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PubMedDate not supplied

Pyogenic liver abscess after hepatobiliary and pancreatic surgery.

From 1984 to 1998, a total of 2158 patients underwent hepatobiliary and pancreatic surgery, and 12 patients developed liver abscess after hepatobiliary and pancreatic surgery; thus, the incidence of liver abscess was 0.6%. The main reasons for liver abscess were anastomotic stricture in 5 patients, obstruction of percutaneous transhepatic biliary drainage (PTBD) tube in 3 patients, and portal vein and hepatic artery obstruction due to intraoperative radiation in 1 patient, transportal chemotherapy in 1 patient, chemo-lipiodolization in 1 patient, and unknown in 1 patient. Ten of the 12 patients initially underwent percutaneous transhepatic abscess drainage of whom 2 patients subsequently received surgical drainage. The other 2 patients were treated with antibiotics only. Eight of the 12 patients were cured, but 4 patients died. The reasons for death were sepsis in 3 patients and liver failure due to portal vein and hepatic artery obstruction in 1 patient. Our results indicate that liver abscess should be taken into consideration for patients with risk factors.

Aged↗
PubMed1999

[Abscesses caused by deciduous teeth].

Abscesses in children, caused by deciduous teeth, ar not so frequently as seen in the permanent dentition. In most cases caries or an odontogenic infection of the associated deciduous tooth have already been treated by the dentist or oral surgeon at an earlier stage, i.e. before the infection exacerbates to an abscess. At the department of Oral and Maxillofacial Surgery of the Academic Hospital Nijmegen, between April 1997 and April 1998 20 children have been treated on a total of 1,693 patients with an odontogenic infection. Of this group, nine young children had an abscess caused by a deciduous tooth. In most cases the mandibular deciduous molars were involved. In one case an osteomyelitis of the mandible was diagnosed. All abscesses and infections could be treated adequately. The use of antibiotics is of paramount importance in the treatment of these abscesses in children.

Anti-Bacterial Agents↗
PubMed2002

Cerebellar abscess due to Listeria monocytogenes.

Brain abscess due to listeria monocytogenes mainly involves the cerebral hemispheres. Cerebellar abscess is an infrequent event, which could lead to rapid neurological deterioration if unrecognized. We present a case of multiple brain stem and cerebellar abscesses in a previously healthy individual exposed to unpasteurized milk. This is the 2nd case of cerebellar abscess due to listeria monocytogenes reported in the English literature. The diagnosis of listeria monocytogenes was made in the surgical specimen. Our case illustrates the difficulty of early diagnosis of cerebellar listeria monocytogenes abscesses and the importance of prompt neurosurgical intervention.

Aged↗
PubMed2002

[Recurrent cerebellar abscess secondary to middle ear cholesteatoma: case report].

We report a case of recurrent cerebellar abscess secondary to middle ear cholesteatoma. A 57-year-old man was admitted to our hospital because of symptoms of headache and nausea in August, 1992. Brain CT scans revealed acute hydrocephalus complicated by a cerebellar abscess. The patient was discharged without any neurological deterioration after systemic antibiotics combined with intrathecal aminoglucoside administration via ventricular drainage. Mannitol was also administrated for 7 days immediately after the patient's admission. The clinical course was uneventful for 8 years afterwards. Follow-up MR images revealed no signs of recurrence. Unfortunately, the patient suffered a recurrence of cerebellar abscess in October, 2000. His condition continued to deteriorate in spite of being treated by systemic antibiototics. MR images and CT scans targeting a portion of his middle ear revealed extensive pus-coated mastoiditis and middle ear cholesteatoma. We thus performed radical mastoidectomy including removal of the middle ear cholesteatoma. After the operation, the cerebellar abscess was ameliorated. He has been free from recurrence for 2 years, so far. Early diagnosis and prompt intervention are necessary for reducing mortality and morbidity rates due to otogenic brain abscess. Recognizing middle ear cholesteatoma as one of the major causes of neurological entities in the cerebellopontine angle portion, accurate otological examination and prompt treatment can possibly bring about a better prognosis.

Brain Abscess↗
PubMed2002

Spinal epidural abscess: a diagnostic challenge.

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. Risk factors for epidural abscess include immunocompromised states such as diabetes mellitus, alcoholism, cancer, and acquired immunodeficiency syndrome, as well as spinal procedures including epidural anesthesia and spinal surgery. The signs and symptoms of epidural abscess are nonspecific and can range from low back pain to sepsis. The treatment of choice in most patients is surgical decompression followed by four to six weeks of antibiotic therapy. Nonsurgical treatment may be appropriate in selected patients. The most common causative organism in spinal epidural abscess is Staphylococcus aureus. Spinal epidural abscess involving actinomycosis is rare.

