Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.894
Filtrar
1.
Khirurgiia (Mosk) ; (5): 81-86, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500694

RESUMO

Increase of the frequency of soft tissues pyoinflammatory diseases and purulent-septic complications against the background the antibiotic-resistance of organism dictates the necessity of search of rational new surgical technologies and preparations with the intense bactericidal effect. Period of the connective tissue (cicatrix) formation on a place of wound defect of the operated purulent abscess of soft tissue (PAST) is defined by the speed of the granulations and epithelial tissue formation. Therefore, one of the task of experimental surgery is search of new methods of the effective postoperative influence on terms of the regeneration and complete obliteration of the PAST cavity. The perspective direction in treatment of surgical infection is application of metals nanoparticles. In treatment of pyoinflammatory processes it is applied the preparation Eplan and also zinc oxide nanoparticles which have bactericidal, antiinflammatory and regenerative effects. However, till now it was not carried out experimental works on modelling and surgical treatment of PAST with local application of the laser technologies in combinations with Eplan and metals nanoparticles.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Nanopartículas Metálicas/uso terapêutico , Infecções dos Tecidos Moles/terapia , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Antibacterianos/administração & dosagem , Combinação de Medicamentos , Humanos , Terapia a Laser , Nanopartículas Metálicas/administração & dosagem , Pomadas/administração & dosagem , Pomadas/uso terapêutico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/cirurgia , Supuração/tratamento farmacológico , Supuração/cirurgia , Supuração/terapia , Óxido de Zinco/administração & dosagem , Óxido de Zinco/uso terapêutico
2.
West J Emerg Med ; 21(2): 336-342, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32191191

RESUMO

INTRODUCTION: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary. METHODS: We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure. RESULTS: A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44-0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74-93). CONCLUSION: This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure.


Assuntos
Abscesso , Sistemas Automatizados de Assistência Junto ao Leito , Infecções dos Tecidos Moles , Ultrassonografia , Abscesso/diagnóstico por imagem , Abscesso/terapia , Adulto , Antibacterianos/uso terapêutico , Celulite (Flegmão) , Drenagem/métodos , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Alta do Paciente , Exame Físico , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/terapia , Falha de Tratamento , Ultrassonografia/métodos
3.
Br J Radiol ; 93(1108): 20191046, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31971831

RESUMO

OBJECTIVE: To study the outcome of salvage percutaneous transhepatic biliary drainage (PTBD) in complex and technically challenging post-liver transplant (LT) biliary complications and analyse the reason for failure of endoscopic retrograde cholangiopancreatography (ERCP). METHODS AND MATERIALS: Hospital data were searched for all LT patients with biliary complications requiring salvage PTBD (upon failure of ERCP) from January 2010 to May 2017. Patients who underwent primary PTBD were excluded. Patients clinical and biochemical parameters were analysed for clinical, biochemical and imaging response, stent-free survival and the reason for ERCP failure. RESULTS: Salvage PTBD was performed in 32 patients with post-LT biliary stricture/bile leak presenting with deranged liver function in 12 (37.5%), cholangitis in 12 (37.5%) and cholangitis with cholangitic abscess in remaining 8 (25%) patients. Of 32 patients, 20 (62.5%) already had plastic biliary stent placed by ERCP, while in remaining (n = 12, 37.5%) a wire could not be negotiated across stricture by ERCP. These patients were found to have long/tortuous stricture (n = 18, 56.3%) and multiple duct disconnection at anastomosis (n = 14, 43.7%). Immediate as well as sustained (persisting for a year or more) clinical and biochemical improvement was seen in 26 (81.3%) patients, while failure of resolution of sepsis and death occurred in remaining 6 (18.8%). CONCLUSION: Salvage PTBD is an effective treatment in difficult-to-treat post-LT biliary strictures with deranged liver functions with or without cholangitis/cholangitic abscess. It can reduce graft loss with improved clinical outcome. Post-LT ductal anatomy at anastomosis is important to decide the appropriate approach (ERCP/PTBD). ADVANCES IN KNOWLEDGE: (1). PTBD as a salvage procedure in difficult anatomy or upon failure of ERCP-based intervention is effective and a good alternative strategy. (2). Postoperative surgical anatomy (type & length of stricture, number of ductanastomosis, location and graft-recipient duct alignment) is the key factor indeciding the appropriate therapeutic procedure.


