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PubMed1996

A clustering of epidural abscesses in chronic hemodialysis patients: risks of salvaging access catheters in cases of infection.

The objective of this study was to investigate factors that might increase the risk of epidural abscesses in hemodialysis patients. The charts of all hemodialysis patients presenting with an epidural abscess over a period of 5 yr at Duke University Hospital and the Durham Veterans Administration Medical Center were reviewed for patient demographics, months on dialysis, vascular access, recently treated infections, signs and symptoms at presentation, and results of any surgical intervention. Ten patients developed an epidural abscess during a 5-yr period. Severe, debilitating back pain was the only consistent initial complaint. Eight patients had dual-lumen intravenous catheters for hemodialysis access, and five patients had or were receiving parenteral antibiotics for catheter salvage. There were no consistent physical, clinical, or laboratory findings. Surgical drainage of the abscess with removal of the hemodialysis catheters and parenteral antibiotics were required for cure in six patients. It was concluded that attempts at catheter salvage with parenteral antibiotics has significant risks for complications. Hemodialysis patients with recently treated or ongoing bacteremia who complain about severe and debilitating back pain with or without neurologic findings should raise the suspicion of an occult epidural abscess.

Abscess↗
PubMed1994

Effect of treatment on some periodontopathogens and their antibody levels in periodontal abscesses.

Twenty patients suffering from abscess of periodontal origin were treated and followed clinically and microbiologically for 6 months. Microbiological examination was performed by culture technique. One deep and one shallow periodontal pocket in the same patient were examined concomitantly. Serum was collected and analyzed for specific antibody level using ELISA methodology. Treatment included supragingival scaling, drainage, and irrigation of the periodontal pocket with 0.85% sodium chloride and systemic tetracycline administration, 1 g per day for 2 weeks. At baseline, 90% of the abscesses harbored Porphyromonas gingivalis and/or Prevotella intermedia. After 6 months, abscess sites demonstrated a reduced probing depth, less bleeding on probing, and gain of attachment. Abscess sites showed no P. gingivalis and the proportion of P. intermedia was significantly reduced 6 months after treatment. In deep periodontal pockets a similar pattern was seen. Shallow pockets demonstrated few clinical signs of inflammation and the number of bacteria was generally low. Campylobacter rectus, Capnocytophaga spp, and Fusobacterium nucleatum were frequently seen in low numbers in most sites during the study period, while Actinobacillus actinomycetemcomitans was detected only in a few sites. The IgG levels in patient sera against antigens of homologous bacterial strains remained fairly constant for 6 months. The result of the present study indicates that P. gingivalis and P. intermedia are involved in periodontal abscess formation. Also, treatment where drainage is combined with tetracycline administration promotes healing and reattachment.

Antibodies, Bacterial↗
PubMed1997

Tooth loss due to periodontal abscess: a retrospective study.

This retrospective study focused on the frequency of tooth loss due to periodontal abscess among 42 patients who were treated by a single clinician over a 5- to 29-year period. A total of 114 patients were selected from the active periodontal recall schedule of a single periodontist at The University of Iowa College of Dentistry. The criteria for inclusion in the study included having a history of moderate to advanced periodontitis, being on 3 to 6 month recall periodontal maintenance care, and completion of active periodontal therapy prior to October 1987. Other parameters evaluated were age; gender; number of teeth present and missing at the initial, reevaluation, and last periodontal recall visit; initial periodontal prognosis; furcation involvement; non-surgical and surgical periodontal therapy; and reasons for tooth loss. Patients were grouped according to the number of teeth lost following active periodontal treatment into well-maintained (0 to 3), downhill (4 to 9), and extreme downhill (10 to 23) groups. Forty-two of the 114 patients were identified as having one or more periodontal abscesses. A total of 109 teeth were affected by periodontal abscess of which 49 (45%) teeth were lost and 60 (55%) were successfully maintained over an average of 12.5 years (5 to 29 years). More furcated teeth were lost than nonfurcated teeth and teeth given a hopeless prognosis were lost more consistently than those given a questionable prognosis in all groups. The frequency of periodontal abscess and tooth loss per patient was greater in the downhill and extreme downhill response groups than the well-maintained group. This suggests that teeth with a history of periodontal abscess can be treated and maintained for several years.

