[Phlegmonous angina (acute phlegmonous tonsillitis) and peritonsillitis and paratonsillitis from a pathohistological and clinical viewpoint].
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Acute Disease↗
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Results for “PHLEGMON”
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[Cervical phlegmons with a report on 2 clinical cases of cervical phlegmon with odontogenic origin].
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Acute Disease↗
[Putrescent phlegmon of the maxillofacial region as a complication of phlegmonous angina].
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Adult↗
A case of phlegmonous esophagitis associated with diffuse phlegmonous gastritis.
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Adult↗
Pancreatic phlegmon. Clinical features and course.
The clinical course of 19 patients with pancreatic phlegmon, as diagnosed by computed tomography (CT) and clinical criteria, was assessed retrospectively and compared to that of eight patients with pancreatic abscess diagnosed either at surgery or with percutaneous aspiration. Controls consisted of 55 patients with uncomplicated acute pancreatitis without CT scans and 11 patients with acute pancreatitis in whom CT scans were negative or only consistent with acute pancreatitis (no phlegmon). The age, sex, and presumed etiology of the pancreatitis were not significantly different in the four groups. Patients with phlegmon had a higher incidence of severe pancreatitis as defined by Ranson's criteria, presence of an abdominal mass, as well as a longer duration of fever, abdominal pain and leukocytosis than controls without CT scans. With the exception of a palpable abdominal mass and fever lasting over five days, the results were similar when comparing the phlegmon group and controls with CT scans, although the severity of the disease and prolonged abdominal pain tended to be increased in the former patients. There was no statistically significant difference in clinical or laboratory criteria between the phlegmon and abscess groups, although the latter group had longer hospital stays and periods with no oral intake (npo). Management of patients with phlegmon tended to include TPN, longer npo periods, antibiotics, and longer hospital stay than in controls without CT scans. Controls with CT scans were managed similarly to the phlegmon group because of prolonged amylase elevation and abdominal pain. Percutaneous aspiration was successful in differentiating abscess from phlegmon in five of six cases. Major complications were rare in the phlegmon group and spontaneous resolution was the rule. Pancreatic phlegmon is a distinct clinical/radiologic entity which may be very difficult to differentiate clinically from pancreatic abscess. Early percutaneous thin-needle aspiration of the inflammatory mass (under CT guidance) seems to be the diagnostic procedure of choice. Management is nonsurgical unless complications arise. The role of TPN and antibiotics is unknown, and controlled studies of these therapeutic approaches in pancreatic phlegmon are needed.
Abscess↗
Phlegmonous enterocolitis.
Eight cases of phlegmonous enterocolitis which involved the small intestine exclusively in 5 patients, colon exclusively in 2, and both small intestine and colon in one are reported. Seven of the cases were studied at autopsy. The intestinal lesion was clearly the cause of death in 3 patients and was probably a secondary finding in 4 others. In one case, the cecum was involved and this segment was surgically resected. Five of the patients gave a history of alcoholism. The livers of the 7 patients studied at autopsy were all abnormal; cirrhosis was present in 4, severe fatty metamorphosis in 2, and moderate fatty metamorphosis in 1. The clinical, morphological, and bacteriological aspects of phlegmonous gastritis and phlegmonous enterocolitis are similar, and these two conditions are thought to represent the same infectious disease involving different levels of the gastrointestinal tract. In most patients the factor(s) predisposing to infection of the gastric and intestinal wall are unknown. In some patients mucosal injury of varied type and septicemia appear to have been the forerunners of the phlegmonous lesion. The possible relationships of ischemic bowel injury, alcoholism, and liver disease to phlegmonous inflammation of the gastrointestinal tract are discussed.
Adult↗
[Results of treatment of deep neck abscesses and phlegmons].