Assuntos
Colangite/terapia , Colestase/terapia , Drenagem/métodos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/terapia , Terapia de Salvação/métodos , Abscesso/terapia , Adulto , Fístula Anastomótica/terapia , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica/terapia , Drenagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Terapia de Salvação/estatística & dados numéricos , Stents/estatística & dados numéricos
4.
BMC Endocr Disord ; 19(1): 130, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31791298

RESUMO

BACKGROUND: Abscess in the thyroid gland is a rare but severe infectious disease. The condition can have anatomic or iatrogenic underlying causes. If untreated it could be fatal. Pathogens vary considerably. Treatment is intravenous antibiotics, drainage, and sometimes surgery. METHODS: The electronic medical records of all adult patients with acute thyroiditis 2003-2017 treated at the Karolinska University Hospital (catchment area 2 million) in Sweden were systematically reviewed. RESULTS: Five patients were found in the catchment area. One patient from another region but known to us was also included. Thus, six patients (aged 28-73 years) were included in the study. Median length of hospital stay was 7.5 days (4-79 days). All were treated with antibiotics (intravenous n = 5, oral n = 1). Total antibiotic treatment duration was 13.5 days (10-41 days). Blood cultures were positive in three (streptococcus pneumonia, streptococci sanguineous, pepto streptococci), deep tissue culture in three (Escherichia coli, Candida, Hemophilic influenza) and no positive culture at all in two. Drainage was used in three patients. All patients recovered without recurrences. Surgery was performed twice in the acute phase in one. There was no recurrence during 7 years (3-12) of follow-up, but one patient died after three years (severe heart failure and pneumonia). CONCLUSION: Thyroid abscess in adults is extremely rare nowadays in the developed world. With prompt antibiotic therapy, drainage and in some cases thyroidectomy the prognosis seems favourable.


Assuntos
Abscesso/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Tireoidite Supurativa/diagnóstico , Abscesso/microbiologia , Abscesso/terapia , Doença Aguda , Adulto , Idoso , Antibacterianos/uso terapêutico , Biópsia por Agulha Fina , Candidíase/tratamento farmacológico , Drenagem , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Infecções por Haemophilus/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Doenças da Glândula Tireoide/microbiologia , Doenças da Glândula Tireoide/terapia , Tireoidectomia , Tireoidite Supurativa/microbiologia , Tireoidite Supurativa/terapia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(52): e17802, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876702

RESUMO

RATIONALE: Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis. PATIENT CONCERNS: We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier. DIAGNOSES: On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess. INTERVENTIONS: The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage. OUTCOMES: On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy. CONCLUSION: Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.


Assuntos
Abscesso/diagnóstico , Doenças da Córnea/diagnóstico , Septo Nasal , Doenças Nasais/diagnóstico , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/terapia , Doenças da Córnea/etiologia , Drenagem , Eletrocoagulação/efeitos adversos , Epistaxe/complicações , Epistaxe/terapia , Humanos , Lipídeos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/diagnóstico por imagem , Doenças Nasais/etiologia , Tomografia Computadorizada por Raios X
7.
Georgian Med News ; (294): 57-61, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687950

RESUMO

Objective of the investigation - to increase the effectiveness of treatment of phlegmon of the maxillo-facial area and neck with the influence onto the pathogenic factors, complementing the main treatment plan with the injection of a second antibiotic in a regionary lymphatic way. 100 patients with acute inflammatory odontogenic diseases of the maxillofacial area were examined. Patients received both traditional medical treatment and regional lymphotropic antibiotic therapy added to the main method of treatment as well. Regionarnl lymphotropic antibiotic injection in the treatment of phlegmon of the maxillofacial area and neck leads to an accelerated onset of the second phase of the development of the wound process, more rapid detoxification of the body. Key words: acute inflammatory odontogenic diseases, maxillofacial area, lymphatic system.


Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Pescoço , Doença Aguda , Adolescente , Adulto , Idoso , Celulite (Flegmão)/sangue , Celulite (Flegmão)/diagnóstico , Face , Dermatoses Faciais/diagnóstico , Feminino , Infecção Focal Dentária/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
8.
J Med Case Rep ; 13(1): 342, 2019 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-31759391

RESUMO

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


Assuntos
Abscesso/diagnóstico por imagem , Antibacterianos/uso terapêutico , Drenagem , Endoscopia , Imagem por Ressonância Magnética , Doenças da Hipófise/diagnóstico por imagem , Abscesso/patologia , Abscesso/terapia , Idoso , Terapia Combinada , Descompressão Cirúrgica , Feminino , Cefaleia/diagnóstico por imagem , Terapia de Reposição Hormonal , Humanos , Masculino , Doenças da Hipófise/patologia , Doenças da Hipófise/terapia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(48): e17830, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770199

RESUMO

RATIONALE: Neonatal scalp mass is common in clinical practice. After birth canal compression and traction force, a cephalohematoma is usually found. However, cephalohematoma with abscess is extremely rare and dangerous. So far, there have been no reported cases of multidrug-resistant Escherichia coli infections in giant neonatal scalp hematoma. PATIENT CONCERNS: We present a 9-day-old with a scalp abscess and a large scalp defect that remained after surgical drainage. DIAGNOSIS: Physical examination showed a giant mass suggestive in the parietal region. B-mode ultrasound indicated the scalp mass was liquid. The early diagnosis was massive scalp hematoma. During conservative treatment, purulent fluid flowed from the mass region through a rupture in the scalp. MR examination showed the scalp had burst and no abnormalities were found in the medial side of the skull and skull. INTERVENTIONS: The surgeon opened up the mass and removed necrotic tissue. The scalp was severely damaged; the aseptic auxiliary materials that we made in-house were used to gradually reduce the defect. OUTCOMES: The scalp was healed by anti-infection treatment and frequent changing of the dressings. The patient was successfully treated without two-stage surgery. There were no complications. LESSONS: A scalp hematoma is a potential site of infection. Anti-infection treatment and surgery are necessary to correct infected scalp hematoma. This work offers a new way of treating other large scalp defects.


Assuntos
Abscesso/microbiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli , Hematoma/microbiologia , Dermatoses do Couro Cabeludo/microbiologia , Abscesso/terapia , Anti-Infecciosos/uso terapêutico , Terapia Combinada , Drenagem/métodos , Infecções por Escherichia coli/terapia , Feminino , Hematoma/terapia , Humanos , Recém-Nascido , Couro Cabeludo/microbiologia , Dermatoses do Couro Cabeludo/terapia
10.
Medicine (Baltimore) ; 98(48): e18159, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770260

RESUMO

RATIONALE: Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment. PATIENT CONCERNS: A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra. DIAGNOSIS: Intramuscular abscess associated with toothpick injury. INTERVENTIONS: Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra. OUTCOMES: A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day. LESSONS: Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Desbridamento/métodos , Dispositivos para o Cuidado Bucal Domiciliar/efeitos adversos , Traumatismos do Antebraço , Ferimentos Penetrantes , Abscesso/etiologia , Abscesso/terapia , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/etiologia , Traumatismos do Antebraço/terapia , Humanos , Masculino , Peptostreptococcus/isolamento & purificação , Prevotella intermedia/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Resultado do Tratamento , Estreptococos Viridans/isolamento & purificação , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/microbiologia , Ferimentos Penetrantes/terapia
11.
BMC Musculoskelet Disord ; 20(1): 445, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604445

RESUMO

BACKGROUND: Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the "dorsal subscapularis approach". CASE PRESENTATION: A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient's clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient's right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection. CONCLUSIONS: The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.


