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At least 883 records · Page 49Linked to original sources
PubMed2003

Amoebic liver abscess--results of a conservative management policy.

OBJECTIVE: To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. DESIGN: A prospective study carried out over a 1-year period. SETTING: Inpatients and outpatients in a tertiary referral institution. SUBJECTS: Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours. MAIN OUTCOME MEASURES: Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). RESULTS: In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. CONCLUSION: Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.

Adult↗
PubMedDate not supplied

[Giant liver abscess due to nearly asymptomatic choledocholithiasis].

Solitary pyogenic liver abscess is usually caused by a metastatic infection through the portal blood flow or through the hepatic arterial blood flow from extra-abdominal pyogenic foci. Besides, it may be the result of local inflammatory diseases, such as cholecystitis, hydatid cyst, haematomas particularly with retained foreign bodies, etc. Suppurative cholangitis usually causes multiple pyogenic liver abscesses. Solitary pyogenic abscess is rarely caused by cholangitis, but practically always by suppurative cholangitis. Giant pyogenic liver abscess due to asymptomatic or mild cholangitis is a rarity. We present on a 63 year old man who developed a giant solitary pyogenic liver abscess in whom no other possible cause could be found or anticipated except practically almost asymptomatic choledocholithiasis accompanied with mild elevation of bilirubin content, alkaline phosphatase and gamma-GT. The patient was successfully treated operatively. Over 1800 ml. of pus was aspirated from the abscess cavity. Operative cholangiography performed in spite of the absence of gall bladder stones undilated and noninflamed common bile duct stone showed a small nonobstructing distal common bile duct stone. The duct was not dilated, the bile was clear and there were no signs of cholangitis in the inside of the common bile duct. Cholecystectomy and abscess cavity drainage led to uneventful recovery. The patient has been symptom-free for more than 3.5 years.

Gallstones↗
PubMed1992

[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↗
PubMed2003

Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes.

Over a 6.5-year period, 5,848 patients who had ingested a foreign body were admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong. Potentially serious complications developed in 12 patients (0.21%). Eight patients had an esophageal perforation; three had clinical evidence that their injury had been caused by the foreign body itself and five were deemed to have been injured iatrogenically during esophagoscopy. One of the latter group eventually developed an abscess. Four patients originally presented with an abscess. Three of these patients and the patient who later developed an abscess were treated with neck exploration and surgical drainage. One of the patients who initially presented with an abscess refused surgical treatment and was treated conservatively. Conservative treatment was also initiated for all patients who had a perforation. Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal) related to an ingested foreign body should be explored and surgically drained.

Abscess↗
PubMed1992

Percutaneous catheter drainage of tubo-ovarian abscesses.

We present the successful treatment of tubo-ovarian abscesses in three young patients by continuous percutaneous drainage, inserted under the guidance of real-time ultrasonography using only local anesthesia. Each patient had been diagnosed laparoscopically as suffering from acute pelvic inflammatory disease, but had formed abscesses despite extensive broad-spectrum antibiotic therapy. One case involved a complication of the ovum pick-up procedure; the woman had tubo-ovarian abscesses with infected hematomas. Because the abscesses were localized anteriorly in the lower abdomen and did not reach the pouch of Douglas, they could not be drained through a posterior colpotomy. Ultrasound guidance allowed us to drain all the areas of the multioculated abscesses. We suggest that percutaneous abscess drainage be the initial treatment of choice for tubo-ovarian abscesses before laparotomy is considered.

Abscess↗
PubMed2004

Causative agents of liver abscess in Thai hepatitis B carriers.

Liver abscess and hepatitis B virus (HBV) infection are two significant tropical gastrointestinal disorders. The concurrence between these two disorders yields poor prognosis, which then often leads to the need for intensive care. The aim of this study was to investigate the causal pathogens of liver abscess in HBV carriers. This retrospective case review was conducted on 35 Thai hospitalized HBV carriers who had diagnosis of liver abscess. A high rate of amoebic liver abscess in this series (37.1%) was demonstrated; Gram-negative aerobes were the major abscess pathogens. The causative pathogens of HBV carriers were similar to those in the overall patient population with abscess. The treatment plan for liver abscess in the general population can also be applied to HBV carriers.

