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PubMed1980

Frontal sinus fractures--their suppurative complications and surgical management.

A series of 54 patients treated for frontal sinus fractures at Charity Hospital, New Orleans, from 1967-77 is presented. There were a large number of suppurative complications related to the various medical and surgical managements. Initial treatments included: observation (15), exploration and open reduction (22), obliteration (16), and ablation (1). Four patients with open fractures were not explored and developed recurrent frontal sinusitis; one progressed to an osteomyelitis. Two with posterior table fractures were not explored and developed meningitis (one was then obliterated and developed an epidural abscess). Three patients developed frontal sinus abscesses after obliterations for anterior wall fractures. Fat gave fewer complications than the other commonly used materials. Exploration is advocated for most frontal sinus fractures. Obliteration should be avoided when possible. Fat is the material of choice when obliteration is required.

Adolescent↗
PubMed1989

Preoperative therapeutic considerations in chronic suppurative otitis media.

The present randomized, prospective study of 119 cases of chronic suppurative otitis media compares the effectiveness of inexpensive, atoxic, nonallergenic disinfectants applied locally, to that of a number of occasionally toxic antimicrobial chemotherapeutic agents, administered systemically. Systemic treatment resulted in a cure rate of 53.5% (SEp = 5.9%) while ototopical treatment resulted in a 39.5% cure rate (SEp = 7%). Eradication of pathogens or colonization by a nonpathogen occurred in 50.7% (SEp = 5.9%) with systemic treatment, and in 39.5% (SEp = 7%) with ototopical treatment. Bacteriological modification was 2.5 times more frequent with systemic treatment than with ototopical treatment. No recurrences were noted with ototopical treatment, while 13% to 36% recurrence rates were noted in various subgroups of cases treated systemically. Cure rates achieved with particular drug regimens (administration based on sensitivity tests in vitro) were: Azactam 25% (5%-57% confidence limits), sulfamethoxazole plus trimethoprim 58.6% (38%-76%), ciprofloxacin 87.5% (47%-99%), ciprofloxacin plus metronidazole 90% (55%-99%). Cure rates with other drugs were inconclusive because of the limited number of observations.

Adolescent↗
PubMed1988

Suppurative mediastinitis after open heart surgery. A case control study of risk factors.

Suppurative mediastinitis occurred in 68 of 9,965 patients (0.7 percent) who underwent median sternotomy at Emory University Hospital from 1973 through 1982. Case-control methodology was used to identify preoperative, intraoperative, and postoperative risk factors for the development of poststernotomy mediastinitis. The following 12 individually significant risk factors were identified by univariate analysis: preoperative factors: history of chronic obstructive pulmonary disease (COPD), history of prior sternotomy, pyuria, low ejection fraction, and high left ventricular end-diastolic pressure; intraoperative factors: valvular or aortic aneurysm surgery, prolonged bypass pump time, repeat placement on bypass, duration of surgery; and postoperative factors: surgical reexploration due to postoperative hemorrhage, cardiopulmonary resuscitation in the immediate postoperative period, prolonged time (greater than 48 hours) on mechanical ventilation. By logistic regression analysis, three of these factors were found to be associated independently with increased odds of developing mediastinitis: duration of surgery, history of COPD, and prolonged postoperative mechanical ventilation.

Adult↗
PubMed1996

Branchial pouch sinus tract from the piriform fossa causing acute suppurative thyroiditis, neck abscess, or both: CT appearance and the use of air as a contrast agent.

OBJECTIVE: Our objective was to describe the CT appearance of acute suppurative thyroiditis and neck abscess associated with a congenital sinus tract arising from the piriform fossa. In addition, we describe our observations on the use of air as a contrast agent during CT of the pharynx. CONCLUSION: The thyroid is extremely resistant to acute bacterial infection; hence, when such an infection does occur, an underlying anomaly of the thyroid should be suspected, particularly when the infection is recurrent. In such a case, sonography or CT must be used to confirm the diagnosis of acute thyroiditis, neck abscess, or both. Then the sinus tract must be revealed by barium esophagography, CT scanning that use air as a contrast agent, or endoscopy.

