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PubMed1994

Thyroid imaging in a typical case of acute suppurative thyroiditis with abscess formation due to infection from a persistent thyroglossal duct.

The clinical evaluation of thyroid imaging with 99mTc, 201Tl, and 67Ga in the uncommon, but potentially serious, disorder of acute suppurative thyroiditis (AST) with abscess formation due to infection from a persistent thyroglossal duct is reported. The 99mTc image showed functioning areas of the diseased thyroid gland and the 201Tl image demonstrated abscess formation in the thyroid gland of this patient. In addition, marked 67Ga accumulation was demonstrated in a wide area covering not only the area of the thyroid gland involved, but also associated circumferential inflammatory lesions in a patient with AST. The net thyroid uptake of 67Ga at 72 hours was calculated to be 13.8% of the injected dose.

Abscess↗
PubMed1997

Surgical management of Candida suppurative thrombophlebitis of superior vena cava after central venous catheterization.

Septic deep venous thrombosis is a major complication associated with central venous catheterization in intensive care units. The most common causative organisms are Staphylococcus aureus, gram-negative bacilli and Candida species. The incidence of Candida infections is increasing, especially in intensive care patients receiving total parenteral nutrition and long-term broad-spectrum antibiotics. Although intravascular catheter-induced septic thrombophlebitis is quite common, superior vena cava obstruction is a rare complication. However, few data exist concerning the best strategy for managing septic thrombophlebitis, especially when medical therapy fails. We report successful surgical management of Candida albicans suppurative thrombosis of the superior vena cava in a young patient.

Adolescent↗
PubMed1997

Acute suppurative perithyroiditis: MR findings.

We report the MR findings in two cases of acute suppurative perithyroiditis. MR has the advantages over other imaging modalities of being able to distinguish areas of inflammation from adjacent normal tissue and of allowing imaging in planes which more accurately demonstrate the extent of the lesion. MR imaging is one of the most useful methods to evaluate this entity.

Acute Disease↗
PubMed2005

Intracranial abscesses associated with chronic suppurative otitis media.

Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.

Adolescent↗
PubMed1998

Surgical drainage for idiopathic suppurative pylephlebitis.

Idiopathic suppurative pylephlebitis is quite rare and only a few cases have been reported. Conservative systemic administration of antibiotics and urokinase is reported to be effective. In this report, surgical drainage was performed on an 18-year-old man who complained of fever and abdominal pain. He had no past history of abdominal inflammatory disease or abdominal surgery. Ultrasonography and computed tomography showed wide spread thrombosis of the portal vein. Laparotomy was performed and the occluded superior mesenteric vein was incised. Massive pus was removed. Thereafter, a drain was placed at the opened mesenteric vein. Drainage resulted in a dramatic decrease in fever. Postoperative radiographic studies of the colon, the small intestine, and other organs did not show any abnormalities. Emergency surgical drainage was performed successfully, instead of systemic administration of antibiotics and urokinase. Surgical drainage may be useful for wide spread pylephlebitis and pylethrombosis.

Abdomen, Acute↗
PubMed2006

An exceptional complication following appendectomy: acute inguinal and scrotal suppuration.

Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.

Appendectomy↗
PubMed1981

Combined suppurative and noncaseating granulomatous oophoritis associated with distal ileitis (Crohn's disease).

A nulliparous 30-yr-old woman, presenting with nonspecific systemic symptoms, was found radiologically to have distal ileitis (Crohn's disease). A partial ileocolectomy was done along with excision of the firmly adherent right adnexa. Pathologically, the ovary showed a suppurative oophoritis related to an ileo-ovarian fistula and a noncaseating granulomatous inflammatory response similar to that found in the ileum.

Adult↗
PubMed1991

Acute suppurative parotitis: a forgotten cause of upper airway obstruction.

A patient had threatened upper airway obstruction as a result of bilateral acute suppurative parotitis. Because of the rarity of this condition in recent times, accurate diagnosis was delayed and fiber-optic intubation in the intensive care unit was required to safeguard the airway. Management is described with reference to the surgical anatomy and previously reported cases.

Acute Disease↗
PubMed1992

Medical treatment of chronic suppurative otitis media without cholesteatoma in children--a two-year follow-up.

A prospective long-term study was carried out in 48 infants and children with chronic suppurative otitis media without cholesteatoma treated initially with wide spectrum intravenous antibiotics and suction and debridement. Patients were followed for a period of two years. All children were cured after completion of therapy. At 3 and 6 months follow-up 75% of the children were still free of discharge and at 12, 18 and 24 months the proportion of dry ears dropped to 71%, 66% and 52%, respectively. Eighty percent of all recurrences developed already during the first 6 months of follow-up. Pseudomonas aeruginosa was the most common pathogen isolated, both in the initial and recurrent bouts of the disease, and was commonly associated with other pathogens. Children with early reappearance of ear discharge were less likely to benefit from further antimicrobial or surgical treatment. The recurrence rate was not affected by the antibiotic regimen, age, duration of drainage before treatment or the presence of granulation tissue. No intracranial or intratemporal complications were observed during the follow-up period.

