from abscesses and can spread in various directions. It becomes complicated if associated with certain comorbidities like Diabetes mellitus. Fourniers gangrene is a complication associated with scrotal fistula. In Ayurveda it is referred to as Bhagandara. The surgical approach aims to be minimally invasive and reduce the chances of recurrence employing techniques such as fistulotomy, Kshar Sutra ligation and laser ablation which has gained popularity for treating fistulas. Case: A 51 year old male patient presented with a swelling in the scrotum along with severe pain at perianal region extending up to base of the scrotum,that was persistent for 5 days, which made sitting and walking difficult for him. Due to recurrent symptoms following surgery for perianal abscess four months prior, he was admitted for treatment.. He was managed and treated of recurrent fistula that originated from scrotal abscess. Discussion: This was Unmargi Bhagandara in which patient faced a challenge as he suffered with diabetes and severe pain. The patient was offered an approach of combining surgical techniques with Ayurvedic principles utilizing specific medications and innovative pain management methods which resulted in significant improvements. Conclusion: The remarkable outcome of this case truly demonstrates the results. It wasn't, about resolving the surgical issue; it also had a positive impact, on the overall wellbeing of the patient. This exemplifies how practicing Ayurveda entails adopting an integrated approach to successfully treat and care for patients.

Predictors of length of stay following maxillofacial abscess surgery: A 10-year retrospective cohort

The aim of this study was to identify predictors of length of stay (LOS) after surgical therapy of maxillofacial abscess. Patients diagnosed with a maxillofacial abscess who underwent extraoral incision and drainage under general anesthesia between January 1st, 2012 and January 1st, 2022 were retrospectively reviewed Univariable and multivariable linear regressions were performed to identify the association between pre- and perioperative variables and the LOS. In total, 228 patients were included. In the forward stepwise multivariable analysis, all factors with a p-value <0.2 in the univariable model were included. Ultimately, six independent predictors of increased LOS were identified: female (coef. 0.14, 95% CI 0.03–0.25), immunosuppression (coef. 0.37, 95%CI 0.13–0.61), penicillin allergy (coef. 0.25, 95% CI 0.04–0.46), C-reactive protein (coef. 0.0008, 95% CI 0.0001–0.0014), multiple spaces involvement (coef. 0.36, 95% CI 0.13–0.59), and time to operation (coef. 0.005, 95% CI 0.002–0.008). In conclusion, our study provides new insights into predicting LOS for patients admitted with maxillofacial abscesses. The identification of these markers not only enhances the ability to forecast LOS, but also lays the groundwork for optimizing resource planning and potentially integrating them into a primary prevention algorithm.

Successful pneumovaginoscopic surgery for recurrent abscess of OHVIRA syndrome, preventing further recurrence and subsequent pregnancy

AbstractIntroductionOHVIRA syndrome is a rare congenital anomaly of Müllerian duct development characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The primary treatment is surgical excision of the obstructed hemivaginal septum and hematometrial drainage. In recent years, minimally invasive approaches such as hysteroscopic or vaginoscopic septum resection have been reported. Furthermore, we originally developed some novel pneumovaginoscopic gynecologic surgeries for years using a device that consists of a cylinder that fits into the vagina and a lid that mounts multiple ports, allowing the vagina to be dilated with carbon dioxide gas, similar to a single‐port laparoscope.Materials and Surgical TechniqueWe report a successful pneumovaginoscopic surgery for a complicated recurrent abscess in a patient with OHVIRA syndrome. Conventional surgery was performed with a single forceps in a liquid, as in cystoscopy or hysteroscopy. However, this new surgery allowed multiple forceps in a gas, as in laparoscopy. So pus and blood were aspirated and washed away without leaking into the abdominal cavity via fallopian tubes. The surgical smoke generated by thermal coagulation also aspirated to clean the field of vision immediately. And thick, complicated abscesses were drained successfully. The patient conceived through IVF with ICSI and delivered safely at full term.DiscussionPneumovaginoscopy could benefit complex vaginal surgery cases, such as abscess formation in patients with OHVIRA syndrome.

