Acute suppurative terminal cholangitis:Clinical characteristics of a new subtype of acute cholangitis

Background:Acute suppurative terminal cholangitis(ASTC)is rarer than acute obstructive cholangitis and is not well studied.To explore this subtype of acute cholangitis,we described our clinical experience with ASTC.Methods:We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020.We analyzed their clinical characteristics,including etiology,clinical manifestations,imaging features,treatment and prognosis.Results:A total of 32 ASTC patients were included in the analysis.The majority of the patients had a history of biliary operations,and clinical manifestations were occult and atypical.The positive rate of bacterial culture was 46.9%.All the patients had typical imaging features on computed tomography and magnetic resonance imaging.Treatment with effective antibiotics was provided as soon as diagnosis was established.After treatment,most patients had a good outcome.Elevated levels of total bilirubin,aspartate aminotransferase,procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis.Conclusions:Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis,and that earlier diagnosis and more personalized treatments are needed.

Acute suppurative oesophagitis with fever and cough: A case report

BACKGROUND Suppurative oesophagitis is a diffuse inflammation of the oesophagus characterized by suppurative exudate or pus formation.Suppurative infections can affect any part of the gastrointestinal tract,most commonly the stomach,with inflammation involving the entire gastric cavity.However,cases extending beyond the cardia or pylorus and involving the oesophagus,small intestine,and colon are rare.Usually such cases are discovered during surgery or autopsy.CASE SUMMARY We report a rare case of acute suppurative oesophagitis.A 57-year-old man presented at the Emergency Department of our hospital with fever and productive cough.The patient had a significant history of lower oesophageal mucosal frostbite.He was successfully diagnosed and treated with repeated gastroscopy,appropriate antibiotics,and innovative symptomatic treatment.CONCLUSION Early diagnosis and appropriate treatment of acute suppurative oesophagitis are critical.Nutritional support,postural drainage,and other symptomatic treatments must be considered.

Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.

Aural Toileting and Dressing—Important Intervention Measures in the Management of Acute Suppurative Otitis Media

Background: Otitis media is one of the most common childhood infections, the leading cause of doctor’s visit by children in ENT clinic. The acute form if not recognized early is commonly characterized by suppuration from the middle ear following perforation of the tympanic membrane otherwise referred to as acute suppurative otitis media (ASOM). If not adequately treated, it progresses to chronic suppurative otitis media with attendant challenges in management. Ceasation of ear discharge is an indication of resolution of disease. The objective of this study is to appraise the value of local ear suction toileting and dressing in the ceasation of ear discharge in acute suppurative otitis media. Materials and Method: Consecutive new cases of acute suppurative otitis media seen at the Ear, Nose and Throat clinic of a tertiary health centre in north western Nigeria were assessed for efficacy of aural toileting and dressing with antibioctic impregnated guaze in the treatment of acute suppurative otitis media and compared with patients with similar disease without aural toileting and dressing or dressing with normal saline soaked guaze in addition to systemic antibiotic and antihistamine medications. Ear toileting was done by suctioning the discharge with suction machine, and cleaning the external auditory canal with hydrogen peroxide and methylated spirit. They were then dressed with gauze impregnated with antibiotic ear drops daily until there was no more ear discharge. The period of ceasation of ear discharge in each group was assessed. Results: There were 39 patients with acute suppurative otitis media (ASOM). Eighteen were females (46.2%) while 21 were males (53.8%), giving M:F ratio 1:2.1. Their ages ranged between 1 month and 45 years. About 36 (92.3%) were children and out of this, 28 (77.8%) were less than 5 years old. The average period of ceasation of discharge was 24 - 48 hours with those undergoing ear toileting and dressing but varied between 7 and 10 days with those without ear dressing or dressing with normal saline soaked guaze. This finding compelled us to stop the study on ethical grounds when this was carried out in the first 5 patients on each side of the study groups necessitating reversals of other groups to aural toileting and dressing with antibiotic impregnated guaze. Conclusion: Local ear toileting and dressing appear to show significant contribution to the early ceasation of ear discharge and are highly recommended not only for acute suppurative otitis media but also for all suppurative ear diseases.

PROGRESS AND PROSPECT ON BRONCHIAL ASTHMA TREATED BY SUPPURATIVE MOXIBUSTION

Research of 1960’s show that treating asthma with suppurative moxibustion has obvious effectiveness and can improve immune function of asthmatic patients. But, making a comprehensive survey of the research situation, effectiveness of asthma treated by suppurative moxibustion needs to be heightened, two defects of suppuration and scar of suppurative moxibustion are worth notice, and we must explore the mechanism of asthma treated by suppurative moxibustion above all, which should be setted about from "supperative effect" and from preventing and treating air passage inflammation of asthmatic patient, so as to progressively promote and promote the research going deep into molecule and gene levels.

