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Ofloxacin eardrop treatment for active chronic suppurative otitis media: prospective randomized study.

This report presents a prospective randomized study of 0.3 percent ofloxacin eardrops for the treatment of active chronic suppurative otitis media. Twenty-nine patients were treated with ofloxacin eardrops for 1 week, and another 27 patients were treated with Augmentin for 1 week. One week after completion of treatment, 22 (76%) patients of the group treated with ofloxacin had dry ears, and only seven (26%) patients treated with Augmentin had dry ears. Ofloxacin eardrops were effective in the initial treatment of active chronic suppurative otitis media.

Administration, Oral↗

Changing anaerobic spectrum in suppurative lung disease: a case report.

A spectrum of three different anaerobes were isolated from a debilitated patient with suppurative lung disease, within a two-year period. Repeated isolation from three consecutive samples and symptomatic relief with metronidazole provide clinical evidence of anaerobic lung infection. This case emphasizes the importance of anaerobic culture in cases of protracted pulmonary suppurative disease.

Bacteria, Anaerobic↗

[Acute suppurative thyroiditis. Report of a case and review of the literature].

The authors present a case of acute suppurative thyroiditis complicated by acute dyspnoea with asphyxia in a patient of geriatric age. In this patient there were present possible infectious focuses like multiple dental abscesses and contamination of the urinary tract. Histological examination highlighted a focus of papillifer carcinoma in the context of the gland. We have a review of the literature on this observation and description. Acute suppurative thyroiditis is currently a pathology of rare observation. This rarity is due, apart from the availability of antibiotic therapy, to an intrinsic resistance of the thyroid gland to contamination. In most cases we are talking of bacterial infections, but in immunodepressed subjects fungal etiology is noteworthy. The infection could arise from primitive focuses present in any bodily district with propagation to the thyroid across different ways. Expressive is the anamnestic observation of preexisting thyroid dysfunction. After an attentive evaluation of the clinical findings, usually characteristic, it is important to complete the diagnostic course with some instrumental investigations. In particular cervical sonography, possibly associated with agobiopsy is fundamental. Initially therapy is medical (basically antibiotic). The surgical resolution foresees the drainage of the purulent abscess or the thyroidectomy if it is associated with a struma.

Acute Disease↗

Bilateral acute suppurative parotitis due to Staphylococcus aureus: an hospital acquired case with fatal outcome.

During recent decades, acute bacterial parotitis has progressively changed its etiological and clinical spectrum. New risk factors and causative agents are emerging, while the associated rates of complications and mortality may remain still significant. A rare case of concurrent bilateral suppurative parotitis caused by Staphylococcus aureus has been observed in a patient hospitalized for prior abdominal surgery and multiple underlying illnesses. The disease had a complicated and ultimately fatal outcome, despite a timely diagnosis being made and a specific treatment started. A literature review dealing with risk factors, microbiology, clinical picture, complications, differential diagnosis, treatment and outcome of suppurative parotitis is presented.

Acute Disease↗

[Use of antiseptic myramistin in the multimodality treatment of nonspecific suppurative pleuropulmonary diseases].

To treat patients with suppurative diseases of the bronchi, lung, and pleura, the new aseptic myramistine was topically applied as 0.005% myramistine solution in isotonic sodium chloride solution in 28 patients with acute and chronic pleural empyema, acute abscess of the lung, and suppurative endobronchitis-complicated bronchoectatic disease. The therapy made it possible to arrest the intoxication syndrome, to achieve abacillation of contents in the cavities of empyema, abscesses, and bronchoectases, to cure endobronchitis, to obliterate destructive cavities in the lung more rapidly and to prepare patients for a planned surgical intervention more valuably and to improve the results of surgical treatment. The studies allow the antiseptic myramistine to be recommended for topical treatment of pyodestructive diseases of the lung.

Administration, Topical↗

Recurrent acute suppurative thyroiditis.

Two patients had two recurrent episodes each of acute suppurative thyroiditis. Circulating concentrations of plasma thyrotrophin, thyroxine, and triiodothyronine were within the range of normal. Antibodies to thyroid microsome or thyroglobulin were not found. Anaerobic bacteria such as Bacteroides, Peptostreptococcus, and Peptococcus were identified as causative agents, indicating that anaerobic organisms may play an important role in the pathologic process. The present cases are the third and fourth reported cases of recurrent acute suppurative thyroiditis in the literature.

Acute Disease↗

Primary suppurative myositis in children.

