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PubMed1986

Suppurative keloidosis in a black woman.

The development of suppuration and sinus tract formation within previously well developed keloidal scars is a rare event, predominantly occurring in the beard, neck, and presternal areas of black men. Keloidal entrapment of epithelial cystic elements, such as pilosebaceous units, has been suggested as one possible mechanism for the occurrence of suppurative keloids. We report the extremely rare development of a large, submental, submaxillary suppurative keloid in a black woman, with resulting sinus tract formation and intraoral drainage. The important clinical characteristics and treatment of suppurative keloidosis are discussed. The gross pathologic picture of keloidal epithelial-cystic entrapment and inflammation is also demonstrated.

Female↗
PubMed2000

Aeromonas infection in acute suppurative cholangitis: review of 30 cases.

OBJECTIVES: Aeromonads, though not common pathogens in biliary sepsis, caused substantial mortality in patients with impaired hepatobiliary function. Our aim was to study the pathogenic role of Aeromonas in acute suppurative cholangitis. METHODS: Between 1996 and 1998, the medical records of patients with a diagnosis of biliary sepsis were reviewed. Those who fulfilled the diagnostic criteria for acute suppurative cholangitis and had positive bile or blood cultures for Aeromonas species were studied. RESULTS: One thousand and forty-five patients were confirmed to have acute suppurative cholangitis. Of these, 30 patients (2.9%) had Aeromonas species isolated from bile; four were complicated by aeromonas septicaemia with simultaneous recovery of the bacteria from blood. All except two isolates were A. hydrophila. Twenty-four patients (80%) had bile duct stones, four (13%) had cholangiocarcinoma and two (7%) pancreatic cancer. Twenty-five cases (83%) had previous exploration of the biliary tract. There was substantial resistance to piperacillin (58%), ceftazidime (30%) and imipenem (15%). Most patients improved after biliary decompression. Only three patients (10%) died, two had terminal malignancy and one had end-stage liver failure. No excess mortality was attributable to Aeromonas infection in biliary sepsis. CONCLUSIONS: Previous instrumentation facilitated ascending Aeromonas infection of the biliary tract from the gastrointestinal tract. Unlike early reports, our results showed that aeromonads did not adversely affect the clinical outcome of acute suppurative cholangitis with successful drainage of biliary obstruction.

Acute Disease↗
PubMed1998

Suppurative intracranial complications of sinusitis.

OBJECTIVES: To familiarize the contemporary surgeon with the pathogenesis, diagnosis, and appropriate management of suppurative intracranial complications of sinusitis. STUDY DESIGN: Retrospective chart review. METHODS: All patients admitted to the University of Virginia Health Sciences Center with a diagnosis of intracranial suppuration between 1992 and 1997 were reviewed. RESULTS: One hundred seventy-six cases were identified, of which 15 patients had 22 suppurative intracranial complications of sinusitis. These were epidural abscess (23%), subdural empyema (18%), meningitis (18%), cerebral abscess (14%), superior sagittal sinus thrombosis (9%), cavernous sinus thrombosis (9%), and osteomyelitis (9%). CONCLUSIONS: The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series.

Adolescent↗
PubMed1992

Oral ciprofloxacin in the management of chronic suppurative otitis media without cholesteatoma in children: preliminary experience in 21 children.

The current medical management of children with chronic suppurative otitis media without cholesteatoma unresponsive to local treatment and oral antibiotics is intravenous antibiotic therapy in the hospital setting. We studied the efficacy and toxicity of oral ciprofloxacin in chronic suppurative otitis media. Twenty-one children received oral ciprofloxacin, 30 mg/kg/day. Ear discharge was positive for bacteria resistant to other oral medications and susceptible to the quinolones. The mean duration of treatment was 16.7 days. In 18 children suppuration ceased and 3 failed their first course. During a mean follow-up of 15.4 months, 6 children remained free of ear, nose and throat problems. Otorrhea recurred in 12 children. Ear cultures were positive for organisms susceptible to amoxicillin in 5 of them. In 7 cases Pseudomonas aeruginosa was again isolated from otorrhea. Repeated antibiotic therapy was advocated only in 3 (2 responded to ciprofloxacin; 1 failed ciprofloxacin and was cured by ceftazidime). Adverse clinical effects were not observed. Transient neutropenia was observed in 1 child. There was no change in the height percentile. The results of this study show that children with chronic suppurative otitis media without cholesteatoma can be effectively treated with oral ciprofloxacin. This novel approach may prevent hospitalization.

