UNASSIGNED: Hydatid cyst is a parasitic infection, often caused by Echinococcus granulosus. Although it is classified as a benign disease, cyst ruptures in the abdomen can be fatal. Ruptures occur spontaneously or after trauma. We aimed to report data from patients who underwent emergency surgery due to spontaneous intra-abdominal hydatid cyst rupture.
UNASSIGNED: Upon a retrospective review of the records at Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa, Turkey, we found that 34 cases were operated on due to hydatid cyst rupture between January 2012 and October 2022. All patients were operated on in an emergency, and partial cystectomy, intra-abdominal irrigation, and drainage were performed using laparotomy. The patients were evaluated in terms of age, sex, symptoms, radiological findings, laboratory results, intraoperative findings, and postoperative follow-ups.
UNASSIGNED: Twenty-two (64.7%) female and 12 (35.3%) male patients were enrolled. The mean age was 39.1 (±17.58) years. All patients experienced spontaneous rupture. The ruptured cyst was found in the liver in 32 patients (94%), the spleen in 1 patient (3%), and the pelvis in 1 patient (3%). The diagnosis was determined using ultrasonography in 12 (35.3%) patients, computed tomography in 21 (61.8%) patients, and magnetic resonance imaging in 1 (2.9%) patient. All patients exhibited acute abdomen and leukocytosis. The average length of hospital stay was 5.14 (±1.37) days.
UNASSIGNED: Hydatid cyst rupture should be considered in cases of acute abdomen, particularly in regions where the disease is endemic, as in our region. The ruptured hydatid cyst was primarily observed in the liver (94.11% of cases).

The management of perforated diverticular disease has changed in the past 10 years with a move towards less surgical intervention. This population-based cohort study aimed to define the risk of death and readmission following non-operative management of perforated diverticular disease.
Patients diagnosed with perforated diverticular disease and managed without surgery were identified from the linked Clinical Practice Research Datalink and Hospital Episode Statistics data from 2000 to 2013. The outcomes were 1-year case fatality, readmissions, and surgery at readmission.
In total, 880 patients with perforated diverticular disease were managed without surgery, comprising 523 women (59.4 per cent). The 1-year case fatality rate was 33.2 per cent (293 of 880). The majority of deaths occurred in the first 90 days after the index admission, with a 90-day case fatality rate of 28.8 per cent. The 90-day survival rate varied by age, and was 97.2 per cent among those aged less than 65 years, compared with 85.0 per cent for those aged between 65 and 74 years, and 47.7 per cent in those at least 75 years old. Of 767 patients discharged from hospital, 250 (32.6 per cent) were readmitted (47 elective, 6.1 per cent; 203 emergency, 26.5 per cent) during a median of 1.6 (i.q.r. 0.1-3.9) years of follow-up, with similar proportions in each age category. In the first year of follow-up, only 5.1 per cent of patients required surgery, of whom 16 of 767 (2.1 per cent) required elective and 23 (3.0 per cent) emergency operation.
Non-operative management of perforated diverticulitis in those aged less than 65 years is feasible and safe. Reintervention rates following conservative management were low across all age categories.

暂无摘要。

Glenoid perforation is not the intended consequence of the surgery and must be avoided. The analysis on biomechanical aspect of glenoid vault perforation remains unknown. The purpose of this study is to determine the impact of glenoid perforation towards stress distribution and micromotion at the interfaces. Eight glenoid implant models had been constructed with various size, number and type of fixation. A load of 750 N was applied to centre, superior-anterior and superior-posterior area. Implant perforation had minimal impact on stress distribution and micromotion at the interfaces. However, cement survival rate for implant without perforation was the highest with a difference of up to 37% compared to other perforated models. Besides that, implant fixation and high stresses at the implant had more of an impact on implant instability than implant perforation. As a conclusion, glenoid perforation did not influence the stress distribution and micromotion, but, it reduced cement survival rate and increase the stress critical volume.

The benefit of taking intra-abdominal cultures during source control procedures in patients with complicated intra-abdominal infection (CIAI) is unknown. The aim of this study was to evaluate whether intra-abdominal cultures reduce the mortality rate of CIAI.
The Japanese Diagnosis Procedure Combination database was used to identify adult patients with CIAI who had undergone source control procedures on the first day of admission to hospital between April 2014 and March 2016. In-hospital mortality was compared between patients who did and those who did not have intra-abdominal cultures taken. A generalized linear mixed-effect logistic regression model and a random intercept per hospital were used to adjust for baseline confounders and institutional differences. Subgroup analyses were also performed according to disease cause, site of onset and severity of CIAI.
Intra-abdominal cultures were taken from 16 303 of 41 495 included patients. Multivariable logistic regression analysis showed that patients with intra-abdominal cultures had a significantly lower mortality than those without (odds ratio 0·85, 95 per cent c.i. 0·77 to 0·95). Subgroup analyses revealed statistically significant differences in mortality between patients with and without cultures among those with lower intestinal perforation, biliary tract infection/perforation, healthcare-associated CIAI and high-risk community-acquired CIAI.
Intra-abdominal cultures obtained during source control procedures may reduce in-hospital mortality, especially in patients with lower intestinal perforation, biliary tract infection/perforation, or healthcare-associated or high-risk community-acquired CIAI.