Fistula development after anal abscess drainage—a multicentre retrospective cohort study

PurposeAnal abscesses are common and, despite correct treatment with surgical drainage, carry the risk of developing fistulas. Studies identifying risk factors for the development of anal fistulas are sparse. This study aimed to identify the risk factors for anal fistulas after anal abscess surgery.MethodsThis was a multicentre, retrospective cohort study of patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019. The patients were identified using ICD-10 codes for anal abscesses. Predefined clinicopathological factors and postoperative courses were extracted from patient records.ResultsA total of 475 patients were included. At a median follow-up time of 1108 days (IQR 946–1320 days) following surgery, 164 (33.7%) patients were diagnosed with an anal fistula. Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50–5.06) and ischioanal (OR 2.48, 95CI 1.36–4.47) abscesses, Crohn’s disease (OR 5.96, 95CI 2.33–17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47–7.01) or repeat surgery (OR 5.96, 95CI 2.33–17.2), E. coli-positive pus cultures (OR 4.06, 1.56–11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57–6.71).ConclusionSeveral significant clinical risk factors were associated with fistula development following anal abscess surgery. These findings are clinically relevant and could influence the selection of patients for specialised follow-up, facilitate expedited diagnosis, and potentially prevent unnecessarily long treatment courses.

#393 : Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) — A Series of 6 Cases at a Tertiary Referral Centre

Background and Aims: OHVIRA is a rare congenital urogenital anomaly. Diagnosis is often delayed because patients have normal onset of puberty and menstruation if there is partial obstruction with a communicating fenestration in the hemivagina. Symptoms can be non-specific such as abdominal pain and dysmenorrhoea, but urinary retention and a pelvic mass have been reported. Haematocolpos can cause anatomical distortion, making imaging difficult. Definitive management is by vaginoplasty but that can be complex, especially in an anatomically small child, or cases with chronic inflammation. Retrograde bleeding during obstruction is common, leading to endometriosis and ascending infection. This is associated with complex surgery, increased morbidity and subfertility, which is why early diagnosis and timely management are important. Method: Medical records were retrieved from 6 patients with OHVIRA treated between 1 April 2021 and 31 March 2023 at a tertiary referral centre. For each patient, age of diagnosis, referral source, symptoms, diagnostic investigations, diagnostic challenges, anatomical findings, surgical managements, complications and outcomes were reviewed. Results: Patient’s ages ranged from 10 to 33 years. Median age of diagnosis was 30. Cases were referred from paediatric surgery (n=1), gynaecology (n=2), general surgery (n=2) and urology (n=1). Symptoms included abdominal pain (n=4), pyrexia (n=2), intra-menstrual bleeding (n=2) and vaginal discharge (n=1). 3 patients had been misdiagnosed before referral. All had unilateral haematocolpos and underwent ultrasound (n=6) and either MRI (n=4) or CT (n=2), followed by vaginoplasty. 2 patients had emergency surgery for pelvic abscesses. There were no intra- or post-operative complications, or adverse outcomes. Conclusion: Median age at diagnosis was advanced, and symptoms and referral source were variable. Misdiagnosis was frequent. Surgical management was successful with a single stage vaginoplasty. Ascending infection can be a consequence of delayed diagnosis and management. It is important to evaluate any female with dysplastic or absent kidneys for uterovaginal abnormalities.

Application of platelet-rich-plasma in the postoperative treatment of perianal abscess pseudohealing: A case report.

Perianal abscess is a common disease of the anus and intestine. Surgery is an important treatment option for perianal abscess. However, some patients have a long healing time, poor healing effect after surgery, or even pseudo-healing. Platelet-rich plasma (PRP) is rich in platelets that can release a large number of factors when activated and promote wound healing. Moreover, there are few reports on the use of PRP for wounds that are difficult to heal after perianal abscess surgery. The patient had reported a complaint of perianal swelling and discomfort associated with anal pain, which was considered a perianal abscess. Ceftriaxone, fumigation, and sitz bath were administered after mixed hemorrhoid and perianal abscess surgeries were performed; however, the wound remained unhealed for more than 3 months, and there was a fistula under the skin. Perianal color ultrasonography revealed perianal abscess. Autologous PRP treatment was performed 5 times for each patient. The postoperative wound healed within 15 days after 5 times PRP treatments. PRP is a novel treatment option for pseudo-healing.

