Puncture Of Abscess Research Articles

Impaired consciousness revealing a cerebral amebiasis in an immunocompetent adult

Amebiasis is a parasitic infection with manifestations, mainly digestives. It is rarely described extra-gastrointestinal locations including the brain. We report the case of a patient aged 42, made five months earlier for an appendectomy, and was admitted to the ICU after a convalescent stable uncomplicated. At admission, he was 12/15 in Glasgow and had a right hemiplegia. Brain CT revealed a discrete diffuse hypodensities perilesional edema. An abdominal ultrasound found an aspect for multiple hepatic abscesses. Abscess puncture was performed, which was not conclusive, and no seed could be identified. On Ultrasound, no cardiac abnormalities were found, and no endocarditis was present. And since the appearance macroscopic (chocolate-brown), amebic serology is performed and has been highly positive. The therapeutic management included an intubation and ventilation as well as a tri-antibiotic-based ceftriaxon, metronidazol and gentamycin. Confirmation of amebiasis required high doses of metronidazol for an extended period. The replay of the play was an appendectomy for an amebome. Evolution was favorable. Amebiasis can have extraintestinal locations, issues to think about including the cerebral forms.

Kontrastmittelsonografische Drainagenkontrolle: eine Feasibility-Studie

Liver abscesses still represent a life-threatening disease. Interventional abscess puncture and/or drainage are often the most adequate treatment. The aim of our study was the evaluation of drainage control with contrast-enhanced sonography. We included 15 patients in our feasibility study, three of whom had infected liver cysts, three had abscesses after liver resection or transplantation, six had intrahepatic abscesses and three had abscesses of other localisations. For drainage control with contrast-enhanced sonography we administered 1 mL of the contrast agent SonoVue® (Bracco, Germany) diluted in 10 mL of 0.9 % of NaCl through the indwelling drainage or an 18-G Chiba needle. A total of 28 sonographic controlled examinations was performed. The position of the drainage, as well as the size of the abscess itself could be demonstrated in all cases. Furthermore, possible septs or the communication of different abscess regions could be seen. Drainage remained in position for an average of 13.3 days. Assessment of drainage position and size of the abscess region is of clinical relevance. The main advantages of the described examination with contrast-enhanced sonography are the lack of radiation and the low costs due to the small amount of contrast medium used.

Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

Acute mastoiditis in children: A retrospective study of 188 patients

Objective The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment. Methods In this retrospective study, 188 children between 3 months and 15 years of age (15 ± 24 months; median ± SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001–January 2008). Results Fifty seven percent were male and 43% were female. Clinical follow-up duration was 3.9 ± 0.7 months (mean ± SEM). The incidence of AM remained stable during the whole study period. Microbiological samples ( n = 236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%), Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed to isolate the involved germ(s). All the patients were hospitalized and received intravenous antibiotics, and 36.2% ( n = 68) underwent surgery. Several surgical procedures were necessary in 4 cases (2.1%). AM recurrences requiring a second hospitalization were observed in 8 patients (4.3%). The only observed complication was lateral sinus thrombosis ( n = 6; 3.2%). Surgical failures, requiring more than one surgical procedure, were more frequent in case of: (i) presence of Anaerobes ( p ≤ 0.001) or Gram-negative bacteria ( p ≤ 0.05) in microbiological samples; (ii) surgical drainage without mastoidectomy ( p ≤ 0.001). Recurrences were more frequent in AM due to Streptococcus pneumoniae. Conclusions Based on our findings and on literature data, a protocol was established in order to standardize the management of pediatric AM in our center. The mains points are: no systematic surgery; if surgery is indicated, it must encompass a mastoidectomy; broad-spectrum intravenous antibiotic treatment covering the most commonly involved germs (3rd generation cephalosporin) and secondarily adapted to the results of microbiological samples. If the infection is not controlled after 48 h of intravenous antibiotherapy, a mastoidectomy had to be performed.

