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Abstract Background In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. Methods We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. Results We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. Conclusions US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. Level of evidence IV (case series). Trial registration IRB-MTP_2021_05_202100781

Background: In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. Methods: We retrospectively included 67 children (mean age, 3.0 years; range: 1 month–12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. Results: We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. Conclusions: US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. Level of evidence: IV (case series). Trial registration: IRB-MTP_2021_05_202100781 [ABSTRACT FROM AUTHOR]

Aim: To evaluate and synthesise the effectiveness of intra-operative gentamicin in reducing post-operative surgical site infections compared to other irrigating solutions or no irrigation. Background: Surgical site infection has posed challenges to health care providers around the globe. It is influenced by many risk factors, only a few of which are under the control of the surgeon and operating team. Wound irrigation is considered an essential part of the intra-operative process. It aims to minimise the risk of surgical site infection by thorough lavage of the operative site. Design: Systematic review of effectiveness. Review methods: The databases CINAHL, Scopus, Embase, Medline, PubMed, OpenGrey, Google Scholar and ProQuest Dissertations & Theses Global were searched with parameters set between 1 January 2013 and 31 July 2023. The review followed the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020) guidelines. Two independent reviewers conducted the selection process, critical appraisal and data extraction. The eligible studies were critically appraised using JBI critical appraisal tools for randomised controlled trials and cohort studies. Data synthesis was performed through subgroup analysis and narrative synthesis, since meta-analysis was not possible. Results: The impact of intra-operative gentamicin irrigation on surgical site infections was analysed across eight studies. The subgroup analysis favoured the gentamicin saline group over the saline group in reducing post-operative surgical site infections (RR=0.27 [0.13;0.55], P < 0.001.) Conclusion: This systematic review shows that intra-operative gentamicin irrigation lowers the incidence of surgical site infections when compared to normal saline irrigation. However, there were contradictory results when intra-operative gentamicin irrigation was compared to alternative interventions such as no irrigation, diluted povidone iodine and combination antibiotic irrigation. [ABSTRACT FROM AUTHOR]

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question.

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question. [ABSTRACT FROM AUTHOR]

There is much controversy about the application of abdominal irrigation in the prevention of wound infection (WI) and intra‐abdominal abscess (IAA) in the postoperative period. Therefore, we performed a meta‐analysis of the effect of suctioning and lavage on appendectomy to assess the efficacy of either suctioning or lavage. Data were collected and estimated with RevMan 5.3 software. Based on our research, we found 563 publications in our database, and we eventually chose seven of them to analyse. The main results were IAA after the operation and WI. Inclusion criteria were clinical trials of an appendectomy with suctioning or lavage. In the end, seven trials were chosen to meet the eligibility criteria, and the majority were retrospective. The results of seven studies showed that there was no statistically significant difference between abdominal lavage and suctioning treatment for post‐operative WI (OR, 1.82; 95% CI, 0.40, 2.61; p = 0.96); There was no statistically significant difference between the two groups in the risk of postoperative abdominal abscess after operation (OR, 1.16; 95% CI, 0.71, 1.89; p = 0.56). No evidence has been found that the use of abdominal lavage in the treatment of postoperative infectious complications after appendectomy is superior to aspiration. [ABSTRACT FROM AUTHOR]

PURPOSE: Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA. METHODS: All primary TJA between 2019-2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates. RESULTS: A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups. CONCLUSIONS: Although betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

Abstract Background This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue. Objective To compare low-pressure and high-pressure irrigation delivery systems for wound cleansing in DNI. Methods we designed a retrospective cohort study and reviewed the medical records of patients operated on due to DNI from June 2016 to December 2017 at our institution. One cohort included patients treated with an intraoperative irrigation method that exerts low pressure over the irrigated tissue, and the other cohort, to a system capable of generating higher pressure. The Pearson Chi-squared test was used to analyze the data. Results A total of 42 patients whose ages ranged from 16 months to 72 years were included. The low-pressure irrigation system was used in 18 patients, and the high-pressure system was used in 24 patients. No statistical differences were observed regarding the irrigation methods, the complexity of the DNI, and the overall outcomes. Conclusions The present is the first study in which low- and high-pressure systems for wound lavage were evaluated in the treatment of DNI. When comparing these methods, we did not find one to be superior to the other; however, the additional cost associated with the high-pressure devices may not justify their in head and neck procedures. [ABSTRACT FROM AUTHOR]

