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PubMed1987

Acute suppurative thyroiditis in appearance of unusual neck mass.

We report on three adult cases of acute suppurative thyroiditis due to infection through a piriform sinus fistula. In these cases, the lesion did not exhibit the clinical symptoms characteristic of acute suppuration, but appeared as an unusual neck mass. Repeated barium meal roentgenograms, however, demonstrated the internal fistula in two of the three cases. Acute suppurative thyroiditis may not be so rare even in adults. When acute suppurative thyroiditis occurs in adults with scanty symptoms of acute suppuration, the piriform sinus fistula could easily go undetected. Recognition of acute suppurative thyroiditis in adults per se seems to be important for correct diagnosis.

Acute Disease↗
PubMedDate not supplied

[Mucociliary transport in Eustachian tubes in chronic suppurative otitis media].

Eustachian tube dysfunction is one of the well-known factors leading to development of chronic suppurative otitis media. Tube mucociliary transport is important for elimination of the inflammation products from the middle ear enabling recovery of the affected mucosa of the middle ear, local circulation and restoration of normal air pressure in the middle ear. The study was aimed at determining: 1. whether perforation site on the tympanic membrane influences tube mucociliary transport time in individuals with traumatic rupture of the eardrum; 2. possible time difference of tube mucociliary transport between group of patients with chronic suppurative otitis media and group of patients with traumatic rupture of the tympanic membrane; 3. possible time difference of tube mucociliary transport between chronic tubotympanic type of suppurative otitis media, so called tubotympanic otitis media and atticoantral type of chronic suppurative otitis media, the so called atticoantral otitis; 4. the association between the degree of defect of the tympanic membrane mucosa and time of tube mucociliary transport in each individual type of chronic suppurative inflammation of the middle ear. Eustachian tube mucociliary transport was studied in 16 patients with tubotympanic otitis, in 13 patients with atticoantral otitis and in 9 patients with traumatic rupture of the eardrum (control group of patients). All patients were treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia in Belgrade during 2002. Tube mucociliary transport was studied upon instillation of 10 microl 5% sterile saccharine solution through the existing eardrum perforation in the course of preoperative preparation of the patient for surgical intervention. The time interval from the moment of sterile saccharine solution application till perception of the sweet taste in the mouth and pharynx was measured in studied patients. The obtained results were analyzed using the methods of descriptive and analytical statistics (t-test for small independent samples). The mean time of tube mucociliary transport in patients with traumatic rupture of the tympanic membrane was 7.6 minutes. The mean time of tube mucociliary transport in tubotympanic otitis with normal mucosa of the tympanic cavity promontorium was 15 minutes, while mean time of tube mucociliary transport in tubotympanic otitis with polypoid changes of the promontory mucosa was 24 minutes (t = 5.218; p < 0.01). Mean time of tube mucociliary transport in atticoantral otitis with normal promontory mucosa of the tympanic cavity was 35.5 minutes, while mean time of mucociliary tube transport in atticoantral otitis with polypold changes of promontory mucosa was 48 minutes (t = 6.99; p < 0.01). In the irreversibly changed tympanic cavity mucosa, tube clearance saccharine test was negative even after one hour. The results of our study indicate the possibility that prolonged mucociliary tube transport has greater influence to development of atticoantral otitis rather than to development of tubotympanic otitis. The association between the degree of mucosal defect and time of mucocillary transport was evidenced in both types of chronic suppurative inflammation of the middle ear.

Chronic Disease↗
PubMed2002

Clinical characteristics and management of acute suppurative thyroiditis in children.

