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PubMed1975

Brain stem abscess treated surgically. Wtih special note upon the employment of thorium dioxide.

A 10-year-old girl, with congenital heart disease, harboring a brain stem abscess, was recently treated at the UCLA Hospital. Needle aspirations of the abscess was performed through a posterior occipital craniectomy, and thorium dioxide (Thorotrast) was placed within the abscess cavity as a marker. Postoperatively, the patient improved temporarily but died 18 days later. Autopsy examination included radioactive analysis of brain and liver tissue. Radioautographs were superimposed on H&E preparations of the abscess wall to localize the extent of activity of the thorium dioxide. The unusual occurrence of this abscess in a young patient, clinically diagnosed and treated by operation, provided a rare opportunity to assess the problem of the surgical accessibility of brain stem abscess as well as to reevaluate a role for thorium dioxide as a marker for intracranial purulent collections.

Autoradiography↗
PubMed2000

Pyogenic liver abscess--a tropical centre's experience in management with review of current literature.

AIM OF STUDY: To perform a retrospective study, with the help of literature review, of the management of patients with pyogenic liver abscess in a general hospital. METHOD: A retrospective study of 73 consecutive patients treated atTanTock Seng Hospital between January 1994 and December 1997 was conducted to determine the demographic, clinical, laboratory, radiological and microbiological characteristics of these patients, as well as the management strategies employed. RESULTS: Liver abscess was more common in males, occurring more frequently in the right hepatic lobe. Most patients presented with non-specific clinical and biochemical features. A raised alkaline phosphatase level was the most common biochemical abnormality found in about two-thirds of patients. Ultrasonography was not as sensitive as computed tomographic scans in detecting abscesses. Klebsiella pneumoniae was the most common etiological agent detected in cultures of blood and abscess aspirates. All patients were treated with intravenous antibiotics. Twenty-two (30%) needed percutaneous catheter drainage and five (7%) required surgical management. There was no hospital mortality in our series. Prolonged hospitalisation was associated with advanced age, degree of loculation within the abscess, concomitant diabetes mellitus and Klebsiella septicaemia. CONCLUSION: Pyogenic liver abscesses require a high index of suspicion for early diagnosis. When appropriate therapy in the form of antibiotics in combination with percutaenous drainage or surgery is administered, mortality is very low. However, significant morbidity is still a problem, particularly in the elderly, diabetic patient.

Adolescent↗
PubMedDate not supplied

[Differentiation between cerebral abscesses and necrotic or cystic tumours by means of diffusion sequences].

INTRODUCTION: The diagnosis of a cerebral abscess is a real challenge since the clinical and radiological findings are often non-specific and undistinguishable from those seen with cystic or necrotic tumours. Recently it has been suggested that diffusion sequences may be useful in the differential diagnosis of a necrotic or cystic mass. PATIENTS AND METHODS: Nine patients with cystic or necrotic intracranial masses were studied. The diagnoses were: three pyogenic abscesses, three metastases and three high grade gliomas. The diffusion images were evaluated visually and by means of maps based on the apparent diffusion coefficient (CDA). RESULTS: All lesions showed fine iso-intense or slightly hyperintense walls in T1 potentiated sequences, and isointense or slightly hypointense walls in T2 potentiated sequences. In all cases the wall took up gadolinium intensity, with a well-defined smooth edge (ring uptake). In the diffusion sequences the abscesses showed a very strong central signal, as compared with the low signal of other lesions. The CDA were significantly lower in the abscesses than in the tumours. CONCLUSIONS: Since cerebral abscesses are potentially curable, early diagnosis should be made. A cerebral abscess should be suspected in all cases of cystic or necrotic masses with hypersignals in diffusion sequences and low CDA.

Aged↗
PubMed2001

Crohn's disease presenting as left gluteal abscess.

Although abscesses and fistulae are common complications of Crohn's disease, the gluteal area is a rare site for abscess formation. The abscess results from extension of pus through the fascial plains of the pelvis and through the greater sciatic foramen into the gluteal area. This is the first reported left gluteal abscess due to Crohn's disease as pus extends across the midline to the left side. The clinical picture can be misleading and diagnosing the source of infection may be difficult. Incision of this abscess without identifying the source of infection will result in enterocutaneous fistula. Ultrasound guided aspiration of the abscess as well as treatment of metabolic deficiencies and septicaemia before definitive surgical treatment of the bowel disease will reduce the morbidity and mortality of this rare complication. The clinical picture, management of this complication and review of the literature are discussed.