Clinical analysis of puncture treatment of appendicitis abscess by B-ultrasound-guided

Objective To discuss the clinical effects of the B-ultrasonic guided percutaneous abdominal abscess puncture treatment of appendicitis. Methods To be selected 26 patients with the clinical symptoms typical of appendix abscess from January 2004 to January 2010, used B- ultrasonicposition, and guide the use of fine needle peritoneal puncture, pus out, and then injected into the appropriate antibiotics liquid in the abscess cavity in every 3 - 5d for each time. Results To be treated afterl to 3 times, the clinical symptoms, all patients with appendiceal abscess were recovered after a month after Btype ultrasonic imaging review, abscess disappears.Conclusion B-type ultrasound-guided percutaneous treatment of appendiceal abscess is quick, easy, safe and less invasive and less complication, should be in level hospitals. Key words: Appendiceal abscess; B-mode ultrasonography; puncture

Tuberculous retropharyngeal abscess with posterior mediastinal extension and quadriplegia in a 13-year-old Nigerian girl

Neglected cervical tuberculosis (TB) in a 13-year-old girl with extensive prevertebral abscess extending from C1-T4 is presented along with the plain radiographic and computed tomographic findings. The tuberculous infection progresses to cause multiple vertebral destructions and quadriplegia due to delayed diagnosis. The diagnosis was made on radiological imaging and confirmed by positive mycobacterium bacilli culture. This case illustrated that delayed diagnosis and treatment of cervical spinal TB can be catastrophic. Hence, we suggest consideration of TB of the spine in the differential diagnosis of any patient presenting with neck/back pain since it can be successfully treated, especially if detected early. We advocated the use of easy operating and low-cost examinations such as tuberculin skin test, abscess puncture (not cut) and pus cultivation especially in developing countries for early diagnosis TB infection.

Frontal Sinus Osteoma Complicated by Extended Intracranial Mucocele and Cerebral Abscess: Neurosurgical Strategy of a Rare Clinical Entity

The combination of paranasal sinus osteoma, mucocele and brain abscess is rare. Only one other case has been reported so far, where the cerebral abscess was diagnosed intraoperatively. We report here on a second patient with combined frontal sinus osteoma, intracerebral mucocele as well as cerebral abscess. However, in our case, the diagnosis of cerebral abscess was reached prior to surgery, which allowed for a tailored treatment strategy with abscess puncture under neuronavigational guidance and, after 3 weeks of antibiotic therapy with documented abscess shrinkage, osteoma and mucocele resection as well as reconstruction of the eroded dura.

Liver abscesses--complications after prosthesis and stent occlusions

Patients with malignant, unresectable biliary strictures and endoprosthesis or stents for drainage often develop liver abscess. The aim of the investigation was to assess the relationship and the factors causing the development of these abscesses. 9 patients with a median age of 65.6 years, liver abscess and endoprosthesis or stents were studied retrospectively. The occlusions were made visible sonographically and by ERC or PTC. With sonography the abscess was diagnosed and punctured. 5 patients (56%) had a bile duct carcinoma, two patients had a distal tumor stenosis, one a tumor of the gallbladder and one an obstructive jaundice due to liver metastases. 8 patients required a percutaneous drainage (PTCD). 6 cases of occlusions were found. 1 patient had a biliary obstruction because of a broken endoprosthesis. On an average it took 11.6 months from the first endoprosthesis or stent placement to the formation of an abscess. Plastic endoprostheses tend to occlude more rapidly (5 months versus 17.6 with stents). After the sonographically guided puncture of the liver abscess, i.v. antibiotics were given for 5 to 14 days. The antibiotics were continued orally. Two cases required a sonographically placed percutaneous drainage. 78% of the abscesses could be cured. One patient died because of sepsis. Liver abscesses were connected with intrahepatic carcinomas (56%). In such cases drainage is difficult and requires many interventions. Furthermore, we find this especially after percutaneous transhepatic drainage and with plastic endoprostheses.