Assuntos
Abscesso/terapia , Artrite Infecciosa/terapia , Drenagem/métodos , Meningite Pneumocócica/terapia , Miosite/terapia , Dor de Ombro/cirurgia , Abscesso/sangue , Abscesso/complicações , Abscesso/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artrite Infecciosa/sangue , Artrite Infecciosa/complicações , Artrite Infecciosa/microbiologia , Feminino , Humanos , Meningite Pneumocócica/sangue , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/microbiologia , Miosite/microbiologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/microbiologia , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/microbiologia , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Arch Ital Urol Androl ; 91(3)2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577107

RESUMO

A Caucasian man 64 years old was admitted to our department for fever, strangury, frequency and pain in the perineum secondary to the relapse of Cowper's gland abscess previously treated by antibiotic therapy and trans-perineal ultrasound-guided aspiration. At admission, the clinical parameters were suggestive of sepsis; moreover, the trans-perineal ultrasound detected an hypoechoic mass suspicious for the recurrence of Cowper's gland abscess. A suprapubic catheter was positioned and a targeted antibiotic therapy (Colistin 9000.000 U intravenously every day for 8 days plus meropenem 500 mg intravenously every 8 hours for 10 days) was administered. The patient during the follow up presented long fibers of mucus in the urine and recurrent positive urine culture, therefore two months later underwent trans-perineal surgical asportation of the left Cowper's gland. One month after surgery the patient was readmitted for the presence of a urinary fistula between bulbar urethra and perineum. A new suprapubic catheter was positioned and after three months was removed because a complete restitutio ad integrum was shown by retrograde cystourethrogram and uroflowmetry. In conclusion, the abscess of Cowper's gland could represent a very rare but severe clinical event that need aggressive therapy and close follow up for its potentially high rate of early and late clinical complications; in the presence of recurrence the surgical asportation of the Cowper's gland should be considered.


Assuntos
Abscesso , Glândulas Bulbouretrais , Doenças dos Genitais Masculinos , Abscesso/diagnóstico , Abscesso/terapia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Pessoa de Meia-Idade
14.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
15.
Radiol Med ; 124(12): 1253-1261, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31428958

RESUMO

PURPOSE: We aimed to determine the safety, feasibility and efficacy of interventional radiology method for the management of esophagogastric anastomotic leakage. METHODS: We retrospectively assessed the medical records of 23 consecutive patients with esophagogastric anastomotic leakage treated using intervention protocol. Patients received three-tube method (abscess drainage tube, gastrointestinal decompression tube and jejunal feeding tube) with or without temporary covered esophageal stent placement. Abscess drainage, anti-inflammatory treatment and nutritional support were performed thereafter. The esophageal stents and three tubes were removed after leakage healing. RESULTS: All patient received three-tube method and eight patients received covered stent placement. All operations were technically successful. After a median of 2.4 months, the stents were successfully removed from five patients. No death, esophageal rupture or massive hemorrhage occurred during procedures. The abscess cavity had markedly decreased in seven patients or disappeared in 16 cases. During follow-up, four patients died of cancer recurrence, one died of heart dysfunction and one died of pulmonary infection. The 1-, 3-, 5-year survival rates were 86.4%, 52.3% and 52.3%, respectively. CONCLUSION: Interventional radiology protocol is safe, feasible and efficacious for treatment for esophagogastric anastomotic leakage.