IntroductionProbiotics have been investigated for their many health benefits and impact on the microbiota of the gut. Recent data have also supported a gut–lung axis regarding the bacterial populations (microbiomes) of the two locations; however, little research has been performed to determine the effects of oral probiotics on the microbiome of the bovine respiratory tract. We hypothesized that probiotic treatment would result in changes in the lung microbiome as measured in lung lavage fluid. Our overall goal was to characterize bacterial populations in the lungs of calves fed probiotics in milk replacer and dry rations from birth to weaning.MethodsA group of 20 dairy calves was split into two treatment groups: probiotic (TRT; N = 10, milk replacer +5 g/d probiotics; Bovamine Dairy, Chr. Hansen, Inc., Milwaukee, WI) and control (CON; N = 10, milk replacer only). On day 0, birth weight was obtained, and calves were provided colostrum as per the dairy SOP. On day 2, probiotics were added to the milk replacer of the treated group and then included in their dry ration. Lung lavages were performed on day 52 on five random calves selected from each treatment group. DNA was extracted from lavage fluid, and 16S ribosomal RNA (rRNA) gene hypervariable regions 1–3 were amplified by PCR and sequenced using next-generation sequencing (Illumina MiSeq) for the identification of the bacterial taxa present. Taxa were classified into both operational taxonomic units (OTUs) and amplicon sequence variants (ASVs).ResultsOverall, the evaluation of these samples revealed that the bacterial genera identified in the lung lavage samples of probiotic-fed calves as compared to the control calves were significantly different based on the OTU dataset (p

Introduction Multiple solutions are currently used to cleanse a deep neck infection (DNI), and a variety of devices are available to deliver wound irrigation solutions. An essential difference between these devices is the pressure that the irrigation solution exerts over the wound tissue.

Background: This study aims to investigate the outcomes of patients who received early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy due to esophageal cancer. Methods: A prospective randomized clinical trial was performed between March 2020 and June 2022. Patients who were scheduled for thoracoscopic and laparoscopic esophagectomy due to esophageal cancer were enrolled. Then, these patients were assigned to the control group (traditional postoperative care) and study group (traditional postoperative care with early bronchoscopic sputum aspiration and lavage). The outcomes, which included the length of hospital stay and medical expenses, and postoperative complications, which included pulmonary infection, atelectasis, respiratory dysfunction and anastomotic leakage, were compared between these two groups. Results: A total of 106 patients were enrolled for the present study, and 53 patients were assigned for the control and study groups. There were no statistically significant differences in gender, age, and location of the esophageal cancer between the two groups. Furthermore, the length of hospital stay was statistically significantly shorter and the medical expenses were lower during hospitalization in the study group, when compared to the control group (12.3 ± 1.2 vs. 18.8 ± 1.3 days, 5.5 ± 0.9 vs. 7.2 ± 1.2 Chinese Yuan, respectively; all, P < 0.05). Moreover, there were statistically significantly fewer incidences of overall complications in study group, when compared to the control group (20.7% vs.45.2%, P < 0.05). Conclusions: For patients with esophageal cancer, early fiberoptic bronchoscopic sputum aspiration and lavage after thoracoscopic and laparoscopic esophagectomy can shorten the length of hospital stay, and lower the medical expense and incidence of postoperative complications. [ABSTRACT FROM AUTHOR]

Petroleum is commonly used as a solvent, and primary intrathecal administration or secondary diffusion and subsequent clinical management has not been reported. We report the case of a male patient with intrathecal petroleum diffusion following accidental lumbar infiltration. After the onset of secondary myeloencephalopathy with coma and tetraparesis, continuous cranio-lumbar irrigation using an external ventricular and a lumbar drain was established. Cranial imaging revealed distinct supra- and infratentorial alterations. The patient improved slowly and was referred to rehabilitation. Intrathecal petroleum leads to myeloencephalopathy and continuous cranio-lumbar irrigation might be a safe treatment option. [ABSTRACT FROM AUTHOR]