Abscess↗
PubMed2001

[Cutaneous aseptic abscesses, manifestations of neutrophilic diseases].

BACKGROUND: Neutrophilic skin disease includes several entities: Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutium, Sneddon-Wilkinson sub-keratous pustulosis, and neutrophilic eccrine hidradenitis. We report two cases of aseptic abscesses which correspond to the deepest anatomoclinical form of neutrophilic dermatosis. CASE REPORTS: A 28-year-old man was hospitalized for fever and abdominal pain with bloody diarrhea in relation with Crohn's disease. The patient also presented two skin abscesses on the lower limbs. Bacteriology specimens were negative. The histology specimen of a skin lesion revealed neutrophil infiltration of the hypodermis without granulomatosis. Systemic corticosteroid therapy was given and rapidly led to resolution of the inflammatory bowel disease and the skin lesions. The patient developed inflammatory spondylarthropathy several months later. The second patient was a 36-year-old woman with a history of splenomegaly with asceptic abscesses. She was admitted for abdominal pain with non-bloody diarrhea, fever and multiple joint pain related to spondylarthropathy. She developed several simultaneous abscessed nodules on the legs. Biopsy revealed neutrophil infiltration of the hypodermis. The diagnosis of neutrophilic disease with aseptic cutaneous and visceral abscesses was retained. Nonsteroidal antiinflammatory drugs and dapsone were given leading to regression of the skin lesions and the abdominal and joint pain. DISCUSSION: Aseptic skin abscesses result from a deep localization of neutrophilic disease. They suggest the presence of inflammatory bowel disease, spondylarthropathy or other aseptic visceral localizations.

Abscess↗
PubMed1998

[Comparison of three antituberculous drugs in serum and cold abscesses of patients with spinal tuberculosis].

OBJECTIVE: Pharmacokinetics of INH, RFP and OFLX in serum and cold abscesses of patients with spinal tuberculosis was analyzed to provide reference to choosing clinical therapeutic regimen. METHOD: The aspiration specimens of abscesses and venous blood were collected from 8 patients with spinal tuberculosis at 0.5, 0.75, 1.0, 1.5, 2.0, 4.0, 6.0, 9.0, 12.0, 16.0 and 24.0 h after administration of antituberculous drugs. The specimens were assessed by high performance liquid chromatography (HPLC). The data were processed with software 3P87. RESULT: The Cmax of INH, RFP and OFLX in serum were 10.87 +/- 7.09 micrograms/ml, 9.98 +/- 3.53 micrograms/ml, and 5.29 +/- 0.72 micrograms/ml, while the Cmax of INH, RFP and OFLX in cold abscesses were 2.84 +/- 1.63 micrograms/ml, 0.57 +/- 0.26 microgram/ml and 3.19 +/- 1.29 micrograms/ml respectively. CONCLUSION: After administration, the Cmax of INH and OFLX in the cold abscesses of patients with spinal tuberculosis, reached the level beyond their MIC and appeared and disappeared more slowly than that in the serum; RFP was not easy to permeate into the cold abscesses, the Cmax of RFP in the cold abscesses just reached its MIC.

Abscess↗
PubMed2001

[Diagnostic problems in brain abscess: 45 cases].

BACKGROUND AND PURPOSE: We analysed the difficulties encountered in the differential diagnosis between brain abscess and brain tumor and their influence on treatment and outcome. METHODS: - Forty-five adults with brain abscess operated on between 1993 and 1999 were retrospectively reviewed. We studied preoperative diagnosis, clinical, radiological, bacteriological findings, surgical procedure, primary sources of infection and outcome. RESULTS: Preoperative diagnosis was right in 55.6% (25/45), wrong in 22.2% (10/45) and doubtful in 22.2% (10/45). Diffusion-weighted MR imaging was successfully used in 4 doubtful cases to make the differential diagnosis between abscess and tumor. When the preoperative diagnosis was right, the surgical procedure was a burr-hole aspiration in 73.3% (22/25) whereas when it was wrong, an excision was performed in 60% (6/10) of the cases. Aspiration was the last diagnostic investigation in 80% (8/10) of doubtful cases. Microbacterial organisms were identified in 75.5% (34/45) of the cases and primary cause of infection in 62.2% (28/45). The outcome depended on clinical status on admission, preoperative diagnosis and surgical procedure. In four cases, diffusion-weighted MRI allowed differential diagnosis between brain abscess and tumor through calculation of the Apparent Diffusion Coefficient which is low in abscess and high in cystic tumor. CONCLUSION: The diagnosis of brain abscess remains difficult in certain patients. Correct preoperative diagnosis influences the decision on the appropriate surgical procedure and helps improve outcome.

