Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.
Lateral abdominal herniae are rare, they usually occur after trauma, vascular or renal surgery, their incidence is less than 2%. Since 1906 there are just about 250 reported cases and there are many treatment options, including laparoscopic approach, direct muscle approximation with sutures, mesh, suture anchors and, even, conservative treatment. We present the case of a 30 year old male who suffers a motorcycle crash that results in a posttraumatic flank hernia. He was treated with a delayed abdominal wall reconstruction using polypropylene mesh and a fascia lata graft. There is no algorithm or specific treatment for lateral abdominal herniae and, because of its low incidence, little is known about their evolution and long-term results of the distinct reconstruction techniques. It´s possible to reconstruct the abdomen wall early or delay it, depending on the abdominal cavity contamination and the patient´s general condition.
Background: Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations. Material and methods: A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples. Results: Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm H 2 O) registered were as follows:
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