Mass spectrometry (MS) offers high levels of specificity and sensitivity in clinical applications, and we have previously been able to demonstrate that matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS is capable of distinguishing two-component cell mixtures at low limits of detection. Ovarian cancer is notoriously difficult to detect due to the lack of diagnostic techniques available to the medical community. By sampling a local microenvironment, such as the vaginal canal and cervix, a MS based method is presented for monitoring disease progression from proximal samples to the diseased tissue. A murine xenograft model of high grade serous ovarian carcinoma (HGSOC) was used for this study, and vaginal lavages were obtained from mice on a weekly basis throughout disease progression and subjected to our MALDI-TOF MS workflow followed by statistical analyses. Proteins in the 4-20 kDa region of the mass spectrum yielded a fingerprint that we could consistently measure over time that correlated with disease progression. These fingerprints were found to be largely stable across all mice, with the protein fingerprint converging toward the end point of the study. MALDI-TOF MS serves as a unique analytical technique for measuring a sampled vaginal microenvironment in a specific and sensitive manner for the detection of HGSOC in a murine model.

Cervicovaginal bacteria cause inflammation which in turn increases HIV risk. Profiling the cervicovaginal microbiome, therefore, is instrumental for vaccine development. We show that the microbiome profile captured by cervicovaginal lavage is comparable to samples obtained by vaginal swabs. Thus, lavage may serve as a sampling strategy in NHP vaccine studies.

To improve the outcome of laparoscopic gastrointestinal surgery, improvement in the technology for removing purulent substances from the abdominal cavity is required. Ultrasonic cleaning technology may be suitable for the task. However, it is necessary to examine cleaning efficiency and safety through model tests that can lead to clinical trials for practical use. Nine surgical specialists first estimated the distribution of the actual attachment of purulent substances using videos of removing pus-like model dirt as an evaluation scale. Subsequently, cleaning tests were conducted using a small-size shower with model dirt that was somewhat difficult to remove, and its suitability as a model sample was confirmed. A mixture of miso and other substances was attached to a silicon sheet to prepare a test sample. The model dirt could be removed within a few seconds by cleaning using a probe-type ultrasonic homogenizer while the test sample was submerged in water. This performance greatly surpassed that of water flow cleaning under increased water pressure. An ultrasonic cleaner that is useful for irrigation during laparoscopic surgery will be suitable for practical use in laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background and Aim: Post-breeding treatment is the most common practice in the reproductive management of mares. Oxytocin, uterine lavage, and intrauterine (I/U) antibiotic are usually used as prophylactic therapy. This study aimed to determine the most efficient prophylactic treatment regimen among six treatment protocols applied during natural breeding of cyclic Arabian mares. Materials and Methods: The current study was conducted on cyclic Arabian mares that were subdivided into three age categories (n=968): Category I (5-10 years, n=380), Category II (11-15 years, n=361), and Category III (≥16 years, n=227). Six prophylactic treatments were applied after 4 h of breeding. According to the treatment regimen, treated mares (n=483) were divided into six treatment groups: A (n=80), treated with I/U antibiotic (1 g gentamicin); B (n=81), I/U lavage (normal saline 500 mL); C (n=83), intramuscular (I/M) oxytocin (10 IU); D (n=82), I/U antibiotic and I/M oxytocin; E (n=78), I/U lavage and I/M oxytocin; and F (n=79), I/U lavage with I/U antibiotic and I/M oxytocin. Non-treated mares were classified as controls (n=485). Ultrasonography was performed to monitor pregnant mares 30 and 60 days after mating, and mares were followed until foaling. Results: Pregnancy and foaling results reveals that in age Category I, treatment with oxytocin alone or oxytocin with I/U lavage showed the highest pregnancy and foaling rates (p

Background: Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. Objectives: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. Methodology: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. Results: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23–4.1 and in Group 2 was 7.36–3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43–1 and in Group 2 was 2.4–0.53. Conclusion: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement.