Actinomycetales Infections↗
PubMed2002

Predictors of mortality in brain abscess.

OBJECTIVE: Brain abscess carries significant morbidity and mortality. Our objective was to elucidate the clinical presentation of brain abscess and to assess predictors of mortality in these patients. METHODS: All patients with a brain abscess presenting to the Aga Khan University Hospital, a tertiary care referral center in Karachi, Pakistan, were studied retrospectively. Statistical analysis involved univariate analysis and a logistic regression model. RESULTS: Among the 66 patients analyzed, a distant metastatic focus of infection was the most commonly identified predisposing factor (29%). Otogenic infection was the commonest contiguous source and sinusitis was noticeably absent. Multiple abscesses were frequent (35%). Streptococci were the most common isolates (39%). Lumbar puncture was performed in 44% and steroids administered in 33%. Treatment was surgical in 58%. Most comatose patients were treated conservatively. Overall mortality was 29%. Univariate analysis identified comatose presentation and identification of a distant focus of infection as predictors of mortality. The logistic regression model, however, identified a distant focus of infection as the only independent predictor. CONCLUSION: Age greater than 30 years, corticosteroid use, multiple abscesses, performance of lumbar puncture and conservative management had no affect on outcome.

Adolescent↗
PubMed2002

Clinicopathological analysis of liver abscess in Japan.

Currently, pyogenic liver abscess is not frequent, but it is a severe infectious disease. However a strategy for the effective treatment of liver abscess is not established. We analyzed 75 cases of liver abscess over an eight year period and evaluated their prognosis, any associated underlying disease, or the effect of percutaneous transhepatic abscess drainage (PTAD). For all 75 cases, laboratory data were analyzed and imaging studies were performed. Next, PTAD and antibiotic administration were started on these cases as first choice treatments. These treatments were continued until the laboratory data of the patient were restored to within the normal range. Those cases that were PTAD non-effective or required operation for underlying diseases, underwent operations. Of the total 75 cases, 63 survived after treatment and 12 cases died. Bacteria were detected in 50 cases and Klebsiella pneumoniae was detected in 31 of these 50 cases, but 25 out of 75 cases were negative. The biliary system was the main route of infection. PTAD was effective, especially in cases that were complicated with disseminated intravascular coagulation (DIC) or acute renal failure (ARF). PTAD is an effective treatment for liver abscess, it is especially useful in the restoration of severe general conditions as indicated by this study.

Acute Kidney Injury↗
PubMed1975

[An interhemispheric subdural abscess (author's transl)].

A subdural abscess which is cinfined to the interhemispheric space alone, which does not extend over the convexity is rare. This is a specific form and is a complication of a common intracranial subdural abscess. It is of great practical importance to determins this uncommon location, and cerebral angiography is most useful. Multiple trephinations or craniotomy for exploration and evacuation must be performed near the midline. A 20 year old female was in a comatose state on admission. There was a flaccid paralysis of the right lower extremity and a dilated left pupil. Examination of the eyegrounds showed bilateral choked discs. Left cerebral angiography revealed the proximal pericallosal artery to be shifted to the right side and the callosomarginae artery was displaced from the midline parallel to the distal pericallosal artery. Although 20 ml of pus was evacuated through the parietal burr hole, which was located a bout 2.5 cm from the midline, she died. At autopsy, a subsural abscess was found in the interhemispheric space. It extended from the frontal pole to the occipital and had a thick membrane which adhered firmly to the falx medially. We could find no other subdural nor intracerebral pus collections. The left cerebral hemisphere was edematous. The superior sagittal sinus had a thick wall and was almost occluded. This dural sinus thrombophlebitis may have developed into the interhemispheric subdural abscess. It is emphasized that this uncommon location for subdural abscess poses a specific problem in clinical practice.

Adult↗
PubMed2001

[Analysis of 48 cases of brain abscess].

To analyze brain abscess for its origins of infection, diagnosis, and methods of treatment, 48 patients with brain abscess were retrospectively reviewed and they were treated with nonoperative way, puncture and aspiration, and resection. The results were that the cure rate was 81.25%, the improvement was 12.5%, and the mortality was 6.25%. The chronic otogenic infection and cryptogenic infection are the main origins of infection of brain abscess. The diagnosis of brain abscess depends on CT and MRI, and methods of its treatment are decided by the condition and speciality of brain abscess.

Adolescent↗
PubMed2003

[Treatment of breast abscess. An analysis of patient material and implementation of recommendations].

