Management of lactating breast abscesses by ultrasound-guided needle aspiration and continuation of breastfeeding: A pilot study.

INTRODUCTION: Needle aspiration of breast abscesses during lactation are currently recommended as an alternative to surgery only for moderate forms. In case of breast abscess, many patients stop breastfeeding on the advice of a health professional. We reviewed our experience of treatment of lactating breast abscesses by ultrasound-guided aspiration and suggest an algorithm of their management. We also analyzed the continuation of breastfeeding of these patients after advices from trained teams. MATERIEL AND METHODS: We conducted a retrospective study from April 2016 to April 2017, including 28 patients referred for a breast abscess during lactation at the Duroc Breast Imaging Center. A management by ultrasound-guided aspiration was proposed to each patient. We collected data about the breastfeeding between October 2018 and January 2019. RESULTS: A single aspiration was sufficient in 64.3% of cases. The delay between the occurrence of the abscess and the indication for drainage was significantly higher for patients who have needed finally surgical drainage (p = 0,0031). There were no difference of size of abscesses between patients receiving needle aspiration alone and those who have undergone surgery (p = 0,97). All patients who had been managed by needle aspiration continued breastfeeding after the treatment and 40% of the patients were still breastfeeding at 6 months. CONCLUSION: The management of lactating breast abscess by ultrasound-guided needle aspiration is an effective alternative to surgery. It appears to be effective regardless of the size of the abscess and is compatible with the continuation of breastfeeding. Our study has indeed shown that if they are well advised, the majority of patients continue breastfeeding so that it is essential that health professionals be better trained regarding the management of breastfeeding complications.

Absceso periostomal secundario a perforación intestinal por cuerpo extraño: presentación de un caso / Periostomal abscess secondary to bowel perforation due to foreign body ingestion: a case report

Resumen Objetivo: Reportar un caso de absceso periostomal, su diagnóstico clínico e imagenológico y manejo. Materiales y Método: Paciente de 77 años usuaria de colostomía con dolor abdominal asociado a aumento de volumen y enrojecimiento de la piel alrededor de la colostomía. Una tomografía computada de abdomen muestra un cuerpo extraño perforante de la pared colónica ostomizada, asociado a formación de un absceso. Resultados: Se practica una incisión de la colección, dando salida a gran cantidad de pus y cuerpo extraño correspondiente a tibia de ave. Se inicia cobertura antibiótica y se instala drenaje Penrose. Controles posteriores muestran regresión del absceso y drenaje sin débito. Discusión: 80%-90% de los cuerpos extraños ingeridos son eliminados sin complicación y < 1% producen perforación. Esto es más común en segmentos intestinales angulados o intervenidos quirúrgicamente. La clínica es inespecífica y el diagnóstico requiere una imagen que identifique signos sugerentes. Conclusión: Un absceso periostomal y la perforación intestinal por cuerpo extraño son cuadros infrecuentes. La alta sospecha diagnóstica y una evaluación imagenológica pueden dar una respuesta precisa. Además del manejo quirúrgico, debe asociarse cobertura antibiótica para enteropatógenos y generalmente un sistema de drenaje.

Aim: To report a case of periostomal abscess, its clinical and imaging diagnosis and management. Materials and Method: 77-year-old patient, user of a colostomy with abdominal pain associated to swelling and redness of the skin next to the colostomy. A computed tomography of the abdomen showed a foreign body perforating the ostomized bowel associated to the formation of an abscess. Results: An incision of the gathering was performed, giving out a great quantity of pus and the foreign body, which corresponded to a bird's tibia. Antibiotic therapy was given, and a Penrose drainage installed. Further controls showed regression of the abscess and no flux from drainage. Discussion: 80%-90% of ingested foreign bodies are eliminated without complications and < 1% produce perforation. This is more common in angled intestinal segments or surgically intervened ones. Clinical features are unspecific, and diagnosis requires suggesting imaging signs. Conclusion: Periostomal abscesses and bowel perforation due to foreign body are infrequent. High diagnostic suspicion and an imaging evaluation may give a precise answer. Besides surgical management, antibiotic coverage for enteropathogens must be associated and a drainage system too in most cases.

Different types of dysphagia alleviated by the chin-down position.

