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PubMed2006

Ultrasound guided percutaneous treatment for splenic abscesses: the significance in treatment of critically ill patients.

AIM: To analyze the results of ultrasound guided percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of splenic abscess. METHODS: Thirty-six patients (14 females and 22 males, with an average age of 54.1 +/- 14.1 years) with splenic abscess were treated with ultrasound guided PNA and/or PCD. Patients with splenic abscess < 50 mm in diameter were initially treated by PNA and those with abscess > or = 50 mm and bilocular abscesses were initially treated by an 8-French catheter drainage. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, and mortality rates were analyzed. RESULTS: Twenty-seven patients had unilocular and 9 bilocular abscess. PNA was performed in 19 patients (52.8%), and 8 of them (42.1%) required PCD because of recurrence of abscess. In 17 patients (47.2%), PCD was performed initially. PCD was performed twice in six patients and three times in two. PNA was definitive treatment for 10 and PCD for 21 patients. One patient with PCD was referred for splenectomy, with successful outcome. In all 4 deceased patients, malignancy was the underlying condition. Twenty-one patients (58.3%) underwent 33 surgical interventions on abdomen before treatment. Cultures were positive in 30 patients (83.3%). Gram-negative bacillus predominated (46.7%). There were no complications related to the procedure. CONCLUSION: Percutaneous treatment of splenic abscess is an effective alternative to surgery, allowing preservation of the spleen. This treatment is especially indicative for the patients in critical condition postoperatively. We recommend PNA as primary treatment for splenic abscesses < 50 mm, and PCD for those > or = 50 mm in diameter and for bilocular abscesses.

Abdominal Abscess↗
PubMed1999

Colour Doppler ultrasonography of retropharyngeal abscess.

OBJECTIVE: This study was conducted to determine the capability of colour Doppler ultrasonography (CDU) in evaluating retropharyngeal abscess in children. MATERIALS AND METHODS: From July 1996 to February 1998, five children with clinical suspicion of retropharyngeal abscess were evaluated by CDU. The distance from internal carotid artery (ICA) to cervical vertebra (CV) (DICA-CV) at the upper cervical level was measured by longitudinal ultrasonography. Fifty healthy children, aged from 1 to 15 years, were recruited in the study to measure DICA-CV as control. Colour Doppler ultrasonography was used to differentiate abscess from other pathology and to detect carotid sheath invasion. Computed tomography was performed to confirm the sonographic diagnosis. Measurements of the DICA-CV at regular intervals were performed to monitor the progression of retropharyngeal abscess. RESULTS: Retropharyngeal abscess was highly suspected in all cases under sonographic studies. A patient was found to have carotid sheath invasion. Computed tomography confirmed the diagnosis of retropharyngeal abscess in all cases. Retropharyngeal abscess can be evaluated by the measured DICA-CV. The DICA-CV decreased as the retropharyngeal abscess gradually resolved. CONCLUSION: Colour Doppler ultrasonography offers a sensitive method to evaluate retropharyngeal abscess in children. It can also be used to monitor the progression of retropharyngeal abscess and avoid unnecessary radiologic examinations.

Adolescent↗
PubMed2000

Current concepts in the management of pyogenic brain abscess.

Current philosophy of treatment of brain abscess includes aspiration, appropriate antibiotics, treatment of sequelae and eradication of the primary source. Early clinical suspicion and diagnosis with CT is crucial. Small abscesses (<3 cm) in cerebritis or capsular stage located deep in clinically stable, poor surgical risk patients with diagnosis firmly supported by CT, may be treated with medical treatment only. Biweekly CT scan must be done to monitor the treatment response. CT or ultrasound guided aspiration should be performed in the event of clinical deterioration, failure of reduction in size or enlargement of abscesses. Encapsulated abscess (>3 cm), presence of significant neurological deficit or mass effect, doubt in the diagnosis and presumed resistant organisms are best treated with aspiration. Excision is required in large superficial abscesses resistant to multiple aspirations, post-traumatic abscess with a foreign body or fistula and multiloculated abscess of nocardial or actinomycotic aetiology. Results are directly related to the sensorium at the time of presentation. Stereotactic aspiration of all the loculi of multiloculated abscess in single or staged aspiration, and more completed drainage and lavage with endoscopic stereotactic evacuation may cut down indications of excision of brain abscess in future. It is concluded that, with diagnostic and technical advancements, a trend of adequate drainage of brain abscess via minimally invasive surgery is emerging. Confirmation of diagnosis and monitoring of treatment response with magnetic resonance spectroscopy may allow greater number of patients in future to be managed with medical treatment only.