INTRODUCTION: Neck, as a structure very closely connected with oral cavity and pharynx, with great number of lymph nodes, (about 2, 3 of all are in the neck), is sometimes a localization of purulent inflammatory process but its incidence is not so high as the incidence of inflammations of surrounding organs and tissue. Deep neck abscesses are localized under the upper fascial layer. They have a serious clinical picture which could be further complicated if inflammation spreads on vessels or neck organs. If the processes spread toward the mediastinum because of the communication space between medial and deep fascial layer with mediastinum, it could be mediastinal inflammation with high mortality. The aim of this study is evaluation of results of treatment in patients with deep neck abscesses and phlegmons treated at Clinic in a ten year period (1988-1997). MATERIAL AND METHODS: This study comprised 21 patients who were treated at the ENT Clinic in Novi Sad during 1988-1997. The group consisted of 5 female and 16 male patients from one to 65 years of age. Sixteen (76.2%) patients were treated with antibiotics in general practice, and 5 were admitted without previous therapy, 8 patients were afebrile, with temperatures between 37-38 degrees C and 5 with fever and high temperature. In 17 patients 5 days passed from onset of symptoms to admittance at the Clinic, and 4 patients had enlarged neck lymph nodes a few months. Unknown primary site of infections were in 13 (61.9%) patients, that means abscesses developed as colliquation of inflammatory changed lymph node. In the rest of 8 patients abscesses developed as: oropharyngeal inflammation (4 patients), foreign body perforation of esophagus, chronic otitis media, neck injury, malignant lymphoma. Lateral side of the neck was the most frequent site of neck abscesses and phlegmon in 16 (76%) patients. Red skin over the abscesses didn't appear in 4 patients. In 2 patients neck emphysema developed: anaerobic inflammation in one patient and esophageal perforation in the second. In a patient with SE over the 50 per hour the length of the abscess was over 7 cm, and in those with SE over 100 per hour, the whole neck inflammed. All patients underwent surgical therapy between 24 to 48 h after admission with incision or excision of the abscesses. Pus was collected for culture during the incision or excision of the abscesses and phlegmon. Bacteria were discovered in specimens taken during the incision in 4 (19%) of patients. Different aerobic and anaerobic bacteria were isolated: Enterococcus, Peptostreptococcus sp, Streptococcus viridans, Clostridium species. Surgery was the basic therapy of neck phlegmons and abscesses. In all patients incision was sutured in the second stage. Only one patient got paralysis of n. accesorius. One patient died with gas gangrene of the neck. DISCUSSION AND CONCLUSION: Deep neck abscesses and phlegmons are relatively rare inflammations in spite of high incidence of surrounding tissue inflammations. The most frequent causes are inflammatory changes of lymph nodes. Treatment has to be urgent, because of vital neck structures and communications between deep neck space and mediastinum. We consider that surgery is the basic principle of therapy although we have not had experience with needle aspiration. Antimicrobial agents must be given only parenterally.
Abscess↗
[X-ray diagnosis of a phlegmon of the retroperitoneal space tissue].
The paper is concerned with the results of a combined x-ray study of 36 patients with phlegmon of retroperitoneal fat (RF). The x-ray procedure was described, potentialities and effectiveness of each method (panoramic polypositional investigation of the chest and peritoneal cavity, a contrast study of the G.I. tract) were shown. X-ray semeiotics of phlegmon of RF of different sites, the main differential and diagnostic signs to distinguish between phlegmon and accumulation of gases of other sites and its causes, were described in detail. The accuracy of phlegmon detection with these methods was 97.2%; phlegmon was detected in 35 of 36 patients.
Adult↗
Laparoscopic-assisted ileocolic resections in patients with Crohn's disease: are abscesses, phlegmons, or recurrent disease contraindications?
BACKGROUND: Because of the inflammatory nature of Crohn's disease, ileocolic resections are often difficult to perform, especially if an abscess, phlegmon, or recurrent disease at a previous ileocolic anastomosis is present. Our goal was to determine whether the above factors are contraindications to a successful laparoscopic-assisted ileocolic resection. METHODS: Between 1992 and 1996, 46 laparoscopic-assisted ileocolic resections were attempted. Fourteen patients had an abscess or phlegmon treated with bowel rest before operation (group I), 10 patients had recurrent Crohn's disease at the previous ileocolic anastomosis (group II), and 22 patients had no previous operation and no phlegmon or abscess associated with their disease (group III). These groups were compared with each other and with 70 consecutive open ileocolic resections for Crohn's disease during the same time period (group IV). RESULTS: Operative blood loss and time were greater in group IV than in groups I, II, and III (245 versus 151, 131, and 195 ml, respectively, and 202 versus 152, 144, and 139 minutes, respectively). Conversion to open procedure occurred in 5 patients (group I, 1 [7%]; group II, 2 [20%]; group III, 2 [9%]). Morbidity was highest in group IV (21% versus 0%, 10%, and 10%, respectively). Only one patient died (group IV, 1%). Length of hospital stay was longest in group IV (7.9 versus 4.8, 3.9, and 4.5 days, respectively). CONCLUSIONS: The laparoscopic-assisted approach to Crohn's disease is feasible and safe with good outcomes. Co-morbid preoperative findings such as abscess, phlegmon, or recurrent disease at the previous ileocolic anastomosis are not contraindications to a successful laparoscopic-assisted ileocolic resection in select patients.
Abdominal Abscess↗
Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis.