INTRODUCTION: Several options for treatment of abscesses in the breast have appeared during the last two decades. No randomised studies comparing these options have been performed. MATERIAL AND METHODS: A retrospective study of the treatment of breast abscesses over a four-year-period. Incision or puncture was employed at the discretion of the responsible doctor. RESULTS: A total of 87 women with various types of breast abscesses were treated by means of incision (42 women equal to 48%) or aspiration of pus by puncture (45 women equal to 52%). After incision which was done in general anaesthesia in 38 women (90%) the patients were discharged after 2.9 days (mean), median 2.0 days, and 39 of 45 women treated by means of puncture were discharged after 2.1 days (mean), median 1.0 day, p = 0.001. In six women, puncture treatment was possible as outpatient procedure. Concerning puncture the majority of patients were treated in local analgesia or without any medication. Recurrent abscess formation was observed in eight women (19%) after incision and in nine women (20%) after puncture. DISCUSSION: The two treatment schedules are effective, but abscess treatment by means of puncture is preferred as the most convenient method for the patient and as a cost-effective treatment. Finally, recommendations for the future schedule of breast absess treatment are specified.

Abscess↗
PubMed2003

[A case of a bacterial brain abscess presenting as symptoms of 'sudden stroke-like' onset].

We report a case of a bacterial brain abscess presenting symptoms of 'sudden stroke-like' onset, associated with infective endocarditis. A 59-year-old woman experienced a sudden stroke-like onset of left hemiplegia. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed on the day of ictus. No lesion responsible for the symptom was seen on either CT or a T2 weighted image (T2WI), but a diffusion-weighted image (DWI) revealed focal increased signal intensity in the right frontal lobe. An initial diagnosis of acute embolic infarction associated with infective endocarditis was made. Although the patient's neurological state had been stable, motor paresis of her left extremities became worse starting one month after her admission. MRI with gadolinium-diethylenetriaminepenta-acid (Gd-DTPA) at 37 days after admission showed an irregular-shaped ring-enhancement lesion located at the same place as the initial infarction, and in the left frontal lobe. Surgical drainage of the lesion in the right frontal lobe was performed, and diagnosed as a bacterial abscess. The exact mechanism of a bacterial brain abscess presenting with 'sudden stroke-like' onset is unknown, but various hypotheses have been proposed. One is that paroxysmal septic emboli lead to abscess formation within or near the area of embolic infarction. Our case showed that the creation of a brain abscess followed embolic strokes, and that this hypothesis was demonstrated by MRI carried out on the day of ictus.

Brain Abscess↗
PubMed2003

[Subphrenic abscess during the course of acute brucellosis: diagnosis and treatment with percutaneous sonographically-guided drainage].

Abscess formation during the course of acute brucellosis is a rare event. A case of subphrenic abscess, the first to our knowledge, is described. A 49 years-old male patient with fever and a mild increase in ALT and gamma-GT was referred to our Institution. Routine blood exams tested negative and antibodies against Brucella spp. Were also negative. CT examination of abdomen was normal. After 8 days, US examination showed a liquid area under the right diaphragma and US-guided puncture revealed an abscess; pus culture showed the presence of Brucella melitensis. Seven days later theWright reaction became positive. After percutaneous catheter drainage of the abscess, fever disappeared and US follow-up showed reconstitution of subphrenic space. Our study confirm that sonography is a valid method to demonstrate abdominal abscess and that US-guided percutaneous puncture and drainage are useful tools in diagnosis and treatment of fluid abdominal collections

Acute Disease↗
PubMedDate not supplied

The usefulness of technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan to differentiate periappendiceal abscess from acute appendicitis--a preliminary report.

BACKGROUND/AIMS: The purpose of this study is to assess the usefulness of Tc-HMPAO (technetium-99m hexamethylpropyleneamineoxide) labeled white blood cells abdomen scan to differentiate acute appendicitis from periappendiceal abscess. METHODOLOGY: Forty-five patients with atypical symptoms and signs of appendicitis were included in this preliminary study. At 4 hours after an intravenous injection of Tc-HMPAO labeled white blood cells, static images over the anterior abdomen were obtained using a gamma camera. Two regions of interest were selected, one was over the lumbar spine and the other was over the appendiceal area. The mean count ratio of the appendiceal area over the mean pixel count of the lumbar spine was calculated. Sixteen patients were diagnosed with acute appendicitis and 19 patients with periappendiceal abscess by final operative findings. Meanwhile, the other 10 patients with acute abdomen but with no appendicitis served as controls. RESULTS: The mean count ratio of controls, acute appendicitis and periappendiceal abscess was 0.65 +/- 0.05, 0.82 +/- 0.07, and 1.25 +/- 0.11, respectively. If the mean count ratio > or = 1.00 was defined as the cutoff value to diagnose periappendiceal abscess, the specificity and the positive predictive value was 100%. CONCLUSIONS: We concluded that Tc-HMPAO white blood cells abdomen scan should be a potential tool to differentiate periappendiceal abscess from acute appendicitis.