Analysis of the permeable and retainable components of Cayratia japonica ointment through intact or broken skin after topical application by UPLC-Q-TOF-MS/MS combined with in vitro transdermal assay

Cayratia japonica ointment has been used for many years to promote wound healing after perianal abscess surgery. This study aimed to determine the skin-permeable and skin-retainable components of Cayratia japonica ointment after topical application to intact or broken skin via UPLC-Q-TOF-MS/MS analysis and in vitro transdermal assay. Moreover, a combination of semi-quantitative and molecular docking analyses was performed to identify the main active components of the Cayratia japonica ointment and the probable phases of the wound healing process that they act on. Modified vertical Franz diffusion cells and abdominal skin of rats were selected for the in vitro transdermal study. Mass spectrometry data were collected in both positive and negative ion modes. A total of 7 flavonoids (schaftoside, luteolin-7-O-glucuronide, luteolin-7-O-glucoside, apigenin-7-O-glucuronide, luteolin, apigenin, and chrysin) and 1 coumarin (esculetin), were found to permeate and/or retained by intact or broken skin. Among them, the flavonoids were more permeable through intact/broken skin and exhibited stronger binding affinities for targets related to the inflammatory and proliferative phases of wound healing. This study suggests that the flavonoids in Cayratia japonica ointment are most likely the main active components and are crucial at the inflammatory and proliferative phases of wound healing.

Surgery for paravalvular abscess in children

ObjectiveTo investigate the outcomes of surgery in children with paravalvular abscess at our institution. MethodsA retrospective review of all patients who underwent surgery for paravalvular abscess was performed. ResultsBetween 1989 and 2020, 30 patients underwent surgery for paravalvular abscess, of whom 5 (16.7%) had an intracardiac fistula and 6 (20.0%) had a pseudoaneurysm. Aortic annulus abscesses were most common, occurring in 23 patients (76.7%). Aortic root replacement was performed in 17 patients (56.7%), root reconstruction was performed in 4 (13.3%), and reconstruction of the central fibrous body was required in 5 (16.7%). Postoperatively, 7 patients (23.3%) required extracorporeal membrane oxygenation (ECMO) support, and 1 patient (3.3%) required permanent pacemaker insertion. There were 6 early deaths, 5 of whom were on ECMO, and no late deaths, with a 15-year survival of 79.7% (95% confidence interval [CI], 60.2%-90.3%). Deaths were from sudden cardiac arrest resulting in brain death in 3 patients, inability to wean from ECMO due to severe cardiac dysfunction in 2 patients, and cerebral mycotic aneurysm and hemorrhage in 1 patient. Freedom from reoperation was 40.0% (95% CI, 17.0%-62.3%) at 15 years Reoperation due to recurrence was rare, occurring in only 2 patients (6.7%). Streptococcus pneumoniae (hazard ratio [HR], 9.2; 95% CI, 1.6-51.7) and preoperative shock (HR, 6.4; 95% CI, 1.3-32.0) were associated with mortality. Central fibrous body reconstruction was associated with reoperation (HR, 4.4; 95% CI, 1.2-16.1). ConclusionsAlthough paravalvular abscess in children is associated with high early mortality, hospital survivors have good long-term survival. Reoperation is frequent, but is rarely due to recurrence of endocarditis.

Study on the factors influencing the prognosis after perianal abscess surgery

ObjectiveTo study the influence of clinical characteristics and diagnosis and treatment methods of perianal abscess on postoperative recurrence or formation of anal fistula to provide a basis for selecting appropriate surgical and inspection methods for clinical treatment of perianal abscess in the future.MethodsThe clinical data of 394 patients with perianal abscesses were collected, the influencing factors were investigated, and univariate analysis and multivariate logistic regression analysis were performed to further determine the risk factors affecting the prognosis of perianal abscess.ResultsThe results showed that the rate of preoperative blood routine results in the uncured group was higher (51.16%) than in the cured group (35.61%); the rate of high abscess space in the uncured group (23.26%) was higher than in the cured group (9.11%); the proportion of patients in the uncured group who underwent magnetic resonance imaging (MRI) before surgery (27.90%) was lower than in the cured group (45.30%); the proportion of patients in the uncured group who underwent simple drainage (51.16%) was higher than in the cured group (28.49%). The two groups had significant differences in perineal MRI examination, surgical method, preoperative blood routine, and abscess space (p = 0.030, p = 0.002, p = 0.047 and p = 0.010, respectively). Based on the results of univariate analysis and multivariate logistic regression analysis, the extent of the abscess cavity (OR = 2.544, 95%CI = 1.087–5.954, p = 0.031) and the surgical method (OR = 2.180, 95%CI = 1.091–4.357, p = 0.027) were independent influencing factors for postoperative recurrence of perianal abscess or anal fistula.ConclusionPreoperative assessment of the abscess range and precise intraoperative methods to resolve the infection of the abscess glands in the internal mouth can effectively improve the cure rate.