Adult↗
PubMed1999

Psoas abscess: a 10 year review.

Psoas muscle abscesses are rarely encountered yet, and pose diagnostic and therapeutic challenges because of nonspecific clinical presentations. We retrospectively reviewed the medical records of adults with a psoas muscle abscess who were admitted to our hospital from January, 1988 to May, 1998. Over this ten year period, psoas abscesses were found in 11 cases. Six cases were primary and Staphylococcus spp. was the most commonly isolated. Five cases were a secondary psoas abscess while urological problems were the most common underlying condition. Fever, chills, lower back or flank pain and a palpable mass were the most common manifestations. Only one patient presented the classic triad of fever, flank pain, and limitation of hip movement (a typical psoas sign). Leukocytosis was the most common laboratory finding. Two of 11 cases presented septic shock. Two patients were admitted to the hospital with the initial diagnosis of psoas abscesses. Computerized tomographic (CT) scans accurately confirmed the clinical diagnosis in 9 of 11 patients. Diagnosis was then established one each by ultrasound (US) and magnetic resonance imaging (MRI), respectively. Four of 11 patients had negative findings initially by US. All patients were managed with drainage and antibiotics, nine were drained surgically, and two were managed with percutaneous drainage under CT guidance. Two patients died. Because of the lack of the classic symptoms and signs in most cases, a high degree of suspicion is important for early diagnosis of psoas abscess. CT scan is the standard technique of diagnosis. The prognosis is generally good with appropriate antibiotic treatment and complete drainage.

Adult↗
PubMed2001

[Multiple brain abscesses associated with Rendu-Osler-Weber disease: report of two cases].

Two cases of multiple brain abscesses associated with congenital pulmonary arteriovenous fistula are reported. A 57-year-old male with Rendu-Osler-Weber disease complicated by pulmonary arteriovenous fistula developed multiple brain abscesses in the right parietal region. He responded well to surgical drainage and antibiotic therapy, and the pulmonary arteriovenous fistula, located in the left lower lobe, was resected. A 26-year-old female with Rendu-Osler-Weber disease complicated by pulmonary arterivenous fistula developed recurrent multiple brain abscesses in both the frontal and right parietal regions. The brain abscesses were successfully treated with aspiration and antibiotic therapy. She had a history of two previous brain abscesses in the right parietal regions that were excised on separate occasions at 16 and 23 years of age. Although pulmonary arteriovenous fistula was confirmed by angiography, in this case surgical removal of the pulmonary lesions was not indicated due to multiple vascular shunting. The patient had no recurrence of brain abscess with oral antibiotic therapy.

Adult↗
PubMed2001

Differentiation of psoas muscle abscess from septic arthritis of the hip in children.

A 20-year review was conducted of children presenting with psoas abscess at two major pediatric hospitals. Eleven children with psoas abscesses were identified. The extreme variability in the clinical presentation of this condition is shown. Psoas abscess was most difficult to differentiate from septic arthritis of the hip in pediatric patients. This study also shows the often circuitous investigative route traversed before arriving at the diagnosis of psoas abscess. Atypical features, such as femoral nerve neurapraxia or bladder irritability in association with hip pain, should alert the clinician to consider psoas abscess. Based on this study, a diagnostic algorithm to differentiate between psoas abscess and septic hip was formulated.

Algorithms↗
PubMed2001

[Pyogenic liver abscesses of cryptogenic origin].