Administration, Oral↗
PubMed2002

Acute suppurative thyroiditis in children.

BACKGROUND: Acute suppurative thyroiditis in children is rare and is often related to a pyriform sinus fistula or thyroglossal duct remnant, especially when it is recurrent. METHODS: From January, 1985, through December, 2000, 15 children with acute suppurative thyroiditis were treated. Their clinical, laboratory and radiologic findings were reviewed and analyzed. RESULTS: There were 8 girls and 7 boys, with a mean age at diagnosis of 6.1+/-2.9 years (range, 1.5 to 9.8). A thyroid mass was present on the left in 13 and on the right in 2 (P < 0.05). Fever, neck pain and swelling were the most common symptoms and signs. Seven patients (46.7%) had recurrent disease. Needle aspiration for Gram stain and bacterial cultures were done, and pathogenic organisms were identified on culture in 8 patients but were found only on Gram stain in 2 patients. In one-half of the patients with positive cultures, mixed pathogens were found. The most common organisms isolated were streptococcal species (50%). Barium esophagography was performed in all patients, and 5 (33.3%) had a pyriform sinus fistula on the left. Only 1 of the recurrent patients had a fistula. Thyroid scans were performed in 13 patients, of whom 12 (92.3%) had decreased radioactive uptake. Thyroid function tests were normal in all 15. CONCLUSIONS: Acute suppurative thyroiditis is usually caused by oropharyngeal flora, resulting in mixed pathogens on culture. Broad spectrum antibiotics should be given once cultures have been obtained. Imaging studies might be helpful in the diagnosis of acute suppurative thyroiditis.

Acute Disease↗
PubMed2005

Ultrastructural analysis of the chorda tympani nerve in chronic suppurative otitis media.

OBJECTIVE: To compare ultrastructure of the chorda tympani nerve by light and electron microscopy in patients with otosclerosis and chronic suppurative otitis media. STUDY DESIGN: Comparative prospective study. SETTING: Tertiary care, referral medical center. PATIENTS: The tympanic segments of chorda tympani nerves were collected for ultrastructural investigation in 20 cases with chronic suppurative otitis media and 10 cases with otosclerosis that underwent middle ear surgery. RESULTS: Histopathologic examinations of the suppurative group showed that unmyelinated fibers were almost totally lost and replaced by collagen fibers. The thickness of the myelin sheaths was very slender, whereas some of them were atrophic. A substantial increase was encountered in the endoneural collagen substance and connective tissue, whereas inflammatory elements and edema were present occasionally. Degenerative alterations of the myelinated fibers mainly occurred in the form of adaxonal vacuoles. There was disorganization and separation of parallel lamellae of Schmidt-Lanterman clefts. CONCLUSION: The chorda tympani nerve should be preserved in otologic surgery. However, inadvertent dissection of the chorda tympani nerve in chronic suppurative otitis media surgery will not possibly cause a postoperative disturbance in light of ultrastructural changes that occur in the nerve.

Axons↗
PubMed1989

Thyroiditis. Differentiation of acute suppurative and subacute. Case report and review of the literature.

Acute suppurative thyroiditis is rarely seen during childhood. The classic clinical features of this illness (fever, neck pain, and a swollen, tender mass over the thyroid gland) can differentiate acute thyroiditis from the more common subacute thyroiditis. In less typical cases, however, this distinction can be difficult. An adolescent male presented with a swollen, tender thyroid gland. Atypical laboratory findings and the lack of fever and toxicity delayed the diagnosis and treatment of acute suppurative thyroiditis. A review of the pediatric literature summarizes clinical and diagnostic features valuable in the differential between acute suppurative thyroiditis and subacute thyroiditis in childhood. The important contribution of fistulae between the piriform sinus and thyroid gland to the pathogenesis and acute suppurative thyroiditis is emphasized. Such a fistula should be sought in every patient in whom this entity is diagnosed.