Corrective anterior reaming is an accepted method for addressing retroversion in a biconcave retroverted (Walch classification, type B2) glenoid in anatomic total shoulder arthroplasty. However, concern still exists regarding early glenoid component failure in the setting of severe retroversion, which may be related to loss of component containment and/or violation of subchondral bone resulting from reaming. The goal of this study was to determine what characteristics of B2 glenoids are less amenable to corrective reaming by virtually implanting anatomic glenoid components.
(1) How much medial reaming is required to correct the version of a B2 glenoid to an acceptable position? (2) Are glenoids with more severe retroversion (> 25°) at higher risk of component perforation than less retroverted glenoids? (3) Is correcting to 10° of retroversion associated with greater risk as compared with reaming to 15°? (4) How does corrective reaming affect the underlying bone density on the glenoid face of B2 glenoids?
A series of 71 patients with B2 glenoids (posterior subluxation of the humeral head with posterior bone loss) with CT scans who were indicated for shoulder arthroplasty were reviewed. Forty-four of 71 glenoids (62.5%) had < 25° of native retroversion. Anatomic glenoid implants were then virtually implanted using three-dimensional CT software that allows for preoperative shoulder arthroplasty planning to correct native retroversion to 15° or 10° of retroversion using both a central peg with an inverted triangle peg configuration or a keel. The amount of reaming of the anterior glenoid required to correct retroversion, perforation of peripheral pegs, or keel was compared. Additionally, assessment of the surface area of the glenoid that had poor bone density (defined as cancellous bone under the subchondral plate) was analyzed by the software after correction.
Correction to 15° of retroversion required 5 ± 3 mm of reaming, and correction to 10° of retroversion required 8 ± 3 mm of reaming to obtain at least 80% seating. Peripheral peg perforation with correction to 15° occurred in 15 of 27 (56%) glenoids with > 25° of retroversion compared with 10 of 44 (23%) of glenoids with < 25° of retroversion (relative risk [RR], 2.4; 95% confidence interval [CI], 1.3-4.6; p = 0.006). There was no difference in perforation with keeled components. Increased correction to 10° did not increase the risk of component perforation. When correction to 15°, glenoids with higher native version (> 25°) had a greater risk of poor bone quality support (10 of 27 [37%]) when compared with glenoids with less version (four of 44 [9%]; RR, 4.1; 95% CI, 1.5-12.8; p = 0.006). Increased correction resulted in 13 of 27 (48%) glenoids with version > 25° having poor bone density versus 10 of 44 (23%) with ≤ 25° of version (RR, 2.1; 95% CI, 1.1-4.1; p = 0.028).
There is a high risk of vault perforation after corrective reaming. Glenoid retroversions > 25° are at a higher risk of having poor bone quality supporting the component.
When contemplating options for patients with severe retroversion, surgeons should consider alternatives other than corrective reaming if achieving normal glenoid version is desired.

The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.

Purpose To prospectively evaluate the diagnostic performance of ultrasonography (US) for differentiating perforated from nonperforated pediatric appendicitis and to investigate the association between specific US findings and perforation. Materials and Methods This HIPAA-compliant study had institutional review board approval, and the need for informed consent was waived. All abdominal US studies performed for suspected pediatric appendicitis at one institution from July 1, 2013, to July 9, 2014, were examined prospectively. US studies were reported by using a risk-stratified scoring system (where a score of 1 indicated a normal appendix; a score of 2, an incompletely visualized normal appendix; a score of 3, a nonvisualized appendix; a score of 4, equivocal; a score of 5a, nonperforated appendicitis; and a score of 5b, perforated appendicitis). The diagnostic performance of US studies designated 5a and 5b was calculated. The following US findings were correlated with perforation at multivariate analysis: maximum appendiceal diameter, wall thickness, loss of mural stratification, hyperemia, periappendiceal fat inflammation, periappendiceal fluid, lumen contents, and appendicolith presence. The number of symptomatic days prior to presentation was recorded. Surgical diagnosis and clinical follow-up served as reference standards. Results A total of 577 patients with a diagnosis of appendicitis at US met the study criteria (468 with a score of 5a; 109 with a score of 5b). Appendicitis was correctly identified in 573 (99.3%) of 577 patients. US performance in the detection of perforated appendicitis (5b) was as follows: a sensitivity of 44.0% (80 of 182), a specificity of 93.1% (364 of 391), a positive predictive value of 74.8% (80 of 107), and a negative predictive value of 78.1% (364 of 466). Statistically significant associations with perforated appendicitis were longer duration of symptoms (odds ratio [OR] = 1.46, P < .0001), increased maximum diameter (OR = 1.29, P < .0001), simple periappendiceal fluid (OR = 2.08, P = .002), complex periappendiceal fluid (OR = 18.5, P < .0001), fluid-filled lumen (OR = 0.34, P = .002), and appendicolith (OR = 1.67, P = .02). Conclusion US is highly specific but nonsensitive for perforated pediatric appendicitis. Several US findings are significantly associated with perforation, especially the presence of complex periappendiceal fluid. © RSNA, 2016.