OBJECTIVE: To analyze and clarify the clinical behaviour and outcome of patients with pyogenic liver abscess of cryptogenic origin and, moreover, to observe if there are any differential characteristics in relation to those found in patients with a known pathogenesis. MATERIAL AND METHODS: Multicenter and retrospective study of two groups of patients diagnosed of pyogenic liver abscess, during a period of 13 years. Group 1: 34 cases with abscess of cryptogenic origin and Group 2: 99 patients with a known pathogenesis. Clinical, laboratory, and microbiologic data, morphology and topography of the lesions, treatment and outcome were assessed and compared in both groups. RESULTS: The duration of symptomatology was higher in Group 1 (9.4 +/- 6.5 vs 8.1 +/- 4.4 days; p = 0.05). Although, in this category of patients, it was also observed a lower frequency of jaundice (6 vs 26%; p = 0.02) and lower level of bilirubinemia (0.9 +/- 0.9 vs 2.6 +/- 4.4 mg/dl; p = 0.05), the majority of clinical and laboratory data were similar in both groups. The rate of patients with abscesses on the left lobe (26% vs 12%; p = 0.04) was higher in Group 1. The therapeutic modality carried out in the two groups was not significantly different, neither were hospital stay, and morbidity and mortality rates. CONCLUSIONS: The patients with pyogenic liver abscesses of cryptogenic origin present few specific clinical characteristics which facilitate the diagnosis. Besides, their outcome was no significantly different from that found in patients with abscesses of known pathogenesis.

Adult↗
PubMedDate not supplied

[A double abscess of the cerebellum of otogenic origin].

Brain abscess is a rare, extremely aggressive lethal infection. It is especially important in case of otogenic abscesses. It is known that the problem of otitis existed already thousands of years before Christ, and it is still a current problem. Otogenic brain abscess is the most common otogenic complication encompassing 40-80% of all brain abscesses in adults. In 50-80% of these cases COM (chronic otitis media) with cholesteatoma is found. In the last 20 years CT is of the first rank in diagnosis. Brain abscess can be treated conservatively and surgically; but the ear has to be treated operatively. In this article we present an interesting case from our practice, a double abscess of the cerebellum of otogenic origin, which was successfully treated by simultaneous approach of neurosurgeon and otosurgeon.

Brain Abscess↗
PubMed2001

[The treatment of cerebral abscesses in children--the clinical experiences of neurosurgical clinic of PMMH in Lodz].

In our study we made attempt to assess which clinical criteria are essential for choosing optimal treatment for children suffering from cerebral abscesses. We observed the clinical results obtained at our Department from treatment of infections of the central nervous system (CNS) in children and analysed them with respect to applied therapy and clinical conditions. Between 1990 to 2000, 45 children aged 3 days to 15 years (mean 1.34 years, standard deviation 3.23 years) with infections of the CNS were treated at our Department. Within this group, 26 patients were diagnosed with cerebral abscesses, 1 with epidural empyema, 3 with subdural empyema and 15 with pyocephalus. 42 patients were operated. In 3 patients a conservative treatment was introduced at the moment when the abscesses were in the initial stage of organisation; in each case after a complete cycle of antibiotic therapy a regression of lesion was noted. The most frequently performed--in 19 patients--surgical procedure was the radical excision of the abscess by craniotomy. In 2 cases a re-operation was necessary. The highest rate of re-operations was noted in the group of children treated by external drainage; within this group of 18 patients only one 3-month-old girl did not require an additional surgical intervention. Neuroendoscopic techniques were used in 7 patients with compound hydrocephalus. Out of 45 treated children, 3 died from encephalitis, the primary reason being the infection of the ventriculo-peritoneal shunt. All children were assessed according to the Glasgow Outcome Scale and the results were significantly worse in those under 3 years in age. We suggest that in children above 3 years of age with mature abscesses of the central nervous system an operative evacuation of the abscesses by craniotomy should be performed.

Adolescent↗
PubMedDate not supplied

A case of amebic liver abscess complicated by hemobilia due to rupture of hepatic artery aneurysm.

We report the case of a 51-year-old man with hepatic amebic abscess complicated by hepatic artery aneurysm. The patient first presented with peritonitis caused by perforating appendicitis. Surgical treatment resolved peritonitis but Entamoeba histolytica was detected in the colonic mucosa. Subsequently, liver abscess developed and the size of the abscess increased gradually after surgery in spite of continued treatment with metronidazole. Brown pus was drained from the abscess but 13 days after the drainage process the patient complained of right upper abdominal pain and the drained fluid became blood-colored and stool became tarry in color. Enhanced computed tomography showed a hepatic artery aneurysm that had ruptured into the liver abscess and duodenoscopy revealed bleeding from the ampulla of Vater. Transcatheter arterial embolization with several steel coils was successfully performed which resulted in cessation of bleeding from the ampulla of Vater. The patient was discharged without any complications five weeks after rupture of the aneurysm. Our case demonstrates rupture of the hepatic artery aneurysm as a rare complication of amebic liver abscess and the effectiveness of interventional embolotherapy in this condition.