Early decompressive surgery within 72 hours of admission maintains financial advantages for patients with spinal epidural abscess, as evidenced by a retrospective study involving 130 cases

Abstract Background Several recent studies have highlighted the advantages of early decompressive surgery for patients with spinal epidural abscesses, specifically in terms of neurological function and overall quality of life. However, these studies predominantly advocate for surgery within 24 hours of admission, a time frame that may prove challenging for many hospitals because of limited operating room availability and bed occupancy. Consequently, it is pertinent to investigate whether a more flexible definition of “early surgery” yields observable benefits for patients to address these practical constraints. Materials and Methods In this 10-year retrospective study, we analyzed the electronic medical records of 130 patients who underwent decompressive surgery for epidural abscess. Patients were categorized into three groups based on the time intervals between admission and surgery: ≤24 hours (n = 24), 24 to 72 hours (n = 26), and &gt;72 hours (n = 80). Comparative assessments of demographic data, clinical presentations, and preoperative imaging characteristics revealed no statistically significant differences. We conducted separate analyses at 24 hours (n = 24 vs n = 106) and 72 hours (n = 50 vs n = 80) to explore the effects of different cutoff times. Neurological improvement (American Spinal Injury Association Impairment Scale [AIS] grade), daily living function (modified Prolo scale) changes 6 months postdischarge, and financial burden (hospitalization and postoperative stay duration, total expenditure) were evaluated as outcome measures. In addition, we compared the outcomes of patients within the 24- to 72-hour time range with those in the ≤24- and &gt;72-hour group to determine any differences among the three groups. Results Significant changes in AIS grade (1.17 vs 0.66, P = 0.019) and modified Prolo scale (4.21 vs 2.90, P = 0.011) were observed in the 24-hour group, whereas no such changes were seen in the 72-hour group. However, both groups showed reductions in financial burden, including hospitalization duration (24-hour group: 27.8 vs 46.8 days, P &lt; 0.001; 72-hour group: 31.3 vs 50.7 days, P &lt; 0.001) and total cost (24-hour group: $6551 vs $11,024, P &lt; 0.001; 72-hour group: $6709 vs $12,406, P &lt; 0.001). When analyzing the subgroup of patients with a time interval between 24 and 72 hours, we observed a loss of beneficial effects on AIS grade changes (1.2 vs 0.6, P = 0.045) and modified Prolo scale improvement (4.2 vs 3.1, P = 0.044) compared with the ≤24-hour group. However, this subgroup still exhibited positive effects in terms of reduced financial burden, including hospitalization duration (34.6 vs 50.7 days, P = 0.002) and total cost ($6851 vs $12,406, P &lt; 0.001), when compared with the &gt;72-hour group. Conclusions Our findings indicate that delaying decompressive surgery up to 72 hours after admission negates its benefits in enhancing neurological recovery and restoring daily life capacity. Nonetheless, this surgical approach continues to provide financial advantages by alleviating the financial burden on patients and the health care system. Further research with a larger sample size is recommended to deepen our understanding of these advantages.

Temporal trends in surgery for Crohn's disease: a ten-year single-center retrospective study.

