Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Abscess”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 703 records · Page 39Linked to original sources
PubMed1999

Prevention of intra-abdominal abscesses and adhesions using a hyaluronic acid solution in a rat peritonitis model.

HYPOTHESIS: Hyaluronic acid (HA)-based bioresorbable membrane and 0.4% HA solution reduce intraabdominal adhesion and abscess formation in a rat peritonitis model. DESIGN: Randomized laboratory experiment. SETTING: A university hospital. INTERVENTIONS: In 72 male Wistar rats, a bacterial peritonitis was induced using the cecal ligation and puncture model. Animals were randomized to receive isotonic sodium chloride solution (group 1), HA-carboxymethylcellulose bioresorbable membrane (group 2), or 0.4% HA solution (group 3). Half of each group were killed at day 7 and half at day 21, and adhesions were scored in a blind fashion. The presence and sizes of intra-abdominal abscesses were noted. Cultures were taken for bacterial analysis. MAIN OUTCOME MEASURES: Intra-abdominal adhesions and abscesses. RESULTS: The median severity of adhesions was significantly lower in group 3 compared with group 1 rats at day 7 (II [range, I-IV] vs IV [range, I-IV], respectively; P=.02) and at day 21 (II [range, I-III vs IV [range, II-IV], respectively; P=.02). There was no significant difference between group 2 and group 1 rats on either day. At day 7, abscesses larger than 2 cm were found in 6 of 12 group 1 rats and in 4 of 12 group 2 rats, but in 0 of 11 group 3 rats (P=.01). At day 21, 0 of 11 group 3 rats had an intra-abdominal abscess, in contrast to 4 (33%) of 12 group 1 rats and 5 (45%) of 11 group 2 rats. All cultures of abscesses revealed polymicrobial flora. CONCLUSION: Adhesion and abscess formation are reduced using a 0.4% HA solution, and not HA-carboxymethylcellulose bioresorbable membrane, in a rat model of generalized bacterial peritonitis.

Abdominal Abscess↗
PubMed2001

Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis.

HYPOTHESIS: The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis. METHODS: A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure. SETTING: A tertiary care center. PATIENTS: Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appendixes removed by methods other than laparoscopy or right lower quadrant incision. INTERVENTIONS: Open appendectomy performed through a right lower quadrant incision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution. MAIN OUTCOME MEASURE: The incidence of postoperative intra-abdominal abscess after laparoscopic vs open appendectomy. RESULTS: In perforated appendicitis (170 patients), the incidence of postoperative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant. CONCLUSION: There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.

Abdominal Abscess↗
PubMed1977

Subphrenic abscess. The new epidemiology.

Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operation account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation.

Adolescent↗
PubMed1979

Selective management of subphrenic abscesses.

Although extraserous drainage of subphrenic abscesses has gained wide acceptance, there is some renewed enthusiasm for the more frequent use of a transperitoneal operation because it affords the opportunity to discover unsuspected pathologic conditions, particularly heterotopic abscess. In 44 patients with postoperative subphrenic abscesses, the approach to drainage was selected on the basis of the clinical circumstances. Among 28 patients whose abscesses were drained extraserously, the incidence of heteroptic and recurrent abscesses was low. No serious complications of peritoneal or wound soilage occurred after transperitoneal drainage in 16 patients, yet the problems of inadequate drainage and heteroptic abscess were not eliminated. Celiotomy prior to definitive abscess localization was required for 13 patients. Five patients died. The operative approach should be based on the clinical assessment of the patient and particularly on the probability that multicentric intra-abdominal pathologic conditions exist.

Adolescent↗
PubMed1985

Comparison of indium 111-labeled platelets v leukocytes in a pyogenic abscess.

This study sought to determine which blood component, WBCs or platelets, is the more specific indicator of an abscess and where each localizes. An abscess was created using stool in the hind limb of dogs. After 24 hours, one group was given autologous indium 111-labeled platelets and another group was given autologous indium 111-labeled WBCs. Blood, abscess fluid, infected operative control muscle tissue, and nonoperative control muscle tissue were counted for radioactivity 24 hours after administration of the labeled cells. There was significantly (P less than .001) less WBC radioactivity in blood and more within abscess fluid compared with platelets. The highest platelet activity occurred in muscle tissue adjacent to the abscess (P less than .002) compared with platelet activity in abscess fluid or control muscle tissue. The unwanted high platelet blood background activity and the desirable high concentration of WBC radioactivity within the abscess fluid makes the latter the preferential radionuclide imaging agent.