Brain Abscess↗
PubMedDate not supplied

Splenic abscess: diagnosis and management.

BACKGROUND/AIMS: To evaluate the usefulness of a combination of computed tomography and sonography for splenic abscess diagnosis and management determination. METHODOLOGY: From January 1986 to June 1999, 30 patients of pyogenic splenic abscess were collected in our hospital. Computed tomograms of the spleen were performed on all of the patients, and abdominal sonographies were performed on 26 of them. The imaging findings of all the patients were reviewed with respect to the clinical presentations, predisposing factors, infective organisms, method of treatment and clinical outcome. RESULTS: The clinical triad of splenic abscess was the main presentation of the 30 patients; it included fever (92%), left upper abdominal pain (77%) and leukocytosis (66%). Infective bacteria were identified in 19 patients, and the most offending bacteria were aerobes (82.6%). The radiological findings included single abscess were found in 16 patients and multiple abscesses were noted in 14 patients. The computed tomography and sonography findings included abnormal gas content (6 cases), progressive enlargement of lesion (6 cases), subcapsular extension of lesion (6 cases), extracapsular fluid collection (8 cases) and cystic lesion (7 cases). 59% of the cases had at least one of the above imaging findings. With the combination of the clinical triad and the imaging findings, the diagnostic rate rose up to 86.7%. CONCLUSIONS: Although splenic abscess is rare, it has a high mortality rate if there is delay in diagnosis and treatment. With the combination of computed tomography, sonography and clinical features, early diagnosis and treatment can be made. Percutaneous drainage for single abscess and splenectomy for multiple abscesses are the safe and effective treatment choice. The computed tomography and sonography appearance of splenic abscess is a valuable predictor of outcome of splenic abscess drainage. Medical treatment alone was definitely insufficient.

Abscess↗
PubMedDate not supplied

Amoebic liver abscess: a comparative study of needle aspiration versus conservative treatment.

BACKGROUND: Amoebic liver abscess is a serious problem in Pakistan. Its management includes antimicrobial drugs, needle aspiration and surgical drainage. This study was done to see the therapeutic efficacy, safety and outcome of ultrasound guided needle aspiration of amoebic liver abscess combined with antiamoebic drugs. METHODS: This was a prospective study with a minimum follow up of six months comparing the results of needle aspiration plus antiamoebic drugs with drug treatment alone in Amoebic Liver Abscess. It was carried in Surgical 'B' Unit of Ayub Teaching Hospital from July 1998 to June 2001. The patients were divided into two groups. Group A with abscess < 300 cm3 were treated with drugs alone. Group B patients with abscess > 300 cm3 or smaller abscesses which failed to respond to medical treatment were treated with both needle aspiration and drugs. Main outcome measures were abdominal pain, fever, anorexia, hepatomegaly, resolution of amoebic liver abscess on ultrasound, length of hospital stay and any complications. RESULTS: There were 46 patients in the study group. 21 (45.5%) patients were in Group A and 25 (54.5%) in Group B. The ages ranged from 15-70 years. 38 patients were male and 8 were females. The right lobe was involved in 44 (95.5%) patients and left lobe in 2 (4.5%) patients. Mean volume of abscess in Group A was 225 cm3 and in Group B was 560 cm3. Needle aspiration was successful in 24 (96.3%) patients and failed in 1 (3.7%) patient. The mean time of clinical improvement was 7 and 3 days respectively in Groups A and B. The mean hospital stay was shorter in Group B (3.5 day) than Group A (7.5 days). The resolution of abscess seen on ultrasound was rapid in Group B. Complications occurred in only one patient in Group B. No mortality was seen in any group. CONCLUSIONS: Needle aspiration combined with antiamoebic drugs is more effective than drug treatment alone in the management of amoebic liver abscess.

