Multiple subcutaneous tuberculous abscesses in a dermatomyositis patient without pulmonary tuberculosis: a case report and literature review.

BACKGROUND: Even though remarkable progress for diagnostics of pulmonary TB has been made, it is still a challenge to establish a definitive diagnosis for extrapulmonary TB (EPTB) in clinical practice. Among all the presentations of EPTB, cold abscesses are unusual and deceptive, which are often reported in the chest wall and spine. Subcutaneous abscess in the connective tissue of limbs is extremely rare. CASE PRESENTATION: A 48-year-old man with dermatomyositis was hospitalized because of multiple subcutaneous tuberculous abscesses in his limbs, but without pulmonary tuberculosis. Particularly, one insidious abscess appeared during anti-TB treatment due to "paradoxical reaction". After routine anti-TB therapy, local puncture drainage and surgical resection, the patient was cured and discharged. CONCLUSIONS: Tuberculous infection should be kept in mind for the subcutaneous abscess of immunocompromised patients, even without previous TB history. Treatment strategy depends on the suppurating progress of abscess lesions. Meanwhile, complication of newly-developed insidious abscess during treatment should be vigilant.

Packing versus non-packing outcomes for abscesses after incision and drainage.

CLINICAL QUESTION: In non-diabetic, non-immunocompromised individuals with skin abscesses, does packing after incision and drainage (I&D) reduce the risk of recurrence or reintervention compared with not packing? ANSWER: No. If the abscess is less than 5 cm, packing does not affect outcomes. LEVEL OF EVIDENCE FOR THE ANSWER: B. DATE SEARCH WAS CONDUCTED: November 2014. INCLUSION CRITERIA: Published RCTs and meta-analysis studies. EXCLUSION CRITERIA: Abscess greater than 5 cm, abscess in diabetics, abscess in immunocompromised.

[Surgical treatment for thoracic spinal tuberculosis with intraspinal abscesses by unilateral vertebral lamina limited decompression via posterior-only approach].

OBJECTIVE: To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with intraspinal abscesses by internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
 METHODS: A total of 37 pantients (24 males and 13 females) with thoracic spinal tuberculosis complicated with intraspinal abscess lesions were admitted to our hospital, with age 13-68(39.7 ± 9.1) years old. Spinal lesions of segmental kyphosis Cobb angle was 8°-62° (29.6° ± 3.6°). Frankel grade system was used to assess neurological function. According to the system, there were 3, 7, 19 and 8 cases for grade B, C, D and E, respectively. All 37 cases were treated with internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
 RESULTS: The mean duration for follow-up was 24-90 (53.0 ± 15.7) months. Intraoperative dural tear occurred in 1 cases with cerebrospinal fluid leakage after operation; 2 cases showed postoperative neurological complications; delayed wound healing occurred in 2 cases. The postoperative kyphotic angle was 5°-21° (8.3° ± 1.3°). The kyphotic angle was 8°-26° (10.1° ± 1.9°) at the last follow-up. By the time of the last follow-up, all patients with preoperative neurological symptoms improved at different degree. According to Frankel classification, 2 cases recovered from grade B to D, 1 case from grade B to E, 3 cases from grade C to D, 4 cases from grade C to E, 13 cases from grade D to E. No failure in fixation and pseudarthrosis. All patients obtained satisfactory bone graft fusion.
 CONCLUSION: Posterior internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion might be a effective and feasible method for treatment of thoracic spinal tuberculosis with intraspinal abscess lesions.

[HOW TO PERFORM THE CONVERSION DURING LAPAROSCOPIC CHOLECYSTECTOMY].

The aim of the work was the rationale for the choice of access in the performance of conversion in laparoscopic cholecystectomy. In our study, conversion was performed in 34 (2.78%) cases of 1222 laparoscopic cholecystectomies: when the LCE for chronic cholecystitis--17 (1.6%) cases of 1065, for acute cholecystitis--17 (10.8%) of 157. The most common access for conversion are oblique access Kocher and upper-middle access. Choice of approach for the implementation of the conversion depends on the cause of conversion.

[AMPUTATION OR EXARTICULATION OF TOES IN PATIENTS WITH DIABETIC FOOT SYNDROME].

The results of surgical treatment of 127 patients, suffering diabetic foot syndrome, were analyzed. In 82 patients (1st group) a radical toe extirpation was accomplished; in 45 (2nd group)--a phalangopreserving operations (amputaion of toe, necrectomy, sequestrectomy, the abscess opening) were done. The reoperation rate in patients of the 1st group have constituted 6.1%, the wound suppuration -3.6%, in a 2nd group satisfactory results were achieved in 26.7% of patients, and in the rest of them--reoperations were done for the pathological process progression.

[Expedience of application of a dietic therapy in treatment of purulent-septic diseases of soft tissues].

The results of investigation of the dietotherapy impact on the course of purulent-septic process in soft tissues were analyzed. There were operated 58 patients, to 38 of them a certain diet was prescribed. Immediate impact of the diet therapy on the wound process course was established, what was demonstrated by reduction of duration of the earning capacity loss in patients, who have followed a special diet, by 2.58 days.