Abscess↗
PubMed1989

Nosocomial abscess. Results of an eight-year prospective study of 32,284 operations.

This article details the results of 114 abscesses found after 32,284 operations during a 30-day prospective infection surveillance. Abscesses occurred more often after gastric/esophageal (3.6%), colonic/appendiceal (2.8%), and pancreatic/biliary (1.5%) operations. Abscesses were intra-abdominal (58%), pelvic/perineal (31%), and retroperitoneal (3%). The most common pathogens were Escherichia coli, enterococci, and Bacteroides organisms. Abscess symptoms appeared 10 +/- 6 days (mean +/- SEM) after surgery and were drained 8 +/- 8 days after onset of symptoms. Hospital stay from onset of symptoms to discharge was four times greater than that for wound infection. Twenty-seven patients (28%) died. Mortality was increased in patients older than 50 years and in those with renal failure or multiple abscesses. Nosocomial abscesses had a greater morbidity than would infection. Excessive expense and high mortality warrant infection surveillance for both wound infection and ongoing nosocomial abscesses.

Abscess↗
PubMed1989

Delayed administration of tissue plasminogen activator reduces intra-abdominal abscess formation.

Previous studies demonstrated that intraperitoneal fibrinolysis using tissue plasminogen activator (t-PA) prevented intraabdominal abscess formation in a rat fibrin clot infection model when administered simultaneously with the infecting inoculum. To more closely mimic the clinical setting, the efficacy of delayed administration of t-PA on intra-abdominal abscess formation was examined. A delay of 2, 6, and 18 hours had no effect on the rate of abscess formation but did reduce abscess size, indicating partial fibrinolysis. Since fibrin clots dehydrate in vivo, we hypothesized that a higher concentration of t-PA might be necessary to effect complete abscess resolution. High-dose t-PA (0.1 mg/mL) prevented abscess formation following a 6-hour delay and reduced mean weight following an 18-hour delay. Since heparin sodium may prevent new fibrin deposition and enhance t-PA activity, it was combined with t-PA to investigate potential synergistic effects. Despite adequate anticoagulation with heparin, no synergy with t-PA could be documented. In addition, the combination of antibiotics with t-PA did not affect its efficacy in vivo. We demonstrate that delayed administration of t-PA is effective in preventing abscess formation and may have implications for the clinical setting where initial surgical intervention is usually delayed.

Abdomen↗
PubMed1993

Splenic abscess in the intensive care unit.

BACKGROUND AND METHODS: From 1980 through 1990, nine patients developed de novo splenic abscess during their stay in our intensive care unit (ICU), representing the first series of such reported cases. RESULTS: All nine patients were septic prior to the diagnosis of splenic abscess. The signs and symptoms of splenic abscess commonly described in the literature were of little help in detecting this pathology in ICU patients. Mean +/- SD platelet count, however, increased significantly, from 274 x 10(9)/L +/- 50 x 10(9)/L at admission to 647 x 10(9)/L +/- 94 x 10(9)/L at diagnosis. At diagnosis, left pleural effusion was present in all patients. Only three patients had detectable left upper quadrant tenderness. Abdominal computed tomographic scans, when used, were diagnostic in all cases. All patients were treated by splenectomy; eight had a solitary abscess. Six abscesses were caused by enteric organisms, two by Staphylococcus aureus, and one by Streptococcus epidermidis. Eight patients (89%) had had the offending organism previously isolated from their blood or from another infected site. Mortality was 45%. CONCLUSIONS: Splenic abscess, although a rare clinical entity, does occur de novo in ICU patients and is associated with significant mortality. Unexplained thrombocytosis in a septic ICU patient with persistent left pleural effusion is suggestive of splenic abscess. Previous culture and sensitivity results are useful in guiding perioperative antibiotic choices.

Abscess↗
PubMed1996

Pyogenic liver abscess. An audit of experience over the past decade.

