病灶清除加腔内填塞换药治疗脓肿、溃疡型淋巴结核

目的探讨脓肿型、溃疡型淋巴结核的治疗方法。方法121例病人,在全身抗结核化疗的基础上,采用脓肿切开、脓腔及窦道内病灶清除并结核药物纱条填塞换药的方法治疗脓肿型及溃疡型淋巴结核。结果121例均得到治愈,创口愈合时间最短14d,最长67d,1年内复发者仅4例。结论病灶清除并腔内填塞换药治疗脓肿及溃疡型淋巴结核效果好。     

Testicular infarction secondary to acute inflammatory disease: demonstration by B-scan ultrasound

Acute epididymitis can lead to obstruction of the adjacent testicular blood supply, resulting in focal or diffuse infarction of the testis or epididymis in the absence of torsion. Four cases are presented to demonstrate the spectrum of B-scan ultrasound findings, ranging from focal necrosis of the epididymis and ischemic infarction of the testis to diffuse testicular infarction. Epididymal enlargement and skin thickening are consistently seen on ultrasound as well as swelling and decreased echogenicity of the testicle. The authors suggest a protocol for acute scrotal symptoms, incorporating clinical findings and (where appropriate) radionuclide scans.     

MEBO纱条脓腔引流联合远红外线照射治疗乳房脓肿的临床研究

目的评价湿润烧伤膏（MEBO）纱条脓腔引流联合远红外线照射治疗乳房脓肿的疗效。方法对收治的80例乳房脓肿患者,随机分为治疗组40例和对照组40例,治疗组行脓肿切开术后用MEBO纱条填塞脓腔引流联合远红外线照射治疗;对照组行脓肿切开术后用凡士林纱条填塞脓腔引流联合远红外线照射治疗。结果治疗组创面愈合快,疼痛反应轻,愈合后瘢痕小,无乳瘘发生,两组比较P〈0．05,差异有统计学意义。结论MEBO纱条脓腔引流联合远红外线照射治疗乳房脓肿,能很快控制局部炎症,明显缩短愈合时间,减少疼痛及乳瘘发生,且愈后瘢痕小,临床疗效显著。     

高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

目的探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值。方法使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照。结果肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%。结论高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受。     

CT evaluation of gracilis myocutaneous vaginal reconstruction after pelvic exenteration

After pelvic exenteration for cancer, the gracilis muscles, skin, and subcutaneous fat from the inner aspect of both thighs may be raised as a pedicle flap and tunneled under the skin into the pelvic space to create a neovagina. We reviewed nine pelvic CT examinations in six patients to evaluate the CT appearance of this procedure and its complications. Five patients are alive and without complications. One patient died 6 months after surgery and had a small-bowel fistula to the neovagina. Normal CT findings included air in the vaginal canal in six of nine examinations, gracilis muscle atrophy in two patients who had early and late CT studies, and early separation of the anterior and posterior approximation of the flaps in one patient. Abnormal findings were seen in two patients: one had an abscess near the vaginal apex that was drained per vagina; the other had extraluminal air in the retropubic and subcutaneous fatty tissues due to a small-bowel fistula into the vagina.     

湿润烧伤膏油纱条治疗肛周脓肿疗效观察

目的 观察湿润烧伤膏（MEBO）油纱条引流治疗肛周脓肿切开排脓术后的临床效果.方法 28例肛周脓肿患者行脓肿切开排脓术后用MEBO油纱条填塞脓腔引流换药治疗.结果 27例（96.43％）患者经4～6次MEBO油纱条换药治疗后创口愈合,仅1例愈合后形成肛瘘,经肛瘘挂线手术治疗后痊愈.结论 MEBO油纱条堵塞脓腔引流治疗肛周脓肿效果显著.     

