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PubMed1991

Limitations of percutaneous catheter drainage of abdominal abscesses.

During the past eight years, 119 patients with abdominal abscesses underwent percutaneous catheter drainage (PCD), including 76 who had successful treatment by the initial PCD, 19 who had recurrent abscesses after removal of drainage catheters and 24 who were outright failures and either died of sepsis or required surgical drainage. This study was designed to identify outcome variables that might be used prospectively to assess the therapeutic efficacy of PCD. Outcome variables included abscess size, daily drainage volume and location, presence of a gastrointestinal fistula, age, bacteriologic factors and response of the pulse rate, body temperature and leukocyte count of the patient to PCD. Ninety of 119 patients (76 per cent) ultimately had successful drainage of abscesses by PCD alone. The over-all mortality rate was 16 per cent (19 of 119), with a 75 per cent mortality rate in the failure group. Neither abscess size, bacteriologic findings nor pulse rate correlated with outcome. PCD failure was significantly greater in patients greater than or equal to 60 years (p less than or equal to 0.01) and in patients with pancreatic abscesses versus other locations (p less than or equal to 0.04). Drainage volume was significantly greater in PCD failures than among PCD successes at greater than or equal to 3 days after PCD (p less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1991

Preexposure of the peritoneum to live bacteria increases later mixed intraabdominal abscess formation and delays mortality.

Intraabdominal infections are a major source of morbidity and mortality for the trauma and postoperative patient. Transient peritoneal contamination with bacteria after either intentional or unintentional violation of the gut are common. The effect of this intermittent antigen exposure upon later formation of intraabdominal abscesses is unclear. Previous experiments by others have demonstrated that repeated exposure to Bacteroides fragilis capsular polysaccharide can induce a T lymphocyte-mediated immunity to subsequent induction of pure B. fragilis abscess formation. In a murine mixed intraabdominal abscess model, preexposure to live Escherichia coli, B. fragilis, or both increased the number of later abscesses and in some cases their bacterial composition. Further, immunization with E. coli alone increased late mortality without altering overall mortality. These data suggest that the alterations of immune function produced by live, transient bacteria upon subsequent mixed intraabdominal abscess induction result in fundamentally different consequences from those observed after specific polysaccharide antigen exposure and subsequent monomicrobial abscess induction.

Abscess↗
PubMed1991

Percutaneous drainage of an abscess in the lateral neck region of a horse.

A large abscess in the lateral neck region of a horse was treated with percutaneous drainage. The abscess was localized with ultrasonography and aspirated by use of a 7.7-cm spinal needle. A stainless-steel guide wire was passed through the needle, and tissue dilators were used to enlarge the percutaneous hole. A multiperforated polyvinylchloride catheter that was placed within the abscess cavity permitted aspiration and lavage of the abscess. The abscess resolved over the next 10 days with no complications. Percutaneous abscess drainage is commonly performed in people and may have application in veterinary medicine.

Abscess↗
PubMed1991

Ultraconservative management of appendiceal abscess.

An appendiceal abscess is usually treated conservatively. Drainage of the abscess is instituted if this treatment is unsuccessful. Some surgeons practise immediate appendectomy and abscess drainage. An alternative ultraconservative approach whereby abscess drainage is avoided has been reviewed retrospectively. Twenty-eight patients were treated by observation only. They remained in hospital for between 1 and 36 days (median 10 days) until their signs and symptoms disappeared. No patient required surgery or developed complications in hospital. One patient developed acute appendicitis 10 days after discharge. One developed a recurrent abscess. Another group of 19 patients were treated over the same period of time by immediate operation. Ten developed postoperative complications. Hospitalization ranged from 4 to 36 days (median 8 days). Ultraconservative management of appendiceal abscess is a safe and effective alternative to immediate surgery, or ultrasound- or computed tomographic-guided drainage.

Abscess↗
PubMed1990

Intraabdominal abscess formation after major liver resection.

A series of 138 major liver resections undertaken between 1971 and 1987 were reviewed. Intrabdominal abscesses developed in 11 (8%) patients, a mean of 23 days (range 10-42) after operation and two died (mortality 18%). Eight developed after 63 right hepatectomies, two after 24 right lobectomies, one after 34 left hepatectomies and none after left lobectomies (17). Patients who developed intra-abdominal abscesses underwent significantly longer operations (mean (SEM) 400 (48) compared with 275 (21) min) (p less than 0.05) and had significantly more bleeding during the operation (7,600 (1,750) compared with 3,200 (430), p less than 0.01) than those who did not. The amounts recovered from the abdominal drains, both before and after the diagnosis, were comparatively greater in patients with abdominal abscesses. Antibiotic prophylaxis was given to 10 of 11 patients who did and 89 of 127 patients who did not, form abscesses. We conclude that the risk of intra-abdominal abscess formation after major liver resection is increased: when a large amount of liver tissue is removed (right hepatectomy or lobectomy); when there is a lot of intraoperative bleeding; and when the operation takes a long time. Antibiotic prophylaxis did not affect the risk of abscess formation this series.