AIDS-Related Opportunistic Infections↗
PubMed2004

[Diffusion-weighted MRI in the differentiation of brain abscesses and necrotic tumors].

PURPOSE: The differential diagnosis between brain abscesses and necrotic tumors such as glioblastomas and metastases is often difficult by conventional MRI. The goal of our study was to evaluate the ability of the diffusion-weighted (DW) MRI to differentiate these lesions from each other. MATERIALS AND METHODS: MRI was performed in 19 patients (four abscesses, seven glioblastomas, two anaplastic astrocytomas, six metastases). In addition to standard MR sequences, trace DW imaging and apparent diffusion coefficient (ADC) maps were performed. ADC values were calculated for all lesions. For statistical analysis student t-test was used. A p value less than 0.05 indicated a statistically significant difference. RESULTS: The central portion of all six metastases and eight of nine high-grade gliomas showed unrestricted diffusion, whereas all four abscesses showed restricted diffusion (low ADC values) in their cavity. However, restricted diffusion also was found in one glioblastoma. The ADC values of abscesses (0.69-/+0.05 x103 mm2/s) were significantly lower than of 15 malignant necrotic tumors (2.39-/+0.63 x 103 mm2/s). The difference between abscess and necrotic tumors was statistically significant (p<0.001). CONCLUSION: DW MRI can be used to identify a brain abscess and can help to differentiate it from a cystic brain tumor. However, restricted water diffusion is not specific and pathognomonic in the differential diagnosis between abscesses and necrotic tumors.

Adolescent↗
PubMed2004

[Nocardial brain abscess: surgery and postoperative antibiotic therapy].

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Adult↗
PubMed2004

Role of diffusion-weighted imaging and proton MR spectroscopy in distinguishing between pyogenic brain abscess and necrotic brain tumor.

Brain abscesses and brain tumors may have similar clinical presentations. For example, only 50% brain abscess patients have fever, which could be masked by corticosteroid therapy. Also, the differential diagnosis of brain abscesses versus cystic or necrotic tumors may be difficult based on computed tomography (CT) or magnetic resonance (MR) imaging findings. However, the strategies of management for abscess and neoplasm are very different, and it is especially imperative to have a correct diagnosis before any surgical intervention of cystic brain lesions. The MR special techniques, e.g. diffusion-weighted imaging (DWI) and proton (1H) MR spectroscopy, are useful as additional diagnostic modalities for differentiating brain abscesses from cystic or necrotic brain tumors. DWI shows high signal intensity in most cases of pyogenic abscesses and low signal intensity in most cases of cystic or necrotic tumors. MR spectroscopy shows characteristic metabolites in pyogenic abscesses, distinct from those in cystic or necrotic tumors.

Brain Abscess↗
PubMed2004

[Testicular abscess: report of 2 cases].

We report two cases of testicular abscess. The first case is in a 53-year-old man who had been suffering from diabetes mellitus. Because of cerebral infarction, he had been bedridden and a Foley catheter had been indwelt for a long period of time. The second case is in a 78-year-old man who had suffered from acute prostatitis six months earlier. In both cases, the chief complaints were high fever and painful scrotal swelling. At initial evaluation, ultrasonography revealed that the affected testes were swollen without abscess formation and an ipsilateral epididymal swelling was demonstrated in the second case but not in the first case. The urine bacterial culture (UBC) result was positive for Escherichia coli in first case and Pseudomonas aeruginosa in the second case. In both cases, fever and scrotal pain subsided after antibiotic chemotherapy, and inflammatory reactions on routine blood studies were normalized within 2 weeks. Nevertheless, the swollen testes did not sigunificantly reduce in size, and testicular abscess was suspected by magnetic resonance imaging (MRI). Orchiectomy was performed, and intratesticular abscess formations were confirmed macroscopically and microscopically. In each case, bacterial culture from the abscess was positive for the same bacterium as detected from the UBC. It is difficult to distinguish testicular abscess from acute epididymitis at the early stage because of similarities on symptoms or signs between the two. If testicular swelling lasts after appropriate chemotherapy, we believe that attention should be directed to testicular abscess, which needs orchiectomy to obtain a complete cure and MRI is useful in its diagnosis.