Abdominal Abscess↗
PubMedDate not supplied

[Percutaneous drainage of hepatic pyogenic abscess: management efficacy].

OBJECTIVE: To show the success of percutaneous drainage combined with an antibiotic therapy in the management of hepatic pyogenic abscess. EQUIPMENT AND METHODS: Health histories of 24 patients diagnosed with hepatic pyogenic abscess were evaluated in the Unit of Vascular and Intervention Radiology (URVI) of the Eduardo Rebagliatti Martins Hospital and were checked, during the time period beginning in January 2001 and ending in June 2002. 23 patients underwent percutaneous drainage, guided by echography. RESULTS: A total of 36 abscesses were found, with an average diameter of 6,78 cm (3-18cm); the most common location was on the right (78%). In 37,5% of the patients, the cause of the abscess could not be determined; in 33,3%, the cause was determined after surgical intervention, primarily cholecystectomy (12,5%). Pseudomona (12,5%) was the species most found in cultivation. Only 28 abscesses were drained percutaneously. On average, drainage lasted 15,8 days, and there was an average of 3,6 controls per patient. There was 89,30% overall success for the procedure with three documented errors. CONCLUSION: Percutaneous drainage in conjunction with proper antibiotic coverage is efficient in the management of hepatic pyogenic collections, and its use must be generalized.

Adult↗
PubMed2003

[Pyogenic liver abscess--an unusual presentation of colonic villous adenoma].

A pyogenic liver abscess is a final common pathway of many pathologic processes, mainly suppurative cholangitis or suppurative pyephlebitis, arising from abdominal or pelvic infection. There are many other etiologies, and some abscesses are idiopathic-namely, cryptogenic abscess. We present a case of a man with a pyogenic liver abscess. This was the clue for the diagnosis of a large but clinically silent villous adenoma of the colon. Colonic tumors, manifested clinically as an hepatic abscess, in the absence of liver metastases, are very uncommon. This is the first description of a villous adenomatous tumor with such a presentation.

Adenoma, Villous↗
PubMed1992

[Cardiac abscesses].

The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived.

Abscess↗
PubMed2003

[Late onset of spinal epidural abscess after spinal epidural catheterization].

A 76-year-old diabetic woman received epidural catheterization for sigmoid colectomy. Four months later she started to complain of fever and severe lumbago, and finally fell into coma and tetraplegia. She had severe neck stiffness, and lumbar puncture yielded yellowish pus. Methicilin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus and blood as a causative organism. Magnetic resonance imaging showed extensive abscess in the posterior epidural space at the level between Th1 and L5. We diagnosed her disease as iatrogenic spinal epidural abscess due to epidural catheterization. After emergent laminectomy and evacuation of abscess, inflammation was gradually improved. She returned to normal except for slight gait disturbance. Spinal epidural abscess often develops rapidly after Staphyloccocus aureus infection. In our case, however, neurological deficits appeared 144 days after insertion of epidural catheter. We must remember that spinal epidural abscess is an important cause of lumbago with high fever, even several months after surgical or catheterial intervention to the spine, for immunocompromised patients with diabetes or neoplasm.

Aged↗
PubMed1992

[Percutaneous ultrasound-guided thick catheter drainage of retroperitoneal abscess: report of 2 cases].

Retroperitoneal abscess have been a difficult diagnostic and therapeutic challenge in the past. With the advent of precise, noninvasive imaging modalities, they now are defined more easily. Percutaneous guided catheter drainage has changed our traditional therapeutic approach to this disease, in the majority of cases. In general, massive semilytic fatty tissue of retroperitoneal abscess can not pass through the ordinary percutaneous catheter. Herein we report 2 cases of retroperitoneal abscess successfully treated with percutaneous guided thick catheter drainage combined with medical control. Percutaneous guided thick catheter drainage can be performed in most uroradiological facilities. There are many advantages to percutaneous ultrasound-guided thick catheter drainage compared with surgical drainage of retroperitoneal abscess. They include: earlier diagnosis and treatment, avoidance of general anaesthesia, operations which involve risks and complications, shorter and less expensive therapy, easier nursing care, better infection control with the closed drainage system, and greater patient acceptance. Therefore, we believe that a trial of thick catheter percutaneous drainage of retroperitoneal abscess, without a complex septum, should be the initial mode of therapy, and surgical intervention should be undertaken only when percutaneous drainage fails or is contraindicated.

Abscess↗