Background: Seroma is the most prevalent complication after mastectomy and can lead to significant morbidity. No single method has been shown to be completely effective in reducing seroma rates. Flap fixation can reduce the dead space after mastectomy, thus decreasing the drainage volume and seroma rates. Gentamicin acts against Staphylococcus epidermidis involved in increasing drainage volume, duration, and seroma rates. This study aimed to evaluate the effect of combining flap fixation with gentamicin lavage of the surgical bed for reducing postmastectomy seroma. Method: This prospective randomized controlled study included 100 women with breast cancer scheduled for modified radical mastectomy (MRM). The patients were allocated into the following four groups of 25: GI: flap fixation; GII: surgical bed lavage with gentamicin-containing solution; GIII: both techniques used in GI and GII; GIV: control group. The patients were followed up for the registration of drainage volume, timing of drain removal, and incidence of seroma. Results: Total drainage volume was significantly lower; the drain was removed earlier and seroma rates were lower in group III than the other groups (P = 0.001, 0.009, and 0.005, respectively). Seroma in GIII was mild and managed with aspiration. In the other groups, seroma was more severe and required more aspirations, second tube drainage, or open drainage. Conclusion: Combining flap fixation and gentamicin lavage of the surgical bed after MRM significantly decreased the amount of drained fluid, allowing an earlier removal of the drain and decreasing the incidence of seroma when compared with using each procedure alone. Moreover, the severity of seroma was significantly lower when both techniques were combined. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection. Methods: A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery. Results: After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51–0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms. Conclusion: It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications. [ABSTRACT FROM AUTHOR]

Background. Current evidence based research data lead to reassessment of traditional approaches for treatment of patients with bone and joint disorders especially knee osteoarthritis (OA). The purpose of the study was to review randomized clinical trials (RCT) and meta-analyses of RCT as well as recent guidelines of professional societies for application of arthroscopic lavage, debridement and meniscectomy in knee OA. Materials and Methods. Databases PubMed, e-LIBRARY, EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched for the period from 2000 till 2019. From 138 heats irrelevant and poor quality studies were excluded. In total there were 1614 patients aged 48,9–62,8 in RCT and 20 770 patients aged 42–62,4 in meta-analyses of RCT. Results. Both arthroscopic lavage and debridement do not lead to significant pain relief as well as functional improvement in long term therefore are not recommended. Nonsurgical treatment should be the first line strategy in patients with early and moderate knee OA even with degenerative meniscal tears irrespective of mechanical symptoms like painful locking, catching or sudden giving way. Arthroscopy might be performed only if complex non-surgical treatment including non-steroidal anti-inflammatory drugs, structured exercises program and intra-articular injections failed after 3 months in patients without ‘bone on bone’ cartilage erosions and frontal malalignment or if the knee is mechanically locked due to bucked handle type meniscus tear or loose body. Conclusion. Evidence based medicine approach let us to conclude that arthroscopy in knee OA is non-efficient and rarely indicated therefore if proper non-surgical treatment is failed around the knee osteotomies and partial or total arthroplasty should be considered.

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role.

ABSTRACT Objective There is currently no consensus regarding the optimal management of acute suppurative thyroiditis (AST) secondary to pyriform sinus fistula (PSF). To investigate the benefits and adverse events of aspiration with or without lavage for the treatment of AST secondary to PSF. Subjects and methods This was a retrospective analysis of consecutive patients with AST secondary to PSF who were admitted at the Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University between August 2012 and December 2018. Clinical information, procedural data, and imaging data were analyzed. Results Seven patients (five women; mean age, 16.9 ± 6.3 years; range, 8-26 years) were included. The patients most presented with anterior neck pain and swelling (n = 7), fever (n = 7), or odynophagia (n = 5). Six cases of AST occurred on the left side of the thyroid and 1 on the right. All patients had thyroid abscess. AST was diagnosed by ultrasound-guided needle aspiration cytology in all cases. PSF was diagnosed during the inflammatory stage in five patients and during the quiescent stage in two. All patients were treated with empiric antibiotics. Needle aspiration without lavage was performed in three cases. Needle aspiration with lavage was performed in four cases. Repeat aspiration was performed in three cases. All patients recovered completely, with no procedure-related complications. During 18.3 ± 7.8 months of follow-up, AST recurred in one case. Excision of the PSF was performed in another case. Conclusion Ultrasound-guided aspiration with or without lavage had a good treatment effect and without adverse events for the management of AST secondary to PSF.

