[Pathomorphosis of renal carbuncle].
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Adult↗
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[Retrospective diagnosis of anthrax by intradermal reaction].
The authors report a detailed study of utilization of a skin test with anthraxin to perform a retrospective diagnosis of anthrax in humans who suffered from anthrax 45 days to 31 years after recovery. For a total of 884 persons studied, 762 showed a positive skin test (86.2%). This index was 92.8% for persons tested 45 days to 3 years after convalescence, 82.8% 4 to 15 years after convalescence and 72.7% 16-31 years after recovery. The site of the primary carbuncle on the skin of the fingers, hands, face and neck gave an index of positivity (88.2%) statistically greater (p = 99%) than by localization of the carbuncle on arms, forearms, trunk and legs (77.3%).
Adult↗
[Unusual presentation of urinary tract infection in 6 cases].
Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta- hemolytic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci.
Abscess↗
[Pristinamycin versus oxacillin in the treatment of superficial pyoderma. A multicenter randomized study in 293 outpatients].
BACKGROUND: Superficial pyoderma occurs frequently. Generally, the benign infection is caused by Staphylococcus aureus and/or a group A streptococci. The subject is controversial, but treatment usually is based on narrow-spectrum antibiotics active against both germs. PATIENTS AND METHODS: A multicentric, randomized, double-blind, double-placebo study was conducted to compare pristinamycin (1 g b.i.d.) with a reference antibiotic, oxacillin (1 g b.i.d.) for 10 days. Inclusion criteria were: both sexes, age 15-80 years, clinical diagnosis of superficial pyoderma (impetigo, wound infection within the last 15 days, furunculosis, carbuncle, perionyxis), informed consent. The general practitioner investigators (n = 52) were assisted by 9 dermatologist-coordinators. Clinical diagnosis was validated by a committee of experts at the end of the study after analyzes of the photos and bacteriological results obtained on samples taken at the practitioner's office on visit 1 (D0), visit 3 (D14 +/- 3) and visit 4 (D25 +/- 3). Successful treatment was defined by clinical, bacteriological and photographic efficacy at visit 3 (equivalence analysis: one-way 95 p. 100 confidence interval). RESULTS: There were 293 included patients given pristinamycin (n = 151) or oxacillin (n = 142). Mean age of analyzed patients was 40 +/- 17 years. Diagnosis was confirmed in 255 patients in accordance with the protocol: furunculosis or carbuncle (n = 100), recently superinfected wound (n = 97), impetigo (n = 41), acute perionyxis (n = 17). Thirty-five patients (12 p. 100) were considered to have been wrongly included. The germs most often isolated were: Staphylococcus aureus (n = 126), group A streptococci (n = 13), group B streptococci (n = 5) and P. multocida (n = 3). At visit 3, the two treatments were found to be equivalent with a success rate of 86.7 p. 100 for pristinamycin and 89.8 p. 100 for oxacillin (CI [*9.97]). Tolerance was statistically comparable between the two treatments (27 to 32 percent minor side effects). DISCUSSION: This study is the first performed in outpatients attended by general practitioners with diagnostic confirmation on both bacteriological and photographic evidence of superficial pyoderma. The results obtained demonstrate the good reliability of such studies although 12 p. 100 of the patients were wrongly included, a factor which should be taken into account for future studies. The efficacy and tolerance of pristinamycin were statistically equivalent to those of oxacillin for all the patients with superficial pyoderma. Nevertheless, the subgroup of patients with folliculitis gave rather heterogeneous bacteriology and therapeutic results.
Adolescent↗
Percutaneous aspiration of renal cortical abscess.
Two patients with renal cortical abscesses were treated successfully by an intensive antibiotic regimen together with percutaneous aspiration, rather than by the conventional treatment of open drainage, which often is followed by secondary nephrectomy. This adaptation of percutaneous aspiration to the management of renal carbuncle coincides with a change in the causative microorganism which today is often a gram-negative coliform rather than a hematogenously borne staphylococcus, which usually complicates some pre-existing abnormality in the urinary tract.
Abscess↗
[A case of anthrax in a dog (author's transl)].
A case of anthrax in a dog is described. The origin of infection, clinical symptoms and post mortem changes are discussed. B. anthracis was found in the carbuncle of the stomach wall, mesenterial lymphnodes, blood, liver and kidney.
Animals↗
Surgical infection in art.
The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.
Abscess↗
Occipital lesions: a possible cost of cradleboards.
