典型乳突胆脂瘤并脑脓肿及室管膜炎1例

患者,男,72岁。以发热、头痛三周为主诉入院。患者自三周前始反复出现发热、头痛、头晕,近日加重并出现精神异常,伴恶心呕吐。既往有中耳炎史。体格检查:T38°C,视神经乳头水肿,脑膜刺激征(+),失语,左侧偏瘫。血常规:WBC27.2×109/L。腰穿见脑脊液混浊,脑脊液常规:WBC162×106/L,生化:TP4084mg/L,CL98mmol/L,GLU0.4mmol/L,余无异常。头颅CT平扫:右颞叶见一类环形影,边缘不清,大小约1.7cm×2.5cm,周边见指套状低密度影,左颞叶见一小气泡影。CT增强:右颞叶环形影均匀强化,边清,厚薄均匀,环厚约0.2cm,无壁结节(图1)。脑室扩大,侧脑室壁见线状均匀强化(图2)。骨窗显示双侧中耳乳突呈硬化型,右侧鼓室鼓窦明显扩大,其骨壁破坏吸收,鼓室盖破坏,右颞叶环形影与之紧密相连(图3)。CT考虑右侧中耳乳突炎胆脂瘤形成、鼓室盖破坏并右颞叶脑脓肿、室管膜炎、脑内少许积气、脑积水。手术证实为胆脂瘤合并脑脓肿。讨论胆脂瘤为一种内衬鳞状上皮并充满角质碎屑的囊肿。多为单发,多见于10~40岁,98%为获得性,有慢性中耳炎史。通常认为它是外耳道脱落的角化上皮经穿孔的鼓膜进入...     

Breast abscess caused by Propionibacterium avidum following breast reduction surgery: case report and review of the literature

Propionibacterium avidum was isolated from bilateral breast abscesses following breast reduction surgery. This report highlights the potential pathogenicity of the normal microbial flora following surgical interventions.     

脓肿型颈部淋巴结结核临床治疗分析

目的：探讨区Ⅱ淋巴结清扫术治疗脓肿型颈部淋巴结结核的临床疗效。方法总结2008年9月~2013年6月我院收治的77例脓肿型颈部淋巴结结核,随机分为手术组及对照组,手术组34例行区Ⅱ淋巴结清扫术,对照组33例予局部处理及换药,两组均予正规抗结核治疗。结果手术组的治愈率为82.35%,对照组的治愈率为36.36%,差异有统计学意义(<0.05)。结论区Ⅱ淋巴结清扫术治疗脓肿型颈部淋巴结结核,治愈率高,安全可行。     

中药外敷加灌肠治疗阑尾周围脓肿的疗效及其对C-反应蛋白的影响

【目的】观察中药双柏散外敷配合通腑泻热合剂灌肠治疗阑尾周围脓肿的临床疗效及其对血清中C-反应蛋白(CRP)含量的影响。【方法】将60例阑尾周围脓肿患者随机分为对照组和治疗组各30例,对照组给予常规西药治疗,治疗组在对照组治疗的基础上加用双柏散外敷及通腑泻热合剂保留灌肠,7 d为1个疗程,2个疗程后观察2组患者的临床疗效及血清CRP的变化情况。【结果】(1)治疗组总有效率为93.33%,对照组为73.33%,治疗组疗效优于对照组(P<0.05)。(2)治疗后,治疗组的体温恢复正常时间及腹痛消失时间均较对照组显著缩短(P<0.05),包块较对照组显著缩小(P<0.01)。(3)治疗后,2组血清CRP含量均显著下降(P<0.01),但治疗组的下降作用更明显(P<0.05)。【结论】在常规西药治疗的基础上配合双柏散外敷及通腑泻热合剂灌肠治疗阑尾周围脓肿,不仅能有效改善患者临床症状,还能降低患者血清CRP水平,疗效肯定,且无明显毒副作用,值得临床推广应用。     