BACKGROUND: Acute suppurative thyroiditis is an uncommon disease in children. This paper describes the clinical characteristics and management of children with acute suppurative thyroiditis treated during a 15-year period at National Taiwan University Hospital. PATIENTS AND METHODS: From 1985 to 2000, acute suppurative thyroiditis was diagnosed in 11 previously healthy children (6 boys, 5 girls) at the Department of Pediatrics. Their mean age at diagnosis was 6.4 +/- 4.4 years. Leukocyte count, acute-phase reactants, thyroid function, and thyroid autoantibodies were assessed. Samples were taken by thyroid needle aspiration for cytology study and pus culture. Underlying pyriform sinus fistula (PSF) was demonstrated by barium esophagogram. RESULTS: Leukocytosis was noted in six cases (55%) and acute-phase reactants were elevated in eight cases (73%). Neither thyroid autoantibodies nor thyroid dysfunction was detected in any of the patients. Barium esophagogram detected PSF in eight of 10 patients examined. Five (45%) patients had recurrent suppurative thyroiditis before surgery. Cytology and pus cultures were available for 10 patients. Polymorphonuclear cells were the main findings in the smear from thyroid aspirates. Twenty-two organisms were isolated from six patients (60%). Streptococcus species (45%) and anaerobic organisms (41%) were the most common pathogens isolated. Mixed infection was detected in five of six children who had a causative microorganism identified. The microorganisms were all sensitive to amoxicillin-clavulanate. CONCLUSION: PSF plays a role in the pathogenesis of acute suppurative thyroiditis in children. Streptococcus species are the most common pathogens in acute suppurative thyroiditis. Our results suggest that amoxicillin-clavulanate is the drug of choice for the treatment of this disease.

Acute Disease↗
PubMedDate not supplied

Non-calculus suppurative cholangitis in Danish patients with inflammatory bowel disease.

BACKGROUND/AIMS: We examined the risk of non-calculus suppurative cholangitis in patients with inflammatory bowel disease in the entire Danish population. METHODOLOGY: The study included all patients discharged from Danish hospitals with a diagnosis of Crohn's disease or ulcerative colitis as registered in the Danish National Registry of Patients from January 1, 1977 to December 31, 1992. We compared the observed number of patients hospitalized with suppurative cholangitis with expected numbers on the basis of age, gender, and calendar-specific incidence rates in the general population. RESULTS: Overall, 15,317 eligible patients with inflammatory bowel disease were discharged during the study period. Among these were 52 cases of non-calculus suppurative cholangitis. The incidence rate of non-calculus suppurative cholangitis in the cohort with inflammatory bowel disease was 46.1 per 100,000 person-years. The standardized incidence ratio (SIR) for suppurative cholangitis was increased similarly for patients with Crohn's disease [SIR=6.7, 95% confidence interval (CI): 3.1-12.7] and for patients with ulcerative colitis (SIR=6.6, 95% CI: 4.7-9.1). The highest relative risk was found in male patients younger than 40 years of age, for both Crohn's disease and ulcerative colitis (SIR=70.5 and 78.7, respectively). CONCLUSIONS: Patients with inflammatory bowel disease have an increased risk of non-calculus suppurative cholangitis.

Adult↗
PubMed1994

[Contribution of x-ray computed tomography in the diagnosis of cervical suppuration].

The authors report their experience with computed tomography (CT) in 27 cases of cervical suppurations. The diagnosis was confirmed surgically in 24 cases and by the improvement of clinical signs and CT after antibiotics in 3. Two types of CT features were identified: collected abscesses (n = 22) visualized as encapsulated heterogeneous hypodense formations and extensive suppurative cellulitis (n = 5) formed by large diffuse hypodense collections without a clearly visible peripheral wall. The extension of the suppurative process could be evaluated precisely with CT, especially in certain anatomic areas where physical examination is difficult including mediastinal suppurations (n = 2), extension of parapharyngeal suppurations to the retrostyleal area (n = 1), and pterygo-maxillary and epidural collections (1 each) the latter in combination with a tuberculous abscess. Computed tomography is also useful in the etiological diagnosis (search for foreign body, cystic malformations, tuberculosis) and in post-treatment follow-up to visualize the absence of collections after cure in cases of favourable outcome and to determine the extent of the suppurative process in case of complications.

Adult↗
PubMedDate not supplied

Bilateral suppurative thrombophlebitis due to Staphylococcus aureus.

