Indium 111 leucocyte scintigraphy in abdominal sepsis Do the results affect management?

We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected Intra-abdominal sepsis upon which therapeutic decisions can be based.     

Cerebral abscess with multiple rims on MRI

We present a patient with multiple brain abscesses caused by Nocardia asteroides. On T2-weighted MRI, multiple concentric rims were seen in the abscess, which could be a finding specific for infection. The rims may be due to organization of the necrotic debris and phagocytoses by macrophages in the capsule. Received: 29 November 1996 Accepted: 16 April 1997     

Extraperitoneal manifestation of perforated diverticulitis

We observed five cases of unusual extraperitoneal presentation of diverticulitis during an 11 year period. During that time, a total of 263 patients were operated for diverticulitis. Patients 1–4 presented with an inflammatory spread of diverticulitis through the abdominal wall; in patient 5 multiple abscesses were present in the left thigh. Inadequate resection and previous radiotherapy in patient 4 might have contributed to the complicated course. In patient 5, poor condition initially allowed only local drainage of the thigh abscesses. Despite laparotomy and sigmoid resection a few days after drainage, the fatal outcome could not be prevented. A more extensive resection and a protecting colostomy might have prevented the fistulous complication in patient 4. A primary resection and abscess drainage might have averted the fatal outcome in patient 5.     

Cheiro-oral syndrome because of cerebral abscess

Cheiro-oral syndrome usually results from acute small vessel disease with expected favorable outcome. Simultaneous ipsilateral perioral and hand involvement may be not only due to anatomic proximity but also due to differential sensory threshold. A separate compensatory physiologic mechanism may explain the rarity of slower evolving lesions in producing the cheiro-oral syndrome. Cerebral abscess, surgically treatable with subacute presentation, may produce an identical clinical syndrome.     

30例细菌性肝脓肿漏诊原因分析

119例经外科手术治疗的细菌性肝脓肿中,有30例于入院时漏诊,漏诊率为13.4％。漏诊原因有:临床症状不典型(9例)、术前忽视必要的辅助检查(5例)、缺乏严格的动态观察(3例)、并发症误为原发病(4例)、诱因与肝脓肿相混淆(6例)以及部位特殊(3例)等。     

Endoscopic treatment of brain abscesses

Background Stereotactic aspiration with external drainage has become widely accepted as the standard treatment for intracerebral abscesses. Although neuroendoscopic technique has only been occasionally adopted for this pathology, it introduces some advantages because it presents visual awareness that the pus has been removed.Methods Four patients with cerebral abscess and one with a subdural empyema were operated using a neuroendoscopic technique in our Department between 1996 and 2003. A 4-mm flexible endoscope was introduced into the purulent collection through a burr hole, the pus was meticulously aspirated, and the cavity washed with isovolumetric antibiotic lavages using the working channel for both irrigation and suction.Conclusion Neuroendoscopic treatment of brain abscesses presents some additional advantages as a possible alternative to stereotactic aspiration, which still constitutes the gold standard for this pathology. The adoption of stereotactic or frameless guidance systems can probably be recommended particularly for deep, complex lesions.     

Subcortical deficit pattern after brain abscess: a neuropsychological study

The consequences of brain abscess (BA) on cognition and behaviour have never been examined in detail. The aim of this study was to determine the long-term cognitive deficits of patients who suffered a BA and to estimate its effect on the quality of life. Twenty patients were included in the study. Follow up with neuropsychological and behavioural tests was performed 6 months to 42 years after BA (mean 10.4 +/- 11.9). Cognitive deficits were defined as a test score of 2 or more standard deviations below controls' mean in those tasks which revealed a significant group deficit. Compared with healthy age, sex and education-matched controls, 13 of 20 patients (65%) exhibited neuropsychological deficits in some cognitive tasks. Ten of those patients (50%) were significantly impaired in < or =2 cognition domains, whilst the remaining three patients (15%) showed three to five impaired domains. No correlation was found between neuropsychological impairments and patients' age, sex, initial neurological symptoms, size and localization of BA, or secondary epileptic seizures. Reduction in quality of life was found in five patients (25%). BA may cause long lasting cognitive deficits. Despite the focal character of the lesion, long-term sequelae follow a more diffuse subcortical deficit pattern.     

Surgical treatment of pediatric lung abscess

Eight pediatric patients with lung abscesses underwent surgical intervention in our hospital during a 7-year period. All the abscesses were associated with severe sepsis or complicated by a bronchopleural fistula that did not respond to medical treatment and tube thoracostomy. Seven patients required unilateral thoracotomies, and one patient with bilateral lesions required simultaneous bilateral thoracotomies. One tension pneumatocele required a preceding pneumonostomy. All patients underwent decortication and at least one additional surgical procedure consisting of: lung debridement plus bronchial closure (n = 4); lobectomy (n = 2); bisegmentectomy (n = 3); and/or segmentectomy (n = 1). There were no operative deaths, but two patients had persistent air leakage that was treated by bronchial closure. The average hospital stay was 22 days (postoperative 10.1 days). All the patients recovered completely. For many pediatric lung abscesses that do not respond to medical treatment and simple drainage procedures, surgical intervention is indicated and can shorten the hospital stay.     

Computed tomography-guided percutaneous needle aspiration of lung abscesses in neonates and children

Lung abscesses in children aften respond to conservative treatment. This is unlikely in children less than 7 years of age and in these surgery is associated with significant morbidity and mortality. We repart a neonate and a 2.5 year old child successfully treated with percutaneous computed tomography guided aspiration of lung abscesses.     

Acute appendicitis is rarely the initial presentation of cecal cancer in the elderly patient

Acute appendicitis is rarely the initial presentation of carcinoma of the cecum in elderly patients. A 20-year retrospective review of all patients 65 years of age or older presenting with proven acute appendicitis at the Montefiore Medical Center confirms this opinion. In only 1.8% of patients was acute appendicitis the initial presentation of an underlying carcinoma of the cecum. © 1993 Wiley-Liss, Inc.