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Chronic mesh infection with sinus formation is usually amenable to open method with dye. Recently, intraoperative real-time fluorescent imaging has been applied to various organs but not to mesh infection. A 72-year-old man with the history of two times removal of infected mesh was referred for groin bulge with purulent discharge. Laparoscopy assisted infected mesh removal was undertaken using intraoperative real-time fluorescent imaging with indocyanine green injection via the sinus orifice. We experienced the first case of the infected mesh with chronic sinus formation treated by the help of intraoperative indocyanine green fluorescent. This method is simple and easy to apply for laparoscopic assisted removal of chronic mesh infection with sinus.

Background: Refractory empyemas with collapsed lung and persistent bronchopleural fistulas pose significant problems to thoracic surgeons and impose a substantial burden in terms of morbidity and mortality. The modified Eloesser flap procedure is a useful palliative option for clearing infections. Herein, we present our experiences with the modified Eloesser flap procedure in mixed suppurative lung pathologies with a new technique of irrigation for persistent infection. Methods: A retrospective review was carried out of 56 patients who underwent the modified Eloesser flap with continuous irrigation at Katurba Medical College. These patients had severe morbidities and were not suitable for major thoracic resection surgery, and electively underwent modified Eloesser flap surgery. Regular follow-up was done at 1, 3, 6, and 12 months. Patients with persistent infections were treated with our continuous irrigation technique. Results: The most important finding was that all patients with active sputum acid-fast bacilli–positive findings became sputum smear–negative during the first month of follow- up. Half (50%) of the patients had a patent stoma. Eleven patients had persistent infections, necessitating continuous irrigation. The infection was fully cleared after 1 month in 9 patients, while 2 patients required second irrigation and continued to receive follow-up. In the remaining 50% of the patients, the stoma closed completely, and the lung expanded fully. Conclusion: The modified Eloesser flap is a simple procedure. In suppurative pathologies, infections were well controlled and the general condition of the patients improved. Our continuous irrigation method showed promising results in patients with persistent purulent discharge.

BACKGROUND Surgical site infection still remains a nightmare for most surgeons even in these times despite many advances in medical science, surgical techniques & better operating room environment. Surgical site infection (SSI) is defined as ‘an infection occurring within 30 days of a surgery (or within 1 year if an implant is left in place after procedure) and affecting either incision or deep tissues at the operation site. METHODS A single observer, cross sectional, prospective study was carried out in the Dept. of General Surgery, in collaboration with Microbiology & Pathology Departments of Hi-tech Medical College and Hospital, Bhubaneswar, Odisha. The study included all patients who underwent laparotomy during the period of study, patients of all age groups except neonates and patients with post-operative surgical site infections. RESULTS The prospective study involved culture and sensitivity of 114 patients undergoing clean-contaminated surgeries (group A), contaminated-surgeries (group B) in the Department of Surgery at our institute. The study shows that the maximum number of cases were between 21 to 60 yrs. of age. (78 %) and the mean age in the group A was 39.2 years while in group B, it was 39.8 years. There was a total of 90 patients between 21 - 60 yrs. of age. Mean hospital stay in group A was 5.7 days and group B was 8.9 days. The sex ratio is quite evenly matched, 63 male patients and 51 female patients out of 114 cases. Amongst the 114 subjects, group A comprised of 58.77 % (67) while group B consisted of 41.22 % (47.13) patients. Out of 67, 13 from group A came back as sterile, in group B sterile samples were 10. CONCLUSIONS This study concludes that age, sex, class of wound, peri-operative management, operating time and co-morbidities of the patient, all have a significant effect on the incidence of surgical site infections. KEYWORDS Surgical Site Infection, Laparotomy, Purulent Discharge, Drain

Currently, there is a high interest of health care professionals in the treatment of childhood dacryostenosis. The problem of dacryostenosis is at the intersection of ophthalmology and rhinology. However, more often patients seek eye care due to the fact that the leading complaints are lacrimation and purulent discharge from the eye. Analysis of the literature shows the absence of consensus on the methods of surgical treatment, materials and the timing of the stent in the lacrimal ducts. Purpose . Analysis of the first 30 cases of surgical treatment for dacryostenosis in children performed in the Department of ophthalmology of the Сhildren’s Clinical Hospital in Kazan. Material and methods . Analysis of surgical treatment for dacryostenosis in 30 children aged from 11 months to 8 years 10 months. To restore patency of the tear ducts, we applied the method of S.F. Shkolnik proposed in 2009 with some of our modifications in terms of tools and materials for intubation. Results . In most children, the disease began at birth. Prior to surgical treatment, they had from 0 to 4 soundings of the tear ducts. In the vast majority of cases, dacryostenosis was single-level and associated with congenital anomalies. There were post-traumatic changes in 2 cases. The complications included 2 cases of recurrence of dacryostenosis associated with insufficient stent in the lacrimal ducts and 2 cases of corneal erosion. Conclusion . In our opinion, it is optimal to find a stent in the lacrimal ducts in children for a month. However, the method of surgical treatment for dacryostenosis in children requires further study and standardization.

