Abscess Research Papers - Academia.edu (original) (raw)

Pharyngeal perforations are uncommon in children and are usually secondary to instrumentation or external penetrating injuries. A delay in management can lead to life-threatening complications such as ret-ropharyngeal abscess,... more

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- Adolescent, X Rays, Emergency Room, Pediatric Surgery
- by Guadalupe Fraile
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- Medical Microbiology, Aged, Enfermedades, Abscess

Background. Epiglottitis is more commonly seen in children less than 6 years of age, although this entity has also been well described among adults. A coalescence of infection of the epiglottis, or epiglottic abscess, has been infrequently reported in series of epiglottitis. Risk factors for epiglottic abscess include adult age at onset, diabetes, and the presence of a foreign body.

- by Brendan Stack
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- Dentistry, Clinical Sciences, Abscess
- by Fu-der Wang
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- Treatment Outcome, Critical Care, Hospitals, Stroke

IntroductionObtaining hemostasis in the surgical crypt during periradicular surgery is essential. It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material. Although current materials may not be moisture sensitive during setting, hemostasis is important for proper placement of root-end filling materials during apical surgery. A new hemostatic agent, HemCon dental

- by Harvey Kessler
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- Dentistry, Wound Healing, Chitosan, Treatment Outcome

message: Serratia marcescens infections that occur in older children and adults with chronic granulomatous disease have a pattern different from that seen in infants with CGD in that osteomyelitis is much less common; skin infections form large poorly healing ulcers; and infections frequently occur in a metastatic fashion at multiple sites including cryptic internal sites.

- by Dianne Hilligoss
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- Immunology, Adolescent, Child, Chronic Disease

We aim to compare the incision and drainage against ultrasound-guided aspiration for the treatment of breast abscesses. Sixty-four patients were randomly allocated to Group A (incision and drainage) and Group B (needle aspiration). Incision and drainage was done under general, whereas aspiration was done under local anesthesia with antibiotic coverage after the pus sample was taken for cultures. Time taken to resolve symptoms including point tenderness, erythema and hyperthermia, recurrence of breast abscess, and healing time was recorded. Patients were followed until 8 weeks. Culture and sensitivity of the pus were done. Data were analyzed in SPSS 16.0. The mean difference of healing time was significant (P = 0.001). A total of 93.3 per cent were healed in Group B and 76.6 per cent in Group A (P = 0.033). Twenty-two samples (34.37%) had no bacterial yield and the remaining 42 samples (65.6%) yielded 11 anaerobic cultures (17.18%) and 31 aerobic cultures (48.4%). Ultrasound-guided a...

- by Muhammad Naeem
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- Adolescent, Young Adult, Clinical Sciences, Drainage

BACKGROUND: Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature.
CASE REPORT: A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a “neogallbladder”. Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4 th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel ® Standard for hemostatic purposes. Results of 12-month follow-up were normal.
CONCLUSIONS: Herein, we report the first case of a complication associated with the use of Gelita-Cel ® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.

- by Guglielmo Piozzi
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- Surgery, Neurosurgery, Hemostasis and Thrombosis, Kidney transplantation

Between 1969 and 1987, 68 patients with pancreatic pseudocysts were treated. The median cyst size was 10 cm (range 2–25 cm). Nine patients were managed conservatively with resolution of the pseudocyst occurring in eight patients. These patients had significantly smaller (median 4 cm) cysts compared with those in both percutaneously and surgically treated patients (P<0·01). In 22 patients the pseudocysts (median 9 cm) were punctured percutaneously under ultrasound guidance and the cyst fluid was aspirated or drained through a catheter. Complete resolution occurred in 13 patients after 1–4 (mean 2·8) punctures per patient, regression occurred in six patients after 1–4 (mean 2·0) puncture procedures per patient and three were unchanged. No complications were noted, except that two patients treated percutaneously required additional surgery. Thirty-seven patients were managed surgically (median cyst size 11 cm) with external drainage (12 patients), cystgast-rostomy (17 patients), cystduodenostomy (three patients) cystjejunostomy (three patients) and pancreatic resection (two patients). Resolution of the cyst was noted in 29 patients, regression in five and three were unchanged. Five patients required additional surgery. Twelve complications were seen in ten patients (27 per cent), most frequently after external drainage. One patient died after surgical treatment. Mean hospital stay was 13 days among patients treated conservatively and 30 days in both percutaneously and surgically treated patients. Aspiration or catheter drainage of pseudocyst fluid guided by ultrasonography seems a safe and effective treatment of pancreatic pseudocysts and should be considered as initial therapy. If surgery is required cystgastrostomy is preferred.