OBJECTIVES: To audit our experience in managing patients with pyogenic liver abscesses since 1984 and to identify any risk factor associated with hospital mortality. DESIGN: Retrospective review. SETTING: A tertiary referral center. PATIENTS: Eighty-three patients with pyogenic liver abscesses were studied to determine demographic characteristics; clinical features, laboratory, imaging, and microbiologic findings; methods of treatment; and final outcome. The median follow-up period was 9.8 months. INTERVENTION: All patients were treated with intravenous antibiotic drugs. Fifty-three patients were to image-guided percutaneous aspiration of the abscess. A percutaneous drainage catheter was inserted after aspiration in 27 patients. Laparotomy was performed in 27 patients; seven of them underwent an elective operation. MAIN OUTCOME MEASURE: Hospital mortality, defined as death within the same hospital admission for management of liver abscess. RESULTS: Biliary tract disease was the most frequently identifiable cause. The right lobe abscess was more frequently cryptogenic, while the left lobe abscess was more frequently related to intrahepatic stones (P < .001). The overall hospital mortality rate was 18% (15/83). On univariate analysis, female gender, rupture on presentation, emergency laparotomy, management without aspiration or catheter drainage, presence of malignancy, hyperglycemia, hyperbilirubinemia, elevated prothrombin time, and elevated activated partial thromboplastin time were significantly associated with hospital mortality. On multivariate logistic regression analysis, presence of malignancy, hyperbilirubinemia, and elevated activated partial thromboplastin time were found to be independent risk factors. CONCLUSIONS: Pyogenic liver abscess is still a disease with significant mortality. Early diagnosis and prompt treatment are necessary to further improve our results of management.

Adult↗
PubMed1997

Twelfth rib resection. Preferred therapy for subphrenic abscess in selected surgical patients.

OBJECTIVE: To assess the role of 12th rib resection in the treatment of postoperative, subphrenic abscesses. DESIGN: Consecutive case series. SETTING: University hospital, level I trauma center. PATIENTS: Operative logs for a 13-year period were reviewed for all patients undergoing 12th rib resection for drainage of a postoperative subphrenic abscess. Each individual medical record was reviewed for demographic data, primary diagnosis, computed tomographic scan findings, and clinical status (temperature, white blood cell count, and Acute, Physiologic, Age, and Chronic Health Evaluation II score) at the time of rib resection. MAIN OUTCOME MEASURES: Operative results, microbiological data, complications, and outcomes. RESULTS: Twenty-six patients underwent 27 rib resections for a secondary left subphrenic (23) or a right subhepatic (4) abscess. All patients had undergone at least 1 prior laparotomy (average, 1.5; range, 1-4). Sixteen patients had traumatic injuries, and 7 had complicated pancreatitis. Twelve patients had undergone prior failed attempts at percutaneous drainage before rib resection. Fourteen patients underwent operative drainage without attempted percutaneous drainage, mainly for peripancreatic (7) or multiloculated (3) abscesses. There were 3 postoperative complications (3/27 [11%]): a gastrocutaneous fistula, a gastrocolic-cutaneous fistula requiring laparotomy and temporary colostomy, and fasciitis in the resection site. Four (15%) of the 26 patients died: 3 died of progressive multiple system organ failure, and 1 died of an unrelated injury. The remaining 20 (77%) of the patients were discharged from the hospital with healing wounds and no further episodes of intra-abdominal infection. CONCLUSIONS: Twelfth rib resection is an effective alternative therapy for secondary subphrenic abscesses. The nature of the incision allows for open, dependent drainage; avoids subsequent laparotomy; and effectively controls intra-abdominal infections. Twelfth rib resection remains a useful tool in the treatment of subphrenic abscess and may be the preferred approach when other attempts at abscess drainage have failed.

Adult↗
PubMed1997

Splenic abscess: another look at an old disease.