OBJECTIVE: Retrospective videofluoroscopic swallowing study (VFSS) evaluations of pharyngeal swallowing were used to evaluate the types of dysphagia alleviated by the chin-down maneuver. MATERIALS AND METHODS: The study population consisted of 64 patients who underwent VFSS evaluations during neutral and chin-down maneuvers presenting specifically penetration or aspiration. The assessment of the VFSS movie clips of each maneuver was performed using parameters of the Modified Barium Swallow Impairment Profile (MBSImP) and the presence and degree of airway invasion(PDAI) by three blinded raters in the following five subcategorized groups, 1. patietns presenting penetration or aspiration during swallow 2. after swallow, patients of 3. head and neck, 4. digestive and 5. neuromuscular disorders, respectively. The scores registered for the two maneuvers were statistically compared. Additionally, we examined statistically which factors had the impact on the improvement of the PDAI using fisher's exact test. RESULTS: Compared with the neutral position, PDAI, pharyngeal constriction, anterior hyoid movement, pharyngeal constriction, laryngeal elevation, laryngeal closure, upper esophageal sphincter opening, initiation of the pharyngeal swallow, and pharyngeal clearance in pyriform sinus were significantly (p < 0.01-0.05) improved with the chin-down maneuver. In a subcategory comparison with group 1, 3 and 4, the PDAI improved significantly (p < 0.01) with the chin-down maneuver, in which laryngeal elevation and laryngeal closure had statistically the impact (p < 0.01-0.05) on improvement of PDAI. CONCLUSION: The chin-down maneuver was most effective in improving swallow function when the impairment included penetration and aspiration during swallow caused by inadequate laryngeal elevation and laryngeal closure.

Profile of osteoarticular tuberculosis in children.

OBJECTIVE: To determine clinical profile of osteoarticular tuberculosis (TB) in children. METHODS: Cross-sectional analysis from 2007 to 2013. All patients diagnosed with bone TB, spinal TB or TB abscesses were included. RESULTS: Out of 1318 children with TB, 39 (2.96%) had osteoarticular TB, of which 16 (42%) had osteomyelitis, 8 (20.5%) had spinal involvement, 7 (17.9%) had TB synovitis, 2 (5.1%) had psoas abscess and 6 (15.4%) had abscesses. The mean age of presentation was 7.1 ± 3.5 years (range 2-14 years). Of the 33 cases in which a culture was done, 25 (64%) showed a positive culture. Drug sensitivity tests were done in 21 patients of which 10 (47.6%) tested were drug resistant, of which 4 (36.4%) were multidrug resistant (MDR), 2 (18.2%) were extensively drug resistant (XDR), 3 were pre-XDR (27.3%) and 1 was polyresistant (9.1%). Nine (23.1%) patients had TB in the past with a treatment duration of 8.3 ± 5.3 months. Contact with a TB patient had occurred in 10 (25.6%) cases. Associated pulmonary TB were seen in 6 (15.39%) and TB meningitis were seen in 1 (2.6%) patients. Surgical intervention was needed in 11 (28.2%) patients of which 5 (45.5%) underwent curettage, drainage was done in 1 (9.1%), arthrotomy in 4 (36.4%) and spinal surgery in 1 (9.1%) patient. CONCLUSION: Drug resistant osteoarticular TB is an emerging problem in children.

Deep Neck Infections Are Life Threatening Infections of Dental Origin: a Presentation and Management of Selected Cases.

BACKGROUND: Untreated dental caries or even dental manipulations, such as a tooth extraction, might cause direct spread of an odontogenic infection and consequently the development of life-threatening conditions such as deep neck infections (DNI). The most common source of DNI is of odontogenic origin (38.8-49%). Abscess formation or cellulitis can lead to life-threatening complications, despite new diagnostic imaging technology and widespread availability of antibiotics. OBJECTIVES: To demonstrate the dangers of DNI, which can create life-threatening situations. METHODS: Five cases of DNI of odontogenic origin, which were referred to the oral and maxillofacial surgery unit, are presented. RESULTS: Clinical manifestations included trismus, dysphagia, dysphonia, dyspnea, and infection symptoms. In all cases, computed tomography confirmed diagnosis and extent of abscess. Complications included mediastinitis, respiratory distress, osteomyelitis of the jaws, and in rare cases the mandibular condyle. Treatment included securing the airway, immediate surgical drainage, removal of the infection source, and antibiotic therapy. All patients were discharged in stable and improved condition. CONCLUSIONS: DNI treatment on an emergency basis requires proper diagnosis and effective management. To confirm diagnosis and prevent serious complications, it is essential for physicians to recognize the spaces of the head and neck that are likely to be affected by DNI.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall's procedure.

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall's procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient's preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.

Complications of Transradial Catheterization and Cannulation.

Transradial catheterization and cannulation are typically well-tolerated procedures, but they are associated with various vascular, infectious, and orthopedic complications. Potential complications include radial artery occlusion, hematoma formation, radial artery laceration, pseudoaneurysm, abscess formation, and compartment syndrome. Hand surgeons are commonly consulted to treat such complications. We review recent evidence available to guide decisions about nonsurgical and surgical interventions to treat and prevent the complications associated with transradial access procedures.

Fulminant gas-forming breast abscess associated with synergistic Veillonella infection.