Acute Disease↗
PubMed2003

Enhanced expression of Duffy antigen in the lungs during suppurative pneumonia.

Duffy antigen is a chemokine binding protein expressed on the surface of erythrocytes and postcapillary venular endothelial cells. It binds selective CXC and CC chemokines with high affinity. Although Duffy antigen is present in the normal pulmonary vascular bed, it is not known whether its expression is altered by innate inflammatory responses in the lungs. We studied Duffy antigen expression by immunohistochemistry in autopsy lung specimens from 16 cases of suppurative pneumonia, 11 cases of acute lung injury, and seven normal lungs. In lungs with suppurative pneumonia, Duffy antigen was expressed in higher numbers of pre- and postcapillary parenchymal vessels compared to normal specimens or specimens with acute lung injury (p<0.03 and p<0.02, respectively). Lungs with suppurative pneumonia also showed Duffy antigen expression on the alveolar septa, whereas this was a rare finding in normal specimens or in acute lung injury (p<0.02). Furthermore, Duffy antigen labeling of the alveolar septa localized to regions with airspace accumulation of neutrophil-rich exudates. In summary, Duffy antigen expression is increased in the vascular beds and alveolar septa of the lung parenchyma during suppurative pneumonia, suggesting that Duffy antigen may have a functional role in the lung parenchyma during inflammation.

Bronchi↗
PubMed1993

[A case of acute suppurative thyroiditis associated with thyroid papillary carcinoma].

A sixty-one-year-old female was admitted to our hospital in October 1988 because of fever and a right neck mass associated with redness and tenderness. The size of the thyroid mass had gradually increased over 3 months. Two masses were detected in the thyroid by ultrasonography and MRI. She has positive thyroid autoantibodies, high CRP levels and high erythrocyte sedimentation rates. While she had normal white blood cell counts, massive neutrophils were obtained from her thyroid mass by aspiration biopsy, indicating acute suppurative thyroiditis. However, we could not find any bacteria to cause suppurative thyroiditis either in the blood or in thyroid aspirates. Serum levels of thyroid hormone were slightly elevated but she did not complain of any thyrotoxic symptoms. Radioactive iodine uptake (RAIU) of the thyroid gland was markedly decreased (2%/24h). Following treatment with antibiotics, her inflammation and symptoms immediately improved, and pus spontaneously ran from the collapsed thyroid mass. Then serum thyroid hormone levels and RAIU were normalized and the right thyroid mass disappeared. She was discharged in December 1988. There were no signs of recurrence of suppurative thyroiditis until now. She received a pharyngo-esophageal barium examination in search of the route of infection 4 times, but no fistula was revealed. However, as her left thyroid mass consistently remained thereafter, an operation of the left thyroid mass was performed in December 1989. The histologic examination of the resected thyroid revealed the coexistence of encapsulated follicular adenoma, minute papillary carcinoma and chronic thyroiditis. There are few reports of such a case having a combination of suppurative thyroiditis, thyroid cancer and chronic thyroiditis observed in an elderly female.

Acute Disease↗
PubMed1983

Toothbrushing with hydrogen peroxide-sodium bicarbonate compared to toothpowder and water in reducing periodontal pocket suppuration and darkfield bacterial counts.

This study attempted to isolate and test the therapeutic effectiveness of toothbrushing with hydrogen peroxide-sodium bicarbonate supplemented with scaling and systemic antibiotics. Forty-two subjects selected for pocket suppuration were divided into two groups. Group I was treated sequentially with brushing, scaling and systemic antibiotics. Group II was treated with brushing and scaling performed concurrently. Half of each group were control subjects using an inert toothpowder. Subjects were monitored by darkfield microscopy for spirochetes and motile rods. In Group I, toothbrushing alone showed approximately a 1/3 reduction in the number of suppuration sites, no difference between experimental and control subgroups and no significant changes in the darkfield counts. Scaling, whether subsequent to the toothbrushing (Group I) or concurrent with the toothbrushing (Group II), showed a statistically significant reduction (about 70%) in the number of suppuration sites in all subgroups. Darkfield counts after scaling were reduced significantly in some subgroups but not in others. The addition of systemic antibiotics in Group I resulted in an almost total elimination of suppuration sites and spirochetes in 15 subjects, but there were no significant differences between the test and control subgroups. In both Groups I and II, neither experimental peroxide-bicarbonate subgroup could be differentiated statistically from its toothpowder-water control at any time.