Suppurative thrombophlebitis is an infection of the wall of a superficial vein, usually is associated with intravenous catheter placement, and accounts for about 10% of all nosocomial infections. Suppurative thrombophlebitis occurs most commonly in patients with burns, patients with cancer, and persons receiving steroids. Skin flora organisms (e.g., Staphylococcus aureus and to a lesser extent Enterobacteriaceae) are the most common pathogens. Suppurative thrombophlebitis should be suspected when a patient having phlebitis presents with a temperature of 102 degrees F or higher. The diagnosis of suppurative thrombophlebitis is usually straightforward and made by demonstration of pus coming from the wound of the removed intravenous device or by aspiration of pus percutaneously from the involved vein. Treatment of superficial suppurative thrombophlebitis consists of venotomy of the affected vessel and systemic antimicrobial therapy. We present a case of S. aureus bilateral suppurative thrombophlebitis, which is most unusual.

Arm↗
PubMed2002

Suppurative complications of acute otitis media in the era of antibiotic resistance.

OBJECTIVE: To review our experience with suppurative complications of acute otitis media (AOM) in the era of antibiotic resistance, given a perceived increase in the number of such cases in recent years requiring surgical intervention. DESIGN: Retrospective review of pediatric patients presenting with suppurative complications of AOM from January 1993 to June 2000. SETTING: Academic tertiary care children's medical center. PATIENTS: A total of 90 pediatric patients, ranging in age from 3 months to 16 years (mean age, 45 months). RESULTS: A total of 104 suppurative complications of AOM occurred in 90 patients over the 7.5-year study period. The incidence of noncoalescent, coalescent, and total cases of mastoiditis and total number of suppurative complications all increased over the study period, with coalescent outpacing noncoalescent disease during the last 3 years of the study. A trend toward an increasing number of cases requiring surgical intervention was noted during the study period, corresponding to an increasing number of resistant Streptococcus pneumoniae isolates. Ten of 16 S pneumoniae isolates were resistant, primarily collected from younger children ranging in age from 4 to 24 months (mean age, 11.9 months). CONCLUSION: The rising incidence of resistant S pneumoniae corresponded to the increasing number of suppurative complications of AOM during the study period and seemed to contribute to more aggressive infectious processes requiring surgical intervention.

Adolescent↗
PubMed2006

Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction due to pancreas carcinoma.

Acute obstructive suppurative cholangitis is a well-known clinical entity; however, acute suppuration of the pancreatic duct in the setting of pancreatic ductal obstruction is an uncommon pancreatic disorder. We report a case of acute suppuration of the pancreatic duct without either a concomitant pancreatic abscess or an infected pseudocyst, presenting as acute relapsing pancreatitis. In this case, the underlying cause of suppuration of the pancreatic duct was pancreatic ductal obstruction and chronic pancreatitis secondary to pancreas head carcinoma along with infection of Escherichia coli. Endoscopic placement of a pancreatic stent resulted in an evacuation of grayish thick pus from the distal pancreatic duct with a dramatic improvement of the disease. This case proposes the concept that acute suppuration of the pancreatic duct is a complex process involving the chronically damaged pancreas, pancreatic outflow obstruction, and subsequent bacterial infection. Antibiotic treatment is effective but temporary; therefore, the immediate drainage of the infected pancreatic duct is mandatory.

Aged↗
PubMedDate not supplied

Abscess-forming granulomatous lymphadenitis: histological typing of suppurative granulomas and clinicopathological findings with special reference to cat scratch disease.

