Abscesos mamarios múltiples por Mycobacterium abscessus en mastopexia secundaria con implantes mamarios / Multiple breast abscesses due to Mycobacterium abscessus in secondary mastopexy with breast implant

Las infecciones periprotésicas son una complicación poco frecuente en cirugía de implantes mamarios, pero de difícil resolución si son causadas por gérmenes como las micobacterias. Mycobacterium abscessus es una micobacteria no tuberculosa de rápido crecimiento, que se presenta de manera atípica, generando abscesos y fístulas cutáneas. En este reporte presentamos el caso de una paciente que fue intervenida por recambio de implantes mamarios y mastopexia secundaria. La paciente presentó un seroma temprano como manifestación inicial y posteriormente desarrolló múltiples abscesos en todo el parénquima mamario. El tratamiento instaurado en la paciente fue la extracción del implante mamario,curaciones diarias de la herida, antibioticoterapia prolongada y punciones periódicas guiadas por ecografía, con cultivo del material obtenido. El objetivo de nuestro reporte fue presentar esta complicación generada por un germen poco frecuente, su forma de presentación, diagnóstico y el tratamiento establecido

Although periprosthetic infections are a rare complication in breast implant surgery, they are difficult to resolve if they entail germs like mycobacteria. Mycobacterium abscessus is a rapidly growing, nontuberculous mycobacterium that occurs atypically and generates abscesses and cutaneous fistulas. In this report, we present the case of a patient that underwent surgery for a breast implant replacement and a secondary mastopexy. The initial manifestation the patient evinced was an early seroma. Later, she developed multiple abscesses in all the breast parenchyma. The treatment established for the patient involved extracting the breast implant, daily cleaning and dressing of the wound, prolonged antibiotic therapy, and periodical punctures guided by ultrasound, accompanied by culture sampling. The aim of this report is to present this infrequent germ-generated complication, its form of manifestation, its diagnosis, and the established treatment.

Diagnosis and management of orbital and cranial complications of pediatric acute rhinosinusitis / 中华耳鼻咽喉头颈外科杂志

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.

Diagnosis and treatment of deep neck abscess due to congenital piriform sinus fistula in children / Diagnóstico e tratamento de abscesso cervical profundo por fístula congênita do seio piriforme em crianças

Abstract Introduction: Congenital piriform sinus fistula is a relatively rare type of disease in clinical practice, most occurring during childhood, but doctors have insufficient knowledge regarding this disease, easily misdiagnosing it. Objectives: This study aimed to identify the characteristics of deep neck abscess due to congenital piriform sinus fistula in children. Methods: We performed a retrospective study of 21 cases from January 2016 to August 2018 in our hospital. The onset age, clinical characteristics, auxiliary examination and clinical treatment of the patients was summarized to analyze the diagnosis, treatment characteristics and prognosis. Results: Children from 11 days to 12 years-old were enrolled, with an average age of 3.5 years. Twenty patients had left congenital piriform sinus fistula and 1 had right congenital piriform sinus fistula. Cervical enhanced computed tomography imaging showed gas-liquid equilibrium or air-shadow in the abscesses in 18 cases, and neck ultrasound demonstrated gas echo in the thyroid region in 10 cases. All patients underwent low temperature plasma to seal the internal fistula and returned to the hospital for electronic laryngoscope and neck ultrasound examination at 3 months, 6 months and 1 year after the surgery. No recurrence occurred in any patient. Conclusion: Congenital piriform sinus fistula is an important cause of deep neck abscess in children. The presence of purulent gas-liquid equilibrium or air shadow in cervical-enhanced computed tomography or ultrasound suggests a high possibility of the presence of an internal fistula, and endoscopic low temperature ablation can be done at the same time as the diagnostic endoscopy.

Resumo Introdução: A fístula congênita do seio piriforme é uma doença relativamente rara na prática clínica; a maioria se manifesta na infância; entretanto, os médicos geralmente têm conhecimento insuficiente sobre essa condição clínica e seu diagnóstico é facilmente feito de forma errônea. Objetivo: Identificar as características do abscesso cervical profundo devido à fístula congênita de seio piriforme em crianças. Método: Estudo retrospectivo de 21 casos de janeiro de 2016 a agosto de 2018 em nosso hospital. Idade de início, características clínicas, exames auxiliares e tratamento clínico dos pacientes foram resumidos para analisar o diagnóstico, as características do tratamento e o prognóstico. Resultados: Foram incluídas crianças de 11 dias a 12 anos, com média de 3,5 anos. Vinte pacientes tinham fístula congênita de seio piriforme no lado esquerdo e um no lado direito; a tomografia computadorizada cervical com contraste mostrava distribuição líquido-gasosa ou sombra aérea nos abscessos em 18 casos. O ultrassom cervical demonstrou eco gasoso na região da tireoide em 10 casos. Todos os pacientes foram submetidos a plasma de baixa temperatura para queimar a fístula interna e retornaram ao hospital para exame com laringoscópio eletrônico e ultrassonografia cervical aos 3 meses, 6 meses e um ano após a cirurgia. Não houve recorrências. Conclusão: A fístula congênita de seio piriforme é uma causa importante de abscesso cervical profundo em crianças. A presença de conteúdo líquido-gasoso purulento ou sombra gasosa na tomografia computadorizada ou no ultrassom cervical sugere uma alta possibilidade da presença de uma fístula interna e a ablação endoscópica a baixa temperatura pode ser feita ao mesmo tempo que a endoscopia diagnóstica.

