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[Clinical importance of the division of lung abscesses into acute and chronic].
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[Silent lung abscesses simulating cancer].
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[Treatment of lung abscesses].
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[Clinical manifestations & therapy of lung abscesses].
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[Outcomes and remote results of intrapulmonary penicillin therapy in lung abscess].
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Differentiation of lung abscess and empyema by ultrasonography.
To assess the value of chest ultrasonography in the differentiation between a lung abscess and empyema, 50 patients, including 24 cases of lung abscess and 26 cases of empyema, were studied. The ultrasonographic characteristics of a lung abscess included an irregular wall width, a blurred outer margin, an oval or round shape, an acute chest wall angle and a negative pleural separation. The ultrasonographic characteristics of empyema were an uniform wall width, a sharp outer margin, a lenticular shape, an obtuse chest wall angle and a positive pleural separation. A new ultrasonographic scoring system was proposed; a positive finding for each of the features: sharp outer margin, lenticular shape, obtuse chest wall angle and positive pleural separation was assigned a score of 1, while a negative finding was assigned a score of zero. The total scores for the four features were then assessed. Ninety-six percent of the empyema cases scored 2 or more, while 96% of the lung abscess cases scored 1 or zero. The efficacy of differential diagnosis was 96%. We conclude that chest ultrasonography is a useful tool in the differentiation between lung abscess and empyema and that ultrasonography alone is sufficient to make a correct diagnosis in most cases.
Lung abscess versus necrotizing pneumonia: implications for interventional therapy.
OBJECTIVE: To assess and contrast the role of interventional therapy for two types of cavitating pneumonias: lung abscess and necrotizing pneumonia. MATERIALS AND METHODS: We retrospectively reviewed the imaging, interventional therapy, and outcome of 14 children seen between February 1987 and January 1996 with lung abscess and 9 with necrotizing pneumonia. All children were treated with antibiotics prior to intervention. Pulmonary parenchymal fluid was percutaneously aspirated from ten lung abscesses and three necrotizing pneumonias. Percutaneous catheters drained five lung abscesses. Pleural drainage was performed for three lung abscesses and eight necrotizing pneumonias. RESULTS: All 14 children with lung abscesses had positive Gram stains of the pulmonary fluid; 13 cultures were positive. All 14 defervesced within 48 h of intervention. None developed a bronchopleural fistula. All nine necrotizing pneumonias were presumed to be sequelae of prior pneumonia. Streptococcus pneumoniae was the only organism as documented by pleural fluid latex fixation in three patients, gram stain in two, and culture in only one. Seven of these children developed pneumatoceles, five developed bronchopleural fistulae, and three required long-term chest tubes for persistent pneumothoraces. CONCLUSION: Aggressive interventional therapy can be diagnostic and therapeutic in the infected lung abscess. Interventional therapy can be harmful in postinfectious necrotizing pneumonia.
[Lung abscess: evolution of a complication over 45 years].
143 patients with lung abscesses were hospitalised at the Department of Surgery at University Hospital Zurich from 1946 to 1990. Analysing our patients in a retrospective study we concluded as follows: 1. Lung abscesses have nearly disappeared in our patients. 2. Lung abscesses can be cured without lethality. 3. Cancers of the lung causing abscesses were not seen any more since 1960. 4. A compromised immunological system appeared as a new pathogenetical factor since the beginning of the 1980ies.
Lung abscess and empyema.
Forty-eight patients presenting with lung abscess or empyema were studied between 1976 and 1984. The clinical features, diagnostic techniques and management are discussed. Aerobes were cultured from specimens obtained in 37.5 per cent of cases, both aerobes and anaerobes in 54.2 per cent and anaerobes alone in only 8.3 per cent. Bacteroides fragilis was not isolated. Forty-two per cent of patients had previously received antibiotics, but fully sensitive organisms were grown from 17 of 20 specimens from this group. Forty-five per cent of aerobes and 17.8 per cent of anaerobes were resistant to penicillin. There were no specific clinical features which distinguished the patients with a lung abscess from those with an empyema, nor between those with an underlying abnormality and those in whom the infection arose in a previously normal lung. Lung abscesses should be treated medically with intensive physiotherapy and appropriate antibiotics; penicillin can no longer be considered the antibiotic of choice. If the cavity fails to drain satisfactorily, further investigations should be undertaken to exclude a tumour or other underlying abnormality.
Lung abscess in infants and children.