Assuntos
Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/terapia , Radiologia Intervencionista/métodos , Abscesso/terapia , Idoso , Anastomose Cirúrgica , Descompressão Cirúrgica/instrumentação , Remoção de Dispositivo , Drenagem/instrumentação , Nutrição Enteral/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/terapia , Esofagectomia/efeitos adversos , Esôfago/cirurgia , Estudos de Viabilidade , Feminino , Fístula/diagnóstico por imagem , Fístula/terapia , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Estômago/cirurgia , Taxa de Sobrevida
16.
Pediatr Int ; 61(11): 1146-1150, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31469939

RESUMO

BACKGROUND: Perianal abscess is a common surgical condition in daily pediatric practice. Management is a subject of controversy and a variety of approaches are practiced. While the most frequent approach is drainage with/without fistulotomy, the superiority of this approach and the place of conservative approach has not been established. The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants. METHODS: Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed. RESULTS: Criteria for a conservative approach were: spontaneous drainage into the anal canal (n = 8) or perianal skin (n = 4), and phlegmonous infiltrate with fluid collection detected on ultrasound (n = 7). Mean age at symptom onset was 8.4 months. Twelve patients were managed for the first time. Previous care in seven patients included 1-4 drainage procedures (n = 4), spontaneous drainage (n = 1) and antibiotics (n = 2). Five patients were on oral antibiotics at presentation. After diagnosis, 18 patients received i.v. antibiotics and one, oral antibiotics. Three patients (15.7%) ultimately required surgical drainage; two were lost to follow up. During follow up (mean, 22.4 months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula-in-ano in one patient that healed spontaneously. Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up. CONCLUSIONS: Perianal abscess in infants is amenable to conservative management in selected cases. Avoiding surgical intervention is advantageous, especially given the high recurrence rate.


Assuntos
Abscesso/terapia , Antibacterianos/uso terapêutico , Doenças do Ânus/terapia , Tratamento Conservador/métodos , Drenagem/métodos , Abscesso/diagnóstico , Doenças do Ânus/diagnóstico , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
J Med Case Rep ; 13(1): 247, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395094

RESUMO

BACKGROUND: Cervical lymph node swelling is quite a common symptom mainly caused by infections in the face or as metastasis of a malignant tumor. In infection cases in particular, rare diseases should never be overlooked. With an incidence of 120 cases in the United States of America (USA) and approximately 25 cases in Germany per year, infection with the pathogen Francisella tularensis is one of these rare diseases that can cause massive lymph node swellings and might even be fatal. CASE PRESENTATION: The example of a healthy 67-year-old German woman who was treated at our university hospital presents a typical progression of a localized form of tularemia. The pathogen could be identified in a universal 16S ribosomal deoxyribonucleic acid (DNA) polymerase chain reaction. Pathogen-specific treatment with lymph node abscess incision, daily rinsing of the abscess cavity, and orally administered antibiotic therapy with doxycycline could cure our patient completely without any remaining complications. CONCLUSION: In patients with cervical lymph node swelling caused by infection it is indispensable to perform specific identification of the pathogen for further local and specific antibiotic treatment. Possible infections with atypical bacteria like Francisella tularensis should never be ignored. Universal polymerase chain reactions are a suitable method for early detection of such rare pathogens.


Assuntos
Abscesso/etiologia , Linfadenopatia/etiologia , Tularemia/complicações , Abscesso/patologia , Abscesso/terapia , Idoso , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Drenagem/métodos , Feminino , Francisella tularensis/isolamento & purificação , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/patologia , Linfadenopatia/terapia , Pescoço , Tomografia Computadorizada por Raios X , Extração Dentária , Tularemia/diagnóstico
18.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(5): 349-353, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31427214