Clinical characteristics for conservative therapy of pediatric parapharyngeal abscesses / Características clínicas para tratamento conservador em abscessos parafaríngeos pediátricos

Abstract Introduction The role of surgical drainage versus conservative therapy in treating patients with parapharyngeal abscesses is still a theme of debate. Objectives This study aimed to investigate the characteristics associated with good outcomes in pediatric patients with parapharyngeal abscesses treated with conservative therapy. Methods This retrospective chart review was performed on children aged 0.3-14 years with the diagnosis of parapharyngeal abscesses confirmed by computed tomography from January 2013 to March 2018. Patients with a severe upper airway obstruction required early intervention, while those in a stable condition initially received conservative therapy with antibiotics. If the patients appeared unlikely to recover, additional surgical drainage was provided. Multivariate logistic regression models were constructed to investigate the clinical characteristics associated with a good response to conservative therapy. A receiver operating characteristic curve was used to identify the age and abscess size cutoff for predicting a successful response. Results A total of 48 children were included in the study. Patient age, antecedent illness, and abscess size were significantly associated with a response to therapy (Odds Ratio = 1.326, 2.314 and 1.235, respectively). The age cutoff associated with the conservative therapy was 4.2 years (76.9% sensitivity, 68.2% specificity), and the abscess size cutoff associated with the conservative therapy was 23 mm (84.6% sensitivity, 77.3% specificity). Conclusion The findings suggested that younger age, smaller abscess size, and less frequent antecedent illnesses, such as upper respiratory tract infection and lymphadenitis, could predict a successful response to conservative therapy in pediatric patients with parapharyngeal abscesses.

Resumo Introdução O papel da drenagem cirúrgica versus tratamento conservador na abordagem de pacientes com abscessos parafaríngeos ainda é uma questão controversa. Objetivo Investigar as características associadas a um bom desfecho em pacientes pediátricos com abscessos parafaríngeos tratados com terapia conservadora. Método Revisão retrospectiva de prontuários feita em crianças de 14 anos com diagnóstico de abscesso parafaríngeo confirmado por tomografia computadorizada de janeiro de 2013 a março de 2018. Pacientes com obstrução grave das vias aéreas superiores necessitaram de intervenção precoce, enquanto aqueles em estado inicialmente estável receberam tratamento conservador com antibióticos. Se a recuperação dos pacientes parecesse improvável, drenagem cirúrgica adicional era feita. Modelos de regressão logística multivariada foram construídos para investigar as características clínicas associadas a uma boa resposta a terapia conservadora. Uma curva ROC, ou seja, característica de operação do receptor, foi usada para identificar a idade e o tamanho do abscesso com o intuito de prever uma resposta bem-sucedida. Resultados Foram incluídas no estudo 48 crianças. Idade do paciente, doenças respiratórias prévias e comorbidades e tamanho do abscesso foram significantemente associados à resposta terapêutica. (odds ratio = 1.326, 2.314 e 1.235, respectivamente). O ponto de corte da idade associado à terapia conservadora foi de 4,2 anos (sensibilidade de 76,9%, especificidade de 68,2%) e o ponto de corte do tamanho do abscesso associado à terapia conservadora foi de 23 mm (sensibilidade de 84,6%, especificidade de 77,3%). Conclusão Os achados sugerem que idade mais jovem, menor tamanho de abscesso e menor frequência de doença comuns, como infecção do trato respiratório superior e linfadenite, podem prever uma resposta bem-sucedida à terapia conservadora em pacientes pediátricos com abscessos parafaríngeos.

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.