Postoperative infection of the skull base surgical site due to suppurative parotitis:A case report

BACKGROUND Paraganglioma occurring at the lateral skull base is a rare tumor.Surgery is the primary treatment of benign paragangliomas.Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.CASE SUMMARY A 30-year-old man with a 1-year history of left-side progressive hearing loss,tinnitus,facial palsy,and choking failed conventional treatment and is the focus of this case report.Imaging revealed a mass around the left jugular foramen that was approximately 47 mm×38 mm×34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery.The tumor breached the meninges and occupied the cerebella pontine region.A two-stage surgery was designed for the resection of the mass.In the first-stage,the epidural portion of the mass was removed.The abdominal fat and the temporal muscle flap were transposed within the surgical site.The surgery was successful;however,25 d after surgery,he developed suppurative parotitis,and the infection spread to the surgical site at the skull base.Broad-spectrum antibiotics were used,and debridement was deployed.After that,the wound was cleaned daily.Five months after the first-stage surgery,the wound was still unclosed,and there was intermittent purulent exudation within the surgical site.vacuum sealing drainage(VSD)was used,and the wound healed in a month.One year after the first surgery,the second-stage of the operation was performed to remove the intracranial portion of the tumor.Recurrence of the tumor was not detected after a 6-month follow-up.CONCLUSION After a lateral skull base surgery,suppurative parotitis can spread into the operative cavity leading to infection of the surgical site.VSD can help to effectively heal the infected wound.A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.

Effect of successive irrigation of subarachnoid cavity on body temperature and cerebrospinal fluid-related index in suppurative meningitis model dogs

BACKGROUND： At present, suppurative meningitis is mainly treated through anti-infection with antibiotics, depressing encephalic pressure with mannitol , lowering body temperature with drugs , supporting treatment, etc. However, Jt takes a long course of treatment and has poor therapeutic effect. Successive irrigation of subarachnoid cavity maybe have better effect on suppurative meningitis.OBJECTIVE： We compared the successive irrigation of subbarachnoid cavity with routine therapeutic methods to observe the effect of successive irrigation of subarachnoid cavity on the body temperature, cerebrospinal fluid pressure, the number of white blood cell and the level of protein of suppurative meningitis dogs. DESIGN： A randomized and controlled animal experiment SETTING： Institute of Neuroscience, Taihe Hospital Affiliated to Yunyang Medical College MATERIALS： Totally 17 healthy adult male Beagle dogs, of common grade, weighing 9 to 10 kg, were involved in the experiment, and raised in the 20 ℃ temperature with relative humidity of 50% for 1 week. They were randomized into 3 groups： normal group （n=5）, control group （n=5） and irrigation group （n=6）. Artificial cerebrospinal fluid was prepared according to the level of glucose and chloride of cerebrospinal fluid of normal dogs, and then it was sterilized with high pressure. METHODS ： This experiment was carried out in the experimental animal center of Yunyang Medical College from April to August 2001. ① After the dogs were anesthetized,1 mL fresh staphylococcus aureus liquid [（1.5-1.6）× 10^9 L 1] was injected into medullary cistern to establish suppurative meningitis models. ② After models were successfully established, intravenous drip infusion of 1.2 ×10^6 U/（kg.d）, muscular injection of sulfadiazine sodium of 100 mg/（kg.d ）and intravenous injection of 200 g/L mannitol of 5 g/（kg .time） for 3 times a day were performed in the control group. The irrigation of subarachnoid meningitis was conducted in the irrigation group besides the routine treatments in the control group： Artificial cerebrospinal fluid was successively injected into the epidural catheter in the waist part. The mixtures of artificial cerebrospinal fluid and inflammatory cerebrospinal fluid flowed out incessantly from epidural catheter of medullary cistern. Irrigation was ended 48 hours later. Dogs were routinely raised in the control group. ③ From the first day after being modeled to the 14^th day after treatment, the rectal temperatures were daily measured in the morning, at noon and in the evening respectively, then the mean temperatures were calculated. From the 2^nd day after being modeled to the 14^th day after treatment, puncture at waist was given once, and the cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured. MAIN OUTCOME MEASURES ： The body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured on suppurative meningitis model dogs. RESULTS＂ Totally 17 Beagle dogs were involved in this study.①The body temperatures of dogs were significantly reduced in the control group and in irrigation group on the 1^st day after treatment and lower than suppurative meningitis model dogs on the 2^nd day after being modeled （P 〈 0.05）. The body temperatures were gradually decreased in control group from the 2^nd day after being modeled to the 14^th day after treatment （P 〈 0.01）, but were significantly higher than those of dogs in normal group on the 14^th day after treatment （P 〈 0.05）. The body temperatures of dogs were gradually decreased in irrigation group on the 2^nd day or 3^rd day after treatment （P 〈 0.01） and then were close to the normal body temperature on the 14^th day after treatment. ②There was the same cerebrospinal fluid pressure in control group as in irrigation group on the 2^nd day after being modeled （P 〉 0.05）, but significantly decreased in two groups from the 1s＇ day or 2^nd day after treatment （P 〈 0.01）, and cerebrospinal fluid pressure was close to the normal level in irrigation group. Although the cerebrospinal fluid pressure raised a little on the 3^rd day or 4^th day after treatment in the irrigation group （P〈 0.05）, but recovered to the normal level on the 9^th day after treatment again. It decreased slowly in the control group and still was sig- nificantly higher than normal group on the 14^hd day after treatment （P〈 0.01 ）. ③No significant difference existed in number of white blood cell and the level of protein between control group and irrigation group on the 2^nd day following modeled. Both of them began to significantly decrease on the 1^st and 2^nd day after treatment （P 〈 0.01 ）. Although the number of white blood cell and the level of protein rebounded a little in irrigation group 3 or 4 days after treatment （P〈 0.05）, they were gradually decreased and recovered to normal levels on the 13^th day after treatment. The number of white blood cell and the level of protein slowly decreased in the control group compared with irrigation group and were still significantly higher than normal group on the 14^th day （P〈 0.01 ）. EONELUSEON ： Irrigation of subarachnoid cavity can decrease the body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein at early stage of suppurative meningitis, and the therapeutic effect is better than that of routine treatment.