RESUMO

OBJECTIVES: To report an unusual complication of pediatric acute maxillary sinusitis: premaxillary abscess. To describe clinical, radiological and biological presentation, treatment strategy and progression. MATERIAL AND METHODS: A retrospective study included all pediatric patients treated for premaxillary abscess complicating acute maxillary sinusitis in two ENT reference centers between 1999 and 2017. Disease history, clinical presentation, biological and radiological findings, treatment modalities and progression were studied. RESULTS: Ten patients were included, with a mean age of 10±4.2 years. All presented with fever, rhinorrhea and premaxillary edema. Contrast-enhanced CT scan systematically found complete opacity of the maxillary sinus, without bone lysis, and extensive effusion along the intersinonasal wall up to the premaxillary region, extending in 3 cases back toward the parapharyngeal space. Bacteriology isolated Streptococcus anginosus most frequently (n=4; 40%). Treatment comprised intravenous wide-spectrum antibiotics, with surgical drainage of the abscess if>10mm (n=9; 90%). Seven of these 9 patients (78%) had recurrent abscess requiring surgical revision and 3 (33%) required a third drainage. All patients were cured without sequelae at 1 month. CONCLUSION: In case of acute maxillary sinusitis with premaxillary edema, premaxillary abscess should be suspected. The high recurrence rate argues for maximalist surgery associated to close clinical monitoring with radiological examination.


Assuntos
Abscesso/etiologia , Seio Maxilar/diagnóstico por imagem , Sinusite Maxilar/complicações , Abscesso/diagnóstico por imagem , Abscesso/terapia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Drenagem , Feminino , Humanos , Masculino , Seio Maxilar/microbiologia , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X
20.
Infect Dis Obstet Gynecol ; 2019: 4161394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274977

RESUMO

Pelvic inflammatory disease (PID) complicated by tubo-ovarian abscesses (TOA) has long-term sequelae in women of reproductive age. Consensus on the optimal treatment of TOA remains lacking. Most clinicians utilize antibiotics as a first-line conservative approach, failing which invasive intervention is adopted. Our aim is to identify risk factors predicting failed response to conservative medical management for TOA in an Asian population. A retrospective cohort study of 136 patients admitted to a tertiary hospital in Singapore for TOA between July 2013 and December 2017 was performed. Patients were classified into 2 groups: successful medical treatment with intravenous antibiotics and failed medical treatment requiring invasive intervention. 111 (81.6%) of patients were successfully treated with conservative medical approach using intravenous antibiotics; 25 (18.4%) required invasive intervention having failed medical therapy. Multivariate logistic regression model adjusted for age, ethnicity, C-reactive Protein (CRP), TOA size, and body mass index (BMI) showed the odds ratio (OR) of each centimetre increase in TOA size to be 1.28 (95% confidence interval (CI) 1.03-1.61; P=0.030) and every kg/m2 increase in BMI to be 1.10 (95% CI 1.00-1.21; P=0.040). Failed medical management was predicted by a cutoff of TOA size ≥ 7.4 cm and ≥ BMI 24.9 kg/m2. Patients who failed medical treatment received a mean of 4.0±2.1 days of antibiotics before a decision for invasive intervention was made, with a significantly longer intravenous antibiotic duration (9.4±4.3 versus 3.6±2.2 days; P <0.001) and prolonged hospitalization (10.8± 3.6 versus 4.5 ± 2.0 days; P <0.001) compared to the medical group. Patients with higher BMI and larger TOA size were associated with failed response to conservative medical management in our study population. Early identification of these patients for failed medical therapy is imperative for timely invasive intervention to avoid prolonged hospitalization, antibiotic usage, and patient morbidity.


Assuntos
Gerenciamento Clínico , Doenças das Tubas Uterinas/epidemiologia , Doenças Ovarianas/epidemiologia , Doença Inflamatória Pélvica/complicações , Abscesso/epidemiologia , Abscesso/patologia , Abscesso/terapia , Adulto , Grupo com Ancestrais do Continente Asiático , Tratamento Conservador , Doenças das Tubas Uterinas/terapia , Feminino , Hospitalização , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Doenças Ovarianas/terapia , Doença Inflamatória Pélvica/epidemiologia , Doença Inflamatória Pélvica/terapia , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Centros de Atenção Terciária
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA