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At least 595 records · Page 33Linked to original sources
PubMed2003

Abdominal tuberculosis in children.

UNLABELLED: Abdominal tuberculosis (AT) is a rare cause of intraabdominal infection. Surgical intervention is rarely indicated, other than obtaining a specimen for histopathological diagnosis or for the treatment of complications. METHODS: The medical records of 14 patients who were operated on after the diagnosis of AT between 1983 and 2000 were reviewed retrospectively. RESULTS: Median age was 7 years (6 months to 10 years). The presenting clinical signs and symptoms were as follows: colicky abdominal pain (9), weight loss (8), abdominal mass (6), vomiting (5), and night fever (5). Two patients were operated at another centre and referred to our department with faecal fistula and severe malnutrition. Twelve patients were operated on, while diagnostic laparoscopy was performed in two. In uncomplicated cases, surgical intervention was limited to sampling of peritoneal tissue, lymph node and ascites. The reasons for surgical intervention were intestinal obstruction (9), abdominal mass and ascites (6), psoas abscess (1) and intussusception (1). Adhesive peritonitis and ileal loops were the cause of abdominal mass. Necrosis of the bowel (2) and perforation (1) were detected in three patients. The diagnosis was confirmed either by histopathological or microbiological examination. In eight patients, AT was defined at the intestinal mesentery, in three patients it was localised to the peritoneum and in two patients the disease was diffuse. All patients except one with faecal fistula survived and were treated successfully with antituberculous therapy (isoniasid, rifampicin, streptomycin and pyrazinamide combination). CONCLUSION: The diagnosis of AT is difficult before presentation with complications of intraabdominal infection. Since the response to chemotherapy is usually excellent in patients with suspected AT, aggressive surgery should be avoided and initial surgical intervention should be limited to tissue and/or fluid sampling.

Child↗
PubMedDate not supplied

[Spondylodiscitis in childhood].

Spondylodiscitis is a frequently unrecognized disease in childhood because of unspecific symptoms and late arising or radiological signs. The heterogeneous symptoms, the value of diagnostic procedures and the outcome of 8 patients suffering from spondylodiscitis in the time period of 1989 to 1995 are demonstrated. Guiding symptoms were back pain and refusal to walk or sit. Furthermore, abdominal pain and psoas abscess were the only symptoms in two cases. The pathogenomonical narrowing of the disc space arose in X-ray films earliest 3 weeks after onset of symptoms. The MRI was the best method for early diagnosis and detection of complications. In contrast to persistent radiological changes the clinical outcome was good in most of the patients.

Anti-Bacterial Agents↗
PubMed2005

Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients.

BACKGROUND: Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study. METHODS: Patients scheduled to undergo orthopedic surgery performed with a CPNB were prospectively included during 1 yr in a multicenter study. Efficacy of postoperative analgesia, bacteriologic cultures of the catheter, and acute neurologic and infectious adverse events were evaluated after surgery in 1,416 patients at arrival in the postanesthesia care unit, at hour 1, and every 24 h up to day 5. Risk factors for adverse events were determined using logistic regression. RESULTS: The median duration of CPNB was 56 h. Both general anesthesia and CPNB were performed in 73.6% of the patients. Postoperative analgesia was effective in 96.3%, but an increase in pain scores was noted at hour 24 (P = 0.01). Hypoesthesia or numbness occurred in 3% and 2.2%, respectively, and paresthesia occurred in 1.5%. Three neural lesions (0.21%) were noted after continuous femoral nerve block. Two of these patients were anesthetized during block procedure. Nerve damage completely resolved 36 h to 10 weeks later. Cultures from 28.7% of the catheters were positive. Three percent of patients had local inflammatory signs. The bacterial species most frequently found were coagulase-negative staphylococcus (61%) and gram-negative bacillus (21.6%). A Staphylococcus aureus psoas abscess (0.07%) was reported in one diabetic woman. Independent risk factors for paresthesia/dysesthesia were postoperative monitoring in intensive care, age less than 40 yr, and use of bupivacaine. Risk factors for local inflammation/infection were postoperative monitoring in intensive care, catheter duration greater than 48 h, male sex, and absence of antibiotic prophylaxis. CONCLUSION: CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.

Adolescent↗
PubMed1979

Spondylitis caused by Brucella abortus.

A case of severe chronic spondylitis of the lumbar spine caused by Brucella abortus is presented. Infection was probably associated with ingestion of raw cow's milk. A technetium bone scan provided evidence of activity as early as two years before the radiographic abnormalities were evident. Although rarely seen in brucellosis, a large left psoas abscess formed. After extensive resection and debridement of all necrotic tissue, along with prolonged use of oral doxycycline, the patient recovered completely. The clinical, laboratory, therapeutic, and pathogenic aspects of Brucella spondylitis are discussed.

Abscess↗
PubMed1989

Gunshot wounds to the spine associated with a perforated viscus.

