Debridement Of Abscess Research Articles

Complete Resection is Mandatory for Tubercular Cold Abscess of the Chest Wall

Cold abscess of the chest wall is a rare disease and few literature reports detail any treatment experience with a limited patient number. Hence, an optimal treatment plan remains controversial. We retrospectively analyzed patients with cold abscess of the chest wall, focusing on their clinical features, surgical results, and the long-term outcome. Eighty patients were enrolled between May 1981 and April 2005. There were 35 male and 45 female patients, who underwent surgical treatment for cold abscess of the chest wall. The mean age of the patients was 31.4 +/- 12.5 (14 to 73) years. Forty patients (50.0%) had previous history of pulmonary tuberculosis. A growing chest wall mass was present in every patient. Surgical treatments performed were as follows: abscess debridement and drainage in 15 (18.8%), complete excision of the abscess without chest wall resection in 9 (11.2%), and complete excision of the abscess including chest wall in 56 patients (70.0%). There were no cases of operative mortality. Operative morbidity developed in four patients; two wound infections, one pneumonia, and one prolonged chest tube drainage. Postoperative antituberculous medication was given to all patients. Twelve patients (15.0%) recurred and required a second operation. The recurrence rate was higher in patients where only drainage of the abscess was performed compared with those in whom complete resection was performed (40.0% vs 9.2%, p = 0.008). Cold abscess of the chest wall can be surgically managed successfully with low operative risk. Complete resection of the abscess, including a portion of the involved chest wall, is mandatory to avoid recurrence.

Complex Hepatic Injuries: an Audit from a Tertiary Center.

Nonoperative management is being increasingly employed in the management of blunt hepatic injuries. We analyzed patients with complex hepatic injuries over a period of 10 years (1996-2006). Two hundred and ten patients with blunt hepatic injury were admitted and 103 patients had complex liver injuries. The predominant mode of injury was road traffic accidents in 91.2%. The grade distribution of liver injuries was grade III (72.8%), grade IV (23.3%) and grade V (4.9%). Twenty-four patients (23.3%) underwent surgery for persistent hemodynamic instability, persistent fall in hemoglobin level, bile leaks and intra-abdominal collection with sepsis. Associated intra-abdominal injuries were present in 19.4%, and 58.4% had associated extra-abdominal injuries. The operative procedures included hepatectomy (1), suture hepatorraphy (12), T-tube drainage for bile duct injuries (5), perihepatic sponge and gel foam packing (9), liver abscess drainage (3), and resection and debridement of liver tissue in six patients. The mortality and morbidity in this series was 10.7 and 56.4%, respectively. Multiorgan failure was present in 5, single organ failure in 37, sepsis in 24, biliary complications in 16 and intra-abdominal collection in 17 patients. Endoscopic management for bile leaks was performed in five patients, image-guided pig-tail drainage for abscesses in 11 patients, while angioembolization was done in two patients for right hepatic artery bleed. The mortality was not significantly different in surgical and nonoperative groups but operated patients had significantly higher morbidity. Complex liver injuries can be managed successfully with conservative treatment in majority, with low mortality and acceptable morbidity. Surgery is reserved for selected indications.

Teaching Atlas of Interventional Radiology: Non-Vascular Interventional Procedures

1. NECK AND THORAX Nasolacrimal duct strictures Percutaneous parathyroid ablation Thyroid biopsy Mediastinal biopsy Mediastinal abscess Pleural Biopsy Pleurodesis Bronchial stenosis 2. ABDOMEN Esophageal stricture Percutaneous gastrostomy / gastrojejunostomy Strictured enteric anastomosis Malignant colonic obstruction Intussuception Abdominal abscess 2a. Liver Ultrasound guided biopsy Abscess drainage Cyst Ablation Hydatid disease Laser ablation RF ablation Cryoablation 2b. Biliary Obstructive jaundice Malignant hilar obstruction Sclerosing Cholangitis AIDS-related cholangitis Removal of bile duct calculi Intrahepatic calculi and Caroli's disease Giant common duct calculi Transjejunal biliary intervention Acute Cholecystitis Cholecystolithiasis 2c. Pancreas Pancreatic abscess Debridement of Infected pancreas necrosis Percutaneous biopsy 3. PELVIS 3a. Abscess Drainage Transgluteal drainage Transrectal drainage Transvaginal drainage 3b. Reproductive System Female infertility: An overview Fallopian tube recanalization Transcervical lysis of intrauterine adhesions Uterine cervix dilatation 4. RETROPERITONEUM 4a. Urinary System Nephrostomy and ureteral stenting Ureteral occlusion for urinary leaks Symptomatic renal cyst Staghorn calculus Accidentally ligated ureter Caliceal diverticulum calculi Retrorenal colon 4b. Adrenal Percutaneous biopsy Pseudotumor 5. MISCELLANEOUS Conscious sedation for the Interventional Radiologist Infection and sepsis: an overview for the interventional radiologist Vertebroplasty for painful hemangioma Treatment of Osteoid Osteoma Drainage / ablation of lymphoceles

