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PubMed1976

Intrathoracic presentation of amebic liver abscess.

Amebic infection is endemic in tropical and subtropical countries and still remains a common cause of chronic morbidity in these areas. This is a report of 10 patients with different intrathoracic presentations of amebic liver abscess who were treated surgically after conservative measures had failed. Five of these patients had empyema when first seen, 3 had lung abscess, and 1 had intrathoracic shadow that proved on exploration to be an amebic liver abscess. All of these 9 patients had abscesses on the right side secondary to amebic liver abscess of the right lobe of the liver. The tenth patient had amebic pericarditis secondary to amebic abscess of the left lobe of the liver. Failure of conservative treatment in these patients is attributed to the thick nature of the amebic pus and the severe reaction of the pleura and pericardium to the amebic infection. To avoid the serious complication of pleuropulmonary amebiasis, early operation is advised for large liver abscesses that are unlikely to be controlled by conservative treatment. Transpleural drainage of such abscesses gives direct approach to their sites, which are commonly located in the superior part of the right lobe of the liver. Such drainage has proved to be safe provided that the patient is receiving antiamebic drug treatment.

Adolescent↗
PubMed2002

Biodistribution of long-circulating PEG-liposomes in a murine model of established subcutaneous abscesses.

The biodistribution of long-circulating PEG-liposomes in a subcutaneous mouse model of established mixed infection abscesses was investigated to assess their possible role as drug carriers in the treatment of small, undrainable intra-abdominal abscesses. There was a 10-30-fold greater localisation of (67)Ga-labelled PEG-liposomes in abscesses compared to uninfected normal skin samples. Over 3% of the injected dose (ID) of liposomes was present in the abscesses 24 h after liposome administration in contrast to 0.1% in normal skin sections. The percentage ID present in the liver, spleen and kidneys was 17%, 4% and 2% per organ respectively. Five days after liposome injection, 2% ID could still be recovered from the abscesses. Using colloidal gold-labelled PEG-liposomes, it was shown that there was a 4-fold greater density of liposome clusters in the subcutaneous tissue surrounding the capsule than in the core of the abscesses. The clusters within the abscesses were distributed evenly. We conclude that PEG-liposomes localise to a significant degree at the infection focus in our mouse model and may provide a new approach to the antimicrobial treatment of intra-abdominal abscesses.

Abdominal Abscess↗
PubMed1986

The diagnosis of aortic root abscess by cross-sectional echocardiography.

Aortic root abscess is frequently a lethal complication of infective endocarditis. Early diagnosis of this complication is of paramount importance because antibiotic therapy is often ineffective and early surgery is probably the treatment of choice. We have compared the diagnostic accuracy of cross-sectional echocardiography with operative findings in the diagnosis of aortic root abscess. Aortic root abscess was diagnosed in nine of 129 patients with infective endocarditis at the National Heart Hospital between 1983 and 1985. Cross-sectional echocardiography demonstrated the presence and location of the aortic root abscess in eight cases; in the ninth case a small abscess was missed. In two other cases, a large abscess was visualised, but abscesses of between 2 mm and 4 mm were missed; the extent and size of large aortic abscesses tended to be underestimated. Echocardiography should be an integral part of the investigation of patients with aortic valve infective endocarditis.

Abscess↗
PubMed2000

Non-surgical treatment of biliary liver abscesses: efficacy of endoscopic drainage and local antibiotic lavage with nasobiliary catheter.

BACKGROUND: It is universally recognized that the most frequent cause of hepatic abscess is biliary disease. The aim of this study was to determine the efficacy of endoscopic drainage and local antibiotic lavage via nasobiliary catheter in the treatment of liver abscesses of biliary origin. METHOD: From January 1994 to December 1995, twenty-two cases of pyogenic liver abscess were treated. Diagnosis was established with ultrasound, computed tomography, endoscopic retrograde cholangiography, and laboratory tests. All patients were assigned prospectively to endoscopic or other non-surgical forms of therapy, depending on the etiology of the pyogenic process. Patients in whom this treatment failed underwent surgical drainage. Twenty patients had hepatic abscesses of biliary origin. In this subgroup, a nasobiliary catheter was placed into the biliary tree for continuous antibiotic lavage (infusion technique: 1 to 1.5 mL/min for 8 to 10 days) after endoscopic sphincterotomy. Two patients had hepatic abscesses of hematogenous and amebic origin, respectively. They were treated only with the appropriate systemic antibiotics. RESULTS: Nineteen patients of the biliary subgroup (95%) and the two patients with non-biliary disease (100%) had complete resolution of the abscesses. "Salvage" surgical drainage was required in only one patient (4.5%). There was no treatment related mortality. CONCLUSION: Endoscopic sphincterotomy and local antibiotic lavage via an endoscopically placed nasobiliary catheter is a safe and effective treatment for biliary liver abscesses. It should be considered as first-line treatment in this subgroup of patients with liver abscesses. Percutaneous or surgical drainage modalities should be reserved for patients in whom endoscopic treatment fails.

