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[Surgical management of abscessing mastitis and of retromammary abscesses].

This paper analyses the frequency of abscess-forming mastitis and retromammary abscess in evaluating patients of 11712 births from 1972 to 1978. In 69 cases we found an abscess-forming mastitis and in 6 cases a retromammary abscess. In differential diagnosis there are discussed the clinical symptoms of both diseases. Whereas in the case of intramammary abscess a radial incision with contra-incision and drainage is made, the retromammary abscess indicates a curved incision according of the retromammary abscess are not so frequent but must be taken into consideration in the differential diagnosis of inflammatory diseases of the mamma during puerperium.

Abscess

Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess

[Brain abscess (Part 5)--Brain abscess following internal carotid occlusion (author's transl)].

Three cases of brain abscess following an occlusion of the internal carotid artery were reported. Case 1: A 6-year-old girl with congenital heart disease was admitted with headache, disturbance of consciousness and left hemiparesis. Right carotid angiography revealed an occlusion of the right internal carotid artery. After 6 months, she was readmitted with high fever. CT scan revealed a low density area and a ring-like shadow at the same site of cerebral infarction. Case 2: A 69-year-old man was admitted in semicoma and with right hemiplegia. Left angiography revealed an occlusion of the left internal carotid artery. After 2 months, a brain abscess was noted in the infarcted area. Case 3: A 20-year-old man with congenital heart disease, was admitted due to headache, vomiting and high fever. CT scan revealed a brain abscess in the right frontal lobe. Carotid angiography showed bilateral internal carotid artery occlusion. We concluded that diminution of cerebral oxygen and encephalomalacia are predisposing factors to the evolution of brain abscess.

Adult

Relevance of antibiotics in the treatment of brain abscesses. Report of a case with eight simultaneous brain abscesses treated and cured medically.

A case of eight simultaneous brain abscesses in the right cerebral hemisphere, treated medically after puncture of two of them, is reported. Antibiotics and hypertonic mannitol and, after seven days, dexamethasone were sufficient to cure these lesions. CT scan was of primary importance to follow the evolution under treatment. To get the best efficiency from antibiotics, identification of the microorganism and assessment of its resistance to antibiotics are necessary. It is suggested that in certain conditions medical therapy might be sufficient to treat cerebral abscess, after simple puncture to isolate the infecting agent. Corticosteroids should be avoided in the acute phase because they prevent antibiotics from penetrating the abscesses.

Adult

Role of vascular proliferation on angiographic appearance and encapsulation of experimental traumatic and metastatic brain abscesses.

Experimental traumatic abscesses were produced in rhesus monkeys by intracerebral injection of nutrient agar contaminated with Staphylococcus epidermidis, and metastatic abscesses were induced by intracarotid embolization of silicone cylinders contaminated with Staphylococcus epidermidis. All monkeys underwent preoperative and serial postoperative carotid angiography. Traumatic abscesses produced early capsular blushes and progressive anterior cerebral artery displacements. Metastatic abscesses induced transient midline shifts but no capsular stains. Postmortem studies on the monkeys showed that mean capsular thickness and segmental wall vascularity of the traumatic and metastatic abscesses were significantly different (p less than 0.001), despite equal abscess ages and similar abscess volumes. In comparison to traumatic abscesses, metastatic abscesses demonstrated reduced inflammatory cell infiltration and retarded collagen formation around proliferating capsular vessels. Brain surrounding the metastatic abscesses demonstrated ischemic changes. The results suggest that 1) capsular blushes during cerebral angiography are secondary to vascular proliferation within the capsule and not to compression of surrounding brain, 2) vascular staining reflects capsular thickness, 3) capsular vascularity contributes to collagen formation, 4) encapsulation is dependent upon the integrity of surrounding brain, and 5) adjacent cerebral ischemia may impede inflammatory responses involved in capsule formation.

Animals

Ultrasound and gallium for the diagnosis of abdominal and pelvic abscesses.