Abscess↗
PubMedDate not supplied

Aerobic and anaerobic bacteria in chronic suppurative otitis media. A quantitative study.

The aerobic and anaerobic bacterial flora of middle ear exudate (MEE) of 47 consecutive patients with chronic suppurative otitis media were studied using a quantitative bacteriological technique under strictly anaerobic conditions. Specimens from the external auditory canal (EAC) and the nasopharynx (NP) were obtained in order to correlate the bacterial findings with those of the MEE. Aerobic bacteria were invariably present in the MEE, the predominant aerobic species being Pseudomonas, found in 32%. Anaerobic bacteria were found in 45%: most anaerobes (55%) were cocci, 33% were of the Bacteroides species. The flora of the MEE correlated well with the bacteriological findings in the EAC cultures. In contrast, most organisms isolated from the NP represented the normal skin flora or were common respiratory pathogens.

Adolescent↗
PubMed1992

Opsonization of middle ear bacteria during chronic suppurative and secretory otitis media.

Samples of middle ear effusion were obtained from 16 patients with chronic suppurative otitis media (COM) (20 ears, age range from 1 1/12 to 69 years) and 13 patients with secretory otitis media (SOM) (15 years, age range from 8 months to 13 8/12 years). Qualitative and quantitative bacteriological analyses of the effusions were performed and the intensity of immunoglobulin G (IgG) and complement component C3b adhering to the bacteria was estimated using immunofluorescence technique. In COM effusions, S. aureus in particular was intensely opsonized, whereas Ps. aeruginosa showed minimal, if any, coating with IgG and C3b. SOM effusions exhibited extremely sparse IgG- and C3b-coated bacteria. The difference in IgG and C3b coated bacteria between COM and SOM effusions was significant (p less than 0.01). Specific (IgG) as well as non-specific (C3b) coating of the bacteria that have gained access to the middle ear cavity is of importance for the host defence.

Adolescent↗
PubMed1986

Suppurative Staphylococcus aureus thyroiditis.

Suppurative thyroiditis with septicaemia caused by Staphylococcus aureus in a 65-year-old male patient with diabetes mellitus was diagnosed by needle aspiration. Antibiotic treatment and surgical drainage cured the patient.

Aged↗
PubMed1994

Acute suppurative thyroiditis: a ten-year review in a Taiwanese hospital.

12 patients with acute suppurative thyroiditis were treated over a 10-year period. Their ages ranged from 2-81 years. Eight of them had a pre-existing thyroid mass. A piriform sinus fistula was demonstrated in one of the 2 patients with a history of recurrent infections. Cultures of the pus taken from the infected glands grew Gram-positive streptococci in 4 patients, Gram-negative bacteria in 4, and anaerobic bacteria in 1; the other 3 were sterile. Both patients who grew Klebsiella pneumonia were diabetic. Most of the patients received drainage in addition to systemic antibiotics. Only 2 patients had recurrence during the follow-up period. We present a review of our experience with this uncommon infection.

Acute Disease↗
PubMed1992

[The quantitation of Pseudomonas aeruginosa elastase in suppurative chronic otitis media using a sensitive ELISA method].

A sensitive sandwich ELISA method has been developed in order to quantitate the Pseudomonas aeruginosa elastase (PE) of ear discharge from chronic suppurative otitis media (CSOM) patients. Samples were incubated with EDTA-2Na before ELISA in order to inhibit the PE activity which hydrolyzes anti-PE IgG antibody into smaller molecular fragments. Quantitation of PE in middle ear effusions (MEE) from 10 patients with chronic otitis media with effusion (OME) were also performed. In CSOM, 12 of 14 samples revealed a significant amount of PE from 0.6 microliter/ml to 62.1 microliters/ml, which was significantly higher than those in MEE (p less than 0.05). In MEE, 8 of 10 samples were under the detection limit. Two samples in CSOM with Pseudomonas aeruginosa infection had high levels of PE. The quantitation was linear, with a concentration from 5 ng PE/sample to 500 ng PE/sample. This ELISA system is a sensitive method for quantitation of PE requiring only very small samples.

