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Background. The problem of purulent inflammatory diseases of the maxillofacial area remains one of the most pressing problems of modern dentistry and maxillofacial surgery. The aim of the study is to conduct a comparative evaluation of the effectiveness of a drug based on nanodispersed silica (NDS) with antimicrobial properties for the local treatment of purulent inflammatory diseases of the maxillofacial area. Materials and methods. A comparative assessment of the postoperative period was performed in 71 patients with maxillofacial phlegmon, who were divided into two representative groups: comparison (39 patients), in whose local treatment of purulent wounds was carried out by conventional methods, and the main group (32 patients), where the local treatment was carried out using a drug based on NDC. The level of endogenous intoxication was determined by the level of C-reactive protein (CRP), by the level of blood metabolites of average mass (MAM) and leukocyte intoxication index (LII) in the blood serum. The data obtained were statistically processed and compared. Results. During the study of the dynamics of СRР was found that starting from 3 days in the main group there was a tendency to its faster decrease and normalization before discharge, while in patients of the comparison group it was significantly higher (p < 0.05)., The level of MAM in patients of the comparison group remained significantly (p < 0.05) elevated throughout the treatment in the postoperative period, while in the main group it was on the verge of normal before discharge. Comparison group of patients had significantly higher LII during treatment and at the time of discharge from hospital (p < 0.05) than the main group. Conclusions: The treatment of maxillofacial phlegmon by the developed method provided a more favorable course of the postoperative period than in the comparison group, as evidenced by a significantly (p < 0.05) faster normalization of endogenous intoxication blood parameters.

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: According to the International Working Group on the Diabetic Foot (2015), 28 % of diabetic foot ulcers result in major amputations. Over 30 % of patients with diabetic foot undergo major amputations that result in death in 13.0 %-14.0 % of the cases. Clinical case: In our experience of treating a female patient with diabetic foot complications, we observed that such cases require a multidisciplinary approach to determine management strategies, as well as strict surgery staging. Early plastic and reconstructive surgery demonstrated its positive impact on postoperative wound closure. Conclusions: We managed the infection and achieved the complete closure of the major wound and primary intention healing through the multidisciplinary approach and strict adherence to surgical staging (debridement, revascularization, reconstruction). Thus, patient quality of life and rehabilitation potential significantly improved.

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.

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]

Background. Radical surgeries for phlegmons, abscesses, necrotizing infection are often followed by extensive wounds which require an individual approach to their rapid closure by means of plastic surgery methods. In such a case, the optimal wound therapy is primary healing with the use of vacuum therapy.Cases description. The study involved three clinical trials of patients with acute purulent-necrotic diseases of soft tissues of various localizations, volumes and grades, for which vacuum therapy was used as a part of complex therapy. Surgical interventions are proved to be urgently performed in acute purulent-necrotic diseases. Early reconstructive skin and bone plastic surgery aimed at closing post-operative wound defects is also very important.Conclusion. In the demonstrated clinical cases, the purulent process was stopped and wound therapy was performed by means of primary healing, which undoubtedly ensures medical and social rehabilitation of such patients. Notably, vacuum drainage is not an independent method, but an important component in the complex active surgical treatment of purulent wounds.

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 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]

Purpose of the study. Analysis of the effectiveness of cryoprecipitate – antienzymatic with common soft tissue phlegmon and sepsis.Patients and methods. To achieve the intended goal, a study of the results of treatment of 92 patients with a diagnosis of advanced soft tissue phlegmon and sepsis was performed. All patients underwent a comprehensive diagnostic study with an in-depth study of the indicators of the hemostasis system. For a comparative assessment, 2 groups of patients were identified. Group 1 (46 (50 %) patients – the main one) – received cryoprecipitate-antienzymatic therapy as part of complex treatment, group 2 (46 (50 %) patients – comparisons) – received only the generally accepted basic treatment.Results. An in-depth study of the hemostasis system in patients with widespread soft tissue phlegmon and sepsis indicated the development of thrombohemorrhagic syndrome, which was manifested by depletion of both the coagulation and anticoagulation systems of the blood, a drop in AT III, an increase in thrombinemia and fibrinolysis depression. In order to correct thrombohemorrhagic syndrome, a cryoprecipitate-antienzymatic complex was included in the complex treatment of patients with widespread soft tissue phlegmons and sepsis, aimed at unblocking microcirculation in inflammatory foci and parenchymal organs, to improve the penetration of antibacterial drugs and other drugs into these foci, thereby stopping inflammation and preventing the increase of multiple organ failure. The effectiveness of the cryoprecipitate-antienzymatic complex was evaluated based on clinical data of the course of the purulent – inflammatory process and the results of indicators of the hemocoagulation and fibrinolysis system on 8–10 days from the start of therapy.Conclusion. The use of cryoprecipitate-antienzymatic complex, which includes freshly frozen plasma (FFP), heparin, proteinase inhibitors, in patients with widespread soft tissue phlegmon and sepsis effectively eliminates thrombohemorrhagic syndrome, which improves microcirculation in purulent – inflammatory foci and affected parenchymal organs, improving the flow of antibacterial drugs into these foci. At the same time, there is an improvement in the course of the wound process, so the wounds are cleaned faster from necrotic masses and filled with healthy granulation tissue, which makes it possible to perform plastic closure of the wound defect 1.6 times faster. Mortality is reduced by 2.2 times and the number of thrombotic and thromboembolic complications in the structure of deaths is reduced.

