Secondary Abscess Research Articles

Primary Closure of Below-Knee Amputation Stumps: A Prospective Study of Sixty-Two Cases

Between January 1, 1985, and December 31, 1988, we prospectively studied the outcome of 62 consecutive below-knee amputations with primary closure in 56 patients. There were 35 men and 21 women; mean age was 70 years. Above-knee amputation was performed for occlusion of the profunda femoris artery, acute thrombosis of a popliteal aneurysm with inadequate sural artery vascularity, intractable knee flexion contracture, suspended ischemia, and occasionally, when ischemia was found intraoperatively to extend proximally during below-knee amputation. Bedridden patients deemed unfit for prosthetic devices were also candidates for above-knee amputation. Fifty-four lower extremities (87%) were gangrenous and rest pain was present in eight patients (13%). Twenty-nine limbs (47%) were amputated primarily, 33 (53%) after failure of one or more revascularization procedures. Six patients had bilateral amputation. Forty patients (71%) were diabetic. Mean hospital stay was five days. Fifteen patients (27%) died during a mean follow-up period of 29 months. Eleven stumps (17.5%) required reoperation; five for postoperative infection, four for wound breakdown after a fall, and two for secondary abscess. Three secondary above-knee amputations (5%) were necessary. Of 44 below-knee amputations in diabetic patients, one had to be revised at the level of the thigh. Of 33 amputations after revascularization failure, one secondary above-knee amputation was necessary. Restoration of preischemic status was achieved after a mean of 58 days. Upon patient discharge from a rehabilitation center, 44 stumps (81%) were suitable to be fitted with prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Molluscum Contagiosum‐Induced Comedo and Secondary Abscess Formation

A 9-year-old boy had recurrent formation of fluctuating abscesses of the forearms, leading to surgical incisions. Histopathologic examinations revealed that the etiologic agent was a molluscum virus in the lower portion of a pilosebaceous follicle, which formed a comedo. The comedones developed into pustular and cystic lesions after the boy attempted to squeeze out the contents. Two different reaction patterns to molluscum contagiosum seem to be present: a lymphocyte-mediated immunologic reaction in normally regressing lesions, and an acute inflammatory reaction due to disruption of infected epidermal tissue into the dermis, as seen in this patient.

Die perkutane Drainagebehandlung primärer Leberabszesse

28 primary liver abscesses, including 9 amoebic abscesses, in 24 patients were drained percutaneously. Indication for drainage in amoebic abscesses was imminent rupture and clinical symptoms as pleural effusion, lung atelectasis and pain. 95% of the primary abscesses were cured by percutaneous drainage and systemic antibiotic treatment. There was one recurrence of abscess, which was managed surgically. Reasons for drainage failure were: tumour necrosis and tumour perforation with secondary liver abscess.

The laser apicoectomy: Endodontic application of the CO 2 laser for periapical surgery

This article describes the development of a surgical technique employing a carbon dioxide laser for endodontic periapical procedures. The advantages of laser application for sterilization and removal of the infected root apex, as well as enhanced hemostasis, are cited. A case in which the "laser apicoectomy" technique was performed successfully for treatment of secondary apical abscess is presented.

Mycobacterium Fortuitum as a Cause for Nasolacrimal Obstruction and Granulomatous Eyelid Disease

A case of dacryocystitis due to Mycobacterium fortuitum is reported with secondary chronic granulomatous abscess of the eyelid. Mycobacterium fortuitum is an atypical Mycobacterium rarely encountered in ophthalmic practice. The clinical course of the abscess caused by Mycobacterium is reviewed and the successful management of this problem by cryotherapy discussed.

Pyogenic psoas abscess: worldwide variations in etiology.

AbstractPyogenic abscess of the psoas muscle results from primary suppuration or direct extension of intraabdominal infection. The etiology varies with the country of origin. Our experience with 9 cases prompted a review of 367 cases from the world literature. A total of 286 primary abscesses occurred mainly in developing nations (200 cases), although 74 were reported from the United States. Younger patients predominated in developing nations (81.4% <20 years old), while only 47.8% from the United States were younger than 20 years. PureStaphylococcus aureus was commonly cultured (88.4%); simple incision and drainage cured 97.3% of patients with primary psoas abscess. Of 7 (2.5%) patients who died, 6 were from the United States; therapy was inadequate or delayed in all 7 patients. Ninety secondary abscesses appeared almost exclusively in reports from Europe, the United States, and Canada. Crohn's disease was the most common etiology followed by appendicitis and colon inflammation or cancer; mixed enteric infections predominated (55.7%). Although rare during the first decade, distribution was otherwise relatively even across all age groups. Simple drainage succeeded in only 49% of cases. Higher mortality accompanied secondary abscess (17 cases, 18.9%). The etiology of pyogenic psoas abscess guides the selection of proper medical and surgical therapy. While primary abscess is the likely etiology in developing nations and secondary abscess in Europe, either may occur in the United States. Early diagnosis and proper therapy are necessary to reduce mortality.