Two hundred and twenty-two patients presented with clinical suspicion of an abdominal or pelvic abscess. Abscesses tend to locate in the perihepatic spaces or the pelvis, and these areas can easily be examined by ultrasound, using the liver or the urinary bladder as acoustic windows. Thirty-eight of 42 abdominal abscesses, and 32 of 33 pelvic abscesses were correctly diagnosed and located by ultrasound, giving a sensitivity of 93.3%. Of the 145 patients without abscesses, 143 were correctly excluded, giving a specificity of 98.6%. Thirty of these patients also underwent gallium 67 examination. This detected all 7 true negatives and all 10 abscesses, 1 of which was missed by ultrasound. Of the remaining 13 patients with positive gallium results, 10 had nonspecific uptake in diffuse inflammatory conditions, and 3 were false positives with uptake in bowel or in a surgical wound. In those patients with nonspecific gallium uptake, ultrasound was valuable in documenting the absence of an abscess cavity. Conversely, gallium detected a left subphrenic abscess missed by ultrasound. For reasons of economy, speed, and high sensitivity, we believe that ultrasound should be the initial screening procedure for patients with clinical suspicion of abdominal or pelvic abscess. Gallium should be reserved for patients with equivocal ultrasound results of those with septic foci not revealed by ultrasound.

Abdomen

[Cryptogenic liver abscess (author's transl)].

The successful treatment of two patients with cryptogenic liver abscess, a special type of pyogenic abscess, is reported. Quick diagnosis by methods which do not distress the patient, e. g. scintigraphy and echography, leads to a decisive improvement in the prognosis. Opinions are given on the differential diagnosis of cryptogenic, pyogenic and parasitic (amebic) liver abscesses. The good chances for treatment of cryptogenic abscesses compared with the secondary pyogenic liver abscesses are to be found not least in their usually solitary appearance. This is shown particularly clearly in the classification of the patients operated on for pyogenic liver abscess in our hospital in the last ten years into multiple and solitary liver abscess. As in the pyogenic abscess, so in the primary cyptogenic liver abscess is transperitoneal open drainage the method of choice for treatment.

Diagnosis, Differential

EEG in brain abscess: its value in localization compared to other diagnostic tests.

The EEG records of 13 cases of brain abscess were reviewed for their value in localization. Of the 11 cases of supratentorial abscesses localization was achieved in 10, and correct lateralization in the remaining 1 case. Two other cases were cerebellar abscesses; 1 of them showed a false cerebral localization; the other showed no focal abnormalities. The most consistent EEG localizing sign was focal arrhythmic delta waves. These were as slow as 0.5 c/sec in 6 of the 13 cases. Epileptiform discharges in the pre-operative EEG were seen in 4 of the 13 cases. Asymmetry of beta activity correctly lateralized the abscess in 7 of the 11 supratentorial abscesses. Generalized abnormalities when present correlated with depression of consciousness rather than with the duration of illness or the presence of raised intracranial pressure. Indium brain scans were done in 6 supratentorial abscesses and provided correct or approximate localization in 5. Carotid angiograms were also done in 7 cases and localized the abscess in 6. Our findings show that the EEG is comparable to brain scans and contrast radiological studies in localizing supratentorial abscesses. We feel that the combination of EEGs and brain scanslization in suspected brain abscess.

Adolescent

Genomic prediction and genome-wide association study for liver abscesses in crossbred beef cattle.

Liver abscesses are a concern in feedlot cattle, and little is known about the role of genetics in their development. This study aimed to estimate genetic parameters and to identify single-nucleotide polymorphisms (SNPs) associated with liver abscesses. Crossbred cattle representing 18 breeds in the U.S. Meat Animal Research Center Germplasm Evaluation Program were phenotyped for liver abscesses at slaughter (n&#x2005;=&#x2005;9,044). Seventeen percent of cattle had liver abscesses. These cattle had genotypes that were imputed to sequence variant genotypes. After filtering and quality control, 340,723 SNPs were used in the analysis. Liver abscess prevalence was modeled with a single-step genomic best linear unbiased prediction (ssGBLUP) threshold model using a Bayesian framework. The model included contemporary group (sex, treatment group, and slaughter date), additive genomic, and residual effects. Genomic heritability was 0.039 (95% highest posterior density&#x2005;=&#x2005;0.005, 0.081), which was very small. To assess prediction quality, a 5-fold random cross-validation structure was used. Method Linear Regression was used to assess accuracy, bias, and dispersion by comparing estimated breeding values (EBV) from full and reduced analyses. Cross-validation metrics showed EBV based on genotypes had 0.05 reliability (SD&#x2005;<&#x2005;0.01) with no bias relative to EBV based on genotypes and phenotypes. For the genome-wide association study, SNP effects were back calculated from the EBV solutions from ssGBLUP. No SNPs were associated with liver abscesses at a Benjamini-Hochberg adjusted 0.05 significance level. Although a large dataset was used, this result was because of the low genomic heritability and imprecise EBV used to calculate SNP effects. Based on these results, environmental factors contribute to most of the variation in liver abscesses. Genetic selection to reduce liver abscesses would be slow because of the low genomic heritability, measurement late in life, and inability to measure breeding animals. A faster approach would be finding additional environmental interventions that maintain animal performance.