Adolescent↗
PubMed1998

Benign superior vena cava syndrome due to suppurative mediastinal lymphadenitis: anterior mediastinoscopic management.

The benign superior vena cava syndrome is an uncommon medical emergency. We describe a case of the superior vena cava syndrome caused by suppurative mediastinal lymphadenitis. The organisms isolated from various cultures were group C beta-hemolytic Streptococcus, Fusobacterium species, Corynebacterium species, Eikenella corrodens, and Streptococcus milleri. These anaerobic bacteria are part of the normal flora of the upper respiratory tract and the oral cavity. Anterior mediastinoscopy through the right parasternal approach was used to drain the anterior mediastinal abscess and to establish the etiologic factor.

Adult↗
PubMed2004

[Acute suppurative thyroiditis. Report of a pediatric case].

Acute suppurative thyroiditis (AST) is an uncommon condition because thyroid gland is remarkably resistant to infections. In children, anatomic defects such as a left pyriform sinus fistula or a thyroglossal duct remnant predispose to this infection. Once the diagnosis is confirmed by ultrasound or computed tomography, antimicrobial therapy based on the culture and Gram staining must be started. After two or three weeks of treatment, predisposing anatomic defects must be sought cautiously. We report a 13 year old girl presenting with cervical pain and fever. A cervical ultrasound showed an enlarged thyroid lobule with hypoecogenic zones that suggested a supurative collection. Cefotaxime and cloxacillin were started. A needle aspiration of the collection obtained a purulent material. The culture of this material yielded a Streptococcus Pneumoniae. The clinical condition of the patient improved and she was discharged in good conditions. Two months later a contrast esophagus X ray did not show predisposing anatomic defects.

Acute Disease↗
PubMed2003

Intention-to-treat analysis in the chronic suppurative otitis media trials.

OBJECTIVE: To determine the extent of application of the intention to treat principle in the chronic suppurative otitis media (CSOM) randomised controlled trials. DESIGN: Data were extracted from 28 CSOM randomised controlled trials. MAIN OUTCOME MEASURES: Conceptual and methodological approaches of dealing with protocol deviations with respect to withdrawal, missing response and non-compliance. RESULTS: Of the 28 CSOM trials included in this study, only one (4%) trial mentioned intention-to-treat (ITT) analysis. However, 10(36%) other trials which did not mention ITT, had no protocol deviations and thus carried out an ITT analysis by default. It is highly likely that a biased treatment effect existed in the trial that mentioned ITT since the authors undertook a complete case analysis disregarding the 22% protocol deviators. There were no attempts in any of the trials to impute for missing responses and carrying out a sensitivity analysis. For trials with a big percentage of protocol deviations, the validity of their results are brought to question. CONCLUSIONS: In practice, not all those entered into a randomised-controlled trial will complete the trial. Thus intention-to-treat analysis is an important aspect of randomised controlled trials of health care interventions which tries to bridge this gap. It is important for authors to explicitly state the protocol deviations, the methods used to handle them and the potential effect with reference to bias and study outcome.

Data Collection↗
PubMed2006

Chronic suppurative otitis media in Tanzanian school children and its effects on hearing.