Eficacia clínica del MTA en Pulpotomías de pacientes pediátricos: Una Revisión Sistemática / Eficácia Clínica da MTA em Pulpotomias Pediátricas de Pacientes: Uma Revisão Sistemática / Clinical Efficacy of MTA in Pediatric Patient Pulpotomies: A Systematic Review

Objetivo: Analizar la eficacia clínica del Agregado Trióxido Mineral (MTA) en pulpotomías a través de estudios comparativos con el formocresol, sulfato férrico e hidróxido de calcio; en pacientes pediátricos con edad de tres a nueve años. Materiales y Métodos: El artículo se basa en una revisión sistemática de la literatura, por ello, se utilizaron como fuentes de información las bases de datos: PubMed, Scielo, y Biblioteca Virtual de Salud. Asimismo, como criterios de inclusión se establecieron publicaciones del año 2008 al 2019, cuya procedencia se derivó de journalsy revistas académicas arbitradas; los cuales permitieron obtener dieciséis ensayos que evaluaban la eficacia clínica a través de los signos y síntomas de las patologías pulpares más comunes: absceso, inflamación gingival, movilidad patológica, dolor a la percusión y dolor espontáneo. Resultados: El MTA obtuvo una eficacia de 97,9% en contraposición al 86,9% del Sulfato Férrico. En relación al Formocresol, el MTA logró el 99% contra un 98,3% de eficacia. Además, en la comparación del MTA con el Hidróxido de Calcio el primero logró un 98,2% y el segundo 74,5%. Conclusiones: El MTA obtuvo una mayor eficacia clínica debido a su biocompatibilidad, pH básico y su elevada facultad al sellar la cámara pulpar. Por lo tanto, puede emplearse como un material seguro para las pulpotomías de pacientes pediátricos.

Objetivo: Analisar a eficácia clínica do Agregado de Trióxido Mineral (MTA) em pulpotomias através de estudos comparativos com formocresol, sulfato férrico e hidróxido de cálcio; em pacientes pediátricos de três a nove anos de idade. Materiais e Métodos: O artigo é baseado em uma revisão sistemática da literatura, portanto, bases de dados foram utilizadas como fontes de informação: PubMed, Scielo, e Biblioteca Virtual. Da mesma forma, como critério de inclusão, foram estabelecidas publicações de 2008 a 2019, cuja origem foi derivada de periódicos e revistas acadêmicas de referência; o que nos permitiu obter dezesseis ensaios que avaliaram a eficácia clínica através dos sinais e sintomas das doenças mais comuns da polpa: abscesso, inflamação gengival, mobilidade patológica, dor na percussão e dor espontânea. Resultados: A MTA obteve uma eficácia de 97,9% contra 86,9% para o sulfato férrico. Em relação ao Formocresol, o MTA alcançou 99% contra 98,3% de eficácia. Além disso, na comparação do MTA com o hidróxido de cálcio, o primeiro atingiu 98,2% e o segundo 74,5%. Conclusões: A MTA obteve uma maior eficácia clínica devido a sua biocompatibilidade, pH básico e sua alta faculdade ao selar a câmara de celulose. Portanto, pode ser usado como material segura para pulpotomias de pacientes pediátricos.

Objective: To analyze the clinical efficacy of the Mineral Trioxide Aggregate (MTA) in pulpotomies through comparative studies with formocresol, ferric sulfate and calcium hydroxide; in pediatric patients aged three to nine years. Materials and Methods: The article is based on a systematic review of the literature, therefore, databases were used as sources of information: PubMed, Scielo, and Virtual Health Library. Likewise, as inclusion criteria, publications from 2008 to 2019 were established, whose origin was derived from journals and refereed academic journals; which allowed us to obtain sixteen trials that evaluated clinical efficacy through the signs and symptoms of the most common pulp diseases: abscess, gingival inflammation, pathological mobility, pain on percussion and spontaneous pain. Results: MTA obtained an efficacy of 97.9% as opposed to 86.9% for ferric sulfate. Concerning to Formocresol, MTA achieved 99% versus 98.3% efficacy. Also, in the comparison of MTA with Calcium Hydroxide, the former achieved 98.2% and the latter 74.5%. Conclusions: MTA obtained a higher clinical efficacy due to its biocompatibility, basic pH and its high faculty when sealing the pulp chamber. Therefore, it can be used as a safe material for pediatric patient pulpotomies.

Abscesos cervicofaciales de origen odontógeno: ¿cuándo y cómo debemos drenarlos? / 6 EFFICACY OF PERCUTANEOUS TREATMENT AND SURGICAL DRAINAGE IN DENTAL ABSCESSES