We present a rare case of a rapidly fulminant and destructive breast abscess with gas production by the synergistic infection of Veillonella and Streptococcus species. To our knowledge, this is the first reported case of Veillonella infection in the breast. Early recognition, empiric antibiotic cover, aggressive surgical debridement, and drainage are necessary to avoid systemic septicemia. Staged reconstructive breast surgery allows for correction any resultant breast deformity.

Bartholin Duct Cyst and Gland Abscess: Office Management.

The Bartholin glands, located in the base of the labia minora, have a role in vaginal lubrication. Because of the presence of other glands, removal of a Bartholin gland does not affect lubrication. Ductal blockage of these typically pea-sized structures can result in enlargement of the gland and subsequent development of Bartholin duct cysts or gland abscesses. Two percent of women will develop a cyst or an abscess in their lifetime, and physicians should be familiar with the range of treatment options. Bartholin duct cysts and gland abscesses can be treated in the office. The healing and recurrence rates are similar among fistulization, marsupialization, and silver nitrate and alcohol sclerotherapy. Needle aspiration and incision and drainage, the two simplest procedures, are not recommended because of the relatively increased recurrence rate.

Postinjection abscesses and granulomas in children adopted from Russia.

Up to 1.3 million children from the former Soviet Union (fSU) and Eastern Europe have been placed in institutional care worldwide. With the hope of ensuring the child's health in the immediate post-adoption period, these children are known to receive many injections of vaccines, vitamins, and medications, many unnecessary and often administered with unsafe technique. This practice can lead to formation of suppurative granulomas in these children. Though rare, dermatologists should be aware of these conditions in adoptees from Eastern Europe.

Transrectal and transvaginal catheter drainages and aspirations for management of pelvic fluid collections: technique, technical success rates, and outcomes in 150 patients.

PURPOSE: To evaluate outcomes of image-guided transrectal/transvaginal (TR/TV) drainage for symptomatic pelvic fluid collections (SPFCs). MATERIALS AND METHODS: Single-center retrospective study of 150 consecutive patients (36 males, 114 females, average age 41 years) who underwent attempted TR/TV drainages of SPFCs during an 11-year, 5-month period. All patients presented with pain and had SPFCs with rectal or vaginal contact on preceding diagnostic CT. Routine technique included Foley catheter insertion, image-guidance with ultrasound and fluoroscopy, 18 g/20 cm Chiba needles, and Seldinger technique for catheter insertion. No anoscope or speculum was used. SPFCs causes were classified by etiology including postoperative-70 (47%); gynecologic-49 (33%); and gastrointestinal-31 (21%). Resolutions of the SPFCs without the need for surgical intervention, collection recurrence, and complications were assessed. Surgical management after attempted TR/TV drainage was considered a failure. RESULTS: Technical success was achieved in 172/180 procedures [TR 128/134 (95%); TV 44/46 (96%)]. TR/TV drainage successfully managed SPFCs in 141/150 patients (94% success rate) and 145/150 patients (97%) did not require surgical intervention; 4 patients with failed TR/TV drainage attempts were managed conservatively. In 5 patients requiring surgery, 4 were after technically successful TR/TV and 1 was after a failed TR attempt. Complications occurred in 4 (3%) patients: 2 bladder punctures (both resolved with medical management), 1 propagation of sepsis, and 1 hemorrhagic return from TR drainage that prompted surgical exploration. CONCLUSION: Transrectal and transvaginal drainage had high technical success rates and were successful in managing the majority (141/150; 94%) of patients with pelvic fluid collections.

Computed tomography-guided navigation assisted drainage for inaccessible deep neck abscess: A case report.

RATIONALE: Deep neck infections (DNIs) in the head and neck area are difficult to treat due to the anatomical complexity of the cervical region. Since inflammation causes changes in anatomy, it is often difficult to find the exact location of the abscess, which leads to failed surgical drainage. PATIENT CONCERN: A 76-year-old female patient was referred to our clinic with trismus and right-side facial swelling. After extraction of her lower third molar 2 weeks ago, due to chronic periodontitis, her trismus had aggravated and her maximal mouth opening was 20 mm. DIAGNOSES: Computed tomography (CT) revealed an approximately 2.5 cm-sized abscess pocket with cellulitis in the right pterygomandibular space. INTERVENTIONS: Since the first surgical drainage attempt using the intraoral approach under general anesthesia had failed and conservative antibiotic treatment was also ineffective, a second surgical procedure with a CT-guided navigation system was performed and the pus was successfully evacuated. OUTCOMES: After drainage with CT-guided navigation, the clinical symptoms and septic conditions of the patient showed remarkable improvement, and there was no recurrence of infection within a year after the procedure. LESSONS: Drainage with CT-guided navigation can be used as a successful surgical tool to aid in the surgery of patients with DNI when it is difficult to accurately target the abscess due to inflammation.

