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Introduction: Procalcitonin (PCT) as a marker of inflammation has not been studied and analyzed in purulent inflammations of the head and neck of odontogenic origin, which is the aim of this original article. Materials and methods: This retrospective study includes 31 men with odontogenic abscesses of the head and neck with a mean age of 42 years. As a control group, 31 healthy men are used. In all of them, leukocytes (WBC), neutrophils (Neu), C-reactive protein (CRP), and procalcitonin (PCT) are tested. Results: The average values of the studied indicators in the patients are: CRP - 89.45±85.15 mg/l, WBC - 11.78±4.61x103/L, Neu - 8.79±4.58x103/L and PCT - 0.8±0.8 ng/ Jr. The average values of the same indicators in the control group are: CRP - 0.9±1.17 mg/l, WBC - 7.37±1.9x103/L, Neu - 4.13±1.43x103/L and PCT - 0.18±1.27 ng/ml. There is no positive correlation between PCT on the one hand and CRP, WBC and Neu on the other hand. Discussion: The mean values of CRP, WBC, Neu and PCT are higher in men with odontogenic abscesses compared to the healthy controls, and this is statistically significant. Although PCT does not correspond to WBC, Neu and CRP, it has a number of advantages over them - it increases its concentration only in infections of bacterial origin, it increases its levels earlier and reaches its highest concentration earlier, it has a longer half-life, and its level declines more rapidly after infections. Conclusions: All this suggests that PTC may soon become the most accurate marker in diagnosing, treating, and follow-up of patients with head and neck odontogenic abscesses.

Botox treatment has become a popular method for reducing facial lines and wrinkles and rejuvenating the signs of aging. However, like any procedure, Botox can lead to temporary and minor complications. In the presence of certain systemic diseases such as diabetes mellitus, it is essential to take additional precautionary measures that should not be ignored, as it could turn into a life-threatening situation which may need to surgical intervention. Therefore, the key to success lies in ensuring that the procedure is carried out by skilled professionals, conducting a comprehensive medical history assessment, despite the simplicity of the procedure. Thus, we present a case of A 52-year-old diabetic woman came with a severe facial phlegmon persisting for 7 days and mentioned a previous Botox treatment 8 days ago. Drainage of the phlegmon was performed under general anesthesia using an intraoral vestibular approach.

Background: Odontogenic abscesses are the most common pathology in maxillofacial surgery. Their frequency is significantly higher in people with poor social status. Materials and methods: The study retrospectively included 81 patients with odontogenic abscesses and phlegmons of the head and neck, hospitalized and operated on as an emergency case. Incision wound secretion for microbiological examination and preparation of an antibiogram were taken from each of them as a standard routine procedure. Results and discussion: The most affected are young patients (till 44 years), followed by patients in middle age (45-59 years). The reason for this is that with age, teeth gradually fall out of the dentition of mature individuals, and with this, the possibility of the occurrence of odontogenic infections decreases. The lower jaw is more affected. A mixed resident microflora comprising more than one bacterial species is isolated in 62% of all patients. Gram-positive bacteria isolated in the samples of the studied patients were coagulase-negative staphylococci (Staphylococcus coagulase negative, CNS), Staphylococcus aureus, Streptococcus anginosus and Streptococcus viridans. Gram-negative bacteria were Escherichia coli, Enterobacter cloacae and Stenotrophomonas maltophilia. Obligate anaerobes were found in only one sample. The isolated fungi were Candida albicans and Candidanonalbicans. Conclusion: In the studied group of patients with odontogenic abscesses, Gram-positive bacteria In the studied group of patients with odontogenic abscesses, Gram-positive bacteria were 2.5 times more than Gram-negative. Single antibacterial therapy is preferable for patients with small-area odontogenic abscesses, while triple antibacterial therapy is recommended for large-area odontogenic abscesses and their phlegmonous forms.

Gastric wall abscess is a rare condition characterized by a purulent inflammatory process resulting in the formation of a pocket of pus in the stomach. As the mucosa is usually intact, it requires various tools such as endoscopic ultrasonography or computed tomography for the differential diagnosis to rule out more common subepithelial tumors. Even after the diagnosis, the treatment for gastric wall abscess was previously restricted to surgical resection in combination with antibiotics. Currently, in order to avoid unnecessary surgery, the alternative method of initial treatment with an endoscopic approach is recommended. It also helps to choose appropriate antibiotics with confirmation of the pathogen by drainage. There are few reports that describe the detailed processing of the endoscopic drainage, and there is no consensus on the treatment. The pathogens that cause gastric wall abscess are usually Streptococci, Staphylococci, and Escherichia coli. There is only one case reported to be caused by Candida albicans. This is the first report of Elizabethkingia anopheles as the pathogen of the gastric wall abscess. Here, we report a case of gastric wall abscess in a 75-year-old man, safely treated by endoscopic drainage and antibiotics, confirmed by isolating the contents of the abscess.

Background: Clarifying the bacterial causes of inflammatory diseases has a major role in the treatment of this type of pathology. Materials and methods: In a retrospective study of 138 adult patients with abscesses and phlegmons of the head and neck, hospitalized and operated on urgently in the Clinic for Maxillofacial Surgery at University Multispecialty Hospital for Active Treatment "Sveta Marina" EAD – city of Varna, Bulgaria. Depending on their origin, the patients were divided into two groups - with odontogenic and non-odontogenic abscesses. Results: The study group consists of 73 men (52.9%) and 65 women (47.1%) with a mean age of 43 (18-84) years. The mixed resident microflora, including more than one bacterial species, is isolated in the largest number of cultures – 64.2%. The total number of cultures with Gram-positive bacteria isolated in the samples of the studied 92 patients with isolates is 20,33%. Representatives of Gram-negative bacteria are isolated in 7.49% of all. Obligate anaerobes are found in 2.14% of the isolates. Microorganism fungi are encountered in 3.21% of the crops. In patients with phlegmons of odontogenic origin the ratio between Gram-positive and Gram-negative bacteria is 3:1. In phlegmons of non-odontogenic origin, they are entirely of the Gram-negative spectrum. Conclusion: Microorganisms are not isolated in a third of the examined patients, which are most likely long errors in taking material for microbiological examination or in its improper storage and transportation. Of the other crops, the share of resident microorganisms as opportunistic pathogens is the largest. Of the conditionally pathogenic microorganisms, Gram-positive ones predominate.