- by Stig Bengmark and +1
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- Surgery, Operations Management, British, Treatment Outcome

Objectif.-Les complications orbitaires des sinusites sont rares mais graves, pouvant engager le pronostic fonctionnel et vital. Le but du travail est d'étudier les particularités épidémiologiques, cliniques et paracliniques des complications orbitaires des sinusites, ainsi que les différentes modalités thérapeutiques et évolutives. Patients et méthodes.-Nous rapportons une étude rétrospective portant sur 34 cas de complications orbitaires des sinusites, colligés sur une période de 12 ans, allant de 1998 à 2009. Résultats.-L'âge moyen de nos patients était de 19 ans trois mois, avec une nette prédominance masculine. Aucun facteur favorisant n'a été retenu. Tous les patients ont consulté pour un oedème périorbitaire. L'examen ophtalmologique a retrouvé en plus de l'oedème périorbitaire, une exophtalmie chez 19 patients, une baisse de l'acuité visuelle chez huit patients et des troubles oculomoteurs chez dix patients. Tous les patients ont eu un scanner du massif facial en urgence, deux patients ont eu une échographie orbitaire et un patient a eu une imagerie par résonance magnétique. Le traitement s'est basé sur une antibiothérapie probabiliste par voie intraveineuse. Un drainage orbitaire a été réalisé chez 20 patients. Le traitement du foyer sinusien a été réalisé chez 16 patients dont 14 cas pendant la phase aiguë, comportant une méatotomie moyenne dans tous les cas. L'évolution immédiate a été favorable dans 97,5 % des cas. Un patient a présenté une récidive. Le recul moyen était de 11 mois. Conclusion.-Les complications orbitaires des sinusites constituent une urgence diagnostique et thérapeutique. Le recours à l'imagerie permet d'orienter la prise en charge. Un traitement adapté et une prise en charge précoce permettent d'améliorer le pronostic vital et fonctionnel.

- by Chiraz Mbarek
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- Magnetic Resonance Imaging, Adolescent, Medicine, Young Adult

The authors describe 51 cases of local complications due to intradermal BCG vaccination which occurred among 117 533 children between 1974 and 1979, in the city of Niteroi (Riode Janeiro State).

- by Clemax Sant'Anna
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- Adolescent, Tuberculosis, Child, Infant

Human lagochilascariasis (HL) is a parasite produced by Lagochilascaris minor Leiper 1909 that also can be found in cats and dogs. HL is considered an emerging zoonosis in the Americas, spreading from Mexico to Argentina, and the Caribbean Islands. The present paper describes three HL cases from the Peninsula of Yucatan, Mexico, recorded in the last decade. It describes the characteristics of the lesions and discusses the route of transmission in humans and particularly in the observed patients.

- by Francisco J Escobedo-Ortegon and +1
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- Adolescent, Mexico, Albendazole, Aged

Figure 1-Dorsoventral (A) and right lateral (B) radiographic views of the skull of a 12.5-year-old Prevost's squirrel (Callosciurus prevostii) evaluated because of right-sided facial swelling and a recent history of dysphagia and stridor.

- by Ellen Bronson and +1
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- Dentistry, Treatment Outcome, Cats, Dogs

