Acute suppurative thyroiditis with bilateral piriform sinus fistulae.

Although there are many possible routes of infection in AST, the clinician must be aware of a possible fistula between the piriform sinus and the perithyroidal space--especially in patients with recurrent episodes of AST. Diagnosis of this congenital tract requires a high index of suspicion and radiographic demonstration by a barium swallow or endoscopic visualization. Effective treatment of AST with intravenous antibiotics and appropriate surgical intervention have greatly reduced the mortality and secondary complications. Complete fistulectomy, however, is required for permanent cure.     

Common bile duct pressure in patients with common bile duct stones with or without acute suppurative cholangitis

Resting common bile duct pressure was measured in three groups of patients: group 1, 53 patients with gallstones but without common duct stones; group 2, 35 patients with common bile duct stones unaccompanied by cholangitis; and group 3, 36 patients with common duct stones and acute suppurative cholangitis. A significantly higher pressure in the common bile duct was documented in patients with cholangitis when compared with the other two groups. Twenty-four patients with cholangitis had common duct pressure values above 20 cm H2O, the maximal values of normal. Additionally, patients with cholangitis with pressure values over 30 cm H2O (nine patients) showed absence of green bile in the extrahepatic biliary tract, suggesting cessation of bile excretion into biliary duct. In all these cases, an impacted stone at the distal end of the common bile duct was documented.     

The correction of immunodeficiency states in patients with acute suppurative pyelonephritis

The analysis of the examination findings of 54 patients with purulent pyelonephritis showed a great variety of immunological changes, which appeared both as differences in the types of abnormal immunity parameters and in the degree of the recorded pathological conditions. T-cell immunity deficiency was revealed in 55.6% of the patients, in a half of whom it was associated with humoral factor deficiency. In 25.9% of the patients the immunograms were similar to those in the controls and in 18.5% they were indicative of humoral immunity activation. Supplement of T-activin to the conventional antibacterial therapy contributed to an early immunological and clinical remission. The immunomodulatory effect was associated with the initial immune deficiency and manifested itself by higher relative and absolute T-lymphocyte contents along with elimination of their subpopulation imbalance. The effect proved to be less profound on the humoral immunity system. The arrest of an inflammatory reaction was evidenced by a decrease in beta-lysine levels in the serum up to normal ones. In contrast, antibacterial therapy without immunomodulation deteriorated the abnormal ratios of immunocompetent cells. The findings suggest that it is essential to take an individual approach to the use of immunomodulating therapy in patients with acute purulent pyelonephritis, taking into account not only clinical but immunological indications. It is most advisable to apply T-activin in cases of T-cell immune deficiencies with a significant imbalance of T-lymphocyte populations.     

Anal fistula and pilonidal sinus disease coexisting simultaneously: An audit in a cohort of 1284 patients

Fistula‐in‐ano and pilonidal disease are not known to occur together. In a retrospective study, all patients having fistula‐pilonidal disease coexisting simultaneously were included. Out of 1284 patients, 933 were operated (fistula‐in‐ano, 849; pilonidal disease, 77; and coexisting fistula‐pilonidal, 7). A total of 351 patients did not undergo any surgery (two patients had coexisting fistula‐pilonidal). Thus, a total of nine patients having coexisting fistula‐pilonidal sinus were included in the study (mean age 35.8 ± 19.9 years, M/F 7/2). pIn 6/9 patients, the pilonidal tract was communicating with fistula‐in‐ano, and in 3/9 patients, they were not communicating/connected. The connection could be established preoperatively with the help of MRI. In all patients with communicating fistula‐pilonidal sinus (n=6), the fistula was posterior. 6/9 patients had recurrent fistula and all (9/9) had multiple tracts. The fistula was high and complex in 8/9 patients (grade IV‐7, grade V‐1). 4/9 patients tested positive for tuberculosis while one patient was suffering from hidradenitis suppurativa. The latter improved on medical treatment. One patient did not agree for surgery and seven were operated. The disease healed in four patients, the disease did not heal in one patient, and two patients were in the convalescent stage. Anal fistula and pilonidal disease can coexist in a same patient and can even be connected. Such diseases are more complex and have a higher incidence of associated diseases like tuberculosis. Magnetic resonance imaging plays a pivotal role in diagnosis. If the connection is missed, the disease treatment becomes difficult.     