In order to clarify the histological and immunohistochemical characteristics of suppurative granuloma in abscess-forming granulomatous lymphadenitis (AGL), and the relation between AGL and cat scratch disease (CSD), 36 cases of AGL were studied. The combined results showed that there were two types of suppurative granulomas. The suppurative granulomas histologically revealed small lymphocytes of predominantly T cell phenotype distributed among the epithelioid histiocytes bordering central necrotic areas in the suppurative granulomas. These suppurative granulomas could be further subdivided into two groups, mainly those with and without the intermingling of large transformed cells of B-cell phenotypes: Type B granuloma with large transformed B cells and Type A without large transformed B cells. Both types of granulomas were observed in a varying degree in most cases. According to the predominant type of granulomas, 36 patients with AGL were further classified into two groups: Group I of Type A dominance and Group II of Type B dominance. Warthin-Starry (WS) silver stain positive bacteria, which are said to be a causative agent of CSD, were present in about 50% of both groups. No Brown-Hopps' Gram-positive bacteria, fungus, toxoplasma, Chlamydia or Bacillus Calmette-Guérin antigen were found in any case. Clinically, there was no significant difference between these two groups. On the other hand, the detection of WS-positive bacteria seemed to have some relationship with the duration of disease and the history of exposure to cats, and 70% of AGL cases occurred in autumn without a single concurrent epidemic.

Adolescent↗
PubMed1991

Management of suppuration in regional lymph nodes secondary to BCG vaccination.

We describe 50 patients with suppurative regional lymphadenitis following intradermal BCG vaccination. For non-drained suppurations we performed needle aspiration in twenty-three patients (aspiration group). Of the remaining 27 patients (drainage group) 16 had spontaneous drainage and 11 incisional drainage. In the drainage group, 17 patients were followed up conservatively. Ten patients from the drainage group and 3 patients from the aspiration group (drained after needle aspiration) accepted total surgical excision to terminate the drainage. Twenty of twenty-three patients in the aspiration group recovered after needle aspiration. Average period of cessation of drainage and healing of wound was 7.5 weeks in patients with drainage (spontaneous and incisional). Healing was complete after total surgical excision of draining suppurations in all of 11 patients. We concluded that simple needle aspiration was sufficient for the treatment of suppurating but non-drained BCG lymphadenitis. For suppurating lymph nodes that were surgically (not recommended) or spontaneously drained, a more invasive procedure, total surgical excision, was proposed to terminate the long and disturbing drainage period.

BCG Vaccine↗
PubMed1978

Prevention of chronic experimental pyelonephritis by suppression of acute suppuration.

In order to evaluate the importance of suppuration, persistent infection, and scar formation in the evolution of Escherichia coli chronic pyelonephritis, we treated rats with different antibiotic regimens at different stages of the disease. The results show that (a) if acute suppurative pyelonephritis is aborted with early antibiotic therapy, chronic pyelonephritis is prevented; (b) chronic pyelonephritis can develop even after eradication of infection if acute suppuration persists beyond 3 days; (c) persistent infection does not lead to chronic pyelonephritis, if the acute suppuration is suppressed; and (d) residual infection, antigen-load, antibody, and(or) cell-dependent autoimmune processes did not play a significant role. We interpret these results as evidence that the pathologic entity recognized as chronic pyelonephritis results from kidney damage, scarring and shrinkage secondary to acute suppuration.

Acute Disease↗
PubMed2000

[Pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actinomyces].

We report a case of pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actimomyces. A 49-year-old man was admitted to our hospital because of hemoptysis on March 30, 1999. A chest X-ray film showed a localized shadow in the right middle lobe, and a tumor shadow was recognized on chest CT. The anaerobic bacterium were isolated from specimens collected bronchofiberscopically. A diagnosis of pulmonary suppuration due to anaerobic bacterium was made, and treatment with sulbactam/ampicillin, followed by imipenem/cilastatin, was initiated. Although his clinical symptoms and laboratory data improved rapidly following this treatment, the abnormal finding on the chest radiographs remained, with only slight improvement. Accordingly, surgical resection of part of the right middle lobe was performed on June 29 using a video-associated thoracic surgery technique. Actinomycosis was recognized by pathological examination of the resected lesion. A revised diagnosis of pulmonary suppuration due to a mixed infection of anaerobic bacterium and Actinomyces was made. Anaerobic bacterium in the oral cavity are recognized as significant pathogens in pulmonary suppuration. In the present case, we considered anaerobic bacterium and Actinomyces aspirated from the oral cavity into the lung to have caused the pulmonary suppuration.

