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PubMed1991

[Abscess of the psoas: a not-so-rare entity. Analysis of a series of 18 cases].

We have studied 18 patients with abscess at the psoas who had a mean age of 43.55 +/- 18.9 years and a predominance of males (77.8%). In nine cases the abscess was secondary to a lumbar discal spondylitis, in 5 cases to a sacroiliitis, in one case to abdominal disorder, and 3 cases the abscess was considered of a primary origin. The etiologic agents were S. aureus (8 cases), E. granulosus (5 cases), M. tuberculosis (3 cases), and B. melitensis (1 case). In one patient the infective agent was not isolated and in two cases the abscesses were infected by E. granulosus and P. aeruginosa. The clinical picture on admission was studied in all cases. Microbiological and pathologic analysis of the abscess allowed to establish the diagnosis in 11 cases (yield: 84.6%). Computerized axial tomography was the most useful imaging technique. Antimicrobial treatment was undertaken in 16 cases. Four patients recovered with pharmacological treatment alone. Surgical treatment was performed in 13 cases. Aspirative punction/drainage was carried in only one patient. The clinical course was favourable in 16 patients (88.9%). Our data indicate that the incidence of abscess of the psoas in cases of intraabdominal infections is low. In our series the incidence of abscesses secondary to hydatidosis is relatively high.

Abscess↗
PubMed1991

[The relationship between predisposing factors in liver abscesses and the causative bacteria].

In order to assess the correlation between bacteria isolated from liver abscesses and factors predisposing to liver abscesses, a retrospective study of clinical and bacteriological data on 21 patients with 27 episodes of pyogenic abscesses was carried out at the University Medical Centre, Amsterdam. Out of 27 episodes, 15 (55%) were associated with biliary or pancreatic disease; in seven of these 15 episodes more than one microorganism was cultured. Enterobacteriaceae were isolated in 13 (85%) of 15 episodes. Anaerobic bacteria were recovered only when operations in the pancreatico-biliary area had been performed previously. Seven episodes (26%) were related to extrahepatic disease; anaerobic bacteria (Bacteroides and Fusobacterium spp.) were isolated in five of these seven episodes. Streptococcus milleri seemed especially prominent, since this bacterium was cultured in six of seven episodes. Enterobacteriaceae were not involved in these seven episodes. Other factors predisposing to liver abscesses (15%) were diabetes mellitus n = 2), paraproteinaemia (n = I), and metastatic carcinoid (n = I). Blood cultures were positive in 65% of 23 episodes, but 40% of the positive cultures contained a smaller number of bacterial species than could be cultured from the abscess itself. Bacteria isolated from liver abscesses are related to the underlying predisposing condition. For diagnosis of the underlying condition and antibiotic therapy, puncture and bacteriologic examination of the abscess is essential.

Adult↗
PubMed1990

Indium-111-granulocyte scintigraphy in brain abscess diagnosis: limitations and pitfalls.

The scintigrams and records of 28 patients referred for indium-111-granulocyte scintigraphy (111In-GS) because of a suspected brain abscess were studied retrospectively. The final diagnosis was brain abscess in 8 patients, brain tumor in 18 patients, and infarct and hematoma in 1 patient each. Five patients not on corticosteroid treatment showed intense focal 111In accumulation in abscesses, whereas an abscess patient receiving a high steroid dose showed no uptake. Two patients studied twice showed intense uptake in abscesses when not on steroid therapy or on a low dose, whereas no uptake was seen when they received high or medium doses. Weak or moderate 111In uptake was observed in nine tumors. Microscopically assessed degree of tumor granulocyte infiltration, vessel proliferation, and hemorrhage did not correlate with the outcome of 111In GS. Our results suggest that intense focal cerebral 111In uptake favors the abscess diagnosis. Abscesses may go undetected, however, in patients on high- or medium-dose steroid therapy.

Adolescent↗
PubMed1987

[Results of treatment of pyogenic liver abscesses].

