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1.
Artigo em Chinês | MEDLINE | ID: mdl-33794630

RESUMO

Objective:To summarize the clinical manifestations and treatment of patients with deep neck infection with descending mediastinal infection. Methods:The clinical data of 12 patients with deep neck infection with descending mediastinal infection were reviewed. The clinical manifestations, infection origin, bacterial culture results, related systemic diseases, surgical drainage methods and treatment results were analyzed. Results:The typical clinical features of descending mediastinal infection were chest pain and subcutaneous crackling, diagnosis can confirmed by CT scan detected gas and abscess in the neck and mediastinal space. The main origin of infection was pharyngeal infection, followed by odontogenic infection. Systemic diseases were mainly diabetes mellitus. The positive rate of purulent secretion culture was 58.3%(7/12), streptococcus account for the highest proportion. Surgical treatment included 9 patients undergoing neck surgery alone and 3 patients undergoing combined neck and chest surgery. Chest drainage was performed by thoracic surgery through mediastinoscopy or thoracoscopic surgery or B-ultrasound guided puncture, and no patient underwent open surgery. Ten patients were cured and two died, with a mortality rate of 16.7%. Conclusion:The deep neck infection with descending mediastinal infection has no specificity in the early stage. Timely abscess drainage, effective airway protection, antimicrobial therapy, and management of potentially life-threatening complications such as sepsis, mediastinitis, and pneumonia are the key to successful treatment.


Assuntos
Mediastinite , Abscesso/diagnóstico , Abscesso/terapia , Dor no Peito , Drenagem , Humanos , Mediastinite/diagnóstico , Mediastinite/terapia , Pescoço
2.
Ann R Coll Surg Engl ; 103(2): e59-e64, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559550

RESUMO

Aggressive angiomyxoma is a rare mesenchymal tumour, primarily arising in the soft tissue of the pelvis and perineum in women of reproductive age. There is a paucity of evidence on optimal management because of the rarity of these tumours, but the consensus has been for surgical excision. We present the case of a 65-year-old woman who was admitted with left-sided buttock pain and initially diagnosed with a perianal abscess. She underwent examination under anaesthesia rectum with surgical excision of the lesion, subsequent histopathological and immunochemical analysis was suggestive of aggressive angiomyxoma. To complement our case report, we also present a literature review focusing on aggressive angiomyxoma in the ischioanal fossa (also known as the ischiorectal fossa) with only eight cases of primary aggressive angiomyxoma involving the ischioanal fossa documented to date. The primary aims of this case report and literature review are to familiarise clinicians with the clinical, histopathological and immunochemical features of these tumours, and to increase appreciation that despite the rarity of aggressive angiomyxoma, it might be considered in the differential diagnosis of ischioanal lesions.


Assuntos
Mixoma/diagnóstico , Períneo/patologia , Pós-Menopausa , Abscesso/diagnóstico , Idoso , Doenças do Ânus/diagnóstico , Erros de Diagnóstico , Exame Retal Digital , Feminino , Humanos , Imagem por Ressonância Magnética , Mixoma/patologia , Mixoma/cirurgia , Neoplasia Residual , Períneo/diagnóstico por imagem , Períneo/cirurgia , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (2): 84-87, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570360

RESUMO

Acute hematogenous osteomyelitis (AHO) in adults is a rare disease complicating timely diagnosis. Even greater difficulties are observed in case of pelvic bone lesion. The authors report AHO of the pelvis an adult. Osteomyelitis was complicated by generalized infection and multiple pyogenic abscesses in subcutaneous adipose tissue of the upper and lower extremities. Detection of primary infectious focus was complicated by extreme severity of the patient's condition and low informative value of X-ray and ultrasound at the early stage of disease. Staphylococcus aureus was obtained from blood culture and infectious foci. Surgical debridement along with complex intensive care ensured a positive outcome.


Assuntos
Abscesso , Osteomielite , Ossos Pélvicos , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/microbiologia , Abscesso/terapia , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Extremidades/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/microbiologia , Osteomielite/terapia , Ossos Pélvicos/microbiologia , Ossos Pélvicos/cirurgia , Pelve/diagnóstico por imagem , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Gordura Subcutânea/microbiologia
4.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431529

RESUMO

Abdominoperineal excision of rectum (APER) is one of the widely used surgical procedures to treat low rectal cancer, benign conditions like Crohn's proctitis with anal involvement and as a salvage procedure for anal cancer. Perineal wound infection is a well-recognised complication following such major surgery. Occurrence of appendicitis in a few weeks' time following such a major surgery is uncommon. However, here we present a rare case report of perforated appendicitis presenting as persistent perineal discharge in an elderly man, following laparoscopic APER for a low rectal tumour. To our knowledge, this is the first time such a rare clinical presentation of appendicitis is reported in the history of medical literature. Through this case report, we aim to highlight the importance of considering such an uncommon presentation in patients with perineal discharge, following APER.