Actinomycosis↗
PubMed2002

Evaluation of the etiologic agents for acute suppurative tonsillitis in children.

BACKGROUND: Acute suppurative tonsillitis is one of the most common pediatric infectious diseases, and has Group A beta-hemolytic streptococci (GABHS) as its most frequent bacterial cause. Prevention of acute rheumatic fever is the principal goal of treatment. Antimicrobial agents, in contrast, is not needed. Therefore, the cause of acute suppurative tonsillitis in children must be determined. METHODS: Fifty-nine children were diagnosed as having acute febrile suppurative tonsillitis with the etiologies of Gr. A streptococci, adenovirus and Epstein-Barr (EB) virus. There were 25 cases of adenoviral tonsillitis, 20 cases of Epstein-Barr viral tonsillitis, and 14 cases of Gr. A streptococcal tonsillitis. This study aimed to find out whether the serum CRP, ESR or peripheral WBC counts could differentiate the etiological agents of acute tonsillitis from group A streptococcal to EB-viral or adenoviral infection. We also evaluated the effectiveness of epidemiological and clinical factors in predicting the etiology of acute suppurative tonsillitis in childhood. RESULTS: There was no difference between adenoviral and streptococcal groups in the measurement of serum CRP, neither in WBC count or the level of ESR. Patients with Gr. A streptococcal tonsillitis were significantly older than those with EB-viral or adenoviral tonsillitis (p < 0.05). Seventy-two percent of patients with adenoviral tonsillitis were under 4 years of age, 70% of the patients with EB-viral tonsillitis were under 6 years of age, whereas 71% of the patients with streptococcal tonsillitis were over 6 years of age. CONCLUSIONS: It is impossible to differentiate the etiology of acute suppurative tonsillitis by laboratory examinations (including serum CRP, peripheral WBC counts and ESR), based on its limited clinical pictures and epidemiological factors. Age was clearly the most important factor in distinguishing between viral and bacterial tonsillitis in children.

Acute Disease↗
PubMedDate not supplied

[Suppurative complications of acute pancreatitis].

BACKGROUND/AIMS: This retrospective study investigated the management of the suppurative complication of acute pancreatitis in our clinic. MATERIALS AND METHODS: A retrospective study was made in the Surgery no. 1 Clinic of Timisoara during the period of 6 years (1996-2001) and on the subject of the acute pancreatitis with suppurative complications. RESULTS: As a result the study found a number of 16 cases of suppurative complications out of a total number of 224 acute pancreatitis (7.14%). The acute pancreatitis with suppurative complications was most frequent of biliary etiology (56.2%). All suppurations have occurred on serious necrotizing hemorrhagic acute pancreatitis background. The major elements that contributed to determining the diagnosis were: systemic toxicity, the permanent sepsis, the association of multiple organ failure, but the element that provided certainty in the diagnosis was the computed tomography (CT scan). The surgical mortality was 18.7%. CONCLUSIONS: The acute pancreatitis that evolves unfavorable under medical treatment must be operated. Necrotic tissues and purulent collections must be evacuated and drained efficiently. Open drainage through laparotomy lowered postoperative mortality. The early surgical intervention had a favorable effect on the prognostic.

Abscess↗
PubMed2006

[Evaluation of eustachian tube function with impedance audiometry in chronic suppurative otitis media].

