微创穿刺引流术治疗脑脓肿15例临床分析

目的分析微创穿刺引流术治疗脑脓肿(ICA)的临床效果,探讨其手术适应证和手术时机。方法回顾性分析微创穿刺引流术治疗脑脓肿15例的临床资料。结果13例痊愈,症状、体征消失,术后1个月CT增强扫描病灶区可见部分脓肿壁,3个月CT增强扫描病灶影完全消失。2例好转,术后2个月CT增强扫描病灶区可见环状强化影。全部病人随访6个月~6年,均未见复发。结论微创穿刺引流术是治疗单发性和部分多发性脑脓肿的一种简单有效的方法,手术时机应选择在脓肿壁完全形成之后。     

微创穿刺治疗脑脓肿的临床体会

目的在新疆和田经济落后，卫生条件差的地区脑脓肿的发生率仍然较高。在脑脓肿早期，多有所忽视或误诊，多数病例在发生脓肿包膜形成或病情加重而入院治疗发现，我院目前自2001年开始应用经穿刺针清除脓肿技术代替开颅手术疗效满意。方法脑脓肿位置深或靠近功能区，危重患者或小儿脑脓肿，不能耐受较大手术者，病程较短，且影像学见到的脓肿壁形成者行进针穿刺持续冲洗引流治疗：结果58例脑脓肿经治疗后，多数病例术后5～7天脓肿清除，病情平稳，并给予继续运用合理抗生素口服控制感染4～6周，预防并发症，于8～16周随访复查头颅cT，局部脓肿壁闭塞或局部软化灶，临床症状消失，基本符合临床治愈标准。死亡4例（6．8％）。结论是用YL-I型一次性使用颅内血肿粉碎穿刺针在微创治疗颅内血肿的延伸运用。随着它的应用不断扩大，使脑脓肿得到了安全、可靠、经济、实用的治疗，提高了患者的生存率，缩短了病程、降低了医疗费用、减轻了开颅手术治疗带来的创伤性大、脑组织损伤多或并发症多的弊端、降低了脑脓肿病人的病死率和病残率，为神经外科治疗脑脓肿增加了有效手段。     

脑脓肿的诊断和治疗(附20例报告)

目的探讨脑脓肿的诊断和治疗.方法1996年1月～2004年6月20例脑脓肿均行CT检查,8例行MR检查中2例行磁共振波谱检查,应用头孢曲松联合甲硝唑治疗1～9周,平均3.7周.CT或B超引导下3例行脓肿切除术,5例行脓肿穿刺引流术.结果1例因脓肿破入脑室死亡,16例治愈(无后遗症),3例好转(残留肢体偏瘫).8例手术患者无一例死亡.合并有糖尿病、结核、HIV抗体阳性及肾移植8例中4例治愈,无相关疾病12例治愈;脓肿与脑室关系密切9例中有5例治愈,脓肿表浅11例均治愈.5例多发脓肿均治愈,15例单发脓肿有11例治愈.结论脑脓肿早期诊断、早期抗感染治疗大部可治愈,MR是早期明确诊断的重要方法,立体定向手术是较好的手术方式.     

小儿细菌性肝脓肿97例分析

目的 提高小儿细菌性肝脓肿早期诊治水平,评价手术方法。方法 对97例小儿细菌性肝脓肿进行回顾性分析和总结。结果 非手术治疗57例（58.8%),手术治疗40例（41.2%)。94例治愈,病死率3.1%。结论 （1）肝脓肿的早期诊治依据临床表现有发热、肝肿大、肝区疼痛,辅助检查首选B超。（2）治疗采用经皮小切口置管引流抗生素反复冲洗。     

32例儿童细菌性肝脓肿治疗体会

目的探讨有效治疗儿童细菌性肝脓肿的方法。方法对2000年2月至2005年10月我科收治的32例儿童细菌性肝脓肿患者的临床资料进行回顾性分析。结果采用两种治疗方法:①非手术疗法,早期穿刺抽脓、脓腔冲洗和抗生素注入;②手术疗法:经腹膜腔入路的双管瓮式引流术。32例儿童细菌性肝脓肿患者,有7例发生并发症,非手术治疗23例,手术治疗9例,全部治愈。结论早期穿刺抽脓,加之脓腔冲洗和抗生素注入是非手术治疗的有效措施,穿刺疗法应成为脓肿治疗的首选。经腹膜腔入路的双管瓮式引流术,操作简单,不遗漏多发病灶,引流效果好。     