Clinical Application of a Microbiological Study on Chronic Suppurative Otitis Media

Our prospective study conducted over a period of 9 months includes 100 samples of ear discharge collected from 90 patients suffering from tubo-tympanic type of chronic suppurative otitis media (CSOM). The ear discharge which is collected with sterile swabs is subjected to Gram’s staining and culture of the causative organism. Antibiotic sensitivity test of cultured bacterial growth is undertaken to know the susceptibility of the causative organism. Of the 100 samples, 62 were culture positive where Pseudomonas aeruginosa was the most common pathogen followed by Staphylococcus aureus. Most of the cultured organisms in our study were sensitive to drug Ciprofloxacin. The outcome of our study enabled us to set an empirical medical treatment for an early resolution of ear discharge and inflammation in our patients with CSOM as we could understand the aetiological pathogens and their susceptibility pattern. Effective medical treatment in obtaining a discharge free ear prior to surgical treatment led us to improve the surgical outcome in our patients with CSOM.

A Rare Case of Suppurative Parotitis with Facial Nerve Palsy

Parotid mass causing facial nerve palsy is rare, and is associated with malignant tumours. Acute infection or abscess leading to facial nerve palsy is an extremely rare complication. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction.

Analysis of the Clinical Value of Surgical Treatment and Postoperative Anti-Infection Treatment of Acute Suppurative Appendicitis

Objective: To explore the clinical value of surgical treatment and postoperative anti-infection treatment for acute suppurative appendicitis. Methods: A total of 116 patients with acute suppurative appendicitis were enrolled in this study. The collection period was from December 2021 to December 2023. The patients were randomly grouped into a control group (surgical treatment) and an observation group (surgical treatment and postoperative anti-infection treatment), of 58 patients each. At the end of the treatment, the results of each index of the two groups were compared. Results: The length of hospitalization time, exhaust time, and incidence of complications in the observation group were shorter than those of the control group (P < 0.05). The total effective rate of the observation group was higher than that of the control group (P < 0.05). Conclusion: It is crucial to perform anti-infective treatment promptly after surgical treatment in patients with acute suppurative appendicitis. It can effectively prevent the occurrence of complications and improve the clinical efficacy. Hence, it is worthy of research and promotion.