In the last 7 years 53 patients with liver abscesses were treated at surgical clinic of Charité. Since November 1982 we treated in 27 cases with solitary and multiloculary liver abscesses by percutaneous drainage of the abscess diameter more than 3 to 4 cm. 12 patients with multiloculary small biliary liver abscesses were treated by antibiotics. The bacteriological examination were performed after CT-supported puncture of the abscess. Seven patients with complicated abscesses could not be healed with CT-drainage. Surgical drainage via laparotomy was necessary. The diagnostic clarification of the dignity is important in every case. The lethality of all treated liver abscesses was 5.6% and the causes of death were the existing basic diseases.

Adolescent↗
PubMed1989

Acute gluteal abscesses: injectable chloroquine as a cause.

One hundred and seven patients admitted to the casualty department with acute gluteal abscesses and surgically drained were studied. In 91 patients (85%) the abscess was a result of an intramuscular injection, of whom 71 patients (66%) had the abscess following a chloroquine injection (antimalarial). Of those patients with an abscess following an intramuscular injection, in 64 patients (70%) a disposable syringe was used for injection of the drug and in 18% a boiled disposable was used. The injection was administered by a nurse in 55% of cases. The abscess occurred after the first injection in 17% of cases, the second in 25% and the third in 48% of cases at the same gluteal side. Where bacteriological culture was done (n = 44 abscesses) Staphylococcus aureus was isolated in 54% of cases. Pyogenic injection abscesses are common following the i.m. injection of chloroquine in the gluteal region.

Abscess↗
PubMed1988

Prevention of intra-abdominal abscesses with fibrinolytic agents.

Fibrin deposition during secondary peritonitis predisposes to abscess formation by protecting bacteria from host-defence mechanisms. To test the hypothesis that local fibrinolytic therapy can prevent the formation of intra-abdominal abscess, daily injections of the fibrinolytic enzymes trypsin and tissue plasminogen activator (t-PA) were administered intraperitoneally to Wistar rats inoculated intraperitoneally with infected fibrin clots. After 5 days, trypsin (1 mg/ml) had significantly (p less than 0.001) reduced abscess formation in animals inoculated with monomicrobial Bacteroides fragilis clots (20% versus 87%) or mixed Escherichia coli-B. fragilis clots (11% versus 91%). Bacteroides fragilis abscesses were also completely prevented with t-PA (0.25 mg/ml). The number of B. fragilis organisms present in residual abscesses in the trypsin-treated group was significantly (p less than 0.05) lower than in the control group (8.2 +/- 0.2, n = 7 versus 5.7 +/- 1.4, n = 4, log CFU/g abscess). In-vitro studies demonstrated that trypsin had no bactericidal effect on B. fragilis, suggesting enhanced clearance of bacteria. From these studies it appears that controlled fibrinolysis at operation may be a useful adjunct to surgery and systemic antibiotics in preventing abscess formation postoperatively.

Abdomen↗
PubMed1987

Therapeutic efficacy and pharmacokinetic properties of ciprofloxacin in intra-abdominal abscesses caused by Bacteroides fragilis and Escherichia coli.

Experimental intra-abdominal abscesses were produced in mice by intraperitoneal injections of Bacteroides fragilis and Escherichia coli. The therapeutic efficacy of ciprofloxacin was investigated in this mixed intra-abdominal abscess model and was compared with that of rifampicin. Treatment with ciprofloxacin at 0.2 to 20 mg/kg or rifampicin at 20 mg/kg prevented all mice from death, as compared to the 60% mortality rate observed in the vehicle-treated controls. Rifampicin concentrations at 10 and 20 mg/kg were effective in preventing abscess formation and eradicated bacterial abscess. Ciprofloxacin at all the levels tested neither reduced the incidence of abscess nor eradicated Bact. fragilis from abscesses. However, ciprofloxacin at levels of 20, 10, 5, and 1 mg/kg reduced significantly the number of E. coli cells in the abscess. The peak serum level of ciprofloxacin at the oral dose of 20 mg/kg was 0.43 mg/l which was well above the MIC values for E. coli but not for Bact. fragilis.