ANTECEDENTES: La afectación de los espacios cervicales como resultado de focos infecciosos cervicofaciales son eventos infrecuentes, pero potencialmente mortales. La causa más frecuente de infecciones profundas del cuello son el resultado de la infección odontogénica (IO). Estas afectan a individuos de todas las edades y pueden presentar distintos grados de severidad. Son diagnosticadas con examen físico, estudios por imágenes, Ecografía o Tomografía Computada (TC). Debe realizarse siempre el drenaje quirúrgico de forma clásica o percutánea según el caso de las colecciones en forma precoz. OBJETIVO: Analizar la eficacia clínica del tratamiento percutáneo y el drenaje quirúrgico en abscesos odontogenos MATERIALES Y MÉTODOS: Se llevo a cabo un trabajo transversal de enero de 2015 a diciembre de 2019. Se realizo revisión de historias clínicas en la sección de Cirugía de Cabeza y Cuello de nuestro Hospital de todos los pacientes que requirieron internación y fueron sometidos a drenaje quirúrgico y/o percutáneo por la presencia de absceso cervical de origen odontogeno. RESULTADOS: Fueron analizados 174 pacientes. Edad promedio 36 +/- 2 años. Solo al 37% se les realizo drenaje quirúrgico abierto. Al resto se realizó punciones percutáneas en forma seriada. El 25 % presento algún signo de compromiso de vía aérea (escala de severidad 3), y solo 2 pacientes con mediastinitis que requirieron drenaje urgente. Se realizo la exodoncia a todas los pacientes durante la internación. DISCUSION: Las infecciones cervicofaciales representan un tipo de infección potencialmente fatal si no se inicia rápidamente un tratamiento eficaz. La causa principal son IO que se manifiestan como flemones o abscesos. Las caries dentales suelen ser el origen. Debe establecerse la terapéutica antibiótica empírica en forma precoz y corticoides con bajas dosis cuando hay edema y/o trismus. A estos pacientes se les realiza tratamiento antibiótico (ampicilina sulbactam), acompañado de tratamiento quirúrgico (drenaje percutáneo o drenaje quirúrgico). La complicación más temida, es la progresión de la infección al mediastino (mediastinitis descendente) y / o Angina de Ludwig. CONCLUSIONES: No está protocolizado a quienes se les debe realizar tratamiento quirúrgico o tratamiento percutáneo. El drenaje quirúrgico abierto parece ser la primera opción frente al compromiso de vía aérea o colecciones no pasibles de drenaje percutáneo. Para el resto de los pacientes, que son la mayoría, las punciones percutáneas guidas con ecografía y en forma seriada son la mejor opción

Background: The involvement of cervical spaces as a result of cervical infectious focuses are rare but life-threatening events. The most common cause of deep neck infections is the result of dental infection (DI). These affect individuals of all ages and may have varying degrees of severity. They are diagnosed with physical examination, imaging, ultrasound or computed tomography (CT). Surgical drainage should always be performed in a classic or percutaneous method early. Objective: To analyze the clinical efficacy of percutaneous treatment and surgical drainage in dental abscess Materials and methods: Cross-sectional study was carried out from January 2015 to December 2019. Medical records were reviewed in the Head and Neck Surgery Section of our Hospital of all patients who required hospitalization and were subjected to surgical and/or percutaneous drainage due to the presence of cervical abscess of dental origin. Results: 174 patients were analyzed. Average age was 36 +/- 2 years old. Only 37% were performed open surgical drainage. The rest of them were percutaneous drainage. 25% showed any signs of airway engagement (severity scale 3). Only 2 patients had mediastinitis who required urgent drainage. Exodontics was performed on all patients during hospitalization Discussion: Cervical infections represent a potentially fatal type of infection if effective treatment is not initiated quickly. The main cause is DI that manifest as phlegmons or abscesses. Tooth decay is usually the source. Empirical antibiotic therapy should be established early and low-dose corticosteroids should be established when there is edema and/or trismus. These patients are treated with antibiotics (ampicillin sulbactam), accompanied by surgical treatment (percutaneous drainage or surgical drainage). The most feared complication is the progression of infection to the mediastinum (descending mediastinitis) and/or Ludwig's Angina. Conclusions: Surgical or percutaneous treatment are not protocolized. Open surgical drainage seems to be the first choice over airway compromise or non-passable collections of percutaneous drainage. For the rest of the patients, who are the majority, guided percutaneous drainage with ultrasound and serial form are the best option

Absceso subpectoral como diagnóstico diferencial de hombro doloroso: reporte de un caso / Subpectoral abscess as a differential diagnosis of painful shoulder: a case report

Los síndromes dolorosos del hombro son relativamente comunes en la práctica clínica. Habitualmente son causados por un número limitado de patologías. Dentro de los diagnósticos diferenciales, el pinzamiento subacromial, las lesiones aisladas del manguito rotador, capsulitis adhesiva, tendinitis cálcica, patología degenerativa de las articulaciones glenohumeral y acromioclavicular, y la inestabilidad crónica del hombro, son causas comunes. Causas infrecuentes son la rotura del tendón del bíceps, neuralgias, patología infecciosa articular y tumores del hombro. Un absceso subpectoral sin sintomatología infecciosa clara es una causa extremadamente rara de hombro doloroso en el adulto. Presentamos el caso de un paciente de 60 años, que inicia con un cuadro de hombro doloroso cuya causa se identifica como un absceso subpectoral por staphylococcus aureus que se maneja con drenaje quirúrgico y tratamiento antibiótico endovenoso con buenos resultados.