Perkutane, sonographisch gesteuerte Feinnadelpunktion und Drainage pyogener Abszesse

Between January 1988 and April 1991, a total of 79 ultrasound-directed percutaneous punctures and (or) drainage of abscesses were performed on 31 patients (15 men, 16 women; mean age 63 [31-85] years). There were 14 hepatic, 4 splenic, 4 abdominal wall and 3 pancreatic abscesses, and one each subphrenic, presacral, retrocaecal, ischiorectal, pulmonary and in the psoas. After ultrasound localization of the abscess a fine-needle puncture was performed, after which the abscess cavity was emptied as much as possible or, in abscesses larger than 5 cm in diameter, drained through a pig-tail catheter (6-8, 4 F). Several punctures were needed in 16 patients, while in 15 a percutaneous drainage over 2-8 days was necessary. Treatment was successful after 4-17 days in 25 patients. One patient died in septic shock. Operative intervention after diagnostic puncture was undertaken in 5 patients. There were no complications related to the method. In 11 patients the further course was determined by an underlying malignant disease. No recurrence has been noted (4-36 months after treatment) in 14 patients with a benign underlying disease. Percutaneous puncture and drainage of pyogenic abscesses is a technically simple method which achieves good results.

Ultraschallgeführte Feinnadelbiopsie herdförmiger Lebererkrankungen - Teil II: Benigne herdförmige Lebererkrankungen

Sixty patients with benign focal liver disease underwent sonography-guided percutaneous fine needle biopsy for definitive diagnosis. The benignancy of all lesions was determined accurately by cytohistologic evaluation. All 44 liquid space-occupying lesions (30 hepatic cysts, 9 abscesses, 3 hematomas, 2 serous residual cavities after surgery) could be classified by cytological, biochemical and bacterial examination. The diagnosis of hepatic hemangiomas by fine needle puncture is problematic, because the cytological identification of benign endothelial cells is difficult. The histological examination of tissue cylinders of 4 small echogenic lesions revealed focal fatty change of the liver. Tissue fragments of focal nodular hyperplasias and liver cell adenomas showed histologically typical liver cells arranged in trabecular structure. The additional identification of bile ducts supplies proof of focal nodular hyperplasia and excludes liver cell adenoma. Percutaneous puncture of liver abscesses and cysts afforded effective therapeutic decompression. Eight out of 9 liver abscesses were cured by evacuating fine needle puncture. More than 50% of the liver cysts showed long-term growth shrinkage subsequent to puncture. The histological confirmation of benign and malignant liver tumors by sonographyguided fine needle biopsy is considered a decisive step forward in the diagnostic possibilities of update imaging methods.

Grosse jambe rouge aiguë fébrile révélant une fistule aorto-duodénale

Aortoduodenal fistulas are rare and severe complications of aortic prostheses. The clinical picture usually includes digestive features and fever, unlike our observation where fistula was revealed by heavy and swollen leg with cutaneous septic abscesses but no digestive signs. A 59 year-old man who had undergone aortoiliac prosthetic repair of an aortic aneurysm 6 years earlier was hospitalized in a dermatology department for fever beginning three months previously associated with a heavy and swollen leg. Clinical and ultrasound examination revealed vascularised cutaneous nodules on the leg. Abdominal CAT showed left iliac venous compression caused by periprosthetic inflammation and particularly retroperitoneal fluid accumulation, gas bubbles in which suggested aortoduodenal fistula, which was confirmed during surgery. Aspirative puncture of abscesses was positive for E. Coli and Candida Glabatra. Aortoduodenal fistula is a rare complication of vascular prostheses. Clinical features include digestive symptoms and fever. However, diagnosis may be difficult and delay surgery. Cutaneous manifestations appear later and are often associated with other symptoms; they are caused by septic emboli or vascular compression. Imaging methods may assist diagnosis, but surgical procedures provide confirmation and form the cornerstone of management.