Abscess↗
PubMed1988

Percutaneous catheter drainage of abscesses associated with enteric fistulae.

In the past six years, percutaneous catheter drainage (PCD) has been performed in the treatment of 99 patients with abdominal and retroperitoneal abscesses. Of these 99 patients, 15 had abscesses associated with an enteric fistula. Fistula sites included small bowel (five), colon (three), complex (three), duodenum (two) and one each for the stomach and common duct. Two of these 15 patients had an initially successful PCD, ten developed recurrent abscesses after the first PCD and the procedure failed in the remaining three patients. Of the ten patients with recurrent abscesses, eight were successfully treated by a second PCD while two required small-bowel resection. Of the three failures, all three required operation and eventually died of septic complications. The diagnosis of fistula was made at the initial PCD in only six of 15 cases. There was a significant correlation between PCD failure and presence of an enteric fistula (P less than 0.001 by chi-square test). These data suggest that the diagnosis of fistula associated with abdominal abscess is elusive, but once established, most recurrent abscesses can be successfully treated by a second PCD. Operative treatment of recurrent fistula-related abscesses should be reserved for persistent fistula drainage after a second PCD or for unresolved sepsis following the initial PCD.

Abscess↗
PubMed1987

The surgical management of pancreatic abscess.

In the past 6 years we have operated on 13 patients with pancreatic abscess. Sepsis recurred in all 12 in whom the primary procedure was closed drainage. Following further surgical debridement of these recurrent abscesses 2 patients had further closed drainage and in 10 the cavities were packed open to heal by granulation. One patient underwent primary open packing which eliminated the pancreatic abscess but the patient subsequently died. Six patients (46%) died: one of lung abscesses after recovering completely from secondary open packing, one of an unsuspected carcinoma of the pancreas after secondary closed drainage and 4 of multiple organ failure after secondary open packing. There were no residual intraabdominal abscesses in any of these at autopsy. Four of those who died had initially presented with catastrophic pancreatitis according to Ranson's criteria and all 3 patients with initial sepsis scores of greater than or equal to 15 died. Open packing, whilst appearing to provide better drainage of pancreatic abscesses than closed drainage does not have a dramatic influence on mortality. Future reports of the results of open and closed methods of treating pancreatic abscesses should take account of both the severity of pancreatitis and of sepsis.

Abscess↗
PubMed1987

The role of percutaneous drainage of pancreatic abscesses.

Pancreatic abscess remains the most lethal form of intra-abdominal abscess despite a wide variety of operative approaches that have been advocated for its control. Mortality is frequent, and recurrent abscesses after operative drainage are common. Death often results from ongoing uncontrolled sepsis. The role of percutaneous drainage (PCD) of pancreatic abscesses is controversial. Recent experience with five patients who had pancreatic abscess and in whom a combination of operative drainage and PCD proved instrumental in survival leads the authors to recommend the consideration of both forms of drainage dependent upon the circumstances. Specifically, indications for PCD may include the following: use as a temporizing measure prior to celiotomy in a critically ill patient; use in postoperative patients who have recurrent abscesses and in whom the presence of dense inflammation precludes safe evacuation of pus; and use in the patient who has known portal hypertension and in whom massive bleeding is likely to result from celiotomy and abscess drainage.

Abdomen↗
PubMed1987

[EEG topographic changes of brain abscesses in children].

