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Pathogenic organisms in chronic suppurative otitis media from 62 patients were identified. Pseudomonas aeruginosa was responsible in 46%, Staphylococcus aureus in 29%. Proteus mirabilis in 13%, Streptococcus pyogenes in 6%, Aspergillus niger in 5% and Mucor sp. in 2%. The most prevalent organism in children was Staphylococcus aureus. The role of fungi in chronic suppurative otitis media is discussed.
Cefmetazole (CMZ) was compared to cefazolin (CEZ) for efficacy and safety in the treatment of suppurative otitis media (including acute otitis media and chronic otitis media in acute aggravating stage) under well controlled clinical trials. The therapeutic effects were analyzed statistically in 172 patients (82 administered CMZ, 90 administered CEZ). The adverse reactions were also analyzed statistically in 199 patients (CMZ 99, CEZ 100) in whom the judgement was possible. 1. The efficacy rate of CMZ (72.3% for good to excellent response) was assessed by physicians in charge to be similar to that of CEZ (59.3%). This was the same being assessed by the committee, too (CMZ 64.6%, CEZ 56.7%). 2. When patients were classified into 2 groups (acute otitis media, chronic otitis media in acute aggravating stage) with respect to diagnosis, statistically significant difference in clinical efficacy assessed by physicians in charge was observed in the cases with chronic otitis media (CMZ, CEZ). In addition, the improvements of flares on the drum membrane and the mucous membrane of eardrum were significantly better in the CMZ group than in the CEZ group. 3. Bacteriologically, 16 cases (19.8%) of S. aureus were resistant to CEZ, while only 1 case (1.2%) to CMZ. CMZ was judged to be effective in 5 of the 6 cases in which CEZ-resistant strains were detected. 4. Side effects were found in 2 cases (2.0%) treated with CMZ: one complained of retching and abdominal pain and the other developed skin eruption. On the other hand, only 1 case (1.0%) developed skin eruption in the CEZ group. These results suggest that CMZ is a new antibiotic agent which is highly valuable in the treatment of suppurative otitis media.
Suppurative cholangitis in 5 aged cats was characterized clinically by weight loss, depression, dehydration, icterus, and fever. The major abnormal laboratory findings were a severe left shift of WBC and a high, conjugated bilirubin concentration consistent with an inflammatory process and cholestasis. Gross pathologic findings included periductal biliary fibrosis (4 cats), periductal pancreatic fibrosis (2 cats), cholelithiasis (2 cats), deformation of the gallbladder (2 cats), and chronic interstitial pancreatitis (2 cats). Histopathologic findings in all cases were portal hepatic fibrosis, biliary hyperplasia, and suppurative exudate within dilated intrahepatic biliary ducts. Weight loss and portal fibrosis were suggestive of chronic, intermittent illness. The pathogenesis appeared to involve invasion of the bile duct by enteric bacteria. Cholangitis was observed to occur in association with pancreatitis, cholelithiasis, or anatomic abnormalities of the biliary tract.
The therapeutical use of bronchial fibroscopy is very promising. Already today it is much used in postsurgery atelectasies by obstruction or in suppurative atelectasies related to important infectious foci. It considerably improves the bronchial clearing previously done by blind aspiration or bronchoscopy. The coupling of this aspiration to a perfusion-lavage in severe suppurative bacterial pneumopathies yielded interesting results.
Acute suppurative thyroiditis in children is very rare and has been reported in only six cases. We describe a 4 1/2 year old girl who presented with acute suppurative thyroiditis of the left lobe. All thyroid function tests were normal but the radioisotope scan showed decreased activity over the upper pole of the left lobe. The child was treated with massive doses of antibiotics and gradually recovered. Three years later she presented with exactly the same findings in the left lobe of the thyroid. Thyroid function tests were again normal but repeated radioisotopic scan showed decreased activity over the left upper pole. Again she recovered gradually under massive antibiotic treatment. A follow up scan showed great improvement with almost complete recovery of activity in the left lobe.