Introduction: Studies evaluating the rate and histology of appendiceal neoplasms between complicated and uncomplicated appendicitis include a small number of patients. Therefore, we sought a meta-analysis and systematic review comparing the rates and types of appendiceal neoplasm between complicated and uncomplicated appendicitis. Methods: We included articles published from the time of inception of the datasets to September 30, 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. Results: A total of 4962 patients with appendicitis enrolled in 4 comparative studies were included. The mean age was 43.55 years (16- 94), and half were male (51%). Based on intra-operative findings, 1394 (38%) had complicated appendicitis, and 3558 (62%) had uncomplicated appendicitis. The overall incidence rate of neoplasm was 1.98%. No significant difference was found in the incidence rate of appendiceal neoplasm between complicated (3.29%) and uncomplicated (1.49%) appendicitis (OR 0.44, 95% CI 0.16- 1.23; p < 0.087; I2 = 54.9%). The most common appendiceal neoplasms were Neuroendocrine Tumors (NET) (49.21%), Nonmucinous Adenocarcinoma (24.24%), Mixed Adeno-Neuroendocrine Tumor (MANEC) (11.40%), Mucinous Adenocarcinoma (4.44%). There was a significant difference between complicated and uncomplicated appendicitis in rates of adenocarcinoma (50% vs. 13%), NET (31% vs. 74%), MANEC (19% vs. 13%) (P < 0.001). Conclusion: While there was no significant difference in the overall neoplasm rate between complicated and uncomplicated appendicitis, the NET rate was significantly higher in uncomplicated appendicitis. In comparison, the Adenocarcinoma rate was considerably higher in Complicated appendicitis. These findings emphasize the importance of evaluating risk factors for neoplasm when considering appendectomy in patients with appendicitis. [ABSTRACT FROM AUTHOR]

The number of patients with deep phlegmon in the neck and acute secondary mediastinitis is increasing from year to year, which entails an increase in temporary disability, and in severe cases leads to death. Based on the research, we proposed a medical technology for the use of controlled negative pressure in the treatment of patients with acute secondary mediastinitis, developing against the background of a deep phlegmon of the neck. The dynamics of changes in the concentration of pro- and anti-inflammatory cytokines in the blood serum in patients with deep phlegmon of the neck and acute secondary mediastinitis with various methods of treatment was determined. It was found that in the group of patients in the treatment of which vacuum therapy was used, there is a decrease in the acute inflammatory process by 37.5% and by 28.6%, respectively, than with conventional treatment. The use of vacuum therapy in the treatment of patients with deep phlegmon of the neck reduces the duration of treatment in the intensive care unit by 20%, inpatient treatment by 15.4%, reduces the number of repeated surgical interventions and complications by 17.3% and 15.5%, respectively. At the same time, this method of treating patients with acute secondary mediastinitis leads to a decrease in the duration of treatment of patients by 12.2%, the number of complications and repeated surgical interventions by 21.2% and 34.4%, respectively. When used in the treatment of patients with deep phlegmon of the neck and acute secondary mediastinitis of vacuum therapy in the postoperative period on the 5th and 10th days and patients with acute secondary mediastinitis on the 10th and 14th days, there is a low concentration of cytokines in the blood serum by an average of 2 times, which indicates a decrease in the intensity of the acute inflammatory process. [ABSTRACT FROM AUTHOR]

Background/Aim: Basal cell carcinoma (BCC) is a frequent tumor entity, especially in the facial region. The standard therapy for BCC is surgical tumor excision which is generally a low-risk procedure. One of the life-threatening surgical risks and complications when removing BCC in the facial area is infection with the possibility to spread across the deep neck spaces as well as systemic inflammation (sepsis). Case Report: A 73-year-old patient presented to the emergency department with a swelling of the right cheek, extended towards the neck. Based on his medical history, an outpatient BCC excision of the cheek had been performed the day before. Laboratory tests showed a fulminant inflammatory process of sepsis. Computed tomography (CT) revealed a buccal phlegmon on the right extended towards the deep neck. A diagnosis of septic cervicofacial phlegmon following BCC excision was made. The therapy consisted of intensive care sepsis treatment, surgical relief, and drainage of the phlegmon and a calculated antibiotic treatment (piperacillin/tazobactam, clindamycin). Conclusion: Removal of BCC in the facial region is generally a low-risk procedure. A possible complication is postoperative wound infection. In rare cases the clinical picture of a septic cervicofacial phlegmon can develop. Surgical focus sanitation, broad-based antibiotic therapy and intensive care sepsis management are the key therapeutic pillars of this postoperative complication. [ABSTRACT FROM AUTHOR]

Appendiceal diverticulitis is a rare pathology which is distinctly different to acute appendicitis and associated with higher rates of morbidity and mortality. Furthermore, diagnosis is often retrospective on histopathological analysis of appendicectomy specimens due to the atypical clinical and radiological features. Herein, we present a case of ruptured appendiceal diverticulitis in a young patient with atypical clinical features and a radiologically normal appearing appendix in close proximity to an inflammatory phlegmon. This case highlights the importance of maintaining a high clinical suspicion of surgical pathology and considering atypical diagnosis in patients with inflammatory changes in the right iliac fossa.

Abstract Background Gastric carcinoma is one of the most frequent malignancies worldwide. Gastric cancer metastasis to the appendix is uncommon in incidence, and has been rarely described in acute-appendicitis-related literature reviews. In this presented case, we have reported a rare case of appendiceal phlegmon, due to a diagnosis of metastatic gastric adenocarcinoma with uncommon symptoms. Case presentation A 79-year-old Caucasian male presented to the emergency department with history of weakness, anorexia, lethargy, and mood changes for 2 months. Abdominopelvic computed tomography showed an abscess in right iliac muscle. After percutaneous drainage of the abscess and 6 weeks antibiotic therapy, an appendectomy was done for the patient. Histopathologic findings revealed the involvement of the appendiceal wall by adenocarcinoma, most probably with gastrointestinal origin. Gastric cancer was confirmed later by upper endoscopy and pathologic report. Conclusions Although the presence of tumor in appendectomy specimens is rare, and metastasis to appendix is even rarer, it should be considered as a cause of appendicitis, especially in elderly patients.