EEG topography was investigated before and after surgical treatment in 4 patients with brain abscess aged from 5 to 13 years. According to the recording technique designed by Matsuoka and Ueno, the recorded EEG for each 5 seconds was analyzed to obtain square roots of power spectra for each band of delta (2-3.8 Hz), theta (4-7.8 Hz) and alpha (8-12.8 Hz) which were then added for the 60-seconds duration of each trial. After that, numerical matrix presenting the topographic distribution of spectral energy of each band were constructed and displayed as color images. In addition, the EEG topographies of brain abscesses were compared with the CT scans simultaneously obtained. In all of four cases before surgical treatment of the brain abscess, the location of the focal delta wave on the EEG topography was more closely related to the site of brain abscess comparing with its correlation between the location of the delta focus on the conventional EEG and the site of brain abscess. In contrast, as for the theta wave, there was no prominent correlation to the site of the brain abscess. In the early stage of 10-15 days after aspiration of the brain abscess, the most characteristic change of the EEG topography was an approximately 25% reduction of the maximum equivalent voltage of delta band with associated disappearance of the sharply located focal delta wave being noted before aspiration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Psoas abscess in inflammatory bowel disease.

The inflammatory bowel disease (IBD) is sometimes complicated by the development of a psoas abscess. We recently encountered three patients of IBD with psoas abscess. Two patients had Crohn's ileocolitis and one with ulcerative colitis. During 1979-1984, 23 patients with psoas abscess due to a variety of underlying disease processes were seen at our institution. At the same time period, 483 cases of Crohn's disease and 283 cases of ulcerative colitis were encountered. Therefore, of 766 patients with IBD only three were complicated by psoas abscess (incidence ratio = 0.6%). Thus, psoas abscess was a very rare complication of IBD in patients seen at our institution. In our series of 23 psoas abscess patients, IBD was not a major causative factor. Additionally, to our knowledge, psoas abscess complicating ulcerative colitis has not been reported previously.

Abscess↗
PubMed1979

Clinical aspects of grave pyogenic abscesses of the liver.

Solitary hepatic abscess has a favorable prognosis in contrast with multiple abscesses which generally are fatal. As compared with the classical cause of appendicitis, at present, abscesses are frequently related to biliary tract and diverticular disease. Occult or temporally remote processes are responsibile for many solitary abscesses. Lethality of multiple abscesses is related to fulminant hepatic and source sepsis, atypical syndromes, late diagnosis and difficult, complex treatment. Causative organisms are predominantly gram-negative and increasingly anaerobic, requiring special bacteriology for isolation. Various laboratory data are useful in diagnosis and prognosis, but liver scans and celiac angiography are critical procedures. Treatment aimed at lowering the mortality of multiple liver abscesses includes early diagnosis, surgical exploration and abscess drainage, direct bacterial identification emphasizing anaerobic techniques, intense specific antibiotic therapy and identification and definitive therapy of the seeding focus with special attention being given to the biliary tract.

Adult↗
PubMed1983

Retroperitoneal and retrofascial abscesses. A review.

The anatomy of retrofascial and retroperitoneal abscesses is not widely understood by orthopaedic surgeons because these abscesses are encountered infrequently and may cause symptoms at their points of extension rather than at their origin. Recent developments in bone-imaging and computed tomographic scanning have made it easier to diagnose and treat these abscesses and to identify their origins. These same diagnostic techniques have also made it easier to distinguish retrofascial from retroperitoneal abscesses. In this paper we define the retrofascial and retroperitoneal spaces, enumerate the possible sources of infection and the pathways of drainage, identify the pelvic spaces where the abscesses collect, and list the peripheral extrapelvic areas where these abscesses cause symptoms. The clinical signs and symptoms of retrofascial and retroperitoneal infection differ from those of osseous infection of the pelvis and spine, the two most common sources of retrofascial infection. The diagnostic value of the various radiographic methods is discussed, the prognoses for various types of abscesses are reported, and approaches to treatment are presented.

Abscess↗
PubMed1982

Gentamicin and cefsulodin efficacy in a rat abscess model.

The pharmacokinetics and therapeutic efficacy of gentamicin and cefsulodin were studied in an abscess model in the rat induced by Pseudomonas aeruginosa and a foreign body. Both agents reached therapeutic concentrations in the abscess fluid and its ultrafiltrate and persisted longer in the abscess fluid than in blood. Gentamicin did not prevent the development of abscesses or reduce the bacterial inoculum when administered immediately following the induction of the abscesses. Cefsulodin sterilized 82.7 per cent of abscesses in 61.5 per cent of injected rats. Low oxygen tension present in the abscess was probably responsible for the inefficacy of gentamicin in this model, while not significantly diminishing the antibacterial activity of cefsulodin.