The cases of 42 patients with low-velocity gunshot wounds to the spine with an associated perforated viscus were reviewed. All viscus perforations occurred prior to the spinal injury. There were a total of 51 perforations, including 14 of the colon, 15 of the small bowel, 15 of the stomach, five of the esophagus, and two of the pharynx. All patients had significant neurologic deficits, with 23 patients suffering a complete neurologic injury. Average clinical follow-up was 18 months (range: 4-64 months). Only three patients developed documented spinal or paraspinal infections. One case of acute meningitis occurred after an isolated stomach perforation, while two other patients developed psoas abscesses after colon injuries. The roles of initial antibiotic therapy and of early bullet removal were evaluated in regard to infection. An extended course of broad spectrum antibiotics combined with bedrest appeared to significantly reduce the risk of spinal or paraspinal infection as compared with a previous study. Early bullet removal did not appear to be a significant factor in the prevention of infection. Prospective studies are needed to accurately delineate the role of initial antibiotic therapy for the prevention of spinal infection in these injuries.

Adolescent↗
PubMed2006

Recurrent invasive intraductal papillary mucinous carcinoma of the pancreas mimicking pott disease: review of the literature.

Specific information regarding intraductal papillary mucinous neoplasm (IPMN) recurrence is limited because most series are small and the follow-up interval is short. We report an unusual case of cancer recurrence in an 86-year-old woman who had undergone a pancreaticoduodenectomy for a large IPMN in the head of the pancreas. Final pathological evaluation of the resected pancreas found a component of in situ and invasive ductal adenocarcinoma without lymph node involvement. The patient did not receive postoperative chemotherapy and was monitored with transaxial imaging at regular intervals. Nine years later, the patient developed a retroperitoneal psoas abscess that was misdiagnosed as tuberculous spondylitis (Pott disease) but was proven to be recurrent mucinous adenocarcinoma of pancreatic origin. In our review of published reports in patients who underwent resection of IPMN, we found a combined mean recurrence rate of approximately 20%.

Adenocarcinoma, Mucinous↗
PubMed2005

Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes.

OBJECTIVE: Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. METHODS: Retrospective chart review using standardized data collection form. RESULTS: S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days. CONCLUSIONS: Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).

Abscess↗
PubMed1981

Acute osteomyelitis of the spine with paraplegia.

A case is reported of acute osteomyelitis of the lumbar spine presenting with a psoas abscess which extended into the epidural space mimicking an epidural abscess. The patient also had severe septicaemia and a complete cauda equina lesion. The septicaemia was controlled by draining the abscess by an anterior approach to the lumbar spine. Decompression of the cord was achieved by removing the sequestrated discs, the necrotic body of the fourth lumbar vertebra and draining the epidural abscess by opening the posterior longitudinal ligament.

Diabetes Complications↗
PubMed2006

Xanthogranulomatous pyelonephritis: our experience with review of published reports.

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.

Adolescent↗
PubMed2003

[Successful treatment with linezolid in two cases of methicillin-resistant Staphylococcus aureus infections in the orthopedic field].

We have reported two orthopedic patients with Methicillin-resistant Staphylococcus aureus (MRSA) infections successfully treated with linezolid. The first case was a 64-years-old man with bacteremia, spondylitis and psoas abscesses caused by MRSA. He was treated with arbekacin (ABK) and vancomycin (VCM), and then became afebrile. However he complained of a recurrence of fever and oliguria, we administered linezolid for two weeks intravenously because of fluctuating renal dysfunction. Thereafter his clinical conditions improved. The second case was a 26-years-old man with MRSA infection of the pelvis after a trauma. He was treated with teicoplanin (TEIC) for two weeks. However the minimum inhibiratory concentrations (MICs) of TEIC and VCM against MRSA, isolated from the wounds, were 4 micrograms/ml each, we administered linezolid intravenously and the patient was successfully treated in four weeks. Linezolid has been proven to have high efficacy against MRSA by some trials abroad. But the agent has the indication only for VRE by the Medical Insurance in Japan. These cases also suggest that linezolid is useful for MRSA infections in these cases.

Acetamides↗
PubMed1985

The late effect of grenade fragments.

Following the explosion of a grenade or shell, the victim may be peppered with literally hundreds of pieces of metal. Troublesome fragments which perforate a major viscus may be removed but others are often left behind, as it is felt (usually correctly) that these fragments will cause no harm. We describe a case in which a grenade fragment received 16 years previously pierced the large bowel. A psoas abscess developed which was located by ultrasound. Pus was aspirated under ultrasound control and the lesion was successfully treated by antibiotics.

Abscess↗
PubMed1988

Unusual presentation of culture positive brucellosis.

We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.

Adult↗
PubMed2000

MRI of retroperitoneal collections: a comparison with CT.

Retroperitoneal collections in the absence of pancreatitis are rare. Imaging plays an important role in determining the aetiology of these collections and in allowing percutaneous drainage to be performed safely. A review of the imaging characteristics on both CT and MRI is presented, highlighting the advantages and disadvantages of these two modalities and their complimentary roles.