Thrombophlebitis in children is almost always related to intravenous therapy. In most cases the inflammatory reaction is self-limited and resolves when the intravenous catheter or needle is removed. In some cases contamination may result in suppurative thrombophlebitis, a potentially life-threatening complication of intravenous therapy. This report describes two-6-year-old children with suppurative thrombophlebitis that was successfully treated by drainage of periphlebitic abscess and excision of the infected vein. Early recognition and prompt surgical management should reduce morbidity and prevent mortality in these cases.
Because of its rarity and unusual features, the diagnosis of suppuration in the thyroid gland is often delayed. Progress to abscess formation may then occur, with all the inherent dangers of advanced suppuration in the neck. Should an abscess form, surgical excision of the diseases tissue is the management of choice.
This report describes a two-year-old White Alpine ram with suppurative pleuropneumonia and a lung abscess. Prior to admission, the ram had been unsuccessfully treated with antibiotics and levamisole. Clinical examination revealed that the general behaviour and condition of the ram were severely disturbed. The rectal temperature and respiratory rate were increased. Auscultation of the lungs revealed increased vesicular sounds. Based on clinical findings, a tentative diagnosis of bronchopneumonia was made. To confirm the diagnosis, blood was taken for serological testing for Maedi-Visna, and endoscopic examination of the respiratory tract and ultrasonographic and radiographic examination of the thorax were performed. Cytologic and bacteriologic examination of tracheal secretions revealed large numbers of neutrophils and Actinomyces pyogenes organisms. A pocket of gas, surrounded by a capsule of soft tissue density, overlying the base of the heart, and a horizontal fluid line were observed on radiographs. Ultrasonographic examination revealed an effusion between the pleura and the lung on the left side of the thorax; an encapsulated abscess was seen on the right side of the thorax. Centesis and aspiration of this accumulation of fluid yielded foul-smelling pus. Post mortem examination confirmed the clinical, radiographic and ultrasonographic findings. The ram had severe chronic suppurative pleuropneumonia with abscess formation between the pleura and lung on the right side.
The results of treatment of 42 patients with prolonged crush syndrome complicated by suppuration are analyzed. The results of bacteriological studies are presented, which helped monitor the treatment efficacy. Surgical treatment of the injured limbs is described, as is the combined application-adsorption method of local detoxifying therapy of suppurative wounds, which, combined with staged necrosectomy, helped cope with purulent complications, prepare the wounds of the limbs to repair plastic surgery within 35 to 55 days after the injury, and rule out lethal outcomes.
Pseudomonas aeruginosa, Diphtheroid bacilli, Staphylococcus aureus were the major causes of diffuse bacteria otitis externa and chronic suppurative otitis media. This study showed that 0.3 per cent ofloxacin used for 2 weeks gave good clinical and bacteriological control of chronic suppurative otitis media and diffuse bacterial otitis externa without significant side effects.
Some factors (sex, age, the way of onset, previous antibiotic therapy, instant of hospitalization in relation to the appearance of initial symptoms) associated with the course of suppurative meningitis prior to the hospitalization have been analyzed and a trial has been made to locate them in the prognosis of the disease progression. At the Clinic of Infective Diseases in Novi Sad during 10 years (1977 to 1987, except 1983) 162 patients with a diagnosed purulent meningitis had been treated. The patients were classified into two groups: a group of 62 patients with complications and a group of 100 patients with an expected progression of the disease. Statistical data were analyzed using the x2 test and t test. In the period considered in this investigation the sickness passed with complications in 38.24% cases, 32.10% of them being of neurological nature, while 6.14% of complications appeared in other organs and systems. The statistical analysis shows that sex, age, the way of onset (data from history of the disease), previous antibiotic therapy, time of hospitalization in relation to appearance of initial symptoms, can not be used as reliable parameters in predicting the further course of suppurative meningitis. Complications have been registered in patients having more than 2.16g/l proteins and less than 1.12mmol/l sugar in the liquor at the beginning of the disease. These values can be used as a reference for predicting the further course of the disease.