脾脓肿

目的　介绍脾脓肿的病因 ,发病机理 ,临床表现及诊治方法。方法　根据作者收治的 9例脾脓肿的临床资料 ,结合文献复习。结果　脾脓肿可分为尸检型和临床型。尸检发现率为 0 4%～0 7%。临床型以单发巨大脾脓肿多见。脾脓肿主要为血源性感染所致。早期临床表现无特殊性。血培养阳性率为 1 5 %～ 70 % ,影像学检查对诊断有帮助。本病误诊率高达 2 2 2 %～ 50 %。脾脓肿手术治疗效果好。结论　脾脓肿临床少见 ,术前诊断率低 ,易误诊漏诊。一经确诊 ,应及时手术治疗。     

前列腺脓肿1例报告并文献复习

目的:提高前列腺脓肿的诊断和治疗水平。方法:回顾性分析1例前列腺脓肿患者的病史、临床表现、影像学资料及治疗经过。对前列腺脓肿患者采用经直肠超声引导下前列腺脓肿抽吸术及抗生素治疗。结果:前列腺脓肿消退,症状缓解。结论:前列腺脓肿临床罕见,诊断依赖于病史、临床表现及影像学检查。经直肠超声引导下前列腺脓肿抽吸术简单有效,无明显并发症。     

高场强MR引导下精准穿刺抽吸治疗多房性脑脓肿

目的观察高场强MR引导下经皮精准穿刺抽吸治疗多房性脑脓肿的有效性及安全性。方法回顾性分析9例接受1.0T高场强MR引导经皮穿刺抽吸治疗的多房性脑脓肿患者,记录手术时间、并发症及随访结果。结果对9例共接受25次高场强MR引导下脓腔穿刺抽吸,其中2例行2次、7例行3次穿刺抽吸,技术成功率100%(25/25);手术时间40～100 min,平均75 min。抽吸脓液细菌培养8例呈阳性。1例术中出现少量硬膜下出血,无严重并发症。术后随访6个月,症状均显著好转;影像学随访显示脓腔皆完闭塞或肉芽肿形成,有效率100%(9/9)。结论高场强MR引导下经皮精准穿刺抽吸治疗多房性脑脓肿安全、有效。     

隐源性小儿脑脓肿22例临床分析

<正> 隐源性脑脓肿因其临床表现、CT影像学改变与典型脑脓肿不同,常造成诊断的困难并影响治疗。我科自1990年以来收治隐源性小儿脑脓肿22例,现报道如下。 1 临床资料 22例中男性13例,女性9例,年龄4～6岁2例,6～9岁14例,9～14岁6例,平均年龄7.8岁。均以癫痫为首发症状就诊,     

小儿重型颅脑损伤132例治疗体会

目的探讨儿童重型颅脑损伤的临床特点及治疗方案。方法分析132例小儿重型颅脑损伤患者的致伤原因、损伤类型、临床表现、治疗方法及预后。结果手术治疗96例,非手术治疗36例,111例存活,56例恢复良好,25例轻残,13例中残,17例重残,21例死亡,病死率为15.9%。结论儿童重型颅脑损伤变化快,临床症状重,需要尽早确立诊断,正确掌握手术与非手术治疗的适应证,采取综合治疗措施,能取得良好的预后。     

Retroperitoneal abscess: 7-year experience of 29 cases in a tertiary care center in Taiwan

ObjectiveRetroperitoneal abscess is a rare condition with an insidious onset and difficult diagnosis. It can occur from various origins. To analyze our experiences, we conducted a case series study of retroperitoneal abscess cases in our hospital.Materials and methodsTwenty-nine patients in whom retroperitoneal abscesses were diagnosed at our hospital were reviewed from January 2007 to January 2014 for the purpose of analyzing the presenting symptoms, diagnostic tools, microbiology, treatment methods, and mortality.ResultsOf the 29 patients reviewed, a genitourinary origin was the most common source and accounted for 51.7% of the patients, and perinephric abscess was the main type of abscess. Diabetes mellitus, previous surgery, and an immunocompromised condition were common factors. The common clinical manifestations were fever (65.5%), back pain (37.9%), and abdominal pain (20.7%). Escherichia coli was the most prevalent pathogen (31.3%), followed by Klebsiella pneumoniae (25%). A polymicrobial pathogen accounted for 13.8% of infections. An anaerobic pathogen was only found in one case of gastrointestinal origin. Computed tomography and magnetic resonance imaging were found to be accurate diagnostic tools with sensitivities of 88.5% and 100%, respectively. Percutaneous drainage was commonly performed for abscesses of genitourinary origin, whereas surgical drainage was preferred in abscesses of gastrointestinal origin. The overall mortality rate was 3.4%, with one death reported.ConclusionRetroperitoneal abscesses exhibit an insignificant clinical manifestation and varied origin. Both computed tomography and magnetic resonance imaging were shown to be reliable tools for early diagnosis. K. pneumoniae was found to be a prevalent pathogen in the Taiwanese patients, especially in cases of perinephric abscess. The treatment methods for retroperitoneal abscess varied according to the origin and presentation.     