Evaluation and Treatment of Children with Primary Immune Deficiency in the Emergency Department

The potential for morbidity and mortality in an ill child with primary immune deficiency (PID) is extremely high. It is estimated that there are more than 500,000 cases of PID in the United States and an incidence of up to 1 in 2000 live births. Although the increased outpatient care of these patients necessitates a standardized approach to maximize emergent treatment, the diversity of these rare diseases and their potential infectious, autoimmune, and malignant sequelae complicate treatment guidelines. We present an overview of the clinical characteristics of primary immune deficiencies and then describe unique aspects of emergent care for these complex patients. Conservative management with empiric antimicrobials, early and aggressive surgical debridement of abscesses, and admission at a tertiary pediatric care center are often indicated. Familiarity with the clinical manifestations of PID and collaboration with a pediatric immunologist are prerequisites for optimal emergent care of these complex patients.

Endosurgical treatment of a retrobulbar abscess in a rabbit

A 1-year-old sexually intact female Netherland dwarf rabbit was examined because of a 3-week history of signs of lethargy, decreased appetite, left unilateral exophthalmia, a previous draining sinus from a left maxillary facial abscess, and bilateral nasal discharge. The rabbit weighed 1.0 kg (2.2 lb) and had a body condition score of 1.5/5. Physical examination revealed generalized muscle atrophy, bilateral mucopurulent nasal discharge, and severe left-sided exophthalmia. Diagnostic investigation revealed anemia, neutrophilia, severe dental disease, a superficial corneal ulcer of the left eye, and a retrobulbar abscess. Stomatoscopy-aided dental trimming, tooth removal, and abscess debridement were performed. Antimicrobials were flushed into the tooth abscess cavity, and antimicrobial treatment was initiated on the basis of cytologic findings and results of bacterial culture and susceptibility testing. Two months after the initial surgery, minimal exophthalmia was evident and no further physical, radiographic, or ultrasonographic changes were evident. Stomatoscopy is a valuable technique that can facilitate diagnosis, treatment, and serial reevaluation of rabbits with dental disease.

Successful Video-Assisted Mediastinoscopic Drainage of Descending Necrotizing Mediastinitis

Descending necrotizing mediastinitis is an uncommon form of mediastinitis that can rapidly progress to septacemia. To date, the optimal surgical approach has remained controversial. We report a case of descending necrotizing mediastinitis that was treated successfully through a transcervical approach with video-assisted mediastinoscopy. In our case, because the abscess was separated into small compartments, especially in the paratracheal space, the abscess was drained using video-assisted mediastinoscopy. This less-invasive approach may be an option in the treatment of descending necrotizing mediastinitis, especially when the abscess in the paratracheal space is separated into small compartments.

Circumferential Negative-Pressure Dressing (VAC) to Bolster Skin Grafts in the Reconstruction of the Penile Shaft and Scrotum

Abstract:This paper presents 4 consecutive cases using negative-pressure dressings (VAC) to bolster skin grafts in male genital reconstruction. In this series reconstruction followed 1 case of tumor ablation and 3 cases of debridement of abscesses or Fornier’s gangrene. The VAC was applied circumfer

Hematogenous Vertebral Osteomyelitis Due to Staphylococcus aureus in the Adult: Clinical Features and Therapeutic Outcomes

Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. Retrospective chart review using standardized data collection form. S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days. Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).