Study Objective. To assess the effect of daptomycin compared with vancomycin on the clinical and economic outcomes in patients with complicated skin and skin structure infections. Design. Prospective, open-label study. Setting. Level 1 trauma center in Detroit, Michigan. Patients. Fifty-three adult patients with complicated skin and skin structure infections at risk for methicillin-resistant Staphylococcus aureus (MRSA) infection who were treated with daptomycin and a matched cohort of 212 patients treated with vancomycin. Intervention. Patients in the prospective arm received intravenous daptomycin 4 mg/kg every 24 hours for at least 3 days but not more than 14 days. Historical controls received at least 3 days of vancomycin dosed to achieve trough concentrations of 5-20 µg/ml. Measurements and Main Results. Outcomes evaluated included blinded assessments of clinical resolution, duration of therapy, and costs. The most common diagnoses were cellulitis (31%), abscess (22%), and both cellulitis with abscess (37%). Microbiology differed significantly between groups, with S. aureus found in 27 patients (51%) in the daptomycin group and 167 patients (79%) in the vancomycin group and MRSA in 22 (42%) and 159 (75%), respectively (p<0.001). The proportions of patients with clinical improvement or resolution of their infections on days 3 and 5 were 90% versus 70% and 98% versus 81% in the daptomycin versus vancomycin groups, respectively (p<0.01 for both comparisons), and 100% at the end of therapy in both groups. Among patients with complete resolution of their infections (41 patients [77%] with daptomycin vs 89 patients [42%] with vancomycin, p<0.05), median duration of intravenous therapy was 4 and 7 days, respectively, (p<0.001), and hospital costs were 5027and5027 and 5027and7552 (p<0.001). Conclusions. Patients receiving daptomycin achieved more rapid resolution of symptoms and clinical cure and had a decreased duration of inpatient therapy compared with those receiving vancomycin. This study suggests that daptomycin is a cost-effective alternative to vancomycin for complicated skin and skin structure infections.

- by Peggy McKinnon
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- Treatment Outcome, Vancomycin, Prospective studies, Hospital costs

Pyoderma gangrenosum is a cutaneous disorder associated with systemic diseases such as ulcerative colitis, Crohn's disease, rheumatoid arthritis, and blood dyscrasias. We are reporting two cases of pustular pyoderma gangrenosum associated with ulcerative colitis. One patient had inactive bowel disease when she developed her third episode of pustules, erosions, and nodules on the left leg. The other patient exhibited a widespread painful vesiculopustular eruption that coincided with the onset of her colitis. Both patients presented with pustules as the primary manifestation of their pyoderma gangrenosum. Histologic examination of skin from both patients revealed an acute perifollicular inflammation. Pyoderma gangrenosum should be considered in the differential diagnosis of pustular disorders in children with underlying conditions such as ulcerative colitis. (J AM ACAD DERMATOL 15:608-614, 1986.)

- by Frederick Suchy
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- Inflammation, Adolescent, Child, Ulcerative colitis

Introduction: Bartholin's cysts/abscess affects 2% of women. Conventional treatment is marsupialisation under general anaesthetic. We evaluated a conservative approach in a non-randomised prospective interventional study over 12 months.Method: Women with a Bartholin's abscess were counselled and those who opted for the Word catheter (WC) had it inserted under local anaesthetic (follow up at one week and four weeks, when catheter was removed). Women recorded pain scores and completed a qualitative questionnaire and had telephone follow up at six months. Outcome measures were abscess resolution and acceptability of treatment.Results: Fifty-eight women attended with a Bartholin's abscess requiring drainage. Twenty-three of 58 (40%) elected for marsupialisation. Thirty-five of 58 (60%) women had a WC inserted. Twenty-seven of 35 (77%) women retained their catheter for four weeks (three catheters fell out within 24 h of insertion, three catheters fell out within one week, one fell out after 11 days and there was one failed insertion). One woman had a recurrence six months after treatment. Abscess resolution occurred in 34 of 35 (97%). No woman reported significant discomfort at one week. Twenty-four of 27 women (89%) said that if they suffered a recurrence, they would have another WC inserted. Three of 27 (11%) women had intercourse within the second week of catheter insertion and reported that it was not uncomfortable. Fourteen women who had marsupialisation were traced and none had suffered a recurrence six months after treatment.Conclusions: The WC is a safe and effective treatment for a Bartholin's abscess. It may be considered as an alternative to marsupialisation.

- by Tom Bourne
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- Pain, Treatment Outcome, England, Prospective studies
- by Rupert Woods and +1
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- Perissodactyla, Differential Diagnosis, New South Wales, Lung

Dermoid cysts are rare lesions of the head and neck that usually present in children as an asymptomatic, slowly growing mass. We report a case that demonstrates that dermoid cysts can present later in life as a recurrent acute infection. Our patient was a 48-year-old man with a 22-year history of recurrent abscesses of the tongue and floor of the mouth that had required a tracheotomy and multiple hospitalizations. Magnetic resonance imaging performed between acute episodes revealed the presence of a 1.8-cm lesion within the tongue musculature. The patient underwent resection, and pathology was consistent with a lingual dermoid cyst. At 2 years of follow-up, he experienced no recurrence of symptoms.

