Suspicion Of Abscess Research Articles

Usefulness of several factors and clinical scoring models in preoperative diagnosis of complicated appendicitis.

The preoperative distinction between uncomplicated and complicated appendicitis is important to determine the appropriate treatments, such as antibiotics, surgery, or interval appendectomy. Computed tomography (CT) plays an important role; however, combining clinical and imaging factors may make preoperative evaluation more reliable. This study evaluated and analyzed cases and the usefulness of several preoperative factors and clinical scoring models to detect complicated appendicitis. A total of 203 patients preoperatively diagnosed with acute appendicitis at our facility were included. Complicated appendicitis was defined as appendicitis with gangrene, perforated appendix, and/or abscess formation. Preoperative factors were collected from published clinical scoring models; patient information, symptoms, signs, results of laboratory tests, and findings of CT. Factors were analyzed using a chi-squared test and the Mann-Whitney U test. The preoperative factors were compared between 151 uncomplicated and 52 complicated appendicitis patients. The significant factors were age ≥40, duration of symptoms >24 hours, body temperature ≥37.3°C, high levels of CRP, findings in CT scan (appendix diameter ≥10 mm, stranding of the adjacent fat, presence of fluid collection, and suspicion of abscess or perforation). We also evaluated the usefulness of clinical scoring models for the detection of complicated appendicitis and found the Appendicitis Inflammatory Response score and two prediction models (Atema score and Imaoka score) showed significance (p < 0.05). High serum CRP level was significantly associated with complicated appendicitis (p < 0.001), and the predicted existence rates of complicated appendicitis were 52.7% for serum CRP level ≥50mg/L, 74.4% for ≥100mg/L, and 82.6% for ≥150mg/L. The results demonstrated several preoperative factors and clinical scoring models to increase suspicion of complicated appendicitis. Specifically, high serum levels of CRP may be a useful factor in predicting complicated appendicitis prior to surgery when supported by clinical findings and imaging; however, further research is needed.

Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy

BackgroundPulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess.Case presentationA 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed.ConclusionsVisceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure.

Letter to the Editor Infection caused by Aeromonas sobria , complicated by lower extremity paraplegia and the cauda equine syndrome in a patient with well-controlled type 2 diabetes

Letter to the Editor Infection caused by Aeromonas sobria , complicated by lower extremity paraplegia and the cauda equine syndrome in a patient with well-controlled type 2 diabetes

Acute Lymphadenitis with Cellulitis Caused byStaphylococcus lugdunensis

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patient's clinical condition improved with appropriate antimicrobial therapy and pus drainage.

SPONTANEOUS RECTUS SHEATH HEMATOMA -A CASE REPORT-

Spontaneous rectus sheath hematoma, which is not derived from an external force, is rare and difficult to diagnose. The authors have recently experienced a clinical case of this disease. This is a report of the case with some comments based on the literature. The patient was a 63-year-old woman who visited our hospital because of right hypogastric pain. Physical examination indicated a tumor with pressure pain when palpated around areas slightly right of the median line and adjoining the pubic tubercle in the hypogastrium. Ultrasonography revealed a tumor in the abdominal wall, and surgery was performed under suspicion of abscess in the abdominal wall. A hematoma was found in the musculus rectus abdominis, and the right musculus rectus abdominis was separated 1/3 of the way from the lateral border. The hematoma was surgically removed under a diagnosis of rectus sheath hematoma. Women of middle or advanced age are frequent among patients with this disease. Although coughing and exercise are considered to be common inducing factors, there are many cases of unknown cause, resulting in a low rate of accurate diagnosis. The usefulness of ultrasonography has recently been recognized. However, rectus sheath hematoma is often difficult to differentiate from acute abdomen, so that this disease should be borne in mind on medical examination.