Endoscopic debridement of paraesophageal, mediastinal abscesses: a prospective case series

Mediastinal abscesses after esophageal perforation or postoperative leakage nearly always require surgical intervention. Patients with paraesophageal abscesses were treated with EUS-guided or endoscopic mediastinal puncture if the abscess was >2 cm and sepsis was present. Abscess cavities were entered with a 9.5-mm endoscope after balloon dilation to allow irrigation and drainage. Debris was removed with a Dormia basket. Concomitant pleural effusions were treated with transthoracic drains. Patients received intravenous antibiotics and enteral/parenteral nutrition. Twenty patients fulfilled the entry criteria. Simple drainage was sufficient in 4 cases, and puncture was impossible in one case. Of the 15 treated patients (age 39-76 years, 5 women) the etiology of perforation was Boerhaave's syndrome (n = 8), anastomotic leak (n = 3), and iatrogenic perforation (n = 4). Debridement was successful in all cases and required a median of 5 daily sessions (range 3-10). All patients became apyrexial, with a C-reactive protein < 5 mg/L within a median of 4 days (range 2-8 days). Esophageal defects were closed with endoclips (n = 7), fibrin glue (n = 4), metal stents (n = 1), or spontaneously healed (n = 3). One patient died from a massive pulmonary embolism one day after successful debridement (mortality 7%). No other complications were seen. Median follow-up was 12 months (range 3-40 months). Nonoperative endoscopic transesophageal debridement of mediastinal abscesses appears safe and effective.

Circumferential Negative-Pressure Dressing (VAC) to Bolster Skin Grafts in the Reconstruction of the Penile Shaft and Scrotum

This paper presents 4 consecutive cases using negative-pressure dressings (VAC) to bolster skin grafts in male genital reconstruction. In this series reconstruction followed 1 case of tumor ablation and 3 cases of debridement of abscesses or Fornier's gangrene. The VAC was applied circumferentially to the penis to secure skin grafts either directly to the penile shaft or to facilitate skin grafting to the scrotum. Graft areas ranged from 75 to 250 cm. All cases resulted in successful genital wound coverage; minor complications are described. Three practical points are brought forth. First, the VAC facilitates skin grafting to the complex contour of male genitalia. Second, the VAC can be applied circumferentially to the penis without the need for perfusion monitoring or fears of avascular necrosis. Third, with the use of the VAC, bolster use can likely be discontinued as early as 72 hours with good graft adherence and survival.

Aortobifemoral graft infection with mycobacterium tuberculosis: Treatment with abscess drainage, debridement, and long-term administration of antibiotic agents

Aortic graft infection with Mycobacterium tuberculosis is rare. We report a patient with a Dacron aortobifemoral prosthetic graft infection secondary to tuberculosis. The infection was successfully treated with surgical drainage without removal of the graft, and long-term antimycobacterial medications. A review of the literature contains only 1 other report of tuberculosis graft infection and treatment. We discuss a rare form of aortic graft infection from M tuberculosis and its treatment.

Therapeutic pancreatic endoscopy.

In view of increasingly accurate noninvasive diagnostic imaging modalities for pancreatic diseases, endoscopic retrograde cholangiopancreatography (ERCP) should be mainly restricted to therapeutic indications. Acute pancreatitis is still the most common complication of ERCP. Prevention measures should focus in particular on well-defined risk groups. Temporary pancreatic duct drainage, preferably using small-diameter endoprostheses, can reduce the incidence of post-ERCP pancreatitis in at-risk individuals. By contrast, pharmacological prevention does not appear to be effective. ERCP in conjunction with sphincter of Oddi manometry frequently reveals the diagnosis of undetermined causes of acute recurrent pancreatitis. Endoscopic sphincterotomy (EST) is the treatment of choice in patients with sphincter of Oddi dysfunction or papillary stenosis. For these indications, dual pancreaticobiliary sphincterotomy promises a lower early morbidity and a better long-term outcome than biliary EST alone. In patients with pancreatic divisum, the cannulation rate of the dorsal duct can be improved by methylene blue staining and/or stimulation of the pancreatic secretion. Papillotomy of the minor papilla with short-term stenting appears to be an effective and safe approach for associated acute recurrent pancreatitis. Large-scale trials indicate that the majority of symptomatic patients with chronic pancreatitis can be well managed in the long term by endoscopic interventions. There is still a lack of prospective randomized controlled trials on endotherapy for chronic pancreatitis; however, they are also lacking for the surgical approach. Endoscopic and/or endosonographically guided drainage has become the treatment of choice for the majority of symptomatic pancreatic pseudocysts. Transmural debridement of pancreatic abscesses and infected necroses is still investigational, but appears to offer a minimally invasive alternative to surgery in selected cases. Pancreatic endotherapy is technically demanding and potentially hazardous; these interventions should be restricted to high-volume centers with options for an interdisciplinary team approach. Methods that have not yet been established should be evaluated in carefully designed prospective trials.