Systemic sclerosis (SSc) is a rare disease characterized by autoimmune pathogenesis, alterations to the vascular system, and fibrosis of the skin and internal organs. Nonhealing venous ulcers are quite common in SSc patients. A 32 years old female was brought with a foul-smelling ulcer with purulent discharge which was not healed despite using the allopathic treatment for 2 months. Even with treatment, it got worsened so the fear of amputation of leg enforced her to take Ayurvedic consultation. After 1 month of treatment with leech therapy along with Ayurvedic medicines and 3 months of follow-up, the wound got healed. It is concluded that leech therapy with Ayurvedic medicines is highly effective for the management of nonhealing venous ulcers.

Canaliculitis is a rare disease that relapses when not properly diagnosed and treated. It usually occurs in middle-age and advanced age. It is extremely rare in children and infants. A healthy 12-year-old girl presented with lower eyelid swelling and watery discharge in her right eye. During the last 2 years, the patient had been examined several times for the same complaints but there was no improvement despite treatment. Examination showed that the lower punctum had a pouting punctum appearance, and applying pressure to the lacrimal sac area resulted in purulent discharge. Lavage showed that the lacrimal passage was patent. In light of these clinical findings, the patient was diagnosed with canaliculitis. Punctoplasty with surgical curettage of the dacryoliths were performed. After the surgical procedure, a topical antibiotic was prescribed. Histopathological examination of the dacryoliths revealed that the infective cause was Actinomyces. No recurrence or complications were observed during 12 months follow-up.

Background Congenital prepubic sinus is a rare anomaly found in the midline of the lower abdomen. Congenital prepubic sinus is usually asymptomatic in neonates, and a diagnosis is often achieved later in life after spontaneous extrusion of purulent material from the pre-existing hole in the pubic region. We present a case of congenital prepubic sinus presenting with purulent discharge after circumcision. Case summary A 4-year-old Caucasian boy presented to our urology out-patient clinic with purulent discharge from the distal part of the dorsum of his penis. He had a history of circumcision performed at a different center, 6 months ago. His parents stated that although various antibiotics were used, the purulent discharge continued for 6 months and the child had no complaints before circumcision. His condition was reported as superficial dorsal venous thrombosis, known as penile Mondor disease, in magnetic resonance imaging that was performed in the previous hospital. A physical examination revealed a small pinhole lesion at the distal part of his penis and a rigid cylindrical tube extending to the proximal side of his penis. We performed fistulography by injecting contrast material through a small angiocatheter and confirmed the diagnosis of prepubic sinus. Surgical exploration was performed and a long sinus, apparently ending as a fibrous tract at the anterior surface of his pubic symphysis, was found and resected. Conclusions Before congenital prepubic sinus surgery, it is critically important to rule out penile Mondor disease and the possibility of a circumcision complication (especially infective complications) mimicking congenital prepubic sinus.

CASE A 36-year-old patient with chronic alcohol abuse and previous medical history of total hip arthroplasty suffered a fracture of the femoral shaft. During osteosynthesis, a milky fluid similar to purulent discharge emerged at multiple locations. Immediate Gram stains were negative, and the surgery was performed as planned. Laboratory tests showed massive elevated levels of triglycerides. During further workup, chylomicronemia syndrome was diagnosed. CONCLUSION This case report shows that chylomicronemia syndrome can have an appearance during surgery similar to a purulent infection. Immediate Gram stains and laboratory work can identify the reason.

A 22-year-old man was referred to our ophthalmology department with a 10-day history of progressive right eyelid swelling and yellow purulent discharge. Eleven days previously, he had received a diagnosis of viral conjunctivitis, which was treated with a course of steroid and levofloxacin eye drops

This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor.