Female↗
PubMed2003

Gingival/soft tissue abscess following subepithelial connective tissue graft for root coverage: report of three cases.

BACKGROUND: The subepithelial connective tissue graft (SCTG) is a predictable technique for root coverage. The small number of potential postoperative problems make SCTG the current treatment of choice for reversing gingival recession. METHODS: The purpose of this article is to report three cases of complications after the use of an SCTG where an abscess occurred following the initial healing phase. The surgical technique that was used and the treatment that was provided for the abscesses are reported, and the possible causes of these complications are discussed. RESULTS: The abscesses were treated conservatively, and no recurrence has been observed after treatment. CONCLUSIONS: Possible causes of the abscesses include "stitch abscess" or reaction to the suture material used for the submerged sutures, or a possible role of epithelium implanted during the procedure. The clinical outcome of the root coverage procedure was not affected.

Abscess↗
PubMed1994

Abscesses secondary to parenteral abuse of drugs. A study of demographic and bacteriological characteristics.

Seventy-seven patients (eighty-six lesions) who had been seen over a fifteen-month period because of an abscess at the site of injection due to parenteral abuse of drugs were identified in a retrospective review. Forty-one patients (forty-five abscesses) had had cultures before antibiotic therapy. Thirty (73 per cent) of the forty-one patients had isolation of a streptococcal species on culture, with microaerophilic streptococci identified in sixteen. Twenty (49 per cent) of the forty-one patients had isolation of a staphylococcal species. Four of the staphylococcal organisms were identified as oxacillin-resistant Staphylococcus aureus. Two patients who had three abscesses each had different organisms in each abscess. Gram-negative bacilli were identified in the cultures of ten (24 per cent) of the forty-one patients; patients who were forty years old or more had a sixfold greater risk of having gram-negative bacilli. Specimens of the abscess had been obtained from thirty-six patients for culture from twelve to seventy-two hours after the first dose of antibiotics had been given. The microbiological findings in these cultures were similar to those in the cultures of specimens obtained from patients before antibiotics had been given. Five (14 per cent) of thirty-five patients who had been tested for the human immunodeficiency virus had a positive result. This finding emphasizes the importance of surveillance for and precautions against the human immunodeficiency virus in people who abuse drugs parenterally.

Abscess↗
PubMed2001

Discrimination of brain abscess and cystic tumor by in vivo proton magnetic resonance spectroscopy.

Proton magnetic resonance (MR) spectroscopy was evaluated for the differentiation of brain abscesses and cystic brain tumors. Proton MR spectroscopy was performed in vivo in two patients with brain abscess and eight patients with various cystic brain tumors (anaplastic astrocytoma, glioblastoma, and metastatic brain tumor). MR imaging with contrast medium demonstrated ring-like enhanced mass lesions in all patients. The various resonance peaks in proton MR spectra were assigned to metabolites according to chemical shifts. Treatment of the cystic brain lesions was based on the information from proton MR spectroscopy. Aspirated pus from one patient with brain abscess was examined using ex vivo proton MR spectroscopy. The in vivo spectra of brain abscess contained resonance peaks attributed to acetate, lactate, alanine, amino acids, and lipids in both cases, and an additional peak of succinate in one case. In vivo spectra of the neoplasms contained resonance peaks corresponding to lactate, lipids, choline, creatine, and N-acetyl aspartate. Proton MR spectroscopy is useful for discriminating brain abscess from cystic tumors with similar neuroimaging appearance, which is very important for determining the treatment strategy.

Acetates↗
PubMed2002

Detection and characterization of the evolution of cerebral abscesses with diffusion-weighted magnetic resonance imaging--two case reports.

A 57-year-old man and a 45-year-old woman presented with cerebral abscesses. Diffusion-weighted magnetic resonance (MR) imaging and conventional MR imaging clearly showed the different stages of the course of the brain abscesses. As the abscess matured, the signal intensity of the center gradually increased to the typical high value with a low apparent diffusion coefficient (ADC) on diffusion-weighted MR imaging, and enhancement of the capsule on T1-weighted MR imaging with gadolinium. Healing of the abscess was revealed by the signal intensity of the center returning to isointense and an increase in ADC to the baseline. Surrounding edema showed an increase in ADC, followed by a return to the baseline. These changes probably reflect the pathological processes occurring in the abscesses.