Anti-Bacterial Agents↗
PubMed1988

Histological characteristics associated with suppurating periodontal pockets.

The purpose of this study was to characterize histologically the gingival lesion associated with suppuration in advanced periodontitis. Thirty-three bleeding, suppurating (S) and 23 bleeding, nonsuppurating (NS) interproximal biopsies were obtained from nine patients and processed for light microscopy. Pocket depths (mean +/- SD) were 6.7 +/- 1.6 mm (S) and 5.4 +/- 2.2 mm (NS). Six-micron serial sections were stained with (1) hematoxylin/eosin and (2) van Gieson. Quantitative cell types were determined by a grid intersection counting technique at x 1000. Volumetric analysis of collagen-poor (inflammation) areas was conducted using a computer biometric system that revealed three histologic patterns: Type I sites showed mild to moderate inflammation (less than 50% infiltrate, S = 15, NS = 20); Type II sites showed intense inflammation (greater than 50% infiltrate, S = 17, NS = 3); and only one (S) site had a large connective tissue abscess (Type III). The mean percentage of collagen-poor area was significantly larger in suppurating (42.1 +/- 25.5%) versus nonsuppurating (27.7 +/- 20.4%) sites (P = 0.02). In both S and NS sites, plasma cells (means = 66%) and lymphocytes (means = 27%) predominated in the inflammatory infiltrates. Histologically, suppuration appeared to be associated with increased gingival inflammation and a slight increase in connective tissue neutrophils.

Adult↗
PubMedDate not supplied

[Suppurative middle ear infection as a complication after tympanostomy tube placement].

INTRODUCTION: Suppurative otitis media after tympanostomy tube placement is the most frequent complication of this surgical intervention. Otorrhea that occurs in the first two weeks following tube placement is called early, late otorrhea occurs at least two weeks following placement. Early otorrhea is usually a result of either an infection that already existed when the tube was placed, or contamination of the external auditory canal during operation. Late otorrhea is mostly a result of upper respiratory tract infection. MATERIAL AND METHODS: Our investigation was performed at the ENT Department, Mother and Child Health Care Institute in Belgrade. The research included children treated for secretory or recurrent otitis media. RESULTS AND DISCUSSION: We have examined 411 children implanted with 796 tympanostomy tubes in the last three years. We investigated changes within two weeks after operation. Suppuration was recorded with 81 children (19.7%). Staphylococcus aureus was established in 33 (40.7%) Pseudomonas aeruginosa in 26 (32%), Haemophilus influenzae in 12 (15%) and Streptococcus pneumoniae in 10 (12.3%) cases. All children were treated with antibiotic ear drops according to the antibiogram for a period of 7 days. Full recovery was achieved after treatment with Ciprofloxacin drops in 67%, Neomycin in 18% and Gentamycin in 9% of cases. In other cases a combination of drops and oral antibiotics was used. CONCLUSION: In cases of suppurative otitis media after implantation of tympanostomy tubes, the secret should be treated with suction and after that antibiotic drops should be applied during 5 to 7 days. If suppuration is persistent, drops should be used with oral antibiotics.

Adolescent↗
PubMedDate not supplied

[Facial nerve paralysis as a sequelae of chronic suppurative otitis].

