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Suppuration occurring in inflamed parotid glands is an uncommon observation in the neonatal age group. This case report describes a male neonate, 12 days of age, who presented with high grade fever, irritability, poor feeding and bilateral swelling in the parotid region. Workup showed bilateral suppurative parotitis. Abscess developed despite antibiotic therapy requiring surgical drainage before final recovery.
OBJECTIVE: To alert the pediatric emergency physician about suppurative mediastinitis as an unusual, life-threatening complication of retropharyngeal abscesses in children and to report an alternative therapeutic option for these cases. METHODS: We describe a case of suppurative mediastinitis secondary to a retropharyngeal abscess in a 19-month-old girl and discuss the pathophysiology, diagnosis, and treatment of this disease. RESULTS: Prompt diagnosis, based on clinical, radiographic, and CT findings, followed by immediate retropharyngeal drainage and appropriate antibiotic therapy, allowed conservative management of the mediastinal abscess, without the need for surgery. The child presented a good outcome and was discharged on hospital day 14. CONCLUSIONS: When evaluating a retropharyngeal abscess, the pediatric emergency physician should be aware of its complications. A chest radiograph should be prescribed for each patient presenting with an indolent course. Widening of the mediastinum should be considered as strong evidence of a mediastinal abscess for which the best therapeutic option is aggressive surgical drainage. In the rare cases in which marked improvement is achieved after retropharyngeal drainage, a nonsurgical approach to the mediastinal abscess could be attempted. CT scan and a simple chest radiograph have proved to be useful for diagnosis and follow-up.
Discussing something about the methods of examining the eustachian tube function of chronic suppurative otitis media. The examination of the eustachian tube function were given on 96 cases of chronic suppurative otitis media with Valsalva method, tympanium drip and acoustic impedance method. Though the former two methods were imperfect, the combination of them was similar to the acoustic impedance method in outcome, which is easy and convenient and doesn't need expensive instrument. The combination of the former two methods in result could get rid of the imperfection of each of them and could evaluate the eustachian tube function in accuracy, which is fit for basic-level hospital.
Among 140 patients with hydatid echinococcosis of the liver complications were noted in 58 cases: suppuration of the cyst - in 38 (27.1%), cyst rupture in the anterior abdominal wall and abdominal cavity - in 4 (2.8%), in bile ducts - in 10 (7.1%), its rupture into the right lung lower lobe, calcification of the cyst was noted in 4 patients (2.8%). It is concluded that open echinococcotomy with partial excision of the fibrous capsule and drainage of the residual cavity with a rubber tube seem to be the most effective operation for suppurative echinococcosis of the liver.
OBJECTIVE: To discuss the best material and operation style of synchronal ossicular chain reconstruct for chronic suppurative otitis media patients. METHOD: Review and analyze the effect of ossicular chain reconstruct in 389 cases with chronic suppurative otitis media after surgery. RESULT: The result of hearing improve of macro-tympanum III mould of ossicular chain reconstruct with artificial ossicle was better than other materials and operation types. The outcome of hearing improvement of incudostapedial joint reconstruct was better than the group of macrotympanum III mould of ossicular chain reconstruct with aritificial ossicle. CONCLUSION: The result of hearing improvement of macro-tympanum III mould of ossicular chain reconstruct with aritificial ossicle was better than other material and operation types. The effect of aritificial ossicle better than self-ossicle in ossicular chain reconstruct surgery.
OBJECTIVE: To investigate the pathophysiological mechanism, clinical menifestation and radiographic diagnosis of cholesterol granuloma following chronic suppurative otitis media. METHOD: Six cases of CG following chronic suppurative otitis media, confirmed by surgery and pathology, were reviewed and analyzed. RESULT: CG frequently accompanied with other middle ear diseases, and was shown as a high signal intensity on both T1-and T2-weighted images in magnetic resonance imaging(MRI). CONCLUSION: It was postulated that the obstruction of pneumatized temporal bone air cell, caused by other middle ear diseases such as cholesteatoma and tympanosclerosis, might be the pathophysiological mechanism of CG. The evaluations of computed tomography (CT) and clinical manifestation were limited to distinguish CG from cholesteatoma or other neoplasm, while the MRI can be of great value to characteristic diagnosis.
This prospective study was done to compare the different aspects of tubotympanic (group I) and atticoantral types (group II) of chronic suppurative otitis media. The study included 200 patients of chronic suppurative otitis media, of them 100 were of tubotympanic type and 100 were with atticoantral disease. The age (mean +/- SD) of group I and II were 17 +/- 2.7 years and 12 +/- 2.3 years respectively (P < 0.05). The majority of the patients having poor socio-economic condition 69% in group I and 87% in-group II. In both groups, slum dwellers with bathing habit in pond or river and illiterate were more sufferer (P < 0.05). There was central perforation in all patients in-group I, and in-group II, 67% were with attic and 33% were with marginal perforations. In group I, aural discharge was mucoid or mucopurulent in majority of cases 80% and in-group II foul smelling scanty ear discharge was from 88% of subjects. In atticoantral type, hearing impairment was more than tubotympanic disease. Complications were more in atticoantral type of disease. In-group II, post auricular sinus 25% was the commonest extracranial complication followed by subperiosteal abscess 18%, and meningitis 10% was the commonest intracranial complication followed by brain abscess 8%. In tubotympanic type conservative treatment with reconstructive surgery were the treatment of choice, whereas radical or some modifications of radical surgery (with or without reconstruction) were the treatment plan for atticoantral disease. Among the groups the mortality rate was only 4% in-group II and was due to intracranial complications. The study recommends early detection and effective surgical treatment of the disease to improve the situation.
