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2.
Urologiia ; (5): 114-118, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808644

RESUMO

The problem of urinary stone disease and acute destructive pyelonephritis remains to be relevant in the current urologic practice. The acute pyelonephritis is the most common infectious and inflammatory complication after retrograde ureteroscopy. According to data of leading urologists in Russian Federation and worldwide, the incidence of acute purulent pyelonephritis ranges from 0.1 to 0.2%. Infectious and inflammatory complications of retrograde ureteroscopy often require urgent interventions. Acute pyelonephritis can result in destructive changes in the renal parenchyma. In case of ineffective conservative measures, pyelonephritis can progress into sepsis with the development of multiple organ failure. Therefore, infectious and inflammatory complications require to start combined antibacterial, anti-inflammatory and detoxification therapy, as well as to resolve any upper urinary tract obstruction. If acute pyelonephritis leads to destructive phase with a formation of a carbuncle or an abscess in the kidney, an open surgery is indicated. Despite being minimally-invasive, retrograde ureteroscopy can lead to serious complications requiring an open surgical intervention. In some cases, the severity of the patients condition may require nephrectomy.


Assuntos
Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Cálculos Renais/terapia , Litotripsia/efeitos adversos , Pielonefrite/tratamento farmacológico , Ureteroscopia/efeitos adversos , Humanos , Nefrectomia , Pielonefrite/complicações , Pielonefrite/microbiologia , Federação Russa , Índice de Gravidade de Doença , Cálculos Urinários
4.
Turk J Pediatr ; 61(1): 40-43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559720

RESUMO

Zhu Y, Xu F. The pathogens and curative effects analysis of perianal abscess of infants under 3 months. Turk J Pediatr 2019; 61: 40-43. In order to guide clinical treatment for perianal abscess of young infants, the characteristics of pathogens and curative effects analysis were conducted. Bacterial culture results, antibiotics susceptibility tests and curative effects of abscess incision were retrospectively analyzed in 66 cases of perianal abscess of infants under 3 months. There were 48 cases of Klebsiella pneumoniae, 7 cases of Staphylococcus, 6 cases of Escherichia coli, 5 cases of Proteus in the pathogen culture results. Klebsiella pneumoniae, the predominant pathogen, was susceptible to most antibiotics, especially to imipenem, cefoperazonesulbactam and amikacin with low drug resistance rates. However, high drug resistance rates were found to ampicillin and nitrofurantion. After abscess incision, the complication rate of anal fistula was 6.6% in infants under 3 months and 60.3% in the adult group. There was significant difference P<0.01. In conclusion, Klebsiella pneumoniae was the most common pathogen in perianal abscess of infants under 3 months and was commonly resistant to ampicillin and nitrofurantion. Since perianal abscess of infants under 3 months is a self-limited disorder, simple surgical intervention and synchronous sensitive antibiotic administration are suggested as the optimal management.


Assuntos
Abscesso , Doenças do Ânus , Infecções por Escherichia coli , Infecções por Klebsiella , Klebsiella pneumoniae/isolamento & purificação , Infecções Estafilocócicas , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Doenças do Ânus/diagnóstico , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/microbiologia , Doenças do Ânus/cirurgia , Terapia Combinada , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/cirurgia , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Resultado do Tratamento
5.
Int J Pediatr Otorhinolaryngol ; 127: 109682, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546061

RESUMO

OBJECTIVE: To review a single-surgeon, 16-year experience with the management of infected preauricular sinuses/cysts. METHODS: Computerized search of all office notes and operative reports during the years 2002-2018. SETTING: Academic medical center and suburban office practice. PARTICIPANTS: Children from 0 to 18 years of age with symptomatic preauricular sinuses/cysts. INTERVENTION: Children with symptomatic preauricular sinuses/cysts underwent surgical excision. Those presenting with infected cysts were treated with oral antibiotics, needle-aspiration and/or incision and drainage to control infection prior to surgery. The chronic preauricular abscesses were curetted without resection of overlying skin or the abscess walls. MAIN OUTCOME MEASURE: Control of infection without recurrence following surgery. RESULTS: 415 patient encounters involved preauricular sinuses/cysts. These ultimately led to 56 surgical excisions. 28 of the sinuses/cysts were infected at presentation. All infected lesions were treated with oral antibiotics. 6 infected sinuses/cysts were needle aspirated. 2 infected sinuses/cysts required incision and drainage. 1 infected sinus/cyst could not be controlled by either drainage technique and was surgically excised while actively infected. Nine children presented with chronic preauricular abscesses. One the 28 infected sinuses/cysts (3.5%) recurred 10 years after surgery- it was cured with re-resection at the root of the helix. CONCLUSION: Treatment of infected preauricular sinuses/cysts remains controversial. Control of infection prior to definitive surgery is desirable, but not mandatory. Chronic preauricular abscesses can be managed by sinus/cyst excision and subcutaneous abscess curettage without resection of the abscess wall or overlying skin. This leads to consistent control and favorable cosmesis.


