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PubMed1981

Nonaneurysmal suppurative aortitis.

Two patients had nonaneurysmal suppurative aortitis. In one, the aortic ruptured and the patient died. The second patient had Salmonella sepsis and occlusion of the infrarenal aorta. He was treated with aortic resection and extra-anatomic bypass, but died 20 months later of an unrelated illness. Patients with Salmonella sepsis who are over 50 years of age or who are suspected of having aortic atherosclerosis should be evaluated carefully for aortitis since rupture or aneurysm formation is associated with a dismal prognosis.

Aged↗
PubMed1998

Acute suppurative thyroiditis and aggressive malignant thyroid tumors: differences in clinical presentation.

BACKGROUND AND OBJECTIVES: Aggressive malignant thyroid tumors (AMTT) may mimic the clinical symptoms and signs of acute suppurative thyroiditis (AST) in the early course of the disease process. Our objective was to analyze the clinical features of these two conditions, to assess the best way of early diagnosis, and to propose proper treatment. METHODS: We retrospectively reviewed and analyzed the clinical features of 30 patients, who had similar clinical pictures of AST and were managed at Chang Gung Memorial Medical Center in Linkou, Taiwan, during the period from 1983 to 1996. These patients were consequently diagnosed as either AST or AMTT. The data were analyzed by the Mann-Whitney U, chi-square and Fisher's exact tests. RESULTS: Among the 30 patients, 25 patients (Male/Female (M/F) ratio = 9/16) were diagnosed as having AST and 5 (M/F ratio = 1/4) as AMTT. After statistical analysis we concluded that the presence of the following factors, namely, older age at diagnosis (P = 0.0155), history of dysphonia (P = 0.0325), right thyroid lobe involvement (P = 0.0151), large size of lesions (P = 0.0013), presence of anemia (P = 0.0075), and sterile pus cultures from thyroid aspirates (P = 0.0013) were cause to suspect a malignancy if the condition did not improve after antibiotics. Delay in diagnosis and management of AMTT may result in a poor prognosis (P = 0.0082). CONCLUSION: Due to the high mortality rate of AMTT, we should closely observe the patients with poor prognostic variables of acute thyroiditis. Earlier detection and aggressive surgical intervention for AMTT might improve the outcome.

Acute Disease↗
PubMed1998

Fine-needle aspiration cytology and immunocytochemistry of Hodgkin's disease, suppurative type.

We describe 3 cases of Hodgkin's disease (HD) of unusual suppurative type, which were diagnosed on fine-needle aspirates. The smears were dominated by neutrophils, macrophages, and cellular debris. Only a few large, atypical cells of Hodgkin and Reed-Sternberg type were observed. The differential diagnoses of such smears include infectious mononucleosis, tuberculosis, metastatic lymph node involvement, non-Hodgkin's large-cell anaplastic Ki-1-positive lymphomas, T-cell-rich B-cell lymphomas, and peripheral T-cell lymphomas of mixed type. Immunocytochemistry identified the large atypical cells as CD 30 (BerH2)-positive and negative for CD 45 (LCA) in cytospin material from 2 patients, which allowed a conclusive diagnosis of HD.

Adolescent↗
PubMed2000

Interventions for chronic suppurative otitis media.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a serious bacterial infection of the middle ear that can follow untreated acute otitis media. OBJECTIVES: To assess the effects of different treatments for CSOM. SEARCH STRATEGY: We searched Medline from 1966 to 1996 and a bibliographic collection of the Hearing Impairment Research Group in Liverpool, UK. We handsearched two otolaryngology journals and contacted members of an international hearing network. SELECTION CRITERIA: Randomized trials of any method of management for patients with eardrum perforation and persistent otorrhea. DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed eligibility and trial quality. One reviewer extracted data. We contacted investigators for clarifications. MAIN RESULTS: Twenty-four trials involving 1660 people were included. Clinical definitions and severity of CSOM varied, methodological quality was generally low and follow-up was short. Treatment with antibiotics or antiseptics accompanied by aural toilet was more effective in resolving otorrhea than no treatment (two trials, odds ratio 0.37, 95% confidence interval 0.24 to 0. 57) or aural toilet alone (six trials, odds ratio 0.31, 95% confidence interval 0.23 to 0.43). Topical treatment with antibiotics or antiseptics was more effective than systemic antibiotics (six trials, odds ratio 0.46, 95% confidence interval 0.30 to 0.69). Combining topical and systemic antibiotics was not more effective than topical antibiotics. Topical quinolones were more effective than non-quinolones (five trials, odds ratio 0.26, 95% confidence interval 0.16 to 0.41). No difference in the effectiveness of topical antibiotics and topical antiseptics was found (three studies, odds ratio 1.34, 95% confidence interval 0.64 to 2.81). Some topical antibiotic combinations may be more effective than others in resolving otorrhea. Rates of adverse drug events were low and equal between groups. REVIEWER'S CONCLUSIONS: Treatment of CSOM with aural toilet and topical antibiotics, particularly quinolones, is effective in resolving otorrhea and eradicating bacteria from the middle ear. Longterm outcomes such as preventing recurrences, closure of tympanic perforation and hearing improvement need to be further evaluated.

