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PubMedDate not supplied

[Pathogenesis and methods of treatment of otogenic brain abscess].

UNLABELLED: Otitis media, acute or chronic, is a potentially dangerous disease which may lead to fatal complications. Meningitis is the most common intracranial complication, followed by otogenic brain abscesses while lateral sinus thrombosis is fairly uncommon. Mortality from otogenic brain abscesses remains relatively high. The aim of the study was to investigate mechanisms of development, diagnostic methods and treatment of these complications of otogenic brain abscesses. MATERIAL AND METHODS: The retrospective study covered 42 patients with otogenic brain abscess (28 cerebral and 14 cerebellar) treated from 1973 to 1995 at the ENT and Neurosurgical Hospital in Belgrade. Medical records of the studied patients were analyzed for the occurrence of the disease, diagnosis and mode of therapy. Special care was dedicated to type of otitis, surgical findings, diagnostic methods, mode of therapy and therapy outcome. RESULTS: In the period of 23 (1973-1995) 114 patients with otogenic intracranial complications were treated at the Clinic of Otorhinolaryngology and Maxillofacial Surgery. Meningitis was the most common complication in this series, followed by cerebral abscess, lateral sinus thrombosis, cerebellar abscess, while extradural abscesses were rare, and subdural occurred only exceptionally (Table 1). In somewhat more than half of the patients (55%) one intracranial complication was present, While in 54% two or more intracranial complications were recorded (Table 2). Otogenic brain abscesses are usually associated with meningitis. Meningitis was present in 20 patients with cerebral abscess (71%), and in 5 (33%) patients with cerebellar abscess. Meningitis and lateral sinus thrombosis were more commonly associated with cerebellar abscess (41%), and less with cerebral abscess (10%). In our group of patients otogenic brain abscesses were most common in the third decade of life, than in the second, while the frequency of the complication fell significantly in older age groups (Figure 1). Headache (92%). fever (91%), vomiting (68%) were the most common symptoms, while photophobia and vertigo were less common (38% and 30%, respectively). Active chronic otitis with cholesteatoma was most commonly present in patients with otogenic brain abscess, only somewhat more common in patients with cerebral abscess (84%), than in those with cerebellar abscess (80%). Neurological examination of 28 patients with cerebral abscess evidenced the abscess in 11, while in 15 the examination suggested meningitis. (Table 3). The diagnosis of abscess was most commonly established by computerized tomography. It revealed cerebral abscess in 18 out of 28 patients, and cerebellar abscess in 10 out of 12 patients. (Table 3). Radical trepanation of the temporal bone was performed in all our patients, while in nine patients revision was required after the surgery, since the initial operation was not sufficiently radical. (Table 4). Out of 28 patients with cerebral abscess 5 (18%) died while 3 (29%) patients died out of 14 patients with cerebellar abscess (Table 4). DISCUSSION: Otogenic brain abscesses imply accumulation of pus in the cerebrum or cerebellum developing after encephalitis, caused by pyogenic microorganisms originating from inflammatory process in the middle ear cavity. This is a severe otogenic complication with high mortality. Even with modern therapeutic alternatives, mortality remained high, about 40% (7). According to the data reported by several authors introduction of antibiotic therapy resulted in drastic fall of associated mortality. The annual risk of otogenic abscess of the brain is 1 per 1000 adults with active chronic otitis. The incidence of abscess is significantly higher in a certain age groups, i.e. 1 per 200 between the ages of 20 and 40 (3). The diagnosis of brain abscess established clinically is not quite reliable. The disease is usually associated with severe meningitis, so that neurological examination usually detects only signs of meningi

Adult↗
PubMed1997

Single and multiple pyogenic liver abscesses: clinical course, etiology, and results of treatment.