Brain Abscess↗
PubMed2005

Combined approach for otogenic brain abscess.

Otogenic intracranial infections usually require both neurosurgical and otolaryngological surgery. This prospective, non-randomized study investigated the value of combining both surgical procedures. Thirteen patients with otogenic intracranial abscess were treated by mastoidectomy and abscess removal through the same incision between 1993 and 2002. Another 12 patients underwent abscess removal or mastoidectomy followed by the other procedure within 7 days. The clinical features of the patients were compared. Four patients died in our series. All four patients had Glasgow Coma Scale (GCS) scores of 7 or less. The preoperative GCS score was the main factor in mortality. One patient had recurrence after the combined approach compared to nine patients with recurrence after separate procedures. The surgical procedure was the main factor affecting the recurrence rate. The combined approach and total capsule excision of the abscess may reduce the risk of recurrence of otogenic intracranial abscess.

Adolescent↗
PubMed1980

Diagnostic imaging of hepatic abscesses: a retrospective analysis.

Seventeen patients with pathologically proven intrahepatic abscesses seen over a 12 month period were retrospectively evaluated. Of these 17 patients, 16 had at least three of the four commonly used imaging techniques for the evaluation of hepatic abscesses, including scintigraphy with technetium-99m-labeled sulfur colloid and gallium-67 citrate, sonography, and computed tomography. Of the 17 abscesses, 12 were of pyogenic and five were of amebic origin. Technetium-99m sulfur colloid correctly identified 14 of 16 abscesses; gallium, nine of 10; sonography, 12 of 16; and computed tomography, 15 of 17. The rational approach to the diagnosis of intrahepatic abscesses should be a 99mTc sulfur colloid scan followed, if necessary, by either sonography or CT. In equivocal cases a gallium scan may be of value.

Adult↗
PubMed1982

Anterior left subphrenic abscess: characteristic plain film and CT appearance.

Abdominal abscesses located in the left upper quadrant may occur in two major anatomic locations, the subphrenic space or the lesser sac. The left coronary or triangular ligament extending from the dorsal aspect of the liver to the diaphragm separates the subphrenic space from the lesser sac. As the ligament usually extends posteriorly, the anterior subphrenic space extends under the dome of the diaphragm, occupying the most superior part of the left upper quadrant. Both the lesser sac and the left anterior subphrenic space extend to the right of midline. The left anterior subphrenic compartment is bounded on the right by the falciform ligament while the lesser sac extends to the right coronary ligament and foramen of Winslow. Therefore, abscesses either in the left anterior subphrenic compartment or lesser sac may extend across the midline into the right upper quadrant. Left anterior subphrenic abscesses will be immediately subdiaphragmatic while lesser sac abscesses extending to the right of midline will not usually extend up to the diaphragm. Six cases are presented demonstrating midline air-fluid levels and soft-tissue masses in the immediate subdiaphragmatic area, characteristic signs of anterior left subphrenic abscesses.

Humans↗
PubMed1983

The silent abdominal abscess: role of the radiologist.

An abdominal abscess usually causes severe distress with fever, leukocytosis, pain, and toxicity. However, a small but significant proportion of patients with abdominal abscess may appear entirely well with no elevated temperature or white blood cell count. Fifteen patients are reported whose initial clinical presentation was unremarkable but who had significant abscess formation that was well documented by radiographic methods. Both the radiologist and the patient's primary physician must be aware of the not infrequent presentation of abdominal abscess in a clinically innocuous manner. The lack of fever, elevated white blood cell count, or patient complaint should in no way rule out the diagnosis of abscess when positive radiographic evidence is found.

Abdomen↗
PubMed1984

Temporizing effect of percutaneous drainage of complicated abscesses in critically ill patients.