Repositioning catheters in surgically drained abscesses

Primary percutaneous drainage of intraabdominal abscesses under local anesthesia is an accepted method of treatment, with low morbidity and mortality. This technique was extended to patients with recurrent or secondary abscesses after initial primary surgical drainage. Four patients had abscesses drained operatively but were reevaluated several weeks later for recurrent fever. Sinography demonstrated an inadequately drained abscess cavity. Under fluoroscopic control and using local anesthesia, new drains were inserted and repositioned to provide better drainage. Resolution of the abscess cavity was documented radiographically, with improvement in the patients' clinical status.

Percutaneous drainage of pyogenic liver abscesses.

This report summarizes the results of percutaneous catheter drainage in 23 cases of primary or secondary pyogenic liver abscess. The overall success rate was 76%. Only three (60%) of five cases of secondary abscess (infected hematoma or infected tumor) were cured with catheter drainage, but 11 (91%) of the last 12 primary pyogenic abscesses were drained successfully. Six patients with abscesses of less than 4 cm in diameter required catheter drainage for less than 72 hr. Although six abscesses in the series appeared septated or multiloculated, only one required more than a single catheter for curative drainage. Diagnostic and technical considerations for successful drainage of hepatic abscesses are discussed. The differential diagnosis includes echinococcal disease and hepatic amebiasis. Therapeutically, specific measures should be taken to ensure proper catheter position to prevent contamination of the subphrenic, perihepatic, and pleural spaces. Percutaneous catheter drainage should be attempted as a first choice of treatment in all pyogenic hepatic abscesses.

Spontaneous rupture of a hydronephrotic kidney during pregnancy

Acute abdominal pain during pregnancy can be of urologic origin. Hydronephrosis of pregnancy can be complicated by symptomatic renal colic, pyelonephritis, and secondary renal abscess formation. In this report, rupture of a hydronephrotic kidney with retroperitoneal urinoma formation was treated by retroperitoneal drainage and internal ureteral until a term delivery was achieved. However, if severe renal hemorrhage accompanies renal rupture, surgical exploration of the kidney with partial or complete nephrectomy may be necessary.

BCG vaccination as a cause of osteomyelitis and subcutaneous abscess.

Ten patients with osteomyelitis and three with a subcutaneous abscess, all caused by BCG vaccination, are described. All patients were less than 3 years old and had as newborns been vaccinated intracutaneously in the left gluteal or hip area. Pain, limping, or a slightly tender subcutaneous induration were the primary symptoms. The sites of predilection of osteomyelitis were the metaphysis or epiphysis of the femur, these being affected in five out of 10 cases. All three subcutaneous abscesses were in the thoracic region. Prolonged (up to 30 months) combined tuberculostatic medication, in addition to appropriate surgical procedures, resulted in healing, but two cases of arthritis and two of secondary abscesses developed. In addition, sequestrectomy and two late operations, for coxa valga and hip subluxation, were deemed to be necessary. Radiographs showed femoral overgrowth of up to 1 cm in two symptomless patients three to seven years after the first discharge. We conclude that the benefits of BCG vaccination should be weighed against the risk of complications, especially in countries with a low incidence of tuberculosis.

Pneumonia and Lung Abscess

The epidemiologic, microbiologic, radiographic, and clinical presentations of pneumonias caused by the most common pathogens are discussed in detail, and current recommendations for hospitalization are reviewed. Also considered are the clinical characteristics, diagnosis, and treatment of primary and secondary lung abscess.