Brucellar spondylodiscitis: comparison of patients with and without abscesses.

Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

Right-sided pyriform sinus fistula in an adult.

Pyriform sinus fistula is important despite its rarity, as it can induce a recurrent neck abscess. Most of the reported cases occur in children and the majority affect only the left side. We report a patient with a pyriform sinus fistula of the right neck in an adult, which was successfully treated by surgery. The aetiology of this entity is also discussed herein.

Osteomyelitis of a long bone due to Fusobacterium nucleatum and Actinomyces meyeri in an immunocompetent adult: a case report and literature review.

BACKGROUND: Fusobacterium species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to Fusobacterium nucleatum in an otherwise healthy adult. CASE PRESENTATION: A 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew F. nucleatum. In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of F. nucleatum to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillin-clavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up. CONCLUSIONS: Clinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.

Periurethral abscess following polyacrylamide hydrogel (Bulkamid) for stress urinary incontinence.

Bulkamid is a periurethral bulking agent used to treat stress urinary incontinence (SUI). Manufacturers describe it as nontoxic, nonbiodegradable and biocompatible. Periurethral abscesses are one of the known complications of bulking agents. We present the first reported case of periurethral abscess following Bulkamid injection. The woman had previously had a transobturator tape (TOT) and total vaginal mesh repair. At 6 weeks after injection of the bulking agent, she reported 100 % cure of her SUI. Transperineal ultrasound was used to diagnose and monitor an abscess that developed anterior and lateral to the urethra and separate from the TOT. Magnetic resonance imaging was helpful in delineating the extent of the abscess into the retropubic space but was not able to identify the urethra or the TOT. Surgical drainage of the abscess was performed vaginally, resulting in successful resolution of pain but recurrence of incontinence.

Irreversible muscle damage in bodybuilding due to long-term intramuscular oil injection.

Intramuscular oil injections generating slowly degrading oil-based depots represent a controversial subject in bodybuilding and fitness. However they seem to be commonly reported in a large number of non-medical reports, movies and application protocols for 'site-injections'. Surprisingly the impact of long-term (ab)use on the musculature as well as potential side-effects compromising health and sports ability are lacking in the medical literature. We present the case of a 40 year old male semi-professional bodybuilder with systemic infection and painful reddened swellings of the right upper arm forcing him to discontinue weightlifting. Over the last 8 years he daily self-injected sterilized sesame seed oil at numerous intramuscular locations for the purpose of massive muscle building. Whole body MRI showed more than 100 intramuscular rather than subcutaneous oil cysts and loss of normal muscle anatomy. 2-step septic surgery of the right upper arm revealed pus-filled cystic scar tissue with the near-complete absence of normal muscle. MRI 1 year later revealed the absence of relevant muscle regeneration. Persistent pain and inability to perform normal weight training were evident for at least 3 years post-surgery. This alarming finding indicating irreversible muscle mutilation may hopefully discourage people interested in bodybuilding and fitness from oil-injections. The impact of such chronic tissue stress on other diseases like malignancy remains to be determined.

Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review.

Intramedullary spinal cord abscess (ISCA) without meningitis is an extremely rare entity in the central nervous system, and it is often difficult to diagnose immediately, and no definitive imaging findings have been established. We experienced the case of a 61-year-old male who presented with a sudden onset back pain without fever following rapidly worsening paraparesis for 3 days, who subsequently become unable to walk. According to the initial MRI and 3D-CTA, the presumptive diagnosis was spinal infarction due to spinal artery embolism. However, his symptoms did not improve, despite the gradual changes in MRI following antiplatelet therapy. He underwent a biopsy in an attempt to prevent the lesion from progressing toward the upper spinal cord. The pathological examination revealed an intramedullary abscess, so we performed a midline myelotomy and drained the pus from the abscess. After surgery, MRI showed improvement, but the patient's paraplegia persisted. To the best of our knowledge, this is the first case report of spinal cord abscess with the confirmation of spinal artery occlusion on angiography, which could have been caused by a bacterial embolism. We herein discuss its possible etiology and also review recent reports on ISCA.

[Tuberculosis of shoulder bone]. / Gruzlica kosci ramiennej.

We present a case of 39-year old man in whom after one year of corticotherapy due to suspicion of lung sarcoidosis, pathologic changes in left shoulder bone were diagnosed. Bone biopsy was carried out with subsequent development of skin fistula with matter drainage. Based on histological examination of bone specimen and bacteriological tests - tuberculosis was diagnosed. Patient received typical antituberculous therapy for 6 months resulting in healing of the fistula. After next 6 months new fistula developed within the muscles of the left arm. Examination by magnetic resonance revealed changes suggestive of tuberculosis of the left shoulder bone with the presence of two fistulas and abscess in the muscle. The patient received another course of antituberculous treatment and the content of fistula was removed. After 8 months of therapy fistula was healed while changes in shoulder bone regressed only partially, so the therapy was prolonged until 12 month.

A case of primary syphilis characterised by lymphadenitis with abscess formation treated with only antibiotic without surgical excision of lymph node.