Aged↗
PubMed2000

Endoscopic transpapillary drainage of pancreatic abscess: technique and results.

BACKGROUND: Pancreatic abscess is one of the serious complications of acute pancreatitis. Traditionally, pancreatic abscess has been treated by operative drainage. Based on experience with endoscopic transpapillary drainage of pseudocysts, a similar technique was used in patients with pancreatic abscess. METHOD: Patients were evaluated by endoscopic retrograde cholangiopancreatography. In those with pancreatic abscess communicating with the main pancreatic duct, pancreatic sphincterotomy, saline irrigation of the abscess cavity, and catheter dilation followed by 10F pancreatic stent placement were done. Instillation of gentamicin and nasopancreatic catheter drainage were used in difficult cases. RESULTS: Of 22 patients with pancreatic abscess, 11 underwent endoscopic transpapillary drainage with technical success in 10 patients (90%); 8 patients (74%) had resolution of pancreatic abscess, clinically and radiographically. Intracavitary instillation of gentamicin and nasopancreatic catheter drainage were used in 2 patients. Two patients in whom endoscopic transpapillary drainage failed underwent operative drainage with a favorable outcome, and the one patient in whom endoscopic treatment was technically unsuccessful underwent successful percutaneous drainage. One patient had mild pancreatitis. CONCLUSION: Endoscopic transpapillary drainage is an effective nonoperative therapy for selected cases of pancreatic abscess and is associated with minimal morbidity and no mortality.

Abdominal Abscess↗
PubMed1997

Diagnostic and staged stereotactic aspiration of multiple bihemispheric pyogenic brain abscesses.

BACKGROUND: Empiric antibiotic therapy for multiple brain abscesses is not advised, as biopsy to rule out other causes and material for cultures can be obtained with minimal morbidity using computed tomography (CT)-guided stereotaxy. METHODS: We report a good outcome following treatment of this 60-year-old nonimmunocompromised patient with six pyogenic cerebral abscesses. CT-guided stereotactic aspiration of two abscesses were done on the first occasion and appropriate antibiotics were administered. Serial CT scans were done and the abscesses that recollected or enlarged were again aspirated. RESULTS: Group A beta hemolytic streptococci were grown from the pus. Two abscesses recollected and one enlarged during antibiotic therapy. These were aspirated on the second and third occasions, 1 week and 2 weeks after the first procedure. The abscess less than 3 cm resolved with antibiotics alone. Intravenous crystalline penicillin, chloroamphenicol, and metronidazole were given for 2 weeks followed by oral ampicillin and cotrimoxazole for 10 weeks. There was no morbidity related to the multiple procedures and the patient had a good outcome at the end of 16 weeks. CONCLUSIONS: CT-guided stereotactic aspiration of multiple brain abscesses is known to have a low morbidity and mortality. We highlight the additional option of multiple, staged aspirations for those abscesses not readily responding to antibiotic therapy.

Brain Abscess↗
PubMed1999

Spinal epidural abscess: contemporary trends in etiology, evaluation, and management.