Painful shoulder syndromes are commonly caused by a limited assortment of pathologies. Differential diagnosis include rotator cuff impingement syndrome, rotator cuff tears, adhesive capsulitis, calcific tendonitis, degenerative disease of the joint including acromio-clavicular and gleno-humeral joints and chronic instability. Less common causes are labral tears, biceps tendon rupture, soft tissue infection, neurologic disease, joint infection and shoulder tumors. A subpectoral abscess without infectious clinical features is a very rare cause of shoulder pain in adults. We present the case of a 52 years old male who develops a painful shoulder syndrome caused by a staphylococcus aureus subpectoral abscess, treated by surgical drainage and intravenous antibiotic therapy with good results.

Abcesos profundos de cuello: Reporte de tres casos pediátricos / Deep neck infections: Report of three pediatric cases

Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. En los últimos años, se ha detectado un aumento de incidencia de estas infecciones, que se debe, principalmente, a una mayor disponibilidad de la tomografía computada y a mayor virulencia de los gérmenes (Streptococcus beta hemolítico del grupo A y Staphilococcus aureus meticilino resistente). Predominan en menores de 5 años. El tratamiento de los abscesos retro y parafaríngeos consiste en antibiótico endovenoso y, eventualmente, drenaje quirúrgico. Serían pasibles de tratamiento quirúrgico aquellos pacientes con abscesos mayores de 2 cm³, con dificultad respiratoria o mala respuesta al tratamiento antibiótico inicial. El objetivo de este reporte es presentar las características clínicas y el tratamiento de tres pacientes con abscesos profundos de cuello que se presentaron en Otorrinolaringología del Hospital de Niños Pedro de Elizalde en el período de un año.

Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. In recent years, there has been an increase in the incidence of these infections, mainly due to a greater availability of computed tomography scan and a greater virulence of the germs (Group A b-hemolytic Streptococcus and methicillin-resistant Staphylococcus aureus). They predominate in children younger than 5 years. Treatment of retropharyngeal and parapharyngeal abscesses consists of an intravenous antibiotic and eventually surgical drainage. Surgical treatment is indicated in patients with abscesses greater than 2 cm³, with respiratory difficulty or poor response to initial antibiotic treatment. The aim of this study is to describe clinical features and treatment of three cases of deep neck abscesses presented at Hospital de Niños Pedro de Elizalde, Otorhinolaryngology Department in the period of one year.

Abscesos profundos de cabeza y cuello: nuestra experiencia en dos años / Deep head and neck abscesses: Our experience in two years

Introducción: Los abscesos son procesos de origen infeccioso, que forman una colección de material purulento y necrótico, que pueden diseminarse a través de diferentes planos. Los abscesos de cabeza y cuello se clasifican en superficiales y profundos. El manejo de estas infecciones depende de varios factores. El objetivo de este estudio es describir nuestra experiencia con los abscesos profundos de cabeza y cuello. Objetivos: Describir nuestra experiencia con los pacientes que fueron atendidos por abscesos profundos de cabeza y cuello en el Sistema de Salud de Malvinas Argentinas en octubre de 2014 y octubre de 2016. Material y Método: Estudio longitudinal, retrospectivo y observacional con base en la revisión de las historias clínicas de todos los pacientes con diagnóstico de absceso profundo de cabeza y cuello en el sistema de salud de Malvinas Argentinas durante dos años. Las variables fueron tabuladas y analizadas por los autores. Resultados: Todos los pacientes fueron internados con tratamiento antibiótico endovenoso. En 13 pacientes (56.52%) fue necesaria una intervención quirúrgica para su drenaje, 5 presentaron drenaje espontáneo (21,74%) y 5 respondieron únicamente al tratamiento médico (21,74%). El promedio de días de internación fue de 6,74 días. Se fueron de alta con buena evolución clínica 22 pacientes (95,66%) y un paciente falleció al 4° día de internación. Conclusiones: El absceso profundo en cabeza y cuello es una patología con manifestaciones clínicas variadas, existiendo muchas veces una disociación clínico-imagenológica. Al ser una patología potencialmente mortal es necesaria la internación para un tratamiento médico endovenoso, control clínico y un eventual drenaje quirúrgico.

Introduction: Abscesses are processes of infectious origin, which form a collection of purulent and necrotic material, which can be disseminated through different planes. Head and neck abscesses are classified as superficial and deep. Management of these infections depends on several factors. The aim of this study is to describe our experience with deep head and neck abscesses. Objectives: to describe our experience with Patients who were treated for Deep head and neck abscesses in argentine Malvinas Health system in October 2014 and October 2016 Material and method: Longitudinal, retrospective and observational study based on the review of the medical records of all patients diagnosed with deep head and neck abscess in the Malvinas Argentinas health system for two years. The variables were tabulated and analyzed by the authors. Results: All patients were hospitalized with intravenous antibiotic treatment. In 13 Patients (56.52%), surgical intervention was required for drainage, 5 had spontaneous drainage (21.74%) and 5 only had medical treatment (21.74%). The average number of hospital days was 6.74 days. Twenty two patients (95.66%) went on a good clinical course and one patient died on the 4th day of hospitalization. Conclusions: Deep Abscess in the head and neck is a pathology with varied clinical manifestations, and there is often a clinical -Imaging dissociation. Being a potentially deadly pathology, hospitalization for intravenous medical treatment, clinical control and eventual surgical drainage is necessary.