Abstract Purpose Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA. Methods All primary TJA between 2019–2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90‐day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates. Results A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90‐day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow‐up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups. Conclusions Although betadine is cost‐effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

Background and Aim: Post-breeding treatment is the most common practice in the reproductive management of mares. Oxytocin, uterine lavage, and intrauterine (I/U) antibiotic are usually used as prophylactic therapy. This study aimed to determine the most efficient prophylactic treatment regimen among six treatment protocols applied during natural breeding of cyclic Arabian mares. Materials and Methods: The current study was conducted on cyclic Arabian mares that were subdivided into three age categories (n=968): Category I (5-10 years, n=380), Category II (11-15 years, n=361), and Category III (=16 years, n=227). Six prophylactic treatments were applied after 4 h of breeding. According to the treatment regimen, treated mares (n=483) were divided into six treatment groups: A (n=80), treated with I/U antibiotic (1 g gentamicin); B (n=81), I/U lavage (normal saline 500 mL); C (n=83), intramuscular (I/M) oxytocin (10 IU); D (n=82), I/U antibiotic and I/M oxytocin; E (n=78), I/U lavage and I/M oxytocin; and F (n=79), I/U lavage with I/U antibiotic and I/M oxytocin. Non-treated mares were classified as controls (n=485). Ultrasonography was performed to monitor pregnant mares 30 and 60 days after mating, and mares were followed until foaling. Results: Pregnancy and foaling results reveals that in age Category I, treatment with oxytocin alone or oxytocin with I/U lavage showed the highest pregnancy and foaling rates (p<0.01). In age Category II, the highest pregnancy and foaling rates were observed in lavage treatment (p<0.01), whereas, in age Category III, the good pregnancy and foaling rates were monitored in treatment with oxytocin and I/U lavage (p<0.01). Conclusion: Treatment with systemic I/M oxytocin is ideal in early age group mares (5-10 years of age). However, irrespective of the age categories, all mares exhibited high pregnancy and foaling rates after treatment with systemic I/M oxytocin and I/U lavage with normal saline (0.9%) 4 h post-breeding. [ABSTRACT FROM AUTHOR]

Dysbiosis of host-associated commensal microbiota is emerging as an important factor in risk and phenotype of immunologic, metabolic, and behavioral diseases. Accurate analysis of microbial composition and functional state in humans or mice requires appropriate collection and pre-processing of biospecimens. Methods to sample luminal and mucosal microbiota from human or mouse intestines and to profile microbial phylogenetic composition using 16S rRNA sequencing are presented here. Data generated using the methods in this unit can be used for downstream quantitative analysis of microbial ecology.

Abstract Background Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon’s attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion The observational nature of this study is mandatory to examine surgeons’ attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting.

Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. Objectives: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. Methodology: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. Results: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23-4.1 and in Group 2 was 7.36-3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43-1 and in Group 2 was 2.4-0.53. Conclusion: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement. [ABSTRACT FROM AUTHOR]

The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with 'needle scopes' used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features—such as calcinosis—beg further arthroscopic investigation. A new generation of 'needle scopes' with far superior optics awaits future investigators. [ABSTRACT FROM AUTHOR]