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.

Background. The treatment of purulent-inflammatory processes of soft tissues remains today an area of surgery that is not given enough attention by specialists of both inpatient and outpatient levels, with many unresolved problems. Of particular importance in the pathogenesis of purulent-septic processes are the emerging microcirculation disorders due to the formation of micro-clots. An important point that aggravates the course of the disease is the development of thrombohemorrhagic syndrome. As a result, even with a variety of antibacterial drugs and the ыavailability of new treatment methods, it is often not possible to achieve positive results in the treatment of this heavy contingent of patients.Aim: to improve the effectiveness of complex therapy of patients with extensive soft tissue phlegmon by relieving thrombohemorrhagic syndrome.Materials and methods. Cryoplasma-anti-enzyme therapy in the composition of complex treatment was received by 59 (48.8 %) patients of the main group, 62 (51.2 %) patients of the comparison group received only the generally accepted treatment. In each group, there are three variants of the course of the disease – moderate, severe and septic.Results. The analysis of the clinical course of the disease showed that in patients of the first group, wounds were cleared of necrotic masses and purulent discharge with filling them with healthy granulation tissue 5.3 days faster than in the second group (p˂0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The number of deaths decreased – 11.9 % in the first group against 27.4 % in the second group (p˂ 0.001). The proportion of thrombotic and thromboembolic causes of death in the first group (14.3 %) was lower than in the second (17.7 %) (p˂ 0.05).Conclusion. The use of cryoplasma-anti-enzyme therapy as part of complex treatment contributed to the effective relief of thrombohemorrhagic syndrome, the elimination of microcirculatory disorders, which allowed performing plastic closure of a wound defect 1.6 times faster, prevented the progression of multiple organ failure, and contributed to a reduction in mortality.

Despite the progress in modern surgery, the number of patients with purulent finger and hand diseases keeps growing these days in the clinical practice of surgeons. In recent years, there has been a tendency to develop more severe forms of panaritium and phlegmon in an increasingly young contingent of patients. Increasingly, doctors refuse to use the classical method of managing a postoperative wound of the hand involving the installation of drainage tubes. This phenomenon is polygenic and calls for special attention due to the frequent deplorable consequences of a treatment failure. The high urgency of this issue in Moscow Hospital No. 4 has become a rationale to study the effect of photodynamic therapy (PDT) on the course of the wound process in patients with this pathology.The purpose of this work is to develop a technique to advance the treatment outcomes for patients with purulent finger and hand diseases in case of open postoperative wound treatment.This study includes a comparative analysis of the wound process dynamics in 49 (49.5%) patients who underwent a photodynamic therapy session in the postoperative period and in 50 (50.5%) patients who received an open wound treatment after the operation. Photodynamic therapy was performed on the second postsurgical day by a laser apparatus “Atkus-2” (wave length 661 nm) with a gel form of the chlorinseries photosensitizer photoditazin in the form of an application at the rate of 1 g ml per 3–5 cm2 of the wound surface. The power density was chosen in the range of 0.1–1 W / cm2, and the time of exposure to the wound varied from 30 to 400 seconds, depending on the area of the wound.To assess the dynamics of the wound process in the postoperative period, we took measurements of all the patients’ wound areas on the 1st and 5th days, monitored the gross impression daily. In the patients who received PDT, we observed an earlier wound cleansing and remitting of the inflammatory process, acceleration of the edge epithelization, and earlier appearance of the granulation tissue by an average of 2 days. In the group of patients who were treated with PDT in the postoperative period, on the 5th day, the wound defect decreased by an average of 1 cm2, which amounted to 22.4%, in the control group – by 18%. The analysis of cytological and morphological patterns also revealed an accelerated switch from the inflammatory stage of the wound process to the reparative one - the reparative processes in the PDT group began earlier by 2 days. The microbiological analysis of wound exudate showed a downregulation of microflora after a PDT session - only in 6 cases pathogens were identified in the repeated seeding, which amounted to 12.24% of the group compared to 38% of the control group. After a session of photodynamic therapy, patients noted a significant reduction in pain, including during dressings. The pain syndrome immediately after the session decreased by 2–3 points. By the 5th day it became moderate – 4–5 points. In the control group, this indicator on the 2nd day was 8 points, decreasing by the 5th day to 6 points. For all analyzed indicators, the groups had statistically significant differences (p