Crohn's disease (CD) is a chronic inflammatory bowel disease that requires surgery in many cases.The aim of this article is to present the experience of a referral center regarding surgical interventions for CD, while also exploring the transformations that have occurred over 10years. The data of patients underwent abdominal surgery for CD between 2013 and 2022 were collected prospectively. Data were compared between two periods (2013-2017 and 2018-2022). Temporal trends were assessed with the Mann-Kendall trend test. A total of 1059 individuals underwent 1176 surgical procedures, of which 67.1% were male. The median age of patients at the time of surgery was 36.0years, and an overall increasing trend was observed in surgical volume (z = 3.04;p = 0.002). The proportion of patients treated with biologics increased from the first period (2013-2017) to the second (2018-2022), rising from 19.2% to 33.5% (p < 0.001). In the second stage, the proportion of patients who underwent surgery for abscesses or fistulas increased (47.8% vs. 40.0%, p = 0.028), while the percentage of emergency surgeries declined (3.0% vs. 7.1%, p = 0.001). Furthermore, there was a rise in the proportion of laparoscopic surgeries (76.5% vs. 63.7%, p < 0.001), coupled with a decrease in stoma rates (15.4% vs. 30.5%, p < 0.001) and postoperative complications (23.0% vs. 30.5%, p = 0.007). The frequency of biologics use in CD surgery have increased over time, and the proportion of penetrating patients has grown. Minimally invasive surgical methods have become the norm, and surgical outcomes have markedly enhanced, evidenced by a substantial reduction in both stoma rates and complication rates.

Artificial Intelligence Automation of Proptosis Measurement: An Indicator for Pediatric Orbital Abscess Surgery.

To evaluate the ability of artificial intelligence (AI) software to quantify proptosis for identifying patients who need surgical drainage. We pursued a retrospective study including 56 subjects with a clinical diagnosis of subperiosteal orbital abscess (SPOA) secondary to sinusitis at a tertiary pediatric hospital from 2002 to 2016. AI computer software was developed to perform 3D visualization and quantitative assessment of proptosis from computed tomography (CT) images acquired at the time of hospital admission. The AI software automatically computed linear and volume metrics of proptosis to provide more practice-consistent and informative measures. Two experienced physicians independently measured proptosis using the interzygomatic line method on axial CT images. The AI software and physician proptosis assessments were evaluated for association with eventual treatment procedures as standalone markers and in combination with the standard predictors. To treat the SPOA, 31 of 56 (55%) children underwent surgical intervention, including 18 early surgeries (performed within 24h of admission), and 25 (45%) were managed medically. The physician measurements of proptosis were strongly correlated (Spearman r = 0.89, 95%CI 0.82-0.93) with 95% limits of agreement of ± 1.8mm. The AI linear measurement was on average 1.2mm larger (p = 0.007) and only moderately correlated with the average physicians' measurements (r = 0.53, 95%CI 0.31-0.69). Increased proptosis of both AI volumetric and linear measurements were moderately predictive of surgery (AUCs of 0.79, 95%CI 0.68-0.91, and 0.78, 95%CI 0.65-0.90, respectively) with the average physician measurement being poorly to fairly predictive (AUC of 0.70, 95%CI 0.56-0.84). The AI proptosis measures were also significantly greater in the early as compared to the late surgery groups (p = 0.02, and p = 0.04, respectively). The surgical and medical groups showed a substantial difference in the abscess volume (p < 0.001). AI proptosis measures significantly differed from physician assessments and showed a good overall ability to predict the eventual treatment. The volumetric AI proptosis measurement significantly improved the ability to predict the likelihood of surgery compared to abscess volume alone. Further studies are needed to better characterize and incorporate the AI proptosis measurements for assisting in clinical decision-making.

Differences in Gut Microbiota between Healthy Individuals and Patients with Perianal Abscess before and after Surgery.

Surgery is the most important treatment for perianal abscesses. However, the gut microbiota of patients with perianal abscess and the effects of perianal abscess on the gut microbiota after surgery are unknown. In this study, significant changes in interleukin 6 and tumor necrosis factor-α in the blood of healthy subjects, patients with perianal abscesses, and patients after perianal abscess surgery were identified. 16S rRNA gene sequencing technology was used to detect the changes in the gut microbiota among 30 healthy individuals and 30 patients with perianal abscess before and after surgery. Venn diagrams and alpha diversity analyses indicated differences in the abundance and uniformity of gut microbiota between the healthy individuals and patients with perianal abscesses before and after surgery. Beta diversity analysis indicated that the grouping effects among the control, abscess, and surgery groups were good. The classification and compositional analysis showed significant differences in the gut microbiota between healthy individuals and patients with perianal abscesses before and after surgery. LEfSe analysis, random forest analysis, and ROC curve analysis showed that Klebsiella (AUC = 0.7467) and Bilophila (AUC = 0.72) could be potential biomarkers for the diagnosis of perianal abscess. The functional prediction results showed that the differential microbiota is significantly enriched in the pathways related to nutrition and drug metabolism. This study may have important implications for the clinical management and prognostic assessment of patients with perianal abscesses.