Abdomen↗
PubMed1990

[Improvement of the transthoracic method of puncture sanitation in complex treatment of lung abscess].

A method of transthoracic puncture sanitation treatment of the cavity of a lung abscess with the use of a needle of an original design and the proteolytic enzyme karipazyme (0.5% solution) is suggested. Fifty-two patients with abscess of the lung (main group) were treated by this method, 46 (88.4 +/- 4.4%) were cured, in 5 (9.6 +/- 4.1%) transformation to a chronic abscess occurred, one patient (1.9 +/- 1.7%) died. Transthoracic puncture with a commonly used needle and administration of antibiotics into the cavity of the abscess were performed in 57 patients (control group). Thirty-eight patients (66.7 +/- 9%; p less than 0.05) recovered, chronic abscess formed in 14 patients (27.6 +/- 5.9; p less than 0.05), 5 patients (8.7 +/- 3.7%) died. The duration of treatment of patients in the main group was reduced by 16.1 days. The method of skin coloured liquid-crystal thermography was employed in 28 patients to determine the optimal point for puncturing the abscess, as the result of which complications were avoided and the number of failures in puncture of the lung destruction cavity reduced by half.

Anti-Bacterial Agents↗
PubMed1990

Delayed breast abscesses after lumpectomy and radiation therapy.

The incidence of delayed breast abscess as a complication following the treatment of breast cancer has not been reported. A retrospective review of 112 patients (pts) undergoing lumpectomy and radiation therapy (RT) in our institution revealed a six per cent incidence of delayed breast abscess (range 1.5-8 months, median 5 months). Prophylactic antibiotics (P = 1.0), postoperative chemotherapy (P = 1.0), primary vs. re-excisional lumpectomy (P = 1.0), and different surgeons (P = 0.514) were not associated with increased risk of delayed abscess. All abscesses occurred in the first 32 pts of this series. The size of the lumpectomy cavity correlated with the incidence of infection (P = 0.0440). Since six of seven abscess cultures grew staphylococci (coagulase negative three pts, coagulase positive three pts), and four of these pts experienced prior biopsy site infection, skin necrosis or repeated seroma aspirations, a skin source for contamination was suggested. Treatment of the abscesses with antibiotics and immediate drainage produced acceptable but inferior cosmesis. We conclude that a small but significant subset of patients treated with lumpectomy and RT will develop delayed wound infections and that expeditious treatment affords satisfactory cosmesis.

Abscess↗
PubMedDate not supplied

Hepatic intraarterial antibiotic therapy for resistant hepatic abscesses.

Liver abscesses present a severe problematic medical entity. The traditional treatment modality consists of surgical drainage, which cannot be accomplished in all circumstances. Other modes of therapy include systemic antibiotics or percutaneous catheter drainage under ultrasonography or computerized tomography. Despite new treatment regimes liver abscesses, to date, are a potentially lethal disease, with a mortality rate of about 50%. We report an innovative approach of high dosage intrahepatic arterial antibiotic infusion for the therapy of hepatic abscesses, which are resistant to conventional treatments. A patient who underwent mastectomy for breast carcinoma, developed liver metastases one year later. She was prescribed systemic chemotherapy for one year, but no antitumor response was evident. Since ther was no evidence for extra-hepatic metastases, intraarterial hepatic chemotherapy was instituted, using an Infusaid (Mi-400) implantable pump. Marked regression of liver metastases was observed. Therapy was withheld after 19 months because of biliary sclerosis development. At this stage, the patient developed liver abscesses, which were resistant to systemic antibiotic therapy. Intraarterial antibiotic therapy, using the implantable pump, was initiated. Following the treatment, a marked improvement in the patients' clinical condition was recorded and shrinkage of the abscesses was evident by ultrasonography. The patient was free of symptoms for three months, when she was readmitted with evidence of terminal metastatic disease and sepsis. It is suggested that intrahepatic arterial antibiotic therapy is an additional mode of treatment for patients with persistent liver abscesses which fail to respond to conventional treatment.

Adult↗
PubMed1989

[Brain abscess following cerebral infarction: a case report].