Adolescent↗
PubMed2003

Liver abscess caused by an infected ventriculoperitoneal shunt.

Pyogenic liver abscess in Taiwan is most commonly due to Klebsiella pneumoniae infection in diabetic patients, and less frequently due to biliary tract infections. Liver abscess caused by ventriculoperitoneal (VP) shunt is very rare. We report a case of liver abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), which developed as a complication of an infected VP shunt. A 53-year-old woman, who had shad a VP shunt implanted 3 months previously for hydrocephalus due to intracranial hemorrhage, presented with fever off and on, drowsiness and seizure attacks for 1 week. Computed tomography (CT) of the brain showed only mild right-sided hydrocephalus, and was negative for intracranial hemorrhage and intracranial mass. Analysis of cerebrospinal fluid showed significant pleocytosis and hypoglycorrhachia. CT scan of the abdomen disclosed a huge abscess in the right lobe of the liver. Cultures of both the cerebrospinal fluid and aspirated liver abscess isolated MRSA. The patient was treated with intraventricular and intravenous vancomycin, intravenous teicoplanin and oral rifampicin, followed by oral chloramphenicol and rifampicin. Percutaneous drainage of the liver abscess and externalization of the VP shunt were performed. The liver abscess had resolved almost completely on ultrasonography after 2 weeks of therapy. Liver abscess in patients with a VP shunt should be considered a possible abdominal complication of the VP shunt, and may be caused by unusual pathogens. Diagnosis requires CT scan and direct aspiration and culture of the liver abscess. Treatment requires management of both the liver abscess and the infected shunt.

Female↗
PubMed2004

Abscess formation within cerebellar metastatic carcinoma--report of two cases and review of the literature.

BACKGROUND: The occurrence of an abscess in conjunction with a tumor in the brain is very rare. Only presumptions exist about their origin and manner of dissemination. Preoperative discrimination between a brain tumor with cystic degeneration and a brain abscess within a tumor may be difficult or even impossible. The purpose of this report is to demonstrate the difficulty of such discrimination using conventional CT diagnostics alone. METHODS: Two patients with abscess formation in association with metastatic carcinoma in the cerebellum are presented and compared with similar cases in the literature. The etiology and the route of dissemination are discussed. RESULTS: In our first patient with previously diagnosed lung carcinoma and a CT showing suspected cerebellar metastasis only, an abscess caused by Propionibacterium acnes was found in the cerebellum and treated surgically. No tumor was recognised during the operation. Post-mortem examination six weeks later revealed the coexistence of remnants of a chronic abscess as well as metastatic lung carcinoma at the operation site. The second patient presented with an enhanced, ring-like cystic cerebellar lesion. During surgery, a purulent exudate with a coagulase-negative type of Staphylococcus species was found within the metastatic carcinoma of unknown origin. Both were radically excised and the patient recovered well. Neither patient had a history of previous infection and the pathway for abscess formation in both patients remained unclear. About 30 cases of abscesses associated with intracranial neoplasms were found in the literature. Including our own report, only three cases of abscesses within metastatic carcinoma have been published. CONCLUSIONS: Modern diagnostic tools reported to differentiate more reliably between an abscess and a tumor are diffusion-weighted MR and proton MR spectroscopy techniques. Brain imaging using CT alone may not reliably demonstrate both coexisting lesions or differentiate between them. It is important to know that a metastatic brain lesion can occur in association with a brain abscess and that tissue sampling for pathological as well as microbiological testing is of crucial importance for optimal therapy for both lesions.

Adenocarcinoma↗
PubMed2004

Liver abscess in the tropics: an experience from Nepal.