A total of 483 patients with pyogenic liver abscess during the years 1986 to June 1995 were studied at Chang Gung Memorial Hospital in Kaohsiung: 343 were a single abscess and 140 were multiple abscesses. Males were predominantly affected by this disease. Abdominal pain was more frequent with the single abscess than with multiple abscesses, and jaundice was more frequent with multiple abscesses. Blood levels of alkaline phosphatase, bilirubin, and creatinine and the white blood cell count were significantly higher in patients with multiple abscesses than in those with a single abscess; and the hemoglobin level was higher with single abscesses. The single abscess was usually larger than 5 cm, and the multiple abscesses were usually smaller than 5 cm. The single abscess was always located on the right side (72%) and the multiple abscesses always on the right or both sides. Single abscesses mainly had a cryptogenic origin (58.9%) and multiple abscesses a biliary origin (45.0%). Liver aspirates revealed Klebsiella pneumoniae, Escherichia coli, Streptococcus, Bacteroides, Enterococcus, among others. K. pneumoniae was more often found in a single abscess and E. coli more often in multiple abscesses. Percutaneous catheter drainage and aspiration comprised the main treatment initially, and the failure rate with multiple abscesses was higher than that with single abscesses. Surgical intervention should be considered for multiple abscesses because of the underlying disease. The overall mortality with multiple abscesses (22.1%) was higher than that with a single abscess (12.8%). Partial hepatectomy produced a low mortality rate for both single and multiple abscesses and should be considered in the presence of severe hepatic destruction by an abscess or a stone.

Adult↗
PubMed2003

Multiloculated pyogenic brain abscess: experience in 25 patients.

OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS: The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.

Adolescent↗
PubMed2004

Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages.

OBJECTIVE: We undertook this study to determine the incidence and results of repeated (secondary) percutaneous abscess drainage performed on recurrent abscesses after successful initial (primary) percutaneous abscess drainage. MATERIALS AND METHODS: Imaging studies from patients who underwent multiple drainages were reviewed to define a cohort of patients who underwent secondary percutaneous abscess drainage after successful initial percutaneous abscess drainage of the same abscess. Medical records of these patients were then reviewed to assess the results of secondary percutaneous abscess drainage. RESULTS: Forty-five abscesses in 43 patients required secondary percutaneous abscess drainage. Twenty-four of the 43 patients avoided surgery. Secondary percutaneous abscess drainage was successful in evacuating the abscess cavity in 39 (91%) of 43 patients. Duration of drainage and time until recurrence were not significant predictors for avoiding surgery. Mean duration of secondary percutaneous abscess drainage was significantly longer than mean duration of primary percutaneous abscess drainage, but duration of secondary percutaneous abscess drainage (25 vs 14 days, respectively; p = 0.007) did not differ significantly between patients who ultimately required surgery and those who did not (17 vs 11 days, respectively; p = 0.10). Time to recurrence ranged from 2 days to 1 year (mean, 51 days). CONCLUSION: After successful primary percutaneous abscess drainage, secondary percutaneous abscess drainage of recurrent abscesses succeeded in evacuating the abscess cavity in most patients, and surgery was avoided by slightly more than half. Patients with postoperative abscesses were significantly more likely to avoid surgery (p = 0.008), whereas patients with pancreatic abscesses were significantly more likely to require it (p = 0.03).

Abdominal Abscess↗
PubMed1999

Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images.

The purpose of this study was to determine the magnetic resonance imaging (MRI) features of pyogenic hepatic abscesses on T1-weighted, T2-weighted, and serial gadolinium (Gd)-enhanced T1-weighted spoiled gradient-echo (SGE) images including images acquired in the immediate, intermediate, and late phases of enhancement. The MRI studies of 20 patients with pyogenic liver abscesses were retrospectively reviewed. All patients were examined on 1.5 (n = 19) and 1.0 (n = 1) T MR scanners. MR studies included T1-weighted, T2-weighted, and serial Gd-enhanced SGE images. The following determinations were made: signal intensity of the abscess cavity and perilesional liver tissue, and the presence of internal septations, layering material, or air in the abscess cavity. The pattern of enhancement of the abscess wall, internal septae and peri-abscess liver were evaluated on serial Gd-enhanced SGE images. A total of 53 abscesses were observed in the 20 patients. Fortyeight abscesses were hypointense on T1-weighted and hyperintense on T2-weighted images. Internal septations were present in four abscesses. Lower signal intensity material was observed in a dependent location on T2-weighted images in one abscess. Signal void foci of air located on the nondependent surface was observed in two abscesses. Two other abscesses contained signal void air that occupied the entire abscess cavity, observed on all imaging sequences. On serial gadolinium-enhanced images, all abscesses revealed early enhancement of the wall, which persisted with negligible change in degree of enhancement or thickness on delayed images. Abscess walls ranged in thickness from 2 to 5 mm. Internal septations ranged in thickness from 2 to 3 mm. Abscess walls and septations were relatively uniform in thickness with no evidence of focal nodularity. Periabscess liver tissue was mildly hypointense on T1-weighted and mildly hyperintense on T2-weighted images in 20 lesions, which were either circumferential (n = 12) or wedge-shaped (n = 8). All these regions enhanced more than the remainder of the liver on immediate post-gadolinium images and remained relatively hyperintense on late phase images. Periabscess liver parenchyma was isointense on both T1- and T2-weighted images in 18 lesions, and in these lesions wedge-shaped subsegmental (n = 6) or segmental (n = 12) enhancement was observed on immediate gadolinium-enhanced images, which faded to isointensity on intermediate phase images. No perilesional signal changes and enhancement difference was observed in 15 lesions. Characteristic features of abscesses include: intense mural enhancement on early gadolinium-enhanced images, which persists with negligible change in thickness and intensity on later post-gadolinium images, and the presence of periabscess increased enhancement on immediate post-gadolinium images. These MRI features may help to distinguish abscesses from other focal liver lesions during differential diagnosis.