Fifteen patients who would not have been candidates for percutaneous abscess drainage previously, and who were exceedingly high-risk for surgery, underwent initial catheter drainage. The patients were critically ill and had complicated abscesses, which were poorly defined, multiloculated, phlegmonous, and had associated fistulas. The percutaneous drainages were not curative. However, the patients dramatically improved and became fit for surgery (13 patients) or another interventional procedure (three patients). Five hypotensive patients were stabilized by the catheter drainage; mean white blood cell count in the 15 patients decreased by 14,000/mm3; mean temperature decreased from 40 degrees C to 38.1 degrees C; and anemia, coagulation factors, and overall condition improved. Eventual surgery was more limited (directed to the cause of the abscess) and less time-consuming. All these high-risk patients survived with this combined radiologic-surgical approach. Temporizing percutaneous abscess drainage in gravely ill patients with complex abscesses offers significant therapeutic benefit, although it may not be curative. With realistic expectations for partial success rather than cure, the scope of candidates for percutaneous drainage has broadened.

Abscess↗
PubMed1986

CT in the management of periappendiceal abscess.

Abdominal CT was the primary diagnostic method used to evaluate 40 patients with suspected periappendiceal abscess. Its subsequent impact on patient management was then analyzed for several categories of clinical presentation, including patients with and without a palpable right-lower-quadrant mass and postoperative patients. CT was reliable in distinguishing periappendiceal abscesses from phlegmons; 17 of 18 patients with phlegmons responded promptly to antibiotic therapy alone without need for surgery. Patients with larger, poorly localized abscesses underwent early surgical drainage. CT was successful in guiding percutaneous catheter drainage (nine patients) or aspiration (one patient) of well-localized periappendiceal abscesses in 10 of 11 patients. One attempted catheter drainage guided by sonography was technically unsuccessful. In patients without a palpable right-lower-quadrant mass, CT was helpful in establishing the diagnosis of periappendiceal inflammation. However, there were three false-positive diagnoses in patients with pericecal fluid collections including a ruptured cecal lymphoma, a ruptured cecal diverticulum, and a ruptured corpus luteum cyst. A diagnostic approach with CT is presented in patients with suspected periappendiceal abscess.

Abscess↗
PubMed1988

Percutaneous drainage of abscesses in patients with Crohn disease.

Up to one-quarter of patients with Crohn disease present with abdominal abscesses at some point in their illnesses, most of which have enteric communication. The efficacy of percutaneous drainage alone vs either a combined percutaneous/surgical approach or a purely surgical approach has not been established. We reviewed the results of percutaneous drainage of nine abscesses in eight patients with Crohn disease. Six of these abscesses communicated with the intestine. Those with enteric communication had temporary palliation, with improved medical status. However, all patients required definitive surgery within 7 weeks of initial drainage. Percutaneous drainage in the three patients without enteric communication resulted in a permanent cure. Our experience with this small series suggests that abscesses that have an enteric communication in patients with Crohn disease can be temporarily palliated by percutaneous drainage. However, use of this technique is unlikely to result in long-term palliation or cure. It appears that abscesses with intestinal communication in Crohn patients can be cured by percutaneous therapy alone.

Abdomen↗
PubMed1994

Transrectal sonographically guided drainage of deep pelvic abscesses.

OBJECTIVE: As an alternative to traditional surgical transrectal and transgluteal drainage, we have examined the efficacy of transrectal sonographically guided drainage for deep pelvic abscesses not accessible by percutaneous transabdominal or transvaginal routes. SUBJECTS AND METHODS: In nine patients (five males and four females) 5-51 years old, sonography or CT showed pelvic abscesses that were deemed unapproachable by percutaneous transabdominal or transvaginal routes because of interposed bowel (five patients), presacral location (two patients), or inability of the pediatric vagina to accommodate a transvaginal probe (one patient). One patient refused both transvaginal and transgluteal routes in preference to transrectal drainage. IV sedation (adults) or general anesthesia (children) was used for all drainages. A 7.5-MHz end-fire transrectal sonographic probe fitted with a biopsy guide was inserted into the rectum, and the collection was localized. With sonographic guidance, an 18-gauge needle and then a guidewire were advanced into the collection. Then with fluoroscopic guidance, a self-retaining drainage catheter was placed by using the Seldinger technique. RESULTS: All nine collections were successfully accessed and effectively drained without complication. Catheters were removed after 1-24 days (mean, 7 days; median, 5 days) without recurrent abscesses. CONCLUSION: Transrectal sonographically guided drainage of deep pelvic abscesses is a safe, well-tolerated, effective alternative to the more traditional surgical transrectal drainage or transgluteal approach, especially in pelvic abscesses that cannot be safely drained via a percutaneous transabdominal or transvaginal route.