Assuntos
Abscesso/diagnóstico , Apendicite/complicações , Infecções por Escherichia coli/diagnóstico , Perfuração Intestinal/diagnóstico , Infecção Pélvica/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Abscesso/etiologia , Abscesso/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Diagnóstico Diferencial , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Infecção Pélvica/etiologia , Infecção Pélvica/cirurgia , Períneo/microbiologia , Períneo/patologia , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia
5.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431537

RESUMO

Acute parotitis progressing to parotid abscess is rare in children. Staphylococcus aureus is the usual pathogen in parotid abscess. Granulomatous parotid abscess due to tubercular aetiology is extremely rare. Authors report a case of chronic parotid abscess in a child who received multiple courses of antibiotics without any cure. The ultrasonography and CT scan of the parotid gland confirmed the extent of parotid abscess and the changes in the parotid lymph nodes. The surgical drainage and the biopsy of the lymph nodes lead to the diagnosis of granulomatous abscess. The antitubercular therapy finally cured the disease without further recurrence.


Assuntos
Abscesso/microbiologia , Antituberculosos/uso terapêutico , Parotidite/microbiologia , Tuberculose dos Linfonodos/diagnóstico , Tuberculose Bucal/diagnóstico , Abscesso/diagnóstico , Abscesso/terapia , Biópsia , Criança , Drenagem , Quimioterapia Combinada , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/microbiologia , Glândula Parótida/patologia , Glândula Parótida/cirurgia , Parotidite/diagnóstico , Parotidite/terapia , Tomografia Computadorizada por Raios X , Teste Tuberculínico , Tuberculose dos Linfonodos/microbiologia , Tuberculose dos Linfonodos/terapia , Tuberculose Bucal/complicações , Tuberculose Bucal/microbiologia , Tuberculose Bucal/terapia , Ultrassonografia
7.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504527

RESUMO

The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A's blood culture grew E. coli, while twin B's blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.


Assuntos
Abscesso/diagnóstico , Bacteriemia/diagnóstico , Doenças em Gêmeos/diagnóstico , Infecções por Escherichia coli/diagnóstico , Pneumonia Bacteriana/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cesárea , Pressão Positiva Contínua nas Vias Aéreas , Doenças em Gêmeos/terapia , Infecções por Escherichia coli/terapia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/terapia , Pneumonia Bacteriana/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Escroto , Gêmeos , Adulto Jovem
8.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318271

RESUMO

Sarcomas are a rare and fatal treatment complication following radiotherapy. Radiation-induced sarcomas (RISs) presenting as a gluteal abscess is a rarity, accounting for its varied presentation. We present a case of a middle-aged woman, post-chemo-radiation for carcinoma cervix 5 years ago, who presented with gluteal abscess. Achieving haemostasis post incision and drainage under anaesthesia was a challenge. On further evaluation, she was diagnosed with radiation-induced gluteal soft tissue sarcoma. Haemostasis was achieved after radiation following failed attempts of surgical and radiological interventions. She is currently planned for chemotherapy. Cancer survivors have an increased risk of developing a second malignancy following radiation treatment. RISs are highly aggressive, exhibit a varied clinical presentation and pose a challenge in early diagnosis; thus, have a poor outcome. RISs pose a diagnostic challenge; any dubious lesion in the previously irradiated field should raise suspicion and prompt aggressive management.


Assuntos
Nádegas , Neoplasias Induzidas por Radiação/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Sarcoma/diagnóstico , Abscesso/diagnóstico , Angiografia Digital , Doenças do Ânus/diagnóstico , Biópsia , Nádegas/diagnóstico por imagem , Nádegas/patologia , Carcinoma de Células Escamosas/radioterapia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Hemorragia/etiologia , Hemorragia/terapia , Técnicas Hemostáticas , Humanos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/complicações , Neoplasias Induzidas por Radiação/patologia , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/patologia , Sarcoma/complicações , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Tomografia Computadorizada por Raios X , Neoplasias do Colo do Útero/radioterapia
9.
Vestn Otorinolaringol ; 85(5): 98-102, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140944

RESUMO

This article describes a clinical case of exacerbation of chronic right-sided epimesotimpanitis, complicated by secondary otogenic purulent meningoencephalitis, an abscess of the right hemisphere of the cerebellum and septic thrombosis of the sigmoid sinus. This is a rare complication of chronic epimesotimpanitis. The article describes the dynamics of treatment and diagnostic justifies the optimal choice of personalized tactics of treatment measures in the hospital, as well as further observation of the patient in the conditions of outpatient health care.