INTRODUCTION: Facial palsy can be a consequence of untreated chronic suppurative otitis media. This disease can last for many years manifesting as partial deafness and ear effusion resulting in palsy after spreading of pathological process in the surrounding cranial structures. The patient with facial palsy cannot rise his forehead, nor close his eye on the involved side, while his cheek and lips just fall. MATERIAL AND METHODS: This retrospective research included patients operated for chronic suppurative otitis media with facial palsy during the last ten years. We have examined data on duration of disease, time of development of facial palsy and relations with other otogenic complications. RESULTS: We described 19 patients with this otogenic complication. Most of them--13 (68%) had symptoms of chronic suppurative otitis media for several years. In some cases, we found other otogenic complications, like acute mastoiditis in 4 (21%), meningitis in 4 (21%), cerebral abscesses in 1 (5%) and cerebellar abscesses in 1 (5%). All patients were operated and the pathological process was completely removed. During operation we found polypoid formations in 9 (47%) patients, granulation tissue in 8 (42%) and cholesteatoma in 7 (37%) cases. In 16 (84.2%) we did not find any visible defects on facial nerve canal, in 2 (10%) cases pathological process destroyed the canal in the tympanic region, and in 1 (5%) facial nerve was partially bare in tympanic and mastoid region. 16 (84.2%) patients have fully recovered, in 2 (10%) cases sequelae remained and in 1 (5%) patient, who had meningitis and cerebral abscess, there were no signs of recovery. DISCUSSION: Facial paralysis as an otogenic complication, can originate from acute otitis media and secretory otitis media. The pathological process in chronic suppurative otitis media causes changes in mucous of middle ear, manifested by edema, submucous fibrosis and infiltration with chronic inflammation cells. Progressive spreading of these inflammation changes causes osteitis, which provokes invasion and bone destruction of inner ear, durae or facial canal and development of palsy. The sex of patients is not relevant. The significant data concern the duration of disease since 13 (68%) patients have suffered from chronic otitis for several years. This points out the silent character of the disease. The clinical picture of all patients with peripheral facial palsy is identical, no matter of etiology, so they are often wrongly classified and treated as Bell's palsy. That is the reason for imperative examination of middle ear in every patient with respective symptoms. Late and inadequate treatment is a common cause of further progressiveness of disease, which causes development of other otogenic complications that can jeopardize life of patient. Acute mastoiditis is the most frequently mentioned, but we also recorded the most severe complications as otogenic meningitis and cerebral and cerebellar abscesses. It is possible that bacterial toxins penetrate and provoke neuritis with bigger or smaller edema. On the other side, it is commonly considered that facial palsy appears with cholesteatoma of middle ear. Cholesteatoma directly distracts bones and provokes inflammation and also makes compression on nerve itself. Our research showed that there were no visible bone defects in most of the cases 16 (84%), but process developed through cracks, and only in 2 (10%) defect was in tympanic part of canal and in 1 (5.8%) facial nerve was bare in tympanic and partially in mastoid part two centimeters in length. Pathological process was operationally removed without opening the facial canal, because removal of the process provides decompression and relieve of nerve. Operation is followed by medicamentous treatment (antibiotics, corticosteroids). This treatment succeeded with full recovery in 16 (84.2%) patients, partial recovery in 2 (10%) and only one did not have any signs of recovery. CONCLUSION: Otogenic facial

Chronic Disease↗
PubMed2002

Needle aspiration as a diagnostic tool and therapeutic modality in suppurative lymphadenitis following Bacillus Calmette Guerin vaccination.

OBJECTIVES: Outbreaks are known to occur after Bacillus Calmette Guerin (BCG) vaccination. An outbreak of suppurative lymphadenitis in 18 infants, following BCG vaccination is reported from Sikkim, with incidence of 8.6%. The outbreak occurred after a change of vaccine. METHODS: In a prospective study the cases of suppurative lymphadenitis were diagnosed by needle aspiration cytology and culture of the material aspirated and managed only with repeated needle aspiration and no antitubercular treatment was given. RESULTS: Cytomorphology revealed necrosis alone in 66.6% and necrotizing granulomas in 22.2%. Acid and alcohol fast bacilli were detected in 77.7% cases. Mycobacterium bovis was isolated in eight cases. One case of staphylococcal suppurative lymphadenitis was detected. Sixteen cases were managed with weekly aspiration with mean period of resolution in eight weeks. CONCLUSIONS: Needle aspiration is useful in the diagnosis and effective in the management of these cases. No antitubercular treatment is desired and required in the cases of suppurative lymphadenitis following BCG vaccination.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis].

Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed. Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients. Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes. Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties. Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties. More than one surgery has been performed in some patients. The risk of infectious complications has been higher in these patients. Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e. in 8.6%. Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis. An infection of postoperative wound is the most severe local complication in vascular surgery. It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.

Adult↗
PubMed2004

[Analysis of sensorineural hearing loss in chronic suppurative otitis media].

OBJECTIVE: To explore the association between chronic suppurative otitis media and sensorineural hearing loss. METHOD: The files of 147 patients with unilateral chronic suppurative media were reviewed in a retrospective study. Differences between diseased and control ear bone conduction thresholds were analysed by the paired student's t-test over the four frequencies (0.5 kHz, 1.0 kHz, 2.0 kHz, 4.0 kHz). The effect of the presence of cholesteatoma and ossicular erosion on sensorineural hearing loss over the speech frequencies (0.5 kHz, 1.0 kHz, 2.0 kHz) and 4.0 kHz were analysed by one-way ANOVA. Linear regression models were used to clarify the relationships between sensorineural hearing loss and chronic suppurative otitis media. RESULT: The differences in bone conduction threshold between diseased and control ear were statistically significant. Bone conduction threshold shift at speech frequency was associated with the ages. The presence of cholesteatoma and ossicular erosion was not associated with a significantly increased risk of sensorineural hearing loss. CONCLUSION: Chronic suppurative otitis media can result in sensorineural hearing loss. The higher frequencies are easier affected than the lower frequencies.

Adolescent↗
PubMed1991

[The prevention of suppuration of postoperative wounds].

A method to prevent operative wound suppuration is offered. An experimental animal model of operative wound suppuration was elaborated to specify rational antibiotic-antiseptic prophylaxis and adequate wound drainage. This yielded a complex of measures to prevent purulent complications on the part of the operative wound. In addition, an original turbidimetric technique to assess the resistance of the biological fluid microflora to antisepsis was elaborated. The complex prophylaxis against suppuration of infected wounds was clinically tested on 124 patients operated on for different acute surgical conditions of abdominal organs. The wound process was controlled by means of an original endoscopic-bacteriologic technique. The postoperative period was complicated by the wound suppuration in two of the 124 patients (1.6 per cent). The postoperative hospital stay in most cases lasted 5-7 days.

Adult↗
PubMed1989

Bacteriological study of choledochal bile in patients with common bile duct stones, with or without acute suppurative cholangitis.

Acute suppurative cholangitis is a serious complication in extrahepatic biliary tract obstruction. Bacteriological studies have shown that in these patients the bile cultures usually present several kinds of bacteria, especially Gram-negative aerobic bacteria such as E. coli and Klebsiella sp. The mortality rate in our patients with common bile duct stones and acute suppurative cholangitis is enhanced 5- to 10-fold. The aim of the present study was to analyse the bacterial properties of choledochal bile in a large number of patients with common bile duct stones, with or without acute suppurative cholangitis, and to determine the sensitivity of the isolated bacteria to several antibiotics used in clinical practice. The greatest sensitivity of the bacteria isolated from the common bile duct was seen for aminoglycosides (gentamicin and amikacin) and for cephalosporins, especially of the third generation (cefotaxime, ceftazidime, ceftriaxone and cefoperazone). Ampicillin showed a low sensitivity rate. The appropriate selection of the antibiotics used in acute suppurative cholangitis depends not only on the concentration of the antibiotic in the bile; a high plasma concentration is even more important to control the septic manifestations. A high excretion to the bile can affect the intestinal flora, leading to diarrhea (e. g. with cefoperazone). Ampicillin has been giving contradictory results in respect of bile and plasma concentrations. Gentamicin attains 30-40% of the plasma concentration in the bile, but persists for as long as 8 hours with excellent sensitivity and clinical efficacy. Amikacin reaches 44% of the plasma concentration with a very high sensitivity (96%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