- by Annemieke van Zante and +1
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- Magnetic Resonance Imaging, Ear Nose and Throat, Recurrence, Clinical Sciences

Purpose: The purpose of this study is to assess the anatomical spaces and causative micro-organisms responsible for deep fascial space head and neck infections and evaluate the resistance of antibiotics used in the treatment of these infections. Patients and Methods: A 6-year retrospective study evaluated hospital records of 103 patients. All patients in this study underwent surgical incision and drainage, received IV antibiotics, and had culture and sensitivity performed. Patient demographics reviewed were gender, age, involved fascial space(s), micro-organisms identified and antibiotic resistance from culture and sensitivity testing. Results: There were 56 male (54%) and 47 (46%) female patients. The submandibular space was the most frequent location for a single space abscess (30%), followed by the buccal space (27.5%) and the lateral pharyngeal space (12.5%). Sixty-three patients presented with multiple space involvement, totaling 142 spaces involved. A total of 269 bacterial strains were isolated from 103 patients. The bacteria were found to be 63.5% gram-positive. Gram-positive cocci were isolated 57.7% of specimens and gram-negative rods were isolated in 33% of cultures. There were 178 aerobes (65.7%) and 91 anaerobes (34.3%) isolated. The most common bacteria isolated were Viridans streptococci, Provetella, Staphylococci, and Peptostreptococcus. Culture and sensitivities were reviewed on 101 patients. Conclusion: Patients who underwent surgical incision and drainage in the operating room had a tendency for involvement of multiple space abscesses with the submandibular space, submental, and lateral pharyngeal spaces effected most frequently. Cultures and sensitivities commonly showed greater growth in aerobes (65.7%) than in anaerobes. Gram positive cocci and gram negative rods had the greatest growth percentage in cultures.

- by Vincent Ziccardi
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- Microbiology, Dentistry, Adolescent, Oral and Maxillofacial Surgery
- by Ajay Singh
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- Facial Paralysis, Magnetic Resonance Imaging, Atherosclerosis, Rheumatoid Arthritis

IDUs who did not have abscess or other bacterial infection during the previous year and who were stratummatched to cases according to age, sex, and race (controls). Subcutaneous or intramuscular, instead of intravenous, injection is a major risk factor for abscess among IDUs. The injection of a cocaine and heroin mixture, or "speedball," may predispose patients to develop abscess by inducing soft-tissue ischemia. Cleaning the skin with alcohol before injection was found to have a protective effect. Neither human immunodeficiency virus nor human T-lymphotropic virus type II seropositivity was significantly associated with abscess.

- by Brian Edlin
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- Biological Sciences, Risk factors, Human immunodeficiency virus, Risk Factors

Objectives: Soft tissue infections are a common presenting complaint in the emergency department (ED). The authors sought to determine the utility of ED bedside ultrasonography (US) in detecting subcutaneous abscesses. Methods: Between August 2003 and November 2004, a prospective, convenience sample of adult patients with a chief complaint suggestive of cellulitis and/or abscess was enrolled. US was performed by attending physicians or residents who had attended a 30-minute training session in soft tissue US. The treating physician recorded a yes/no assessment of whether he or she believed an abscess was present before and after the US examination. Incision and drainage (I 1 D) was the criterion standard when performed, while resolution on seven-day follow-up was the criterion standard when I 1 D was not performed. Results: Sixty-four of 107 patients had I 1 D-proven abscess, 17 of 107 had negative I 1 D, and 26 of 107 improved with antibiotic therapy alone. The sensi-tivity of clinical examination for abscesses was 86% (95% confidence interval [CI] = 76% to 93%), and the specificity was 70% (95% CI = 55% to 82%). The positive predictive value was 81% (95% CI = 70% to 90%), and the negative predictive value was 77% (95% CI = 62% to 88%). The sensitivity of US for abscess was 98% (95% CI = 93% to 100%), and the specificity was 88% (95% CI = 76% to 96%). The positive predictive value was 93% (95% CI = 84% to 97%), and the negative predictive value was 97% (95% CI = 88% to 100%). Of 18 cases in which US disagreed with the clinical examination, US was correct in 17 (94% of cases with disagreement, x 2 = 14.2, p = 0.0002). Conclusions: ED bedside US improves accuracy in detection of superficial abscesses.