OBJECTIVES: To compare different treatment regimens of chronic suppurative otitis media (CSOM) in school children, in regard to their consequence in hearing and discharge from the ear drum perforation. DESIGN: Randomised controlled trial. SETTING: Randomly selected primary schools within Dar es Salaam. SUBJECTS: Three hundred and twenty eight children between 5-17 years of age with CSOM in one or both ears. RESULTS: Three to four months after the onset of treatment 31% of group 1, 54% of group 2, and 56% of group 3, had dry ears. Treatment with dry mopping and boric acid in alcohol ear drops was significantly better than dry mopping alone. Adding amoxicillin to the treatment did not improve the end results. Hearing test performed before and after treatment showed that the hearing thresholds were the same or better after the treatment. The possible risk that boric acid in alcohol ear drops should lead to sensorineural hearing loss has not been confirmed. CONCLUSION: Based on the above results, the treatment of choice for CSOM in children in Dar es Salaam should be dry mopping and boric acid in spirit ear drops.

Adolescent↗
PubMed2003

Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial.

OBJECTIVES: To compare the effectiveness of ototopical ciprofloxacin (0.3%; CIP) with framycetin (0.5%), gramicidin, dexamethasone (FGD) eardrops (5 drops twice daily for 9 days) together with povidone-iodine (0.5%) ear cleaning as treatments for chronic suppurative otitis media (CSOM) in Aboriginal children. DESIGN AND PARTICIPANTS: Aboriginal community-controlled, community-based, multicentre, double-blind, randomised controlled trial in eight Aboriginal Community Controlled Health Services across northern Australia, involving 147 Aboriginal children with CSOM. MAIN OUTCOME MEASURES: Resolution of otorrhoea (clinical cure), proportion of children with healed perforated tympanic membrane (TM) and improved hearing, 10-21 days after starting treatment. RESULTS: 111 children aged 1-14 years (CIP, 55; FGD, 56) completed treatment. CSOM cures occurred in 64% (CIP, 76.4%; FGD, 51.8%), with a significantly higher rate in the ciprofloxacin group (P = 0.009, absolute difference of 24.6% [95% CI, 15.8%-33.4%]). TM perforation size and the level of hearing impairment did not change. Pseudomonas aeruginosa was the most common bacterial pathogen (in 47.6%), while respiratory pathogens were rare (in 5.7%). CONCLUSIONS: Twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Administration, Topical↗
PubMed1999

[Immunological parallels in the use of ultraviolet irradiation of autoblood in patients with suppurative diseases of soft tissue].

Ultraviolet irradiation of autoblood in patients with suppurative diseases of soft tissues increased the titer of specific antibacterial antibodies and the number of antibody-producing cells (APC), which was the most expressed in cases when the erythrocytes and leukocytes were exposed separately. Study of the count of APC during UV exposure showed it to increase 6-8 h after the procedure.

Abscess↗
PubMed1976

[Acute gangrenous cholecystitis with suppurative acute cholangitis in the 1st days of the puerperium].

A 25-year-old secundipara developed acute gangrenous cholecystitis coupled with suppurative cholangitis on the fourth pureperal day. The patient recovered after cholecystectomy and choledochotomy. It is pointed out that cholelithiasis is not rare in pregnancy but acute cholecystitis is very rare, especially in the puerperium. For this reason the diagnosis is difficult, yet the final issue depends on its early establishment and also on the early surgical intervention.

Acute Disease↗
PubMed1975

Tubing, as a treatment for recurrent infant suppurative otitis media.

(1) The details described below have evidenced that the tubing therapy is an influential treatment for the recurrent infant suppurative otitis media. The tube with a beveled head and split shank is very convenient and effective for the treatment since it is not only easily inserted but also easily removed, preventing it from migration into the tympanum. (2) The treatment must promote the drainage of discharges through the infant auditory tubes which are thick and short and improve the ventilation of the middle ear cavity half permanently. (3) According to the author's experience, the spontaneous extrusion of the ideally set tube after 2 or 3 months is a sign of a perfect cure of this disease.

Child, Preschool↗
PubMed1975

[Facial manifestations of suppurative trichophytosis].

Several cases of facial suppurative Trichophytia described by the authors lead to a review of the clinical, mycological and pathological features of this disorder which is on the increase in the region of Nantes.

Animals↗