Pathogenicity of a recently isolated strain of Tritrichomonas foetus in mice

Abstract The pathogenicity of a recently isolated strain of T. foetus in mice was studied. The parasite produced local abscesses 3 days post subcutaneous inoculation (p.i.) in albino mice. The abscesses in mice, inoculated with large numbers (4 × 10 6 ) of organisms, continued increasing in size until the 14th day. Some absceses ruptured between day 11 to 14 p.i., while others formed a point. Secondary abscesses were also found in some mice. the abscesses in mice, inoculated with small numbers (1 × 10 6 ) of organisms reached their maximum on the 5th day and decreased thereafter. All the abscesses had motile trichomonads with no bacterial contamination. The trichomonads, inoculated intraperitoneally in mice, persisted in that cavity till day 5 or 6 p.i., but did not multiply. Subcutaneous inoculations appear to be more reliable than the intraperitoneal ones for studies on pathogenicity. The comparison of present observations with those using a similar model and T. foetus or other trichomonads, suggests that the strain of T. foetus employed was of low pathogenicity.

Pancreatic abscess after alcoholic pancreatitis.

Primary pancreatic abscess should be suspected in patients with acute or subsiding pancreatitis who have a tender abdominal mass with evidence of local and systemic sepsis. These individuals have a prolonged course of illness compared with patients with uncomplicated pancreatitis. Another group of patients without overt signs of sepsis may have abdominal masses thought to be pseudocysts, with unexplained temperature elevation and leukocytosis. This latter group may also have pancreatic suppuration, termed secondary because of its natural history. The distinction between primary and secondary abscesses is difficult unless time of onset of the preceding pancreatitis is known. Both groups of patients require early, thorough operation. Signs of sepsis or progressive deterioration in patients with acute pancreatitis must be recognized early since untreated abscess is usually fatal. Extensive debridement and external drainage of all abscess cavities present, preferably via posterolateral flank drain sites, are essential to successful surgical treatment of pancreatic abscess.

A Histopathologic Study Of The Lungs Infected With Paragonimus Westermani In The Dog

Pulmonary paragonimiasis is one of the most important endemic parasitic disease in Korea. Although it is well known that Paragonimus westermani invades into the lung tissue eventually resulting respiratory failure, the pathogenesis of inducing lung lesions is not fully elucidated. It is still debatable on the nature of morphological component of 'cyst' which is known to be the most consistent change in lung paragonimiasis. For the purpose of clarification of morphological changes associated with pulmonary paragonimiasis, an experimental study was carried out by giving metacercariae of P. westermani to 10 dogs. These dogs were sacrificed 2 months and 6 months after infection respectively, and light microscopic and electron microscopic observations were made. Following conclusions were obtained. 1. Paragonimus lung lesions could basically be classified into two categories, i.e., direct mechanical effects by the worms and eggs, and the changes secondary to the worm infection. The relative importance of these two appeared almost same. 2. Adult worms of P. westermani reside inside the lumina of the dilated bronchi in great majority of the cases. Only exceptions were secondary abscess formation and subsequent scar where no epithelial lining was detected around the worms. In 6 months group almost all P. westermani worms were found inside the bronchial lumina. 3. Obliterative endobronchiolitis was another prominent feature among changes that were not directly associated with worms or eggs. This finding was more prominent in the distal segments of the bronchial trees that harbor the Paragonimus worms. 4. P. westermani eggs were found as isolated and aggregated fashions, provoking characteristic granulomatous inflammation. Some of the egg granulomas were seen in the areas apart from the locations where the worms were physically located. 5. Ultrastructural observations of the cyst wall showed fair numbers of plasma cells and mast cells. Some of the cystlining epithelial cells showed increased deposit of glycogen granules, suggestive of early metabolic alteration of the respiratory epithelium.

Computed tomography of the gallbladder

Computed tomography (CT) was used to study 79 patients with suspected gallbladder disease. First and second generation scanners were used to determine the efficacy of CT in detecting cholecystitis or cholelithiasis. Manifestations of gallbladder disease such as hydrops, opaque and nonopaque gallstones, chronic cholecystitis with thickened inflammatory walls, and secondary liver abscesses can be easily detected. It is a useful technique for individuals in whom the gallbladder has failed to opacity on oral cholecystography. The scanning method is described, and estimates of reliability are given including its accuracy, limitations, and place in the management of gallbladder disease, especially cholelithiasis. When conventional radiographic examinations or ultrasound fail to give definitive diagnostic information, CT can be a useful alternative with an overall diagnostic accuracy greater than 80%.

