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Studies performed up to now in animal and man show that potent BCG strains guarantee a higher protection against tuberculosis than strains with weak virulence. Vaccine prepared from a strong BCG strain may be administered in lower doses, reducing the incidence of suppurative adenitis to a level acceptable by the individual patients and the health authorities.
Renal and perirenal staphylococcal suppurative processes are rare since antibiotic era. Three cases are reported. Gram negative organisms are nowadays the most prevalent bacterial species: a urinary tract disease must then be suspected. Early diagnosis is easier with recent event of new imaging techniques. (Ultrasonography and computerized tomography). Percutaneous drainage with the help of antibiotics is the treatment of choice: it is actually a very safe and efficient procedure.
Clinical effectiveness of TMS-19-Q, a new macrolide antibiotic, was evaluated in superficial infectious diseases classified into 6 groups at 13 departments of dermatology. The results obtained were as follows: Final global improvement rating in 311 cases were excellent in 91, good in 158, fair in 45 and poor in 17 and the effective rate was 80.1%. Effective rates in each group were 71.1% in 1st group (folliculitis and acne pustulosa), 78.6% in 2nd group (furuncle, furunculosis and carbuncle), 100% in 3rd group (impetigo), 76.9% in 4th group (phlegmone, superficial lymphangitis, erysipelas and infectious paronychia), 88.7% in 5th group (inflammatory atheroma, subcutaneous abscess, hidradenitis suppurative and acne conglobata) and 77.3% in 6th group (secondary infection). Dominant strains isolated were S. aureus (40.7%), S. epidermidis (26.9%) and anaerobic bacteria (20.8%). S. aureus was frequently isolated from most of all disease. On the other hand, S. epidermidis and anaerobic bacteria were isolated mainly from 1st and 5th group. Optimum daily doses would be over 600 mg. Slight adverse reactions such as gastrointestinal disorders, eruption and malaise were observed in 12 cases.
This report records the first known case in the literature of suppurative pylephlebitis associated with multiple intrahepatic and extrahepatic abscesses and gross hypoalbuminaemia, as a consequence of colonic diverticulitis.
The route of infection in acute suppurative thyroiditis is unknown in most cases; when demonstrated, pyriform sinus fistula appears to be the most frequent one. We report the clinical and laboratory findings of a child in whom culture of the thyroid pus yielded two bacteria which are part of the normal oropharyngeal flora: capnocytophaga ochracea and group F Beta-hemolytic streptococcus. The preliminary results of the culture, which showed a mixed flora, prompted us to search and to find a pyriform sinus fistula. Apart from the onset in infancy, the left lobe involvement and the frequent recurrence, the recovery from the thyroid pus of bacteria from normal oropharyngeal flora should be included in the characteristic features of thyroiditis resulting from an infection through the pyriform sinus fistula.
Report of a 28-year-old female patient with a metastasizing soft tissue sarcoma confined to the oral mucosa and subcutis. The basic disease attracted clinical attention as a nodular febrile nonsuppurative panniculitis (Pfeifer-Weber-Christian disease). Perivascular tumor cells in the subcutis obviously induced localized fat necroses. Ultrastructurally, the pathological cells showed no indicative cytological characteristics other than a close association with reticulin fibers. Apparently, a metastasizing tumor disease can be concealed under the clinical picture of a nodular febrile non suppurative panniculitis--as a paraneoplastic syndrome.
Neonatal suppurative parotitis is described in 6 patients followed by a review of the literature. About 30-40% of the patients were premature, dehydration constitutes a predisposing factor. Infection occurs usually by bacteria ascending the duct. In 5 of our 6 patients infection had been caused by staphylococci; E. coli was found in 2 patients and pseudomonas in 1 patient. The parenteral therapy with antibiotics is usually sufficient.
Initially liver morphology of chronic destructive non-suppurative cholangitis (CDNC) is rather atypical. Therefore, early morphological diagnosis is difficult. First symptoms are severe pruritus and an increase of IgM, AP and gamma-GT. Own investigation of 101 CDNC patients showed that antimitochondrial antibodies (AMA) are generally later present than the increase of the a/m enzymes. Also remarkable is the fact that among 101 patients are 13 men generally observed during the last 3 years. The most difficult problem is the treatment of CDNC. Here we have to differentiate between symptomatic basic treatment and so-called specific treatment. As basic treatment, ammonia-reducing amino acids, phenobarbital and finally cholestyramine are administered in order to diminish the severe pruritus. The diet must be rich on pectine. Lactulose and bifidum milk improve the diminished detoxication function of the liver. As specific treatment prednisolone and/or azathioprin have disappointed. D-penicillamine can influence CDNC at least temporarily. Because of the frequent side-effects D-penicillamine should be administered only in low doses (100-200 mg daily together with 300 mg vitaminee B6). Until not it is uncertain if the extremely bad prognosis of CDNC can be improved by medical treatment of its early stages.
The results of phage therapy applied in further 150 cases of suppurative bacterial infections were analyzed. Positive therapeutic results were obtained in 137 cases (91.3%). The results obtained confirmed the previous findings on great effectiveness of bacteriophages in the treatment of septic infections, spontaneous or postoperative, caused by pyo genic Staphylococci, Klebsiella, Escherichia, Proteus and Pseudomonas.
The experiments with laboratory animals have convincingly shown that CO2-laser can be successfully used for prophylactics of suppurations of postoperative wounds in clinics.
