Pyogenic psoas abscesses: noninvasive diagnostic techniques and review of the literature

Psoas muscle abscesses are a diagnostic and therapeutic challenge. Until recently, surgery was mandated for diagnosis and drainage of these deep posterior lesions. Scanning techniques such as computerized tomography, radionuclide imaging, and ultrasonography now enable noninvasive visualization of abnormalities of the psoas muscle. Patients with abscesses in the greater psoas muscle fall into two distinct groups. Six of 12 patients reviewed had no apparent predisposing conditions. These patients presented with subacute symptoms of fever, pain, and disability. Staphylococcus aureus was the predominant organism isolated. Psoas infections developed in six other patients secondarily to infection or trauma elsewhere in the abdomen. Gram-negative and enteric organisms were the predominant bacteria isolated from this group. Surgical drainage in selected patients and appropriate antimicrobial therapy is necessary for treatment of these infections. Late complications such as osteomyelitis are not unusual.     

Splenic abscess: Report of 10 cases and review of the literature

Ten cases of splenic abscess seen between 1964 and 1974 are reviewed. Pain referable to the abscess was the most common symptom, but was present in only five cases. Fever was present in all but one case. Tenderness in the region of the spleen was noted in six cases, in three cases the spleen was palpable and in one case a large mass in the upper left quadrant of the abdomen was palpated. Abdominal films were suggestive of the diagnosis in two cases, and the liver-spleen scan demonstrated a defect in three cases. Seven abscesses were caused by gram-negative bacilli of bowel origin; the etiologic agents in the other three were Staphylococcus aureus, Streptobacillus moniliformis and a Nocardia species. Associated conditions predisposing to splenic abscess included trauma in three cases, splenic arteritis or embolization in five cases, and foci of infection elsewhere in the body in six, including two cases of endocarditis. The mortality was 60 per cent. Half of the deaths were due to the underlying illness, but failure to diagnose splenic abscess contributed to a fatal outcome in three cases.     

细菌性肝脓肿58例

目的:总结分析细菌性肝脓肿的临床特征及相关实验室检查结果,为该病的诊断和合理治疗提供依据.方法:总结我院2000-06/2011-12的58例确诊细菌性肝脓肿患者的临床资料,回顾性分析该病的临床特征、实验室检查、影像学、病原学及治疗特点.结果:58例细菌性肝脓肿患者最常见的临床表现为畏寒发热(94.8%)及右上腹痛(58.6%).糖尿病(46.5%)为最常见的合并症.血清碱性磷酸酶(77.6%)、白细胞(70.7%)和纤维蛋白原(60%)升高最常见.最常见的细菌为肺炎克雷伯菌(17.2%).脓肿多为单个(86.2%),肝右叶居多(81.1%).所有患者均选用联合抗生素治疗,其中26例患者(44.8%)行穿刺抽脓或置管引流,3例患者(5.2%)行手术治疗,1例患者(1.7%)死亡.结论:患者临床表现为畏寒发热、右上腹痛时应高度警惕细菌性肝脓肿可能,尤其是糖尿病、胆管疾病及恶性肿瘤患者.病原学仅在部分患者出现阳性结果,而血清碱性磷酸酶、白细胞和纤维蛋白原升高更常见,可能对临床诊断具有提示意义.抗感染结合穿刺抽脓或置管引流是临床安全有效的治疗手段.     

Pituitary abscess: Report of four cases and review of literature

Pituitary abscess is a rare disorder and its presenting manfestations are non-specific therefore, the diagnosis is usually made either postoperatively or at postmortem. We describe four such cases seen over a period of 10 years. All the patients presented with fever, systemic signs of toxaemia and endocrine dysfunctions. Two of them had pre-existing pituitary pathology. A preoperative diagnosis of pituitary abscess was considered in all in view of characteristic MR findings. Three patients underwent transsphenoidal drainage of abscess, whereas the remaining one succumbed to sepsis and was diagnosed at necropsy. Offending organisms including Pseudomonas, Acinetobacter and Staphylococcus were isolated in three cases respectively. During follow-up for 4 years, 2 patients are doing well, one had a recurrent abscess after 1 year and required redo-surgery.     

嗜酸细胞性食管炎临床资料回顾性分析

[目的]了解嗜酸细胞性食管炎(EoE)的临床表现、内镜表现、病理学特点和诊治经验。[方法]回顾性分析2006-01—2016-01期间武汉第一医院收治的6例EoE患者的临床资料。[结果]EoE以吞咽困难、烧心等症状为主要表现;胃镜下可见食管黏膜糜烂、溃疡、水肿、狭窄,部分可见食管环;食管黏膜组织学检查可见大量嗜酸性粒细胞和肥大细胞浸润,细胞水肿和固有层纤维化。5例经脱敏和使用糖皮质激素治疗后均明显好转,1例经内镜下食管球囊扩张术联合糖皮质激素治疗效果满意,均随访1年以上无复发。[结论]EoE临床表现和内镜下表现无特异性,病理组织学检查对诊断EoE有重要价值,糖皮质激素是一线治疗用药。     

Cronkhite-Canada syndrome: Report of six cases and review of literature

Cronkhite-Canada syndrome (CCS) is a rare nonfamilial polyposis syndrome characterized by epithelial disturbances in the gastrointestinal tract and skin. The aim of this study was to investigate the clinical features and potential therapies for CCS. Six patients with CCS admitted from December 1992 to July 2008 to Peking Union Medical College Hospital were evaluated. All patients had clinical manifestation of nonhereditary gastrointestinal polyposis with diarrhea, skin hyperpigmentation, alopecia, and nail dystrophy. Fecal occult blood was positive in all six cases. Serum hemoglobin, potassium, calcium and protein were below the normal range in two cases. Anti-Saccharomyces cerevisiae and antinuclear antibodies were present in three cases. Multiple polyps were found in all patients by gastroscopy and colonoscopy, with only one in the esophagus. Histologically, there were hyperplastic polyps in five cases, tubular adenoma in three, and juvenile polyp in one with chronic inflammation and mucosal edema. Comprehensive treatment led by corticosteroids can result in partial remission of clinical symptoms, and long-term follow-up is necessary.     