Background There is no consensus definition to distinguish infectious from non-infectious phlebitis associated to peripheral venous catheter. Aims To evaluate the impact of an intervention program on the rate of infectious (those associated to bacteremia or local purulent discharge) and non-infectious phlebitis (the rest) and identify differential features. Methods Interventional study developed in three stages: basal measurement, intervention, and evaluation. Results Ten infectious and 186 non-infectious phlebitis were registered. Infectious phlebitis diminished after intervention (0.2 to 0.04 events per 1,000 bed-days; p = 0.02) but not the rest (2.3 per 1,000 bed-days before and after). Five of 10 patients with infectious phlebitis had bacteremia, one with infectious endocarditis and valve replacement, and other with septic shock and a fatal outcome. None of the patients in the non-infectious group presented complications. Infectious phlebitis appeared later (mean 4.1 versus 2.4 days; p = 0.007) and were associated to fever (40% vs 5.9%, p = 0.004). Non-infectious phlebitis was associated to irritating compounds (OR 6.1; IC95 1.3-29, p Conclusions The intervention program demonstrated a favorable impact only on the rate of infectious phlebitis. Distinction appears to be relevant because those of infectious origin are associated with fever, complications or death, respond to an intervention program, and emerge lately.

Lymphomas are primarily tumours of lymph nodes. They are further classified as Hodgkin lymphoma and Non-Hodgkin lymphoma. Non-Hodgkin lymphoma is primarily present in Lymph nodes.

Case report An 84 year-old woman was referred for evaluation of a painless swelling with small purulent discharge in her left upper canaliculus, and an associated epiphora of one-month duration. The patient was diagnosed with acute primary canaliculitis. She was treated with topical and oral antibiotics, as well as topical corticoids for three months, with little response. Surgical treatment with left upper canaliculotomy and curettage was then performed, and Gemella haemolysans was identified from the curetted material. The patient had no recurrence of the disease two months after the surgery. Discussion This is the first time that Gemella haemolysans is described as unique agent causing primary canaliculitis.

Urachal anomalies are rare, in the literature it is reported that the three most common types of urachal anomalies are urachal cysts, urachal sinus, and urachal diverticulum. We present the case of an infant who has come to our observation with painful umbilical mass and purulent discharge, irritability and fever. The suspicion of abscess of urachal sinus was confirmed by ultrasound examination, the VCUG was performed to exclude urinary abnormalities. Surgical removal of urachal sinus was resolutive without complications in follow-up. Keywords: Urachal anomalies, Patent urachus, Urachal abscess, Urachal sinus, Umbilical abscess, Diagnosis, Treatment, Children, Infection

Lucio phenomenon is a distinct necrotizing lepra reaction arising from diffuse lepromatous leprosy that may easily be mistaken for other systemic conditions. We report a 17-year old female admitted for a 4-year history of recurrent, extensive ulcerations with crusting and purulent discharge, involving the arms, legs, face, and back. Clinical presentation, slit skin smear and skin biopsy confirmed the diagnosis of Lucio phenomenon and treatment with multidrug therapy resulted in resolution of the ulcerations.

Puyalasa, one among the Sandhigataroga can be correlated to dacryocystitis based on the symptomatology which includes swelling in inner canthus, which later undergoes suppuration causing thick purulent discharge. Dacryocystitis is the inflammation of the lacrimal sac. Management of acute dacryocystitis differs based on the stage. Puyalasa treatment includes Raktamokshana (blood letting), Upanaha (poultice) and other Vranashotha (inflammatory swelling) treatment. A 28 year old female patient diagnosed as Puyalasa (acute dacryocystitis) was treated with blood letting, Ksharavarti (alkali thread) insertion and Bidalaka (applying medicines in paste form over eyelids) and the results proved to be significant on the basis of clinical assessment.

Case summary A 12-year-old neutered male onychectomized Ragdoll cat presented for a 3 day history of swelling and hemorrhagic purulent discharge on the first digit of the left manus. Radiographs revealed fragments of the third phalangeal bone (P3) present in the partially amputated digits with swelling adjacent to the P3 fragment on the first digit of the left manus. Thoracic radiographs revealed no evidence of primary or metastatic neoplasia. Surgery was performed to remove all P3 fragments and the associated swelling on the diseased digit. On gross examination of the excised swelling, a mass was present at the cut edge of P3. The bone fragment and associated mass were submitted for histopathological evaluation. Osteosarcoma was diagnosed. Because neoplastic cells extended to the surgical margins, amputation of the left thoracic limb was performed. The cat recovered from surgery, and survival time at the time of writing was 8 months. Relevance and novel information To our knowledge, this is the first reported case of onychectomy-associated osteosarcoma. Trauma from partial P3 amputation during onychectomy is suspected to have played a role in osteosarcoma development in this case. Malignant transformation may be considered a potential complication of onychectomy achieved by partial P3 amputation.