Thirty-six consecutive cases of liver abscess seen at the BP Koirala Institute of Health Sciences Hospital, Dharan, Nepal, from 1995 to 1998, were reviewed. Twenty-one cases were male and 15 female, with a mean age of 42 years. Twenty-four cases (66.7%) were amebic, 7 (19.4%) pyogenic, 3 (8.3%) indeterminate and 2 (5.5%) tuberculous. The most frequent clinical features included fever (88%), leukocytosis (66.7%), abnormal level of serum albumin (44.4%) and alkaline phosphatase (38.9%). The liver abscess was single in 61.1%, multiple in 27.8%, and in 66.7% of cases the abscess was present in the right lobe of the liver. Ultrasonography was diagnostic in all cases. A positive culture of the abscess was obtained in 7 cases (19.4%). The most frequent bacteria found were Klebsiella pneumoniae (4;11.1%), followed by Escherichia coli (3;8.3%). Two cases were due to Mycobacterium tuberculosis and none had malignancy. Percutaneous drainage was performed in 27 patients (75%). Mortality attributable to the abscess was 5.5%. We found percutaneous needle aspiration of liver abscess helpful in confirming diagnosis, as it provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculosis. These two conditions should certainly be considered possible causes in our part of the world when an abscess fails to respond to standard treatment. In developing countries like Nepal, the clinical presentation of liver abscess has not varied over time. At present, rapid diagnosis and image-guided percutaneous drainage offer a better prognosis for liver abscess. We also recommend routine cytological examination of aspirated abscess materials, as well as stains and cultures for acid-fast bacilli.

Adolescent↗
PubMedDate not supplied

Prevalence of dental abscess in a population of children with vitamin D-resistant rickets.

A population of patients with vitamin D-resistant rickets whose present ages range from 4 to 22 years was examined to determine the prevalence of dental abscess associated with that condition. For those patients affected with abscesses in the primary dentition, four associated factors were examined: 1) the age at onset of the first abscess; 2) the tooth/teeth most commonly involved; 3) whether or not other teeth were involved over time; and 4) the order of occurrence of multiple abscesses. Six of 24 patients (25%) were affected with abscesses of the primary dentition; all had multiple abscesses. Males were more commonly involved than females. The sequence of involvement generally followed the pattern of tooth eruption; however, dental treatment in susceptible individuals shortened the time between eruption and abscess. Medication dose and measurement of radiographs were not reliable predictors of the occurrence of abscesses in this population; however, the results indicate that one abscess is a predictor of future abscesses for that patient.

Abscess↗
PubMed2006

Treatment procedures for anal fistulous cryptoglandular abscess--how to get the best results.

INTRODUCTION: Up to date anal fistulous cryptoglandular abscess is a subject of controversial scientific discussions and the number of medico legal cases dealing with treatment procedures is growing . In principal, there is a dispute whether it is reasonable to perform a primary fistulotomy at the time of abscess drainage or to wait for a secondary fistulotomy. The purpose of this study was to compare studies focussing on the treatment of anal fistulous abscess with regard to different treatment procedures, their outcome (recurrence, incontinence, follow-up) and factors influencing outcome (primary or recurrent fistulous abscess, comorbidity, exclusion criteria, anaesthesia, microbiology, antibiotics, search for internal opening, classification). METHODS: A Medline search included the terms: fistulous abscess, anal abscess, horseshoe abscess, anorectal sepsis, and perianal infection/abscess. RESULTS: In 63 (1964-2004) studies we found 35 different treatment methods: the most often used procedures were incision and drainage (I+D; n = 35) and incision and drainage and primary fistulotomy (I+D+pF; n = 23). Only in ten studies the treatment has been restricted for primary anal fistulous abscess; the remaining studies investigated primary and recurrent anal fistulous abscess. There was a considerable lack of information on morbidity, microbiology, and exclusion criteria. In only 16/63 studies patients were routinely diagnosed and treated under general anaesthesia. We found nine different classifications of fistulous abscess. There is a wide range of recurrence after different treatment procedures: up to 88% after I+D and 21% after I+D+pF. The incontinence rate after I+D ranged from 0-26%, after I+D+pF 0-52%. However, in many studies there was no information on incontinence available. CONCLUSION: A true comparison of different treatment methods is not available. This is mainly due to either a lack of information on important factors influencing outcome, even unclear definitions in some instances. Recent randomized studies have been criticized for missing information and flaws in the randomization procedure. The choice of treatment, e.g., primary or secondary fistulotomy, depends on the clinical experience of the surgeon on duty, the hospital structure (staff, equipment, and anaesthesia), the patient's history and the local anatomical circumstances. On the basis of up to date knowledge there is no reason to condemn primary or secondary fistulotomy without more clinical studies and without knowing the individual situation.