Update on spinal epidural abscess: 35 cases and review of the literature

Thirty-five cases of spinal epidural abscess were evaluated retrospectively and compared with 153 cases reported in the literature. As in other series, Staphylococcus aureus was the major pathogen. Patients with acute abscesses had fever, leukocytosis, and purulence at surgery. Patients with chronic abscesses had less fever and leukocytosis, more granulation tissue at surgery, and a greater delay in diagnosis but retained the potential for rapid neurologic deterioration. In contrast to other studies, abscesses in both the lumbar and anterior spinal compartments and patients with specific sources of infection occurred with greater frequency. Myelography was the diagnostic method of choice. Only four of nine patients had diagnostic computed tomography. Earlier diagnosis and treatment led to a significant improvement in outcome. Both steroid administration and greater neurologic impairment adversely affected outcome. Neurologic improvement following surgery was dependent on the duration of the deficit. A combination of antibiotics and surgical drainage remains the treatment of choice.     

Venlafaxine withdrawal syndrome: report of six cases and review of the literature

INTRODUCTION: Venlafaxine is an antidepressant that selectively inhibits serotonin reuptake and is a norepinephrine inhibitor. Withdrawal syndromes can occur after abrupt drug discontinuation of long-term regimens. EXEGESIS: We report six cases of withdrawal symptoms after venlafaxine discontinuation. CONCLUSION: Physicians must be aware of the frequency, rapidity and potent severity of these withdrawal syndromes.     

Methyldopa hepatitis: A report of six cases and review of the literature

Six cases of methyldopa hepatitis, including two in which the patients died are reported; and 77 cases from the literature are reviewed. Patients in whom severe hepatotoxic reactions to methyldopa develop usually complain of prodromal symptoms typical of hepatitis, often with fever, one to four weeks after therapy is initiated. Jaundice, when it occurs, is usually manifest within three months.

Asymptomatic, transient elevations of serum transaminase levels may occur in patients receiving methyldopa. However, since the clinical and histologic features of hepatic injury from methyldopa are indistinguishable from viral hepatitis, it is suggested that the incidence of this iatrogenic disease is higher than generally appreciated.

Serum transaminase levels should be determined at the initiation of therapy with methyldopa and four weeks later. Moreover, any patient who has unexplained fever or the prodromal symptoms of hepatitis should undergo liver chemistry studies immediately.     

Pyogenic arthritis caused by Streptococcus agalactiae: report of four cases and a review of the literature

Most infections by group B streptococcus of the Lancefield classification (Streptococcus agalactiae), were reported in pregnant women or during the puerperal period, as well as in neonates. During the past three decades there have been reports of increasingly invasive infections in adults unrelated to pregnancy, although arthritis and osteomyelitis are still very rare. In this article, we describe four new adult patients with arthritis by S. agalactiae (two postmenopausal women and two men), two of them with affection of the sternoclavicular joint. We also review the medical literature.     

三发性甲状旁腺功能亢进症六例分析并文献复习

回顾分析三发性甲状旁腺功能亢进症患者6例.其中骨骼疼痛3例,双下肢无力1例,双下肢酸胀1例,碱性磷酸酶升高1例.既往有肾衰竭史5例,另1例有严重肠道吸收障碍,其中行肾移植4例.X线显示骨膜下骨质吸收、骨质脱钙或伴纤维素性骨炎.骨密度示有骨质疏松5例,其中1例发生骨折.有2例出现骨外钙化,1例左房室膜钙化,1例臀部钙化.4例患者血钙升高,2例血钙正常,4例患者血磷下降,6例甲状旁腺素(PTH)均升高.术后甲状旁腺病理显示甲状旁腺腺瘤4例,增生2例.手术后6例患者血钙降低,补钙10～ 15 d后恢复正常,PTH均恢复正常.     

Evans syndrome: a study of six cases with review of literature

Abstract

Evans syndrome is an uncommon condition characterised by simultaneous or sequential development of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a positive direct antiglobulin test (DAT) in the absence of a known underlying aetiology. The great majority of patients with Evans syndrome have a chronic relapsing course despite treatment, which is associated with significant morbidity and mortality. We reviewed the clinical and laboratory features of six patients with Evans syndrome. All patients had thrombocytopenia, bleeding symptoms and haemolytic anaemia with positive direct Coombs test at presentation. We discuss the aetiopathogenic, clinical, therapeutic and natural history of Evans syndrome.     

Ophthalmologic manifestations of systemic vasculitis: report of six cases and review of the literature

PURPOSE: Study of characteristics of ocular involvement in systemic vasculitis. METHODS: We describe six cases of systemic vasculitis with ocular involvement observed between 1992 and 2000. These cases are compared with those reported in the literature. RESULTS: Our patients suffered from Wegener's granulomatosis (four cases), periarteritis nodosa and Churg-Strauss syndrome. Ocular manifestations were conjunctivitis, scleritis, orbital pseudotumor, optic neuritis and extraocular muscle palsy. These manifestations are similar to those reported in the literature. Their treatment requires steroids and immunosuppressive drugs. In one of our cases, intravenous immunoglobulins were effective in controlling an optic neuritis. CONCLUSION: Ocular involvement in systemic vasculitis may concern any orbital structure. It usually occurs during the course of vasculitis but may be one of its first manifestations. It requires an appropriate treatment to prevent ophthalmic complications and especially blindness.