Aerobic bacteria associated with chronic suppurative otitis media in Angola

Background:Chronic suppurative otitis media(CSOM)is an important cause of hearing loss in children and constitutes a serious health problem globally with a strong association to resource-limited living conditions.Topical antibiotics combined with aural toilet is the first-hand treatment for CSOM but antimicrobial resistance and limited availability to antibiotics are obstacles in some areas.The goal of this study was to define aerobic pathogens associated with CSOM in Angola with the overall aim to provide a background for local treatment recommendations.Methods:Samples from ear discharge and the nasopharynx were collected and cultured from 152 patients with ear discharge and perforation of the tympanic membrane.Identification of bacterial species was performed with matrix-assisted laser desorption/ionization-time of flight mass spectrometry and pneumococci were serotyped using multiplex polymerase chain reactions.Antimicrobial susceptibility testing was done according to EUCAST.Results:One hundred eighty-four samples from ear discharge and 151 nasopharyngeal swabs were collected and yielded 534 and 289 individual isolates,respectively.In all patients,correspondence rate of isolates from 2 ears in patients with bilateral disease was 27.3%and 9.3%comparing isolates from the nasopharynx and ear discharge,respectively.Proteus spp.(14.7%),Pseudomonas aeruginosa(13.2%)and Enterococcus spp.(8.8%)were dominating pathogens isolated from ear discharge.A large part of the remaining species belonged to Enterobacteriaceae(23.5%).Pneumococci and Staphylococcus aureus were detected in approximately 10%of nasopharyngeal samples.Resistance rates to quinolones exceeded 10%among Enterobacteriaceae and was 30.8%in S.aureus,whereas 6.3%of P.aeruginosa were resistant.Conclusions:The infection of the middle ear in CSOM is highly polymicrobial,and isolates found in nasopharynx do not correspond well with those found in ear discharge.Pathogens associated with CSOM in Angola are dominated by gram-negatives including Enterobacteriaceae and P.aeruginosa,while gram-positive enterococci also are common.Based on the results of antimicrobial susceptibility testing topical quinolones would be the preferred antibiotic therapy of CSOM in Angola.Topical antiseptics such as aluminium acetate,acetic acid or boric acid,however,may be more feasible options due to a possibly emerging antimicrobial resistance.

Surveillance of antibiotic sensitivity pattern in chronic suppurative otitis media of an Indian teaching hospital

Introduction:Chronic suppurative otitis media (CSOM) is a common problem in worldwide and untreated CSOM leads to fatal complications like facial nerve paralysis,lateral sinus thrombosis,labyrinthitis,meningitis and brain abscess in developing country like India.Objective:To isolate causative bacteria and antibiotic sensitivity pattern for CSOM and to know the prevalence of extended spectrum beta lactamases (ESBL) and Metallobetalactamases (MBL) in CSOM patients.Methods:A total of 500 ear swabs of clinical suspected CSOM patients were cultured on specific cultured medium and identified the bacteria with conventional methods.Then all the identified bacteria were subjected with specific antibiotics by the Kirby-Bauer's method to know the resistance pattern of antibiotics.ESBL and MBL strains were detected by double disc diffusion test.Results:A total of 384 bacteria were isolated from 500 CSOM patients,among them 86 P.aeruginosa (22.40%),112 Staphylococcus aureus (29.17%),53 A.baumannii (13.80%),32 E.aerogenes (18%),26 C.freundii (6.77%),24 K.oxytoca (6.25%),23 P.vulgaris (5.99%),18 K.pneumoniae (4.69%) and 10 P.mirabilis (2.60%) identified with conventional methods.From antibiotic disc diffusion methods 74.22% ESBL strains and 9.90%MBL strains were documented.Multidrug resistant strains of P.aeruginosa (86/384,22.40%) were more prevalent than those of S.aureus (112/384,29.17%) and other bacteria in ear discharges.Imipenem and vancomicin could control to gram negative bacteria and gram positive bacteria respectively.Conclusion:Continuous and periodic evaluation of microbiological profile and antimicrobial sensitivity pattern of bacterial is essential for optimum management of CSOM patients.

慢性化脓性中耳炎活动期并发耳后骨膜下脓肿的临床分析(附6例报告)

目的分析慢性化脓性中耳炎活动期并发耳后骨膜下脓肿的临床特点和治疗方案。方法回顾性分析2020年8月~2022年4月于青海大学附属医院耳鼻咽喉科就诊的6例耳后骨膜下脓肿患者的致病特点、治疗方式及效果。结果6例均为慢性化脓性中耳炎患者,1例伴有胆脂瘤形成,均表现为耳后红肿及明显疼痛,无全身症状。6例患者的听骨链及外耳道后壁均有不同程度的破坏,5例的手术方式为完壁式乳突根治及鼓室成形,1例中耳胆脂瘤为开放式乳突根治及鼓室成形。1例患者为混合性聋,5例患者为传导性聋。随诊12个月,术后听力较术前改善,预后良好,6例患者均无复发。结论慢性化脓性中耳炎活动期并发的耳后骨膜下脓肿破坏力强,容易出现听骨链、外耳道后壁的破坏,引起明显的听力下降。耳后骨膜下脓肿患者应尽早行脓肿切开,在鼓室成形的同时,应根据是否合并中耳胆脂瘤决定乳突根治为完壁式或开放式。