经体表高频超声在肛周脓肿和肛瘘诊断中的应用

目的:回顾分析经体表高频超声诊断肛周脓肿和肛瘘的价值.方法:应用6～14MHz高频探头,对89例肛周脓肿和(或)肛瘘患者在肛门周围进行超声检查并与手术结果对比分析.结果:本组中,经体表高频超声对肛周脓肿诊断的灵敏度94.3%,特异度100%,阳性预测值100%,对肛瘘诊断的灵敏度85.4%,特异度95.1%,阳性预测值95.3%.结论:经体表高频超声能方便、直接、无痛苦、较为准确地诊断肛周脓肿和肛瘘.     

Nephrobronchial fistula a case report and review of the literature

Nephrobronchial fistula is an extremely rare complications of renal infections. We present a case of nephrobronchial fistula in a middle age immunocompetent woman who complained cough and weight loss, with underlying asymptomatic nephrolithiasis. She underwent a chest X-ray that showed left lower lobe infiltrate and abdominal ultrasound. Abdominal ultrasound showed a complicated pyonephrosis ; CT of chest-abdomen-pelvis with intravenous contrast was performed in order to stage and define the extension of the pathology. At CT, a suspected diagnosis of stage III xanthogranulomatous pyelonephritis complicated with pyonephrosis and a nephrobronchial fistula was formulated. A nephrostomy tube was placed, and the patient was treated with antibiotics. Follow up CT, performed after 15 days, showed the healing of the fistulous connection between the perinephric abscess and bronchi; the patient underwent nephrectomy with no airway complication during intubation. Histopathological diagnosis confirmed the presence on complicated xanthogranulomatous pyelonephritis.     

Transrenal Ureteral Occlusion for Palliation of Refractory Urine Leaks Using Vascular Plugs and Liquid Ethylene Vinyl Alcohol

PurposeTo describe outcomes of transrenal embolization with vascular plugs and ethylene vinyl alcohol (EVOH) in a case series of patients with refractory urinary leak or fistula.Materials and MethodsFifteen ureteral occlusions performed over 53 months in 9 consecutive patients (56% female; mean age 61 y; range, 45–80 y) were reviewed retrospectively. The main indication was palliation for refractory fistula or leak in the setting of malignancy not responding to urine diversion by percutaneous nephrostomy tube or nephroureteral stent. Transrenal ureteral occlusion was performed using EVOH injected between vascular plugs placed distal and proximal to the leak or fistula.ResultsTechnical success was 100%. Considerable reduction of urine leak or symptoms (clinical success) was achieved in 64% of ureters after mean follow-up of 105 days (range, 0–632 d). Complete ureteral occlusion on follow-up anterograde nephrostogram (imaging success) was achieved in 60% of ureters after mean follow-up of 139 days (range, 0–643 d). One patient with distal ureterovesical junction–perineal fistula had continued leak despite complete proximal occlusion of ureter owing to retrograde urine reflux from the bladder and was treated with endoscopic injection of intramural calcium hydroxyapatite to the ureteral segment distal to the fistula. Three ureters (33%) in 2 patients with vesicovaginal fistula had recanalization, requiring additional proximal embolization, yielding secondary success rates of 91% (clinical) and 90% (imaging) per ureter. One minor urinary tract infection and no major complications occurred.ConclusionsTransrenal anterograde ureteral occlusion using EVOH between vascular plugs could be considered a relatively safe and potentially valuable treatment option for refractory ureteral fistulae.     

Septic arthritis as a presentation of Crohn's disease

A 42-year-old man with colonic Crohn's disease presented to the orthopaedic department with septic arthritis of the knee with frank intra-articular pus, which persisted despite repeated joint washouts. This coincided with a symptomatic flare of his colonic Crohns. Imaging revealed a fistulous connection from the proximal sigmoid colon into the pelvis, a psoas abscess, myositis of the musculature around the left pelvic girdle and left thigh and two focal collections almost surrounding the distal femur. The knee symptoms only settled after laparotomy and resection of the diseased sigmoid colon and fistula. This case report demonstrates an unusual presentation of fistulating Crohns disease as septic arthritis.     