Primary suppurative myositis is rare in the United States when compared with the incidence of disease in the tropics. Clinically, it may mimic many of the more common diseases, such as hematoma, osteomyelitis, arthritis, or appendiceal abscess. It usually has a benign course, with complete recovery after appropriate treatment. Prolonged morbidity and an increased mortality may result from unfamiliarity with this entity. Six children had primary suppurative myositis; one died as a result of perforation of a psoas abscess into the dural sac causing staphylococcal meningitis.

Child↗

Tumor necrosis factor alpha and interleukin 1 beta in synovial fluid of infants and children with suppurative arthritis.

Tumor necrosis factor alpha and interleukin 1 beta concentrations were measured in synovial fluid of 24 infants and children with diagnoses of suppurative arthritis (n = 16) and other kinds of arthritis (n = 8). Large concentrations of tumor necrosis factor alpha (range, 100 to 85,000 pg/mL) were found in 12 (75%) of 16 patients with bacterial infection and in none of the patients with noninfectious origins. Large concentrations of interleukin 1 beta (greater than 200 pg/mL) were found in 15 (94%) of 16 patients with bacterial infection and in none of the other patients. In the latter group, small concentrations of interleukin 1 (range, 40 to 120 pg/mL) were present in 5 (63%) of 8 patients. Serum samples obtained simultaneously were negative for both cytokines. Tumor necrosis factor alpha and interleukin 1 beta concentrations correlated significantly and with leukocyte counts in synovial fluid. We conclude that large concentrations of tumor necrosis factor alpha and interleukin 1 beta are produced locally in patients with suppurative arthritis and they may be potentially useful in differentiating this condition from other kinds of arthritis.

Adolescent↗

Reappraisal of surgery for suppurative cholecystitis.

Ninety-two patients with suppurative cholecystitis operated on as emergency cases were studied in retrospection. Obstructive cholangitis was seen in two, who eventually died. The mortality after cholecystectomy alone was related to the presence of stones in the common bile duct. The mortality after cholecystostomy alone was related to shock and septicemia, but not to the presence of common bile duct stones or obstructive cholangitis. It was concluded that suppurative cholecystitis with accompanying common bile duct stones should be treated with cholecystectomy and choledocholithotomy, because of the lower rate of reoperations and possibly lower mortality than after cholecystectomy alone; an exception should be made in patients with deterioration in clinical condition or patients in whom technical difficulties develop during the operation. These patients should be subjected to a cholecystostomy as the only emergency procedure.

Adolescent↗

Piriform sinus fistula. A route of infection in acute suppurative thyroiditis.

Fifteen patients had acute suppurative thyroiditis resulting from infection through the left piriform sinus fistula. Characteristic clinical features included (1) onset in infancy or childhood, (2) left lobe involvement, and (3) frequent recurrence unless the fistula was extirpated completely. Fistulectomy in eight patients demonstrated three distinct courses of the fistula: lateral to, medial to, and penetrating the left thyroid lobe. Anatomical and histological findings suggest that the fistula is a remnant of the third pharyngeal pouch. We believe that the fistula is a common route of infection in acute suppurative thyroiditis, allowing bacterial infection to begin either in the perithyroidal space, spreading into the thyroid gland secondarily, or in the thyroid gland, primarily in cases where it penetrates the gland. Complete removal of the fistula is essential to a permanent cure.

Acute Disease↗

Epstein-Barr virus in B-cell lymphomas associated with chronic suppurative inflammation.

Chronic antigenic stimulation is considered to play an important role in neoplastic lymphoid transformation. This paper describes three cases of non-Hodgkin lymphomas (NHLs) associated with long-standing chronic suppuration. Two were primary bone lymphomas associated with long-standing chronic osteomyelitis and one was a primary skin lymphoma associated with chronic venous ulcers with a latent period of 13 years. All were diffuse large B-cell lymphomas, with plasmacytoid differentiation in two cases. Epstein-Barr virus (EBV)-encoded RNAs were demonstrated in virtually all tumour cells in all cases by in situ hybridization. Immunohistochemistry revealed EBV-encoded latent membrane protein (LMP)-1 expression in one case and BZLF1 protein expression in all three cases, whilst the EBV-encoded nuclear antigen (EBNA)-2 was not detected. Kaposi's sarcoma-associated herpesvirus (KSHV) sequences were absent in two cases studied. Our cases show similarities with pyothorax-associated pleural lymphomas reported mainly from Japan and recently from France, which are invariably associated with EBV. These findings suggest a causal effect of EBV in the development of this type of lymphoma complicating long-standing chronic suppuration. Localized immunodepression induced by chronic inflammation or immunosuppressive cytokines may favour the clonal proliferation of EBV-infected B cells.

Aged↗

Anaerobic isolates in chronic recurrent suppurative otitis media. Treatment with carbenicillin alone and in combination with gentamicin.