Aneurysm, Ruptured↗
PubMed2002

[Recurrent tuberculous abscess in the chest wall; report of a case].

A case of recurrent tuberculous abscess in the chest wall which was successfully treated by resection of the rib and transposition with a latissimus dorsi muscle flap is reported. A 70-year-old man was admitted to the hospital for the purpose of receiving tuberculostatic treatment after an operation for tuberculous abscess in the chest wall at another hospital. When he first visited the another hospital, he had complained of a left chest wall tumor and Mycobacterium tuberculosis was isolated from the pus. After admission to the hospital, tuberculous abscess recurrenced in the left chest wall 2 months after the operation. We performed resection of the abscess, 5th and 6th ribs, as well as transposition of the latissimus dorsi muscle flap. There have been no signs of recurrence and is followed in the clinic, as of 4 months after the operation. We think that resection of the abscess, ribs, and, transposition of the muscle flap are useful methods for tuberculous abscess in the chest wall.

Abscess↗
PubMed2002

Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess.

BACKGROUND: Perivalvular abscess is an ominous development in patients with infective endocarditis. There is little information concerning the long-term outcome of these patients. METHODS: Patients admitted to a tertiary care centre in Ottawa between November 1987 and December 1995 because of infective endocarditis complicated by perivalvular abscess were identified by chart audit and by review of the transesophageal echocardiography database. The patients were followed for at least 4 years to determine cardiac complications, late cardiac surgery, long-term outcome and functional status. RESULTS: Forty-three consecutive patients with infective endocarditis and perivalvular abscess (32 men and 11 women; mean age 56 [standard deviation 16] years) were identified; 17 had native valve endocarditis and 26 had prosthetic valve endocarditis. Of the 43 patients, 31 had cardiac surgery during the hospital stay; 6 died in hospital, and 10 died during follow-up. Twelve patients received medical treatment alone; none died in hospital, and 8 died during follow-up. The medically treated patients had less severe heart failure than the surgically treated patients (p = 0.12), but the 2 groups were similar in age and infective organisms. After a mean of 4.5 years of follow-up, the cumulative death rate was 57%; survival was similar among the medically and surgically treated patients. The survivors were younger than the nonsurvivors (p = 0.04). Complications of perivalvular abscess, including pseudoaneurysms and fistulae, were common, occurring in all medically treated patients and in 10 of the 24 surgically treated patients who had follow-up transesophageal echocardiography. INTERPRETATION: Patients with infective endocarditis and perivalvular abscess had a high rate of death after hospital discharge and a high incidence of complications of perivalvular abscess, despite early surgical intervention in most patients. Lower age was the only predictor of long-term survival.

Abscess↗
PubMed2002

Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. CLINICAL PRESENTATION: A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. Blood cultures yielded Staphylococcus aureus. Magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine. INTERVENTION: The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment. CONCLUSION: Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparison of hepatic abscess after operative and nonoperative management of isolated blunt liver trauma.

Hepatic abscess has been well recognized as a complication after blunt hepatic injuries. The clinical presentation of hepatic abscess after the operative and nonoperative management of isolated blunt liver injury is compared in this study. From 1995 to 2000, 674 patients with blunt liver injury were admitted and were managed either operatively or nonoperatively. Hepatic abscess occurred in 21 of these patients. Six of the 21 patients had their liver injuries managed nonoperatively (group 1) and the remaining 15 had their liver injuries managed operatively (group 2). The severity of injury of both groups of patients was similar, but group 2 patients required more blood transfusion and had a higher incidence of abscess formation. The formation of abscess occurred within 12 days after admission in the group 1 patients but ranged from 5 days to 6 years in the group 2 patients. One of the group 1 and eight of the group 2 patients had recurrent abscesses and required repeated admission. The nonoperative management of blunt hepatic trauma had a better outcome than the operative approach in terms of a significant decrease in abdominal infections and tended to result in complete recovery without the need of repeated admission and drainage.

Adult↗