This examination of a Mimbres-Mogollon pueblo skeletal sample reveals a surprising percentage of individuals with occipital lesions. Each lesion is located in the approximate center of the squama immediately superior to the external occipital protuberance. Notably, no child over the age of 1 year exhibits a lesion that would have been active at the time of death, but a number of older children and adults exhibit evidence of healed lesions in this same area on the occipital. The restricted nature of these lesions, in terms of both their locations and ages of those actively affected, suggests that the use of cradleboards may have been at least a contributing, if not initiatory, factor in their creation. Specifically, this study suggests that the pressure and friction of an infant's head against a cradleboard may have 1) produced ischemic ulcers, 2) produced the conditions favorable for bacterial infections such as impetigo or carbuncles, or 3) complicated the treatment of other infections appearing on the back of the scalp.
Anthropology, Physical↗
Leukemia, lymphoma, and multiple myeloma following selected medical conditions.
The role of selected prior medical conditions in the etiology of hematopoietic malignancies was examined in a case-control study of members of two regional branches of the Kaiser Permanente Medical Care Program (USA). Past history of chronic infectious, autoimmune, allergic, and musculoskeletal disorders was abstracted from medical records for leukemia (n = 299), non-Hodgkin's lymphoma (NHL, n = 100), and multiple myeloma (n = 175) cases and matched controls (n = 787). Little difference was found between cases and controls for most of the chronic conditions evaluated, including sinusitis, carbuncles, urinary tract infections, pelvic infections, herpes zoster, asthma, rheumatoid arthritis, psoriasis, bursitis, and gout. Only three statistically significant elevated risks were found, i.e., with combined disc disease myeloma among patients with prior eczema and disk and other musculoskeletal conditions, and NHL following tuberculosis. Only two of these associations showed consistent patterns by sex and geographic region (myeloma with eczema and with musculoskeletal conditions). While prior history of eczema and musculoskeletal conditions may slightly increase risk of myeloma, this study provided little if any support for an association of chronic infectious, autoimmune, allergic, and musculoskeletal conditions with subsequent occurrence of the leukemias or NHL. Additionally, these data did not support a role for chronic antigenic stimulation, as defined in previous epidemiologic studies, in the etiology of hematopoietic malignancies.
Aged↗
Radioisotope studies in the diagnosis of acute complications in the post-transplantation stage.
The possibilities of radionuclide investigations with various labelled compounds (125I- and 131I-hippuran, 99mTc-albumin, 99mTc-DTPA, 99mTc-citrate, 99mTc-calcium gluconate) in the diagnosis of acute complications of the post-transplantation period are discussed on the basis of observations in 105 recipients in whom acute complications arising in different stages of the post-transplantation period required diagnostic differentiation between various syndromes, i.e. renal arterial or venous thrombosis, ureteral occlusion, failure of ureterocystoanastomosis, acute renal failure, infarct, carbuncle or abscess of the transplant, acute rejection, rupture of the transplanted kidney. The sequence of radionuclide studies in the individual syndromes by means of the gamma-camera and computer processing is set down and the value of these methods in the diagnosis of complications arising in the early or late stage of the post-transplantation period are discussed.
Humans↗
Mycobacterium szulgai--a case of cutaneous infection?
An infant presented with a carbuncle over the angle of her jaw which grew a scotochromogenic mycobacterium, subsequently identified as Mycobacterium szulgai. The problems of identification of this organism and its possible pathogenic role are outlined.
Chromatography, Thin Layer↗
Urographic and angiographic changes in acute unilateral pyelonephritis.
The pyelographic and angiographic changes in acute unilateral bacterial pyelonephritis are illustrated in our series of 12 patients. The radiographic abnormalities were completely reversible within a few weeks after clinical recovery. Complications (abscess) occurred in only one patient. Unilateral renal enlargement, diffuse or focal, impaired or absent excretory function, and attenuated calyces were the predominant findings; non-obstructive pelvicalyceal and/or ureteral dilatation were infrequent. Angiographic studies (fivepatients), performed to rule out vascular occlusion, tumour or carbuncle, showed attenuated and somewhat stretched intrarenal vessels associated with the diffuse or focal cortical swelling. Occasionally, a characteristic striated nephrogram is seen.
Acute Disease↗
Renal abscess in children.