Abstract Background The research objectives of the Femoroacetabular Impingement Randomised controlled Trial (FIRST) are to assess whether surgical correction of the hip impingement morphology (arthroscopic osteochondroplasty) with or without labral repair, in adults aged 18–50 years diagnosed with non-arthritic femoroacetabular impingement (FAI), provides decreased pain and improved health-related quality of life at 12 months compared to arthroscopic lavage of the hip joint. This article describes the statistical analysis plan for the FIRST trial. Methods/design FIRST is an ongoing multi-centre, blinded randomised controlled trial of 220 patients who have been diagnosed with FAI and are optimized for surgical intervention. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes and their respective analyses. In addition, we will present the planned sensitivity and subgroup analyses. Discussion Our rationale for FIRST is based upon (1) an epidemic of FAI surgery with resultant increased healthcare costs over that last decade, (2) worldwide disparity in perceptions about its utility, and (3) consensus that definitive evidence for or against surgical approaches is lacking. Trial registration ClinicalTrials.gov, NCT01623843. Registered on 20 June 2012.

Objective: To report our initial experience using the ultrasound (US)-guided single-needle lavage technique for treating calcific Achilles tendinitis. Methods: Eighteen patients with chronic ankle pain refractory to medical treatment were treated percutaneously using a fine needle lavage technique under US guidance. Patients were evaluated using the visual analogue scale (VAS) pain score both before and 3 months after the procedure. Treatment-related complications were also recorded. Results: All 18 cases of US-guided single-needle lavage were performed successfully. The range of recovery time was 30-45 days, and there was a significant reduction in the VAS pain score. Conclusion: The US-guided single-needle lavage technique seems to be an effective and minimally invasive way to treat calcific Achilles tendinitis.

The study was conducted in six calves presented with septic arthritis belonging to different age, breed and sex. Among the six calves, three were affected with chronic stage of disease with joint contracture and non-weight bearing on the affected limb. Clinical signs of arthritis were noticed in all the cases. Radiography and goniometry provided information regarding response to treatment protocol adapted. Haematology and serum biochemistry were found to have limited diagnostic value. Treatment protocol formulated which contains, three stage lavaging, application of splint and empirical antibiotic therapy showed satisfactory results. The progression of the evaluation of joint disorder, efficacy of the diagnostic modalities and standardisation of treatment protocol was attempted in this study

Background: Gas conditioning minimizes complications associated with invasive ventilation of neonates. Poorly conditioned gas contributes to humidity deficit, facilitates condensate pools, and contributes to safety events. The specific aim was to objectively quantify the temperature drop across the unheated portion of a neonatal circuit and the impact condensation has to resistance to flow in the ventilator circuit. Methods: Ventilator circuits and filters were obtained, assembled according to manufacturer recommendations, and operational verification procedures were performed prior to data collection. A neonatal test lung was connected to each Servo-I ventilator with the following settings: pressure control IMV mode; inspiratory pressure: 14 cm H2O to achieve an exhaled tidal volume of 6.0 mL; PEEP: 5 cm H2O; pressure support: 5 cm H2O, FIO2: 0.21; set frequency 40/min; and inspiratory time: 0.4 s. The Fisher and Paykel MR850 and ChonchaTherm Neptune heaters were set at a temperature of 40°C. To evaluate both systems under similar conditions, the ChonchaTherm Neptune heater humidity control was set to midline. Heaters were turned on simultaneously and given 1 h to equilibrate. Readings for room temperature, airway temperature at the patient connection, airway resistance, exhaled tidal volume, and direct observation of circuit condensation and (or) pooling were recorded hourly for a 48-h period. Summary statistics were calculated for the variables of interest. Results: Mean (±SD) air temperature was 26.3°C (±1.4) for the Fisher & Paykel MR850 system and 26.2°C (±1.5), for the ChonchaTherm Neptune system. Mean (±SD) airway resistance was 229.3 cm H2O/L/s (±81.0) for the Fisher & Paykel system and 196.2 cm H2O/L/s (±39.4) for the ChonchaTherm Neptune system. Mean (±SD) tidal volume for the Fisher & Paykel MR850 system was 6.5 mL (±0.4), and for the ChonchaTherm Neptune system was 7.2 mL (±0.6). Conclusion: Circuit condensate increased tidal volume delivery and airway resistance. Temperature at the patient connection was lower than the temperature monitored by the system 12 inches distally, which can negatively impact gas conditioning. [ABSTRACT FROM AUTHOR]