BACKGROUND: Despite advances in neuroimaging and neurosurgical treatment, spinal epidural abscess remains a challenging problem; early diagnosis is often difficult and treatment is delayed. Optimal management is unclear, and morbidity and mortality are significant. To define contemporary trends in etiology and management, and establish diagnostic and therapeutic guidelines, we reviewed our 10-year experience with spinal epidural abscess. METHODS: We examined medical records, laboratory data, radiological (CT and MRI) studies, and operative reports from 75 cases of spinal epidural abscess between 1983 and 1992. Demographic characteristics, frequency, clinical features, pathogens, risk factors, surgical and medical treatment, and outcome were analyzed. RESULTS: We found a significant increase in the frequency of spinal epidural abscess over the 10-year period (p-value = 0.0195). Intravenous drug abuse was present in 28 patients (33%), diabetes mellitus in 22 patients (27%), and prior spinal surgery in 11 patients (17%). Back pain, progressive neurologic deficit, and low grade fever remained the distinguishing diagnostic features. Erythrocyte sedimentation rate was elevated in 48 of 50 patients (95%); peripheral leukocyte count was elevated in 45 patients (60%). MRI was the most effective technique for diagnosing spinal epidural abscess, revealing or suggesting the diagnosis in all 59 patients (100%) studied. Sites of spinal epidural abscess were equally distributed along the spinal axis. Staphylococcus aureus was the predominant organism (67% of patients, with 15% having a methicillin-resistant strain); 8% of patients had Streptococcal species. Most patients had open surgical drainage followed by prolonged antibiotic treatment; 22 patients were managed with antibiotics alone; 50 patients (66%) had a good clinical outcome after treatment. Multiple medical problems, prior spinal surgery, and methicillin-resistant Staphylococci were correlated with a significantly worse outcome. CONCLUSIONS: The frequency of diagnosis of spinal epidural abscess is increasing. To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such abscesses or who have an increased erythrocyte sedimentation rate and/or neurologic deficit should have an immediate MRI scan with contrast enhancement. Surgical drainage and prolonged antibiotic use are the cornerstones of treatment, although selected patients may be treated conservatively.

Abscess↗
PubMed1999

Stereotactic surgery in the management of brain abscess.

BACKGROUND: Bacterial brain abscesses can be diagnosed and treated with stereotactic aspiration. METHODS: From 1991 to 1997 we have used computed tomography-guided stereotactic aspiration to diagnose and treat 21 patients with a total of 58 bacterial brain abscesses. The ages of the patients ranged from 4 to 72 years (median 25 years); 11 of these 21 patients had multiple abscesses. The number of abscesses per patient with multiple abscesses ranged from 2 to 9, all located deep in subcortical white matter. RESULTS: All patients underwent stereotactic surgical drainage and an 8-week intravenous antibiotic medical treatment. Of the 58 abscesses, 23 were aspirated. Of these 23 abscesses, 19 were radiologically stage III or IV and four were stage I or II. Pathological examination confirmed radiological staging in 19 patients (83%). Except for the three patients who have mild residual hemiparesis and one patient recovering from ataxia, all patients had complete neurological recovery. CONCLUSIONS: Computed tomography-guided stereotaxy achieved all the objectives of management; namely, ascertaining the diagnosis, draining the content of the mass, and obtaining pus for accurate bacteriological diagnosis without morbidity. Stereotactic aspiration combined with an 8-week intravenous antibiotic regimen has yielded an effective therapeutic result in all of our abscesses, small or large, solitary or multiple, superficial or deep-seated. A high radiological-pathological correlation was also deduced from this study.

Adolescent↗
PubMed2001

Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning.

OBJECTIVES: To examine retrospectively the clinical presentations, microbiologic characteristics, and treatment outcomes of psoas abscess in patients with diabetes mellitus (DM) and to assess the usefulness of computed tomography and gallium-67 scanning in its early diagnosis. METHODS: During a 9-year period, psoas abscesses in patients with DM were collected at a medical center. The clinical history and associated etiologic factors, microbiologic results, clinical outcomes, and hospitalization days were recorded. The use of imaging in the diagnosis of psoas abscess and other concomitant infectious lesions was also studied. RESULTS: Fifteen patients with DM and psoas abscess (13 women and 2 men; mean age 58.7 +/- 9.0 years) were found. The most frequent symptom was fever (12 of 15). Of the six different microorganisms that grew in the blood and/or abscess cultures, Staphylococcus aureus was the most frequent (7 of 15). The most commonly associated pathologic finding was vertebral osteomyelitis (5 of 15). Computed tomography and/or magnetic resonance imaging confirmed the diagnosis of psoas abscesses in all 15 patients. The gallium-67 scan especially aided in the diagnosis of the patients who had initially been diagnosed as having fever of unknown origin (4 of 5) and in the diagnosis of concomitant lesions (9 of 12). Debridement or surgical drainage of the abscess was done in 12 patients. All the patients received adequate antibiotic treatment. However, the mortality rate was 20%. The average hospitalization stay was 42.7 +/- 20.7 days. CONCLUSIONS: Psoas abscess in patients with DM is a disease with both diagnostic and therapeutic challenges. We found the infecting microorganisms to be variable and the mortality rate high.

Adult↗
PubMed2004

[Renal abscess perforated into the thorax].