OBJECTIVE: To study the changes in the incidence, causes, bacteriologic profile, and management of a splenic abscess. DESIGN: Retrospective case study. SETTING: Tertiary, university referral center. PATIENTS: Thirty-nine patients with a splenic abscess. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Demographics, signs and symptoms, causes, risk factors, diagnostic methods, bacteriologic profile, treatment, and outcome. RESULTS: Patients presented at a mean age of 43 years (range, 2-83 years), after a mean symptomatic period of 16 days, with fever (69%), abdominal pain (56%), nausea and vomiting (38%), and splenomegaly (31%). The majority of abscesses represented metastatic infection (n=19), and 11 were secondary to immunosuppression. Twelve patients had human immunodeficiency virus disease and 9 used intravenous drugs. In patients who underwent computed tomography, all had abnormal scans (n=33), with a well-defined abscess(es) in 28. Nine abscesses were polymicrobial; monomicrobial isolates included gram-positive organisms (23%), gram-negative organisms (31%), fungi (23%), and mycobacteria (23%). Patients presenting before 1989 (1981-1988) (n=15) and those presenting after 1989 (1989-1996) (n=24) differed in risk factors (intravenous drug abuse, 0% vs 47% [P=.02]; hematologic malignancy, 43% vs 9% [P=.04]) and gram-positive isolates (18% vs 64%; P=.06). Patients underwent splenectomy (n=18), open drainage (n=4), medical therapy (n=10), or percutaneous drainage (n=5) with respective survival rates of 94%, 50%, 70%, and 100%. CONCLUSIONS: In 1996, splenic abscesses are increasingly common. Intravenous drug abuse and human immunodeficiency virus disease are significant risk factors, and the diagnosis should be considered in a patient with fever and abdominal pain who uses intravenous drugs. Antimicrobial agents should be broad since 36% of abscesses were polymicrobial, and should include coverage of gram-positive organisms.

Abscess↗
PubMed1998

Brain abscesses in children with cancer.

BACKGROUND: Brain abscesses in pediatric patients are rare events, and the causative organism and prognosis vary with the population under study. Children with cancer seem to be particularly susceptible to the development of brain abscesses because of the immunological changes induced by cancer and its treatment. We reviewed the records of children who developed a brain abscess during treatment of a malignancy to define the clinical characteristics, prognosis, and management of these patients. PROCEDURE: We performed a retrospective review of the clinical and laboratory characteristics of all cancer patients younger than age 20 years who were admitted to our institution between 1980 and 1996 for a brain abscess. RESULTS: Twelve children were identified. Cancer diagnoses were brain tumor in two, systemic PNET in two, and leukemia in eight. Six patients had multiple abscesses. Eleven received prior chemotherapy. Abscesses were surgically excised or aspirated in seven, and empiric antibiotics were given to the other five. At surgery, Listeria monocytogenes, Aspergillus fumigatus (3), Fusarium, and Candida lusitanea were cultured. Aspergillus was identified in other locations in four patients. Abscesses were successfully treated in seven patients, two of whom received antibiotics only; five patients (42%) died from infection. CONCLUSIONS: Mortality is high in this immunosuppressed population, in part due to the preponderance of fungal infection. The finding of very rare organisms suggests that drainage and culture should be performed whenever possible; empiric antibiotics that include an antifungal agent may, on occasion, be successful.

Abscess↗
PubMed1997

Anorectal abscesses: need for accurate anatomical localization of the disease.

Anorectal abscesses constitute a common problem of the perianal area. Considerable morbidity is expected if an immediate and anatomically correct drainage procedure is not performed in a timely manner. Acute infection of an anal gland leads to the formation of the anorectal abscess, while the chronic stage of the infection appears as a fistula in ano. It is imperative to perform operations with accurate anatomical knowledge; this is particularly true in the case of fistula-in-ano and anorectal abscesses, for which inappropriate surgery can lead to disastrous results. Here we report our experience with anorectal abscesses in various locations in 14 patients. Four of the 14 had a transrectal drainage. The internal (transrectal) or external drainage of the anorectal abscesses depends mainly on the mechanism of their formation and the anatomical relationship of the abscess to the levator ani. Apart from a death occurring 1 month after drainage due to a cause not related to suppurative disease (subdural hematoma), all patients had an uneventful recovery and were discharged from hospital after a mean stay of 1.2 days. A brief and practical description of the macroscopic anatomy of the area will assist in understanding better the selection of the appropriate route of drainage of anorectal abscesses.

Abscess↗
PubMed1987

Ultrasound-guided percutaneous drainage of intra-abdominal abscesses.