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role. [ABSTRACT FROM AUTHOR]

Penetrating traumatic injuries or laceration wounds in horses often affect joints and tendon sheaths. The open wound allows bacteria and foreign material to enter the joint or tendon sheath. A thorough lavage of the affected synovial space is required to remove bacteria, foreign material and inflammatory mediators. In cases with traumatic injuries, lavage is performed along with the surgical reconstruction of the injured tissue. In literature two methods for joint/tendon sheath lavage are generally acknowledged: the arthroscopic/tenoscopic guided lavage and a through-and-through needle lavage. The efficiency of both previously mentioned methods is discussed controversially, as arthroscopic/tenoscopic lavage provides higher flow rates and volumes of sterile irrigation fluid. Further, the synovial space can be visualized and debris can be removed under visual control. The advantages of the through-and-through needle lavage are the reduced costs and expense and the facilitated performance by less-experienced surgeons. In a case series of 60 foals treated with septic arthritis, both methods did not show any significant difference in outcome (Wright et al. 2017). This is consistent to a study describing an age-mixed population suffering septic arthritis from different etiologies (Schneider et al. 1992). However, other authors favor arthroscopic lavage to treat septic joints (ter Braake 2002). In cases of septic tenosynovitis, the surgical technique for lavage was not found to be associated with outcome (Wereska et al. 2007). A recent study from Duggan and Mair (2019) focusing on the outcome of horses suffering septic calcanean bursitis also concluded no dependence of lavage method and outcome. There is lack of information about the outcome of horses presented with septic arthritis due to a penetrating or lacerating wound treated with either arthroscopic or needle-lavage. Therefore, the aim of our study is to proof the efficiency of a through-and-through needle lavage in horses with penetrating traumatic joint and tendon sheath injuries. We hypothesized no significant difference regarding complications and outcome in comparison to horses treated with arthroscopic/ tenoscopic guided lavage. We assumed other factors to be associated with outcome. Data from clinical records from the Department for Horses at the University of Leipzig from the years November 2008 to August 2019 were analyzed. Horses were included if they were presented with a joint or tendon sheath penetrating injury treated surgically with either arthroscopic/tenoscopic lavage or needle lavage and primary wound closure. Horses with accompanying bone injuries were excluded from the study. The age of the horse, localization of the synovial injury, duration of injury, results of synovial analysis, antimicrobial therapy and hospitalization time were documented. Outcome was defined in terms of being discharged from the clinic without lameness when walked. Results were evaluated descriptively and tested for normal distribution using the Shapiro-Wilk test. Groups were compared using the Mann-Whitney-test. Data were further analyzed with Fisher's exact test to test statistical correlation. Significance was set at p < 0.05. Within that time 42 horses met the inclusion criteria, 31 were lavaged arthroscopically/tenoscopically, 10 via needle lavage and one horse with two injured synovial structures was treated with both methods. There was no significant difference for horses to be discharged non-lame when walked among those groups. Also, the necessity to repeat lavage treatments did not depend on the initial lavage method. The age of the wound (≤6 hours versus > 6 hours) as well as synovial parameters like white cell count, percentage of polymorphonuclear leucocytes, total protein and proof of bacteria did not influence the outcome. Horses with shorter systemic antibiotic therapy and shorter hospitalization time were significant more likely to be discharged non-lame at walk. This study suggests that in cases with penetrating or lacerating joint and tendon sheath injuries the method for joint/tendon sheath lavage is not associated with the outcome. Through-and-through needle lavage is a considered equivalent to arthroscopic/tenoscopic joint/tendon sheath lavage in such cases. [ABSTRACT FROM AUTHOR]

Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.