OBJECTIVE: To present a case of secondary renal abscess to a xanthogranulomatosis pyelonephritis with perforation to chest that required nephrectomy and decortication left pleural. METHODS AND RESULTS: Patient feminine of 38 years that present infections from the tract urinary secondary to kidney lithiasis that evolve to a kidney abscess that you perforates to chest where you forms an abscess. It was treated with nephrectomy and drainage of chest abscess by chest tube, and later decortication, with good evolution. CONCLUSIONS: The kidney abscess and/or xanthogranulomatosis pyelonephritis are the result of a lithiasis not treated obstruction that conditions to the appearance of urinary infection and posterior pyonephrosis and or kidney abscess. The not early detection of the kidney abscess conditions to the perforation to retroperitoneal, intra-abdominal and to chest. The early treatment of the abscess (antibiotics and percutaneous drainage) it can avoid the nephrectomy.

Abscess↗
PubMedDate not supplied

Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure.

AIM: The rate of liver abscesses after radiofrequency ablation (RFA) of liver tumors is probably high in patients with a biliary tract drainage procedure connecting the biliary duct system to the upper gastrointestinal tract. And yet, to date this rate, the time of onset of these abscesses, and the prior status of the bile ducts have never been reported in the literature. METHODS: Among 574 patients treated with RFA over 8 years, only 11 patients (with 13 sessions of RFA, 2 patients undergoing two different RFA sessions) presented with an enterobiliary anastomosis or biliary stenting at the time of RFA. This is a retrospective study of patients who were verified prospectively. RESULTS: Among the 9 patients in whom a biliary tract procedure preceded RFA, 4 developed a liver abscess at the site of RFA, which emerged between 13 and 62 days after RFA. It occurred in spite of different types of short-term antibiotic prophylaxis. Pathogenic bacteria were typical of the digestive flora. Abscesses were cured after percutaneous drainage. No abscess occurred among the 4 patients in whom a biliary tract diversion was performed synchronously with RFA. CONCLUSION: When RFA is performed in a patient with a preexisting biliary diversion, the risk of developing a liver abscess is high. Currently, we are unable to recommend any kind of preventive antibiotherapy. A preexisting biliary diversion is not an absolute contraindication for RFA, but the risk of developing a liver abscess is close to 40-50%. When RFA is performed synchronously with a biliary diversion, the risk of a liver abscess seems to disappear.

Anti-Bacterial Agents↗
PubMed1999

Extra- and intracellular accumulation of ultrasmall superparamagnetic iron oxides (USPIO) in experimentally induced abscesses of the peripheral soft tissues and their effects on magnetic resonance imaging.

UNLABELLED: The effects of ultrasmall superparamagnetic iron oxide (USPIO) particles on magnetic resonance imaging (MRI) were studied in an animal abscess model and the findings compared with microscopic sections of the abscesses. Staphylogenic abscesses of the right hind leg were induced in six Sprague-Dawley rats. The USPIO particles consisted of polyethylene-glycol-coated Fe3O4 with a mean size of 26 nm and were injected intravenously (i.v.), with three animals receiving a dose of 50 micromol/kg and three animals a dose of 150 micromol/kg. Before and immediately after i.v. administration of the particles, MR data were acquired with fast gradient-echo technique FLASH sequences applied over a period of 60 min. The Fe3O4-induced signal changes were registered in regions of interest (ROIs) placed over the margin and center of the abscess, over the perifocal granulation tissue and over corresponding sites of the contralateral healthy muscle. Microscopic sections were prepared using the conventional paraffin technique and, in part, a kryohistologic method before staining of the specimen with hematoxylin and Berlin-blue reaction. In addition to the mostly perfusion dependent loss of signal intensity within 8 s after injection, a signal reduction, which could be rather pronounced, was observed in the abscess margin and perifocal granulation tissue, with the underlying mechanism mainly attributed to extravasation and predominantly extracellular deposition of Fe3O4. CONCLUSION: The USPIO particles used in this study lead to a prolonged demarcation of abscesses in the peripheral soft tissues due to particle extravasation and accumulation in the periphery of the abscesses. Besides the known accumulation of already characterized USPIO in the RES of liver, spleen and lymph nodes the study could demonstrate ultrasmall iron oxide deposition (BY 818) in abscesses of the peripheral soft tissue.

Abscess↗
PubMed1997

Renal and perirenal abscesses.

Our knowledge of the spectrum of renal abscesses has evolved as a result of more sensitive radiologic techniques. The classification of intrarenal abscesses currently includes acute focal bacterial nephritis, acute multifocal bacterial nephritis, renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. The clinical presentation of these entities does not differentiate them, however, and various radiographic studies are helpful in making the diagnosis. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy, in addition to antibiotic therapy, are required for resolution.

Abscess↗
PubMed2006

Otogenic brain abscess: management by otologist.