- by Chris Fox
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- Emergency Medicine, Adolescent, Prospective studies, Follow-up studies

Lung disease is common among wild and managed populations of bottlenose dolphins Tursiops truncatus. The purpose of the study was to apply standardized techniques to the ultrasound evaluation of dolphin lungs, and to identify normal and abnormal sonographic findings associated with pleuropulmonary diseases. During a 5 yr period (2005 to 2010), 498 non-cardiac thoracic ultrasound exams were performed on bottlenose dolphins at the Navy Marine Mammal Program in San Diego, California, USA. Exams were conducted as part of routine physical exams, diagnostic workups, and disease monitoring. In the majority of routine exams, no abnormal pleural or pulmonary findings were detected with ultrasound. Abnormal findings were typically detected during non-routine exams to identify and track disease progression or resolution; therefore, abnormal results are overrepresented in the study. In order of decreasing prevalence, abnormal sonographic findings included evidence of alveolar-interstitial syndrome, pleural effusion, pulmonary masses, and pulmonary consolidation. Of these findings, alveolar-interstitial syndrome was generally nonspecific as it represented several possible disease states. Pairing ultrasound findings with clinical signs was critical to determine relevance. Pleural effusion, pulmonary masses, and pulmonary consolidation were relatively straightforward to diagnose and interpret. Further diagnostics were performed to obtain definitive diagnoses when appropriate, specifically ultrasound-guided thoracocentesis, fine needle aspirates, and lung biopsies, as well as radiographs and computed tomography (CT) exams. Occasionally, post mortem gross necropsy and histo pathology data were available to provide confirmation of diagnoses. Thoracic ultrasound was determined to be a valuable diagnostic tool for detecting pleural and pulmonary diseases in dolphins.

- by Mauricio Solano and +1
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- Biological Sciences, Lung Diseases, Lung, Species Specificity

new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation; X. Anorectal sinus and band: anatomic nature and surgical significance. Dis Colon Rectum 1980;23:170-179. A study, comprising dissection and microscopic examination of the pectinate area with special consideration to anal glands, was performed in 29 cadavers varying from fully mature neonatal deaths to 52 years of age. At the junction of the anal canal proper with the rectal neck, an "anorectal sinus" (a submucosal anal circumferential depression) was identified in 18 specimens; in 6 specimens, the anorectal sinus was replaced by a fibroepithelial band ("anorectal band"); in 5 specimens, the anorectal sinus was absent, and in 3 of the 5 specimens only scattered epithelial cells ("epithelial debris" of the anorectal sinus) were detected. T h e s e findings suggest that the anorectal sinus is an embryonic vestige which results from hindgut "invagination" by the proctodeum. Its persistence or partial obliteration w o u l d result in the formation of tubular structures which are considered by investigators as anal glands. The sinus may be completely obliterated or may leave b e h i n d a submucosal "anorectal band" or scattered "epithelial debris." Evidence in favor of this new concept is put forward. The role of anoreetal sinus, anorectal band, and epithelial debris in the genesis of some idiopathic anal lesions is discussed. [

- by Zakaria Hamid
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- Surgery, Adolescent, Methods, Child

Different neoplasms and infections are known to involve the masticator space, but pathological diagnosis and treatment of these lesions are not always simple due to anatomical complexity. We treated a 65year-old woman with an abscess in the masticator space suffering from trismus and swelling over left cheek region and left-TMJ pain, which was initially diagnosed as a superficial cheek abscess. Masticator space abscesses have been reported more frequently in recent years. They are usually secondary to extractions of the first and second mandibular molar teeth Therefore, Successful aspiration of pus was followed by an instantaneous improvement in the ability to open the mouth for a period of at least 24 hours. The infection had spread upward along the mastication muscles, resulting in an abscess in both the upper masseter muscle and the lower temporalis muscle. Based on a review of the literature, most abscesses in the masticator space originate from the mandibular molar, while the most impressive physical finding varied between the submandibular region and temporal fossa, as did its acute or chronic clinical course. We emphasize diagnostic significance when assessing findings for each masticator muscle and mandibular bone depicted using computed tomography.