A case of chronic suppurative otitis media is described in a patient with a chronic cold and cough. The presenting symptoms were otorrhoea, perforation of the tympanic membrane and granulation in the air cells of the left mastoid cavity. X-ray showed sclerotic mastoid and partial cellular obliteration. Histologic sections revealed aggregated fungal masses, filamentous hyphae and single-celled structures of Paecilomyces variotii. The infection responded to topical ketoconazole therapy. This is the first reported case of chronic suppurative otitis media caused by P. variotii.
Seven cases of acute suppurative cholecystitis underwent percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy at the Tainan Municipal Hospital. All the patients had frank septic phenomena clinically, including fever, jaundice, leukocytosis and unstable blood pressure. Organisms were cultured from both blood and bile specimens. Ultrasound-guided transhepatic puncture of the gallbladder was performed for bile drainage, and laparoscopic cholecystectomy was subsequently performed two to five days later after the patients had stabilized. No procedure-related complications from either percutaneous transhepatic gallbladder drainage or laparoscopic cholecystectomy were observed. All patients had early recovery, shortened hospital stay and good cosmetic results. These preliminary results show that laparoscopic cholecystectomy is a safe method and can be employed in those patients with symptomatic gallstone associated with suppurative cholecystitis after preoperative biliary drainage.
Fifteen cases of suppurative mediastinitis secondary to perforation of pharynx or esophagus are reported. The cervical fascial spaces are the main route of spread of infection from the neck to the mediastinum. The infection is caused by both aerobic and anaerobic bacteria. Major treatments for suppurative mediastinitis are early surgical drainage and proper use of antibiotics; Irrigation of the mediastinum with povidone-iodine is a safe and effective treatment. Of these 15 patients, 11 survived and 4 died. One case complicated by common carotid artery rupture was cured by surgical repair.
The authors report two case studies of suppurative thyroiditis in type II diabetics patients, giving emphasis to the rapid evolution for sepsis, which took one of the patients to death. An earlier diagnosis, antibiotictherapy and a large surgical drainage are essential to avoid a fatal course in these patients. A brief review of suppurative thyroiditis is also presented.
The experience with treatment of 2512 patients with acute diseases of the abdominal organs permitted the authors to draw a conclusion that the local measures are of primary importance in prevention of suppuration of an operative wound. Of these measures, the main ones are the following: observance of the surgical technique, differential draining the wound with the use of a drainage tube of original construction, dynamic control of a state of the wound after the operation. The use of the measures mentioned permitted to reduce the incidence of suppuration of an operative wound from 8.2 to 4.8%.
The main morphogenetic and pathogenetic elements of pulmonary chronic suppurations were experimentally investigated in rabbits. The animals were sensitized by blood way with complete Freund adjuvant containing serum proteins, which determined a nodular and diffuse granulomatous reaction in the pulmonary tissue. The perturbing agent of the model system was a maintained immediate type hypersensitivity reaction produced by an excess of intrapulmonary antigen accumulation after an intratracheal injection of the same agent with antigens in excess. The animals sacrificed 15, 30 and 45 days after the intratracheal challenge presented a wide and progressive cellulofibrous restructuring of the lung tissue with exclusion of lung areas, persistence of granulocytic foci, release of lactic-dehydrogenase, chronic vascular lesions and diffuse fibrosclerosis. The importance of the persisting antigens which maintain the Arthus type hypersensitivity reaction, of vascular chronic lesions determined by the blood transport of deleterious products and by immunopathologic phenomena, as well as of the cellulo-fibrous proliferation, are emphasized as elements of autoaggressive processes with common and immune components, all contributing to the chronic evolution of pulmonary suppurations.
A group of patients presenting a pathology of pulmonary suppuration is examined and a type of basic treatment used for preparing such patients for surgery, not always indicated by suppuration, is presented. A number of clinical and functional parameters measured before and after such treatment are also examined. The therapy carried out personally in the immediate postoperative period and in the long term is illustrated.