Chronic Disease↗
PubMed2006

Antibiotics for the prevention of acute and chronic suppurative otitis media in children.

BACKGROUND: Acute otitis media (AOM) is a common childhood illness. These middle ear infections may be frequent and painful. AOM may be associated with perforation of the tympanic membrane and can progress to chronic suppurative otitis media (CSOM). OBJECTIVES: To determine the effectiveness of long-term antibiotics (for longer than six weeks) in preventing any AOM, AOM with perforation and CSOM. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (January 1966 to March Week 3 2006), OLD MEDLINE (1950 to 1965), EMBASE (1990 to December 2005) and the references of relevant studies. SELECTION CRITERIA: All randomised controlled trials of long-term (longer than six weeks) antibiotics versus placebo or no treatment for the prevention of AOM, AOM with perforation, or CSOM were eligible. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data for: any AOM; episodes of AOM; any recurrent AOM; episodes of illness; any side effects; any antibiotic resistance, as well as outcomes at end of intervention (any AOM); and following cessation of intervention (any AOM). For dichotomous outcomes, the summary risk ratio (fixed and random-effects models) was calculated. For rate outcomes, the summary incidence rate ratio was calculated. MAIN RESULTS: Sixteen studies involving 1483 children met our inclusion criteria. All studies enrolled children at increased risk of AOM, and in seven studies the children were prone to otitis media. The majority of studies were high quality and most (15 studies) reported data for our primary outcomes. None reported AOM with perforation or CSOM. Long-term antibiotics reduced any episode of AOM (13 studies, 1358 children, risk ratio (RR) 0.62, 95% CI 0.52 to 0.75; random-effects model) and number of episodes of AOM (12 studies, 1112 children, incidence rate ratio (IRR) 0.48, 95% CI 0.37 to 0.62; random-effects model). Approximately five children would need to be treated long term to prevent one child experiencing AOM whilst on treatment. Antibiotics prevented 1.5 episodes of AOM for every 12 months of treatment per child. Statistical heterogeneity was explored. Long-term antibiotics were not associated with a significant increase in adverse events (11 studies, 714 children, RR 1.99, 95% CI 0.25 to 15.89; random-effects model). AUTHORS' CONCLUSIONS: For children at risk, antibiotics given once or twice daily will reduce the probability of AOM while the child is on treatment. Antibiotics will reduce the number of episodes of AOM per year from around three to around 1.5. We believe that larger absolute benefits are likely in high-risk children. These conclusions were not affected by sensitivity analyses.

Acute Disease↗
PubMed1981

Perforation of a suppurative solitary renal cyst.

A fatal case of rupture of a large infected renal cyst is presented. Antibiotic therapy is indicated after aspiration of a suppurative renal cyst, and recurrence, particularly if large, is an indication for prompt surgical intervention.

Female↗
PubMed1982

Chronic myringitis and chronic suppurative otitis media.

Thirty-four chronic myringitis cases were examined by otoscopy, pure tone audiometry, tympanometry, skull X-rays, and bacteriologic study of otorrhea. Five atypical cases are presented in detail. Three of these five cases had a perforation of the tympanic membrane preceding the appearance of typical chronic myringitis. The remaining two cases showed a transient small tympanic membrane perforation during the long course of chronic myringitis. These cases suggest that chronic myringitis could occur in some chronic suppurative otitis media and that myringitis could cause tympanic membrane perforation.

Adult↗
PubMed1984

Perforated diverticulum of the terminal ileum. A previously unreported cause of suppurative pylephlebitis and multiple hepatic abscesses.

We describe the case of a 58-year-old man who presented to the hospital with central abdominal pain, nausea, fever, chills, and dyspnea. While in the hospital, jaundice appeared and the liver function tests revealed features of both cholestasis and hepatocellular injury. He developed gram-negative septicemia and died on the sixth hospital day. Autopsy disclosed a perforated terminal ileal diverticulum and a contiguous mesenteric abscess. There was also severe phlebitis of mesenteric venous radicles which extended superiorly to the intrahepatic portal venules and veins. The portal veins were surrounded by multiple hepatic abscesses that varied in size from microscopic to 2.5 cm. This appears to be the first report in the world literature of suppurative pylephlebitis and hepatic abscesses resulting from a perforated ileal diverticulum. The subject of small bowel non-Meckelian diverticulosis is reviewed because of the rarity of this condition and the diagnostic challenges it poses.

Diverticulum↗
PubMedDate not supplied

Piriform sinus fistula: an underlying abnormality common in patients with acute suppurative thyroiditis.