Intracranial complications of otitis media: 15 years of experience in 33 patients.

OBJECTIVES: Complications in the central nervous system (CNS) from acute otitis media (AOM) and chronic otitis media (COM) are becoming fewer, although they still represent a challenge for early recognition, adequate treatment, and satisfactory results. This retrospective study analyzed clinical data and therapeutic options in 33 patients with intracranial involvement resulting from otitis media. Important clinical features of intracranial complications and the sequence of the most efficient therapeutic maneuvers are discussed. METHODS: Charts of six patients with AOM and 27 patients with COM associated with CNS complications were analyzed for clinical presentation, imaging, and therapeutic approach. RESULTS: Ages ranged from 6 months to 79 years, with no gender predilection. Persistent fever, headache, and purulent otorrhea were the main symptoms. Proteus mirabilis , Enterococcus , and Pseudomonas aeruginosa were the most common microorganisms in COM, and Pneumococcus and Haemophilus were the most common microorganisms in AOM. Nineteen patients (58%) presented with more than 1 CNS complication, resulting in a total of 56 complications, including 26 cases of otogenic brain abscess, 21 cases of meningitis, 5 cases of lateral sinus thromboses, two cases of subdural empyemas, 1 case of epidural empyema, and 1 case of meningocele. Surgical interventions included craniotomy and drainage of the abscess (n = 17), open mastoidectomy with abscess drained through the mastoid (n = 10), open mastoidectomy alone (n = 8), and closed mastoidectomy (n = 2). Twelve patients who underwent craniotomy had subsequent mastoidectomy for recurrent abscess. At the 6-month, 66% of patients presented without sequelae, 24% presented with sequelae, and 9% died. CONCLUSION: Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.     

Brain abscess associated with congenital pulmonary arteriovenous fistula

A case of brain abscess associated with congenital pulmonary arteriovenous fistula was presented and 52 reported cases were reviewed. The brain abscess was successfully treated with repeated aspiration and drainage, and the pulmonary arteriovenous fistula, located in the right lower lobe, was resected. The artiovenous fistula occurs as a common pulmonary manifestation of hereditary hemorrhagic telangiectasia; however, no symptoms suggesting these two were noted in this case.

Brain abscesses can be an initial clinical manifestation in asymptomatic pulmonary arteriovenous fistula. This possible association should be borne in mind in cases of brain abscesses of unexplained etiology.     

Multiloculated pyogenic brain abscess: experience in 25 patients

OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS: The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.     

Diagnostic problems in brain abscess: 45 cases

BACKGROUND AND PURPOSE: We analysed the difficulties encountered in the differential diagnosis between brain abscess and brain tumor and their influence on treatment and outcome. METHODS: - Forty-five adults with brain abscess operated on between 1993 and 1999 were retrospectively reviewed. We studied preoperative diagnosis, clinical, radiological, bacteriological findings, surgical procedure, primary sources of infection and outcome. RESULTS: Preoperative diagnosis was right in 55.6% (25/45), wrong in 22.2% (10/45) and doubtful in 22.2% (10/45). Diffusion-weighted MR imaging was successfully used in 4 doubtful cases to make the differential diagnosis between abscess and tumor. When the preoperative diagnosis was right, the surgical procedure was a burr-hole aspiration in 73.3% (22/25) whereas when it was wrong, an excision was performed in 60% (6/10) of the cases. Aspiration was the last diagnostic investigation in 80% (8/10) of doubtful cases. Microbacterial organisms were identified in 75.5% (34/45) of the cases and primary cause of infection in 62.2% (28/45). The outcome depended on clinical status on admission, preoperative diagnosis and surgical procedure. In four cases, diffusion-weighted MRI allowed differential diagnosis between brain abscess and tumor through calculation of the Apparent Diffusion Coefficient which is low in abscess and high in cystic tumor. CONCLUSION: The diagnosis of brain abscess remains difficult in certain patients. Correct preoperative diagnosis influences the decision on the appropriate surgical procedure and helps improve outcome.     