Assuntos
Abscesso/tratamento farmacológico , Abscesso/cirurgia , Anormalidades Craniofaciais/cirurgia , Cistos/cirurgia , Abscesso/complicações , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Anormalidades Craniofaciais/complicações , Cistos/complicações , Drenagem , Humanos , Lactente , Recém-Nascido , Recidiva
6.
G Chir ; 40(3): 243-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484017

RESUMO

Sternoclavicular joint infection is rare. While it is usually treated surgically, we wish to report a case of non-operative treatment of such infection caused by an atypical organism. A 51-year-old woman, known case of diabetes mellitus, hypertension, dyslipidaemia and hyperthyroidism presented with pain over the left upper chest for two weeks associated with redness and fever for one week. The patient was diagnosed to have left sternoclavicular joint septic arthritis with medial end left clavicular osteomyelitis, left sternocleidomastoid, left anterior chest wall abscesses and left lower lobe posterior basal segment cavitating lung lesion with a single nodule in the lingular segment. The blood culture and sensitivity grew extended spectrum beta lactamase (ESBL) Klebsiella pneumonia and the patient was treated with two weeks of meropenem. Computed Tomography was then repeated 2 months later and features were suggestive resolving of left sternoclavicular joint septic arthritis with medial end left clavicular osteomyelitis. The patient is still under surveillance and is currently symptom free 1 year later. We present a case to our knowledge is the first case of rare gram negative rod organism, ESBL Klebsiella pneumoniae infection which caused the left sternoclavicular septic arthritis with medial end left clavicular osteomyelitis, left sternocleidomastoid and left anterior chest wall abscesses. The patient is most likely immunocompromised from being a diabetic with hyperthyroidism. First line treatment can be with antibiotics and when that fails, patient can be treated surgically. Two weeks of antibiotics therapy is possible in selected patients with monitoring of the infective markers.


Assuntos
Abscesso/tratamento farmacológico , Artrite Infecciosa/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Articulação Esternoclavicular , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Tratamento Conservador , Feminino , Humanos , Meropeném/uso terapêutico , Pessoa de Meia-Idade , Osteomielite/microbiologia , Osteomielite/terapia , Articulação Esternoclavicular/microbiologia
7.
Diagn Microbiol Infect Dis ; 95(3): 114865, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31405631

RESUMO

We present a case of subcutaneous infection caused by Bordetella hinzii in a healthy male. The isolate was successfully identified by gyrB gene sequencing. B. hinzii cannot be distinctively identified using 16S rRNA gene sequencing or by biochemical methods. The number of cases infected with B. hinzii might be underestimated owing to the difficulty in accurate identification, which can be achieved by gyrB gene sequencing to gain knowledge about the species.


Assuntos
Abscesso/microbiologia , Infecções por Bordetella/diagnóstico , Bordetella/fisiologia , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/patologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Bordetella/genética , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Infecções por Bordetella/patologia , DNA Girase/genética , DNA Bacteriano/genética , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Pele/microbiologia , Resultado do Tratamento
8.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466967

RESUMO

Rothia aeria is a gram-positive amorphous bacillus and was discovered in the Russian space station 'Mir' in 1997. It shows phylogenetic similarity to Actinomyces israelii, and as determined using 16 s ribosomal RNA gene analysis R. aeria is classified as a bacteria of the genus Actinomyces It was found to colonise in the human oral cavity, and there are some infectious reports but none specifies gynaecological infection. A 57-year-old woman, who had been continuously using intrauterine contraceptive device, presented with fever and lower abdominal pain. She was suspected tube-ovarian abscess caused by A. israelii, but the uterine cavity culture revealed R. aeria infection. Considering surgical treatment, conservative treatment by intravenous benzylpenicillin and subsequently oral ampicillin for 6 months improved the abscess, and she has no recurrence for over 1 year.