口服龙血竭片对低位肛周脓肿术后创面影响的临床观察

目的：观察口服龙血竭片对低位肛周脓肿术后创面分泌物及创面愈合时间的影响。方法将64例低位肛周脓肿患者随机分为治疗组32例、对照组32例。2组患者均行切开引流术。治疗组口服龙血竭片,2400 mg／次,3次／d,对照组口服头孢地尼胶囊,100 mg／次,3次／d。观察2组创面愈合时间、创面分泌物情况评分。结果创面愈合时间治疗组为（12．18±2．14） d,对照组为（14.63±1.94）d,治疗组比对照组明显缩短,2组比较差异有统计学意义（t＝1．241,P＜0．05）。术后第2天治疗组和对照组创面分泌物情况评分比较,差异无统计学意义（ P＞0．05）。术后第5天、第10天治疗组创面分泌物情况评分均明显低于对照组,差异有统计学意义（P＜0．05）。结论低位肛周脓肿术后患者口服龙血竭片可缩短创面愈合时间,减少创面分泌物。     

中西医结合联合超声引导脓腔冲洗治疗盆腔脓肿临床研究

目的：探讨中西医结合联合超声引导脓腔冲洗治疗盆腔脓肿的临床疗效。方法：将88例盆腔脓肿患者随机分为观察组和对照组,每组各44例。对照组采用中西医结合治疗,观察组在对照组治疗基础上联合使用超声引导脓腔冲洗治疗,观察两组临床疗效。结果：观察组临床疗效优于对照组,差异有统计学意义（P＜0．05）。观察组患者体温恢复正常时间、症状消失时间、住院时间均短于对照组,差异有统计学意义（P＜0．05）。结论：中西医结合联合使用超声引导脓腔冲洗治疗盆腔脓肿疗效可靠,能够缩短患者临床体征消失时间和住院时间。     

Orbital Cellulitis and Subperiosteal Abscess: A 5-year Outcomes Analysis

Purpose: Orbital cellulitis and subperiosteal abscess (SPA) are historically associated with poor outcomes. We seek to characterize current associations with abscess formation, surgical failure and vision loss.

Methods: All cases of orbital cellulitis presenting to an affiliated hospital between April 2008 and 2013 were critically reviewed.

Results: Thirty patients met inclusion criteria. Average age was 28.7?±?24.4. The male to female ratio was 2:1. Abscesses were identified in 56.7% of patients. Adults were less likely than children to present with abscesses (28.6% vs. 81.3%, p?=?0.008). Of the other factors analyzed, only antibiotic use before admission (70.5% vs. 23.1%, p?=?0.03) and maximum restriction (?2.5?±?1.2 vs. ?0.9?±?0.7, p?=?0.008) were associated with SPA. Temperature at presentation (37.9?±?0.9 vs. 37.1?±?0.4, p?=?0.04), relative proptosis (5.8?±?3.3?mm vs. 2.1?±?1.1, p?=?0.002) and abscess volume (4.3?±?1.3?mm³ vs. 0.7?±?0.5?mm³, p?=?0.0004) were associated with progression to surgery. Reoperation was required in 26.7% of patients. Of these, two-thirds had combined superior/medial abscesses that re-accumulated after isolated endonasal surgery. Two of the 3 patients with profound vision loss had a dental etiology.

Conclusions: Only young age, prior antibiotics and degree of restriction predicted the presence of an abscess. Re-accumulation was more common than anticipated, and drainage of superior/medial abscesses by endoscopic surgery alone had the strongest association with surgical failure. Patients with odontogenic abscesses must be treated with particular caution.     

A lack of ongoing diabetes is an important factor in preserving eyes from late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess

Purpose:

The purpose of this study is to identify the possible factors for preserving the eyes after late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.

Methods:

A retrospective chart review was conducted for patients admitted with KP liver abscess from January 1991 to June 2012.

Results:

Six hundred and ninety-three patients with KP liver abscess were recorded, in which endophthalmitis was identified in 53 cases (65 eyes, 8.29%). Diabetes was significantly associated with the development of endophthalmitis (p = 0.014). Eleven eyes received their last ocular treatment ≥10 days and final vision ≥ counting fingers, and were defined as benign type KP endophthalmitis. The absence of diabetes was the only consistent candidate factor for benign type KP endophthalmitis.

Conclusion:

A lack of ongoing diabetes is an important factor in preserving eyes with late or suboptimally treated endogenous endophthalmitis second to KP liver abscess.