The article focuses on three contemporary representations of cystic fibrosis (CF) in fiction for younger readers. It analyzes and compares the graphic novel Ghosts by Raina Telgemeier (2016), the children's novel Caleb and Kit (Beth Vrabel 2017), and the Young Adult novel Five Feet Apart (Rachael Lippincott, Mikki Daughtry, and Tobias Iaconis 2018) from a literary disability studies perspective. Through an auto-ethnographic exploration and with "experiential knowledge of disability" (Bolt 131) in mind, the article examines which symptoms of CF are made presentable to the reader and which possible experiences are sanitized, romanticized, distorted, or omitted entirely. Ghosts and Five Feet Apart sanitize the illness experience, trying to spare readers from having to explore pain or unpleasant physical symptoms such as phlegm and digestive issues, and romanticize CF as a source of wisdom and living in the moment. Caleb and Kit, on the other hand, manages to convey a more multifaceted image of living with CF. [ABSTRACT FROM AUTHOR]

Background: Internally penetrating Crohn's Disease complications, including abscesses and phlegmon, represent a high-risk Crohn's Disease phenotype. Anti-tumor-necrosis-factor-α (Anti-TNF) therapies are effective in treating penetrating Crohn's Disease and early initiation has shown unique benefits. However, timing of anti-TNF initiation in the setting of internally penetrating Crohn's Disease complications is typically heterogenous due to concern over precipitating serious infections. Recent studies demonstrate such an association may not exist. Aims: We aimed to describe the multidisciplinary management of pediatric patients with internally penetrating Crohn's Disease complications, focusing on the utilization and timing of anti-TNF therapy relative to complication resolution and adverse events. Methods: We performed a single-center retrospective cohort study of pediatric patients with internally penetrating Crohn's Disease complications from 2007 to 2021. The safety and effectiveness of anti-TNF therapy initiation prior to complication resolution was assessed by comparing rates of infectious and Crohn's Disease-related adverse events between those who received anti-TNF therapy prior to complication resolution, versus those who did not. Results: Twenty-one patients with internally penetrating Crohn's Disease complications were identified. 7/21 received anti-TNF therapy prior to complication resolution. Infectious adverse events within 90 days of complication occurred in 0/7 patients initiating anti-TNF therapy prior to complication resolution and 10/14 patients who did not (p = 0.004). Crohn's Disease-related surgeries and hospitalizations within 1 year of complication occurred in 12/20 patients, with similar frequency between groups. Conclusions: Initiating anti-TNF therapy prior to internally penetrating Crohn's Disease complication resolution may be a safe and effective strategy to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

The management of Crohn's disease has evolved rapidly in the era of immunomodulators and biologicals. Despite this, a significant proportion of patients with Crohn's disease ultimately require surgical management. One of the indications for operative management includes failure of medical therapy. We report two cases of patients with complicated Crohn's disease who have exhausted medical therapy and failed medical management. In both cases, the patients developed large complex intra-abdominal phlegmons and intractable symptoms of intermittent pain, partial obstruction and/or infectious complications requiring operative intervention. Crohn's disease can present with a wide spectrum of disease. Considering the complexity of management in Crohn's disease, it is important for both physicians and surgeons to be aware of what constitutes failure of medical therapy and when it may be important to consider surgical involvement.

Background: Gastric carcinoma is one of the most frequent malignancies worldwide. Gastric cancer metastasis to the appendix is uncommon in incidence, and has been rarely described in acute-appendicitis-related literature reviews. In this presented case, we have reported a rare case of appendiceal phlegmon, due to a diagnosis of metastatic gastric adenocarcinoma with uncommon symptoms. Case presentation: A 79-year-old Caucasian male presented to the emergency department with history of weakness, anorexia, lethargy, and mood changes for 2 months. Abdominopelvic computed tomography showed an abscess in right iliac muscle. After percutaneous drainage of the abscess and 6 weeks antibiotic therapy, an appendectomy was done for the patient. Histopathologic findings revealed the involvement of the appendiceal wall by adenocarcinoma, most probably with gastrointestinal origin. Gastric cancer was confirmed later by upper endoscopy and pathologic report. Conclusions: Although the presence of tumor in appendectomy specimens is rare, and metastasis to appendix is even rarer, it should be considered as a cause of appendicitis, especially in elderly patients. [ABSTRACT FROM AUTHOR]

Despite an uncommon condition, the clinical management of phlegmon appendicitis (retention of the intra-abdominal appendiceal abscess) is still controversial, and probiotics might be partly helpful. Then, the retained ligated cecal appendage (without gut obstruction) with or without oral Lacticaseibacillus rhamnosus dfa1 (started at 4 days prior to the surgery) was used as a representative model. At 5 days post-surgery, the cecal-ligated mice demonstrated weight loss, soft stool, gut barrier defect (leaky gut using FITC-dextran assay), fecal dysbiosis (increased Proteobacteria with reduced bacterial diversity), bacteremia, elevated serum cytokines, and spleen apoptosis without kidney and liver damage. Interestingly, the probiotics attenuated disease severity as indicated by stool consistency index, FITC-dextran assay, serum cytokines, spleen apoptosis, fecal microbiota analysis (reduced Proteobacteria), and mortality. Additionally, impacts of anti-inflammatory substances from culture media of the probiotics were demonstrated by attenuation of starvation injury in the Caco-2 enterocyte cell line as indicated by transepithelial electrical resistance (TEER), inflammatory markers (supernatant IL-8 with gene expression of TLR4 and NF-κB), cell energy status (extracellular flux analysis), and the reactive oxygen species (malondialdehyde). In conclusion, gut dysbiosis and leaky-gut-induced systemic inflammation might be helpful clinical parameters for patients with phlegmon appendicitis. Additionally, the leaky gut might be attenuated by some beneficial molecules from probiotics. [ABSTRACT FROM AUTHOR]

Background.: Critical spinal epidural pathologies can cause paralysis or death if untreated. Although magnetic resonance imaging is the preferred modality for visualizing these pathologies, computed tomography (CT) occurs far more commonly than magnetic resonance imaging in the clinical setting. Objective.: A machine learning model was developed to screen for critical epidural lesions on CT images at a large-scale teleradiology practice. This model has utility for both worklist prioritization of emergent studies and identifying missed findings. Materials and Methods.: There were 153 studies with epidural lesions available for training. These lesions were segmented and used to train a machine learning model. A test data set was also created using previously missed epidural lesions. The trained model was then integrated into a teleradiology workflow for 90 days. Studies were sent to secondary manual review if the model detected an epidural lesion but none was mentioned in the clinical report. Results.: The model correctly identified 50.0% of epidural lesions in the test data set with 99.0% specificity. For prospective data, the model correctly prioritized 66.7% of the 18 epidural lesions diagnosed on the initial read with 98.9% specificity. There were 2.0 studies flagged for potential missed findings per day, and 17 missed epidural lesions were found during a 90-day time period. These results suggest almost half of critical spinal epidural lesions visible on CT imaging are being missed on initial diagnosis. Conclusion.: A machine learning model for identifying spinal epidural hematomas and abscesses on CT can be implemented in a clinical workflow. [ABSTRACT FROM AUTHOR]

Reports on patients hospitalised due to inflammatory diseases of the soft tissues in the head suggest worsening of the course of the underlying disease in the case of coexisting infection with the SARS-CoV-2 virus. The cases of 2 patients with neck phlegmon in the course of Coronavirus disease 19 (COVID-19) hospitalised at our Otorhinolaryngological Unit have been presented in the paper. Despite intensive treatment, the disease was fatal in both cases. COVID-19 probably has a significant impact on the course of disease and treatment results in the cases of patients with neck phlegmon. Coexisting diseases may seriously worsen the prognosis in patients with neck phlegmon and COVID-19. Further research is required to explain the mechanism of the impact of SARS-CoV-2 infection on the course of phlegmon in the head and neck region.