Contrast Media↗
PubMed1998

Medical treatment of pediatric subperiosteal orbital abscess secondary to sinusitis.

BACKGROUND: Subperiosteal abscess may accompany orbital cellulitis secondary to sinusitis. Common surgical principles include incision and drainage of all abscesses. Previous evidence suggests that some orbital abscesses may be treatable with intravenous antibiotics, especially in young children. Children's hospital records were reviewed to determine which abscesses may be treated medically. PATIENTS AND METHODS: Records of patients admitted for orbital cellulitis from 1993 to 1996 were reviewed. Patients with subperiosteal abscess on CT scan were included. Clinical outcomes for initial surgical versus medical management of medial abscesses were compared. Differences in age, hospital stay, and intracranial involvement were analyzed for medial versus nonmedial abscesses. RESULTS: All patients had abscesses adjacent to infected sinuses. Eighteen young children had medial abscesses. Twelve of 13 were cured by initial medical treatment; 4 of 5 underwent successful initial drainage. Outcomes were not statistically different (P > .490). Seven children with nonmedial abscesses were older (P < .001) and had more complicated courses than those with medial abscess. Three of 6 children with superior orbital abscess also had intracranial abscess. Intracranial complication was more likely with superior versus medial orbital abscess (P < .01). CONCLUSIONS: Medial subperiosteal orbital abscesses secondary to sinusitis in children 6 years of age and younger are highly amenable to treatment with intravenous antibiotics. Older children and children with nonmedial abscesses may have more complicated infections. Children with superior orbital abscesses are at higher risk for intracranial abscess.

Abscess↗
PubMed2001

Comparison of tuberculous and pyogenic epididymal abscesses: clinical, gray-scale sonographic, and color Doppler sonographic features.

OBJECTIVE: The purpose of this study was to evaluate the capability of clinical, gray-scale sonographic, and color Doppler sonographic features for differentiating tuberculous and pyogenic epididymal abscesses. MATERIALS AND METHODS: Retrospective analysis was performed in 10 cases of tuberculous epididymal abscess and in 13 cases of pyogenic epididymal abscess. The following clinical, gray-scale sonographic, and color Doppler sonographic features were analyzed: patient's age; duration of symptoms; scrotal tenderness; presence of sinus tract; concurrent tuberculosis in other organs; location, size, and echogenicity of the abscess; hyperechoic rim; testicular involvement; hydrocele; and blood flow in the epididymal lesion. RESULTS: Tuberculous epididymal abscess had a longer duration of symptoms (p = 0.0001) and a lower frequency of scrotal tenderness (p = 0.0048) than pyogenic epididymal abscess. The size of the abscess was larger in tuberculous epididymal abscess than in pyogenic epididymal abscess (p = 0.0002). The degree of blood flow in the peripheral portion of the abscess was lower in tuberculous epididymal abscess (p = 0.001). The patient's age, location and echogeninicity of the abscess, presence of sinus tract, hyperechoic rim, testicular involvement, and hydrocele did not differ between the tuberculous and pyogenic epididymal abscesses. CONCLUSION: Some clinical findings, gray-scale sonography, and color Doppler sonography were useful in differentiating tuberculous epididymal abscess from pyogenic epididymal abscess. The presence of long-term scrotal swelling without tenderness and a lower degree of blood flow in the peripheral portion of a large abscess are suggestive of tuberculous epididymal abscess.