- by IOSR Journals
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- Ct Scan, Trismus, Abscess

482 Correspondence 6 Sidell N, Connor MJ, Chang B, et al. Effects of 13-cis retinoic acid therapy on human antibody responses to defined protein antigens. J Invest Dermatol 1990; 95: 597-602. 7 Tsambaos D, Zimmermann B. Effects of synthetic retinoids on cellular systems. In: Roenigk HH, Maibach HI, eds. Psoriasis, 2nd edn. New York: Marcel Dekker, 1991: 659-707. Figure 1 Pure cultures of Enterobacter agglomerans, blood agar (no-selective medium) and MacConkey agar (selective medium)

An epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia. A fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess. Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5days from his admission to the hospital after an improvement was noticed in his epiglottis. Treatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present.

- by Ben-zion Joshua
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- Treatment Outcome, Risk assessment, Follow-up studies, Clinical Sciences

Lesions in the spleen may be encountered in a variety of clinical settings ranging from asymptomatic patients to patients who are critically ill. Etiologies for multifocal splenic lesions include infectious and inflammatory processes, primary vascular and lymphoid neoplasms, metastatic disease, vascular processes, and systemic diseases. There is often overlap in the imaging appearance alone, so the clinical setting is very helpful in differential diagnosis. In the immunocompromised patient, multiple small splenic lesions usually represent disseminated fungal disease and microabscesses. The spleen is a relatively rare site for metastatic disease; patients with metastatic lesions in the spleen usually have disease in other sites as well. Breast, lung, ovary, melanoma, and colon cancer are common primary tumors that metastasize to the spleen. Vascular neoplasms of the spleen represent the majority of the nonhematologic/nonlymphoid neoplasms and commonly produce multifocal lesions. Sple...

- by Terry Desser
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- Inflammation, Spleen, Differential Diagnosis, Clinical Sciences
- by David Manthey and +1
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- Anti-Bacterial Agents, Drainage, Abscess, New England Journalof Medicine

Artefactually enhanced putrefactive and autolytic changes may be misinterpreted as indicating a prolonged postmortem interval and throw doubt on the veracity of witness statements. Review of files from Forensic Science SA and the literature revealed a number of external and internal factors that may be responsible for accelerating these processes. Exogenous factors included exposure to elevated environmental temperatures, both outdoors and indoors, exacerbated by increased humidity or fires. Situations indoor involved exposure to central heating, hot water, saunas and electric blankets. Deaths within motor vehicles were also characterized by enhanced decomposition. Failure to quickly or adequately refrigerate bodies may also lead to early decomposition. Endogenous factors included fever, infections, illicit and prescription drugs, obesity and insulin-dependent diabetes mellitus. When these factors or conditions are identified at autopsy less significance should, therefore, be attached to changes of decomposition as markers of time since death.

- by Roger Byard
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- Forensic Science, Decomposition, Forensic Pathology, Adolescent

Since 2007, 21 female and 1 male patient aged 25 to 55 years, who either did not have any obvious causative infection source or, despite the presence of nonvital teeth, did not display typical symptoms of odontogenic infection, were treated for acute facial inflammation. All these patients admitted previous application of injectable soft tissue fillers (ISTFs) performed in either private plastic surgery and dermatology practices or cosmetic salons. The period between injection and infection varied from 1 week to 6 years. The injected substance remained unknown in many cases. Of the 22 patients, 3 were diagnosed with facial cellulitis, 4 with periorbital abscess, and 15 with a buccal space abscess. ISTFs provide an attractive option in facial rejuvenation. With their increasing use, the prevalence of complications is also expected to increase. Infectious complications of ISTFs were previously unknown in Kuwait. Although these products are primarily meant for treatment of the aging face, the age pattern of our patients suggests their frequent misuse and spurious indications. Especially worrisome is the recently observed application of fillers in cosmetic salons. We believe that the use of ISTFs should be regulated and their administration in nonmedical facilities prohibited. Patients with an atypical course of facial inflammation should be questioned about a history of cosmetic procedures.