The authors report a case of brain abscess following cerebral infarction. A 73-year-old man was admitted to our clinic with symptoms of right hemiparesis and total aphasia. CT scan revealed abnormal low density area in the left fronto-temporo-parietal region. Cerebral angiography demonstrated occlusion of the left middle cerebral artery at the M1 portion. On the 16th hospital day, an episode of generalized seizure with high fever appeared, and intermittent high fever persisted thereafter. Two months after admission, CT scan revealed several cystic lesions with marked ring enhancement at the site of cerebral infarction, suggesting multiple abscesses. Aspirations of left frontal and parietal abscesses were accomplished and the cultures of the pus disclosed Proteus vulgaris. Due to progressive hydrocephalus, a ventriculoperitoneal shunt was constructed one month later. Repeated CT scans showed a gradual diminution of the abscesses. It is considered that the blood-brain barrier is broken and the local immunological system against bacteria may be weakened when the brain is damaged by ischemia. Brain abscess seems to be developed in such circumstances even under the influence of transient bacteremia which originates in other parts of the body. Therefore the possibility of cerebral abscess should be suspected if patients with cerebral infarction suffer from the symptoms such as fever, neck stiffness or disturbance of consciousness.

Aged↗
PubMedDate not supplied

[Computed tomography in the diagnosis of and tactics of treating abscesses of the brain].

The authors analyse 20 patients with brain abscesses of rhinosinusogenic etiology who were subjected to computed tomography (CT). CT allows exact localization of the abscess, appraisal of its size and depth, the thickness of the capsule, and the relation of the abscess to the cerebral ventricular system. CT is very important in establishing the diagnosis of multiple, multichamber, and hematogenic-metastatic brain abscesses. CT provides for visualization of edema of the brain and changes in the ventricular system and subarachnoid fissures in patients with abscesses and for objective and exact evaluation of the radical character of removal of the abscess and the dynamics of reactive changes in the surrounding tissue.

Adult↗
PubMed1985

Psoas abscess complicating Crohn's disease.

Psoas abscess classically was described as secondary to tubercular spondylitis but now more frequently is a complication of an intraabdominal process such as Crohn's disease. Less well recognized is that the fever, flexion contracture of the hip, and weight loss characterizing psoas abscess may be the first indications of Crohn's disease; in fact, gastrointestinal symptoms may be completely absent. Psoas abscess was the first sign of Crohn's disease in 11 of 46 reported patients. We present three additional patients; two were asymptomatic before psoas abscess formation. Only seven of 26 patients whose sole surgical procedure was drainage had subsequent resolution of the abscess. When drainage was combined with bowel resection, 14 of 18 patients (77.8%) were cured by the initial procedure. Thromboembolic complications occurred in four patients (8.3%). Effective therapy when psoas abscess complicates Crohn's disease, includes appropriate antibiotics, drainage, resection of fistulous intestine, and antithrombotic prophylaxis.

Abdominal Muscles↗
PubMed1986

Lung abscess in small cell carcinoma of the lung during chemotherapy and corticosteroids: an analysis of 276 consecutive patients.

Two hundred and seventy-six consecutive patients with small cell carcinoma of the lung (SCCL) treated with combination chemotherapy and in 79 cases with "high-dose" steroids (greater than 40 mg of prednisone per day) were reviewed for the presence of lung abscess. This was diagnosed in 17 patients, in 4 (1.5%) at the time of their malignant diagnosis and 13 (4.9%) during chemotherapy. Five of 79 patients receiving "high-dose" glucocorticoid therapy and 8 of 184 patients not receiving steroids developed lung abscess (no statistical difference, P greater than 0.05). "High-dose" steroids do not facilitate the development of lung abscess. Eleven patients presented with a lung abscess within a month of initiation of chemotherapy. Median survival of these patients was 182 days and not significantly different from a median survival of 224 days (P greater than 0.05) observed in 31 compatible patients without lung abscess. Lung abscess per se in patients with SCCL should not prevent the use of intensive combination chemotherapy and "high-dose" steroid therapy.

Adult↗
PubMed1988

Effect of ciprofloxacin on subcutaneous abscesses induced with Staphylococcus epidermidis and a foreign body implant in the mouse.

Subcutaneous abscesses were induced in mice with Staphylococcus epidermidis strain G19-85 and a foreign body implant. The MIC of ciprofloxacin for this strain was 0.25 microgram/ml. The ciprofloxacin dosage, 120 mg/kg/day, was divided into three injections, administered to the mice subcutaneously at 8 h intervals. Serum concentration kinetics in normal mice (n = 50) were determined. The peak serum level of ciprofloxacin was 3.18 micrograms/ml at the 15 min sampling time; the trough level was 0.53 micrograms/ml at 8 h. Abscesses were found in 96% (n = 49) of the untreated, infected control mice. Three modes of treatment with ciprofloxacin were tested: (1) four prophylactic injections of ciprofloxacin prior to infection reduced abscess formation to 64% (p less than or equal to 0.0002, n = 50). (2) Eleven therapeutic injections, initiated 4 days after infection, reduced abscess formation to 86% (p less than or equal to 0.17, n = 49). (3) One prophylactic injection prior to surgery and five therapeutic injections after infection reduced abscess formation to 43% (p less than or equal to 0.0001, n = 49). Culture results correlated with the abscess formation rates.