Assuntos
Meningoencefalite , Trombose dos Seios Intracranianos , Trombose , Abscesso/diagnóstico , Abscesso/etiologia , Cerebelo , Cavidades Cranianas , Humanos , Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico
14.
Medicine (Baltimore) ; 99(39): e22335, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991445

RESUMO

INTRODUCTION: Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency viruses -positive patients. Oral cavity is the most commonly PBL affected site. Most oral PBLs presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. Most cases lacked B-symptoms, suggesting a more local involvement of the disease. No standard treatment is yet for oral PBL. Five-year survival rate recorded no more than 33.5%. PATIENT CONCERNS: A 39-year-old male presented to Dental Clinic with 1 month swelling of the oral cavity, in absence of any other symptoms or signs. He followed antibiotic therapy just on suspicion of an oral abscess and later oral surgical treatment on suspicion of bone neoplasm. DIAGNOSIS: Surgical specimen analysis highlighted a diffuse infiltrate of large-sized atypical cells with plasmablastic appearance and plasma cell phenotype. Oral cavity PBL was diagnosed. Blood tests recorded mild lymphopenia and positive human immunodeficiency viruses serology. INTERVENTIONS: Patient underwent chemotherapy including intrathecal methotrexate prophylaxis, in addition to a highly active antiretroviral therapy. OUTCOMES: At 12 months from diagnosis, patient recorded complete hematological remission. CONCLUSIONS: Oral PBL diagnosis requires a high level of suspicion and awareness both by physicians and pathologists. They should be aware of the extent of such disease which is often mistaken as oral abscess or infected tooth, thus leading to delay the most appropriate diagnostic evaluation. As PBL is an aggressive non-Hodgkin lymphoma, a delayed diagnosis might negatively impact on both treatment and survival.


Assuntos
Antineoplásicos/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Boca/patologia , Linfoma Plasmablástico/tratamento farmacológico , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Adulto , Assistência ao Convalescente , Antibacterianos/uso terapêutico , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/uso terapêutico , Quimioterapia Combinada , Edema/etiologia , Infecções por HIV/complicações , Soropositividade para HIV/sangue , HIV-1/imunologia , Humanos , Injeções Espinhais , Linfoma não Hodgkin/patologia , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Plasmócitos/patologia , Linfoma Plasmablástico/diagnóstico por imagem , Resultado do Tratamento
15.
Ther Umsch ; 77(5): 207-212, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32870097

RESUMO

Treatment of Skin Abscesses in the Emergency Department Abstract. Skin abscesses are a common cause for presentation in the emergency department and are in most cases treated by incision and drainage. The diagnosis is usually based upon clinical manifestation. If there is uncertainty regarding the presence of an abscess, bedside ultrasonography is suggested to identify the presence, size and location of the abscess. Uncomplicated abscesses < 5 cm in diameter often can be treated under local or regional anesthesia with or without additional procedural sedation within the emergency department. Sufficient anesthesia and analgesia are essential to avoid undertreatment of the abscess. Certain abscess localizations or conditions require referral to a surgeon and / or operation of the abscess in the operating room. Alternative to the classic incision and drainage the minimal invasive Loop Drainage Technique may be considered. A postoperative systemic antibiotic treatment is only indicated under certain conditions.


Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Dermatopatias , Drenagem , Serviço Hospitalar de Emergência , Humanos , Manejo da Dor
17.
Ned Tijdschr Geneeskd ; 1642020 06 30.
Artigo em Holandês | MEDLINE | ID: mdl-32608925

RESUMO

A 12-year-old boy was referred by the general practitioner with a 3-week history of pain in the popliteal fossa. There was no sign of trauma or infection, physical examination was normal, and his CRP level was mildly elevated. X-ray and MRI revealed a Brodie's abscess, which was treated surgically and with antibiotics and he made a good recovery.