- by Petr Schütz
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- Dentistry, Oral and Maxillofacial Surgery, Adipose tissue, Collagen

- by Shawn Johnson
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- Biological Sciences, Lung Diseases, Lung, Species Specificity

To evaluate real-time qualitative ultrasound elastography as an adjunct to conventional sonography for evaluation of non-nodal neck masses identified in routine clinical practice, 52 consecutive masses in 49 patients underwent both techniques. Lesion stiffness was graded visually on chromatic-scale elastograms from ES0-3 (low to high). Diagnosis was based on (cyto)pathology , corroborative cross-sectional imaging (18) or characteristic conventional sonography (23). There were 16 lipomas, 15 lymphatic/venous vascular malformations (LVVMs), six neurogenic tumours/neuromas, five thyroglossal duct cysts (TGCs), five (epi)dermoids, three abscesses, one second-arch branchial cleft cyst (BCC), and one soft-tissue metastasis. In general terms, lesion stiffness was high (ES2-3) for neurogenic tumours/neuromas, (epi)dermoids and metastasis, and low (ES0-1) for lipomas, LVVM, TGCs and BCC. Abscesses displayed variable stiffness according to fluid content. Technical limitations and artefacts of elastograms were identified. Data from real-time qualitative ultrasound elastography may be a useful adjunct to sonography for diagnosis of non-nodal neck masses (

- by Kunwar Bhatia and +1
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- Ultrasound, Adolescent, Clinical Practice, Child

Background In the interest of presenting historical background for modern-day medicine and surgery, the authors comment on the concepts of the eminent Byzantine physician Aetius of Amida (sixth century A.D.) in surgical treatment of diseases of the womb. Study design The 16th book of Aetius' work Tetrabiblus, in the original Greek language, a treatise on gynecology and obstetrics of his era, was investigated. Comparison was then made of the relative knowledge among ancient and Byzantine physicians. Discussion Aetius analytically describes many surgical diseases of the womb (prolapse, abscesses, phimosis, atresia, hemorrhoids, stones, thymos, chaps) and gives a detailed symptomatology and conservative and surgical treatment. His work followed Hippocratic, Roman, and early Byzantine physicians, especially Soranus, the ''Father of ancient gynecology and obstetrics'' and influenced later physicians of his era and beyond. Conclusions Aetius of Amida gives significant information about surgical approaches to diseases of the womb, the most detailed of any medical writer of his epoch. His descriptions, following the Hippocratic and mainly the Hellenistic and Roman traditions, influenced Islamic and European medicine, and through them the rest of the world, constituting the roots of the specialty of gynecology.

- by Gerassimos Lascaratos
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- Ancient History, Byzantium, Clinical Sciences, Study design

O t o l a r y ng o l o g i a P o l s k a t o m 6 3 , n r 2 , m a r ze c -k w i e c i e ń 2 0 0 9 PRACE ORYGINALNE / ORIGINALS SUMMARY Infl ammatory processes developing in the region of parotid gland can be specifi c or non-specifi c. Non-specifi c infl ammation of bacterial or viral origin, which almost always are secondary to infl ammatory processes in the region of oral cavity and pharynx, can be caused by presence of sialoliths in parotid gland or in the excretory duct. In the paper we presented 11 patients treated for the reason of parotid gland abscesses. Etiology, the course of the disease, and the method of treatment were analyzed.

- by Ewa Osuch-wójcikiewicz
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- Treatment Outcome, Poland, Electrocardiology, Aged

To review the clinical charts of 45 paediatric patients treated for acute otomastoiditis at the ORL Department of the University of Brescia (Italy) between January 1994 and March 2005 and to discuss the diagnostic workup and the outcome of treatment. Twenty-six males and 19 females were admitted with acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented an intracranial complication. Only three of them were not operated upon; one received a ventilation tube (VT); all the others underwent a mastoidectomy within 48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy in 9 cases. Antibiotics alone or with VTs achieved a full recovery in 28 out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients (9 with complications). In severe complications, a canal wall down (CWD) (n=2) or an intact canal wall (ICW) mastoidectomy (n=7) were preferr...

- by Diego Zanetti and +1
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- Treatment Outcome, Adolescent, Child, Infant

The role of emergent musculoskeletal magnetic resonance (MR) imaging has expanded in recent years and now includes assessment of the extent and severity of musculoskeletal infection, diagnosis of occult fractures, characterization of complex fractures, and identification of selected vascular and nerve injuries associated with hip, knee, and elbow fractures and dislocations. In the elite athlete, emergent MR assessment of musculoskeletal injury allows prompt recognition of the nature of the injury, informed decision-making regarding the need for modification of competitive activity, and early institution of therapy. When surgical intervention is required, MR imaging facilitates preoperative planning.