Introduction: Growing concern for Tuberculosis (TB) epidemic forces World Health Organization (WHO) and government of India (GOI) to incorporate newer rapid and highly specific diagnostic test like Cartridge Based Nucleic Acid Amplification Test (CBNAAT). Aim: To find the usefulness of CBNAAT in increasing Acid Fast Bacilli (AFB) positive patient pool over and above the yield of traditional sputum microscopy. Materials and Methods: The cross-sectional survey was conducted in the Department of Respiratory Medicine, Nilratan Sircar Medical College and Hospital (NRSMCH), Kolkata, India. The study involved 94 smear negative TB suspects referred from other health facilities as well as diagnosed by the department itself. After collecting baseline information like age, sex, previous history of TB and its treatment by interview and scrutinizing records using predesigned questionnaire, the patients were put on sputum CBNAAT and Broncho-Alveolar Lavage (BAL)- CBNAAT testing. Data were analysed by estimating mean, Standard Deviation (SD), proportion and using independent t-test, chi-square test. Results: Overall, average age of participants was 44.7±15.3 (mean±SD) years. Male-female ratio was 1:2.8. Altogether 44.7% patients were detected sputum positive out of which 34.0% were detected only by sputum CBNAAT and another 10.7% detected when BAL-CBNAAT testing was used among the negatives yielded from sputum CBNAAT only. These differences were statistically significant. Conclusion: Utility of CBNAAT over and above traditional diagnostic methods was reaffirmed. With added advantage of detecting MDR cases simple, sensitive, speedy and automated CBNAAT seems new mile stone in ‘Stop TB’ strategy and needs utilised to its highest potentiality through monitoring and supervision.

Introduction: Probiotics have been investigated for their many health benefits and impact on the microbiota of the gut. Recent data have also supported a gut-lung axis regarding the bacterial populations (microbiomes) of the two locations; however, little research has been performed to determine the effects of oral probiotics on the microbiome of the bovine respiratory tract. We hypothesized that probiotic treatment would result in changes in the lung microbiome as measured in lung lavage fluid. Our overall goal was to characterize bacterial populations in the lungs of calves fed probiotics in milk replacer and dry rations from birth to weaning., Methods: A group of 20 dairy calves was split into two treatment groups: probiotic (TRT; N  = 10, milk replacer +5 g/d probiotics; Bovamine Dairy, Chr. Hansen, Inc., Milwaukee, WI) and control (CON; N  = 10, milk replacer only). On day 0, birth weight was obtained, and calves were provided colostrum as per the dairy SOP. On day 2, probiotics were added to the milk replacer of the treated group and then included in their dry ration. Lung lavages were performed on day 52 on five random calves selected from each treatment group. DNA was extracted from lavage fluid, and 16S ribosomal RNA (rRNA) gene hypervariable regions 1-3 were amplified by PCR and sequenced using next-generation sequencing (Illumina MiSeq) for the identification of the bacterial taxa present. Taxa were classified into both operational taxonomic units (OTUs) and amplicon sequence variants (ASVs)., Results: Overall, the evaluation of these samples revealed that the bacterial genera identified in the lung lavage samples of probiotic-fed calves as compared to the control calves were significantly different based on the OTU dataset ( p  < 0.05) and approached significance for the ASV dataset ( p  < 0.06). Additionally, when comparing the diversity of taxa in lung lavage samples to nasal and tonsil samples, taxa diversity of lung samples was significantly lower ( p  < 0.05)., Discussion: In conclusion, analysis of the respiratory microbiome in lung lavage samples after probiotic treatment provides insight into the distribution of bacterial populations in response to oral probiotics and demonstrates that oral probiotics affect more than the gut microbiome., Competing Interests: TM, SE, AD, and CC-M were employed by the USDA. KB was employed by the Chr. Hansen, Inc. Mention of trade names or commercial products in this publication is solely for the purpose of providing specific information and does not imply recommendation or endorsement by the U.S. Department of Agriculture. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 McDaneld, Eicher, Dickey, Kritchevsky, Bryan and Chitko-McKown.)

Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema. [ABSTRACT FROM AUTHOR]

The quality of evidence in equids is insufficient to direct clinical practice aside from the following:The use of antiseptic solution to lavage the abdomen causes inflammation and is detrimental to the patient.For peritonitis caused by Actinobacillus equuli, treatment with antibiotics alone may be sufficient. A variety of antibiotics were used in the two reported studies.