Ethmoïdites aiguës extériorisées de l'enfant : à propos d'une série de 125 cas

Acute ethmoiditis are bacterial infections of ethmoid sinuses, which may spread to the orbital or the endocranial spaces. It is essential to fit the antibiotherapy to the bacteria responsible for these infections. Population and methods. – The charts of children hospitalized from 1995 to 2003 for an acute ethmoiditis were reviewed, particularly the results of bacterial exams and the antibiotics delivered. Results. – Over this 9-year period, 125 children (mean age 4.5 years) were hospitalized for acute ethmoiditis. Eighty were checked for blood cultures, which were sterile in 73 cases, and in the other cases, grew Staphylococcus, S. Pneumoniae or Streptococcus pyogenes. Seric soluble antigens were absent in the 5 cases where they were looked for. Ten children had a puncture of a subperiostal abscess: it was sterile in 5 cases, Staphylococcus was found in 4 cases, S. pneumoniae in the last case. Most children received an association of cefotaxim and fosfomycine for a mean duration of 5.6 days. Thirteen per cent of the children received 3 or 4 antibiotics. Discussion. – It is always difficult to found the bacteria responsible for an acute ethmoiditis. In our serie as in others, the most frequent bacteria were Staphylococcus, S. pneumoniae and S. pyogenes. Conclusion. – In view of the bacteria responsible for these infections and their antibiotic resistance, we suggest the association of cefotaxim and fosfomycin for the first line of treatment of acute ethmoiditis.

First Identification of Clostridium celerecrescens in Liquid Drained from an Abscess

We present the first report on the characterization of Clostridium celerecrescens isolated from liquid drained via abscess puncture from a 45-year-old man. The organism was identified by sequence comparison of 16S rRNA genes.

Primäre Pyomyositis der Obturatormuskulatur

The main objective of our work was to draw attention to the possible occurrence of a serious and life-threatening illness, primary pyomyositis of the obturator muscles in countries with a mild climate, and to establish basic diagnostic criteria for the illness, including differential diagnostics, and to propose a treatment method. The authors describe two cases (a boy of 11 and a woman aged 47 years) with the occurrence of primary pyomyositis of the obturator muscles in the Czech Republic and they focus on the most important clinical symptoms and imaging methods necessary for the establishment of the diagnosis. Repeated clinical examinations are important for the establishment of the diagnosis, particularly the presence of the symptom triad (pain in the hip joint, limping, febrile state), positive inflammatory markers and, first and foremost, the demonstration of pyomyositis on CT or MR. Differential diagnosis must also consider inflammatory diseases of the locomotor system (coxitis, sacroiliitis, osteomyelitis), of the digestive tract (Crohn's disease, a tumour, an obturator hernia) and of the urogenital system (gonorrhoea). The therapy of pyomyositis must be initiated in time by bed rest and administration of antibiotics and, if an abscess develops, surgical intervention is unconditionally necessary, consisting either in percutaneous abscess puncture or incision, perfusion, and application of antibiotics. The failure to diagnose an abscess of the obturator muscles and late therapy can result in serious complications, septic shock and death.

Complications in large-bore catheters for extracorporeal detoxification methods.

Catheters for large vessels have become essential tools for the management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as infection, sepsis, and thrombosis. In two retrospective studies, the first (1979-1990) with 1672 patients and 2626 large-bore catheters and the second (1996-2001) with 182 patients and 332 acute catheters, the frequency of infections, thrombosis, bleeding, and other side-effects were investigated. All complications and side-effects are presented. In total, the complication rate was in the first study 27.7% (internal jugular vein 23.8% in 2105 catheters, subclavian vein 43.5% in 521 catheters) and in the second study 32.2% (internal jugular vein 20% in 231 catheters, subclavian vein 60.6% in 94 catheters, femoral vein 57.1% in 7 catheters). The majority of complications were puncture not possible, puncture of the artery abscess, septicemia, bleeding, thrombosis, and faults in catheter material. To minimize these complication rates the handling of the inserted catheters before, during, and after the hemodialysis or apheresis treatment is minimized.