Sepsis after Administering an Intramuscular Iron Injection in the Arm of an Elder Patient with Multiple Comorbidities: A Case Report

Background: Skin reactions and musculoskeletal injuries caused by intramuscular injection are an increased risk for skin and soft tissue infections and may culminate in sepsis. Objective: To describe the history of an elderly patient who developed a lesion in her right arm after home administration of intramuscular iron injection in this arm and its outcome. Methods: This is a case report of a patient who participated in a study in an intensive care unit. Results: This study describes a 65-year-old patient with multiple comorbidities who was admitted to the hospital complaining of pain for two months and difficulty in moving her right shoulder associated with skin and soft tissue infections in her right arm after intramuscular iron administration by a relative for the treatment of multifactorial anemia and refractory melena. The patient worsened her general condition and was transferred to the intensive care unit. Despite the therapy instituted, the patient developed sepsis of cutaneous origin, multiple organ dysfunction, and death. Conclusions: The administration of intramuscular medication requires the participation of qualified professionals, such as nurses, mainly within the scope of the Brazilian public health system which commonly comprises patients in a context of vulnerability.

慢性化脓性中耳炎再次手术及原因分析

慢性化脓性中耳炎是耳科常见疾病,临床表现主要为耳流脓及不同程度的听力损失。乳突改良根治术是治疗胆脂瘤型及骨疡型中耳炎的主要方法,手术目的是清除病变组织,获得干耳;但术后仍有部分患者出现持续或间断流脓,

Gallbladder Carcinoma of the Thyroid Revealed by an Acute Festered Thyroiditis: A Literature Study about a Case

The cutaneous extension of gallbladder thyroid carcinoma is uncommon and is among the aggressive forms of the disease. We are reporting the case of a woman of 54 that shows acute festered thyroiditis worsened by a necrotic ulcer wound on the skin lasting 3 weeks amid a big neglected hetero-multinodular goitre, evolving since 20 years. The anatomopathological test showed a gallbladder thyroid carcinoma of the thyroid with severe inflammation. The treatment consisted of a complete thyroidectomy with recurrent bilateral dredging. There was a favourable evolution. Gallbladder carcinoma, in its aggressive aspect, may be linked to the occurrence of acute festered thyroiditis. Therefore, the prognosis of our patient was favourable.

以化脓性中耳炎为首发症状的韦格纳肉芽肿1例

韦格纳肉芽肿是一种自身免疫性小血管炎,常见的病变器官为上呼吸道、肺部、肾脏。耳部症状为首发表现者少见,容易误诊及漏诊。我科近期诊治1例以化脓性中耳炎为首发症状的韦格纳肉芽肿,现报道如下。1临床资料患者,男,48岁。因左耳流脓1个月,加重伴左眼闭合差、口角向右歪斜1 d于2014-06-25入院。该患者1个月前无明显诱因出现左耳流脓,伴耳痛、耳闷及听力下降,当地医院予抗生素治疗未见明显好转,半月前就诊于我院,诊断为'急性化脓性中耳炎(左)',行鼓膜切开,继续抗感染治疗无明显缓解。入院前1 d上述症状加重,

中耳炎外科之未来

20世纪50年代,由于显微镜的引入,使得耳科手术进入了耳显微外科时代。抗生素的广泛应用、电钻和显微器械不断推陈出新,使得中耳炎手术由经典乳突根治手术向功能重建术式转变,由有创逐渐趋向微创。

手术治疗伴腭裂的中耳炎

腭裂是一种常见的先天性颌面畸形,由于颌面畸形使得腭咽部肌肉解剖异常,造成咽鼓管功能障碍,致使分泌性中耳炎患者发病率升高,继而引起听力下降。虽多数患者幼年行腭裂修复术及鼓膜置管术等方式进行治疗,但仍有部分患者因中耳病情迁延而变为慢性中耳炎,需要手术治疗。

慢性化脓性中耳炎常见病原菌的耐药性

慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)是耳鼻咽喉科常见病,选择敏感的抗生素是主要治疗方法之一,对常见病原菌耐药性分析在临床治疗CSOM有重要意义。本文对168例CSOM的脓性分泌物进行培养并对其耐药性进行分析。