The contribution of preoperative MRI evaluation to emergency surgical management of perianal abscesses

Objective: Perianal abscesses occur as a result of an infection in the anal gland due to the obstruction of the anal gland ducts opening to the anal crypts. Preoperative use of MRI reduces the risk of recurrence, fistula formation, and postoperative fecal incontinence as it allows detailed anatomical imaging. The aim of this study is to investigate the contribution of preoperative MRI to reducing recurrence and surgical complications in patients who underwent emergency surgery for perianal abscess.&#x0D; Material and Methods: A total of 206 patients with perianal abscess evaluated and not evaluated with MRI between January 2016 and 2021 were included in this retrospective study. The patients had no history of surgery or local drainage applied to the perianal region. In addition to demographic data of patients, postoperative complications, hospitalization duration, recurrence ratio, and MRI findings are evaluated.&#x0D; Results: In the preoperative period, recurrence was found in 16 (%13.2) of 121 cases evaluated with MRI, while the disease recurred in 24 (%28.2) of 85 cases who were operated without MRI evaluation. The presence of a fistula was significantly higher while the presence of recurrence was significantly lower in the group that underwent MRI in the preoperative period (p=0.033, p=0.012 respectively).&#x0D; Conclusion: Contrary to popular belief, surgical treatment of abscesses is not that easy due to the high risk of recurrence, the high rate of association with perianal fistula, and the different types and spreads of abscesses. Therefore, preoperative MRI is the most useful diagnostic method for detecting perianal abscesses and additional pathologies.

Sex-based analysis of characteristics contributing to anorectal abscesses requiring acute care surgery

Males present more frequently with anorectal abscesses than females. Factors contributing to this difference are not clear. The purpose of this study is to evaluate comorbidities and demographic features at presentation that may contribute to the male predominance in this disease process. This is a retrospective study on patients who underwent acute care surgery for anorectal abscess at an urban safety-net hospital from 2015 to 2020. Bivariate analysis was used to determine factors associated with the sex difference in anorectal abscesses requiring acute care surgery. This study included 208 patients, of which 160 were male (76.9%). At the time of surgery, males had a higher rate of current tobacco use compared to females (25.6% vs. 8.3%, p = 0.009). Additionally, males who presented for surgery were older compared to females, (42.5 ± 10.8 years vs. 37.2 ± 13.4 years, p = 0.005). No differences were found between males and females with respect to comorbidities including diabetes, hypertension, body mass index (BMI), cardiovascular disease, or end stage renal disease. This study suggests that the male predominance in anorectal abscess necessitating acute care surgery may be partially explained by current tobacco use and older age.

The impact of procalcitonin in assessing outcomes in pediatrics severe trauma cases: A three-year experience from a tertiary hospital.

Although procalcitonin levels are raised in patients with systemic inflammation, its usage in pediatric patients, particularly those in the intensive care unit who are most susceptible to sepsis. It is a retrospective research study that included pediatric patients aged more than two weeks who were brought to the King Fahd Hospital of the University's PICU owing to serious trauma or post-acute postoperative occurrences from January 2017 to December 2019. At 24 h after admission, data such as age, gender, comorbidities, trauma severity as measured by the Injury Severity Score, and PRISM III score were collected. Following a surgery abscess, there were a total of 39 (15.9%) deaths. Patients who died during their hospital stay had significantly higher mean levels of biomarkers such as PRISM III, PCT at 24 h, PCT 48-72 h, and PCT at day 5 (p = 0.001). The area under the ROC curve for PCT level 48/72 h was 0.89 (% CI: 0.85-0.93), p = 0.001, indicating that PCT had highly significant predictive validity in predicting in-hospital mortality at the best cutoff point of >1.35 with a high level of accuracy and precision of 82.1% and 82.0%, respectively. The serum procalcitonin level (PTCL) can help predict the in-hospital prognosis of pediatrics that has had surgery. A combined control system is designed based on PTC expression for the examination of a patient receiving medication over a longer length of time.