The incidence of acute suppurative mediastinitis after open heart cardiac surgery in a 5 year retrospective study was found to be 1.56%. The commonest causal agent was the DNAse + coagulase + staphylococcus (68.8%). All cases were treated with bactericidal antibiotics and local measures (dosed chest irrigation-drainage in 1 or 2 stages). Adult men, early and/or late reoperation, immediate postoperative complications (cardiovascular collapse, haemorrhage) were positive risk factors. On the other hand, the type of underlying cardiac disease, the duration of surgery and bypass time, emergency surgery, and protocols of prophylactic antibiotic therapy did not seem to influence this risk. No sources of exogenous contamination, no notions of epidemics or periodicity were discovered in this study. The clinical course may be complicated, especially by renal failure. Thirty-two of the 109 patients studied died. However, the prognosis has improved in the last 5 years in relation to technical advances in intensive care and, above all, to adoption of 1 stage dosed chest irrigation-drainage: the mortality rate has fallen from 37.2% in the first period to 20% more recently. When a cure is obtained, it is complete and there are no sequellae. Nevertheless, irrespective of the adoption of draconian measures of asepsis and protocols of prophylactic antibiotic therapy, the risk of acute postoperative mediastinitis persists. This suggests that the efficacy of the patient's local (and general) anti-infective immunity defenses may vary in the presence of constant mediastinal bacterial contamination despite aleatory preventive measures, due to the remenance of the skin flora.
A total of 134 cases are discussed, with suppurated acute obstructive angiocholitis, that underwent surgical treatment over a period of 10 years, representing 12,8% of the total number of organic obstructions of the hepato-choledocus. From the standpoint of the etiopathogenic mechanisms the angiocholitis was determined by biliary lithiasis in 59 cases, by sclerosis of the Oddi sphincter in 5 cases, by postoperative cicatriceal stenosis of the main biliary pathway in 2 cases, by hepatic hydatitosis in 16 cases, by Vater ampuloma in 10 cases by cancers of the main biliary pathway in 40 cases and by the congenital cyst of the choledocus in one case. The high frequency was noted, of the severe forms of ictero-uremigenic angiocholitis (representing 68 cases, or 50,7% of the total, with a death rate of 34%). Medico-surgical treatment should be performed as early as possible, and it must be intensive, complex, and adapted to the anatomo-clinical forms. The authors performed evacuation choledocotomy with external draining in 22 cases (3 deaths), and choledoco-duodenal anastomosis in 46 cases (10 deaths), choledoco-jejunostomia in 3 cases, Oddi sphincterotomia in 12 cases (2 deaths) ampulectomia in 5 cases (2 deaths). Peripheral bilio-hepatodigestive anastomoses were performed in 40 cases with 5 deaths.
Clinico-experimental study of the pentoxyl and methyluracil effect upon the natural resistance in mitral stenosis cases is presented together with the findings obtained in the experiments dealing with the healing of the wounds infected with pathogenic staphylococcus. All the control animals developed subcutaneous abscesses leading to the separation of the wound margins. The inflammation of the wound was less pronounced in the animals treated with pentoxyl and methyluracil. The use of pyrimidin derivatives before and during operation and postoperatively resulted in the decrease of the incidence of postoperative suppurative complications.
Suppurative mesenteric lymphadenitis is so rarely encountered and its symptoms and findings so nonspecific tht it has not yet been diagnosed preoperatively. It seems to occur mainly in children between the ages of 3 and 13 years and presents in a manner suggestive of acute appendicitis. A palpable mass may further support this diagnosis (peri-appendiceal abscess) or encourage the consideration of other diagnoses such as lymphoma or inflammatory bowel disease. Even at laparotomy the diagnosis may not be immediately obvious. The organism is usually a haemolytic streptococcus, but a variety of other organisms have also been isolated. In the second case reported here, a pure growth of Staphylococcus aureus was obtained. Treatment consists of operative drainage with incidental appendicectomy followed by a course of the appropriate antibiotic. The postoperative course is usually uneventful and recovery rapid. The aetiology and mechanisms still have to be explained.
The efficacy of a mark-grading system for the prognosis of the occurrence of suppuration in acquired and congenital heart diseases is analyzed in this work. The mathematical relationship between the sum of marks of the risk and the probability of the occurrence of purulent complication is proved. On the grounds of the found phenomenon a group of patients with high risk of purulent complications, needing some supplementary prophylactic procedures, has been selected. A complex of medicamental and organizational measures has been devised, which ensured more than 1.5-fold decrease of the incidence of surgical infection in high risk patients following operations with extracorporeal circulation.
One hundred and thirty eight septic cases were treated with specific bacteriophages. According to the International Classification of the Diseases (WHO, 1977), the treated cases were divided to 9 categories. Nearly all cases were long-term infections with antibiotic resistant organisms. Only specific bacteriophages were used in association with several types of surgical procedure. The technique of treatment is described. In 129 (93.5%) cases the results were good, in 9 (6.5%) cases local improvement was observed. It is concluded that bacteriophage therapy may be helpful in the treatment of long-term suppurative infections.
The data on comparative study of complications after operations on the large intestine are presented. During the preoperative period, 62 patients of the control group were treated with phthalylsulfathiazole, nevigramon and nystatin. Thirty-nine patients of the test group were treated with metronidazole and kanamycin monosulfate. Kanamycin monosulfate was used 3 days before the operation in a dose of 0.5 g orally 4 times a day whereas metronidazole in a dose of 0.5 g 3 times a day. The last doses of the drugs were administered 4-5 hours before the operation. After the operations the patients were treated with kanamycin sulfate for 3-5 days in a daily dose of 2 g intramuscularly. The number of the postoperative suppurative complications decreased from 22 to 5 per cent. No lethal outcomes were registered in the test group. The number of lethal outcomes in the control group amounted to 8 per cent.
Accumulation of intermediate filaments in lung macrophages and endotheliocytes has been found in patients with chronic alcoholism and purulent destructive pulmonary diseases. Excess accumulation of cytoskeletal elements reflects cell dystrophy. The authors believe that impairment of macrophage function may favour the lingering of the suppurative process.