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Computerized tomography and surgical treatment in intracranial suppuration. Report of 30 consecutive unselected cases of brain abscess and subdural empyema.

The authors report their experience with 30 cases of intracranial suppuration: 23 with brain abscess and seven with subdural empyema. All of the cases were diagnosed by means of computerized tomography and enhancement with intravenous contrast material. Most of the patients were treated by single or repeated aspiration through burr holes.

Brain Abscess↗

Acute suppurative dacryoadenitis caused by a cysticercus cellulosa.

A case of acute suppurative dacryoadenitis caused by a cysticercus cellulosa in a male of 20 years is reported. The diagnosis was established by histopathologic examination of the cyst that escaped along with pus during drainage of the abscess. The abscess in the palpebral lobe of the lacrimal gland resulted from acute inflammation produced by the presence of an intact larva. There was no other focus of cysticercosis in the same eye, in the other eye, or anywhere else in the body. Postoperative recovery was uneventful and there were no sequelae. To our knowledge, this is the first case report of acute dacryoadenitis caused by a cysticercus cellulosa. As cysticercosis is still prevalent in the underdeveloped countries, it is to be kept in mind in the differential diagnosis of ocular and adnexal lesions in patients coming from these areas of the world.

Abscess↗

Acute obstructive suppurative cholangitis.

Acute obstructive suppurative cholangitis is an uncommon condition which, if unrecognized, carries a high rate of mortality. This study of 12 patients highlights the clinical features as well as the poor outcome of delayed surgical decompression. Endoscopic and percutaneous drainage of the obstructed biliary tree in acutely ill patients may improve the results of subsequent surgery.

Acute Disease↗

Spondyloarthropathy associated with hidradenitis suppurative and acne conglobata.

We evaluated 10 patients with hidradenitis suppurative or acne conglobata who developed arthritis. In contrast to patients with acne fulminans and arthritis, all our subjects were adults over 22 years of age; nine were black; and four were women. Nine patients had episodic inflammatory oligoarthritis affecting mainly larger joints of the upper and lower extremities. Eight patients had roentgenographic evidence of peripheral arthritis, four with erosions. Nine had clinical axial arthropathy, but roentgenograms showed abnormalities of the axial skeleton in all 10 patients. Pyoderma gangrenosum, erythema nodosum, conjunctivitis, urethritis, and oral and penile ulcers occurred in some patients. Rheumatoid factor was negative in all patients; the erythrocyte sedimentation rate was elevated in nine; five had chronic anemia; four had circulating immune complexes; and complement components were elevated in four. There was no increased incidence of HLA-B27 or other HLA-B7 cross-reacting antigens. A temporal relation of skin and joint disease activity was suggested. We report a spondyloarthropathy associated with hidradenitis suppurativa and acne conglobata. Clinical and laboratory manifestations suggest the arthropathy may be reactive to chronic cutaneous infection.

Acne Vulgaris↗

[Suppurative-necrotic pancreatitis and its surgical treatment].

Purulent-necrotic processes in the pancreas may arise against the background of different forms of acute pancreatitis. Biological tamponade of the pancreas with the greater omentum and hermical closure of the abdomen result in a reduced number of cases of the gland suppuration. The treatment of purulent pancreatitis should be complex, comprising an early surgical intervention with subsequent rational conservative therapy.

Abscess↗

[Course of the postoperative period in infants with suppurative lung diseases].

An analysis of postoperative complications in 167 infants, operated for suppurative lung diseases, indicated that these complications are mainly the result of the purulent-inflammatory process progression. Recommendations concerning the prophylaxis against these complications with the analysis of the results of their use are given.

Bronchial Fistula↗

[Sodium hypochlorite in the treatment of the suppurative-septic complications in patients with strangulated hernias].

The article presents an analysis of surgical treatment of 2155 patients with incarcerated hernias of the anterior abdominal wall. Pyo-septic complications took place in 24.3%. A comparison of results of treatment by traditional methods with those using solution of sodium hypochlorite (indirect electrochemical oxidation of blood) has shown that in the group of patient treated with sodium hypochlorite lethality was reduced from (18.8 +/- 0.2)% to (11.2 +/- 0.2)%, the amount of suppuration of the operative wound was 1.8 times less and the average number of bed-days was (4.5 +/- 0.2) less.

Disinfectants↗

[Postoperative intraabdominal suppurations due to Ristella. Clinical, bacteriological and therapeutic characteristics].