Humans↗
PubMed1991

[CT-guided stereotactic surgery of brain abscess].

Seven patients with brain abscess underwent CT-guided stereotactic aspiration using Iseki's stereotactic apparatus. Three of them were under the age of fifteen and four were older than thirty. The lesions were single and round in four cases, multilobular in two and multiple in one patient. Operations were performed after systemic administration of antibiotics for more than two weeks and after capsule formation was confirmed on CTs. Preoperative volume of the abscesses was estimated from CTs. The target point chosen was the center of the ring of the largest diameter in the enhanced lesion. Abscess was aspirated under monitoring with intraoperative CT scan. No continuous drainage was performed and no antibiotics were given directly into the abscess cavity. In all cases the center of the abscess was punctured with a single trial. Average volume of the preoperative brain abscesses was 18.8ml. Aspirated volume at the time of the operation averaged 16.9ml and all the abscesses decreased to unmeasurable size on CTs. In five of seven patients abscesses were cured after a single aspiration, and in one case after the second operation. One case required extirpation of the lesion. During the follow-up period of four months to five and a half years six patients showed no recurrence. One patient died of unrelated cause four and a half years after the operation. No operative complication was noted. There was no operative morbidity or mortality. Using a CT guided stereotactic method, brain abscess is punctured so accurately, regardless of its location and size, that damage to the surrounding brain during operation can be minimized. Therefore it is highly possible to aspirate abscesses completely.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Management of pyogenic liver abscess in the era of computed tomography.

The advent of high-resolution imaging has allowed earlier diagnosis of pyogenic liver abscess. Because radiologically guided percutaneous drainage (PCD) of liver abscesses is controversial, the authors studied 40 patients with liver abscess admitted to the Toronto Hospital between 1982 and 1987 to determine the role of PCD versus operative drainage (OD). The diagnosis of pyogenic liver abscess was made at autopsy (4 patients), at laparotomy (6) or by radiologically guided aspiration of pus (30). Ultrasonography and computed tomography were highly sensitive (85% and 96% respectively) in detecting liver abscess. Of the 36 patients treated for liver abscess all received antibiotics intravenously; 31 also underwent a drainage procedure. Treatment with antibiotics alone was associated with a success rate of 80% and a death rate of 20%. The success rate for those who had PCD was 75% with a death rate of 13%; 2 patients in this group of 16 subsequently required OD for cure. In the 15 patients initially treated with OD, success and death rates were 87% and 13% respectively. For solitary abscesses, success rates wer comparable for PCD and OD (86% and 90% respectively). For unilobar multiple abscesses the success rate was 100% for both PCD and OD, but for bilobar multiple abscesses the rates were only 40% and 67% respectively. Complication rates were similar for both methods of drainage. The authors conclude that pyogenic liver abscess can now be safely and efficaciously managed with a combination of antibiotics and PCD.

Adult↗
PubMed1989

Neutrophil chemotaxis and adherence in vitro and localization in vivo in rabbits with Staphylococcus aureus abscesses.