Perioperative complications and outcomes following partial ear canal ablation and lateral bulla osteotomy in pet rabbits: 20 cases (2009-2021).

To investigate the perioperative complications and outcomes of rabbits undergoing partial ear canal ablation and lateral bulla osteotomy for treatment of chronic otitis. Surgical logbooks were searched to identify rabbits that underwent partial earcanal ablation and lateral bulla osteotomy between December 2009 and September 2021. Datacollected included signalment, history, clinical signs, historical and current medical management,physical examination findings, preoperative diagnostic imaging and aural bacterial culture results, surgical procedure information, duration of hospitalisation, complications and final outcome. Twenty rabbits with chronic, medically unresponsive otitis underwent 27 partial ear canal ablation and lateral bulla osteotomies. Ten rabbits had pre-existing neurologic deficits and 17 had an ear base abscess at the time of surgery. A total of 13 (65%) rabbits developed at least one complication, either in the perioperative period or between discharge and recheck. Three of these rabbits (15%) underwent revision surgery for persistent or recurrent ear base abscess. Complete resolution of clinical signs ultimately occurred in 12 (60%) rabbits. Three (15%) rabbits showed improved but not completely resolved clinical signs (three facial asymmetry). Five (25%) rabbits died of causes potentially related to chronic otitis and/or partial ear canal ablation and lateral bulla osteotomy; two of these rabbits had undergone revision surgery. Although this study reports a high complication rate (65%), most complications resolved, with 15 (75%) rabbits having a good to excellent final outcome. Since the majority ofrabbits in this study had chronic and severe ear disease, further studies are required todetermineif surgical intervention earlier in the disease process could result in a lower complicationrate.

Brain Abscess Surgery Outcome: A Comparison between Craniotomy with Membrane Excision versus Burr Hole Aspiration

Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases to verify the diagnosis because may even lead to death. CT scan with contrast is a good tool for diagnosing and localizing brain abscesses in late stages, however, it is difficult to diagnose them in the early stages. The development of MRI helps to more accurately diagnose brain abscess. Surgical management of brain abscesses is either medical or surgical through craniotomy or burr holes. Indications of each are still a point of debate among most neurosurgeons. Methodology: This is a descriptive longitudinal prospective study to compare the outcomes of two surgical procedures used in The National Centre for Neurological Sciences-Khartoum-Sudan (NCNS) from 2012 to 2015, craniotomy and excision of the abscess membrane versus burr hole and aspiration of brain abscess in terms of duration of hospitalization, length of antibiotic use, recurrence rate, number of images needed for follow-up, and the final postoperative early and late outcomes. The data was collected through a designed questionnaire and was then analyzed using SPSS version 20. No significant ethical approval was required for this study. Results: Fifty-four patients were operated on through craniotomy (29/54) and burr hole (25/54). Their ages ranged from 1 year to 53 years with an average presentation at 13 years of age. Most patients presented with fever (23.1%), convulsions (16%), vomiting (16.7%) and headache (15.4%). The mean of illness for both groups was almost 2 months. The majority of patients in this study were having no risk factors (38.9%) while the major risk factors seen were cardiac diseases (14.8%), neurosurgical procedures (13%) and otitis media (11.1%). As most patients presented late, the diagnosis of most was made using CT brain with contrast (83.3%). In most of the patients (85.2%) there were no organisms separated in the culture. 8/54 patients had positive cultures, 7/8 were bacterial and only one (1/8) was fungal. Most patients received antibiotics for 45 days postoperatively in both craniotomy and burr hole groups. When both groups were compared, those operated with craniotomy were found to have a relatively higher length of hospital stay, however, no significant difference was found between both groups. Also, it was found that those operated on with craniotomy had a high cure rate and less recurrence in comparison with burr hole group. Deterioration and death were significantly higher among craniotomy group. Only CT brain was used as the imaging modality of choice for follow-up in both groups for 4 months’ duration and it was noted that complete evacuation was significantly higher among craniotomy group while remnants were higher among burr hole group. Conclusion: Brain abscess is still a challenging condition for neurosurgeons in Sudan. The limited number of Sudanese neurosurgeons, neurosurgical centers and diagnostic facilities contributed to delay in diagnosing brain abscess in most patients. It is important to design a strict protocol and precautions for any neurosurgical operation or bedside procedure to prevent infection and subsequent brain abscess development. CT brain with contrast is a good imaging tool for assessing the size, site and stage of brain abscesses. No significant difference between craniotomy or burr hole for clearance from brain abscess in terms of antibiotic used or duration of hospital stay. However, burr hole aspiration is associated with higher rates of recurrences. On the other hand, craniotomy and excision have relatively higher neurologic morbidity postoperative with expectantly higher post-operative hospitalization but no differences in the final outcome. Therefore, the selection of surgical technique should be individualized in each case based on the abscess site size source patient fitness for surgery and neurosurgeon’s preference.