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: 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]

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Aim. To assess the effect of cytoflavin on the dynamics of the blood and oral fluid prooxidant-antioxidant system in patients with maxillofacial area phlegmons.Materials and methods. 55 patients were included in the study. The patients were divided into three groups: control group (group 1, n = 20); comparison group (group 2, n = 15); patients with phlegmons of the maxillofacial area (group 3, n = 20). As part of therapy, the patients in group 3 were additionally receiving cytoflavin (10 ml cytoflavin in 200 ml saline solution, 1 time per day, for 6 days). The treatment and monitoring was performed over the period of 6 days, during which the blood and oral fluid indicators were estimated 4 times (day 1, 2, 4 and 6).Results. Cytoflavin had a positive effect on the state of the prooxidant-antioxidant balance in patients with maxillofacial area phlegmons. In comparison with the control group, patients in group 3 demonstrated a lower content of oxidative modifi cation products and a higher antioxidant activity of blood plasma. Cytoflavin therapy also led to an increase in the activity of glutathione peroxidase and reductase, as well as an increase in the concentration of glutathione at the last stage of the therapy.Conclusion. The obtained data indicate the potential of cytoflavin as part of complex metabolic therapy for patients with purulent inflammatory processes of the maxillofacial area.

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]

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]

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.

The article presents the case of development of anaerobic non-clostridial phlegmon of the anterior abdominal wall, phlegmon of the hernial sac because of the perforation of the small intestine in the hernial sac due to its entrapment in an elderly patient with severe concomitant pathology. The course of the disease, the management of the patient and surgical treatment are described in detail. The given example is interesting because despite the wide availability of qualified medical care in a big city, there are still rare and severe complications of ventral hernias in clinical practice. Moreover, despite the significant concomitant pathology and extremely serious condition of the patient, we carried out stage-by-stage surgical treatment and used the modern methods of treatment of purulent infection, such as specific antibacterial therapy and VAC-therapy (Vacuum-assisted closure), which led to full recovery of the patient.

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]

Objective: The objective of the present study was to analyze the efficacy of 256-slice CT in differentiation between the perforated and non-perforated appendicitis. Subjects and methods: The study included 85 patients with acute appendicitis. Appendicectomy and pathological confirmation were done for 79 patients and classified into 44 patients with non-perforated appendix and other 35 patients with perforated appendix. The statistical analysis was performed using six CT findings (abscess formation, phlegmon, extraluminal air, extraluminal appendicolith, focal defect in the appendicular wall and inflammatory changes of the retroperitoneal space) individually and when combined together in five groups. Results: The sensitivity, specificity and accuracy of each CT finding were ranged between 20%–51%, 86–100% and 65–76% respectively. The PPV and NPV of these findings ranged between 75–100% and 61–70% respectively. Detection of any of these findings in combination of different groups resulted in raising of the sensitivity reaching between 71 and 97%. Conclusion: Multislice CT is considered the modality of choice for imaging of acute appendicitis, not only to confirm the diagnosis but also it plays an important role in assessment of appendicular complication, particularly in detection of perforated appendix.