Decreased neutrophil (PMN) function may contribute to an altered host defense system in hosts with bacterial abscesses but has not been well correlated to in vivo outcome. We have found that blood PMNs from rabbits with chronic (2-week) experimental Staphylococcus aureus abscesses have decreased chemotaxis in response to an S. aureus supernatant (370 +/- 130 microns migration vs 570 +/- 180 microns, p less than 0.05) and decreased adherence (11.5% +/- 13.2% vs 32.9% +/- 18.6%, p less than 0.005) compared with PMNs from animals with acute (24-hour) abscesses. No differences were found in chemokinesis, random migration, and chemotaxis in response to zymosan-activated serum. No plasma inhibitors of PMN chemotaxis or inhibitors of chemotaxins were found. Although animals with chronic abscesses had higher levels of circulating chemotaxins, in both groups of animals abscess chemotaxin levels were greater than the plasma chemotaxin level. Animals with a concomitant chronic abscess had less PMN influx into an acute abscess but also less bacterial growth within the abscess than animals without a concomitant chronic abscess. We conclude that rabbits with chronic staphylococcal abscesses have decreased chemotaxis and adherence measured in vitro and decreased PMN localization in vivo. In this model, these functions were not associated with increased bacterial proliferation in vivo.

Abscess↗
PubMed1983

[In vivo uptake of Ga-67 citrate by an experimental abscess and the mechanism of Ga-67 uptake].

This study was undertaken to investigate the accumulation of 67Ga in an experimental abscess and to elucidate the mechanism of 67Ga uptake in the abscess. Two, three, five, seven and ten days after subcutaneous injection of 0.2 ml turpentine to the rats, 67Ga-citrate was injected to the rats. Twenty-four hours after injection of 67Ga, abscess and organs were excised and uptake rates of 67Ga were assayed. Furthermore, five days after subcutaneous injection of 0.2 ml turpentine to the rats, 67Ga-citrate was injected to the rats, at various time intervals from 10 minutes to 6 days, abscess and organs were excised and uptake rates of 67Ga were assayed. And subcellular distribution of 67Ga in abscess was determined at various time intervals after administration of 67Ga-citrate. On the other hand, to elucidate 67Ga binding substances in abscess, 67Ga-citrate and sodium sulfate-35S were injected to the above rats, respectively. Twenty-four hours after injection, abscess was excised and homogenized. The homogenate was digested with proteinase. After digestion, the reaction mixture was gel-filtered on Sephadex G-100. Eluate samples were assayed for radioactivity, uronic acid and protein. Uptake rates of 67Ga in abscess increased with time after injection of turpentine and reached a plateau 5-7 days later. Ten minutes, 24 hours and 72 hours after injection of 67Ga, uptake rates of 67Ga in abscess were 0.92%/g, 3.3%/g and 5.6%/g, respectively. Uptake rates of 67Ga (24 hours after injection) in abscess was 2.0-3.4 time of tumor uptake rates (previously reported).(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1984

Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses.

In the past 3 years, percutaneous catheter drainage (PCD) was performed for 24 abdominal and retroperitoneal abscesses while open surgical drainage (OSD) was used for treatment of 24 similar abscesses at the affiliated hospitals of UMDNJ-Rutgers Medical School. Although the method of treatment was arbitrarily selected by the attending physician, the two groups were similar with respect to abscess location, underlying illnesses, and previous operations. In the PCD group, 17 of 24 abscesses developed after operations versus 16 of 24 in the OSD group. Location of abscesses were: PCD group: abdominal (9), renal (5), pelvic (4), subphrenic (3), hepatic (2), pancreatic (1); OSD group: abdominal (10), renal (4), subphrenic (4), pelvic (3), hepatic (2), pancreatic (1). With PCD, the abscesses were localized by ultrasound or computerized tomography scan; a 20- or 22-gauge needle passed into the cavity, followed by progressively larger guide wires, dilators, and catheters; the pus evacuated; and abscess cavity thoroughly irrigated with sterile saline. Percutaneous catheter drainage was successful in 22 of 24 cases. There were two inconsequential complications. The mean post-PCD hospital stay was 11.7 days. With OSD, five patients developed major complications, including three deaths from sepsis. The mean post-OSD stay for surviving patients was 21.2 days. The advantages of PCD versus OSD are: 1) precise noninvasive localization of abscesses, 2) avoidance of general anesthesia, 3) avoidance of major complications, and 4) shorter postdrainage hospital stay. Open surgical drainage should be reserved for cases where PCD fails to control sepsis, close fistulae, or when noninvasive scanning either fails to demonstrate a discrete abscess in the face of intra-abdominal sepsis or identifies an abscess that cannot be percutaneously drained without traversing the bowel.

Abdomen↗
PubMed1981

The effect of corticosteroids on subcutaneous abscess formation in the mouse.

We have used a recently developed model for s.c. abscess formation to study the effect of corticosteroids on abscess formation in mice. Mice were given daily i.p. injections of either hydrocortisone, 20 mg/kg/day or dexamethasone, 0.8 mg/kg/day, starting 3 days before inoculation with Staph, aureus and continuing for the duration of the experiment. Another group of mice was given a single injection of dexamethasone, 8 mg/kg, 1 h after inoculation with Staph. aureus. Encapsulated abscesses developed in all animals by Day 4, and there was no mortality. Abscess volume +/- s.l. mean at 4 days was reduced (p less than 0.0005) from 39.9 +/- 3.0 mm3 in controls to 16.7 +/- 3.6 mm3 in the daily dexamethasone group. Abscess volume at 4 days after a single dose of dexamethasone was 39.9 +/- 8.0 mm3. Bacterial concentrations per ml of pus were equivalent in all groups (10(10,6)-10(10.9). The effect of steroids on formation of sterile abscesses was also studied. Abscess volumes were smaller in animals given daily hydrocortisone or dexamethasone when compared to controls, but the difference was significant only for mice receiving daily hydrocortisone. These results suggest that prolonged high-dose steroid administration decreased the magnitude of the acute inflammatory reaction responsible for abscess formation in the soft tissue but did not interfere significantly with the process of containment and encapsulation of s.c. abscesses. A single massive dose of steroid did not influence abscess formation.

Abscess↗
PubMed1995

[Comparative outcome of aortic valve endocarditis with or without annular abscess].

Annular abscess is a not uncommon but serious complication of aortic valve endocarditis. The aim of this retrospective study was to evaluate the prognosis of aortic valve endocarditis with and without annular abscess. Between January 1981 and 1989, 122 consecutive cases of aortic endocarditis fulfilling the diagnostic criteria of Duke University were admitted to hospital. Group I included 40 cases with aortic ring abscess confirmed at surgery, in 35 patients; group II comprised 43 cases of operated aortic valve endocarditis without annular abscess in 41 patients and group III comprised 38 cases of aortic valve endocarditis treated medically without echocardiographic or angiographic signs of annular abscess in 36 patients. The patients in group III were significantly older than those in group I (57 +/- 14 years vs 44 +/- 17 years; p < 0.001). From the clinical point of view, endocarditis of prosthetic valves was slightly more common, but without reaching statistical significance, in group I, but the abscess was associated with more severe cardiac failure. Systemic embolism, atrioventricular block and pericardial effusion were equally common in the three groups. On the other hand, endocarditis with annular abscess was more often the result of infection with streptococci A, B, C or pneumoniae, than forms without abscess (22.5% vs 5% and 3% respectively in the 3 groups; p < 0.05). Of the patients treated surgically, destructive lesions of the valves were more common in cases of abscess (57.5% vs 35%; p < 0.05): the hospital mortality was higher in cases of abscess (17.5% vs 7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1995

Breast abscesses in Nigeria: lactational versus non-lactational.

This review of 299 cases of breast abscesses seen over a 10-year period (1981-1990) at the University of Calabar Teaching Hospital in Nigeria seeks to establish the current status of breast abscesses in the tropics. Lactational breast abscess constitutes 95% of breast abscesses while non-lactational breast abscess constitutes only 5% in this review. The commonest pathogen cultured from lactational breast abscess is Staphylococcus aureus and the disease responds to incision and drainage and systemic antibiotics, while non-lactational breast abscess is caused mostly by anaerobic organisms, usually with underlying mammary duct ectasia. The low incidence of non-lactational breast abscess corresponds to the low incidence of cigarette smoking and mammary duct ectasia in Nigerian women. While the high incidence of lactational breast abscess corresponds to the high rate of breast feeding and low level of personal hygiene in the low income group Nigerian women in which the disease is commonest. Economic recession has also reduced patronage of artificial feeds thus intensifying breast feeding and consequent lactational breast abscess.

Abscess↗