Abscess↗
PubMedDate not supplied

[Conservative treatment of brain abscesses].

The authors present 6 patients with brain abscesses treated conservatively. There were multiple brain abscesses in 4 patients. The patients were in good general condition without marked symptoms of high intracranial pressure. The conservative treatment lasted 4 to 11 weeks under CT control and careful observation of clinical status. 5 patients were cured, 4 of them without any neurological deficit and 1--with visual field defect after bilateral brain abscesses in occipital lobes. 1 patient died in spite of drainage of the biggest of multiple abscesses. The authors confirmed the value of conservative treatment in selected cases of brain abscess, specially in multiple brain abscesses. The early beginning of such treatment seems to be specially important.

Adrenal Cortex Hormones↗
PubMed1987

[Spinal epidural abscess--report of 5 cases].

We reported 5 patients with spinal epidural abscess. They were two men and three women. Their ages ranged from 48 to 56 years (mean, 53 years). In three out of 5 cases, the etiology was thought to be infection after lumbar discography, tracheostomy and lumber surgery. In the other two cases the etiology could not be determined. The abscess was located at cervical, thoracic and lumbar levels in 2, 1 and 2 cases, respectively. The interval between initial symptoms and operation was from 1 to 3 months. Purulent epidural collection was found in four cases at operation. Irrigation and drainage were sufficiently performed postoperatively in 4 cases. Antibiotic therapy had been continued for at least 8 weeks in every case. As demonstrated in the case 2, CT scan was very useful in determining the extension of the abscess and degree of the cord compression by the abscess. Also in the case 2, the epidural abscess extending from cervical canal to extracanalicular space was completely drained by applying draining tubes without laminectomy. The present results indicate that emergency laminectomy is not always necessary for the treatment of epidural abscess, especially in subacute or chronic cases.

Abscess↗
PubMedDate not supplied

[Etiology of brain abscesses in children].

Data on 67 children treated for abscess of the brain in 1966-1984 years are analysed. The work deals with study of the etiology of brain abscesses in children and the possibility of their prevention. Comparative analysis of the causes of brain abscesses in different age groups (from 10 weeks to 15 years) shows pyoinflammatory skin diseases to be the most common cause of brain abscesses in young children, in those under the age of 12 months in particular. In the next age groups the incidence of cerebral abscesses caused by pyogenic diseases of the skin reduces whereas that of abscesses of otorhinosinusogenic origin increases.

Adolescent↗
PubMed1987

[A case of amebic liver abscess rupturing into the stomach].

A forty-eight year-old man complained of upper abdominal pain and diarrhea with mucinous bloody stool. He had not been abroad. Except high fever, anemia, leukocytosis and elevated rate of erythrocyte sedimentation, laboratory findings were not abnormal. Gastrofiberscopy showed the protrusion of gastric mucosa with a hollow on its surface in the angle. Abdominal CT scan and echogram revealed an abscess in the right hepatic lobe and an abscess in the left lobe. Ulceration and small protrusion of the rectal mucosa were found by romanoscopy. Stool examinations could not reveal amebas, but serological test for amebiasis by the Ouchterlony method showed positive. Under the diagnosis of the perforation into the stomach of amebic liver abscess, he was treated with Metronidazole and tetracycline. But, as a diffuse shadow appeared in the right thoracic cavity on the chest x-ray films with bloody sputa, perforation of amebic liver abscess to the right thoracic cavity was suspected. Laparotomy showed the communication of the abscess to gastric lumen. The post operative course was uneventful. We reported a case with the rare complication of amebic liver abscess.

Humans↗
PubMed1985

Pyogenic liver abscess in Crohn's disease.

We describe six cases of pyogenic liver abscess occurring among 1227 Crohn's disease patients admitted to The Mount Sinai Hospital from 1960 through 1982, and review the features of the seven similar cases that have been previously reported. Mechanisms of formation of liver abscess in these 13 patients included direct extension of intraabdominal abscess (three cases), propagation via the portal vein (eight cases), biliary complications (one case), or metastatic cancer (one case). Five of the 13 patients died. All five deaths occurred among the eight patients with multiple abscesses; all five patients with solitary abscess survived. The mean age of the patients who died was 56 years, versus 37 years for the survivors. Three of the four patients treated with antibiotics only died; only two of the nine patients who underwent some form of drainage succumbed. Mortality was usually attributable to failure in making the diagnosis, especially as liver function test abnormalities were often subtle. Furthermore, the generally nonspecific clinical signs and symptoms were often obscured by underlying bowel disease. If a high index of suspicion is maintained, CT scanning and ultrasonography should reveal the lesion at an early stage, so that the necessary drainage procedure can be carried out, with or without concomitant resection of affected bowel and drainage of intraabdominal abscess.

Adult↗