Abscess↗
PubMedDate not supplied

A case of multiple amoebic liver abscesses: clinical improvement after percutaneous aspiration.

Amoebic liver abscesses are by far the most common extra-intestinal manifestation of invasive amoebiasis. The classical clinical picture consists of fever, right upper quadrant pain and hepatomegaly. Ultrasound and serology make an early diagnosis possible. Amoebic liver abscesses usually appear singly and are normally situated in the right lobe of the liver. This case report refers to a white Belgian woman, living in an endemic area for amoebiasis, presenting with 25 amoebic liver abscesses, who did not improve clinically despite appropriate anti-amoebic therapy, is described. Only percutaneous drainage of the larger abscesses led to clinical recovery. Amoebic abscess aspiration and evacuation under ultrasonographic guidance is of limited risk, but in experienced hands may enhance clinical recovery, particularly in patients with large abscesses not responding to conservative medical treatment. Aspiration of large abscesses (> 5 cm) is rarely necessary but should be considered if there is no clinical improvement after 3 days of nitroimidazole treatment with amoebicides.

Adult↗
PubMed2004

[Value of "low-signal zone" sign in the diagnosis of brain abscess in the capsule period].

OBJECTIVE: To evaluate the value of "low-signal zone" sign in the diagnosis of brain abscess in the capsule period. METHODS: The conventional MRI was performed pre-therapy in 21 patients with brain abscess in the capsule period and 25 patients with vesica-astrocytomas. We analyzed the pathologic basis of "low-signal zone" sign in brain abscess and compared the frequency and shape of "low-signal zone" sign in brain abscess and vesica-astrocytomas. RESULTS: The "low-signal zone" sign in MRI occurred more frequently in brain abscess (85.7%, 18/21) than in vesica-astrocytomas (52.0%, 13/25). The "low-signal zone" sign in the former was intact, while that in the latter was not. CONCLUSION: The "low-signal zone" sign is helpful to diagnose brain abscess in the capsule period, and is valuable to differentiate brain abscess and vesica-astrocytomas.

Adolescent↗
PubMed1992

[Usefulness of 111In labeled leukocytes scintigraphy combined with 99mTc phytate liver scintigraphy for diagnosis of hepatic abscess comparing with CT and US].

111In labelled leukocyte scintigraphy (ILLS) was performed in five patients with hepatic abscess. For the accurate diagnosis of hepatic abscess, ILLS was superimposed on 99mTc phytate liver scintigraphy. The results of ILLS were compared with CT and US findings. Four of five patients (80%) showed abnormal accumulations in the liver. The smallest abscess detected was 46 mm x 43 mm. CT scan showed rim enhancement, which was a specific finding for hepatic abscess, in three patients. It was rather difficult to diagnose hepatic abscess by US. In two cases without definite rim enhancement on CT, the abscesses were diagnosed as hot spots by ILLS. We conclude that ILLS combined with 99mTc liver scintigraphy is useful for the diagnosis of hepatic abscess.

Aged↗
PubMedDate not supplied

[Surgical alternatives in the treatment of anal abscesses].

INTRODUCTION: Anal abscess is a pus collection localized in some of the regions around the anus and rectum. We reviewed the experience in the management of abscesses in Coloproctology Unit at the Gastroenterology Service in the General Hospital of Mexico. MATERIAL AND METHODS: This is a retrospective, longitudinal and descriptive study in patients diagnosed as carriers of an anal abscess during the period from January 1998 to December 2002. RESULTS: During this period, 9,233 first consultations took place, 241 fulfilled inclusion criteria: 197 (81.74%) were male and 44 (18.25%) were female. Perianal abscesses affected 156 patients (64.73%), 51 ischiorectal abscesses (21.16%), 17 horseshoe (7.05%), 14 intersphincteric (5.80%) and 3 has supralevator abscesses (1.24%). CONCLUSIONS: There were 96.68% nonspecific anal abscesses. Simple drainage is an initial adequate management. Most patients (73%) were attended in the office. Pain was the most common symptom (99%). Perianal and ischiorectal localizations were the most frequently classified and there was no mortality.