From 1972 to 1974, 8 intraabdominal postoperative suppurations due to Bacteroides have been observed at Hospital Beaujon. Three characteristic features of such infections have been analysed: the high frequency of associated jaundice; the difficulty of isolation of the Bacteroides; their specific sensitivity to some antibiotics. In 5 patients, jaundice related to the bacterial infection has been observed; jaundice was of the cholestatic type; it was mainly due to conjugated hyperbilirubinemia; in approximately 50 p.cent of the cases, serum alkalin phosphatases activity and serum glutamic-pyruvic transaminase activity were moderately elevated; the presence of jaundice did not seem to have any influence on the prognosis. The frequent association to Bacteroids of enterobacteria makes isolation of the Bacteroides difficult. The necessity of some precautions in the handling (storage at 4 degrees C or immediate inoculation in anaerobic conditions) is emphasized. Bacteroides are always resistant to penicillin and to the other broad spectrum antibiotics usually effective enterobacteria. They are sensitive to tetracyclins (5/8), lincomycin (2/4), clindamycin (2/3), rifampicin (8/8), pristinamycin (7/7), carbenicillin (3/3), erythromycin (8/8) and chloramphenicol (8/8).

Alkaline Phosphatase↗

Suppurative arthritis of the hip in children.

Of thirty-seven children treated at the Mayo Clinic for suppurative arthritis of the hip and followed for at least one year (average, 8.3 years), nineteen had a satisfactory result and eighteen, an unsatisfactory result. An analysis of the records of the thirty-seven children revealed the following: (1) duration of symptoms was the most important prognostic feature, there being no unsatisfactory results if treatment was instituted less than four days after onset of symptoms; (2) fourteen of sixteen patients with associated osteomyelitis and six of eight with so-called penicillin-resistant Staphylococcus aureus had unsatisfactory results; (3) if symptoms had been present for more than ten days or if there was osteomyelitis, at least two weeks of parenteral antibiotics with arthrotomy and continuous irrigation offered the best prognosis; and (4) the prognosis has improved in recent years, possibly due to a move vigorous policy of early arthrotomy.

Adolescent↗

[Macrolide antibiotics for oral intake in the treatment and prevention of suppurative surgical infection].

The authors studied the clinical efficacy of antibiotics of the macrolides group--erythromycin, oleandomycin, triacetylalleandomycin and leukomycin--in complex treatment of 280 patients with suppurative surgical infection caused by a gram-positive, mainly staphylococcal, microbial flora. Various medicinal forms were used: tablets, capsules, granules, syrup. Efficacy of treatment comprised 70-78 per cent. Tolerance of antibiotics was good in the majority of patients.

Administration, Oral↗

[MR imaging of ano-perineal suppurations].

A good digital examination is usually sufficient for the diagnosis and the treatment planning of anal fistulae. Cross-sectional imaging techniques, however, can accurately identify deep abscesses and characterize complex fistulae. MRI is well suited for this examination, with almost no motion artifact, excellent contrast between muscles and fatty spaces, and multiplanar acquisition. A fistula starts from an internal opening in the digestive tube and can end in an abscess cavity or open at the skin at an external opening. The cryptoglandular anal fistulae (fistula-in-ano) are non-specific in origin and are usually simple, whereas specific fistulae are due to many diseases such as Crohn's disease, tuberculosis, trauma, radiation, colloid carcinoma, hidradenitis suppurative, actinomycosis or lymphoma and are often complex. MRI appears useful in the cases with recurrent fistulae, Crohn's disease, when the secondary orifice is atypically placed, during a multistep treatment for complex fistulae, or when an anal stenosis forbids a clinical or ultrasound examination. A good knowledge of the perineum anatomy is required for analysing the fistula tracts. The muscle planes separate fatty spaces which have an important role in the spread of the disease: sub-mucosal space, marginal space, intersphincteric space, postanal space of Courtney, supralevator space, and the two ischioanal spaces on both sides of the anal canal. The anal canal is surrounded by the ring-like internal sphincter, which continues the internal muscularis propria of the rectum, and the external sphincter, which is intermingled with the puborectalis muscle. We perform our MRI examination with an external phased array coil, and we place a cannula to identify the anal canal. The T2W sequences give the more interesting information, but the sequences with fat-suppression and gadolinium chelate injection are also very useful. The MRI examination allows the analysis of: 1) the location of the fistula tracts according to Park's classification, 2) the location of the internal opening, 3) the locations of the external opening(s), 4) the location of deep abscesses, 5) the long distance extensions, 6) the state of the ano-rectal wall and the perirectal spaces, 6) the damages of the anal sphincter.