Ceftazidime↗
PubMed1993

Epidemiology of chronic suppurative otitis media in Saudi children.

An epidemiological survey was carried out in Riyadh to establish the prevalence of chronic suppurative otitis media in Saudi children. 6421 children aged 2 months to 12 years were examined clinically, their ears were inspected by otoscopic examination by an ENT specialist, and the evaluation of hearing was undertaken by an audiologist using a memory screening audiometer (Madson 84-11). Ninety-four children (1.5%) had chronic ear disease being of the following types: congenital cholesteatoma (n = 1), acquired cholesteatoma and posterosuperior retraction (n = 5), and central perforation (n = 88), 16 of which had active ear discharge. These results were compared with other results in developed and developing countries. The factors predisposing to or associated with chronic ear disease such as environmental, genetic, congenital ear anomalies and cleft palate have been discussed.

Child↗
PubMed1996

Audiometric findings in children with chronic suppurative otitis media without cholesteatoma.

Chronic suppurative otitis media without cholesteatoma (CSOMWC) is usually associated with an increase in air conduction thresholds. However, only a few investigations reported on loss of cochlear function in the pediatric population. We undertook a prospective study in order to further delineate air and bone conduction levels in children with CSOMWC and the possible relationship between sensorineural hearing loss (SNHL) and other clinical characteristics that might reflect the extent of disease. Eighty-seven children were enrolled, 40 of which had bilateral disease. Hence, the total number of diseased ears tested was 127. Audiometric studies were performed three days after achieving a 'dry' ear following medical treatment. We found no statistically significant differences between the bone conduction threshold tested in ears with CSOMWC and control ears. This was also the case in 47 children with unilateral disease when cochlear function was investigated in the diseased and uninvolved ear in the same patient. Clinical correlation showed no association between age, sex, duration of otorrhea and presence of granulation or polyps and the degree of cochlear loss. Our study shows that CSOMWC in children has little effect on cochlear function.

Adolescent↗
PubMedDate not supplied

Immunoglobulin-coated bacteria in effusions from secretory and chronic suppurative otitis media.

Samples of middle ear effusions from 10 children with secretory otitis media and from 10 children with chronic suppurative otitis media were subjected to qualitative and quantitative bacteriologic analysis. In addition, secretory immunoglobulin A (SlgA)- and IgG-coated bacteria were evaluated using the immunofluorescence technique. Secretory otitis media effusions harbored few, if any, immunoglobulin-coated bacteria, whereas chronic otitis media effusions as a rule had heavily IgG- and SlgA-coated bacteria. However, those chronic otitis media effusions that were culture positive for Pseudomonas aeruginosa had no immunoglobulin-coated bacteria. The effusions of very young children were completely devoid of SlgA-coated bacteria. This study demonstrates that, based on the immunoglobulin coating of bacteria obtained from the middle ear cleft, one can evaluate immunologic response during otitis media.

Adolescent↗
PubMedDate not supplied

Role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media.

BACKGROUND: It is conventional to use antibiotic-steroid combination eardrops, although the advantage of steroid combination has not been substantiated. The present prospective randomized comparative study is designed to assess the role of glucocorticoids in ototopical antibiotic-steroid preparations in the treatment of chronic suppurative otitis media (CSOM). METHODS: Pre-treatment clinical assessment, bacteriology of the middle ear discharge and pure tone audiogram were done. CSOM with organisms sensitive to gentamicin were treated either with plain gentamycin (GM) or gentamycin steroid combination (GM-S) eardrops for a period of 3 weeks. Post-treatment clinical, bacteriological and audiogram response was recorded 1 week after discontinuing the eardrops. The post-treatment clinical improvement, bacteriologic improvement and changes in hearing threshold at speech frequencies were analyzed by using unpaired Student's t test and chi(2) tests. RESULTS: The most common organism associated with CSOM was Pseudomonas aeruginosa (33.92%). Clinical improvement was seen in 87.7 and 86.5% cases but bacteriological improvement in only 82.5 and 75% of cases treated with GM and GM-S (p >0.05), respectively. On comparing the pre- and post-treatment pure tone audiograms in 95 patients, 28.9% treated with GM and 30% with GM-S showed deterioration in bone conduction threshold above 5 dB (p >0.05) at speech frequencies. The mean increase in bone conduction in the two groups was 7.7 and 8.57 dB (p >0.05), respectively. CONCLUSIONS: Our results indicate that there is no difference in the clinical and bacteriological improvement or ototoxicity either with topical GM or GM-S. Hence, we conclude that it is unnecessary to combine steroids with topical antibiotic preparations for the management of CSOM.