Abscess↗
PubMedDate not supplied

CT and ultrasound imaging of retropharyngeal abscesses in children.

PURPOSE: To show the role of ultrasound (US) in distinguishing retropharyngeal abscess from adenitis in children. METHODS: Eleven infants and children had clinical symptoms suggestive of retropharyngeal infection. Radiographic evaluation included, lateral neck radiography (11/11), contrast-enhanced neck CT (10/11), contrast-enhanced neck MR (1/11), and real time US (11/11) patients. US was used to characterize masses as solid (adenitis) or complex (abscess) and for guiding intraoperative aspiration and drainage. RESULTS: Contrast CT and MR showed findings suspicious for abscess in all 11 cases. Only three children had surgically drainable abscesses. CT numbers within inflammatory masses did not distinguish adenitis from abscess. US was able to correctly diagnose abscess or adenitis in each case. CONCLUSION: Lateral neck radiography and contrast CT identify and localize retropharyngeal inflammatory masses in children. US, but not CT, distinguishes between adenitis and abscess and aids in intraoperative aspiration and drainage.

Abscess↗
PubMed2005

Bilateral peritonsillar abscess revisited.

Bilateral peritonsillar abscess is uncommon. When it does occur; patients usually present with sore throat; other clinical signs and symptoms may differ from those usually associated with unilateral peritonsillar abscess. We describe 2 cases of bilateral peritonsillar abscess that were successfully treated with needle aspiration of both sides with a 14-gauge intravenous cannula. Needle aspiration is an accepted form of treatment for unilateral peritonsillar abscess, but to the best of our knowledge, its use as a sole treatment modality (with observation under intravenous antibiotic coverage) for bilateral peritonsillar abscess has not been previously reported in the literature. We also believe that the incidence of acute bilateral peritonsillar abscess may be higher than the rates that have been reported in the literature. Finally, we recommend that the threshold for imaging be low for any patient who is suspected of having acute bilateral peritonsillar abscess to avoid any delay in diagnosis and treatment.

Adult↗
PubMed1991

[Otogenic brain abscesses in children].

In the years 1953-1989 in the Department of Otolaryngology, Medical Academy in Poznań 75 patients were treated for otogenic brain abscesses, among them 19 were children. In the last ten years the number of cases of this complication was not increased significantly in children and adults. In 3 cases abscess was diagnosed in acute otitis media, in the remaining cases it was a complication of chronic otitis media with cholesteatoma. Brain abscesses were situated more frequently in the temporal lobe. In children they developed more frequently on the right side. The survival in temporal lobe abscesses in children was 90%, and in cerebellar abscesses 75%. In adults the survival rate was about 80% for both localizations. In the treatment of these otogenic complications wide radical operation on the middle ear or ++antro-mastoidectomy with exposure of the dura and simultaneous approach to the abscess from the postoperative ear cavity, with puncture of the abscess and replacement of its contents with normal saline with antibiotic is the routine method in the Department.

Adolescent↗
PubMed1991

Analysis of septic morbidity following gunshot wounds to the colon: the missile is an adjuvant for abscess.

Over a 7-year period, 151 patients with gunshot wounds to the colon surviving beyond 24 hours were managed. The bullet was retained in the body in 66% and exited in 34%. Thirty-four (23%) developed major septic complications (diffuse peritonitis, 21%; intraperitoneal abscesses 24%; and extraperitoneal abdominal abscesses, 56%). The septic complication rate was 26% in the bullet-present group compared with 16% in the remainder (p less than 0.15). The increased septic rate in those with bullets present was the result of abscesses developing around the retained missile. That group with missile abscesses had a lesser degree of injury as measured by the abdominal trauma index compared with the other patients with septic complications (p less than 0.001). Fifteen (79%) of the 19 patients with missile and missile track abscesses had them develop in the psoas muscle. These abscesses occur by fecal contamination of the muscle following inoculation by the bullet, which passes through the large bowel. Computed tomography-guided and operative drainage tend to fail if the foreign body is not removed. Computed tomography-guided or operative drainage should be successful in draining missile track abscesses when the bullet has exited the patient.

Abdominal Muscles↗