Fungi are increasingly recognized as microorganisms causing superficial suppurative thrombophlebitis being managed by aggressive surgical therapy and antifungal agents. We report a case of Fusarium proliferatum superficial suppurative thrombophlebitis in an immunocompetent patient with no evidence of systemic infection and who responded to venotomy alone.
Following studies of cases with hepatic suppurations the authors indicate the necessity for regular or atypic hepatectomies. The extension of the suppurative process in the liver made necessary the ligature of the great sagital vein and the authors show, on the basis of anatomic and topographical data (hepatic segmentation), that it is necessary to extend the hepatectomy to the IV-th para-median segment. The authors also present the indications for bi-segmental right hepatectomy in segments VII-VI as well as of the total left regulated hepatectomy.
The carried out researches concerning initial nidus of infection have shown a high rate of anaerobic infection especially in patients with destructive-suppurative lung disease, liver abscess, peritonitis (up to 82.8%). An aerobic-anaerobic association of microbes remarkably often is found in the nidus of infection. We recommend the following preventive scheme to treat patients with different pyoseptic diseases. The scheme is based on the results of our 10 years experience treatment of such patients. It consists of a combination of 2.0 gr. cefoperazoli twice daily, metronidasoli 500 mg. 3 times and amycacini 500 mg twice daily. The intra-arterial or intravenous introduction of the medications was possibly preferred. Having analyzed the results of the treatment of 13,747 patients treated at the center of contaminated surgery, we would note that in 30.2% of the cases were reached excellent results. The above-mentioned scheme of antibacterial therapy with surgical correction of suppurative focus allowed us to reach good results in 45.4%. The satisfactory results of the treatment were achieved in 22.8% of patients. Mortality rate was up to 1.9%.
Peritonitis caused by a suppurating urachal cyst in a young woman. A review of the literature. Urachal cysts are not rare but occur much more often in children. In adults they may become infected and cause clinical symptoms including sub-umbilical mid-abdominal pain, fever, guarding and leukocytosis. Intraperitoneal rupture is rare (21 published cases) and only 7 cases have involved an adult female patient. The authors report the case of a 27 year old woman with peritonitis caused by rupture of a suppurating urachal cyst. 6 cm in diameter, for which the diagnosis had been established by pre-operative ultrasound. The surgical procedure carried out was total excision of the urachus, of the fascia between the umbilicus and the bladder, and partial excision of the dome of the bladder. Indeed total excision should have been carried out because of the risk of malignant degeneration of this mass to an adenocarcinoma.
OBJECTIVE: To compare the efficacy of ceftriaxone and that of cefoperazone plus sulbactam (sulperazon) in controlling infection, in scavenging bacteria from bile, and in their costs when treating acute suppurative cholangitis with choledochostomy. METHODS: Patients were randomly assigned to two groups: the ceftriaxone group (R-group, n=95) and sulperazon group (S-group, n=95). Before choledochostomy, both groups received one intravenous dose of the corresponding antibiotics: and 2 g ceftriaxnoe for the R-group, 2 g sulperazon, containing 1 g cefoperazone and 1 g sulbactam, for the S-group. After the operation, the patients in the R-group received ceftriaxone 2 g i.v. q.d.; the patients in the S-group received sulperazon 2 g i.v. b.i.d.. In addition, all patients in both groups received metronidazole 0.5 g daily before and after the operation. The efficacy was evaluated by efficiency in controlling infection and the persisting days of symptoms due to infection, fever and leukocytosis; the persisting days was compared using the life table method to calculate the "cumulative probability of persistence of symptoms (CPPS)". The two groups were also compared in regards to their biliary bacterial clearance rates and the costs directly attributable to the antibiotics. RESULTS: The efficiency in controlling infection was 98.9% (94/95) in both groups. However, the CPPS of the R-group decreased more rapidly than that of the S-group, Log-Rankchi2=6.7901, P=0.0092. Biliary bacterial clearance rate on post-operative day 3 was 72.0% (36/50) for the R-group, 41.3% (19/46) for the S-group, P=0.0037. Cost directly attributable to the antibiotics were (1788.29 +/- 518.46) yuan (RMB) for the R-group, and (3768.74 +/- 820.55) yuan for the S-group, F=395.51, P=0.0000. CONCLUSION: Both ceftriaxone and sulperazon are effective in treating acute suppurative cholangitis when used before and after choledochostomy. Ceftriaxone is superior in expediting symptom relief and bacterial clearance from bile, and is more cost-effective.
The spontaneous rupture and the suppuration of a mucinous cystadenoma of the pancreas remain exceptional. The authors report about one case. The help provided by ultrasound and computed tomography for the diagnosis is indisputable. The condition is most often mistaken with a pseudocyst of the pancreas. This case is used as a basis to study the mechanism of suppuration and discuss the merits of an emergent histological diagnosis to choose an appropriate therapy.
Despite the generally salutary experience in recent years of managing suppurative pleuropulmonary disease, empyemas and lung abscesses have persisted and increased in incidence in hospitals such as Queens Hospital Center that serve large numbers of the socioeconomically disadvantaged. This study documents the etiology, clinical presentation, treatment, and treatment results of suppurative pleuropulmonary disease at Queens Hospital Center, which serves a large segment of the urban poor, many of whom are black. Results indicate that contributory or antecedent etiologic factors include a history of prior disease (specifically pneumonia, lung abscess, obstructive lung disease, pulmonary neoplasia, and tuberculosis); a predisposition to constitutional or immunologic deficiencies (specifically, alcoholism, anemia/malnutrition, drug abuse, and acquired immunodeficiency syndrome [AIDS]); conditions contributing to tracheobronchial aspiration (specifically, alcoholism and seizure disorders); and a miscellaneous group such as prior surgery, cardiovascular disease, and sepsis syndrome. The patients in this study were young with maximal incidence occurring in the third to fifth decades of life. Patients were predominantly male (75%) and black (66%). There were 18 deaths (23%), with sepsis being the cause in 10 (56%). Most surgical interventions were conservative, ie, bronchoscopies (48), thoracenteses (43), and tube thoracotomies (39). Thirty-one open thoracotomies were performed for drainage, decortication, or pulmonary resection. The surgical mortality was three cases or 5% of the patients who underwent surgery. The designated incidence of proven AIDS in this series (29%) was low, undoubtedly because many patients refused testing, and the multiple gram-positive and gram-negative infections that were seen did not conform to the Centers for Disease Control criteria for diagnosis and case reporting for AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: To explore the differences and common features between adults and children with chronic suppurative otitis media in the course of disease, clinical characteristics and operation. METHOD: To compare and analyze the clinical information before the operation, the range of lesion and ossicular chain damage in adults group (85 cases) and children group (66 cases). RESULT: The morbidity of complications in children group was higher than that in adults group,with few intracranial otogenic complications in children group. The granuloma in external acoustic meatus was common in children group. The range of lesion in children group fixed with granuloma and cholesteatoma was more extensive than that in adults group. The complications in children group were more than those in adults group. CONCLUSION: There are more complications and more extensive lesion in children patients than those in adults patients with chronic suppurative otitis media. The operation of clearing lesion and retaining or reconstructing hearing are regarded as the first choice in the children patients.
The acute suppurative thyroiditis is a rare infection. It affects specially patients with preexisting thyroid gland pathology and its frequency is higher in women. In childhood it's linked to local anatomic defects. The infection used to be located in left thyroid lobe and it's much less usual in right lobe, in both or in isthmus. The most important causal microorganisms are staphylococci (Staphylococcus aureus overcoat) and streptococci (usually Streptococcus pyogenes and Streptococcus pneumoniae), with frequent isolation of mixed flora and anaerobes in the last reported cases. We present the case of a male patient, without previous thyroid disease, who suffered an acute suppurative thyroiditis and Sepsis due to Klebsiella pneumoniae, with right lobe abscess and secondary septic focus formation (kidneys, spleen, lungs), with fatal course despite of medical treatment, favoured or precipitated by the development of serious alcoholic abstinence.
INTRODUCTION: Authors present four cases of acute suppurative thyroiditis treated in our department. Initial symptoms are similar to acute pharyngitis or laryngitis but could end in fulminant course that could be life threatening. MATERIAL AND METHODS: We present etiology, clinical symptoms and accessory exams as well as new treatment methods. RESULTS: All four patients were cured. In one case pharmacological treatment was sufficient. In second case the patient needed intubation due to stridor. In third one after pharmacological treatment we performed partial thyroidectomy. In last case patient with thyroid abscess needed urgent thyroidectomy due to retropharyngeal and mediastinal multiple abscesses. CONCLUSIONS: Acute suppurative thyroiditis needs hospitalisation. Some patients needed surgical intervention due to life threatening course.
It was shown on the basis of laboratory and experimental data that created antibacterial vascular prostheses are marked, on the main, by local bacteriostatic and anticoagulative effect. It was found that heparin concentration of 3 to 500 U per 1 kg collagen causes a hyperadhesive effect on blood platelets and facilitates the formation of the primary thrombocytic thrombus. The free surface energy grows in this case from 34 +/- 0.8 to 66.3 +/- erg/cm2. The optimal thromboresistant effect occurs in heparin content of 1 U per 1 mg collagen. That this choice is correct is confirmed on examination of the inner surface of the prostheses with an electron microscope after being in the blood flow for 45 minutes. Bifurcation and linear antibacterial prostheses were used in 9 patients with a high risk of suppuration verified by cultures of discharge from ulcers and lymph nodes, and the presence of lymphangitis and lymphadenitis. The effect was positive in 8 patients, 2 of them had superficial suppuration of the operative wounds.