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Acute suppurative parotitis and parotid gland abscess are infrequently encountered among children. Fourteen children were diagnosed in the Sheba Medical Center as suffering from these infections and their clinical features are described. Discussion reveals neither significant differences nor predominating factors to differentiate between these two entities.
Suppurative tenosynovitis and septic bursitis are closed space infections of the musculoskeletal system. Appropriate antibiotics in combination with incision and drainage are generally recommended. Aggressive surgical management is particularly important in tenosynovitis to prevent tendon necrosis. Empiric antibiotic coverage should be directed toward staphylococci and streptococci. Patient characteristics and epidemiologic exposures may provide clues to unusual causative organisms that are occasionally encountered, such as Neisseria gonorrhoeae, Pasteurella multocida, atypical mycobacteria, fungi, and protothecosis.
Submandibular sialadenitis is a rarely reported entity in neonatal period. We describe a preterm infant who developed suppurative submandibular sialadenitis. He was diagnosed clinically and confirmed by ultrasound examination. He was treated successfully with antibiotics and drainage. The etiology, diagnosis and treatment of this rare condition are discussed.
Suppurative gastritis was demonstrated in BALB/c mice 3 days after intragastric inoculation with 10(9) organisms of Listeria monocytogenes strain ATCC19113 (serotype 3). Also tested were four other strains of mice (C3H, C57BL/6, FVB and ICR) and three other strains of L. monocytogenes (HPB 3 [serotype 4b], HPB 410 [serotype 1/2a] and HPB 503 [serotype 1/2b]). After inoculation with ATCC19113 the numbers of bacteria found in the stomach wall were greater in C57BL/6 and ICR mice than in C3H and FVB mice; moreover, the gastritis produced in BALB/c and C57BL/6 mice was more severe than that produced in the other mouse strains. The gastritis produced in BALB/c mice with L. monocytogenes HPB 3, HPB 410 and HPB 503 was much more severe than that produced by ATCC19113. The inflammatory response occurred in the lamina muscularis and mucosa of the fundus. Massive necrosis of the gastric epithelium was observed, and there was oedema in a large part of the mucosal layer of the fundus. In addition, the submucosal layer was apparently expanded due to oedema, and in the cardia, the mucosal layer had become thin and flattened. Immunohistochemically, a polyclonal antibody against Listeria spp. produced labelling in areas of the gastric mucosa in which there was an inflammatory response and gastric epithelial necrosis.
Clusters of BCG vaccine-associated suppurative lymphadenitis (BCG-ASLD) have been reported in many countries. We have observed an increase in BCG-ASLD following the change from the percutaneous Evans vaccine to the intradermal BCG Statens Serum Institute (SSI) vaccine.
OBJECTIVE: To identify the treatment of choice for choledocholithiasis in patients with versus without acute obstructive suppurative cholangitis (AOSC) or liver cirrhosis, the outcomes of surgical treatment and endoscopic sphincterotomy (EST) were compared. PATIENTS AND METHODS: Three hundred sixty-two consecutive patients with choledocholithiasis were divided into three groups: 27 with AOSC (Group 1), 12 with cirrhosis (Group 2), and 323 with neither AOSC nor cirrhosis (Group 3). RESULTS: Seventeen patients (63%) in Group 1 underwent emergent treatment, and 3 of them died. Two were treated by emergency surgery and both died; only 1 (7%) of 15 treated by emergent EST died. For all patients with AOSC, morbidity and mortality rates were 67% and 33% with surgery, and 24% and 5% with EST. In Group 2, 2 patients with Child C cirrhosis died after elective EST. One patient in Group 3 died. Mortality rates were significantly higher in Group 1 (11%) and Group 2 (17%) than in Group 3 (0.3%). Although comparisons between the two treatment approaches did not achieve statistical significance, EST had lower morbidity rates than surgery in both Group 1 (24% versus 67%) and Group 2 (22% versus 67%). The required hospital stay was half as long with EST as with surgery. CONCLUSIONS: EST is the recommended treatment for patients with choledocholithiasis associated with AOSC or liver cirrhosis.
A retrospective study of 1,150 consecutive patients with thoracic and cardiovascular diseases seen at the University College Hospital, Ibadan, Nigeria, over a five-year period (January, 1975, to December, 1979) showed that 42% (481 patients) were treated for suppurative diseases of the lung and pleura, notably empyema thoracis, lung abscess, and bronchiectasis. Of these, 336 or 70% were treated for empyema thoracis, most of whom were less than 2 years old. Seventy-five patients (16%) had lung abscess, 53 of whom were treated medically with 8 deaths, while 22 had emergency resection for massive hemoptysis with 9 deaths. Of the 70 patients with bronchiectasis, 37 were treated medically with 2 deaths, while 33 were treated surgically with 5 deaths. These data demonstrate that infectious diseases of the lung and pleura remain the greatest challenge to the thoracic surgeons in tropical, developing countries who are often handicapped by inadequate facilities, lack of drugs, illiteracy, poverty, superstitious beliefs, and poor environmental hygiene.
An increased incidence of postoperative sternal infection has been reported after the use of bilateral internal mammary arteries for coronary artery grafting. In this series, a pedicled pericardial fat pad was mobilized to lie in the retrosternal space before the sternum was approximated. This technique was used in 101 consecutive patients who underwent coronary artery grafting using bilateral internal mammary arteries. Twenty-four percent of the patients were diabetic. No suppurative sternitis developed in any of these patients.