Generalized suppurative peritonitis in patients with destructive forms of acute appendicitis]

The authors undertook comparative analysis of the results of treatment, the number and intensity of postoperative pyo-inflammatory complications, and the mortality rate in a group of 51 patients with generalized purulent peritonitis of appendicular origin in various methods of abdominal cavity cleansing: closed drainage of the abdominal cavity (group I, 10 patients); continuous peritoneal lavage (group II, 15 patients), cleansing of the abdominal cavity in stages (group III, 26 patients). Any type of cleansing did not exclude the development of purulent complications during treatment, the whose number grew with the increase in the period between the appendectomy and the onset of the disease. Complications developed in 23 patients (45%). Their frequency and intensity were, however, much less when the abdominal cavity was lavaged in stages, which enable the number of cases of adhesive obstruction and the formation of abscesses between the loops to be reduced markedly. A progressive septic process and poly-organic insufficiency were the main causes of death. The mortality rate was 30; 26.6 and 11.5%, respectively, in groups I, II, and III.     

Clinical evaluation and treatment in elderly patients with acute obstructive suppurative cholangitis

Elderly patients with acute obstructive suppurative cholangitis (AOSC) have a very poor prognosis due both to the gradual development of symptoms and to acute exacerbation, resulting in a condition that is both severe and irreversible. In this study, we evaluated the clinical characteristics and effects of biliary drainage in patients with AOSC treated in our department, with special attention being focused on patients aged 70 years or more. Of 21 patients with AOSC, 7 (33.3%) were more than 70 years of age. All 7 had choledocholithiasis. In all patients with choledocholithiasis, in this study. AOSC was observed in 23.3% of those who were more than 70 years of age (7/30). In elderly patients with AOSC, typical symptoms are often absent, and the severity of the disease is difficult to determine based on the results of examination alone. Since early diagnosis of AOSC and appropriate biliary drainage from the onset of AOSC are extremely important, clinical findings should be examined with the utmost care.     

Functional disorders of the cardiovascular system in patients with acute suppurative puerperal mastitis

On 82 patients with suppurative puerperal mastitis, in 25 (30.5%) the disorders in function of the cardiovascular system were revealed. The disorders directly depended on the severity of the disease. After the therapy carried out with inclusion of the drugs improving myocardial metabolism, in repeated ECG, the significant positive dynamics was noted.     

老年急性化脓性胆囊炎的外科治疗

目的:探讨老年急性化脓性胆囊炎的合理治疗方法。方法:回顾性分析36例老年急性化脓性胆囊炎的临床资料。结果:36例均有发热(体温37.5～39 ℃)，右上腹疼痛，腹胀；局限性腹膜炎25例（69.4 %），黄疸6例16.7 %），休克5例（13.8 %），胆囊坏疽5例（13.8 %）；合并胆囊结石31例（86.1 %），胆总管结石6例（16.7 %）；合并心脑血管疾病15例，慢性支气管炎11例，糖尿病9例。急诊手术19例，其中腹腔镜胆囊切除(LC)3例，开腹胆囊切除手术(OC)15例，开腹大部切除胆囊1例，同时行胆总管切开探查6例；经皮胆囊穿刺置管引流待急性症状控制后手术切除胆囊11例，单纯经皮胆囊穿刺置管引流6例。35例治愈出院，治愈率为97.2 %。手术切口感染5例，肺部感染2例。急诊手术后死亡1例，急诊手术病死率为5.3 %。结论:对老年急性化脓性胆囊炎应采取稳妥的个体化治疗原则，反对一味冒险急诊手术。B超引导下经皮胆囊穿刺置管引流是一种安全有效的应急治疗措施。     

Acquired left ventricular to coronary sinus fistula: an unusual complication of acute myocardial infarction

Anatomical complications of myocardial infarction include ventricular septal defect and mitral regurgitation. Another unusual complication of myocardial infarction is described, and its diagnosis and surgical management are discussed.     

Spontaneous common iliac arteriovenous fistula manifested by acute renal failure: a case report

Arteriovenous fistulas between the common iliac vessels resulting from spontaneous rupture of aneurysms are rare, with only 31 cases having been reported since 1971. Clinical diagnosis is possible when a unique set of findings is present, namely high-output cardiac failure, a pulsatile abdominal mass associated with a bruit or thrill, and unilateral arterial insufficiency or venous engorgement. Recently, with advancements in diagnostic techniques, the number of cases in which an arteriovenous fistula is found between the common iliac vessels has increased. Diagnosis can be difficult, however, as in the case of one of our patients in whom the predominant sign was acute renal failure. Other reports of renal failure or impairment in the presence of a common iliac fistula have also appeared. Awareness of this phenomenon can help the physician to establish the diagnosis when one or more of the classic signs are absent. Prompt diagnosis and surgical management have contributed to the high incidence of survival in patients with arteriovenous fistulas between the common iliac vessels.