Abscess↗
PubMed2004

The clinical characteristics and outcome of intraabdominal abscess in Crohn's disease.

BACKGROUND: We aimed to elucidate the incidence and natural course of abdominal abscess complicating Crohn's disease (CD). METHODS: Of 352 patients with CD who were observed at our hospital between 1985 and October 2001, we studied 35 patients (9.9%) with abscesses in the mid-abdominal region (the abdominal wall, peritoneal cavity, retroperitoneum, and subphrenic region). RESULTS: The cumulative incidence of complication with an abscess was 9% and 25%, respectively, 10 and 20 years after CD onset. Of the 35 CD patients with abscess, 60% had had surgery by the time of the present study. The age when the abscess developed was 30.1 +/- 8.1 years, and the duration of illness from the onset of CD until development of an abscess was 10.8 +/- 6.3 years (range, 0-29 years). The location of involvement was: abdominal wall, n = 14 (40%); peritoneal cavity, n = 10 (29%); retroperitoneum or iliopsoas, n = 9 (26%); and subphrenic region, n = 2 (6%). In terms of location of abscess, it occurred most often on the right side (65.7%). Almost all abscesses occurred near the site of an anastomosis. Diseased segments of the bowel responsible for abscess formation were categorized radiographically as showing mild stenosis (6.5%), intermediate stenosis and/or simple fistula (41.9%), and severe stenosis and/or multiple fistulas (51.6%). Conservative treatment (including drainage of abscess) alone was effective in 7 patients (20%) and surgery was needed in 28 patients (80%). During the 5.3-year follow-up after treatment for the abdominal abscess, 9 of the 35 patients (26%) had recurrence of an abscess, mostly within 3 years. CONCLUSIONS: Abscess formation was noted in about 10% of patients with CD, with 46% of abscesses occurring in a diseased bowel segment near an anastomotic site. Of the diseased bowel segments responsible for abscess formation, half had neither severe stenosis nor multiple fistulas. Almost all patients underwent surgery for the abscess, and, in more than a quarter of the patients, there was recurrence within a few years after surgery.

Abdominal Wall↗
PubMed2000

Usefulness of magnetic resonance imaging for diagnosing deep anorectal abscesses.

PURPOSE: We evaluated the usefulness of magnetic resonance imaging for the preoperative diagnosis of deep anorectal abscesses. METHODS: Subjects were 21 patients with deep anorectal abscesses. Deep anorectal abscesses were classified into two types, ischiorectal and pelvirectal, according to their location. Patients were also classified into a single abscess group, which showed either an ischiorectal or pelvirectal abscess, and a double abscess group, which showed both ischiorectal and pelvirectal abscesses. The final diagnosis was made from surgical findings, and the types of deep anorectal abscesses determined by digital examination and magnetic resonance imaging were compared. RESULTS: Sensitivity of ischiorectal abscesses (20 lesions) with digital examination and magnetic resonance imaging was 75 and 95 percent, respectively, and that of pelvirectal abscesses (10 lesions) with digital examination and magnetic resonance imaging was 60 and 70 percent, respectively. Sensitivity of the magnetic resonance imaging was significantly higher than that of digital examination in ischiorectal abscesses. Diagnostic accuracy of digital examination and magnetic resonance imaging were both 83 percent in the single abscess group (12 patients), whereas in the double abscess group (9 patients) it was 22 and 78 percent, respectively. The rate of accurate diagnosis of magnetic resonance imaging compared with digital examination in the double abscess group was significantly higher than that in the single abscess group. CONCLUSION: Magnetic resonance imaging was useful for diagnosing and differentiating ischiorectal and pelvirectal abscesses.

Abscess↗
PubMed1989

Liver abscesses.