Assuntos
Abscesso/tratamento farmacológico , Micrococcaceae/isolamento & purificação , Doenças Ovarianas/microbiologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Abscesso/cirurgia , Actinomyces , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Feminino , Febre/diagnóstico , Febre/etiologia , Humanos , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Penicilina G/administração & dosagem , Penicilina G/uso terapêutico , Resultado do Tratamento
10.
Curr Opin Ophthalmol ; 30(5): 349-355, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261188

RESUMO

PURPOSE OF REVIEW: This study is a review of recent literature in the diagnosis and management of preseptal cellulitis, orbital cellulitis and dacryocystitis, including causative organisms, diagnosis and medical or surgical therapy and potential complications. RECENT FINDINGS: Advances in vaccination against Haemophilus influenzae B have resulted in a shift in the most common causative organisms of preseptal and orbital cellulitis. Management of orbital cellulitis has been advanced by adjuvant corticosteroids, and subperiosteal abscess volumes of more than 1250 ml has been shown as predictive for requiring potential surgical intervention. SUMMARY: Periorbital infections require prompt evaluation and management. Although the infectious organisms in both preseptal and orbital cellulitis include Staphylococcus/Streptococcus species, management may differ significantly on the basis of the nidus of infection, presenting signs and symptoms, and response to initial medical management.


Assuntos
Abscesso/microbiologia , Dacriocistite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Celulite Orbitária/microbiologia , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Dacriocistite/diagnóstico , Dacriocistite/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Masculino , Celulite Orbitária/diagnóstico , Celulite Orbitária/tratamento farmacológico
11.
BMJ Case Rep ; 12(7)2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31315845

RESUMO

Pott's puffy tumour (PPT) is a known complication of frontal sinusitis. It is defined as subperiosteal abscess formation due to osteomyelitis of the frontal bone presenting as a forehead swelling. It is a life-threatening condition that can lead to intracranial and intraorbital complications. Gadolinium-enhanced MRI and contrast CT scan are the best modalities to localise and define the collection, in addition to confirming disease extension. Once confirmed by imaging and depending on disease extension, management of PPT requires a multidisciplinary team approach and depends on the local provision of surgical care. Following surgical drainage of the abscess cavity, a prolonged course of antibiotics is required postoperatively to treat the underlying osteomyelitis.


Assuntos
Abscesso/tratamento farmacológico , Osso Frontal/patologia , Tumor de Pott/complicações , Abscesso/cirurgia , Administração Intravenosa , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Sinusite Frontal/diagnóstico por imagem , Sinusite Frontal/microbiologia , Sinusite Frontal/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Celulite Orbitária/etiologia , Celulite Orbitária/patologia , Osteomielite/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Rev Soc Bras Med Trop ; 52: e20190081, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340368

RESUMO

Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.


Assuntos
Abscesso/diagnóstico por imagem , Actinobacteria/isolamento & purificação , Bacteriemia/microbiologia , Doenças Uretrais/diagnóstico por imagem , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Actinobacteria/classificação , Antibacterianos/uso terapêutico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecção Pélvica/diagnóstico , Infecção Pélvica/microbiologia , Fatores de Risco , Tomografia Computadorizada por Raios X , Doenças Uretrais/tratamento farmacológico
13.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036734

RESUMO

We report a 36-year-old man who developed a large epidural and paraspinal abscess as a complication of infliximab therapy being used for underlying Crohn's disease. Cultures of the collection grew methicillin-susceptible Staphylococcus aureus, and treatment consisted of abscess drainage, prolonged intravenous and oral flucloxacillin and temporary withholding of his infliximab. While infection-related complications are well described with infliximab therapy, this is the first description of a large paraspinal abscess with epidural extension.


Assuntos
Abscesso/microbiologia , Doença de Crohn/tratamento farmacológico , Espaço Epidural/microbiologia , Infliximab/efeitos adversos , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/uso terapêutico , Anticorpos Monoclonais , Doença de Crohn/complicações , Drenagem/métodos , Espaço Epidural/diagnóstico por imagem , Floxacilina/administração & dosagem , Floxacilina/uso terapêutico , Fármacos Gastrointestinais/efeitos adversos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Infliximab/uso terapêutico , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
14.
Pediatr Dermatol ; 36(4): e93-e94, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31042815

RESUMO

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


Assuntos
Abscesso/tratamento farmacológico , Abscesso/etiologia , Granuloma/etiologia , Dermatopatias/tratamento farmacológico , Dermatopatias/etiologia , Abscesso/fisiopatologia , Criança Adotada/estatística & dados numéricos , Claritromicina/uso terapêutico , Europa Oriental , Feminino , Granuloma/tratamento farmacológico , Granuloma/fisiopatologia , Humanos , Lactente , Injeções Intramusculares/efeitos adversos , Rifampina/uso terapêutico , Medição de Risco , Federação Russa , Dermatopatias/fisiopatologia , U.R.S.S.
15.
Am J Vet Res ; 80(6): 586-594, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31140853