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019. Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact. Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.

Background: It is important to distinguish between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA) because the treatment methods are different. We aimed to create an algorithm that determines the severity of acute appendicitis (AA) without the need for imaging methods, using the decision tree method.Methods: The patients were analyzed retrospectively and divided into two groups as CAA and NCAA. Age, gender, Alvarado scores, white blood cell values (WBC), neutrophil/lymphocyte ratios (NLR), C-reactive protein value (CRP), albumin value and CRP/Albumin ratios of the patients were recorded.Results: In the algorithm we created, the most important parameter in the distinction between CAA and NCAA is CRP. NLR is predictive in patients with a CRP value of ≤107.565 mg/L, and the critical value is NLR 2.165. In patients with a CRP value of >107.565 mg/L, albumin is the determinant and the critical value is 2.85 g/dL. Age, gender, alvarado score and CRP/albumin ratio have no significance in distinguishing between CAA and NCAA. In the statistical analysis, there were significant differences between NCAA and CAA groups in terms of age (39.56 years vs 13,675 years), gender (48.1% male vs 71.4% male), WBC (13,891.10/mL vs 11,614.76/mL), CRP (27 mg/L vs 127 mg/L), albumin (3 g/dL vs 3 g/dL) and CRP/albumin (9.50 vs. 41).Conclusion: Thanks to the algorithm we created, CAA and NCAA distinction can be made quickly. In addition, by avoiding unnecessary surgical procedures in NCAA cases, patients' quality of life can be increased and morbidity rates can be minimized. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal collections in the form of abscesses or matted bowel loops, called phlegmons, might occur in patients with Crohn's disease (CD). The clinical characteristics and management of such conditions are not well described. We aim to characterize CD-related intra-abdominal collections clinically, and identify predictors of need for surgical interventions and the time to surgery. Methods: We utilized the Saudi Inflammatory Bowel Disease Information System (IBDIS) database to identify all patients treated for radiologically proven intra-abdominal abscesses or phlegmons since inception. Demographics, clinical data, clinical course, and treatment outcomes were recorded. Logistic regression analysis and survival analysis were used to identify predictors of surgical resection and differences in time to surgery between patient subgroups, respectively. Results: A total of 734 patients with a diagnosis of CD were screened and 75 patients were identified. The mean age was 25.6 ± 9.9 years and 51% were males. Nearly 60% of patients had abscesses larger than 3 cm while 13% had smaller abscesses and 36% had phlegmons. On presentation, the most commonly reported symptom was abdominal pain (99%) followed by weight loss (27%). About 89% of patients were treated with antibiotics during hospitalization for an average of 2.7 weeks. Steroids were prescribed for 52% of patients and tumor necrosis factor alpha (TNF-alpha) antagonists for 17%. Surgical resection was required for 33 patients (44% of the cohort) while 51% were managed with antibiotics and/or percutaneous drainage. The most common surgical intervention was ileocecal resection (45%). Although patients who underwent follow-up imaging were more likely to require early surgical intervention (P = 0.04), no statistically significant predictor of surgery could be identified from this cohort. Time to surgery varied numerically according to abscess size (HR = 1.18, 95% CI = 0.62–2.27, P = 0.61). Conclusions: Although the majority of patients with CD-related intra-abdominal collections underwent surgical resection in this cohort, no obvious predictors of surgical intervention could be identified. The decision to perform early surgery appeared to be influenced by the findings observed on cross-sectional imaging during the follow-up of these collections.

Objective: To compare the treatment outcomes in patients with periappendiceal abscess who underwent percutaneous drainage, antibiotics therapy alone, or emergency surgery in a single hospital. Methods: From January, 2013 to December, 2018, a retrospective cohort study was done in 124 patients who were diagnosed as periappendiceal abscess or phlegmon by CT scan in Siriraj Hospital, Bangkok. We evaluated patients’ demographics, the abscess characteristics, and the outcomes of treatment which including one of the three therapeutic options: image-guided percutaneous drainage, antibiotics alone, or emergency surgery. Results: Among 124 patients, 44 (35.5%) underwent percutaneous drainage, 57 (46.0%) were treated with antibiotics alone, and 23 (18.5%) underwent emergency surgery. The percentages of patients with successful outcomes were 84.1% in percutaneous drainage, 98.2% in antibiotics treatment alone, and 95.7% in surgery. Antibiotics treatment alone was significantly associated with more successful outcome, with odds ratio (OR) of 9.882 (95% CI 1.162-84.066; P value 0.036), as compared with percutaneous drainage, while surgery showed no significant difference. The length of stay in the percutaneous drainage group (median of 10 days, minimum or maximum of 3 or 67 days) was significantly longer than the antibiotics group (median of 6 days, minimum or maximum of 1 and 53 days) with a P value of 0.008. Conclusion: The antibiotics treatment alone was significantly associated with more successful outcomes and shorter hospital stays as compared with percutaneous drainage in patients with a periappendiceal abscess or a phlegmon. Percutaneous drainage should be used for patients who show no improvement after antibiotics treatment.

Colorectal cancer (CRC) is the third most common malignancy and the second most common deadly cancer worldwide as of 2020. Unusual presentation of this cancer with locally advanced disease is rare and seen in only 5% to 22% of cases. We present the case of a 53-year-old male who had invasive cecal adenocarcinoma with phlegmon of the abdominal wall musculature at presentation and an aggressive course that did not respond to the standard lines of therapy. In the current era of ongoing tremendous developments in colorectal cancer diagnosis and treatment, this uncommon case reminds us that locally advanced CRC is still a challenge to manage. Precision medicine with treatment strategies tailored to an individual's genetic, environmental and lifestyle factors is the current need. [ABSTRACT FROM AUTHOR]