Adolescent↗
PubMed2005

Neonatal suppurative submandibular sialadenitis: case report and literature review.

Acute submandibular sialadenitis is rare in the neonatal period and appears to be associated with prematurity. We describe a case of a premature neonate who developed suppurative submandibular sialadenitis from a hypervirulent strain of methicillin-resistant Staphylococcus aureus. The etiology, diagnosis, and treatment of this condition are discussed.

Anti-Bacterial Agents↗
PubMed2005

Chronic suppurative otitis media: a review.

OBJECTIVES: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide. Although microbial, immunological, and genetically determined factors, as well as Eustachian tube characteristics, are supposed to be involved in the pathogenesis of CSOM, many aspects of the pathogenesis of CSOM still need to be clarified. Optimal treatment strategy has not been established yet. The objective of this review is to present and evaluate the current state of knowledge of CSOM. DESIGN: Systematic narrative review. METHODS: A PubMed search (1966-January 2005) was performed for studies on epidemiology, pathogenesis, clinical management, and complications of CSOM. All included articles were categorized according to level of evidence. RESULTS: Five hundred and fifty papers were identified, of which 79 were found to be relevant for this review. The definition of CSOM was found to vary. CSOM is a multifactorial disease. Regarding management of CSOM, there is no consensus as to what the optimal management strategy should entail. No convincing evidence is available for most medical and surgical therapies. Topical quinolones have proven effective, but need further monitoring regarding adverse effects. CONCLUSIONS AND RECOMMENDATIONS: Important goals in research of CSOM should be achieving consensus about the definition of CSOM and gaining more in-depth knowledge of the pathogenesis of CSOM, especially the role of innate and adaptive immunity. There is also a need for further well-designed studies on the effectiveness of various management strategies for CSOM.

Anti-Infective Agents↗
PubMed2005

Long-term follow-up evaluation of mastoidectomy in children with non-cholesteatomatous chronic suppurative otitis media.

OBJECTIVE: In spite of declining prevalence chronic suppurative otitis media without cholesteatoma (CSOM) still poses a significant health problem. Randomized clinical trials comparing medical and surgical intervention are not available. Hence, the treatment of CSOM is almost exclusively based on empirical experience. The purpose of the present study was to evaluate the long-term effects of mastoidectomy combined with myringotomy and exploration of the middle ear in children with CSOM. METHODS: 47 children with CSOM underwent surgery including mastoidectomy. Ear status was investigated peri-operatively and at a long-term follow-up (5-21 years post-operatively). MAIN OUTCOME MEASURES: Final success rate, FS (dry ears for several years) and the optimal final success rate, OFS (dry ears for several years without re-operations and without retractions/perforations) were estimated. RESULTS: No serious surgical complications occurred. Post-operatively re-mastoidectomy was performed in 13% and re-myringoplasty/tympanoplasty in 21%. At the long-term follow-up the FS rate was 94% and the OFS rate was 61%. CONCLUSIONS: Surgery alone did not entirely cure CSOM which may justify randomized studies comparing conservative treatment and myringoplasty with/without mastoidectomy. Finally, mastoidectomy in these patients must be considered as a last resort when intense conservative treatment fails.

Adolescent↗
PubMed2005

Cost-utility analysis of tympanomastoidectomy for adults with chronic suppurative otitis media.

OBJECTIVE: To undertake cost-utility analysis for tympanomastoid surgery to analyze its cost-effectiveness in treating adult chronic suppurative otitis media (CSOM). METHODS: Seventy-seven patients with CSOM were evaluated with the Chronic Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health care cost data during the 1st year after operation were retrieved. The utility gain was defined as change in the CES total score. The cost-utility ratio (CUR) was defined as cost per utility gain. Patients were stratified by disease type into wet-ear and dry-ear groups. RESULTS: The average total direct cost attributable to tympanomastoid surgery is (in New Taiwan dollars) 45,716.3 in the 1st postoperative year, and the average CUR is 1850.9 New Taiwan dollars. The lower CUR of 1280.9 New Taiwan dollars for the wet-ear group is due to the greater utility gain (37.6 +/- 3.4 versus 24.4 +/- 6.8, P < 0.05) despite its higher cost (48,163.2 New Taiwan dollars versus 38,419.7 New Taiwan dollars, P < 0.05). CONCLUSIONS: Treating continuously or intermittently draining ears is more cost-effective, as compared with managing a quiescent infection, because of its favorable utility gain.

Adult↗