A woman in her early 30s presented with perianal purulent discharge. A rectal examination showed a high complex fistula-in-ano. A fistulotomy was performed wherein two fistulous tracts at the 4 o’clock and 8 o’clock position involving the external sphincter muscle were identified, and the granulation tissue was submitted for histopathological evaluation. 1. A dense infiltrate of macrophages with an artefact amidst the granulation tissue. 2. Macrophages exhibiting emperipolesis along with a cotton fibre adjacent to them. 3. Macrophages exhibiting emperipolesis along with a parasite in the adjacent tissues. 4. Macrophages exhibiting emperipolesis with a slender vegetable cell adjacent to them. Amidst abundant granulation tissue, without eosinophils, were numerous multinucleated macrophages showing emperipolesis (figure 1). The engulfed cells were lymphocytes, plasma cells and occasional …

A 49 year-old man presented with a several-day history of right upper eyelid swelling and purulent discharge. He had a history of inhalational heroin use. Examination noted intact visual acuity, pr...

Nowadays Pilonidal Sinus (PNS) is becoming common disease in between 20-30 years of age, in men and mostly dense hairy persons. Commonly it occurs midline over the coccyx. It results in purulent discharge, pain and discomfort. In Ayurvedic practice, there are many surgeons who are practicing classical Ksharasutra management to treat PNS, which is very effective but there are some problems using classical Ksharasutra in the management of PNS, such as discomfort, burning sensation, itching and irritation due to Snuhi-ksheera. So to overcome these problems Guggulu Apamarga Ksharasutra has been used, which is very effective in curing PNS and has no complications. So patients can do their daily routine work without any pain or discomfort.

PURPOSE To report a patient with a history of eye involving Stevens-Johnson syndrome (SJS) who developed chronic bilateral purulent discharge attributed to conjunctival diverticuli. CASE REPORT A 75-year-old woman with SJS presented with bilateral chronic relapsing purulent conjunctivitis secondary to inferior conjunctival diverticuli. The symptoms resolved after marsupialization of the diverticuli. CONCLUSIONS The conjunctival scarring associated with SJS can lead to sequestration of conjunctival epithelium that may in turn lead to the formation of a diverticulum. The presence of a diverticulum should be considered in patients with a history of SJS who develop chronic relapsing purulent conjunctivitis.

IntroductionSacrectomy to treat malignant tumors is often results in large pelvic defects to require reconstruction, using a prosthetic mesh. Importance is to avoid its direct contact of mesh with intestine to prevent adhesion between them.Presentation of caseAn 83-year old woman who was diagnosed with a mesh infection caused by a small bowel penetration 10 years after sacrectomy combined with mesh reconstruction for chordoma. In the first operation, because of incomplete re-peritonealization due to a large defect in the retroperitoneum, a mesh unavoidably was compelled to contact with the small intestine. We subtotally removed the mesh and performed mesentric leaf repair of the pelvic defect.The postoperative course was complicated by infection of the pelvis. She was discharged 59 days after surgery with a little purulent discharge from perineal wound, which was persisted for two years after operation.Discussion/ConclusionWe used the mesenteric leaf to repair the pelvic defect at the operation. This procedure might be the best alternative, when the use of mesh has to be avoided like present case. To our knowledge, this is the first report of mesh infection after sacrectomy, so we report herein., Article, International Journal of Surgery Case Reports.30:215-219(2016)

Puyalasa (Acute dacryocystitis) is an acute suppurative inflammation of lacrimal sac characterized by painful swelling in the region of sac associated with epiphora, fever and Malaise. Puyalasa, is one of the Sandhigata Roga which includes swelling in Kaninika sandhi, which later on undergoes suppuration causing thick purulent discharge. The present study was planned to assess the efficacy of Jalaukavacharana and Shadanga Guggulu in Amavastha and Pachyamanavastha of Puyalasa. Total 60 patients of Puyalasa (Amaavastha and Pachyamanavastha) were randomly selected and grouped into Group A, B and C with 20 patients in each group. The patients of Group-A received Jalaukavacharana as a line of treatment, patients of Group-B received Shadanga Guggulu and Patients of Group-C received both Jalaukavacharana and Shadanga Guggula. In all the three groups the Group-C in which both Jalaukavacharana and Shadanga Guggulu were included is very effective after treatment of 15days and statistically significant in reducing Shopha, Savedena, and Sarambha.

INTRODUCTION: Endoscopic Intra nasal approach to by-pass the obstruction of lacrimal apparatus is a simple and commonly practiced surgery among the ENT Surgeons. Various modifications in the form of usage of micro drill, application of Mitomycin C and preserving the nasal flap to line the opening in the sac to name a few are being used. Recurrence of epiphora and closure of the neo opening is described and observed are labeled as failed endonasal DCR. This study makes an attempt to review retrospectively and prospectively to evaluate the degree of recurrence and causes of failure. OBJECTIVE OF THE STUDY: This study also attempts to determine the causes of failure of endonasal DCR and its subsequent management. Thus this study precludes the role of revision DCR. Materials and Methods: 50 patients who underwent endonasal DCR surgery at GGH Kurnool and reported with symptoms of returning of epiphora, purulent discharge from the eye were included. A detailed history taking and endoscopic examination done to find the cause of failure. An attempt is made to classify the causes and find suitable remedy.RESULTS:36% of the patients showed tendency to form synaechiae, 18.6% of patients presented with thick lacrimal crest, 9% of them showed formation of a thin veil like membrane over the neo-ostium. All the patients were subjected to revision surgery and subjective improvement in 92% of the patients reported at the time of reporting of the study.

Objective: Post-operative laminectomy wounds are frequently accompanied by seromas. Post-operative wound drainage may be colonized or infected. The differentiation of wound colonization from infection is difficult for non-infectious disease physicians. Methods: External chart reviewers classified 31/1531 laminectomies (over three years) as post-operative wound infections. We re-evaluated these cases using infectious disease criteria, i.e., while pathogens may be cultured from both colonized and infected wounds, only wound infections have a purulent discharge with abundant white blood cells (WBCs) on Gram stain. Colonized wounds have positive wound cultures but no/few WBCs on Gram stain. Results: We found only 11/31 actual wound infections, the remainder were not bona fide wound infections, but were colonized seromas. Conclusion: Post-laminectomy colonized seromas that are culture positive for one or more organisms often mimic wound infections. In the era of public reporting of nosocomial infections, it is important that external reviewers differentiate colonization from infection to provide regulatory agencies with accurate data.

A 17-year-old healthy boy presented to the emergency room with conjunctival hyperemia, purulent discharge and periorbital swelling of the right eye, lasting for 4 days, without improvement with topical chloramphenicol. On the day of admission, he started ocular pain and photophobia. There was no

Aim This study aimed to evaluate the long-term outcome of the anal fistula plug in the treatment of anal fistula of cryptoglandular origin. Method A review of all patients who had at least one anal fistula plug inserted from March 2007 to August 2008 was performed. Only anal fistulae of cryptoglandular origin were included. Success was defined as the closure of the external opening with no further purulent discharge or collection. Results Thirty anal fistula plugs were inserted in 26 patients [median age 40 (26–70) years]. Twenty-six of the fistulae were transsphincteric and three were suprasphincteric. One patient had a high intersphincteric fistula, which was the only fistula that did not have a seton inserted. The median duration between seton insertion and the plug procedure was 12 (4–28) weeks. The median length of the fistula tract was 3 (1–7.5) cm. After a median follow-up of 59 (13–97) weeks, 26 (86.7%) fistulae recurred. Of the 26 failures, the median time to failure was 8 (2–54) weeks. Subsequent surgical interventions were performed in 20 of the failures. Conclusion The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation.

dissecting cellulitis of the scalp (DCS) is a chronic inflammatory condition characterized by recurrent nodules, abscesses and sinus tract formation.1-3 It usually starts as a simple folliculitis with occlusion of follicular openings mainly on the scalp vertex or nape, generally followed by perifollicular pustules and painful firm or fluctuant nodules releasing a purulent discharge, either spontaneously or after a gentle pressure. This article is protected by copyright. All rights reserved.

Umbilical pilonidal disease is seen less frequently than sacrococcygeal pilonidal disease. The two most common symptoms are mild pain and bloody or purulent discharge from the umbilicus. The authors discuss the clinical features of umbilical pilonidal disease, the different methods of treatment, and their technique for sinus excision and umbilicoplasty.