We analyzed the serum zinc levels of 37 patients with 40 phlegmon lesions. The mean serum zinc level was 52.1 ± 16.4 μg/dL. The serum zinc level was negatively correlated with the C‐reactive protein (CRP) level (r = −0.66) and white blood cell (WBC) count (r = −0.56). It was also positively correlated with the serum levels of albumin, hemoglobin, and hematocrit (r = 0.57, 0.50, and 0.50, respectively). Patients with serum zinc levels of <60 μg/dL had higher CRP levels and WBC counts (p < 0.005 and p < 0.05, respectively) and lower albumin, hemoglobin, and hematocrit levels (p < 0.001, p < 0.01, and p < 0.01, respectively), and were more likely to be hospitalized (p < 0.05) than those with serum zinc levels of ≥60 μg/dL. Patients with low serum zinc levels were given zinc tablets. Three of the seven patients who developed recurrent phlegmons did not develop any further lesions after taking zinc tablets for >10 months. Of the remaining patients, one only developed a minimal lesion, and another two experienced recurrence twice but did not have any further lesions for 10 and 15 months, respectively. These findings indicate that in patients with phlegmons the serum zinc level is a suitable marker of the severity of infection, and zinc supplementation reduces the risk of further recurrence in patients whose lesions relapse. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and spectrum of findings in patients referred for CT imaging of extremity soft tissue infection in the adult emergency department (ED) setting before and during the COVID-19 pandemic., Methods: Two hundred thirteen CT exams in the pre-COVID cohort (February 1, 2018-January 31, 2020) and 383 CT exams in the COVID cohort (February 1, 2020-January 31, 2022) were evaluated in this multicentre, retrospective study. Demographic information and clinical histories were collected, along with regional data on COVID-19 hospitalizations and deaths., Results: Comparable age and sex distribution was found in the pre-COVID (average age of 53.5 years; male: female ratio of 71:29) and COVID (average age of 54.6 years; male: female ratio of 69:31) cohorts. The frequency of reported clinical risk factors (diabetes mellitus, injected drug use, prior surgery, animal bite) was not significantly different between the two cohorts. Findings of simultaneous involvement of both superficial and deep soft tissue infection on CT imaging were significantly higher in the COVID cohort (53.4%) than in the pre-COVID cohort (33.7%). CT findings of phlegmon (49.1% vs 22.1%), ulcers (48.8% vs 30%), osteomyelitis (21.7% vs 13.1%), as well as localized (18.8% vs 11.7%) and extensive (3.7% vs 2.3%) soft tissue gas were significantly more common in the COVID cohort than in the pre-COVID cohort., Conclusions: During the COVID-19 pandemic, the number of ED CT exams for the evaluation of extremity soft tissue infection increased, with this imaging also showing more advanced disease. Pandemic-related modifications to human behaviour and re-distribution of healthcare resources may underlie these observed changes., Advances in Knowledge: This multi-centre study shows an increase in extremity soft tissue infection presenting to the ED during the pandemic. This finding is important for future pandemic preparations, as it can aid in the decision-making process around resource allocation., Competing Interests: No conflicts of interest to declare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology.)

Reports on patients hospitalised due to inflammatory diseases of the soft tissues in the head suggest worsening of the course of the underlying disease in the case of coexisting infection with the SARS-CoV-2 virus. The cases of 2 patients with neck phlegmon in the course of Coronavirus disease 19 (COVID-19) hospitalised at our Otorhinolaryngological Unit have been presented in the paper. Despite intensive treatment, the disease was fatal in both cases. COVID-19 probably has a significant impact on the course of disease and treatment results in the cases of patients with neck phlegmon. Coexisting diseases may seriously worsen the prognosis in patients with neck phlegmon and COVID-19. Further research is required to explain the mechanism of the impact of SARS-CoV-2 infection on the course of phlegmon in the head and neck region. [ABSTRACT FROM AUTHOR]

Horses with behavioral abnormalities may injure themselves or their handlers, display aggression towards humans and other horses and disrupt the human-horse relationship. These behaviors are precipitated by stressful events, such as frightening experiences, changes in herd dynamics or training, traveling and showing experienced frequently by equine athletes. Diagnosis and treatment of equine behavior is challenging with conventional medicine. Traditional Chinese veterinary medicine (TCVM) offers a unique treatment perspective for unwanted equine behavior. In TCVM, equine behavioral abnormalities are commonly due to Shen Disturbance, which may be caused by six underlying TCVM pattern diagnoses: Liver Qi Stagnation, Phlegm Fire Flaring Upward, Phlegm Misting the Mind, Heart Yin Deficiency with False Heat, Heart Yin/ Blood Deficiency and Heart Qi Deficiency. Each pattern has distinguishing features on the TCVM exam which aides in accurate pattern diagnosis which is critical for effective treatment selection of acupuncture points and Chinese herbal medicine. The use of TCVM treatment utilizing acupuncture and Chinese herbal medicine can be an effective approach either as a sole treatment for mild behavior cases or as part of a comprehensive program to resolve unwanted equine behavior and safeguard the wellbeing of horses and their handlers. [ABSTRACT FROM AUTHOR]

Objective: The safety and role of emergency (EA) versus interval appendicectomy (IA) for appendicular abscess and phlegmon remains debatable with no optimal strategy identified. The aim of this systematic review and meta-analysis is to evaluate outcomes of managing appendicular abscesses and phlegmon with emergency or interval appendicectomy. Methods: We conducted a systematic search of electronic databases using key terms including 'appendicular abscess', 'appendicular phlegmon' and 'interval appendicectomy'. Randomised controlled trials and observational studies comparing the two management approaches were included. Operative time, post-operation complication, unplanned bowel resection, rate of surgical site infection, post-operative length of stay and overall mortality rate were evaluated. Results: We identified six studies (2 RCTs and 4 observational studies) with a total of 9264 patients of whom (n = 1352) underwent IA, and (n 7912) underwent EA. The EA group was associated with statistically significant unplanned bowel resection (OR 0.55, 95% CI [0.33–0.90], P = 0.02) and longer total operating time (MD − 14.11, 95% CI [− 18.26–− 9.96] P = 0.00001). However, the following parameters were compared for both EA and IA groups; there were no significant statistical differences: surgical site infection (OR 0.49, 95% CI [0.17–1.38], P = 0.18), post-operative intra-abdominal collection (RD − 0.01, 95% CI [− 0.04–0.01], P = 0.29), total length of hospital stay (MD 1.83, 95% CI [− 0.19–3.85], P = 0.08), post-operative length of hospital stay (MD − 0.27, 95% CI [− 3.66–3.13], P = 0.88) and mortality rate (MD − 0.27, 95% CI [− 3.66–3.13], P = 0.66). Conclusion: Emergency operation for appendicular abscess and phlegmon may lead to a higher rate of reported morbidity when compared with interval appendicectomy. Although emergency appendicectomy performed for appendicular abscess and phlegmon is a feasible and safe operative approach, it is associated with significantly increased operative time and unplanned bowel resection (ileocolic and right hemicolectomies) compared to interval appendicectomy. [ABSTRACT FROM AUTHOR]