Effect of Huayu Qufu Shengji Decoction on Postoperative Pain and Wound Healing Time in Patients with Perianal Abscess

This study aimed to investigate the impact of postoperative pain and wound healing time in patients who underwent perianal abscess surgery. A total of 106 patients who underwent perianal abscess surgery from July 2019 to May 2021 were enrolled as study subjects and randomly divided into a control group and a treatment group with 53 patients in each group. The control group received potassium permanganate sitz bath after surgery, while the treatment group received smoked Huayu Qufu Shengji decoction after surgery. The levels of postoperative pain (measured by visual analog scale score), wound healing, inflammatory factors and treatment response rate were compared between the two groups. Before treatment, the visual analog scale scores were similar in both groups (p>0.05). However, after treatment, the visual analog scale scores in both groups decreased significantly and the visual analog scale score in the treatment group was lower than that in the control group (p<0.05). Moreover, the treatment group had a shorter wound shedding time, a quicker emergence of new epithelium and a smaller wound healing time compared to the control group (p<0.05). Before treatment, the levels of inflammatory factors such as tumor necrosis factor alpha, interleukin-6 and interleukin-1 beta were similar in both groups (p>0.05). However, after treatment, the level of each inflammatory factor was lower in the treatment group than in the control group (p<0.05). The treatment group showed a significantly higher treatment response rate than the control group (p<0.05). The application of smoked Huayu Qufu Shengji decoction and sitz bath in patients who underwent perianal abscess surgery can relieve pain, promote faster wound healing and improve the inflammation state, resulting in a significant overall effect. Therefore, this treatment can be preferred as a first-line therapy.

Treatments and outcomes of adult parapharyngeal and retropharyngeal abscess: 1882 cases from a Japanese nationwide database

PurposeAlthough parapharyngeal and retropharyngeal abscesses are potentially fatal deep neck abscesses, there is limited evidence for the treatment courses for adult patients with these abscesses. We aimed to describe the practice patterns and clinical outcomes of adult patients undergoing an emergency surgery for parapharyngeal or retropharyngeal abscesses using a nationwide database. Materials and methodsWe identified patients aged ≥18 years who underwent emergency surgery for parapharyngeal (para group, n = 1148) or retropharyngeal (retro group, n = 734) abscesses from July 2010 to March 2020, using a nationwide inpatient database. We performed between-group comparisons of the baseline characteristics, treatment course, and outcomes. ResultsCompared with the retro group, the para group was more likely to be older (median, 66 vs. 60 years; P < 0.001) and have several comorbidities, such as diabetes (21 % vs 16 %; P = 0.010) and epiglottitis (33 % vs. 26 %; P = 0.002), except for peritonsillar abscess (14 % vs. 22 %; P < 0.001) and tonsillitis (2.1 % vs. 13 %; P < 0.001). Regarding intravenous drugs administered within 2 days of admission, approximately half of the patients received steroids, non-antipseudomonal penicillins, and lincomycins. The para group received more comprehensive treatments, such as tracheostomy, intensive care unit admissions, and swallowing rehabilitation, within total hospitalization than the retro group. Moreover, it demonstrated higher in-hospital mortality (2.7 % vs. 1.1 %; P = 0.017) and morbidity (16 % vs. 9.7 %; P < 0.001), and longer length of hospitalization than the retro group. ConclusionThe current nationwide study provided an overview of the characteristics, treatments, and outcomes for patients who underwent an emergency surgery for parapharyngeal or retropharyngeal abscess.