Assuntos
Abscesso/diagnóstico , Dor Musculoesquelética/diagnóstico , Osteomielite/diagnóstico , Abscesso/complicações , Abscesso/terapia , Antibacterianos/uso terapêutico , Criança , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Procedimentos Ortopédicos , Osteomielite/complicações , Osteomielite/terapia , Radiografia
18.
BMC Infect Dis ; 20(1): 436, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571225

RESUMO

BACKGROUND: Thyroid gland infections are rare. Their incidence is estimated to be less than 1% in immunocompromised hosts. Most common pathogens isolated are Gram positive aerobic cocci. Infections with Gram negative facultative aerobes such as Salmonella are rare. CASE PRESENTATION: A 55-year-old female with type II diabetes mellitus and a history of a colloid right thyroid lobe nodule presented with neck pain and fever. She was found to have a thyroid abscess 2 weeks following a non-specific diarrheal illness. A needle aspiration for symptomatic and diagnostic purposes was performed. Cultures grew Salmonella enterica serotype Heidelberg. She was treated with a 12-week course of oral antibiotics and serial aspiration. CONCLUSION: A thyroid abscess is a rare occurrence; however, a high index of suspicion is required to make the diagnosis. The management is directed at minimizing morbidity. The mainstay treatment is medical, but surgery is sometimes necessary to achieve adequate source control, particularly when complications arise.


Assuntos
Abscesso/microbiologia , Infecções por Salmonella/complicações , Infecções por Salmonella/tratamento farmacológico , Tireoidite Supurativa/tratamento farmacológico , Tireoidite Supurativa/microbiologia , Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Dor/etiologia , Salmonella/patogenicidade , Infecções por Salmonella/diagnóstico , Tireoidite Supurativa/etiologia
19.
Leg Med (Tokyo) ; 46: 101724, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32516737

RESUMO

Hypochlorous acid, produced by myeloperoxidase upon neutrophil activation, can oxidize various compounds and exert antimicrobial activity in vivo. To elucidate the mechanisms underlying the reactions of the unsaturated phosphatidylcholines, which abound in cell membranes, with hypochlorous acid, we identified and examined phosphatidylcholine chlorination and oxidation products formed under various reaction conditions. We first investigated the products of unsaturated phosphatidylcholine and hypochlorous acid reaction with respect to hypochlorite concentration and reaction time. Next, we examined the lipids extracted postmortem from human abscesses. For all the analyses, we used liquid chromatography-quadrupole time-of-flight mass spectrometry. Various compounds, including phosphatidylcholine chlorohydrin and phosphatidylcholine hydroxide/epoxide, were detected. Oxidized phosphatidylcholines were mainly detectable upon reaction with low concentrations of sodium hypochlorite, whereas chlorinated phosphatidylcholines formed in the presence of higher concentrations. In human abscesses, oxidized phosphatidylcholines were detected in the cases with high procalcitonin concentration, whereas chlorinated phosphatidylcholines were undetected. The detections of oxidized phosphatidylcholines in human tissues might indicate previous exposure to hypochlorous acid in septic cases. Our results provide insight into the mechanisms underlying pathogen survival following inflammation associated with neutrophil activation and topical myeloperoxidase release and show postmortem biomarkers candidates for sepsis.


Assuntos
Abscesso/diagnóstico , Abscesso/metabolismo , Ácido Hipocloroso/metabolismo , Lipídeos/análise , Fosfatidilcolinas/metabolismo , Biomarcadores/metabolismo , Membrana Celular/metabolismo , Cromatografia Líquida , Medicina Legal/métodos , Halogenação , Humanos , Ácido Hipocloroso/química , Espectrometria de Massas , Ativação de Neutrófilo , Oxirredução , Peroxidase/metabolismo , Fosfatidilcolinas/química
20.
Acta Orthop Traumatol Turc ; 54(3): 344-347, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32442124

RESUMO

Brodie's abscess of the calcaneus is an uncommon benign lesion that has rarely been reported in the literature. This study presents a rare case of a Brodie's abscess of the calcaneus caused by Staphylococcus aureus in an adult patient. A 46-year-old immunocompetent man had undergone nonsurgical treatment since childhood owing to the diagnosis of a heel spur. Radiological evaluation revealed a benign radiolucent cystic lesion of the calcaneus surrounded by a sclerotic rim. This condition was accompanied by perilesional bone marrow edema. Thereafter, surgical treatment was planned. During surgery, the content of the lesion was observed to be purulent. Meticulous intralesional debridement was performed, and antibiotic-loaded bone cement beads were placed. Subsequent to microbiological and pathological examinations, the cystic lesion was confirmed to be a Brodie abscess; however, direct clinical evidence of an intraosseous infection was lacking. The patient was followed up for 14 months with no complications until recovery. A Brodie abscess may mimic bone tumors. The onset of a Brodie abscess is insidious, and the clinical findings of such lesions may be obscure. A Brodie abscess of the calcaneus should be considered in the differential diagnosis of patients with chronic heel pain when suspicious radiological findings are evident.


Assuntos
Calcâneo , Desbridamento/métodos , Esporão do Calcâneo/diagnóstico , Abscesso/diagnóstico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Cimentos para Ossos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Calcâneo/diagnóstico por imagem , Calcâneo/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
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