Abscess↗
PubMed1997

Percutaneous radiologic drainage of pancreatic abscesses.

OBJECTIVE: The purpose of our study was to review and report the patient selection, techniques, and results of percutaneous drainage of pancreatic abscesses by retrospective review. MATERIALS AND METHODS: Fifty-nine patients (46 men and 13 women) with a mean age of 44 years old had 80 pancreatic abscesses that were drained percutaneously under radiologic guidance (CT, n = 77; sonography, n = 2; and fluoroscopy, n = 1). Abscesses had a wide spectrum of causes, with alcoholic pancreatitis being most common, trauma second most common, and gallstones third. Ten patients had undergone surgery for pancreatic necrosis or abscess. Patients with pancreatic pseudocysts, necrosis, or acute fluid collections were excluded from this study. RESULTS: Of the 59 patients, 51 (86%) were cured with percutaneous drainage and antibiotic therapy. Of the patients who were not cured with percutaneous drainage, seven required surgery and one underwent repeat percutaneous drainage. In the 59 patients, complications included non-life-threatening bleeding in three patients. Ten of 59 patients (17%) had fistulas that spontaneously formed into the gastrointestinal tract. The duration of catheterization ranged from 4 to 119 days, with a mean duration of 33 days. The rate of mortality at 30 days after completion of percutaneous drainage was 8% (5 of 59). CONCLUSION: Percutaneous drainage was an effective therapy for this defined group of patients with pancreatic abscesses. Factors leading to the relatively high success rate described in this study likely included selection of patients; catheters of adequate size, number, and location; careful follow-up with appropriate catheter manipulations; and an integrated, cooperative approach whereby surgeons were willing to permit drainage to effect its benefits, rather than operating prematurely.

Abscess↗
PubMed1998

Prostatic abscess: diagnosis and treatment.

OBJECTIVE: Prostatic abscesses are uncommon in clinical practice because early antibiotic therapy has reduced complications of prostatitis. Prostatic abscess mainly affects diabetic and immunosuppressed patients. The organisms most frequently involved are Escherichia coli and Staphylococcus, whereas gonococcus is rarely encountered. The results in eight men with prostatic abscess, five of whom were treated with sonographically guided percutaneous drainage, are reported. The diagnosis, clinically suspected in only three patients, was confirmed by transrectal sonography. All patients experienced complete abscess resolution. CONCLUSION: Transrectal sonography is the most reliable imaging method to diagnose prostatic abscess. Percutaneous transperineal or transrectal drainage is the first choice for therapy because of the lower risk of complication compared with surgery.

Abscess↗
PubMedDate not supplied

[Multiple brain abscesses: a case report].

CASE REPORT: 10 days before admission a 45-year old female experienced general weakness, and T 38 degrees C. During that period she had no cardio-respiratory nor neurological complaints, and the temperature varied between 37.5 degrees C and 38 degrees C. Her medical history was unremarkable, without immunodeficiency. The day before admission she presented with left arm paresis and during the next day it progressed to paralysis. She had no headache. On admission the following diagnostic procedures were performed: the cranial CT scan showed two lesions (possibly meta lesions). Chest X-ray was normal. WBC=15x10(9)/L, ESR=90/120. On the second day following admission brain MRI showed multiple abscesses in both hemispheres, mostly in the gray/white junction. High doses of IV metronidasol, cephtriaxon and cipfloxacin were administered without obtaining specimens for micro-biological diagnosis. In next two days she developed coma, respiratory insufficiency and septic temperature. Brain surgery was not performed due to severe involvement of the brain with multiple abscesses. Repeated chest X-ray revealed bilateral pneumonia. A lethal outcome occurred on the third day, regardless of all efforts. Autopsy showed multiple brain abscesses as well as on the lungs and liver. A beta-hemolytic streptococcal infection was established. CONCLUSIONS: Prevention includes treatment of the infection source. The classic triad of headache, fever and focal deficit occur in less than 50% of patients. Even in such cases brain abscess must be reconsidered CT appearance of brain abscess is similar to that of neoplastic and other infectious and non infectious diseases--especially in the stage of early cerebritis. If the CT findings are not clear, MRI should be performed.

Brain Abscess↗