The encouraging results of percutaneous abscess drainage (PAD) in simple intra-abdominal abscesses have led us to employ this method in patients with more complex abdominal inflammatory disease, such as those with multiple enteric communicating or multilocular abscesses and patients in whom the percutaneous approach requires puncture routes traversing uninvolved organs. Cure was achieved in 74 per cent of all patients (83 of 112 patients) who underwent PAD, but in only 50 per cent of patients with multiple intra-abdominal abscesses (n = 16), 50 per cent of patients with complex pancreatic inflammatory disease (n = 8) and 57 per cent of patients with complex intraparenchymal abscesses (n = 7). PAD contributed to cure in eight of nine patients with enteric communicating abscesses. The transhepatic route to perihepatic abscesses proved to be safe. Complications occurred in nine patients (8 per cent). No relationship was noted between the severity or number of complications and the indication for PAD. Of the 29 failures of PAD, 17 patients were cured by either surgical intervention (14 patients) or a second PAD (1 patient) or a combination of the two methods (2 patients). Twelve patients (11 per cent) died, eight from sepsis due to inadequate drainage. Frequent reassessment by ultrasonography and computerized tomography (CT) in patients with prolonged sepsis after PAD is mandatory. These results justify a place for PAD in the management of the often critically ill patient with complex abdominal inflammatory disease.

Abdomen↗
PubMed2001

Aural abscesses in wild-caught box turtles (Terapene carolina): possible role of organochlorine-induced hypovitaminosis A.

Wild-caught box turtles (Terapene carolina carolina) with aural abscesses were observed over a period of several years. Histopathologic evaluation of epithelial tissues (conjunctiva, pharynx, trachea, auditory tube) revealed mucosal hyperplasia and squamous metaplasia, and accumulated keratin-like material in the middle ear cavity. These manifestations suggested the possibility of vitamin A deficiency. A nonsignificant trend toward reduced serum and hepatic vitamin A levels was observed in turtles with abscesses (mean serum and hepatic vitamin A levels 71 and 49% of respective levels in turtles without abscesses). Three organochlorine (OC) compounds (alpha-benzene hexachloride, heptachlor epoxide, and oxychlordane) and total (microg/g) OC compounds were significantly higher in turtles with abscesses compared with turtles without abscesses. No OC compounds were higher in turtles without abscesses compared with turtles with abscesses. These data suggest a possible effect of environmental chemicals on metabolism or utilization of vitamin A in wild box turtles, resulting in hypovitaminosis A.

Abscess↗
PubMed1994

Endoscopic stereotactic treatment of brain abscesses.

Treatment of brain abscess is still a subject of controversy. Craniotomy with primary extirpation and resection of the abscess membrane, burrhole craniotomy with puncture or insertion of a drain, marsupialization, or stereotactic aspiration are different therapeutic approaches. As a consequence of our experiences and results with neuro-endoscopic interventions we have introduced endoscopic stereotactic techniques in brain abscess treatment. Seven patients with brain abscesses were operated on stereotactically using an endoscope. In all cases the abscess contents were aspirated, while the abscess membrane was left in situ. The patients received postoperative antibiotic therapy according to microbial diagnosis. The longest follow-up period was 48 months. Six patients showed a marked improvement of neurological deficit after treatment. One patient died from sepsis caused by a bacterial endocarditis. The results emphasize that endoscopic stereotactic technique as a minimally invasive neurosurgical method can also be used for treatment of brain abscess.

Adult↗
PubMed1994

Intracranial tuberculous abscess mimicking malignant glioma.

Brain abscess is probably the least common manifestation of tuberculous infection of the central nervous system; meningitis and tuberculoma are much more common. A case of tuberculous brain abscess in a 23-year-old man with previous history of Tbc meningitis is presented. The computerized tomographic scan demonstrated a unilocular space-occupying lesion in the left thalamic region, surrounded by a thick hyperdense enhancing rim. It is suggested that a relatively long clinical history and previous Tbc meningitis history together with the appearance of a thick-walled abscess-like lesion on the CT scan may indicate the diagnosis of a tuberculous brain abscess. Only after neurosurgical removal of the abscess, the pathohistological examination reveal tuberculous etiology of the abscess. The patient later died from aspiration bronchopneumonia. Only 28 instances of tuberculous abscess have been reported in the literature.

Adult↗
PubMed1989

Brain abscesses in children--a cooperative study of 83 cases.

This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.

Adolescent↗