1/180. Purulent osteomyelitis of the cervical spine with epidural abscess. Operative treatment by means of dorsal and ventral approach.The present case concerns an acute purulent osteomyelitis with an epidural abscess, located particularly in the intervertebral foramen between C5 and C6, which led to infection by staphylococci of the adjacent vertebral arches and vertebral bodies. An obstruction of the CSF passage was discovered by myelography at the level between C5 and C6. The bony tissue changed by inflammation was removed as far as possible by laminectomy. After irrigation of the epidural space with antibiotics and after control of the severe inflammation, the vertebral bodies C6 and C7 which were destroyed by the spreading inflammatory granulations, could be removed by a ventral approach 4 weeks later. The defect was filled with spongiosa chips. After immobilisation in a plaster shell and Crutchfield extension for 8 weeks the patient was slowly mobilized. A fusion of the vertebral bodies C5 and C6, C6/C7 and C7/C1 was achieved. A dislocation of the cervical spine did not occur and the patient recovered completely except for a paresis of the right hand. Treatment of this very rare and severe case was only possible by a combined dorsal and ventral procedure on the cervical spine.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
2/180. Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report.OBJECTIVE AND IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. CLINICAL PRESENTATION: A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa. INTERVENTION: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. CONCLUSION: Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.- - - - - - - - - - ranking = 21.566091367031keywords = empyema, inflammation (Clic here for more details about this article) |
3/180. Peritoneal abscess formation as a late complication of gallstones spilled during laparoscopic cholecystectomy.The case is described of a 74-year-old woman who presented with an abdominal abscess 1.5 years after laparascopic cholecystectomy. CT and ultrasound showed the presence of gallstones within the abscess. Spillage of gallstones from perforation of the gallbladder is a well recognized complication of laparascopic cholecystectomy, although subsequent abscess formation is unusual especially after a long delay as in this case.- - - - - - - - - - ranking = 3.1306866495352keywords = gallbladder (Clic here for more details about this article) |
4/180. Ultrasonographic evaluation of pericholecystic abscesses.Pericholecystic abscess formation is a serious complication of cholecystitis that develops after gallbladder perforation and is usually associated with acute inflammatory signs and symptoms. Ultrasonographic findings in three surgically proven cases of pericholecystic abscess are reported. The findings ranged from a well defined band of low-level echoes around the gallbladder to multiple, poorly defined hypoechoic masses surrounding an irregular, indistinct gallbladder outline. The former situation correlated with a well encapsulated pericholecystic inflammatory process, while the latter was associated with extensive abscess formation resulting from gallbladder rupture. cholelithiasis was identified in two of the three cases. Ultrasound for preoperative detection of pericholecystic abscess is discussed.- - - - - - - - - - ranking = 13.051113396385keywords = gallbladder, cholecystitis (Clic here for more details about this article) |
5/180. Transdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy.Spillage of gallstones into the peritoneal cavity is a frequent problem during laparoscopic cholecystectomy (as much as 30%) and is frequently dismissed as a benign occurrence. However, several complications associated with spillage of gallstones have been reported recently. Most of these complications presented late after the original procedure, many with clinical pictures not related to biliary etiology, confounding and delaying adequate management. For patients presenting with intraabdominal or thoracic abscesses of unknown etiology, if there is a history of laparoscopic cholecystectomy, regardless of the time interval, certain evaluations should be considered. A sonogram and a CT scan are advisable to detect retained extraluminal gallstones, as most patients will require, not only drainage of fluid collections, but also removal of the stones. A case is described of a patient who presented with a right empyema and transdiaphragmatic abscess 18 months after a laparoscopic cholecystectomy. Treatment included decortication, enbloc resection of the abscess, repair of the diaphragm, and drainage.- - - - - - - - - - ranking = 3.0094416238615keywords = empyema (Clic here for more details about this article) |