- by James Linklater
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- Magnetic Resonance Imaging, Adolescent, Child, Diabetic Foot

The most frequent disorders of the Bartholin glands are cysts or abscesses. Bartholin gland abscesses occur generally as a result of polymicrobial infections or agents that cause sexually transmitted diseases. But as far as we know, no parasite has been previously reported among the infectious agents that are detected from the abscesses of the Bartholin gland. Here, we report a 45-year-old woman, in the Bartholin abscess aspirate of whom Enterobius vermicularis eggs were detected in between the inflammatory infiltrate by cytological examination.

- by Fahri Yılmaz
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- Treatment Outcome, Obstetrics and Gynaecology, Differential Diagnosis, Abscess
- by Valère Mbou
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- Treatment Outcome, Medicine, Biopsy, Child

The value of the Acute Physiology and Chronic Health Enquiry (APACHE-II) score, the Simplified Acute Physiology score, and the Medical Research Council (MRC) sepsis score were compared with clinical assessment and Ranson and Imrie scores in the evaluation and monitoring of acute pancreatitis in 290 attacks. Attacks were graded mild (231) if uncomplicated, or severe (59) when major organ failure or a pancreatic collection occurred. Only APACHE-II scores were available at the time of admission; they correctly predicted outcome in 77% of attacks and identified 63% of severe attacks, compared with 44% achieved by clinical assessment. After 48 h, APACHE-II was most accurate, and correctly predicted outcome in 88% of attacks, compared with 69% for Ranson and 84% for Imrie scores. APACHE-II predicted 73% of pancreatic collections at 48 h, compared with 65% for Ranson and 58% for Imrie scores. In acute pancreatitis, APACHE-II may facilitate rapid selection of patients for intensive therapy or clinical trials, improve comparison between groups of patients, and indicate that a pancreatic collection is probable.

- by David Leaper
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- Evaluation, Pancreatitis, Adolescent, Prospective studies
- by M. Berguiga
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- Endophthalmitis, Visual acuity, Anti-Bacterial Agents, Optometry and Ophthalmology

Introduction and hypothesis We report our experience with surgical excision for treatment of Skene's gland abscess/ infection after conservative measures have failed. Methods A retrospective review of patients that underwent surgical excision of Skene's gland abscess/infection by a single surgeon from 06/1995 to 09/2008 was performed. Patients were separated into groups based on indication for procedure. Recurrence rate and success rate were calculated. Results The final study group included 34 patients. After initial excision, 88.2% (30/34) of patients had resolution of symptoms. Recurrence of signs and symptoms that prompted further treatment occurred in 30% (9/30). In those that recurred, 88.8% (8/9) of patients had resolution of symptoms after further therapy. Overall success rate in complete resolution of symptoms after all treatment was 85.3%. Only patients to fail were in the urethral pain and recurrent UTI groups. Conclusion Surgical excision is a safe and effective therapy for the treatment of Skene's gland abscess/infection after conservative measures have failed.

- by Nirit Rosenblum
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- Lactobacillus, Urogynecology, Young Adult, Urinary Tract Infections
- by Abraham Goldfarb
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- Zoology, Temporomandibular Joint, Streptococcus Pyogenes, Clinical Sciences

Background: Patients with fever, vomiting, and abdominal pain commonly present to the emergency department, often generating a broad differential diagnosis. We describe the first reported case in the emergency medicine literature of acute lobar nephronia (ALN). Objectives: To describe the presentation, evaluation, and management of acute lobar nephronia. Case Report: A healthy 27-yearold woman presented after 18 h of fever to 39.94 C (103.9 F), nausea, vomiting, and severe right-sided abdominal pain. Despite a normal urinalysis, a contrasted computed tomography scan of the abdomen and pelvis demonstrated right perinephric stranding, which was initially interpreted as pyelonephritis. A staff over-read the following day by a radiology body specialist confirmed ''likely developing abscess,'' consistent with the diagnosis of acute lobar nephronia. Conclusion: A normal urinalysis may move clinicians to dismiss a nephrogenic or urologic process. ALN is considered a midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and intrarenal abscess. Diagnosis may be difficult, and inpatient management, sometimes prolonged, is the norm. Published by Elsevier Inc.

- by Kenneth Frumkin
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- Kidney diseases, Clinical Sciences, Abscess, PYELONEPHRITIS
- by Michel Kahaleh
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- Stents, Catheterization, Fluoroscopy, Clinical Sciences

The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing Broutine[ ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasoundguided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves. (Reg Anesth Pain Med 2010;35: 272Y280)