Surgical Management of a Chronic Neck Abscess in a U.S. Navy Bottlenose Dolphin.

Surgical intervention on cetaceans is rarely performed due to challenges including general anesthesia and post-operative wound healing. This report describes the evaluation and treatment of an adult female bottlenose dolphin (Tursiops truncatus) with the US Navy Marine Mammal Program, with a chronic ventral cervical abscess caused by Candida glabrata. Despite aspiration and lavage along with multiple antifungal drugs, the patient developed inspiratory stridor with decreased performance level and surgical treatment was pursued. Under general anesthesia with the dolphin in dorsal recumbency position a 12-cm longitudinal ventral midline neck incision was used for exploration. Intraoperative ultrasound aided the identification of surgical landmarks and the abscess cavity. After adequate drainage and curettage, a closed-suction drain was placed in the surgical site. Retention sutures were used to close the incision and the external drain bulb was secured to a pectoral fin strap. One-year post-op, the dolphin was clinically normal and follow-up imaging showed no significant recurrence of the abscess. This case demonstrates a novel surgical approach of managing abscesses in dolphins, including placement and management of a negative suction drain in a submerged patient. The successful collaboration between veterinary anesthesiology, veterinary medicine, radiology, and general surgery allowed the patient to continue her normal activities as a full-duty service member.

The impact of CO2 laser for treatment of Bartholin's gland cyst or abscess on female sexual function: a pilot study.

The aim of this study is to evaluate the sexual functionality before and after treatment of Bartholin's gland diseases (BGD) with CO2 laser and to compare our results to patients who underwent surgical cold knife and to a healthy control group (HCG). Consecutive patients (n = 15) affected by BG cyst or abscess who underwent CO2 laser treatment were evaluated. Patients were asked to complete the Italian translation of the Female Sexual Functioning Index (FSFI) before and 4 weeks after treatment. Results after CO2 laser were compared with two control groups: patients affected by BG cyst (n = 15) or abscess treated with surgical cold knife treatment and a HCG (n = 18). A statistically significant advantage of CO2 laser versus cold knife treatment in terms of lubrication, pain and global score were recorded. Both the single scores of five domains and total score of FSFI were globally higher after any treatment compared to before (CO2 and cold knife) of BGD. According to our data, CO2 laser therapy is often well tolerated by patients and correlated with a favorable sexual health recovery.

Successful Management of Infected Facial Filler with Brucella.

BACKGROUND: The widespread desire to maintain youth and beauty with minimally invasive procedures made the use of soft tissue fillers an attractive option to correct numerous aesthetic problems. However, many complications have emerged recently especially with the use of non-FDA-approved permanent materials. In this case report, we are demonstrating the effective management of a patient with Brucella isolated from a facial abscess at the site of prior permanent filler injection done 17 years ago. METHODS: A 56-year-old woman presented complaining of painful swelling of the right cheek after a failed trial of filler evacuation and intralesional corticosteroid injection. The patient was interviewed carefully, and physical examination was performed, followed by culture and imaging. RESULTS: The patient had a facial abscess that was complicated by parotid infiltration by Brucella. Eventually she was managed successfully by anti-Brucella antibiotics for 6 months with no further complaints. A review of causative organisms in the literature along with recommendations for management is discussed. CONCLUSION: Permanent fillers have shown many complications that can occur even years after injection. Therefore, physicians should be careful when using permanent fillers and should restrict their use to certain situations. Moreover, rare infections must be kept in mind and careful history, including travel history and animal contact, needs to be considered particularly in the unusual scenarios. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Sigmoid Colon Perforation Mimics a Tuboovarian Absces.

INTRODUCTION: An adnexal mass may be diagnosed after a routine pelvic ultrasonographic examination or an emergent hospital admission due to rupture of ectopic pregnancy, adnexal torsion or rupture of tuboovarian abscess. It is necessary to evaluate the origin of the mass initially and to classify patients who need further evaluation and treatment for an urgent condition. CASE PRESENTATION: We report a case of sigmoid colon rupture due to sigmoid colon adenocarcinoma presenting as acute abdomen with left adnexal mass in a 28 years old woman. Abdominopelvic computed tomography revealed a left adnexal mass with suspicion of tuboovarian abscess. In laparatomy, rupture of sigmoid colon was observed and resection of sigmoid colon was performed. Histological examination of resection part revealed diagnosis of sigmoid colon adenocarcinoma due to familial adenomatous polyposis. CONCLUSION: This case may be interesting for clinicians because pelvic pain, fever, increased infection markers in the laboratory and mass at ultrasonography or other screening methods could cause a misdiagnosis of tubaovarian abscess especially in reproductive age women. Before the operation of the pelvic mass of all age women with the diagnosis of tuboovarian abscess other causes of the pelvic abscess should come into mine and necessary preparation for operation must be done.