Congenital vas deferens-ureteral connection

Congenital drainage of the vas deferens into a ureter permits retrograde passage of urine through the vas to the epididymis. If this anomaly is accompanied by urinary tract pathology with vesicoureteral reflux, hydroureter, stasis, and infection, the passage of urine into the vas can very well lead to epididymitis of a chronic or recurring nature and secondary scrotal abscesses. Two cases of this rare anomalous connection are presented in which such scrotal infections occurred. The diagnosis should be suspected on clinical grounds and can be confirmed by cystograms in which the dye refluxes up the ureter and passes into the vas. The association of rectal anomalies is of embryologic significance and may be additionally important clinically by further suggesting the possibility of the ureteral-vas anomaly.

Action of Corynebacterium ovis exotoxin on endothelial cells of blood vessels

Corynebacterium ovis (C. pseudotuberculosis) causes suppurative infections of sheep, goats and horses and occasional infections in other species2. Like C. diphtheriae, it produces a powerful exotoxin in vitro. But unlike the situation with C. diphtheriae, there is no evidence of acute or chronic intoxication, while the lesions are characteristically pyogenic with suppuration and abscess formation at the initial site of infection (usually a skin wound). This is followed frequently by secondary abscess formation in regional lymph nodes and sometimes internal organs. Toxin is produced in vivo as well as in vitro because circulating antitoxin is found in infected animals. The major role of C. ovis toxin in natural infection seems to be facilitation of the spread of the causative bacteria by its action as a permeability factor. It thus causes marked leakage of plasma from small blood vessels at the site of infection which floods lymphatic spaces and increases the risk of bacteria being carried by lymphatic drainage from the site of infection to regional lymph nodes3,4. We now report experimental evidence that C. ovis toxin is a phospholipase D which attacks the sphingomyelin of endothelial cells of blood vessels.

Vertebral Osteomyelitis

Vertebral osteomyelitis is still a diagnostic problem. Nonspecific symptoms (low-grade fever, malaise, and weight loss) may dominate. Specific infections may be suggested by the history, and the diagnosis may be reinforced by a transient response to antibiotics. The patient may have symptoms resulting from a secondary paravertebral abscess. Even with fever, back pain, and point tenderness over the vertebral column, the correct diagnosis may not be considered. Predisposing conditions include drug addiction, instrumentation of the infected urinary tract, bacteremia from other causes, or previous back surgery. Diagnosis is made by roentgenographic studies and isolation of the causative organism from blood cultures or from the infected area. Staphylococcus aureus is the most common pathogen, although other microorganisms may be responsible. Intensive intravenous antibiotic treatment appears to be curative, without surgical debridement, external stabilization, or porlonged oral administration of antibiotics.

Blood clearance rate as an adjunct to the 198 Au hepatoscan.

Abstract In an endeavour to improve the diagnostic specificity of the hepatoscan, blood clearance rates using a subcritical dose of colloidal 198Au have been used to help the scan interpretation in various liver diseases. The liver diseases, divided into those with (1) diffuse abnormalities and (2) cold areas, according to the scan appearances, are correlated with the clearance rate, which has been classified as either delayed, unaltered or accelerated following all-contrast statistical judgment. The blood clearance rates differed significantly in diseases of the same scan appearance providing a quantitative aid to scan interpretation. Thus, the clearance rate was delayed in cirrhosis, chronic hepatitis (1) and primary hepatoma (2), whereas it remained unaltered in cirrhosis complicated by secondary hypersplenism, fatty liver, acute hepatitis, biliary cirrhosis (1) and pyogenic abscess (2). In contradistinction, the clearance rate was accelerated in typhoid liver especially in the early phase (1), amoebic...

Current status of brain scanning

Radionuclide scanning of the brain has grown from an experimental laboratory procedure to a widely used screening procedure in the study of neurological disorders. Considerable information may be elicited in such conditions as primary and secondary neoplasms, cerebrovascular disease, arteriovenous malformations, abscess, subdural hematoma and calvarial lesions, especially when the scanning studies are correlated with other radiographic procedures. The addition of dynamic studies of the blood flow of the brain has added a new aspect to the usual static imaging procedure. Despite the drawbacks of present-day radionuclides and instrumentation, the overall accuracy of scanning approaches that of cerebral angiography, falling between 80 and 90 per cent. Unfortunately, a significant number of lesions are difficult to detect or missed entirely. It is hoped that this accuracy will increase as a result of the development of biologically more suitable radiopharmaceuticals, instruments with greater resolution and an increasing knowledge of the basic mechanisms by which radionuclides accumulate within lesions of the central nervous system.