OBJECTIVE: To evaluate the Eustachian tube function with impedance audiometry of the various types, durations and status of chronic suppurative otitis media. METHOD: The Eustachian tube functions of 368 patients (402 ears) of chronic suppurative otitis media were measured by the manual model of reading meter and regulating air pressure with impedance audiometry. The data were analysed statistically. RESULT: The average positive opening pressure of Eustachian tube was (23.5-8.3) daPa in expedite status, (79.8+/-16.2) daPa in mild obstruction, (154.1+/-28.7) daPa in serious obstruction and >200 daPa in entire obstruction. The percentage of detection was 50.5% in expedite status, 26.9% in mild obstruction, 11.9% in serious obstruction and 10.7% in entire obstruction, which in expedite status was much higher than that in various types of Eustachian tube obstruction status. However, the incidence of Eustachian tube opening in the cases with duration of 3 month-1 year was significantly lower than that in the cases with other durations. The opening pressure of Eustachian tube in the cases with large perforation of tense part of tympanic membrane was significantly lower than that in the cases with small perforation of tense part of tympanic membrane and perforation of flaccid part of tympanic membrane. Nevertheless, the incidence of Eustachian tube obstruction in the cases with large perforation of tense part of tympanic membrane was significantly lower than that in the cases with small perforation of tense part of tympanic membrane and perforation of flaccid part of tympanic membrane. CONCLUSION: The Eustachian tube was expedite in about 1/2 of cases with chronic suppurative otitis media, mild obstruction in about 1/4 quarter of cases, and serious obstruction and entire obstruction in about 1/10 of cases respectively. The Eustachian tube function was related to the duration, type and location of tympanic perforation in chronic suppurative otitis media. It is a simple, invasion-free method to evaluate the Eustachian tube function of chronic suppurative otitis media with impedance audiometry.

Acoustic Impedance Tests↗
PubMed1980

The respective roles of gallium 67 citrate scanning and diagnostic ultrasound in detecting suppurations in renal allograft recipients.

The authors report their experiments relative to the advantage of using gallium 67 scanning in the diagnosis of suppurative lesions in renal allograft recipients. Nineteen cases suggesting abscess were analyzed. In 7 cases in which abnormal isotope uptake was noted, a suppuration was detected in the area where the gallium 67 had accumulated. In 2 cases, the abnormal image corresponded to the location of a healing drained abscess, and, in 1 case of pathological uptake at the level of the graft, it was determined that the cause was chronic rejection without suppurative lesion. In 9 cases in which no abnormal focus of uptake was noted, the symptomatology suggesting abscess was eventually attributed to nonsuppurative causes (rejection, urinary fistula, etc.). It is concluded that gallium 67 scanning is a useful means of detecting suppurations in immunodepressed patients undergoing treatment with steroids which prevent the usual signs of suppuration from appearing. Generally, it can be said that diagnostic ultrasound, performed with respect to the area of abnormal gallium 67 uptake, permits optimum determination of the possibilities of an abscess existing.

Adolescent↗
PubMed1991

Case report 662. Bilateral avascular necrosis of femur, with supervening suppurative arthritis of right hip.

We present a case of suppurative arthritis occurring in a patient with bilateral osteonecrosis of the femoral head. Predisposing factors were chronic alcoholism (osteonecrosis) and septicemia due to intravenous drug abuse (suppurative arthritis). Although the association of suppurative arthritis and osteonecrosis is rarely reported in the literature, the prevalence of osteonecrosis and of various factors predisposing to the development of suppurative arthritis should remind us of the possibility that a patient with osteonecrosis who develops sudden worsening of joint pain or fever may have developed suppurative arthritis of the affected joint, particularly when there is evidence of bone destruction.

Arthritis, Infectious↗
PubMed1999

Neonatal suppurative parotitis: a study of five cases.

UNLABELLED: Suppurative parotitis is uncommon in newborns. During a 9-year study period, five cases of neonatal suppurative parotitis were detected in 3,624 hospital admissions. The relative risk of developing neonatal suppurative parotitis in admitted infants was 5.52 (0.62-49.35). Staphylococcus aureus was the causative organism most commonly detected in the hospital-acquired cases. Antimicrobial therapy was effective in all cases; surgery was not required. CONCLUSION: Although neonatal suppurative parotitis is now uncommon in the newborn, it cannot be considered a "vanishing disease".

Cross Infection↗