We retrospectively reviewed 18 cases of primary lung abscess and 10 cases of secondary lung abscess in infants and children during a 6-year period. Among 18 patients with primary abscesses, nine were boys and nine girls, from 9 months to 20 years old, but only two of 18 were less than 5 years old. Each had a solitary abscess. Location of abscesses included the right lower lobe (8), the right upper lobe (3), the left upper lobe (1), and the left lower lobe (6). One patient had Streptococcus pneumoniae bacteremia. Other bacterial isolates were from the upper respiratory tract and of uncertain significance. All patients recovered, although lobectomy was considered necessary in five patients because of failure to respond to intravenous antibiotic therapy. Secondary lung abscesses occurred in six boys and four girls who were from 2 1/2 months to 13 years old. All 10 had solitary, right-sided lesions, seven in the right lower lobe and three in the right upper lobe. Bacteria of unclear significance were recovered from three of 10 patients, while two had documented gram-negative bacteremia. Three secondary abscess patients underwent lobectomy because of perceived inadequate response to medical therapy, including intravenous antibiotics. Based upon the literature and our experience, therapy for pulmonary abscess should include a parenteral antibiotic with gram-positive activity against both penicillinase-producing Staphylococcus aureus and anaerobes for a minimum of 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Empyema thoracis and lung abscess caused by viridans streptococci.
We retrospectively studied the bacteriology and clinical features of empyema thoracis and lung abscess caused by viridans streptococci in 72 patients seen from January 1984 to September 1996. A total of 76 strains of viridans streptococci were isolated, of which the most common isolates were Streptococcus constellatus (21 strains), S. intermedius (17), and S. sanguis (10). Species belonging to the S. milleri group accounted for the majority (68%) of isolates. In 38 (53%) patients these organisms were recognized as the sole pathogens. Of the 72 patients, 53 had empyema, 14 had lung abscesses, and five had both empyema and lung abscess. Forty-six (64%) patients had underlying diseases. Of these, malignancies were the most common (17 patients), followed by diabetes mellitus (12 patients) and central nervous system diseases (10 patients). Of the 48 patients who underwent chest-tube drainage, 27 (56%) received further treatments, including intrapleural streptokinase (18 cases), surgery (9), and both intrapleural streptokinase and surgery (3). Two (14%) of the patients with lung abscess alone underwent surgical treatment. Although all viridans streptococcal isolates were susceptible to penicillin, the patients in the study had a high mortality (21%). Univariate and multivariate analysis of data for patients with empyema alone (n = 53) showed a significantly increased risk of death in those with underlying malignancy (OR = 16.0, p = 0.023) and those with non-S. milleri-group isolates (OR = 3.72, p = 0.030). These data imply a strong clinical significance of viridans streptococci in the pathogenesis of empyema and lung abscess, as well as the need for species identification of viridans streptococci in patients with pleuropulmonary diseases.
Pulmonary strongyloidiasis and lung abscess.
We report a case of lung abscess associated with pulmonary strongyloidiasis which occurred in an asthmatic patient three years after migrating to Australia from Burma where strongyloidiasis is endemic. Thiabendazole was effective in eradicating the Strongyloides infection.
Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess.
Aspiration pneumonia, necrotising pneumonia and primary lung abscess are complications arising from the aspiration of infectious material from the oral cavity or stomach. There is limited information on optimal antibacterial therapeutic regimens. Patients with pulmonary infection following aspiration (n = 95) were included in a prospective, open, randomised, comparative multicentre trial to compare the safety, clinical and bacteriological efficacy of ampicillin + sulbactam vs. clindamycin +/- cephalosporin. Treated patients (n = 70) received sequential antibiotic therapy with either ampicillin + sulbactam (n = 37) or clindamycin (n = 33), with or without a second- or third-generation cephalosporin, administered until the complete resolution of clinical and radiological abnormalities. Definite or presumptive pathogens were isolated from 58 patients. Mean duration of therapy was 22.7 days for ampicillin + sulbactam and 24.1 days for clindamycin. In patients treated with ampicillin + sulbactam, the clinical response was 73.0% at the end of therapy and 67.5% 7-14 days after therapy. For clindamycin, the rates were 66.7% and 63.5%, respectively. Bacteriological response was similar in both treatment arms. Nine patients died (12.9%), with a Simplified Acute Physiology Score of > 30 points being the only significant predictive factor for therapeutic failure. Ampicillin + sulbactam and clindamycin +/- cephalosporin were both well-tolerated and proved equally effective in the treatment of aspiration pneumonia and lung abscess.
Management of giant lung abscess.
Ten cases of giant lung abscess were treated by one-stage closed tube drainage after initial medical therapy. Sepsis or hemorrhage was relieved in all patients. There were no operative deaths, serious complications, or late recurrences. Three patients have subsequently died from bronchogenic cancer.
[Ruptured lung abscess; report of a case].
We reported an extremely rare case of ruptured lung abscess. A 60-year-old male was admitted to our hospital with sudden loss of consciousness. Thoracocentesis demonstrated pneumopyothorax. Right middle and lower lobectomy for ruptured abscess was performed. The patient remains well with no recurrent lung abscess 2 years postoperatively. This case emphasizes that ruptured lung abscess is a cause of pneumopyothorax.