Syphilis is an increasingly common infectious disease caused by the bacterium Treponema pallidum. Atypical clinical presentations occur that may delay its diagnosis and treatment. Regional enlargement of lymph nodes is seen in both primary and secondary stages. Such lymph nodes very rarely become abscesses. Antibiotics should be administered in this situation; however, if this fails, the lymph nodes should be surgically excised.

[Surgical treatment of sacrococcygeal epithelial fistula and dermoid cysts].

The results of surgical treatment of 246 patients in Department of Proctology of Ivano-Frankivsk regional clinical hospital in 2000-2008 yrs were analyzed. There were 232 men and 14 women ageing 18-46 years old. There were admitted to the hospital 38 (15.4%) patients for coccygeal epithelial fistula (CEF) abscess and 6 (2.9%)--for atypical localization of CEF. In 12 (5.8%) patients dermoid cyst of sacrum region was diagnosed. Radical excision of all CEF with suturing of the cutaneous--subcutaneous layers edges to the yellow ligaments edges or periosteum of cristae sacralis medianae in the wound bottom was performed in 76 (84.6%) patients. In 32 (15.4%) patients, after radical excision of CEF, the operation was concluded by mildly approximating interrupted suturing with the wound tamponade, using the gauze band. In 12 (4.9%) patients the radical excision of dermoid cyst with suturing of the skin edges and subcutaneous layer to the wound bottom was made. The abscess revision and restricted necrectomy was performed, the wound was managed, using open method, in 38 (15.4%) patients, suffering CEF abscess. Radical operative intervention was performed in 2 - 4 months. The disease recurrence had occurred in 3 (1.28%) patients due to performance of insufficiently radical excision of ECF.

Squamous metaplasia of lactiferous ducts (SMOLD): an under-recognised entity.

Breast abscesses are a common surgical problem, typically occurring secondary to lactation mastitis. Recurrent subareolar abscesses are rarely reported and may be poorly recognised as a presentation of squamous metaplasia of lactiferous ducts, known eponymously as 'Zuska's disease'. Other synonyms include subareolar breast abscess and lactiferous or mammary fistulas. Recognition of this painful entity is crucial for optimal outcomes since typical breast abscess management of recurrent aspiration or incision and drainage can lead to recurrence and chronic complications, such as fistula formation.

Acute presentation of an intraoral dermoid cyst causing airway compromise in a young child.

A 4-month-old boy presented with a cystic swelling at the floor of the mouth causing acute airway compromise. The only previous history of note, was a tongue tie release at 3 days old. CT scan suggested a dermoid cyst with extensive floor of mouth abscess. He had an excision of the cyst and drainage of the superimposed abscess and made a good recovery. The histology report revealed a dermoid cyst which is a rare diagnosis in a child, particularly within the oral cavity. Early treatment is required to remove these lesions especially when they cause airway compromise or swallowing difficulties. This is the first case to our knowledge which suggests tongue tie release procedures causes a predisposition to the development of dermoid cysts in the oral cavity.

Pituitary abscess: two case reports.

BACKGROUND: Pituitary abscess is a rare condition with nonspecific symptoms that can be delayed. Proper diagnosis needs to occur preoperatively so that the management can be set up accordingly. Accurate diagnosis is challenging because many differential diagnoses can exhibit the same magnetic resonance imaging features. CASE PRESENTATION: We report two cases of pituitary abscess. The first patient was a 66-year-old Arab woman who underwent a surgical procedure for a pituitary macroadenoma and presented 3 months later with chronic headaches and panhypopituitarism. A pituitary abscess was found on the follow-up magnetic resonance imaging. The second patient was a 64-year-old Arab man with no medical history who presented with a chiasmal syndrome with headaches and panhypopituitarism. Brain magnetic resonance imaging showed a heterogeneous pituitary mass that turned out to be a pituitary abscess intraoperatively. These two patients were treated with hormone substitution, endoscopic transsphenoidal drainage, and antibiotherapy, with excellent outcomes. CONCLUSIONS: Pituitary abscess is a rare and serious condition. Preoperative diagnosis can be challenging because of the many existing differential diagnoses upon imaging. Magnetic resonance imaging is the mainstay technique of imaging due to its multimodal nature. These cases demonstrate the variable patterns of a pituitary abscess seen on magnetic resonance imaging and the potential difficulties in achieving an accurate diagnosis preoperatively due to many other conditions potentially exhibiting the same magnetic resonance imaging features.

Bartholin's gland abscess caused by Streptococcus pneumoniae in a sexually active young woman.

Gynaecological infections are frequent in women, particularly in young women during their reproductive time. Anatomophysiologically, Bartholin's gland is greatly susceptible to infections and is characterised by an inherent polymicrobial population. In fact, gynaecological microbiota has a set of agents coming from the perianal region that colonise the vagina and, in particular, Bartholin's gland. Taking this into account, infections caused by agents that do not belong to the genital microbiota are less frequent. Here, we describe a case of a 23-year-old young woman with an abscess in Bartholin's gland caused by Streptococcus pneumoniae.