MEBO纱条脓腔引流治疗乳房脓肿的疗效观察

目的 观察湿润烧伤膏(MEBO)纱条引流治疗乳房脓肿的临床效果.方法 32例乳房脓肿患者行脓肿切开术后,用MEBO纱条填塞脓腔引流治疗.结果 30例(93.75%)患者经3次～5次MEBO纱条换药治疗后创口愈合,无1例有乳瘘形成.结论 MEBO纱条脓腔引流治疗乳房脓肿效果显著.     

Acute epididymitis in ultrasound: Results of a prospective study with baseline and follow-up investigations in 134 patients

Objectives

To perform a comprehensive follow-up analysis of ultrasonographic scrotal features and associated signs in patients with acute epididymitis.

Methods

Between 2007 and 2012, 134 adults (median age 54 years) with acute epididymitis underwent scrotal ultrasonography and palpation at first presentation and after 2 weeks and 3 months.

Results

At first presentation, 61 patients (45.5%) had hydrocele, 63 (47.0%) concomitant orchitis, and 8 (5.9%) epididymal abscess. Epididymitis was predominantly located in 24 cases (17.9%) in the head, 52 cases (38.8%) in the tail, and 58 cases (43.3%) in both. On the affected side, testicular volume was 16.9 ± 6.8 ml and peak systolic velocity of the testicular artery was 23.7 ± 7.5 cm/s, compared to the healthy side with 12.3 ± 4.4 ml and 9.5 ± 3.6 cm/s respectively (P < 0.001). Concomitant orchitis was associated with hydrocele, testicular enlargement and pain (P < 0.01). Orchiectomy due to secondary testicular infarction was necessary in four cases, while in all other patients ultrasound parameters normalized. Only 16/90 patients (17.8%) showed a persistent epididymal swelling after 3 months.

Conclusions

Common ultrasound features include hydrocele, epididymal enlargement, hyperperfusion, and testicular involvement. Under conservative treatment, ultrasound parameters normalize without evidence of testicular atrophy even in patients with epididymal abscess or concomitant orchitis.     

Subcutaneous herniation of gall-bladder with spontaneous cholecystocutaneous fistula

Spontaneous cholecystocutaneous fistula is now a clinical rarity due to improvements in the treatment of biliary tract diseases. This case report describes a 67-year-old woman in whom subcutaneous herniation of a pathologically dilated gall-bladder was followed by spontaneous discharge of pus and mucus with formation of a cholecystocutaneous fistula. The use of serial computed tomography examinations enabled this unusual diagnosis to be made.     

Gastric interposition following transhiatal esophagectomy: CT evaluation

Transhiatal esophagectomy without thoracotomy (THE) but with gastric interposition results in less morbidity and mortality than standard transpleural esophagectomy with thoracotomy. Barium examination has been the primary radiographic study following THE for detecting postoperative complications. We reviewed computed tomography (CT) scans of 21 patients who had undergone THE and correlated CT appearance with clinical status and with findings of the barium studies. Local mediastinal recurrent neoplasm was detected by CT in seven patients; barium study within 2 weeks of the CT scan failed to detect tumor recurrence in three of these patients. A mediastinal abscess well delineated by CT was percutaneously drained under CT guidance. Water-soluble contrast medium/barium study is preferable for the evaluation of certain postoperative complications such as anastomotic leak. However, CT is the modality of choice for detecting locally recurrent neoplasm and distant metastases following THE and may also be helpful in patients with postoperative mediastinal abscess. Normal mediastinal CT anatomy after esophagectomy is reviewed in order to warn against pitfalls in scan interpretation.     

