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PubMed1978

Immunological abnormalities in bronchiectasis with chronic bronchial suppuration.

Fifty-three patients with bronchiectasis (chronic bronchial suppuration) of unknown cause, in whom the chronic production of purulent sputum was the prominent clinical feature, were investigated for possible immunological abnormalities. They were compared with two control groups comprising 50 patients with chronic bronchitis and emphysema and 33 patients with bronchial asthma. Forty-two patients with bronchiectasis(79%) had at least one abnormality of immunoglobulin, usually elevation of IgA, IgG or IgM. Eight patients had all three immunoglobulin levels raised and this was related to severity of disease. Similar increases in immunoglobulin levels were observed in the control groups, but the frequency and severity of these changes were significantly greater in the bronchiectasis patients. Two patients had IgA deficiency. There was a very high prevalence of rheumatoid factor (52%) and an increased prevalence of antinuclear factor (10%) in the bronchiectasis patients compared with the control groups. The presence of these autoantibodies did not correlate closely with severity of disease. Ten patients with bronchiectasis (19%) had one or more autoimmune disorders, and the association of severe bronchiectasis, Hashimoto's thyroiditis and pernicious anaemia in one patient is described in detail. The immunoglobulin changes, high incidence of autoantibodies and association with autoimmune disorders raises the possibility that in some patients with bronchiectasis (chronic bronchial suppuration) of apparent unknown cause abnormal immune mechanisms may be important in causing or perpetuating the condition.

Adolescent↗
PubMed1994

Suppurative stomatitis glandularis.

A case of diffuse, recurrent, suppurative sialadenitis and sialodochitis is presented. I believe this entity to be analogous to cheilitis glandularis and propose the name suppurative stomatitis glandularis.

Adult↗
PubMed1989

Use of sonography in the early detection of suppurative flexor tenosynovitis.

Eighteen patients with swollen fingers suggesting acute suppurative tenosynovitis were studied by ultrasonography. All patients received intravenous antibiotics. Twelve patients required surgical drainage. Eleven of 12 patients had sonographic evidence of both a swollen tendon and fluid in the flexor sheath. Eleven of the 12 patients operated on had purulent fluid in the flexor sheath. Four of the operative cases were culture positive and four were culture negative. All six patients treated only with antibiotics had swollen tendons, but five of the six had no sonographic evidence of fluid in the flexor sheath. All patients had a full recovery. Sonographic evidence of fluid in the flexor sheath is a useful sign in the early diagnosis of acute suppurative flexor tenosynovitis.

Adult↗
PubMed2006

Immunohistological findings of suppurative granulomas of Yersinia enterocolitica appendicitis: a report of two cases.

We report on the histopathologic and immunohistologic findings of two cases of suppurative granulomatous appendicitis of Yersinia enterocolitica (Y. ent.). Using formalin-fixed, paraffin-embedded materials, polymerase chain reaction revealed Y. ent. in both cases. Histologically, the epithelioid cell granulomas (EPGs) were transmural in both cases. The EPGs were predominantly nonsuppurative, and were surrounded by a lymphoid cuff composed of small lymphocytes. A portion of EPGs contained suppuration of the centers of the granulomas (central microabscesses). The EPGs were composed of numerous histiocytes with or without epithelioid cell features, along with scattered small T-lymphocytes and plasmacytoid monocytes. None of the EPGs contained monocytoid B-cells. Immunohistochemical study demonstrated that EPGs were usually surrounded by surface IgM/D+ small mantle zone lymphocytes. Moreover, CNA.42 immunostaining occasionally demonstrated residual follicular dendritic cells in the center of the EPGs. The overall histomorphologic and immunohistochemical findings demonstrated that the EPGs with Y. ent. are of the B-cell negative hypersensitivity type and occur in reactive germinal centers. In one case, regional lymph nodes contained EPGs showing the same histologic and immunohistologic findings as those of the appendix. The present study indicates that among abscesses forming epithelioid granulomatous lesions, EPGs with Y. ent. were B-cell negative granulomas, and it demonstrates histopathologic and immunohistochemical findings different from those of cat scratch disease and lymphogranuloma venerum, which contain numerous monocytoid B-cells.

Abdominal Abscess↗
PubMed2002

Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial.

BACKGROUND: Endoscopic drainage has replaced emergent surgery for biliary decompression in patients with acute cholangitis. The aim of this study was to prospectively compare the efficacy of the nasobiliary catheter and indwelling stent as temporary measures for biliary decompression in acute suppurative cholangitis caused by bile duct stones. METHODS: Over a 60-month period, 79 patients with acute cholangitis who required emergent endoscopic drainage were recruited. Indications for urgent drainage included any one of the following: temperature greater than 39 degrees C, septic shock with systolic blood pressure less than 90 mm Hg, increasing abdominal pain, and impaired level of consciousness. Patients who had previously undergone sphincterotomy or had coexisting intrahepatic duct stones were excluded. After successful bile duct cannulation, patients were randomized to receive either a nasobiliary catheter or indwelling stent without sphincterotomy for biliary decompression. Outcome measures included procedure time, complications, clinical response, and patient discomfort (scored with a 10-cm, unscaled visual analog score). RESULTS: Of the 79 patients, 5 were excluded because of previous sphincterotomy and intrahepatic duct stones, 40 were randomized to receive a nasobiliary catheter (NBC group), and 34 to receive indwelling stent (stent group). Demographic data were similar between the groups. All procedures were successful in the NBC group; there was one failure in the stent group. The mean (SD) procedure time was similar (NBC group 14.0 [9.3] minutes vs. stent group 11.4 [7.2] min). There were 2 ERCP-related complications in the NBC group. Four patients pulled out the nasobiliary catheter and one catheter became kinked. One stent occluded. There was a significantly lower mean (SD) patient discomfort score on day 1 after the procedure in the stent group (stent group 1.8 [2.6] vs. NBC group 3.9 [2.7]; p = 0.02 t test). The overall mortality rate was 6.8% (2.5% NBC group vs. 12% stent group). CONCLUSION: Endoscopic biliary decompression by nasobiliary catheter or indwelling stent was equally effective for patients with acute suppurative cholangitis caused by bile duct stones. The indwelling stent was associated with less postprocedure discomfort and avoided the potential problem of inadvertent removal of the nasobiliary catheter.

Acute Disease↗
PubMed1987

Acute suppurative obstructive cholangitis due to stones: treatment by urgent endoscopic sphincterotomy.

Endoscopic sphincterotomy is an accepted treatment for retained common bile duct stones, but there is little specific information available regarding its application in acute suppurative obstructive cholangitis with sepsis due to choledocholithiasis. Thirteen patients with this condition were referred to the authors for consideration of urgent endoscopic common bile duct decompression. All had been judged to be poor surgical candidates. Pus was released from the common bile duct by sphincterotomy within 24 hours of admission in all 13. Stones were removed endoscopically in 10 patients (77%) without complications. After endoscopic stone removal, symptoms, signs, and abnormal laboratory values returned to normal rapidly; follow-up endoscopic retrograde cholangiography did not show retained stones. Three patients whose large stones precluded endoscopic removal underwent operative choledocholithotomy. Urgent endoscopic sphincterotomy offers an important alternative in the treatment of acute suppurative obstructive cholangitis secondary to choledocholithiasis.

Aged↗
PubMed1979

Acute suppurative thyroiditis in children.

Ten cases of acute suppurative thyroiditis were studied. All patients remained euthyroid clinically during the course of this disease and during the follow-up. Of seven cases in which bacterial cultures were performed, an aerobic bacterium alone was isolated in one patient and anaerobic bacteria alone in four patients. Mixed aerobic and anaerobic microorganisms were recovered from one patient and cultures were negative in one case. Plasma TSH, T4, T3, and PBI levels were normal except in one case. The 131I uptake values were normal in six of seven cases. Plasma TSH response to TRH stimulation was normal in four of five cases. Antibodies against thyroglobulin and thyroid microsome were negative in four of six cases. These findings suggest that anaerobic bacteria may play an important role in the pathogenic process of acute suppurative thyroiditis and that the pituitary-thyroid functions are not impaired.

Bacterial Infections↗
PubMed1989

Anaerobic bacteria in suppurative genitourinary infections.

Bacterial growth was obtained from specimens of 55 male and 48 female patients with localized suppurative genitourinary tract infections. The 55 male patients had abscesses of the genitalia (15), scrotal cyst (3), penis (7), testis (6), prostate (3), kidney (4), perinephric area (2) and periurethral area (4), wounds of the scrotum (3) and penis (6), and infected hydrocele (2). The 48 female patients had abscesses of Bartholin's cyst (26), vulva (4), vagina (4), labial cyst (2), kidney (2), perinephric area (1), periurethral area (3) and bladder (2), and a labial wound (4). Anaerobic bacteria only were present in 34 specimens (33 per cent), aerobic bacteria only in 7 (7 per cent), and mixed aerobic and anaerobic flora in 62 (60 per cent). A total of 275 isolates (189 anaerobic and 86 aerobic) was recovered, for an average of 2.6 isolates per specimen (1.8 anaerobes and 0.8 aerobes). The predominant anaerobes recovered were Bacteroides species (103 isolates) and anaerobic cocci (54). The most frequently recovered aerobes were Escherichia coli (26 isolates), Staphylococcus aureus (10) and Proteus species (8). These data illustrate that most suppurative genitourinary infections involve anaerobic bacteria. These findings have important implications regarding the culturing techniques of these infections and for the selection of antimicrobials for their management.

Abscess↗
PubMed1981

Acute suppurative cholangitis.

Acute suppurative cholangitis is characterized by obstruction, inflammation, and pyogenic infection of the biliary tract associated with the clinical pentad of fever (and chills), jaundice, pain, shock, and central nervous system depression. The disease occurs most commonly in the elderly who have a history of calculous biliary tract disease. The disease represents a true surgical emergency. Appropriate antibiotic therapy and immediate surgical decompression of the biliary tract are essential and carry a mortality rate of approximately 33 per cent. Nonoperative management is uniformly fatal. If inadequately treated or untreated, the disease follows a fulminant course of progressive systemic sepsis, hepatic abscess formation, and heptic failure leading ultimately to death. Acute suppurative cholangitis, the most serious sequela of calculous biliary tract disease, is preventable by early elective surgical treatment for benign biliary tract disease.

Acute Disease↗
PubMed1998

Spontaneous disappearance of a middle cranial fossa arachnoid cyst after suppurative meningitis.

BACKGROUND: Spontaneous disappearance of an arachnoid cyst is very rare, particularly after suppurative meningitis. CASE REPORT: A 2-month-old boy with a high fever was diagnosed with suppurative meningitis by cerebrospinal fluid examination. Computed tomography disclosed a large arachnoid cyst in the left middle cranial fossa. Two months later, the meningitis was cured. The arachnoid cyst disappeared with long-term antibiotic therapy alone. CONCLUSION: Although an infected arachnoid cyst may disappear with antibiotic treatment alone, careful observation and individualized patient management are essential.

Arachnoid Cysts↗
PubMed1979

Internal fistula as a route of infection in acute suppurative thyroiditis.

Seven cases of acute suppurative thyroiditis are described. Six patients had a recurrent painful swelling of the left anterior neck and one was seen at her first episode of the disease. A barium meal revealed a fistula originating from the apex of the left pyriform sinus in all cases. The fistula, a remnant of the fourth pharyngeal pouch, thus seems to be a common route of infection in acute suppurative thyroiditis, allowing bacterial infection to begin in the perithyroidal space and spread to the thyroid gland. Complete extirpation of the fistula is required for a permanent cure.

Acute Disease↗
PubMed2002

The intriguing association between prematurity and neonatal isolated submandibular suppurative sialadenitis.

Submandibular suppurative sialadenitis occurring as an isolated lesion in the neonatal period is extremely rare. A case of a preterm newborn, who developed an isolated submandibular suppurative sialadenitis is described. A literature review highlighting salient points on this topic is also presented. In particular, an important role of prematurity in the etiology of this pathological condition is shown and discussed.

Ceftazidime↗
PubMed2002

Suppurative intracranial complications of sinusitis in children.

OBJECTIVE: A review of suppurative intracranial complications of sinusitis in children. METHODS: Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore. RESULTS: There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days. CONCLUSIONS: Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.

Adolescent↗
PubMed1998

Complicated neonatal submandibular suppurative sialadenitis.

Acute suppurative infection of salivary glands in the neonatal period is a rare entity; and almost always involves the parotid glands. A rare case of neck abscess in association with right submandibular suppurative sialadenitis in a 7-day-old baby is presented. The possible etiology, diagnosis, and management of this uncommon disease are discussed.

Abscess↗
PubMed1995

Suppurative lesions without prominent epithelioid cell response in abscess-forming granulomatous lymphadenitis.

To clarify the clinicopathological significance of the suppurative lesions without an epithelioid granulomatous response (SLs without Ep) in lymph nodes and their relationship to abscess-forming granulomatous lymphadenitis (AGL) and cat scratch disease (CSD), 10 cases were assessed clinicopathologically and immunohistologically. SLs without Ep were located in the subcapsular sinus, paracortical area and medullary cords, but not in the germinal centers. The microabscesses were surrounded by collections of monocytoid B-lymphocytes (MBLs), histiocytes without epithelioid features, neutrophils, small lymphocytes and small numbers of plasma cells. The majority of the MBLs seen in the SLs without Ep were of the large cell type. The histological triad of toxoplasmic lymphadenitis, i.e., reactive follicular hyperplasia, small clusters of epithelioid cells and aggregates of MBLs, were also seen in all cases. Some of the clinical and pathological findings in our 10 cases were characteristic of CSD, i.e., (1) cat exposure before the lymphadenopathy was in four of the 10 cases, (2) occurrence in autumn and winter months in all cases, (3) typical suppurative granulomas surrounded by palisaded epithelioid cells were in four of the 10 cases, and (4) Warthin-Starry silver stain-positive bacteria were detected in seven of the 10 cases. The results of our study suggest that SLs without Ep are an early stage of CSD.

Abscess↗
PubMed2007

Subdural empyema and other suppurative complications of paranasal sinusitis.

Suppurative intracranial infection, including meningitis, intracranial abscess, subdural empyema, epidural abscess, cavernous sinus thrombosis, and thrombosis of other dural sinuses, are uncommon sequelae of paranasal sinusitis. A high index of suspicion is necessary to identify these serious complications. We present a patient with subdural empyema in whom the diagnosis was delayed, followed by a discussion of suppurative complications of sinusitis. The case shows the rapid progression of subdural empyema, which represents a true neurosurgical emergency requiring prompt diagnosis and management.

Empyema, Subdural↗
PubMed2001

Techniques and complications of one-lung ventilation in children with suppurative lung disease: experience in 15 cases.

OBJECTIVE: To evaluate lung isolation with Fogarty catheters and to analyze respiratory consequences of one-lung ventilation (OLV) in children with suppurative lung disease. DESIGN: Prospective. SETTING: University hospital. PARTICIPANTS: Fifteen children undergoing thoracotomy. INTERVENTIONS: Bronchial blockade with a 7F Fogarty catheter was attempted. In case of incomplete blockade or failure in directing the catheter into the desired mainstem bronchus, endobronchial intubation was done. Volume-controlled ventilation was performed with fraction of inspired oxygen (F(I)O2), 0.5; inspiratory-to-expiratory (I: E) ratio, 1:2; and 10 mL/kg tidal volume during two-lung ventilation (TLV). F(I)O2 was increased to 1.0 by the initiation of OLV. If peak airway pressure exceeded basal values during TLV by 35%, tidal volume was reduced to 8 mL/kg, inspiratory pause was zeroed, and I:E ratio was increased to 1:1. Hemodynamic and respiratory parameters were recorded during TLV and 30 minutes after initiation of OLV. Peripheral oxygen saturation and end-tidal carbon dioxide tension were recorded every 5 minutes. MEASUREMENTS AND MAIN RESULTS: Right lung isolation was successfully obtained by Fogarty catheters in 10 children undergoing right thoracotomy. Endobronchial intubation was performed in 2 children (40%) undergoing left thoracotomy. Three children (20%) developed episodes of severe hypercapnia and hypoxia requiring treatment during OLV. All of the parameters recorded at 30 minutes of OLV revealed statistically significant differences from TLV. OLV was transiently discontinued in 1 child. CONCLUSION: The use of Fogarty embolectomy catheters for lung isolation in children undergoing thoracotomy is recommended. Respiratory problems are not rare during OLV in children with suppurative lung disease and require immediate management.

Adolescent↗
PubMed2001

Rapid progress of acute suppurative cholangitis to secondary sclerosing cholangitis sequentially followed-up by endoscopic retrograde cholangiography.

A 66-year-old man was admitted to our hospital because of right hypochondralgia and fever after colonic polypectomy. Endoscopic examination revealed purulent bile excretion from the duodenal papilla orifice; based on this finding, acute suppurative cholangitis was diagnosed. An endoscopic retrograde cholangiography revealed no abnormality in the biliary tree. However, chronic cholestasis persisted, and endoscopic cholangiography performed 4 months later disclosed a beaded appearance of the intrahepatic bile ducts; this sign is a characteristic finding of sclerosing cholangitis. This is the first report of rapid progression of acute suppurative cholangitis to secondary sclerosing cholangitis sequentially followed-up by endoscopic retrograde cholangiography.

Acute Disease↗