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

Absceso perirrenal recidivante con atrofia renal izquierda: reporte de un caso / Recurrence perrinephric abscess with left kidney atrophy: case report

El absceso perirrenal es una entidad infrecuente donde la presentación insidiosa y variable favorece el retraso del diagnóstico reportándose una mortalidad de 39-50 por ciento. Nuestro objetivo es presentar y analizar una paciente con absceso perirrenal que recidivó, con énfasis en el tratamiento y diagnóstico. PRESENTACIÓN DEL CASO: Mujer de 56 años consulta en Hospital Regional de Antofagasta por síntomas urinarios de un mes de evolución, reciente aparición de dolor en zona lumbar y fiebre. Se realiza tomografía computarizada: hipodensidad en espacio perirrenal e hiperdensidad en pelvis renal diagnosticándose cálculo coleriforme en pelvis renal y absceso perirrenal. Paciente evoluciona hipotensa: 72/40 mm Hg, posteriormente se realiza lumbotomía exploradora, drenaje e inicio de terapia antibiótica evolucionando favorablemente. Diez días después, vuelve a consultar por sensación febril, eritema y aumento de temperatura local en cicatriz operatoria. Se realiza drenaje percutáneo y tratamiento antibiótico no focalizado debido a urocultivos negativos. Paciente progresa asintomática, con clara reducción deabsceso. La función renal es evaluada con cintigrama informando exclusión funcional renal izquierda, indicándose nefrectomía izquierda. Paciente responde de forma adecuada a antibióticos y procedimientos quirúrgicos dándose de alta. DISCUSIÓN: El absceso perirrenal es una entidad poco sospechada, infrecuente y de difícil manejo donde el diagnóstico precoz adquiere vital importancia. A pesar de lo que recomienda la literatura en casos de abscesos de gran tamaño, el drenaje percutáneo fue efectivo sin recidiva. Como en nuestro caso, la recidiva de esta patología suele ser frecuente por tanto recomendamos evaluar con precisión el tratamiento y el alta del paciente...

The peritoneal abscess is an infrequent entity, the insidious and variant presentation favors delay on the reporting diagnosis with a mortality rate of 39-50 percent. CASE REPORT: A 56 years-old woman with a history of recurrent urinary tract infections asks for help due to urinary-related symptoms, fever and lower back pains. A computed tomography(CT) is performed: hypodensity in the perirenal space and hyperdensity in the renal pelvis. A coral shaped calculus in the renal pelvis along with perirenal abscess is diagnosed. The Patient evolves on a hypotensive way, this is followed the realization of a lumbotomy incision, drainage and antibiotic therapy. Evolving favorably, she is discharged. Ten days later, she consulted again due to a feverish sensation, erythema and increased local temperature on the operation scar. A percutaneous drainage is performed along with the initiation on a non-focal antibiotic treatment due to negative urine culture. The patient progressed asymptomatically with a clear reduction of the abscess. Renal function was evaluated with a reported scintigram process of the left kidney. Left nephrectomy is pointed out. The patient responds appropriately to the antibiotic therapy and surgical procedures. she was discharged being summoned to the urology clinic. DISCUSSION: The perirenal abscess is a rare and unwieldy entity, where an early diagnosis is imperative. Despite what the literature recommends in cases of large abscesses, percutaneous drainage was effective without recurrence. As in our case, the recurrence of this condition is usually prevalent therefore recommend to accurately assess treatment and patient discharge...

Avaliacão do uso da amoxicilina em, diferentes períodos no tratamento de abscessos dentoalveolares / Evaluation ot use of amoxicillin in different periods for the treatment of dentaolveolar abscess