6/180. Descending necrotizing mediastinitis with sternocostoclavicular osteomyelitis and partial thoracic empyema: report of a case.We present herein the case of a 50-year-old woman in whom descending necrotizing mediastinitis originating from an anterior neck abscess spread to the left upper bony thorax, resulting in osteomyelitis of the left sternocostoclavicular articulation and left partial thoracic empyema. Transcervical mediastinal irrigation and drainage was performed with aggressive antibiotic therapy, followed by resection of the left sternocostoclavicular joint and debridement of the anterior mediastinum. The patient had an uneventful postoperative course, and her left arm and shoulder mobility was well preserved.- - - - - - - - - - ranking = 15.047208119308keywords = empyema (Clic here for more details about this article) |
7/180. Intralenticular candida species abscess in a premature infant.PURPOSE: To report the clinical and histopathologic findings of a premature infant with severe retinopathy of prematurity complicated by the development of an intralenticular fungal abscess. methods: Case report and literature review. RESULTS: A markedly premature infant developed candida septicemia at 29 weeks postconception. Over the ensuing 10 weeks, cataract and intraocular inflammation developed sequentially in each eye, as did progressive retinopathy of prematurity with tractional retinal detachment. Pars plana vitrectomy and lensectomy revealed intralenticular candida species abscess. CONCLUSION: Progressive cataract and intraocular inflammation in a low birth weight infant may be caused by endogenous intraocular infection secondary to systemic candidiasis. Cataract secondary to retinopathy of prematurity is rare.- - - - - - - - - - ranking = 1keywords = inflammation (Clic here for more details about this article) |
8/180. Retroperitoneal abscess after retained stones during laparoscopic cholecystectomy.Laparoscopic cholecystectomy is associated with a significant risk of gallbladder perforations with bile and stone spillage. The retrieval of dropped stones is sometimes impossible, and intraperitoneally retained stones can be the source of serious complications, such as inflammatory masses or abscesses. The authors describe a patient in whom a large retroperitoneal abscess developed as a result of missed stone fragments during cholecystectomy. Although several cases of intraperitoneal abscess have been reported in the literature, retroperitoneal collection is very uncommon. Crushed and infected stones seem to be the essential prerequisite for abscess formation. Therefore, every attempt should be made to avoid stone spillage and intra-abdominally retained stones. conversion to open surgery has to be considered in the presence of adverse factors, such as primary acute cholecystitis or cholecystitis induced by previous sphincterotomy, or bilirubinate stones believed to be infected. abdominal abscess treatment requires removal of missed stones by surgical incision or new laparoscopic procedure because simple percutaneous drainage is usually unsuccessful.- - - - - - - - - - ranking = 4.1874202460239keywords = gallbladder, cholecystitis (Clic here for more details about this article) |
9/180. A devastating ocular pathogen: beta-streptococcus Group G.PURPOSE: To report the clinical findings, treatment, and outcomes of four cases of beta-streptococcus Group G (BHS-G) ocular infection. methods: The medical and microbiologic records of four cases of BHS-G ocular infection were retrospectively reviewed. RESULTS: Two cases of BHS-G endophthalmitis and two cases of BHS-G keratitis were recorded. Three patients developed fulminant infection within 12 hours of the onset of symptoms. One patient's history was incomplete. One patient developed endophthalmitis from a contaminated donor button; another following cataract surgery. One developed keratitis in a keratoplasty suture tract; and another patient developed a corneal abscess after being struck with a tree branch. The patient with the contaminated donor button developed overwhelming endophthalmitis resulting in no light perception vision, severe pain, and evisceration. The postoperative cataract patient developed a purulent endophthalmitis and is still hypotonus with light perception vision. The second keratitis patient developed a significant suture abscess with marked stromal loss but eventually healed. The traumatic keratitis patient developed a large ulcer with hypopyon and descemetocele but was lost to follow-up. CONCLUSIONS: This is the first report of a series of BHS-G ocular infections. The ocular infections were characterized by rapid onset, extreme inflammation, and--despite in vitro antibiotic sensitivity--a poor or sluggish response to antibiotic therapy.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
10/180. Postoperative mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation.OBJECTIVE: To describe a case of postoperative endophthalmitis caused by mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. methods: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.- - - - - - - - - - ranking = 0.5keywords = inflammation (Clic here for more details about this article) |
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