Three-dimensional ultrasound guidance for percutaneous drainage of prostatic abscesses

Objectives To evaluate the feasibility and effectiveness of three-dimensional ultrasound-guided transperineal puncture and drainage of prostatic abscesses. Methods Between 1985 and 2003, a prostatic abscess was diagnosed in 22 patients. One of the therapeutic modalities used to drain the abscesses was transperineal puncture under three-dimensional ultrasound guidance. The postoperative results were compared with the outcomes of other modalities. Results The average patient age was 52 years. Predisposing factors were present in 12 patients. Transperineal puncture was performed in 7 patients under general anesthesia. In addition to antibiotic therapy, a nephrostomy tube was left in place in all cases for a mean period of 3 days to drain the abscess. All patients were treated effectively without additional therapy or complications. Conclusions Three-dimensional ultrasound-guided transperineal puncture is a minimally invasive and effective technique for the treatment of prostatic abscesses.

Editorial Comment

Objectives. To evaluate the feasibility and effectiveness of three-dimensional ultrasound-guided transperineal puncture and drainage of prostatic abscesses. Methods. Between 1985 and 2003, a prostatic abscess was diagnosed in 22 patients. One of the therapeutic modalities used to drain the abscesses was transperineal puncture under three-dimensional ultrasound guidance. The postoperative results were compared with the outcomes of other modalities. Results. The average patient age was 52 years. Predisposing factors were present in 12 patients. Transperineal puncture was performed in 7 patients under general anesthesia. In addition to antibiotic therapy, a nephrostomy tube was left in place in all cases for a mean period of 3 days to drain the abscess. All patients were treated effectively without additional therapy or complications. Conclusions. Three-dimensional ultrasound-guided transperineal puncture is a minimally invasive and effective technique for the treatment of prostatic abscesses.

Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.

A new procedure for frameless computer navigated stereotaxy.

Stereotactic procedures using frame-based systems have become well established in neurosurgery. Later, stereotactic computers have provided the neurosurgeon with a broader range of applications. A new, frameless stereotactic guide which utilizes the navigational abilities of a computer has been developed. This clinical study evaluates the accuracy and safety of the system when applied for puncture of tumours and abscesses in the cerebrum. Using a frameless setup 36 patients were operated on for a total of 39 intracranial processes over a period of two years. Three patients were operated on twice. Computer data, time of surgery, anesthesia, complications, tumour localization and tissue examinations were recorded. Biopsies were obtained from all lobes of the cerebrum and a diagnosis established in all cases except two. Mean age and total range was 52 years and 15-82 years, respectively. Median time of surgery was approximately 60 minutes including positioning of the patient and the registration process on the stereotactic computer. Local anesthesia was used for 25 operations and general anesthesia for 14 operations. There was one postoperative abscess formation in a previously immunosuppressed patient and a per-operative epileptic seizure caused by electrocoagulation of the dura in a second patient. Based on this clinical study a new procedure for obtaining stereotactic biopsies of intracranial processes is introduced. All tumours were successfully reached with two cases of complications.

Seudotumor pancreático de etiología tuberculosa

To review the clinical findings of pancreatic tuberculosis and to establish a differential diagnosis with pancreatic tumours. To describe three cases of pancreatic tuberculosis diagnosed in a 850 bed teaching hospital during the last two years. In the three case the imaging procedures showed a pancreatic mass with hypodense area. One of the cases was erroneously initially diagnosed of a pancreatic tumour. In one case was diagnosed by a subcutaneous abscess puncture, in another by clinical suspicion and in third patient by laparotomy. Only one patient was immunosuppressed. All patients were cured with standard antituberculous therapy. Pancreatic tuberculosis should be considered in patients presenting with pancreatic tumours.