Background: The treatment algorithm for appendicitis is evolving, with recent interest in non-operative management. However, the safety of non-operative management for patients with complicated appendicitis has been questioned due to concern for increased risk of occult appendiceal neoplasm in this patient population. Our study aims to determine the rate of neoplasms discovered during interval appendectomy for patients with complicated appendicitis and determine the necessity of interval appendectomy. Methods: A retrospective chart review was conducted on interval appendectomies performed in adult patients for complicated appendicitis at our institution over a 9-year period. Interval appendectomy was defined as appendectomy delayed from initial presentation with appendicitis. Complicated appendicitis was defined as perforation, phlegmon, and/or abscess as seen on computed tomography at time of presentation. Results: We identified 402 patients who underwent interval appendectomy for complicated appendicitis. A total of 36 appendiceal neoplasms were discovered on final pathology with an overall neoplasm rate of 9%. Patients with an appendiceal neoplasm were significantly older (56.6 years vs 45.1 years, p < 0.01). No patients under the age of 30 had a neoplasm. The rate of appendiceal neoplasms in patients 30 years and older was 11%. The rate for patients 50 years and older was 16%. For patients 80 years and older, the rate of appendiceal neoplasm was 43%. Conclusion: The risk of occult appendiceal neoplasm is low in patients under the age of 30; however, there was an 11% rate of appendiceal neoplasm in patients 30 years and older. The risk increases with increased age, with a 16% risk in patients 50 years and older. Given these findings, we recommend consideration of interval appendectomy in all patients 30 years and older with complicated appendicitis. [ABSTRACT FROM AUTHOR]

The article presents data on the number, type and nature of microflora in patients with purulent-inflammatory diseases of the maxillofacial region. The originality of the microbiocenosis of the oral cavity is due to the fact that living in this ecological niche of microflora is influenced by numerous environmental factors and regulatory, protective mechanisms of the macroorganism. The purpose of the study is to determine the composition of abscess microflora and the phlegmon of the maxillofacial area to evaluate its sensitivity to widely used antibiotics in patients living in the Poltava region. Object and methods. In our study, there were 188 patients with acute purulent diseases of the maxillofacial area between the ages of 18 and 74 years. The ratio of odontogenic inflammatory diseases to non-odontogenic diseases was 3:1. In case of odontogenic inflammatory diseases, the molar of the mandible was 61.8% of cases, the molars of the upper jaw were 19.1%, the lower premolars were 4.4%, 7% are upper premolars, 2.2% are lower incisors, 2.1% are upper incisors and 0.7% are upper jaw canines. In the first stage of the study, microflora characteristic of the oral cavity of healthy residents of Poltava region with intact dental rows and without concomitant pathology were studied. Analysis of the microbial spectrum revealed that most of the microbial landscape of the oral cavity is composed of different types of facultative anaerobic bacteria, non-fermenting gram negative bacteria. In addition, the absence in the oral cavity of Staph. aureus, Str. pyogenes, Bacillus, Fusobacterium, Peptostreptococcus, Peptococcus, Streptobacterium, Clostridium are sown in residents of other regions of Ukraine. To study the peculiarities of oral microflora in the development of purulent-inflammatory diseases of the thyroid gland microbiological studies were performed in patients treated in the maxillofacial department of CP " POKL them. 38 people were surveyed, in the Khorol district – 6, in the Lubny district – 5, in Kremenchuk – 15, and the rest were residents of the countryside. In the next stage of the study we studied the sensitivity of cultures isolated from purulent foci in the maxillofacial area to antibacterial preparations of groups of enicillins, cephalosporins, tetracyclines, aminoglycosides macrolides, levomycetin, rifampicin. The results obtained indicate 100% sensitivity of all microorganisms isolated in patients with jaw periostitis to cefotaxime, moderate sensitivity of most microorganisms to ampicillin, gentamycin and rifampicin, and lack of sensitivity of most microorganisms to microorganisms. The revealed facts indicate that the number, type and nature of the microflora change significantly in the examined patients at different ages. In addition, it is noted that the characteristics of the microflora of the oral cavity of patients which significantly depends on the prevalence of purulent-inflammatory process. The greatest sensitivity of pathogens of purulent-inflammatory processes of thyroid cancer patients living in the Poltava region, was found to cefotaxime and gentamicin, and the least – to lincomycin, rifampicin and erythromycin. In further studies, it is planned to determine the reduction in bed days of inpatient stay with purulent-inflammatory diseases of the maxillofacial area after prescribed treatment with determination of the composition of the microflora.

The complex treatment results of 127 patients with extensive purulent processes in diabetes mellitus that were treated in our clinic with ozone therapy and ultrasonic cavitations at 2001–2018 are presents. The problems of the course of the disease and the aggravating influence of the accompanying pathology on it are noted. The options improving the results of treatment considered.

Modern and glance at the methods of diagnosis and treatment of patients with odontogenic inflammatory diseases of the maxillofacial area and neck was and remains one of the pressing problems that are frequent complications that lead to disorders in the tooth-jaw system, and can be a direct life-threatening ill. Purposeofthestudy. Toincreasetheeffectiveness of treatment of phlegmon of maxillofacial area and neck due to the active evaluation of the dynamics of the inflammatory process comparing a specific patient with standard indicatorschanges in the limits of edema of infiltration. Materials and methods. We carried out diagnostics and complex treatment of 120 patients with odontogenic phlegmons, who were in hospital treatment. The patients were divided into 2 groups: group I – 60 patients, treatment of which was carried out by the traditional method. Group II – 60 patients, modern treatment methods regional administration of attibiotics, vacuum drainage of purulent wound and plasmolifting at the stage of reparation, were added to their standard therapy. Conclusions: The proposed method is simple, reliable and does not require expensive equipment and makes it possible to predict the development of the disease only by clinical measurements of the volume of inflammation.

One of the known methods of treatment is biomesotherapy, in which the patient’s own biomaterials are used for injection. It ensures complete biocompatibility and practically eliminates the possibility of beginning the allergic reactions. One of the options for mesotherapy is the using of Plasmolifting TM (plasmolifting) – commercially patented title of PRP-therapy (Platelet Rich Plasma), which involves the using of an injection form of platelet-rich plasma. Purpose of the study. Increase the efficiency treatment phlegmon of the maxillofacial area and neck with the help of impact of autoplasma rich in platelets on the proliferative phase. Materials and methods. We carried out the diagnosis and complex treatment of 80 patients with odontogenic phlegmons who were hospitalized in the Department ofMaxillofacial Department. surgical and therapeutic dentistry State Institution «Zaporizhia Medical Academy of post-graduate education Ministry of Health of Ukraine». The patients were divided into 2 groups: 1st group – 25 patients, their treatment was carried out by the traditional method and 2nd group – 55 patients among whom platelet-rich plasma (PRP) was added to the treatment at the repair stage. Conclusions. Treatment in this way accelerated the course of the healing process due to the additional reparative and proliferative effects of such therapy.

Infectious complications such as invasive aspergillosis or infection with Stenotrophomonas maltophilia (SM) in immunocompromised patients are associated with a high mortality rate. Our report concerns a 40-year-old male newly diagnosed very severe aplastic anemia (vSAA) who in consequence of a mosquito bite was suffering from skin lesion and consecutive soft tissue phlegmon subsequent to the administration of antithymocyte globulin; a full-thickness autologous meshed skin graft successfully performed to cover skin ulcera after allogeneic stem cell transplantation (SCT). This unusual case illustrates the importance of appropriate diagnosis, anti-infective therapy and close interdisciplinary diagnostic algorithms to minimalize side effects and the selection of resistant strains and to improve patients’ outcome.

Introduction: Pediculosis capitis is a common parasitic disease that occurs most frequently in childhood. The main symptom is pruritus of the scalp. Serious, life-threating complications have been rarely reported in literature. Objective: To present severe complications of neglected pediculosis capitis and utility of dermoscopy in making a final diagnosis. Case report: A 38-year-old woman presented to emergency department with the presence of painful, unilateral neck tumor and fever as well as multiple, painful ulcers within the scalp and neck. Based on clinical and computed tomography assessment phlegmon and abscess of the neck were diagnosed. After dermatological assessment, based on clinical and dermoscopic assessment, active pediculosis capitis with secondary bacterial infection was recognized - the most probable initial cause of the life-threating bacterial complications. Conclusions: Pediculosis capitis is generally associated with a very good prognosis, however when accompanied with particular comorbidities or neglect it can lead to serious complications. [ABSTRACT FROM AUTHOR]

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019. Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact. Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), and only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%. Conclusion: Mucosectomy is a safer modification of standard appendicectomy in patients with appendicular mass, early mass formation, phlegmon, recurrent appendicitis and where the appendix is in an uncommon site, inflamed and adherent. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal collections in the form of abscesses or matted bowel loops, called phlegmons, might occur in patients with Crohn's disease (CD). The clinical characteristics and management of such conditions are not well described. We aim to characterize CD-related intra-abdominal collections clinically, and identify predictors of need for surgical interventions and the time to surgery. Methods: We utilized the Saudi Inflammatory Bowel Disease Information System (IBDIS) database to identify all patients treated for radiologically proven intra-abdominal abscesses or phlegmons since inception. Demographics, clinical data, clinical course, and treatment outcomes were recorded. Logistic regression analysis and survival analysis were used to identify predictors of surgical resection and differences in time to surgery between patient subgroups, respectively. Results: A total of 734 patients with a diagnosis of CD were screened and 75 patients were identified. The mean age was 25.6 ± 9.9 years and 51% were males. Nearly 60% of patients had abscesses larger than 3 cm while 13% had smaller abscesses and 36% had phlegmons. On presentation, the most commonly reported symptom was abdominal pain (99%) followed by weight loss (27%). About 89% of patients were treated with antibiotics during hospitalization for an average of 2.7 weeks. Steroids were prescribed for 52% of patients and tumor necrosis factor alpha (TNF-alpha) antagonists for 17%. Surgical resection was required for 33 patients (44% of the cohort) while 51% were managed with antibiotics and/or percutaneous drainage. The most common surgical intervention was ileocecal resection (45%). Although patients who underwent follow-up imaging were more likely to require early surgical intervention (P = 0.04), no statistically significant predictor of surgery could be identified from this cohort. Time to surgery varied numerically according to abscess size (HR = 1.18, 95% CI = 0.62–2.27, P = 0.61). Conclusions: Although the majority of patients with CD-related intra-abdominal collections underwent surgical resection in this cohort, no obvious predictors of surgical intervention could be identified. The decision to perform early surgery appeared to be influenced by the findings observed on cross-sectional imaging during the follow-up of these collections. [ABSTRACT FROM AUTHOR]

Objective: To compare the treatment outcomes in patients with periappendiceal abscess who underwent percutaneous drainage, antibiotics therapy alone, or emergency surgery in a single hospital. Methods: From January, 2013 to December, 2018, a retrospective cohort study was done in 124 patients who were diagnosed as periappendiceal abscess or phlegmon by CT scan in Siriraj Hospital, Bangkok. We evaluated patients' demographics, the abscess characteristics, and the outcomes of treatment including one of the three therapeutic options: image-guided percutaneous drainage, antibiotics alone, or emergency surgery. Results: Among 124 patients, 44 (35.5%) underwent percutaneous drainage, 57 (46.0%) were treated with antibiotics alone, and 23 (18.5%) underwent emergency surgery. The percentages of patients with successful outcomes were 84.1% in percutaneous drainage, 98.2% in antibiotics treatment alone, and 95.7% in surgery. Antibiotics treatment alone was significantly associated with more successful outcome, with odds ratio (OR) of 9.882 (95% CI 1.162-84.066; P value 0.036), as compared with percutaneous drainage, while surgery showed no significant difference. The length of stay in the percutaneous drainage group (median of 10 days, minimum or maximum of 3 or 67 days) was significantly longer than the antibiotics group (median of 6 days, minimum or maximum of 1 and 53 days) with a P value of 0.008. Conclusion: The antibiotics treatment alone was significantly associated with more successful outcome and shorter hospital stay than percutaneous drainage in patients with a periappendiceal abscess or a phlegmon. We suggest percutaneous drainage in the patients with larger sized abscess and show no improvement after antibiotics treatment. [ABSTRACT FROM AUTHOR]

Phlegmon is a purulent infection which spreads in loose connective tissue. It occurs most commonly in the limbs as a complication of other local infections. Untreated or inadequately treated infections in the skin of the fingers or hands are susceptible to phlegmon. In most cases, the infecting organism is Staphylococcus aureus. This article reports 7 cases of phlegmon involving upper limbs, caused by the Streptococcus pyogenes organism. The course of these types of infection are more serious, and the range of tissue damage greater, than those caused by staphylococci. This article presents the causes of the phlegmon, the methods and course of management, and the results of these. The principles of surgical management include wide incisions in the skin and an evacuation of pus and necrotic tissue debris. The skin is then sealed with stitches or a skin graft once the wound is clean. Of the 7 treated patients, 1 died in the intensive care unit due to sepsis and mutli-organ failure and 1 patient lost his all fingers due to necrosis. The authors believe that it is desirable that doctors working in emergency units and surgical admission rooms should be familiar with the basic rules of diagnosing and managing these potentially life-threatening or hand crippling disease [ABSTRACT FROM AUTHOR]

