Mammary tuberculosis: percutaneous treatment of a mammary tuberculous abscess

It is currently very rare to find mammary involvement in cases of tuberculosis, in either primary or secondary form. Diagnosis is classically clinical and microbiological, and the basic techniques used in imaging diagnosis are mammography and ultrasound. Computed tomography may define the involvement of the thoracic wall in those cases which present as mammary masses adhering to deep levels, and is also able to evaluate accompanying pulmonary disease, if it is present. Traditionally, treatment has consisted of quadrantectomy and specific antibiotic therapy. We present a case of tuberculous mammary abscess secondary to pulmonary disease, which was treated by percutaneous drainage controlled by CT and specific antibiotic therapy. We revise the diagnosis, differential diagnosis and treatment of mammary tuberculosis. Received: 27 July 1998; Revision received: 2 February 1999; Accepted: 20 April 1999     

Subarachnoid Haemorrhage as Initial Symptom of Multiple Brain Abscesses

The case of evolving multiple brain abscesses which became symptomatic with a sudden hemianopsia and the clinical and radiological signs of a subarachnoid haemorrhage, is reported. A common pathomechanism which could explain both the sudden focal neurological deficit and the subarachnoid bleeding is discussed.     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

Salmonella enteritidis brain abscess: case report and review

Intracranial infections are unusual manifestations of salmonellosis. Even with adequate medical and surgical interventions these infections are often associated with significant morbidity and mortality. We report a case of brain abscess caused by Salmonella enteritidis associated with a brain neoplasm and review previous reports in the literature.     

早期手术治疗阑尾周围脓肿63例分析

目的 探讨阑尾周围脓肿早期手术的疗效。方法 对63例1990—2005年阑尾周围脓肿行早期阑尾切除，脓肿清除，肠粘连松解，回盲部修补和右半结肠切除术进行回顾性研究，分析其术中情况、手术方法、并发症以及治疗结果。结果 所有患者均在术后3周内痊愈出院，手术发生并发症10例，发生率15．87％。结论 阑尾周围脓肿早期手术切实可行。     

中西医结合治疗细菌性肝脓肿临床观察

目的：观察抗生素、厌氧治疗、局部穿刺引流合用中药“银鱼角消脓汤”治疗细菌性肝脓肿的疗效。方法：对临床诊断细菌性肝脓肿患者66例随机分为两组。治疗组44例用中西医结合治疗，对照组22例用单纯西医治疗。观察两组总有效率及体温复常、疼痛消失、血象复常、脓肿消失、住院时间五项临床指标。结果：治疗组总有效率95．5％，明显高于对照组的77．3％（P〈0．05），临床五项指标治疗组均优于对照组。结论：中西医结合治疗细菌性肝脓肿比单纯西医治疗更有效。     

Tubo-ovarian Abscess in Virginal Adolescent Females: A Case Report and Review of the Literature

BackgroundA tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID), predominantly polymicrobial and present in sexually active women. TOA in virginal adolescent females are extremely rare but have serious and lifelong consequences.CaseA 13 y.o. virginal female presented to the Emergency Room of a tertiary care pediatric hospital with abdominal pain and vomiting. Imaging suggested bowel compromise with potential perforation. An exploratory laparotomy revealed TOA which grew Escherichia Coli. This is the first reported case of Escherichia Coli TOA due to suspected bowel translocation.ConclusionReview of the literature identified 8 cases of TOA in virginal adolescents. Given the severity of outcomes following TOA, this pathology should be considered in the differential diagnosis of virginal adolescents who present with fever and abdominal pain. If suspected, a prompt gynecology consult should be initiated, followed by a first line antibiotic therapy and when indicated, surgical drainage.     

腹腔镜治疗阑尾周围脓肿25例报告

目的：探讨腹腔镜手术治疗阑尾周围脓肿的手术方法及临床疗效。方法：回顾分析2010年4月至2013年4月为25例阑尾周围脓肿患者行腹腔镜手术的临床资料。其中18例行阑尾切除加脓肿病灶清除术，7例行脓肿引流术。结果：25例均顺利完成腹腔镜手术，手术时间平均（60．25±30．12）min，平均住院（7．53±3．44）d。术后2例发生切口脂肪津化，切口延迟愈合：余均无并发症发生。结论：腹腔镜手术治疗阑尾周围脓肿是安全、可行的，应根据患者病情采取合适的术式。     

Spinal epidural abscesses – The role for non-operative management: A systematic review

BackgroundSpinal Epidural Abscesses (SEAs) are traditionally seen as a surgical emergency. However, SEAs can be discovered in entirely asymptomatic patients. This presents a dilemma for the attending clinician as to whether to subject these patients to significant surgery. This systematic review updates the evidence surrounding the efficacy of non-operative SEA management by means of intravenous antibiotics ± radiologically-guided aspiration.Aims1. To assess failure rates of medical therapy for SEA. The absolute definition of ‘failure’ used by the study was recorded, and comparisons made. 2. To review of risk factors for success/failure of medical treatment for SEA.MethodsA database search with the MESH term ‘epidural abscess’ and keywords [‘treatment’ OR ‘management’] were used.Results14 studies were included. The number of SEA patients managed non-operatively ranged from 19 to 142. There was significant heterogeneity across the studies. Pooled Failure of Medical Therapy (FMT) (defined as any poor outcome) was 29.40%. When FMT = mortality the pooled rate was 11.49%. Commonly cited risk factors for FMT included acute neurological compromise, diabetes mellitus, increasing age and Staphylococcus aureus.ConclusionSEA will always be a condition mostly managed surgically. Despite this, there is growing evidence that non-operative management can be possible in the correct patients. The key is in patient selection – patients with any of the above-mentioned risk factors have the potential to deteriorate further on medical treatment and have a worse outcome than if they had undergone emergency surgery straight away. Ongoing research will hopefully further investigate this crucial step.