Lesser sac abscesses and fluid collections: drainage by transhepatic approach

Twelve abscesses and fluid collections in the lesser peritoneal sac were drained percutaneously using an access route across the intervening liver. This rather unusual access was chosen when other approaches were contraindicated because of surrounding colon, stomach, or spleen. All collections were drained successfully, and no specific complications such as hemorrhage, bile leak, or liver abscess occurred. Placement of an abscess drainage catheter should be done through the peripheral portion of the liver if possible. The technique offers a new, safe approach to percutaneous drainage of hitherto inaccessible collections.     

MEBO治疗腰腹部巨大脓肿1例报告

目的观察湿润烧伤膏（MEBO）局部换药联合全身应用抗生素治疗巨大脓肿的疗效。方法对1例腰腹部巨大脓肿患者静脉应用抗生素和营养支持治疗3d后,将脓肿部位切开引流,抽出腔内脓液后,应用MEBO药纱条填塞,每日换药1次,观察治疗效果。结果应用MEBO药纱条填塞引流治疗3d后,分泌物明显减少并长出新鲜肉芽组织,28d后痊愈出院,愈后瘢痕组织轻微。结论MEBO能减轻创面疼痛,促进创面愈合,治疗效果显著。     

Indium 111 white blood cell imaging of epididymitis

The clinical diagnosis of epididymitis is frequently substantiated radiographically with pertechnetate 99m (^99mTc) testicular scintigraphy and scrotal sonography. Indium 111 (¹¹¹In) autologous leukocyte imaging in a patient with epididymitis has to our knowledge not been reported previously. The case presented is an elderly man with epididymitis. An¹¹¹In-labelled white blood cell scan demonstrated increased tracer accumulation in the region of the right epididymis. This suggests that¹¹¹In-labelled leukocyte scanning may be helpful in evaluating an inflammatory process involving the epididymis or testis and potentially may allow for differentiation of epididymitis and orchitis from missed torsion, tumour or cystic lesions.     

Long-term follow-up of pyogenic liver abscess by ultrasound

Background/aims

To study the morphology of residual abscess in successfully treated pyogenic liver abscess by ultrasound.

Methods

116 consecutive patients of liver abscess diagnosed from April 2004 to March 2007 were included in this study. Patients with amebic liver abscess were excluded. Patients were treated with antibiotics for 6 weeks and when indicated drained percutaneously. Ultrasound scan was repeated after 2 weeks, 1 month, 3 months, 6 months and 12 months of treatment. Thereafter it was repeated every 6 months.

Results

After exclusion, 102 patients with >150 lesions were studied. Diagnosis was made on the basis of clinical presentation, ultrasound examination and diagnostic aspiration. It was single in 83, double in 12 and more than 2 in seven patients. Size varied from 4.2 cm to 15 cm. Organisms were isolated in 29 patients (E. coli 10, Kliebsiella sp. 6, S. aureus 5, Pseudomonas aeruginosa 2, Acenetobacter 1 and multiple growth 5) in blood and eight patients (E. coli 5 and S. aureus 3 and multiple growth 2) in pus. Majority of abscess resolved sonologically after 2-18 weeks of treatment. Healing was delayed in alcoholic and diabetic patients. In eight patients there was residual abscess even after 104 weeks of follow-up. In four patients it healed with calcification.

Conclusions

Majority of pyogenic liver abscess resolve to normal parenchyma within 18 weeks time. However, some lesions may take longer time to heal even after successful treatment. It should be considered in differential diagnosis of space occupying lesion of the liver in ultrasound and need no therapeutic intervention.     

Ultrasound detection of a subperiosteal abscess secondary to coalescent otomastoiditis

We report the unusual ultrasound appearance of coalescent otomastoiditis with subperiosteal abscess in a 3-month-old boy with a 1-week history of an enlarging lump behind the left ear. Ultrasound examination of the lump revealed subcutaneous oedema with an abscess extending from a defect in the cranial vault as a result of extension of the inflammatory process. We believe that this sonographic appearance has not been previously described in the published literature.