Exudates and Transudates↗
PubMed1992

CT of the extraperitoneal space: normal anatomy and fluid collections.

Knowledge of the appearance and location of the normal fascial structures surrounding the kidneys and the bladder is the key to proper CT analysis of extraperitoneal fluid collections. Recent studies have shown that the renal fascia and the perirenal space are more complex than previously recognized. An extracapsular renal hematoma, confined against the kidney by the posterior renorenal septum within the perirenal space, can entirely simulate a subcapsular hematoma. Pancreatitis fluid can dissect between the discrete layers that constitute the posterior renal fascia, allowing fluid in the anterior pararenal space to extend posterior to the kidney without directly involving the posterior pararenal space. The umbilicovesical fascia separates the small perivesical space from the potential large reservoir of the prevesical space in the extraperitoneal portion of the pelvis. Fluid in the prevesical space can communicate directly with the retroperitoneal spaces surrounding the kidney. In addition to compartmental localization, CT features of the fluid itself or the presence of ancillary findings such as aortic aneurysm, enlarged pancreas, renal mass, or hydronephrosis will frequently indicate the cause and the extent of most extraperitoneal fluid collections.

Contrast Media↗
PubMed2000

Evaluation of the acutely limping child.

A limp may be defined as any asymmetric deviation from a normal gait pattern. The differential diagnosis of a limp includes trauma, infection, neoplasia and inflammatory, congenital, neuromuscular or developmental disorders. Initially, a broad differential diagnosis should be considered to avoid overlooking less common conditions such as diskitis or psoas abscess. In any patient with a complaint of knee or thigh pain, an underlying hip condition should be considered. The patient's age can further narrow the differential diagnosis, because certain disease entities are age-specific. Vigilance is warranted in conditions requiring emergent treatment such as septic hip. The challenge to the family physician is to identify the cause of the limp and determine if further observation or immediate diagnostic work-up is indicated.

Adult↗
PubMedDate not supplied

[Differential diagnosis of deep vein thrombosis].

UNLABELLED: The incidence of deep venous thrombosis (DVT) is high in numerous surgical and medical diseases [1]. There are increasing data on higher incidence of DVT in patients with malignant and other diseases [2]. The diagnosis of DVT is not always simple since there are subclinical and asymptomatic forms of the disease [3]. Besides, there are numerous pathological conditions that imitate deep venous thrombosis [4]. METHODS: We present the results of a retrospective study over the period of January 1, 1996--June 30, 1998 at the Department of Vascular Surgery. Over that period we treated 113 patients (64 females, 49 males, average aged 60.3 +/- 7.5 years) with clinical picture of deep venous thrombosis. All patients underwent duplex scanning examinations (Toschiba SSA-100 A, 3.5 MHz and 8 MHz probes) [5, 6]. Special examinations such as angiography (8 patients), computerised tomography or nuclear magnetic resonance (27 patients) were performed in cases with unclear findings. RESULTS: True DVT was established in 91 (80.3%) patients (Fig. 1). Seven of these patients had asymptomatic phlebothrombosis. Of 12 (10.6%) patients in 9 other pathologic conditions were found (Fig. 2). This symptomatic DVT was caused by malignant diseases (5 sarcomas, 2 metastatic carcinomas, 1 lymphoma); aneurysms of common femoral artery (2) and popliteal artery (2 patients). Ten patients (8.9%) with clinical picture of DVT established by special examinations had no evidence of the presence of intravenous thrombs (Fig. 3). This pseudo DVT was caused by calf haemathoma (3), Baker's cyst (2), popliteal artery aneurysm (1), lipoma of thigh (1), psoas abscess (1), gluteal abscess (1) and acute arthritis of the knee (1). The treatment of these groups of patients was different: surgical thrombectomy, use of streptokinase or heparine (true deep vein thrombosis), tumour extraction (Fig. 4) or another surgical treatment (symptomatic phlebothrombosis) and special decompression measures (Fig. 5) (pseudophlebothrombosis). DISCUSSION: Aetiopathogenesis of true DVT is determined by Virchov's triad [3, 4, 7, 8]. The incidence of DVT in medical and surgical patients is high (30-75%). Initially true DVT may be asymptomatic in 35-70% of patients [1, 3, 8] and depended on detection methods [1, 6, 7, 9, 10]. DVT may be only a symptom of other pathological conditions [2, 3, 7]. This symptomatic DVT is mostly caused by malignant diseases [2]. Pseudo DVT or primary deep vein obstruction may be caused by external abnormalities (right common iliac artery; compression of the left common iliac vein, malignant disease, retroperitoneal fibrosis, internal iliac compression of the external iliac vein, latent femoral hernia compression of the femoral vein, masses in the thigh (large tumours, true or false aneurysms, popliteal masses/aneurysms, large Baker's cysts), changes in the wall or within the lumen of a vein as aplasia, primary tumours, intraluminal spurs [7].

Diagnosis, Differential↗