Abscess↗

Suppurative sinusitis in critically ill patients: a case report and review of the literature.

Nosocomial sinusitis is occasionally overlooked as a source of sepsis in critically ill patients. Physical examination is usually unreliable and purulent nasal discharge is absent up to 73% of the time. Computed tomography scans of the sinuses and aspiration and culture of sinus fluid are the hallmark of diagnosis. Therapy consists of removal of tubes and packing, appropriate antibiotics, and drainage. Risk factors for nosocomial sinusitis include nasotracheal tubes, nasogastric tubes, prior steroid and antibiotic therapy, and facial fractures. This article reports a case of suppurative sinusitis following prolonged intubation and reviews the literature.

Critical Care↗

Radiographic signs of acute suppurative cholecystitis.

In a recent series of 26 pathologically proven cases of acute cholecystitis, preoperative radiographic examination of the abdomen confirmed the presence of an inflammatory process in 17. The radiographic signs associated with acute suppurative cholecystitis are:1. Enlargement of the gallbladder, as indicated by separation or alteration in position of opaque calculi or indentation of adjacent bowel.2. Localized peritoneal irritation, manifested by (a) ileus of hepatic flexure of colon; (b) ileus of duodenal loop; (c) effacement of haustra of the hepatic flexure or valvulae conniventes of the duodenum; (d) obscuration of fat line marking inferior border of liver.3. Cholecystitis emphysematosa.4. Perforation of gallbladder, which if localized (retroperitoneal) is manifested by bubbles of gas in the gallbladder bed. If generalized (intraperitoneal) the signs are adynamic ileus of small and large bowel, increased intraperitoneal fluid, subdiaphragmatic abscess and plate atelectasis of right lung base. Visualization of the gallbladder and biliary tree after intravenous cholecystography rarely occurred in the presence of acute cholecystitis. Plain film examination of the abdomen aids in establishing the diagnosis of an acute cholecstitis and leads to the early recognition of complications such as perforation and peritonitis.

Abdomen↗

[Prevention of suppuration in open fractures].

The authors have elaborated the complex of prophylactic measures against suppuration in treatment of open bone fractures, a special attention being given to the use of specific and nonspecific antistaphylococcic drugs: antibiotics of a wide spectrum of action, adsorbed staphylococcic anatoxin and staphyloccic polyvalent bacteriophage. Therapeutic measures and the results of their utilization are described.

Adolescent↗

[Biliogenic liver abscess caused by acute obstructive suppurative cholangitis].

Biliogenic liver abscess was found by autopsy in 52 of 61 (85.2%) cases died of acute obstructive suppurative cholangitis (AOSC) at our hospital from 1957 to 1980. Of the 52 cases with liver abscess, 44 (84.6%) had multiple abscesses and 47 (90.4%) suffered complications of the rupture of liver abscess. Liver abscess was clinically diagnosed in only 7 of 52 cases who underwent emergency operation, with the predeath definite diagnosis of 13.5% (7/52). The authors considered biliogenic liver abscess an inevitable outcome not an accidental complication of AOSC when the high pressure in bile duct could not be relieved, and emphasized the importance of prevention, early diagnosis and treatment of liver abscess in order to decrease the mortality of AOSC.

Acute Disease↗

[The role of the genotype in the development of suppurative inflammatory complications in trauma to the facial bones].

The distribution of the genetic markers of leukocytes (HLA I and II), serum proteins (allotypes Gm, transferrin, haptoglobin, group-specific component), red cell enzymes (acid phosphatase--AP, phosphoglucomutase--PGM, esterase D, adenosine deaminase) was found to be universal in patients suffering from various pyoinflammatory diseases. The incidence of HLA A10, Cw4, DR5 antigens, IgG allotype G1m (2) and phenotype G1m (+1+2) and AP (aa) and PGM (2-2) phenotypes was found increased in patients with maxillofacial suppuration and pyoinflammatory complications of maxillofacial injuries as against normal subjects and patients with maxillofacial injuries without such complications. Traumatic osteomyelitis much more often develops in the carriers of the before genetic markers than in those in whom these markers are absent (61.6 and 20.4%, respectively).

Abscess↗