RESUMO

OBJECTIVE: To determine oxytetracycline concentrations in plasma and in fluid from Corynebacterium pseudotuberculosis (CPT)-inoculated tissue chambers (used as experimental abscess models) and uninoculated (control) tissue chambers in sheep after IM or local administration of the drug and to investigate whether CPT growth was reduced or eliminated by these treatments. ANIMALS: 10 clinically normal female sheep. PROCEDURES: Sterile tissue chambers were surgically implanted in both paralumbar fossae of each sheep; ≥ 2 weeks later (day -6), 1 randomly selected chamber was inoculated with CPT, and the opposite chamber was injected with sterile growth medium. Sheep received oxytetracycline IM (n = 5) or by percutaneous injection into CPT-inoculated (4) or uninoculated (1) chambers on day 0. Tissue fluid from each chamber and venous blood samples for plasma collection were obtained at predetermined times over 6 days for bacterial counts (tissue chambers) and analysis of oxytetracycline concentrations (tissue chambers and plasma). Sheep were euthanized on day 6. Regional lymph nodes were collected bilaterally from each sheep for culture. RESULTS: Measurable concentrations of oxytetracycline were present in each chamber throughout the study, regardless of administration route or presence of CPT. No CPT growth was detected after the 48-hour time point in inoculated chambers injected with oxytetracycline; however, CPT was isolated from all inoculated chambers throughout the study after IM drug administration. One regional lymph node (ipsilateral to a CPT-inoculated, oxytetracycline-injected chamber with no CPT growth after 48 hours) was culture positive for CPT. CONCLUSIONS AND CLINICAL RELEVANCE: Intralesional administration of oxytetracycline may eliminate growth of CPT locally, but complete elimination of the organism remains difficult.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Corynebacterium/veterinária , Corynebacterium pseudotuberculosis , Injeções Intralesionais/veterinária , Injeções Intramusculares/veterinária , Oxitetraciclina/administração & dosagem , Doenças dos Ovinos/tratamento farmacológico , Abscesso/tratamento farmacológico , Abscesso/prevenção & controle , Abscesso/veterinária , Animais , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Infecções por Corynebacterium/metabolismo , Infecções por Corynebacterium/prevenção & controle , Modelos Animais de Doenças , Líquido Extracelular/metabolismo , Feminino , Linfadenite/tratamento farmacológico , Linfadenite/veterinária , Oxitetraciclina/farmacocinética , Oxitetraciclina/uso terapêutico , Distribuição Aleatória , Ovinos , Doenças dos Ovinos/prevenção & controle
16.
Infect Dis (Lond) ; 51(8): 570-577, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31144548

RESUMO

Background: Knowledge about the treatment of skin and soft tissue infections in injecting drug users in countries with a low prevalence of antibiotic resistance is limited. We investigated bacterial antibiotic resistance and treatment of skin and soft tissue infections in Norwegian drug users. Methods: We performed a two year clinical cross-sectional observational study in a Norwegian hospital. Data were collected retrospectively from hospital records. We examined bacteriological findings and antibiotic resistance, and evaluated compliance to treatment guidelines and appropriateness of empirical antibiotic therapy relative to results of cultures and susceptibility testing. Descriptive and univariate analyses were performed. Results: Hundred and thirty-five injecting drug users were admitted with skin and soft tissue infection in the study period. Cultures were obtained from 103 (77%) abscesses and eight (24%) erysipelas and cellulitis, with bacterial growth in 80 (78%) and five (63%), respectively. Streptococci and staphylococci were the most prevalent bacteria, but methicillin-resistant Staphylococcus aureus was found in only one patient. Compliance to hospital antibiotic guidelines was 70%. Ninety-one per cent of patients in the compliant and 79% in the non-compliant group were given effective empirical antibiotics (p = .334). In the non-compliant group, significantly more patients received broad-spectrum empirical antibiotics (p < .001). In 30 cases where adjustment of antibiotic therapy was possible according to susceptibility testing, this was performed in only 14 cases. Conclusions: Bacteria and resistance patterns did not differ significantly from the skin and soft tissue infections in the general population in Norway. Compliance to antibiotic guidelines led to significantly less use of broad-spectrum antibiotics and to good bacterial coverage. General guidelines for treatment should be applied to injecting drug users with skin and soft tissue infections.