Tympanocentesis was performed in 32 pediatric patients with chronic recurrent suppurative otitis media. The aspirate was cultured aerobically and anaerobically. Aerobes were isolated from ten patients (31.2%); anaerobes from one patient; and both aerobes and anaerobes from 21 patients (65.6%). There were 46 aerobic isolates. The aerobes commonly recovered were Pseudomonas aeruginosa (24 isolates) Proteus sp. (5) and Staphylococcus aureus (3). There were 32 anaerobes isolated including anaerobic gram-positive cocci (19 isolates) and Bacteroides sp., the latter of which included Bacteroides fragilis group and Bacteroides melaninogenicus (9). The patients were treated by parenteral carbenicillin 300 to 400 mg per kg per day given in four dosages administered for a period of 12 to 21 days (average 17 days). An aminoglycoside (gentamicin) was added in 15 patients. The clinical response was good in 17 patients and poor in 15. There were no side effects or adverse reactions noted during therapy. The above findings demonstrate the polymicrobial etiology of chronic recurrent suppurative otitis media and suggest that treatment directed against the aerobic and anaerobic isolates is efficacious in more than half of the cases.

Adolescent↗

Suppurative lymphadenitis with Yersinia enterocolitica.

Extraintestinal suppurative complications of Yersinia enterocolitica infections are rarely observed. Two cases of suppurative lymphadenitis due to Yersinia enterocolitica are reported which mimicked other, more common disorders.

Abscess↗

The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.

We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.

Alcohol Drinking↗

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. VI. The central abscess: a new clinicopathologic entity in the genesis of anorectal suppuration.

The central abscess is a new clinicopathologic entity which plays an important role in the pathogenesis of anorectal abscess and fistula. Eight cases are presented. The abscess occupies the central space, which lies between the longitudinal muscle and the base loop of the external sphincter. The anatomic pattern and the clinical manifestations of the abscess are discussed. The abscess extended, in some cases, to the subcutaneous space and perianal skin, to the anal canal proper, or to the intersphincteric spaces. This is due to the fact that the central space communicates with all of the other perianal spaces along the central septa. A new theory in the pathogenesis of anorectal suppuration and fistula is put forward. It is believed that all anorectal abscesses or fistulas originate as central space infection which spreads to the other perianal spaces. Proper diagnosis and early drainage of the central abscess prevent further spread of suppuration to other spaces.

Abscess↗

Experimental chronic non-suppurative destructive cholangitis in rabbits following immunization with bile duct antigen.

Experimental chronic non-suppurative destructive cholangitis induced in rabbits following immunization with bile duct antigen. Histological changes similar to chronic non-suppurative destructive cholangitis were induced in rabbits by sensitization with antigen prepared from bovine gallbladder mucous membrane. The occurrence of these pathological changes was significantly higher in female animals than in males: 11 out of 14 female rabbits and 4 among 11 male rabbits exhibited histological changes. Immunoprecipitation using gel-diffusion and histological analysis by an immunofluorescence technique showed that this antigen was localized exclusively in the bile duct but not in either hepatocytes or other tissues. It is suggested that histological changes induced following immunization with bile duct antigen are specific immunological phenomena. This interesting experimental model may be helpful in explaining the pathogenesis of primary biliary cirrhosis.

Animals↗

Suppurated mediastinal and cardiac echinococcosis: report of a case.

We herein report the case of a suppurated mediastinal and cardiac hydatid cyst which occurred after the initial treatment of the patient for a primary mediastinal hydatid cyst in a radiology department. Both extracorporeal circulation and total circulatory arrest were used during the operation. We believe that surgery is the only feasible treatment for hydatid cysts located in the mediastinum, and surgery should be urgently performed whenever a possible rupture is suspected in order to avoid a possible anaphylactic reaction, mediastinal suppurations leading to serious complications, and growth into the pleural cavity.

Aortic Diseases↗

Retroperitoneal suppurative lymphadenitis complicating Staphylococcus aureus acute bacterial endocarditis.

Acute bacterial endocarditis is commonly caused by Staphylococcus aureus. Acute bacterial endocarditis due to S. aureus is often complicated by metastatic infection to distant organs, i.e. the central nervous system, the heart, lungs, kidneys and joints. However, metastatic lymph node involvement has not been reported. This is a case report of S. aureus acute bacterial endocarditis complicated by metastatic suppurative lymphadenitis of retroperitoneal lymph nodes. We believe this is the first reported case of suppurative lymphadenitis of the mesenteric lymph nodes secondary to S. aureus acute bacterial endocarditis.

Acute Disease↗