O objetivo foi avaliar a eficácia da amoxicilina em diferentes periodos (3 e 7 dias) no tratamento coadjuvante de abscessos dentoalveolares após realização de drenagem. Foram avaliados 20 voluntários divididos em 2 grupos (n=10): G1 - 19 de amoxicilina, antes do procedimento de drenagem e 500mg de 8/8h por 3 dias; G2 - 1 9 de amoxicilina antes do procedimento e 500mg de 8/8h por 7 dias. Foram avaliados o edema, dor, febre, supuração e trismo, e os voluntários tiveram acompanhamento clínico diário. O edema foi avaliado em duas medidas (Tragus a Asa do Nariz e Tragus a Comissura Labial). A abertura bucal e o edema foram avaliados antes da drenagem, 1, 2, 3 e 7 dias após. Para a avaliação de dor foi utilizada a escala analógica visual (EAV) antes e nos intervalos O, 1 h, 2h, 4h, 12h, 1 dia, 2 dias, 3 dias e 1 semana após. Os resultados fora m su bmetidos à a ná I ise estatística (Kruska II-Wa II is), com n ivel de sig n ificâ ncia de 5%. Quanto aos parâmetros clínicos avaliados, não foram observadas diferenças estatisticamente significantes entre os grupos [p>0,05), e nenhum dos voluntários apresentou complicações no período do pós-atendimento. Concluiu-se que, após a intervenção clínica, a eficácia da amoxicilina nos períodos avaliados foi similar na amostra avaliada

The aim of this study was to compare the use of amoxicillin for different time intervals (3 and 7 days) for treatment of acute dentoalveolar abscesses after performing drainage. Twenty volunteers were divided into two groups (n = 10): G 1 - The volunteers received 1 9 of amoxicillin before the drainage procedure, and 500mg of amoxicillin every 8 hours for 3 days; G2 - The volunteers received 19 of amoxicillin before the drainage procedure, and 500mg of amoxicillin every 8 hours for 7 days. For each patient followed-up, acute infectious conditions were investigated, and pain, edema, fever, suppuration and trismus were evaluated. To evaluate pain was used a visual analog scale [VAS) in the intervals O, 1 h, 2h , 4h , 12 h , 1,2 and 3 days and 1 week after the drainage. The results were submmited to statistical analysis [Kruskal - Wallisl. with a significance levei of 5 %. There was no statistically significant difference between the groups considering the parameters evaluated [p>0.05). None of the volunteers had complications in the post clinical care assessed. It was concluded that after clinical intervention, the effectiveness of the use of amoxicillin in periods of 3 and 7 days was similar in the evaluated volunteers

Deep lobe parotid abscess with facial nerve palsy: a case report / Absceso del lóbulo profundo de la parótida con parálisis del nervio facial: un reporte de caso

Acute suppurative sialadenitis mostly occurs in the parotid gland, while parotid abscesses principally arise in the superficial lobe. However, facial nerve palsy, secondary to parotid abscess, is rare. Predisposing factors for the ductally ascending infection are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstruction or reduced saliva secretion. Obstruction of Stensen's duct and diminished production of saliva are regarded as the promoting factors. Painful swelling of the preauricular region and cheek is the most familiar symptom of acute suppurative parotitis. The most common pathogens associated with acute bacterial infection are Staphylococcus aureus and anaerobes. We report a rare case of deep lobe parotid abscess with facial nerve palsy. Aside from adequate fluid hydration, good oral hygiene and treatment with empiric parenteral antibiotics, surgical treatment with drainage can provide a remedy for this disease.

La sialoadenitis aguda supurativa aguda ocurre sobre todo en la glándula parótida, mientras que los abscesos parotídeos se producen principalmente en el lóbulo superficial. Sin embargo, la parálisis del nervio facial, secundaria al absceso parotídeo, es rara. Los factores predisponentes para la infección ascendente ductal son la deshidratación, los medicamentos xerogénicos, y las enfermedades de las glándulas salivales asociadas con obstrucción ductal o reducción de la secreción salival. La obstrucción del conducto de Stensen y la disminución de la producción de saliva, se consideran los factores promotores. Una inflamación dolorosa de la región preauricular y la mejilla es el síntoma más conocido de la parotiditis supurativa aguda. Los patógenos más comunes asociados con la infección bacteriana aguda son los anaerobios y el estafilococo dorado. Reportamos un caso raro de absceso del lóbulo parotídeo profundo con parálisis del nervio facial. Además de una hidratación fluida, una buena higiene oral y tratamiento con antibióticos parenterales empíricos, el tratamiento quirúrgico con drenaje puede proveer un remedio para esta enfermedad.

Management of breast abscesses in jamaican women: is there need for a paradigm shift? / Tratamiento de abscesos mamarios en mujeres jamaicanas: ¿es necesario un cambio de paradigma?

A paradigm shift from operative to non-operative management of breast abscesses has occurred in surgical centres worldwide. The recent experience in managing these patients at the University Hospital of the West Indies (UHWI) was examined. Data were obtained retrospectively from dockets retrieved from the UHWI medical records department, and were analysed using the SPSS version 11.0 software package for Windows. Seventy-seven patients with breast abscesses presented during the 66-month study period, but complete data were unavailable for seventeen cases. The mean age of the remaining sixty patients was 32 years. There was one male patient. There were no cases of bilateral disease, and the majority was right-sided. Mean white blood cell count at presentation was mildly elevated at 11.9 x 10(9)/L, and had no relationship to method of management or length of stay. There were two cases treated with aspiration and antibiotics only. All other cases were treated with incision and drainage. Culture results were available in forty-four cases, and in 80%, Staphylococcus aureus was identified, with one case of methicillin resistant Staphylococcus aureus. The mean delay to the operating theatre was one day after presentation and the mean length of stay was 4.5 days. Seventeen patients had a 'non-cosmetic' incision. The traditional management of breast abscess provides challenges in terms of delay to the operating theatre and prolonged hospital stays. There is increased expense, as well as loss of productive work hours, associated with this line of treatment. Non-operative management has not traditionally been undertaken in our institution, but it is documented elsewhere to be safe, practical, and results in improved cosmetic outcomes. Prospective protocol-based trials are necessary to identify the patients most suitable for this line of management in a setting with limited resources.

Un cambio de paradigma de tratamiento operatorio a tratamiento no operatorio de los abscesos mamarios, se ha producido en los centros quirúrgicos a nivel mundial. Se examinó la experiencia reciente en el tratamiento de estos pacientes en el Hospital Universitario de West Indies (HUWI). Se obtuvieron datos tomados retrospectivamente de listas de casos archivados en el Departamento de Historias Clínicas de HUWI, los cuales fueron analizados usando la versión 11.0 del software SPSS para Windows. Durante el período de 66 meses de estudio, se presentaron setenta y siete pacientes con abscesos de mama, pero en diecisiete casos no pudo disponerse de todos los datos. La edadpromedio de los otros sesenta pacientes fue 32 anos. Hubo un paciente varón. No hubo ningún caso de enfer-medad bilateral, y la mayoría se trataba del lado derecho. El conteo promedio de leucocitos a la hora de la presentación fue ligeramente elevado en 11.9 x 10(9)/L, y no guardaba ninguna relación con el método de tratamiento o duración de la estancia. Hubo dos casos tratados con aspiración y antibióticos solamente. Todos los otros casos se trataron con incisión y drenaje. Los resultados del cultivo se hallaban disponibles en cuarenta y cuatro casos, y en el 80% se identificó el estafilococo dorado, con un caso de Staphylococcus aureus resistente a la meticilina. La demora promedio para entrar al salón de operaciones fue de un día después de la presentación y la duración promedio de estancia eran 4.5 días. Diecisiete pacientes tenían una incisión 'no cosmética'. El tratamiento tradicional del absceso mamario presenta retos en términos de demora para ingresar al salón de operaciones y estadía prolongada en el hospital. Esta línea de tratamiento conlleva un aumento de los gastos así como pérdida de horas de trabajo productivo. El tratamiento no operatorio no ha sido tradicionalmente practicado en nuestra institución, pero sí en otras partes donde se documenta que es seguro, práctico, y produce mejores resultados cosméticos. Se requieren ensayos protocolares prospectivos a fin de identificar a los pacientes más convenientes para esta línea de tratamiento en un contexto de recursos limitados.

Ultrasound-guided needle aspiration of parotid abscess.

Ultrasound (US) has been used as a tool for parotid abscess diagnosis and treatment. The present article aimed to report a case of 72-year-old woman with parotid abscess treated by US-guided needle aspiration and conventional surgical drainage. Along with the clinical report, indications, advantages, and limitations of the method are discussed.

Abscesso de língua: relato de caso / Tongue abscess: case Report

INTRODUÇÃO: Os abscessos na língua são raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido às características imunológicas da saliva e algumas características histológicas e anatômicas da língua. Este trabalho tem como objetivo relatar um caso de abscesso de língua ocorrido em nosso serviço, e fazer uma revisão da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a deglutição de evolução progressiva há uma semana, com piora importante há 3 dias. Relata história de cirurgia para implante dentário no início do período. Na admissão durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terço médio posterior de língua à direita, doloroso a palpação. Optou-se pela internação do paciente. Solicitou-se uma ressonância nuclear magnética que evidenciou lesão sugestiva de abscesso na base da língua à direita. Foi submetido a tratamento clínico com antibioticoterapia drenagem cirúrgica. O paciente evoluiu satisfatoriamente. DISCUSSÃO: A manifestação clínica do abscesso de língua pode ser variada. O diagnóstico deve ser feito pela história clínica, correlacionando os fatores de risco associados, exame físico e aos exames de imagem confirmatórios. A etiologia e os diagnósticos diferenciais devem ser considerados dependendo do local da manifestação clínica. A abordagem deve incluir a permeabilidade da via aérea, suporte clínico, antibioticoterapia sistêmica e drenagem do abscesso. CONSIDERAÇÕES FINAIS: O abscesso de língua deve entrar no diagnóstico diferencial dos abaulamentos de língua devendo ser conduzido com antibioticoterapia e drenagem cirúrgica de maneira rotineira.

INTRODUCTION: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. CASE REPORT: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2x2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. DISCUSSION: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. FINAL CONSIDERATIONS: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.