Assuntos
Antibacterianos/uso terapêutico , Usuários de Drogas , Fidelidade a Diretrizes/estatística & dados numéricos , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/complicações , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Estudos Transversais , Farmacorresistência Bacteriana , Uso de Medicamentos , Fidelidade a Diretrizes/normas , Humanos , Noruega , Prevalência , Estudos Retrospectivos , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Abuso de Substâncias por Via Intravenosa/microbiologia
17.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133552

RESUMO

A 38-year-old man presented with an acute onset of pain and swelling of the right testis. On examination, he was tender in the right iliac fossa (RIF) with a grossly enlarged and tender right testis. Ultrasonography and contrast-enhanced CT of the abdomen and pelvis revealed right epididymo-orchitis, a bulky and inflamed right spermatic cord and a well- defined, thick-walled collection in the RIF.


Assuntos
Apêndice/microbiologia , Doenças dos Genitais Masculinos/diagnóstico , Neoplasias Testiculares/patologia , Abdome/diagnóstico por imagem , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Apendicectomia/métodos , Apêndice/patologia , Apêndice/cirurgia , Diagnóstico Diferencial , Epididimite/patologia , Doenças dos Genitais Masculinos/patologia , Humanos , Laparotomia/métodos , Masculino , Orquite/patologia , Cordão Espermático/patologia , Resultado do Tratamento
19.
Med Phys ; 46(7): 3259-3267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31056771

RESUMO

PURPOSE: Deep tissue abscesses remain a serious cause of morbidity, mortality, and hospital stay despite development of percutaneous drainage and increasing use of perioperative antibiotics. The goal of this study was to examine the feasibility of methylene blue (MB) mediated photodynamic therapy (PDT) for treatment of infected abscesses with intracavity MB delivery, using computed tomography (CT) imaging data from a representative abscess patient population and Monte Carlo simulation of light delivery. METHODS: This retrospective study included all adult subjects that received percutaneous abscess drainage between 1 January 2014 and 31 December 2014 at our institution whose abscess was confirmed by abdominal CT imaging less than 1 week preprocedure (n = 358). Of these, 40 subjects were further analyzed with Monte Carlo simulation. Abscess volumes were segmented from CT images, and imported into the Monte Carlo simulation space. Monte Carlo simulations were performed with a single fiber placement for each abscess, with the optical power at which a fluence rate of either 4 or 20 mW/cm2 was achieved for 95% of the abscess wall recorded. Subjects for which a fluence rate of 4 mW/cm2 was attainable in 95% of the abscess wall with a maximum input optical power of 2000 mW were considered eligible for MB-PDT. RESULTS: 42.5% of subjects would have been eligible for MB-PDT, with 17.5% attaining the higher threshold of 20 mW/cm2 in 95% of the abscess wall, given a 1% Intralipid concentration within the abscess cavity and the assumed abscess wall optical properties. The mean optical power necessary was 680 ± 580 mW for the 4 mW/cm2 threshold, and 1100 ± 600 mW for the 20 mW/cm2 threshold. Abscess surface area and threshold optical power were correlated (Spearman ρ = 0.73, P = 0.001), with larger abscesses requiring higher optical power. Of the subjects who were not eligible for MB-PDT, abscess volumes (150 ± 120 vs 62 ± 41 cm3 , P = 0.0049) and surface areas (320 ± 200 vs 140 ± 70 cm2 , P = 0.0015) tended to be larger than for those who were eligible. There were no significant differences in eligibility, optical power required, or abscess volume or surface area based on abscess location. For all eligible subjects, at the optical power necessary to achieve 4 mW/cm2 in 95% of the abscess wall, 2.5 ± 3.7% (0%-13.2%) of the wall experienced a fluence rate greater than or equal to 400 mW/cm2 . At the 20 mW/cm2 threshold, 8.8 ± 11.4% (0%-31.1%) of the wall surpassed this 400 mW/cm2 level. If subjects with greater than 5% of the wall exceeding 400 mW/cm2 are treated as ineligible, overall eligibility becomes 32.5% for the 4 mW/cm2 threshold and 10.0% for the 20 mW/cm2 threshold. CONCLUSIONS: Assuming that the subjects analyzed were representative of the overall patient population, over 150 patients that received percutaneous abscess drainage during the study period would have been eligible for MB-PDT at the time of drainage, with smaller abscesses being more amenable for treatment. This technique could potentially reduce abscess recurrence, duration of drainage catheter placement, and reliance on systemic antibiotics. These results motivate a future Phase 2 clinical trial following successful completion of the ongoing safety study.


Assuntos
Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Método de Monte Carlo , Fotoquimioterapia , Tomografia Computadorizada por Raios X , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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