Hemi Le Fort III Fracture with Subdural and Subarachnoid Pneumocephalus with a Mild Mount Fuji Sign

ABSTRACT: Extensive fractures in the fixed facial skeleton combined with traumatic brain injury can cause functional and esthetic impairments, possibly threatening the patient's life. Male patient, 50-year-old, victim of physical aggression, presented with persistent headache and dizziness, fractures in the naso-orbito-ethmoidal, zygomatic-maxillary and right pterygoid process regions, among other minor patterns of facial fracture, with mobility to maxillary traction of the third midface unilaterally. Clinical-imaging findings revealed a Hemi Le Fort III fracture and subdural and subarachnoid pneumocephalus with a mild Mount Fuji Sign. The proposed treatment was facial osteosynthesis and conservative intravenous drug treatment of the pneumocephalus. The patient had a good recovery, with no postoperative motor or functional deficits. The correct management of the patient with facial trauma associated with craniotrauma offers benefits, restoring stability of facial architecture and preventing or correcting neurosurgical complications.

RESUMEN: Las fracturas extensas en el esqueleto facial combinadas con una lesión cerebral traumática pueden causar deficiencias funcionales y estéticas, que posiblemente pongan en peligro la vida del paciente. Paciente de sexo masculino, 50 años, víctima de agresión física, que presentó cefalea persistente y mareos, fracturas en las regiones naso-orbito-etmoidal, cigomático-maxilar y pterigoides derecha, entre otros patrones menores de fractura facial, con movilidad a tracción maxilar del tercio medio facial unilateralmente. Los hallazgos de las imágenes clínicas revelaron una hemifractura de Le Fort III y neumocefalia subdural y subaracnoidea con un leve signo del Monte Fuji. El tratamiento propuesto fue la osteosíntesis facial y el tratamiento farmacológico intravenoso conservador de la neumocefalia. El paciente tuvo una buena recuperación, sin déficit motor ni funcionales postoperatorios. El manejo adecuado del paciente con trauma facial asociado a craneotrauma ofrece beneficios, devolviendo la estabilidad de la arquitectura facial y previniendo o complicaciones neuroquirúrgicas.

Úlcera duodenal benigna con penetración en cabeza de páncreas, con obstrucción de la vía biliar / Benign duodenal ulcer penetrating into pancreas, with obstruction of common bile duct

Resumen Objetivo: Reportamos un caso clínico con presentación atípica de una úlcera duodenal benigna que simula el cuadro clínico y radiológico de una neoplasia de páncreas. Materiales y Método: Presentamos el caso de un varón de 83 años que debuta con un cuadro clínico de astenia e ictericia mucocutánea. En estudio de imagen se identifica una masa en cabeza pancreática. En estudio endoscópico se observa úlcera duodenal benigna penetrada a cabeza de páncreas que condiciona obstrucción de vía biliar. Discusión y Conclusiones: El manejo de estos pacientes suele ser quirúrgico porque desarrollan un deterioro asociado a sepsis o perforación. Si la situación clínica lo permite se puede intentar un tratamiento conservador. En nuestro caso el paciente precisó un mes de hospitalización con antibioticoterapia intravenosa de amplio espectro, reposo alimentario, nutrición parenteral y tratamiento con inhibidores de la bomba de protones (IBP) para la resolución del cuadro. La penetración o fistulización a la cabeza del páncreas es una complicación grave e infrecuente de la enfermedad ulcerosa péptica. Su manejo puede ser conservador en casos seleccionados donde no exista perforación de la úlcera a la cavidad peritoneal, ni exista deterioro séptico ni hemodinámico.

Aim: To report an atypical presentation of a benign duodenal ulcer that simulates pancreatic neoplasia. Materials and Method: A case of a 83 years old male patient with astenia and jaundice due to a benign duodenal ulcer penetrating into the pancreas with obstruction of common bile duct. Imagining study identified a pancreatic head mass. The patient required one month admission, receiving broad-spectrum antibiotics, parenteral nutrition and intravenous proton pump inhibitors. Discussion and Conclusion: Due to frequent complications associated to this condition, such as haemodynamic failure, sepsis or free peritoneal perforation, surgery is the main treatment. However, in mild cases, as in our patient, conservative management can be considered. Penetration or fistulization to the head of the pancreas is a rare and serious complication of peptic ulcer disease. Its management can be conservative in selected cases where there is no perforation of the ulcer into the peritoneal cavity, nor septic or hemodynamic deterioration.

Clinical thinking and evidence-based for decompression of cystic lesions in the jaw bone / 口腔疾病防治

@#Decompression is an effective and widely used treatment for jawbone cystic lesions that can, to a great extent, preserve the function and appearance of the jawbone. However, some problems exist with its clinical application, such as the inappropriate determination of indication and the lack of standardized operational guidelines, resulting in treatment ineffectiveness or even failure. This paper aimed to summarize the clinical value of decompression for jawbone cystic lesions in terms of mechanism, scientific evidence, advancement, indications and effective evaluation by reviewing relevant literature and our clinical experience.

A prospective clinical study of early breast cancer treated with hypofractionated simultaneous integrated boost IMRT/ VMAT after breast conservative surgery / 中华放射医学与防护杂志

Objective@#To evaluate the efficacy, toxicity and cosmetic outcomes of hypofractionated simultaneous integrated boost intensity-modulated radiotherapy (IMRT-SIB) after breast conservative surgery (BCS) for early breast cancer patients.@*Methods@#A total of 76 patients with stage TisT1-2N0M0 breast cancer treated with BCS were enrolled in the analysis. The patients who underwent breast radiotherapy without regional lymph node irridiation and hypo fractionated IMRT/VMAT were used. All patients received whole breast IMRT/VMAT with tumor bed SIB. The doses delivered to the whole breast was 42.4 Gy in 16 fractions, and the dose delivered to tumor bed for SIB was 49.6 Gy in 16 fractions. Cosmetic evaluation was based on the Harvard system. Acute and late toxicities were scored according to CACAT version 3.0. Survival and recurrence rates were calculated by Kaplan-Meier method. The univariate and multivariate analysis were conducted with logistic regression.@*Results@#The median follow-up was 29 months (range 16-40 months). The follow-up rate was 100%. The 1-, 2-and 3-year overall survival rates were 100%. No recurrence or metastasis was observed in this study. The incidence of grade 1 acute skin toxicity was 68.4%, grade 2 was 7.9%. The late skin toxicity of grade 1 was 13.1%, grade 2 was 2.6%.In all, 82.4% of patients had excellent and good cosmetic outcome. The Mean dose of the tumor bed was predictive factor for grade 2 dermatitis.@*Conclusion@#The efficacy, cosmetic effect, the acute and late treatment-related toxicity of hypofractionated IMRT/VMAT-SIB in patients with early breast cancer following BCS might be acceptable. A longer follow-up is needed to define the efficacy on outcomes.@*Trial registration@#Chinese clinical trial registry, ChiCTR1800016287

New opinion on radiological grade and conservative treatment of children splenic injury / 中国小儿急救医学

Objective Radiological grade of splenic injury was seldomly used in China trauma center now,though it had been established in 1994 by American Association for Surgery of Trauma (AAST) and widely used.The present study is aimed to analyze the imaging grade and clinical characteristics of traumatic splenic rupture in children,discuss the feasibility of conservative treatment,and the role of radiographic grading during clinical treatment.Methods Information (including age,gender,severity based on radiological findings,treatment strategies,and clinical outcome) regarding 59 hospitalized splenic injury patients whose injuries occurred between 2008 and 2014 was retrospectively analyzed.Results Between 2008 and 2014,59 pediatric patients with splenic injury were treated in our institution.Median age was 9.5 years (range,3 months to 16 years).Of all patients,41 (69.5%) were male.The injuries were primarily caused by traffic crash (45.7%),stumbling/falling from a height (38.9%).According to AAST,5 cases were grade Ⅰ,26 patients grade Ⅱ (44.1%),and 21 cases grade Ⅲ (35.6%),6 over grade Ⅳ,and only one was unclear.Of all patients,25 cases were with the other organs complications.All patients underwent fasting,bed rest,and antibiotics.Only 1 case was transferred to operation during the conservative treatment.Forty-nine patients underwent with CT scan over 2 times.Conclusion Imaging classification helps guide clinical treatment.Conservative treatment is feasible for traumatic splenic injury in children.Early imaging classification of splenic injury may be helpful in clinical judgment,and reduce children radiation exposure.

Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to suggest an appropriate therapeutic approach by making a comparison between conservative therapy and surgical therapy for a pathologic fractures of the humerus caused by benign bone tumor. MATERIALS AND METHODS: We selected 15 cases with a pathologic fracture of the humerus caused by benign bone tumor from January 2000 to April 2014 to evaluate the fracture union period and remission of primary bone tumor. Eight cases were treated with conservative therapy, and 7 cases by surgical therapy. The mean age was 13.1 years, and the age range was between 1 year and 19 years; there were 8 male cases and 7 female cases. The mean follow-up period was 24.9 months, with a range from 4 months to 72 months. We evaluated the remission of primary benign tumor in accordance with the ‘Modified Neer classification’ system. RESULTS: There was no statistically significant difference in age, sex, and mean follow-up period between the two groups. The pathologic fracture was united in all cases without secondary displacement. There was no statistically significant difference in the fracture union period (p=0.164) and remission of primary benign tumor (p=0.931) between the two groups. CONCLUSION: We suggest that both conservative and surgical therapies can be a treatment for pathologic fracture of the humerus caused by benign bone tumor.

Objective Measurement of Cosmetic Outcomes of Breast Conserving Therapy Using BCCT.core / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate objective cosmetic outcomes and factors related to breast-conserving therapy (BCT) using the BCCT.core software. MATERIALS AND METHODS: Fifty-one patients who received BCT with informed consent were evaluated using the BCCT.core software. Patients were divided into two groups based on the BCCT score: excellent or good (n=42) vs. fair or poor (n=9). Analysis of clinical factors was performed to determine factors affecting cosmetic outcomes. RESULTS: The objective cosmetic outcome of BCT measured using the BCCT.core software was excellent in 10% of patients, good in 72%, and fair in 18%. None of the patients were classified as poor outcome. Tumor characteristics, systemic adjuvant therapy (chemotherapy and hormonal therapy), and radiation dose or energy of electron boost did not show correlation with the score measured by the BCCT.core program (p > 0.05). In univariate analysis, maximum dose within the breast (Dmax), width of tangential field, and excised tumor volume were smaller in patients with excellent or good by the BCCT.core compared to those with fair or poor (Dmax, 110.2±1.5% vs. 111.6±1.7%, p=0.019; width of tangential field, 8.0±1.1 cm vs. 8.6±0.7 cm, p=0.034; excised tumor volume, 64.0±35.8 cm3 vs. 95.3±54.4 cm3, p=0.067). In multivariate analysis, only Dmax was a significant factor for breast cosmetic outcome with a risk ratio of 1.697 (95% confidence interval, 1.006 to 2.863; p=0.047). CONCLUSION: Objective measurement of cosmetic outcome of BCT using the BCCT.core software was feasible. The cosmetic outcome of BCT may be affected by the maximum dose within the breast.

Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation

OBJECTIVES: Limited information is available concerning the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients who receive conservative therapy. Accordingly, this study was designed to evaluate the predictive value of the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients without surgery. METHOD: From January 2009 to January 2011, critical limb ischemia patients were admitted to a vascular center. The demographic data, patient histories, comorbidities and risk factors were documented, and the differential cell count was determined at admission and seven days later after conservative therapy. The cutoff value of the post-treatment neutrophil-lymphocyte ratio was determined by an ROC curve. Patients were divided into groups A and B according to the cutoff value. Amputation-free survival was compared between groups. Univariate and multivariate analyses were used to identify independent risk factors. RESULT: A total of 172 patients were identified with a mean age 71.98±10.09 years; among them, 122 were male. A value of 3.8 was identified as the cutoff value of the post-treatment neutrophil-lymphocyte ratio. Groups A (post-treatment neutrophil-lymphocyte ratio ≥3.8) and B (post-treatment neutrophil-lymphocyte ratio <3.8) showed a significant difference in amputation-free survival (P<0.001). The 1-year, 2-year and 3-year amputation-free survival rates were 79.6%, 55.6% and 46.3%, respectively, in group A; however, in group B, these values were 89.7%, 79.3% and 75.9%, respectively. The post-treatment neutrophil-lymphocyte ratio was identified as an independent predictive factor for amputation in critical limb ischemia patients (P<0.001). CONCLUSION: The post-treatment neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. Patients with a post-treatment neutrophil-lymphocyte ratio ≥3.8 are likely to suffer from ...

Clinical and Magnetic Resonance Imaging Factors Which May Predict the Need for Surgery in Lumbar Disc Herniation

STUDY DESIGN: Case-control. PURPOSE: Evaluate clinical and imaging factors which may predict the risk of failure of medical therapy in patients with lumbar disc herniation (LDH). OVERVIEW OF LITERATURE: LDH is a common cause of low back pain and radicular leg pain, with a generally favorable natural course. At present, however, it is not possible to identify patients who may be candidates for surgery in an early stage of their disease by means of clinical signs or diagnostic imaging criteria. METHODS: We designed a study investigating patients with untreated low back pain to assess the predictive value of demographic, clinical or imaging findings in identifying patients who finally would meet the classic current criteria for surgery. RESULTS: Among 134 patients, 80.6% were successfully treated with conservative therapy and 19.4% finally underwent surgery. Sex, occupation, involved root level, presence of Modic changes, osteophytes or annular tears were not significantly different between the 2 groups, while cerebrospinal fluid block, Pfirrmann's grade, location of herniation with regard to the midline, and type of herniation were significantly different. Anteroposterior fragment size was significantly higher and intervertebral foramen height and thecal sac diameters were significantly lower in the surgical group. CONCLUSIONS: Although it is strongly recommended to practice conservative management at first for patients with LDH symptoms, the results of this study shows that higher Pfirrmann's grade, more laterally located discs, extrusion and protrusion herniation types, and larger fragments could predict the risk of conservative treatment failure. This way, unnecessarily prolonged conservative management (beyond 4-8 weeks) may be precluded.

Clinical outcome of conservative treatment of injured inferior alveolar nerve during dental implant placement

OBJECTIVES: Infererior alveolar nerve (IAN) damage may be one of the distressing complications occurring during implant placement. Because of nature of closed injury, a large proportion is approached non-invasively. The purpose of this study was to analyze the outcomes of conservative management of the injured nerve during dental implant procedure. MATERIALS AND METHODS: Sixty-four patients of implant related IAN injury, who were managed by medication or observation from January 1997 to March 2007 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, were retrospectively investigated. The objective tests and subjective evaluations were performed to evaluate the degree of damage and duration of sensory disturbance recovery. Tests were performed on the day of the first visit and every two months afterward. Patient's initial symptoms, proximity of the implant to the IAN, time interval between implant surgery and the first visit to our clinic, and treatment after implant surgery were analyzed to determine whether these factors affected the final outcomes. RESULTS: Among the 64 patients, 23 had a chief complaint of sensory disturbance and others with dysesthesia. The mean time until first visit to our hospital after the injury was 10.9 months.One year after nerve injury, the sensation was improved in 9 patients, whereas not improved in 38 patients, even 4 patients experienced deterioration. Better prognosis was observed in the group of patients with early visits and with implants placed or managed not too close to the IAN. CONCLUSION: Nearly 70% of patients with IAN injury during implant placement showed no improvement in sensation or dysesthesia with the conservative management. Earlier decision for active treatment needs to be considered because of possibility of deterioration of symptoms and unsatisfactory recovery.

Application of methylene blue in sentinel lymph node biopsy in breast conservative therapy of breast cancer / 中国基层医药

Objective To explore the clinical value of methylene blue in sentinel lymph node biopsy ( SLNB) in breast conservative therapy of breast cancer. Methods 55 patients performed sentinel lymph node biopsy( SLNB)in were analyzed,with breast conservative therapy of breast cancer in clinical stage Ⅰ-Ⅱ. The mapping procedures and SLNB were performed using subareolar injection of Methylene blue dye,followed by the axillary lymph node dissection(ALND). All of the SLN and ALN were evaluated pathologically after the operations. Results Among 55 cases ,52 cases were checked out sentinel lymph node and the positive rate was 95% (52/55). The axillary status was 100% accurately predicted by SLNs;Sensitivity in this group was 93% (52/55) ;False negative rate was 5% (1/20);False positive rate was 0. Conclusion Methylene blue dye is a reliable method for sentinel lymph node biopsy. SLNB is a simple and safe technic, which helps to reveal the state of the axillary lymph nodes.

Revisando as contribuições da reconstrução mamária para mulheres após a mastectomia por câncer / Revising the contributions of mammary reconstruction for women after mastectomy for cancer / Revisando las contribuciones de la reconstrucción mamaria para mujeres después de la mastectomía por cáncer

O câncer de mama é o segundo tipo de câncer mais frequente no mundo e o mais comum entre as mulheres. Em razão da sua elevada incidência, torna-se uma das grandes preocupações, sobretudo pelos impactos psicológicos que acarretam para a saúde da mulher. A mastectomia e a reconstrução da mama constituem-se como terapias cirúrgicas disponíveis e ambas têm resultados semelhantes para a sobrevivência. Este artigo objetivou revisar a produção científica que aborda os benefícios da reconstrução mamária para a mulher mastectomizada. A revisão foi realizada em agosto de 2008 e considerou artigos publicados entre 2001 e 2008 na base de dados SciELO, a partir dos descritores: mastectomia, reconstrução mamária e câncer de mama. A reconstrução mamária tem impacto positivo sobre a saúde mental e a qualidade de vida, e, quanto mais precocemente for realizada, maiores serão os benefícios.

Breast cancer is the second highest occurence of  women cancer in the world. ETherefore it becomes one of the strongest concerns on account of its psychological and social impacts on women’s health. Mastectomy and breast reconstruction are available surgical therapies and both have similar results for survival. This article aims at revising the scientific production on the benefits of breast reconstruction for women after mastectomy. The revision was accomplished in August, 2008 and looked into articles published from 2001 to 2008 on the SciELO’s data base with the following keywords: mastectomy, breast reconstruction, and breast cancer. Breast reconstruction has positive impact on women’s mental health and quality of living and the sooner it is accomplished, the better the benefits.

El cáncer de mama es el segundo tipo de cáncer más frecuente en el mundo y el más común entre las mujeres. Por su incidencia alta, él se vuelve una de las grandes preocupaciones, sobre todo por los impactos psicológicos que causan a la salud de la mujer. Se constituyen la mastectomía y la reconstrucción de la mama como terapias quirúrgicas disponibles y las dos tienen los resultados similares para la supervivencia. Este artículo objetivó revisar la producción científica que enfoca los beneficios de la reconstrucción mamaria e suya importancia como parte del terapeutica para la mujer sometida a la mastectomia. La revisión fue cumplida en agosto de 2008 y consideró artículos publicados entre 2001 y 2008 en la base de datos SciELO, a partir de los descriptores siguientes: mastectomía, reconstrucción mamaria y cáncer de mama. La reconstrucción mamaria tiene impacto positivo sobre la salud mental y la calidad de vida, y cuanto más precocemente sea hecha, más grandes serán beneficios.

Study on Related Factors Leading to Successful Treatment of Ectopic Pregnancy by Conservative Therapy / 国际中医中药杂志

Objective To analyze the rented factors leading to successful treatment of ectopic pregnancy by conservative therapy and to explore importance of this therapy. Methods 152 patients with ectopic pregnancy performed with conservative treatment were randomly recruited into a methotrexate plus Chinese medicine group, a 5-fluorouracil plus Chinese medicine group and a exclusive Chinese medicine group. The curative rate and side effect were observed in groups, and the relation between the treatment condition and the curative rate was analyzed. Results There was no difference in curative rate among groups, while the side effect in the exclusive Chinese medicine group was lower than other groups. It showed high curative rate in patients with two or more conditions of having mass less than 3 cm, the level of bloodβ-hCG less than 1000 IU/L, and the depth of posterior fomix effusion less than 1 cm. Conclusion Among the treatments of ectopic pregnancy, Chinese medicine has fewer side effects. Fully evaluation on the treatment condition can improve the curative rate.

Cervico-thoraco-lumbar Spinal Epidural Abscess and Psoas Abscess Successfully Treated with Parenteral Antibiotic Therapy and Percutaneous Drainage: A Case Report

We describe a 75-year-old man with a cervico-thoraco-lumbar spinal epidural abscess was extended to the psoas muscle. The patient complained high fever and back pain, followed by weakness of the lower extremities. He had received multiple epidural injections in a local pain clinic just few days before the onset of fever. The multi-segmental epidural abscess which was demonstrated by MRI compressed dural sac and cord. The best way to recommend him was to undergo a surgical decompression, but he refused the surgery. Next, we chose nonsurgical treatment such as longstanding parenteral antibiotic therapy and percutaneous drainage of psoas abscess. We could cultivate a causative organism and chose appropriate antibiotics. The patient experienced immediate relief of fever and the improvement of laboratory findings, gradual relief of back pain and full neurological recovery.

Effect of Conservative Therapy on Acute Prolapse of Lumbar Intervertebral Disc: a 365 Case Report / 中国康复理论与实践

@#Objective To observe the clinical effect of conservative therapy on prolapse of lumbar intervertebral disc(PLID).Methods 365 PID patients included 78 acute cases and 287 subacute cases.The treating principle for acute cases was eliminating edema and aseptic inflammation,and that for subacute cases was releasing adhesion and removing inflammatory stimulation to nerve root.Results Of 78 acute patients,60 cases(76.9%) healed,18 cases(23.1%) improved;of 287 subacute patients,186 cases(64.8%) healed,101 cases(35.2%) improved,the effective rate of 365 patients was 99.7%.Conclusion Conservative therapy is effect on PLID at acute and subacute periods.

A successful twin pregnancy after conservative therapy of endometrial cancer / 대한산부인과학회지

Endometrial cancer is increasing in South Korea. In young women, endometrial cancer can be treated by progestins for preserving fertility. We experienced a successful case of twin pregnancy after conservative therapy of endometrial cancer with Megestrol acetate. Ovulation induction and intrauterine insemination was done. A brief review of related literature was done.

Recurrent Colonic Perforation after Successful Conservative Treatment of Colonoscopic Perforation

Although the management of a colonic perforation after a colonoscopy is still controversial, conservative therapy is commonly used in those whose colonoscopy reveals a small perforation, those whose condition is relatively good, those who were diagnosed belatedly, or those who have not developed the symptoms of generalized peritonitis. We encountered a case of recurrent colonic perforation after successful conservative treatment for a colonoscopic perforation of the sigmoid colon in a 69-year-old female, who was treated with tube sigmoidostomy.

A Clinical Study of Submandibular Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Submandibular space might be estimated as the most common space of deep neck infection. It may, in certain cases, be treated conservatively with no need for early open surgical drainage. The purpose of this study is to review the clinical course and outcome in treatment of submandibular abscess. SUBJECTS AND METHOD: A retrospective study was peformed for 9 years on 49 cases admitted from June 1994 to January 2003 for deep neck infection limited to the submandibular space. All patients were treated with intravenous antibiotics. The conservative group was treated with antibiotics only or combination therapy with needle aspiration. The surgical group was treated with intraoral or external drainage. Contrast enhanced computed tomography (CT) imaging was conducted for all cases and had confirmed that they all had an abscess in the submandibular space. RESULTS: The mean period of hospitalization was 7.6 days, with 35 patients treated with IV antibiotics only and 3 patients with aspiration in the conservative group. On the other hand, 3 patients were treated with intraoral drainage and 8 patients with external drainage in the surgical group. One patient required tracheotomy because of severe dyspnea. There was no complication observed in any cases. CONCLUSION: SSubmandibular abscess is an infection of deep neck space and is considered as the most common infection. Conservative treatment is a good therapeutic choice in cases with localized submandibular absess.

Conservative Therapy Compared with Operations in Early Severe Acute Pancreatitis / 中国医师杂志

Objective To explore indications of the conservative therapy an early operative treatment for severe acute pancreatitis and researching comprehensive therapeutic rule.Methods Retrospective analyze the clinical feature and the result as making a diagnosis and giving treatment of 82 cases of SAP admitted from Aug.1986 to dec.2000.Results Among them,28 cases underwent conservative treatment,with the cure rate of 85.7%,54 cases underwent conservative treatment,with the cure rate of 81.5%,the total cure rate was 82.9%.Conclusions The conservative therapy or early operation of SAP is determined by the patients' clinica feature,while the supportive conservative therapy being on,we should carefully observe the changes of the patient's condition and the response to therapy,when once surgical indication being discovered,early operation should be performed ,the emergency surgery should be performed as soon as possible for the biliary obstruction of SAP.

A Review of Acute Emphysematous Pyelonephritis

BACKGROUND: Acute emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires the emergent intensive treatment. Diagnosis is usually established by the certain radiologic findings. Mortality rates of patients reportedly vary from 40 to 90% and patients treated conservatively approaches 80% in some series. Traditional therapy for emphysematous pyelonephritis is nephrectomy. Recent advances on endourologic area have been applied to percutaneous drainage, but appropriate care requires aggressive treatment to preserve renal function without increased mortality. I reviewed the clinical feature, radiologic findings and results of different mode of treatments. METHOD AND RESULTS: Seven patients who admitted with the impression of the acute emphysematous pyelonephritis from March 1997 to March 1999 were enrolled in this study. The clinical feature, radiologic findings and results of different treatments were evaluated. All patient presented with diabetes mellitus and complained fever of short duration. Other characteristics and laboratory findings were variable. Escherichia coli was documented organism in 4 cases and Klebsiella in 1 case. Of the 7 patient, 4 were managed by conservative treatment including with intensive antibiotic therapy followed by prolonged oral antibiotics and supportive care. The results of treatment of 3 cases were successful but, 1 patient with multiple predisposing diseases and poor general condition at the initial presentation was deteriorated despite of intensive care. And among the 7 cases, emergent nephrectomy was performed to 2 patients, as the patient had the evidence of progressive course of septic shock and clinically fetal. After operation, 2 patients improved markedly. And remaining 1 patients were improved after the percutaneous drainage of the collection of prominent perirenal abscess. CONCLUSION: Tough definite prognostic factor were not documented, the underlying disease and general condition in initial presentation may have important role. Standard treatment to emphysematous pyelonephritis are known to be emergent nephrectomy, but my cases revealed that conservative treatment including intensive antibiotics therapy and percutaneous drainage may effective to the less critical patients.