Animals

Pancreatic abscess.

Compared with the general hospital population of patients with pancreatitis, patients with biliary tract or peptic ulcer disease have de novo pancreatic abscesses develop more commonly than patients with alcoholic pancreatitis. The apparent greater predisposition of the patient with biliary tract or peptic ulcer disease to infection does not seem to be due so much to these patients having potential sources of infection, such as an infected biliary tract or leaking ulcer, as to the fact that many patients with alcoholism and hemorrhagic pancreatitis never survive the fluid loss phase of pancreatitis long enough to have a secondary infection and abscess. The mortality associated with the development of de novo pancreatic abscesses is higher in patients with biliary disease, peptic ulcer or idiopathic pancreatitis in comparison with those patients with alcoholic pancreatitis. Some complications of pancreatic abscesses, such as renal failure, may be avoided through appropriate management of fluid losses during the hemorrhagic phase of pancreatitis preceding absecess formation. Good medical management and aggressive use of newer diagnostic and therapeutic modalities may reduce the mortality and complications of pancreatic abscess. Prompt drainage of an abscess once identified is essential to survival. Proximal colostomy or ileostomy is indicated in the patient with a colonic fistula. Large particulate chunks of necrotic pancreas are not easily evacuated through Penrose, cigarette or sump drains. Marsupialization of the abscess may be considered in patients with this type of abscess.

Abscess

Comparison of 131I-tetracycline and 67Ga-citrate as abscess localizing agents.

Previous studies have shown that radiolabeled tetracyclines tend to accumulate in infarcts and necrotic tumors. These results suggested that radiolabeled tetracyclines might also accumulate in necrotic abscesses or areas of inflammation. In order to develop a better abscess scanning agent, we compared the efficiency of 131I-tetracycline with 67Ga-citrate in labeling experimentally induced staphylococcal aureus abscesses in rats 24 and 72 hours after injection. In addition to evaluating 131I-tetracycline as an abscess scanning agent, we hoped to obtain data which might clarify the controversy regarding early versus late gallium scanning in suspected infection. 131I-tetracycline was chosen over 99mTc-tetracycline because the longer half-life of 131I would allow 72 hour imaging. Absolute concentrations of gallium in the abscess contents and in the surrounding areas of inflammation were significantly greater than the concentration of 131I-tetracycline at both 24 and 72 hours. With the exception of blood, muscle, and bone, the abscess-to-tissue activity ratios for gallium and 131I-tetracycline were similar; however, the ratio of gallium activity in the inflammed tissue to other tissues was greater than that of 131I-tetracycline for every tissue examined at both time periods. The data suggest that 131I-tetracycline has little potential as a general abscess scanning agent. The gallium tissue concentrations and tissue ratios suggest that abscesses which can be imaged at 72 hours can probably be imaged at 24 hours, thus allowing earlier initiation of appropriate therapy. Because of the higher lesion-to-blood ratio at 72 hours, a 72-hour scan would appear to be indicated before a scan is interpreted as normal.

Abscess

Tuberculous brain abscess. Report of a case and review of the literature.

Tuberculous brain abscess is a rarely reported form of central nervous system tuberculosis. Fifty-seven cases were found in a review of the world's literature; only 16 met rigid diagnostic criteria. Tuberculous brain abscesses are devoid of the granulomatous reaction associated with tuberculosis. Histologically and clinically, these abscesses are similar to pyogenic brain abscesses. An analysis of 16 verified cases from the literature and one reported case showed that tuberculous brain abscesses usually present acutely, often in the third and fourth decades, commonly have a supratentorial location, frequently present with focal neurologic signs, and are associated with historical and laboratory evidence of tuberculosis. Tuberculous brain abscesses may be difficult to differentiate from pyogenic brain abscesses, tuberculomas, and tuberculous meningitis on the basis of clinical, laboratory, and roentgenographic information. Appropriate therapy includes adequate antituberculous chemotherapy and surgical excision.

Adult

Subphrenic abscess. The new epidemiology.

Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operation account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation.

Adolescent