In an experiment on bovine immunodeficiency-like virus (BIV), the virological and serological aspects of which were reported in an earlier paper, three groups (A, B and C) of three calves were inoculated subcutaneously with a recently isolated strain (FL112). For group B and group C, the virus was suspended in milk, and for group C (controls) the viral suspension was subjected to pasteurization before inoculation. The calves were killed for necropsy 12 months later. Clinical assessment revealed subtle ataxia in two group A calves, which took the form of an intermittent "shifting" (from one leg to another) lameness, and palpable enlargement of the pre-scapular lymph nodes in one group B animal. At necropsy, haemal lymph nodes (0.1 to 0.5 cm in diameter), occurring singly, were observed in all animals. However, in groups A and B (but not C), enlarged haemal lymph nodes (< or = 2 cm in diameter) were also seen, occurring singly and in chains; and in one group A animal they occurred in grape-like clusters. In groups A and B (but not C), histopathological examination revealed generalized hyperplastic changes in lymph nodes, especially the haemal lymph nodes. This finding was particularly striking in the two clinically ataxic animals from group A, which also showed a non-suppurative meningo-encephalitis; the latter was possibly the cause of the subtle clinical signs. This study supports previous findings on lymphadenopathy resulting from experimental infection with BIV.
The development of fistulas between the bladder and right ovary in a 27-year-old woman is reported. This exceedingly rare form of an internal vesical fistula occurred as a consequence of dextrolateral adnexitis with suppurative ovarian inflammation after placement of an intrauterine pessary. Therapy consisted of removal of the right adnexa, excision of the fistulous duct and suturing of the bladder.
Despite advances in public health and medical care, chronic suppurative otitis media is still prevalent around the world. It is most common in developing countries and in certain high risk populations in developed nations, as well as among children who have tympanostomy tubes inserted. Since this chronic infection is caused by persistent acute otorrhea, which in turn is usually secondary to acute otitis media, prevention should be directed toward prompt and appropriate treatment of the acute middle-ear infection. Repair of chronic perforations should prevent recurrence, since reinfection is due either to reflux of pathogenic organisms from the nasopharynx into the middle ear, or water contamination from the external canal. Information from epidemiological studies, which show that populations can be categorized into highest, high, low and lowest prevalence, can be helpful in setting national priorities for prevention and treatment.
A case of acute nontraumatic suppurative mediastinitis in a 56-year-old man is presented. The patient was admitted with signs and symptoms of a left lower lobe pneumonia and acutely developed mediastinal widening on chest radiograph. A mediastinal abscess was drained by posterior mediastinotomy after a complicated hospital course. Mediastinitis is a rare complication of pneumonia. It is a serious condition, requiring prompt diagnosis and aggressive therapy, and should be considered in the differential diagnosis of acute mediastinal widening.
One case of acute suppurative thyroiditis and one case of thyroglossal duct abscess are presented and discussed. Although they may often present similar symptoms and signs, they need to be differentiated from each other and from other causes of painful thyroid-related neck masses to ensure appropriate therapeutic intervention. Techniques and new developments helpful in differential evaluation, including thyroid radioscintigraphy and ultrasonography, are discussed.
Acute oliguric renal failure associated with bacterial pyelonephritis is a rarely recognized clinical entity. We report a woman with an ectopic pregnancy who developed acute renal failure requiring dialytic support. The renal biopsy revealed focal microabscess formation and leukocyte interstitial infiltration compatible with suppurative pyelonephritis. Although her renal function improved gradually with antimicrobial treatment, the process was incomplete and renal dysfunction persisted at a 10-week follow-up, suggesting permanent renal damage.
A case of suppurative arthritis of the temporomandibular joint (TMJ) in a 43-year-old man is reported. Arthroscopic findings are briefly described. Arthroscopy led to the correct diagnosis and treatment, with a complication-free outcome.
A 2-year-old girl admitted with third degree burns (35% TBSA) received 7 weeks poly-antibiotic therapy combined with heparin for a severe Methicillin-resistant Staphylococcus aureus sepsis with multiple metastatic abscesses (lung, skin, brain), from a suppurative thrombophlebitis of the right jugularis interna, extended to the axillary and cava superior veins. Surgical treatment was contraindicated by the local extension. The child was discharged without major neurological sequelae 3 months after admission.
The differential diagnosis for a solitary axillary mass is extensive. Based on the initial history and physical examination of the patient presented in this case report, the diagnosis of suppurative hidradenitis was incorrectly reached. This subjected her to a surgical procedure that was not indicated for the actual diagnosis of ectopic axillary breast tissue. This article reviews the workup for a solitary axillary mass and discusses multiple aspects of ectopic breast tissue.
Following a normal delivery, a 22-year-old primigravida experienced fever resistant to antibiotic therapy. On the tenth post partum day, thoracic pain and chest X-ray were in favour of acute pneumonitis of left inferior lobe. Considering the extension to the right lung and a normal bronchic fibrescopy, a computed tomography (CT) was performed which showed a right ovarian vein thrombophlebitis, right minor subpleural opacities and left pneumopathy. The final diagnosis was post partum ovarian vein suppurated thrombophlebitis with pulmonary septic metastases from haematogenic diffusion. Post partum thrombophlebitis is a rare event with an incidence of 1 per 2,000 deliveries. Pulmonary inaugurating symptoms result rather from pulmonary embolism than from septic metastases. Post partum persisting and unexplained fever should be explored with abdominal CT-scan.