Objective: To compare the treatment outcomes in patients with periappendiceal abscess who underwent percutaneous drainage, antibiotics therapy alone, or emergency surgery in a single hospital. Methods: From January, 2013 to December, 2018, a retrospective cohort study was done in 124 patients who were diagnosed as periappendiceal abscess or phlegmon by CT scan in Siriraj Hospital, Bangkok. We evaluated patients’ demographics, the abscess characteristics, and the outcomes of treatment which including one of the three therapeutic options: image-guided percutaneous drainage, antibiotics alone, or emergency surgery. Results: Among 124 patients, 44 (35.5%) underwent percutaneous drainage, 57 (46.0%) were treated with antibiotics alone, and 23 (18.5%) underwent emergency surgery. The percentages of patients with successful outcomes were 84.1% in percutaneous drainage, 98.2% in antibiotics treatment alone, and 95.7% in surgery. Antibiotics treatment alone was significantly associated with more successful outcome, with odds ratio (OR) of 9.882 (95% CI 1.162-84.066; P value 0.036), as compared with percutaneous drainage, while surgery showed no significant difference. The length of stay in the percutaneous drainage group (median of 10 days, minimum or maximum of 3 or 67 days) was significantly longer than the antibiotics group (median of 6 days, minimum or maximum of 1 and 53 days) with a P value of 0.008. Conclusion: The antibiotics treatment alone was significantly associated with more successful outcomes and shorter hospital stays as compared with percutaneous drainage in patients with a periappendiceal abscess or a phlegmon. Percutaneous drainage should be used for patients who show no improvement after antibiotics treatment.

Management options for the treatment of idiopathic subglottic stenosis (iSGS) are varied and range from conservative medical therapies to traditional endoscopic and open surgery. The introduction of in-office percutaneous steroid injections has provided an alternative to operative interventions for this challenging patient population; however, complications associated with its use are poorly documented and understood.We report the first known infectious complication following office-based percutaneous steroid injections for iSGS. A 42-year-old female with a five-year history of recurrent iSGS presented 8 weeks following a series of in-office, percutaneous steroid injections to her iSGS with left neck discomfort. Contrast-enhanced computed tomography (CT) imaging revealed phlegmonous changes of the left neck and superior mediastinum. Broad-spectrum antibiotics and intravenous dexamethasone were administered with rapid clinical improvement. Repeat CT 4 weeks after presentation demonstrated resolution of inflammatory changes.While in-office percutaneous steroid injections for iSGS are an effective adjunct to operative-based procedures, adverse sequelae remain possible. Infectious complications following percutaneous laryngeal and subglottic injections should be promptly recognized and managed with a tailored antibiotic and steroid regimen, surveillance imaging, and close follow up.

Phlegmonous esophagitis, a rare and life-threatening disorder, is characterized by bacterial infection of the submucosal and muscularis layers of the esophagus. Herein we report a case of acute phlegmonous esophagitis with mediastinitis complicated by an esophageal perforation in a patient with diabetes mellitus and alcoholic liver cirrhosis.

Purpose: The aim of this article is to present a clinical case of severe descending mediastinitis following the insertion of three dental implants in the mandible. Materials and methods: A 64-year-old female was treated with an implant-supported rehabilitation for her mandibular missing teeth in positions 36, 45 and 46. Results: Three days after the dental implant surgery, the patient complained of malaise, shiver and fever (38°C) with dysphagia and swelling of the mouth floor. The following day the patient was admitted to the hospital with a diagnosis of larynx oedema. Due to the worsening clinical conditions on day 5, she was transferred to the Thoracic Surgery Division with a diagnosis of left neck phlegmon and underwent cervicotomy. A CT scan at day 9 showed mediastinal extension of the phlegmon with initial pleural reaction. The patient then underwent cervicotomy again for drainage. On day 16, she underwent videothoracoscopy to drain a left pleural effusion. The patient was discharged on day 31. Conclusions: Despite the fact that descending mediastinitis has a very high mortality rate, in the present case proper treatment was able to resolve this serious complication. It is likely that the early diagnosis and prompt treatment prevented neck and mediastinal infection diffusion. Clinicians should always keep in mind that a potential fatal infection complication may arise after routine dental implant surgery in the mandible. [ABSTRACT FROM AUTHOR]

Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy. [ABSTRACT FROM AUTHOR]

We aimed to describe the presentation and treatment of lactational phlegmon, a unique complication of mastitis in breastfeeding women that may require surgical management. We retrospectively analyzed medical charts of breastfeeding women treated by a single breast surgeon for lactational phlegmon or the related conditions of abscess or uncomplicated mastitis (UM) from July 2016 to October 2018. Demographic variables and treatment details were analyzed using ANOVA and Pearson's Chi‐square test. Ten women with lactational phlegmon (19.2%), 15 women with abscess (28.8%), and 27 women with UM (51.9%) were identified. Phlegmon presented as a tender, erythematous, and nonfluctuant mass in a ductal distribution. Ultrasonography demonstrated an ill‐defined, complex fluid collection. Epidemiologically, women with phlegmon were similar to patients with abscess and UM. Women with phlegmon reported more intense deep breast massage than patients in the other two groups, but significantly lower rates of breast pump use than women with abscess (30.0% vs 80.0%, P <.05). Relative to women with UM, patients with complicated mastitis (CM, defined as phlegmon or abscess) reported greater utilization of nipple shields (36.0% vs 11.1%, P <.05). Treatment of phlegmon entailed effective milk removal, antibiotics (range 10‐30 days), and close follow‐up until both clinical and radiographic resolution (range 8 days to >3 months), with biopsy of persistent masses. Antibiotic duration was significantly longer for patients with phlegmon compared to those with UM (mean 15.0 days vs 9.7 days, P <.05). Two phlegmons coalesced into abscesses within 1 week of diagnosis. Lactational phlegmon is a complication of mastitis in breastfeeding women that is distinct from abscess and UM. Optimal treatment consists of an extended course of antibiotics and close follow‐up to monitor for coalescence into a drainable fluid collection and/or persistence of mass requiring biopsy. [ABSTRACT FROM AUTHOR]

Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and interior lips. Bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericm B), and mouth washing with antiseptic solutions. PeriodontaI prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame. (Quintessence Int 2004:35:572-578) [ABSTRACT FROM AUTHOR]