INTRODUCTION: Fifty per cent of brain abscesses in adults and 25 per cent of those in children are otogenic in origin. The current neurosurgical options are to drain the abscess repeatedly through burr holes or to excise it completely with the capsule. We successfully managed 10 cases of brain abscess by draining through the transmastoid route. The technique and its advantages are discussed. MATERIAL AND METHODS: The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route. RESULTS: In eight cases, ear disease and brain abscess were treated in a single-stage procedure. In the remaining two cases, residual brain abscess was excised subsequently by our neurosurgical colleagues. CONCLUSIONS: Transmastoid drainage of pus can successfully treat mastoid disease and brain abscess in a single surgical intervention. Residual abscess can be subsequently excised, with relatively reduced morbidity. Repeated needling is also avoided with this approach. Diffusion-weighted imaging and proton magnetic resonance spectroscopy are helpful.

Brain Abscess↗
PubMed1996

Stereotactic management of bacterial brain abscesses.

BACKGROUND: CT and MR guided stereotactic techniques have provided promising results in the management of brain abscesses. We reviewed our results of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993. METHODS: 13 abscesses were in the cerebral hemispheres, 12 in the cerebellum, 2 in the pons and 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, were on antibiotics for less than 7 weeks. RESULTS: Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 patients had an excellent recovery with 3 patients having a persistent mild neurologic disability. Stereotactic aspiration of the largest lesion in the patients with multiple brain abscesses combined with intravenous antibiotic therapy was sufficient for the resolution of all lesions. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening. CONCLUSION: Stereotactic aspiration is safe, accurate, and when combined with the appropriate antibiotics, should be considered the procedure of choice in the management of brain abscesses.

Adult↗
PubMed1998

Disseminated aseptic abscesses associated with Crohn's disease: a new entity?

Our purpose is to describe seven cases of disseminated aseptic abscesses with regard to clinical, biological, radiological, and histological information, treatment, and outcome. Data were collected on seven Caucasian patients who had proven sterile deep abscesses diagnosed in French university hospitals. The onset of the disease related to abscesses began at times from June 1988 to August 1994. Follow-up periods were 1 year, 7 months to 8 years, 2 months. The age of the patients ranged from 15 to 26 years old. At onset, all had fever and six had abdominal pain. Abscesses involved spleen and abdominal lymph nodes in six cases; liver in three; pancreas, brain, and chest in one. All had polymorphonuclear leukocytosis. Pathological examination showed granulomatous abscesses. Direct and indirect investigations failed to identify any causal microorganism. On six occasions, Crohn's disease was revealed 1 to 41 months later and in one case, it preceded the onset of abscesses. One subsequently developed Sweet's syndrome. Various antibiotic regimes were inefficient. Steroids, associated in three cases with immunosuppressive agents, resulted in a rapid improvement in six patients. In one case, splenectomy followed by 5-ASA therapy was used successfully. The dramatic effectiveness of steroids and immunosuppressive agents as well as follow-up suggest that disseminated aseptic abscesses might be an extraintestinal manifestation of Crohn's disease. Although the pathogenesis of this condition remains unknown, this entity may be related to neutrophilic dermatosis in which sterile deep abscesses have been reported.

Abdominal Abscess↗
PubMed1999

[Diagnosis and treatment of brain abscesses].

The etiologic pathogens of brain abscesses vary depending on the underlying disease. Aerobic and anaerobic bacteria are frequently involved simultaneously. In most cases, the clinical course is subacute. C-reactive protein is the most sensitive inflammatory parameter in the blood. It is elevated in 80 to 90% of all cases. The diagnosis is made by cranial computer tomography without and with contrast enhancement. The rapid culture of pus from the abscess cavity is crucial for the identification of the pathogen. Antibiotic therapy alone is indicated 1. in the presence of multiple, small and/or deep-seated abscesses or 2. when the general condition of the patient does not allow surgery at an acceptable risk or 3. in early cerebritis without capsule formation. Frequently used surgical procedures are abscess aspiration (usually by stereotaxic surgery), open craniotomy and excision of the abscess with the capsule, and open evacuation of the abscess cavity. For empirical treatment the combination of cefotaxime (3 x 2-4 g/d i.v.) plus metronidazol (3-4 x 0.5 g/d i.v.) is preferred. Corticosteroids are indicated in the presence of a space-occupying effect and imminent brain herniation, or of multiple abscesses and abscesses in critical brain regions such as in the cerebellum.

Anti-Bacterial Agents↗
PubMed1999

Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.

We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.

Adult↗