Advances in diagnosis and treatment of small exotic mammal dental disease

The nature of the dental diseases that occur in pet rabbits, rodents, and small carnivores like ferrets, are directly related to the different types of dentition present in these species. A good understanding of the morphology and physiology of the various types of teeth is essential to understand the disease processes. Incisor malocclusion is most common in rabbits. If this condition occurs as an isolated entity at an early age, it is probably of genetic origin. Incisor malocclusion in older animals is usually secondary to, or occurring concomitantly with, premolar-molar malocclusion. Patients with incisor malocclusion should therefore always receive a comprehensive oral examination. Incisor-premolar-molar malocclusion with periodontal and endodontic disease is a syndrome that may include incisor malocclusion, distortion of the premolar-molar occlusal plane, sharp points, periodontal disease, periapical changes, apical elongation, oral soft-tissue lesions, and maxillofacial abscess formation. It is unclear whether this syndrome is of genetic, dietary, or metabolic origin. The therapeutic options for incisor-premolar-molar malocclusion with periodontal and endodontic disease may include occlusal adjustment of involved teeth, extraction of teeth severely affected by endodontic and/or periodontal disease, and abscess debridement. A specific syndrome occurring in pet prairie dogs is odontoma-like mass formation originating from the root of 1 or both maxillary incisors. Affected animals are middle-aged and are typically presented for upper air-way obstruction. The dental pathology of pet ferrets is similar to the domestic dog and mainly includes periodontal disease due to plaque and calculus accumulation, and endodontic disease secondary to complicated crown fractures. Little is known about the oral pathology of African hedgehogs held in captivity, although they would appear to be very susceptible to oral squamous cell carcinoma formation.

Laparoscopic necrosectomy for acute necrotizing pancreatitis

Severe acute pancreatitis (SAP), a disease state that is often complicated by an intricate pathologic process, has remained difficult to manage and is associated with high morbidity and mortality rates. Approximately 80% of patients have a mild form of the disease, while the other 20% develop a severe life-threatening form of the disease. These patients are at great risk for infection, multisystem organ failure, and, possibly, death. Necrotizing or infected pancreatitis requires a multimodal approach and often offers an indication for surgical intervention. The retroperitoneum of the patient with necrotizing pancreatitis should be treated as an abscess cavity, and drainage and debridement of all necrotic tissue should be performed. Over the past several decades, great achievements have been made in the treatment of the patient that presents with acute pancreatitis. However, the morbidity and mortality have remained high, according to recent literature. The laparoscopic era brings new alternatives in the surgical management of pancreatic diseases. Advances in laparoscopic technology and instrumentation allow the utilization of minimally invasive techniques, and lessen the stress of surgery in the already compromised pancreatitic patient.

Thoracoscopic spine surgery: current indications and techniques.

The first report of thoracoscopic surgery was in 1910, after Jacobaeus used thoracoscopy to lyse tuberculous lung adhesions. However, it was not until the end of the century that Lewis (1991) recognized the value of thoracoscopic surgery, and Mack (1993) reported the application of video-assisted thoracic surgery (VATS) for spine surgery. VATS is still in its infancy and the application of this technology for spine surgery continues to rapidly expand. The current indications for thoracoscopic spine surgery include tissue biopsies, thoracic paravertebral abscess drainage and debridement, thoracic disc herniation excisions, anterior spinal release and/or fusion for spinal deformity, stabilization and fusion of thoracic and thoracolumbar fractures, corpectomy for vertebral tumors, and the placement of anterior spinal instrumentation with fusion. This article reviews these current indications for VATS--the technique and subsequent nursing implications.