Clinical suspicion of a liver abscess mandates an investigation of the liver for evidence of a liver abscess by radionuclide, ultrasound, or CT scan. Amebic abscesses have a lower mortality rate than pyogenic abscesses. Amebic and pyogenic abscesses can be distinguished on the basis of epidemiologic, clinical, and laboratory studies. The definitive studies for identifying amebic liver abscesses are hemagglutinin or gel diffusion studies. Amebic abscess of the liver may be complicated by extension to the lung, with pulmonary complications. Patients suspected to have amebic abscesses require metronidazole. Emetine or chloroquine may be added if there is no response or if the abscess recurs. Unless there is a failure of the amebic abscess to resolve or secondary infection occurs, there is seldom a need to aspirate or drain these abscesses. Pyogenic abscesses should be treated with broad-spectrum antibiotics to cover gram-negative aerobes and anaerobic organisms. All pyogenic abscesses larger than 1.5 cm in diameter should be aspirated, and the aspirate should be Gram stained and cultured. Percutaneous or surgical drainage should then be performed. Operative intervention is required in those patients with intra-abdominal pyogenic infections that are seeding the liver abscess. The marked reduction in the mortality rate of pyogenic liver abscess witnessed in this decade is multifaceted and attributable in part to earlier diagnosis, permitting definitive treatment in a timely fashion, as well as to improved intensive unit care, antibiotic management, and operative technique.

Adult↗
PubMedDate not supplied

Sonographic patterns of splenic abscess: an analysis of 34 proven cases.

BACKGROUND: The sonographic patterns of splenic abscess are seldom reported. We report the different sonographic patterns in 34 proven cases. METHODS: From 1984 to June 2000, 42 patients were diagnosed with splenic abscess by abscess aspiration or pathologic findings of surgical specimens. Among them, 34 cases underwent sonographic studies. RESULTS: Fifteen cases had typical abscess echo patterns that included gas in the abscess (two cases) and debris in the abscess cavity (13 cases). Five cases of abscess showed subcapsular lesions with or without echo in the lesion. Two cases of abscess showed a thickened wall mimicking a tumor with central necrosis. Two cases showed a pattern suggesting a cyst. Ten cases showed a pattern suggesting tumor: eight had multiple lesions and two had solitary lesions. Of those 10 cases, seven multifocal abscesses were hypoechoic, and two solitary and one multifocal abscess were mixed echoic. Mortality from multiple splenic abscesses was higher than that from solitary abscess (p = 0.032). Both patients with gas in the abscess expired. CONCLUSION: Sonography of a splenic abscess is variable. A typical pattern was seen in only 44.1% (15 of 34) of patients in our series. We suggest using needle aspiration in each suspected case. Multiple and gas-containing abscesses indicate a poor prognosis.

Abscess↗
PubMed1991

Epizootic of external and internal abscesses in a large goat herd over a 16-year period.

From 1973 through 1988, 518 external and internal abscesses were diagnosed in a large commercial goat herd. Of the 518 abscesses, 238 were primary and 280 were secondary abscesses in the same or other anatomic locations. During this period, the herd varied in size from 94 goats in 1973 to 431 goats in 1988. Abscesses in the jaw area were detected in 141 goats, 4 of which developed osteomyelitis of the mandible. Sternal abscesses were detected in 72 goats, with 2 also having osteomyelitis of the sternum diagnosed at necropsy. Most of the abscesses were in the jaw, sternal, facial, and cervical areas. Lung abscesses were diagnosed at necropsy in 20 goats that most recently had 1 or more superficial abscesses. Abscess incidence was 27.6% (112 of 406) in wethers and 22.9% (154 of 687) in does. Actinomyces pyogenes was isolated most frequently by bacteriologic culture of abscess specimens and about 3 times as often as was Corynebacterium pseudotuberculosis or Staphylococcus sp, usually coagulase-positive S aureus. Bacteriologic culture of blood samples, taken during abscess episodes, yielded A pyogenes (n = 3) or C pseudotuberculosis (n = 1) in 3 goats. Results of antibiotic treatment of abscesses were disappointing, with little evidence of altering the course of the disease or sterilizing the abscess, despite the fact that the bacteria were susceptible in vitro to the antibiotics used. Excision of intact abscesses was the preferred treatment for abscesses of the jaw and facial areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