Abscess↗
PubMed1994

[Amoebic liver abscess: echographic aspects].

Amoebic liver abscess is the most frequent location of the extra-intestine amibiasis with an epidemio-endemic repartition in our areas. We are reporting in this study the main echographic patterns that can be found. 117 documents were collected and studied between 1982 and 1988 in the main hospitals of Dakar (SENEGAL). Most of the patients were young, the range of age being between 25 and 55 years old and 83% of them, were male. The diagnosis of the amoebic liver abscess was evocated on the basis of the following clinical and biological symptoms: 54.38% of painful haetomegaly, 42.10% of pleuro-pulmonary and digestive signs, 3.50% of long lasting isolated fever, non specific biological sign of inflammation, 74.57% of positive hemaglutination test. An echographic test was performed before the anti-parasitic treatment with an echotomograph PHILIPS SDR 1500 in real time using a probe of 3 MHZ. The amoebic abscess of liver was detected by the echography in all cases. The unique abscess (83.10%) was the most frequent form. It was localized in the right liver (64%) and had an heterogeneous echostructure (55.70%). The hypo-echogeneous form (36.50%) was the earlier stage of the collecting abscess. The liquid form (07.80%) was observed in the latter stages of the disease. Some difficulties to determine the amoebic abscess may appear when primitive liver cancer or pyogensus abscess are present. In these cases it is necessary to analyse the liquid of ponction to be affirmative.

Adult↗
PubMed1995

Elective interval laparoscopic management for periappendiceal abscess.

BACKGROUND: In Far Eastern countries, the right-sided colonic diverticular diseases are more prevalent than the left-sided ones. Accurate differential diagnosis between appendiceal abscess and right-sided diverticulitis with abscess formation is difficult to make preoperatively. Conservative treatment followed by elective interval surgery remains the mainstay of management for patients with periappendiceal abscess. Laparoscopic diagnosis and treatment have been advocated in managing patients with abdominal pain of uncertain diagnosis. The purpose of this study was to evaluate the beneficial effect of interval barium enema and mini-invasive procedures for patients with periappendiceal abscess. METHODS: Patients with periappendiceal abscess (n = 8) were enrolled in this study. Conservative treatment was instituted by administration of antibiotics, and interval barium enema and laparoscopic intervention were scheduled later. Clinical manifestations, results of barium enema, outcomes of laparoscopic intervention and pathological diagnoses were reviewed. RESULTS: The frequency of periappendiceal abscess was 18/263 (6.8%). There were no operative complications. The correlation between barium enema, laparoscopic findings, and pathological diagnosis was quite good. Patients gained the advantages of laparoscopic surgery. CONCLUSIONS: Interval barium enema study and laparoscopic diagnosis and treatment are worthy of trying for patients with periappendiceal abscess, especially in those areas with high prevalence of right-sided diverticular diseases.

Abscess↗
PubMed1995

Antibiotic penetration of experimental intra-abdominal abscesses.

Intra-abdominal abscess is seldom adequately treated by systemic antibiotics alone and often requires surgical or computed tomography-guided drainage for resolution. Abscess penetration of six currently used antibiotics was examined in a murine intra-abdominal abscess model. Ampicillin/sulbactam, cefmetazole, clindamycin, and trospectomycin penetrated intra-abdominal abscesses to a greater degree than cefoxitin and ceftriaxone. Abscess pus antibiotic levels were not significantly higher after multiple doses than after a single dose. Pus antibiotic levels below the MIC90 for Bacteroides and E. coli within intra-abdominal abscess were observed for most antibiotics with the doses used in this study. Selection of antibiotics with a greater ability to penetrate abscess may be important in optimally treating patients with abdominal infection.

Abdominal Abscess↗