Background: Severe outbreaks of bovine interdigital phlegmon (IP) have occurred recently in several free stall dairy herds in Finland. We studied the aetiology of IP in such herds, and the association of bacterial species with the various stages of IP and herds of various morbidity of IP. Nineteen free stall dairy herds with IP outbreaks and three control herds were visited and bacteriological samples collected from cows suffering from IP (n = 106), other hoof diseases (n = 58), and control cows (n = 64). The herds were divided into high morbidity (morbidity ≥50%) and moderate morbidity groups (9–33%) based on morbidity during the first two months of the outbreak. Results: F. necrophorum subspecies necrophorum was clearly associated with IP in general, and T. pyogenes was associated with the healing stage of IP. Six other major hoof pathogens were detected; Dichelobacter nodosus, Porphyromonas levii, Prevotella melaninogenica, Treponema spp. and Trueperella pyogenes. Most of the samples of acute IP (66.7%) harboured both F. necrophorum and D. nodosus. We found differences between moderate morbidity and high morbidity herds. D. nodosus was more common in IP lesion in high than in moderate morbidity herds. Conclusions: Our result confirms that F. necrophorum subspecies necrophorum is the main pathogen in IP, but also T. pyogenes is associated with the healing stage of IP. Our results suggest that D. nodosus may play a role in the severity of the outbreak of IP, but further research is needed to establish other bacteriological factors behind these severe outbreaks. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Contrast computed tomography and magnetic resonance imaging are widely used due to its image quality and ability to study pancreatic and peripancreatic morphology. The understanding of the various subtypes of the disease and identification of possible complications requires a familiarity with the terminology, which allows effective communication between the different members of the multidisciplinary team. Aim: Demonstrate the terminology and parameters to identify the different classifications and findings of the disease based on the international consensus for acute pancreatitis ( Atlanta Classification 2012). Methods: Search and analysis of articles in the "CAPES Portal de Periódicos with headings "acute pancreatitis" and "Atlanta Review". Results: Were selected 23 articles containing radiological descriptions, management or statistical data related to pathology. Additional statistical data were obtained from Datasus and Population Census 2010. The radiological diagnostic criterion adopted was the Radiology American College system. The "acute pancreatitis - 2012 Rating: Review Atlanta classification and definitions for international consensus" tries to eliminate inconsistency and divergence from the determination of uniformity to the radiological findings, especially the terminology related to fluid collections. More broadly as "pancreatic abscess" and "phlegmon" went into disuse and the evolution of the collection of patient fluids can be described as "acute peripancreatic collections", "acute necrotic collections", "pseudocyst" and "necrosis pancreatic walled or isolated". Conclusion: Computed tomography and magnetic resonance represent the best techniques with sequential images available for diagnosis. Standardization of the terminology is critical and should improve the management of patients with multiple professionals care, risk stratification and adequate treatment.

Introduction: Appendicular lump is a serious complication of appendicitis presenting clinically with right iliac fossa mass which has a range of differential diagnosis. Diagnosis of complicated appendicitis and appendicular lump is often difficult and challenging. Computed tomography imaging has an important role in diagnosis and differentiation of appendicular mass. Aim: The purpose of this study was to assess the computed tomography imaging features of inflammatory appendiceal masses. Materials and Methods: Multislice computed tomography (MSCT) images of total 56 patients of inflammatory appendiceal masses were retrospectively analyzed during the period of October 2011 to November 2015. Contiguous axial CT sections obtained before and after injection of iodinated intravenous contrast medium were analyzed. Oral and rectal contrast was also administered in all patients to opacify the bowel. Images were evaluated for inflammed appendix, appendicolith, extraluminal fluid collections, inflammatory phlegmon formation, extraluminal air, fat inflammation, fascial thickening, bowel aggregation, bowel wall thickening and enlarged lymph nodes. Results: Fifty six patients of inflammatory appendiceal masses with mean age 41-50 years were identified which included 31(55%) men and 25 (45%) women. The inflamed appendix could be identified in the inflammatory mass in 22 cases (39%) with appendicolith seen in 12 cases (21%). Extraluminal fluid collections were seen in 35 patients (62.5%) with walled-off collections with enhancing walls labelled as abscesses were seen in 26 cases (46%). Inflammatory phlegmonous mass was seen in 38 cases (68 %) while adjacent ileocecal wall thickening was seen 22 cases (39%). Omental thickening and fat inflammation was present in 46 out of 56 cases (82%) with adjoining aggregated small bowel loops were seen in 36 cases (64%). Extraluminal air pockets were seen in 31 patients (55%). Out of 35 patients with extraluminal fluid collections, 24 were drained percutaneously under image guidance which included 15 patients labelled as abscess. In five patients, the collections were small in size and resolved with conservative treatment. Nineteen patients including four patients with large abscesses and pelvic extensions underwent laparotomy. Conclusion: Appendicular mass is a serious complication resulting from perforation of inflammed appendix, showing inflammatory phlegmon and/or extraluminal fluid collection with associated imaging findings. Computed tomography is highly useful in diagnosis and differentiation of appendiceal masses and deciding the management approach.