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.

An uncommon spontaneous and nontropical pyomyositis

We describe a case of pyomyositis of the thigh caused by Staphylococcus epidermidis in an immunocompetent patient. The outcome was favorable after initiation of treatment combining surgical debridement of muscle abscesses and appropriate antibiotic therapy for a 4-week period. Our case report underlines that magnetic resonance imaging (MRI) may be a helpful method in the management of pyomyositis, in accurately revealing the detailed anatomic extent of the abscessed pyomyositis, and in guiding the surgical debridement of the damaged muscle. Finally, MRI should be performed if there is a strong suspicion of pyomyositis in patients whose ultrasonographic examination is not conclusive.

Craniocervical junction tuberculosis: a rare but dangerous disease

BACKGROUND Mycobacterium tuberculosis of the cervical spine is a rare but dangerous manifestation of extra-pulmonary tuberculosis. The clinical picture ranges from early, nonspecific, insidious symptoms to severe neurological complications and death, attributed to craniocervical junction instability and cervicomedullary compression. The different lines of management include antituberculous medication with traction and external fixation or adjunctive surgery (debridement and stabilization) in patients with severe or persistent neurological complications and/or vertebral instability. METHODS We describe two patients with advanced craniocervical junction tuberculosis. The early clinical picture was nonspecific in Case 1 and obscured by psychiatric illness in Case 2. The detailed clinical and radiological findings, and the management, will be described. Involvement of the occipital condyles and foramen magnum, which has not been reported previously, will be demonstrated. RESULTS Both cases underwent transoral biopsy, aspiration, and debridement of retropharyngeal abscess (granuloma). Histological and tissue culture studies proved the abscesses were tuberculous and anti-tuberculous medications were started. Case 1 showed complete resolution of the clinical and radiological findings. Case 2 developed cardiorespiratory arrest while in a halo jacket. He was resuscitated but remained quadriplegic and semiconscious; he developed nosocomial gram negative pneumonia. He was referred back to his local hospital where he died 1 year later. CONCLUSIONS Tuberculosis is an infrequent but notable cause of cervicomedullary compression. It should be suspected in patients with infective spondylitis who are immunocompromised or reside in an area highly endemic for tuberculosis. Management strategies include antituberculosis medication, transoral biopsy and drainage of the abscess, traction and external fixation, posterior decompression, and internal fixation, according to the clinical and radiological findings.

Surgical Debridement of Scleral Abscesses With Concomitant Resolution of the Complicating Exudative Retinal Detachment

The author reports a case of severe infectious scleritis complicated by scleral abscesses and exudative retinal detachment. A 68-year-old woman with a history of pterygium excision in the left eye 13 years previously presented with pseudomonal scleritis. Despite aggressive therapy for the scleritis, the patient had complications of multifocal scleral abscesses and exudative retinal detachment. Following surgical debridement of scleral abscesses on three separate occasions and vigorous irrigation of the exposed scleral bed with antibiotics, the pathogen was eventually eradicated with subretinal fluid absorbed and the retina reattached. The patient's visual acuity reached 20/40 and she remained symptom free for 1 year after cessation of all treatments. Exudative retinal detachment, although rare, may occur in patients with severe anterior infectious scleritis. Early surgical debridement should be considered as a therapeutic option in treating deep, occult foci of scleral abscesses when antibiotic treatment alone is ineffective.

Eikenella Corrodens: An Unexpected Pathogen Causing a Persistent Peritonsillar Abscess

Eikenella corrodens is a known pathogen in head and neck infections, especially in wounds related to oral cavity contamination. It is uniformly resistant to clindamycin. It is frequently an indolent infectious process, and patients often have persistent or recurrent symptoms despite several weeks of what many would feel would be appropriate antibiotic therapy. A high index of suspicion is necessary to make the correct diagnosis, and culture and sensitivity results are paramount to confirm the diagnosis. Appropriate antibiotic therapy with penicillin, ampicillin, select cephalosporins, to the augumented penicillins is the treatment of choice in most cases, with surgical drainage of abscess cavities and/or debridement of nonviable tissue reserved for appropriate cases and indications.