We have previously reported that an internal fistula (piriform sinus fistula) was the apparent route of infection in 15 patients with acute suppurative thyroiditis (AST). Here, we describe 43 patients with AST, most of whom had a demonstrable fistula. The characteristic clinical features included: onset in infancy or childhood in 74% of cases, a left-sided predominance of involvement (40:3), and frequent recurrence. Twenty-nine patients had had several previous episodes of AST. The fistula was demonstrable in 38 of 42 patients examined by barium meal. Twenty-seven patients underwent fistulectomy. Six of 16 patients who declined fistulectomy had recurrences and 2 of them underwent surgery thereafter. None of 29 patients who had fistulectomy developed recurrences, except for 2 patients in whom the fistula could not be removed completely. The fistula ended medial or lateral to the thyroid lobe, attached to or entered the lobe in 6, 3, 6, and 12 cases, respectively. The thyroid specimens showed several features of inflammatory change. Thus, we concluded that the piriform sinus fistula is the most common underlying abnormality in patients with AST. Recurrence of inflammation can be prevented by complete fistulectomy.

Acute Disease↗
PubMed1995

Burkholderia (Pseudomonas) cepacia as a cause of brain abscesses secondary to chronic suppurative otitis media.

A patient with a cholesteatoma secondary to chronic suppurative otitis media developed infective complications including cerebellar and cerebello-pontine abscesses. Burkholderia cepacia was isolated from ear swabs, infected tissue and surgical pus on five occasions over a six-month period. Despite exhibiting three different antibiotic susceptibility profiles, all five isolates were confirmed as clonally indistinguishable by pulsed-field gel electrophoresis. To the best of the authors' knowledge there are no previous reports of Burkholderia cepacia causing infection of the adult central nervous system.

Adult↗
PubMedDate not supplied

Acute suppurative thyroiditis caused by Salmonella enteritidis.

Acute suppurative thyroiditis in a 47-year-old diabetic woman is reported. Diagnosis was suspected by clinical examination and confirmed by ultrasound, CT-scan and cytological examination. A rare causative agent was isolated--Salmonella enteritidis. No signs of nodular goiter or connection with piriform sinus were found. In spite of our efforts, the source and route of infection remained unclear. However, the haematogenic route seems to be the most plausible. Surgical drainage and antibiotics brought about a complete recovery. Partial lesion of the gland required transitory administration of levothyroxine.

Acute Disease↗
PubMed1993

Neonatal suppurative parotitis: a vanishing disease?

A case of neonatal suppurative parotitis due to Klebsiella pneumoniae is described. This is the first case reported in the last 20 years. Infection with unusual microorganisms should be taken into account when planning antibiotic treatment, especially in hospital acquired infections of the salivary glands in the newborn.

Amikacin↗
PubMed1985

Acute suppurative appendicitis. A rare associate of Crohn's disease.

A case is presented of acute suppurative appendicitis occurring with Crohn's disease. The association is rare (only five other cases described), but if diagnostic uncertainty exists, laparotomy should be performed early. If, at laparotomy for suspected appendicitis, Crohn's terminal ileitis is incidentally found, the appendix should be removed.

Acute Disease↗
PubMed1985

Colonic necrosis in acute pancreatitis. A complication of massive retroperitoneal suppuration.

Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.

Abscess↗
PubMed1994

A 16-year survey of changes in bacterial isolates associated with chronic suppurative otitis media.

Bacteria were isolated and cultured from the ears of outpatients with chronic suppurative otitis media (OMC) who attended the otologic clinics of Kyushu University Hospital from 1976 to 1991. Bacterial isolates were analyzed retrospectively to determine their incidences and antibiotic sensitivities. Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly isolated organisms. The incidence of S. aureus infections gradually rose over 16 years, while the incidence of Proteus infections gradually declined. The frequency of isolation of glucose non-fermenting gram-negative rod (NF-GNR) species, fungi and anaerobic bacteria gradually increased. The species of bacteria isolated from OMC cases with acute and chronic infections, cholesteatoma and postoperative infections were compared. Over the 16 years, the isolation of S. aureus increased in frequency. The differences in each type of OMC ceased to exist. S. aureus were quite sensitive to most of the antibiotics tested, whereas Ps. aeruginosa and NF-GNR showed poor sensitivity.

Acute Disease↗
PubMedDate not supplied

Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy.

Of 613 children evaluated in a village in Haryana 94 (15.3%) were observed to have chronic suppurative otitis media (CSOM). Fifty eight (61.7%) children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired (58/81). On analysis of association of CSOM with literacy and socio-economic status of mothers, and age, sex, and upper respiratory tract infections (URI) in children positive correlation was observed only with URIs (P < 0.001). Literacy and socio-economic status of the mothers did not correlate significantly with knowledge about treatment seeking, and ear cleaning practices, probably due to the narrow range of incomes and literacy levels. An intervention program consisting of play, demonstrations, health charts and slogans, and aural cleaning and antibiotic drops was introduced.

Adolescent↗
PubMedDate not supplied

Suppurative complications of infective sinusitis.

We report three cases of suppurative sinusitis that presented to our casualty department over a one week period. All three patients suffered complications of the disease secondary to extension of the inflammatory process beyond the bony confines of the sinus. None of the patients had previous history of sinus disease. We wish to remind the clinician that such complications still exist and we highlight the necessity of rapid diagnosis and early intervention in the management of complicated sinus disease.

Adolescent↗