Clinical characteristics of renal tubular acidosis in adults and children

Objective To view and compare the clinical characteristics of renal tubular acidosis in adults and children. Methods Clinical data of patients with renal tubular acidosis diagnosed by Shandong Provincial Hospital affiliated to Shandong University from Jan 1991 to Sep 2017 were reviewed. The difference and consistency in clinical characteristics of renal tubular acidosis between adults and children were analyzed. Results Data from 206 adults and 60 children were analyzed. 89.81% cases in adults were secondary to other diseases, mainly primary Sjogren's syndrome. Most children patients (81.67%) were idiopathic, others largely originated from inherited metabolic diseases. The most common subtype of both was distal renal tubular acidosis. Proximal renal tubular acidosis was easier to be found in idiopathic renal tubular diseases of children. Chief complaints or starting symptoms were mainly composed of polydipsia with polyuria (41.4%) and fatigue (35.3%). Children were typical of growth retardation, rickets and digestive symptoms. The rate of missed diagnosis and misdiagnosis was 41.4 percent. Routine therapy consisted of healing metabolic acidosis and electrolyte disorders, treating underlying diseases and preventing complications. The majority of patients (95.5%) improved after treatments. Conclusions Renal tubular acidosis possesses various underlying diseases, diverse clinical manifestation and high rate of misdiagnosis. Given the high incident of secondary types, investigation of underlying disease, especially autoimmune diseases such as Sjogren's syndrome, is of great importance in adults. Most children patients suffer from primary renal tubular acidosis. Attention should be paid to them in order to reduce the rate of misdiagnosis and teratogenicity.     

Retroperitoneal abscesses--analysis of a series of 66 cases

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.     

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/μl (range 1,500–42,000/μl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2–50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954–1960 to 15% in 1991–1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to avoid or reduce permanent neurologic deficits. Received: 18 July 2000 / Accepted: 14 September 2000     

超声引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿临床分析

目的探讨B超引导下经皮肝穿刺置管引流术治疗细菌性肝脓肿的临床意义。方法采用B超介导下经皮肝穿刺置管引流治疗肝脓肿48例,其中单发脓肿39例（81.2%）,2个以上多发脓肿9例（18.8%）。脓肿部位,肝右叶32例（66.7%）,肝左叶9例（18.7%）,左右肝叶7例（14.6%）。结果病人在置管后平均3d体温恢复正常及症状消失,引流量逐渐减少和消失,B超检查证实脓腔萎陷及无脓液。本组48例全愈,治愈率100%,其中42例获得随访,随访时间1～3年,所有病人均恢复正常工作。结论B超介导下经皮肝穿刺置管引流术是一种操作简便的肝脓肿引流方法,医疗费用低,成为肝脓肿的首选治疗方法。     

Non-traumatic brain abscess

Summary Two groups of patients with non-traumatic focal intracranial suppurative diseases were studied retrospectively to illustrate epidemiology, clinical symptoms and therapeutic results.The first group consists of 87 patients treated for brain abscess in the Department of Neurosurgery in Lund. During the 36-year period investigated (1947–1982) marked epidemiological changes occurred. Thus otogenic abscesses, constituting 33% of the cases below the age of 30 during the first 12 years of the study, virtually disappeared. During the third 12-year period of this study a marked increase in the number of abscesses was noted. The increase was caused particularly by the number of cryptogenic abscesses amounting to 51% of the material during 1971–1982.The second group of patients consists of all patients with pre- or post-mortem diagnosed brain abscess in the city of Malmö during 1960–1981. Since during this period 85% of all persons who died in this city were subjected to post-mortem examination this material offers a unique possibility of epidemiological studies.The combined study of these two groups of patients lends no support to the view that a real increase in the number of brain abscesses has occurred. We conclude that in patients with cryptogenic brain abscess the clinical symptoms do not usually indicate the presence of an infectious disease. In the majority of these patients a correct diagnosis has presumably not been obtained until the last decade. Furthermore, the investigation confirms the view that a mortality below 10% is nowadays feasable in unselected cases of brain abscess.This study was partially supported by Research Grant No. 07165 from the Swedish Medical Research Council.