Ten children with renal abscesses treated during the last 25 years are reviewed following our recent experience with 3 children, each of whom presented with an abscess. The diagnosis was not readily apparent before hospitalization, despite characteristic features of the disease. Excretory urography with nephrotomography proved to be the most valuable diagnostic study. Angiography was useful in differentiating the abscess from other intrarenal processes. Staphylococcus aureus was the most common infecting organism. Upper urinary tract anomalies were noted most frequently with gram-negative infections. Treatment consisted of drainage of the abscess in 8 children. Nephrectomy was required in 2 girls, each of whom had multiple extensive gram-negative carbuncles. The pathogenesis and therapy of a renal abscess are discussed.
Abscess↗
The changing clinicopathological pattern of abscesses in or adjacent to the kidney.
We reviewed retrospectively 43 patients with various renal and perirenal abscesses. In contrast to previously published data a primary renal etiology was noted for nearly every abscess in or adjacent to the kidney, irrespective of the type of abscess. Currently, the concept that the renal carbuncle is a metastatic abscess whose origin lies at some distant site may be applicable no longer. Despite earlier recognition of symptoms, improved diagnostic techniques and better therapy the morbidity and mortality of abscesses in and adjacent to the kidney remain high, suggesting the important role of associated medical conditions and the need for early aggressive therapy.
Abscess↗
Bacterial infections of the skin.
This article discusses common bacterial skin infections, including impetigo, cellulitis and erysipelas folliculitis, staphylococcal scalded skin syndrome, blistering distal dactylitis, furuncles and carbuncles, and pseudomonal infections such as external otitis and malignant external otitis, ecthyma gangrenosum, pseudomonal folliculitis, toe web infection, and erysipeloid.
Anti-Bacterial Agents↗
Bacterial urinary tract infections in diabetes.
Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections in the patient with diabetes mellitus. Bacteriuria is more common in diabetic women than in nondiabetic women because of a combination of host and local risk factors. Upper tract infection complications are also more common in this group. Diabetic patients are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess, to the renal carbuncle. A number of uncommon complicated urinary tract infection complications occur more frequently in diabetics, such as emphysematous pyelonephritis and emphysematous pyelitis. Because of the frequency and severity of urinary tract infection in diabetic patients, prompt diagnosis and early therapy is warranted. A plain abdominal radiograph is recommended as a minimum radiographic screening tool in the patient with diabetes presenting with systemic signs of urinary tract infection. Ultrasonography or further radiographic studies such as CT scanning may also be warranted, depending on the clinical picture, to identify upper urinary tract complications early for appropriate intervention.
Abscess↗
[A urologic-radiological view of perinephric abscesses (author's transl)].
Perinephric abscess is a rare condition; it may be acute, but can take a chronic and atypical course as a result of incomplete treatment with antibiotics. In this case the diagnosis is often delayed. The most common cause is primary renal disease, with perforating ureteric stones, abscess-forming pyelonephritis, renal carbuncle and pyonephrosis as the most important factors. Diagnosis depends on a varying combination of clinical signs, any of which is not necessarily present and which is not pathognomic, but nevertheless, in their totality, are fairly typical. Characteristic are pain on percussion and pressure, resistance in the renal angle and fever. Laboratory investigations do not contribute to the diagnosis. These only show findings typical of any infection, and frequently a marked anaemia. An infected urine may be suggestive. The traditional clinical and radiological methods may well indicate a space-occupying lesion, but its further elucidation depends on angiography. Renal and perinephric abscesses must be distinguished from other space-occupying renal lesions. Abscesses can usually be distinguished from cysts because they are generally less clearly demarkated and often show a hypervascular margin with a "blush". A further differential diagnosis of perinephic abscess is a peri-renal haematoma. Radiologically, an haematoma also produces a perirenal mass with displacement and compression of the kidney. As with perinephric abscesses, the angiogram shows dilatation and displacement of the capsular arteries. Differences in the neovascularity, as well as in the clinical symptoms, permit differentiation between abscesses and hypovascular carcinomas in most cases, or at least suggest the probable diagnosis.
Abscess↗
Traumatic rupture of a renal cell carcinoma.
After sustaining very minor trauma, a man presented with flank pain and fever. A complete clinical and radiological evaluation led to exploration for suspected ruptured renal carbuncle with perinephric abscess. A ruptured renal cell carcinoma was found. Differential diagnostic considerations include renal tumor, abscess, cyst, and hydronephrotic kidney. Radical nephrectomy is indicated if the contralateral kidney can sustain life. The patient shows no sign of recurrence or metastases 4 months following antibiotic treatment and nephrectomy followed by chemotherapy and radiation of the renal bed.
Adenocarcinoma↗