Appendicitis is one of the most common and costly acute abdominal states of illnesses. Previous studies suggest two types of appendicitis which may be different entities, one which may resolve spontaneously and another that progresses to gangrene and perforation. Gangrenous appendicitis has a positive association to states of Th1 mediated immunity whereas Th2 associated immune states are associated with lower risk of appendicitis. This study investigated the inflammatory response pattern in patients previously appendicectomized for gangrenous (n = 7), or phlegmonous appendicitis (n = 8) and those with a non-inflamed appendix (n = 5). Peripheral blood mononuclear cells were analysed with ELISPOT analysis for number of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-4, IL-10 and IL-12 secreting cells or with ELISA for concentration of spontaneous or antigen/mitogen stimulated IFN-gamma, IL-5 and IL-10. Spontaneously IL-10 secreting cells/100,000 lymphocytes were increased in the gangrenous group compared to the phlegmonous group (P = 0.015). The median concentration of IL-10 secreted after Tetanus toxoid (TT)-stimulation were higher in the gangrenous group and the control group, than the phlegmonous group (P = 0.048 and P = 0.027, respectively). The median concentration of TT induced IFN-gamma secretion was higher for the gangrenous group compared to both the phlegmonous group and the control group (P = 0.037 and P = 0.003). Individuals with a history of gangrenous appendicitis demonstrated ability to increased IL-10 and IFN-gamma production. The increased IFN-gamma may support the notion of gangrenous appendicitis as an uncontrolled Th1 mediated inflammatory response and increased IL-10 may speculatively indicate the involvement of cytotoxic cells in the progression to perforation.
Adolescent↗
[Pancreatic phlegmon: a potentially fatal form of acute pancreatitis].
AIM: To report the clinical characteristics of a group of patients with pancreatic phlegmon (PF) seen at the Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City. MATERIAL AND METHODS: We reviewed all the cases of acute pancreatitis hospitalized from January 1981 to December 1989. The diagnosis of pancreatic phlegmon was established when the CT scan showed a solid mass in the pancreas and peripancreatic region with more than 20 Hounsfield units without liquid collections or a fibrous capsule. We analyzed clinical, biochemical, and radiological data. RESULTS: Acute pancreatitis was diagnosed in 132 patients. In 14 a pancreatic phlegmon was observed (10.6%). Twelve were men; the mean age was 44.7 years. In six cases acute pancreatitis was secondary to alcohol abuse and in four to gallstones. Abdominal pain was present in all patients. Ten had leucocitosis and seven fever and/or jaundice. An abdominal mass was detected in three cases. The severity of pancreatitis was graded according to our institutional criteria as mild (0-2 signs) or severe (3-5 signs). In 10 patients AP was graded as mild: no mortality was observed in this group but three presented complications (two liquid collections and one an abscess). The four patients with severe pancreatitis presented complications and three died (one abscess, two multiorgan failure). Five patients were operated on. In three an abscess was drained. CONCLUSIONS: Pancreatic phlegmon is a potentially severe form of AP. All patients who died presented, in addition to PF, clinical criteria of severe pancreatitis.
Acute Disease↗
Phlegmon of the pancreas.
One of the significant complications of pancreatitis is the development of a pancreatic phlegmon, a noninfected solid mass of inflamed pancreatic and retroperitoneal tissues. Clinically, a phlegmon may be confused with other pancreatic masses, especially a pseudocyst. Phlegmons typically present as palpable epigastric masses which are solid on sonography and computerized tomography. They usually resolve in a few weeks with nonsurgical conservative therapy. This report discusses the radiographic and clinical picture of pancreatic phlegmons as illustrated by four cases.
Acute Disease↗
Phlegmonous gastritis in a patient with rheumatoid arthritis.
Phlegmonous gastritis is an acute infection of the stomach wall by pyogenic bacteria. It represents an extremely rare disease with a fulminating course and a high mortality rate. A precise lifetime diagnosis is generally unsuccessful. The inflammation, most often caused by alpha-hemolytic streptococci, is most frequently expressed in patients who are more susceptible to infection. Among these are elderly patients, women, patients with chronic gastritis, chronic peptic ulcer, hepatic cirrhosis and decreased immune tolerance, T-cell leukemia, patients with a low socio-economic status and alcoholics. In our paper we are describing the case of a 66-year old female patient, who had received many years of treatment for rheumatoid arthritis. She died due to phlegmonous gastritis, which was only established post-mortem. The authors share the opinion that the occurrence of the phlegmonous form of gastritis was influenced significantly by the treatment with nonsteroidal antirheumatics and corticosteroids, which she had received for many years and also immediately prior to the complication.
Aged↗
Histological features of resolving acute, non-complicated phlegmonous appendicitis.
The histological features of resolving acute appendicitis are described. Formalin-fixed, paraffin-embedded appendices of 200 cases with acute, non-complicated phlegmonous appendicitis were reviewed. In 80 out of 200 cases, a histological picture characterized by a predominantly lymphocytic infiltrate of the subserosa and muscularis propria or the subserosa alone was found. In the affected muscularis propria, eosinophils were admixed with lymphocytes, and the cellular infiltrate showed a lesser degree than that of the classic phlegmonous appendicitis. A multifocal, rather than a diffuse pattern of infiltration was observed. Cases were divided into three groups. Group 1: appendices with the typical features of phlegmonous appendicitis: 120 cases, 60%. Group 2: appendices with a predominantly lymphocytic infiltrate in the muscularis propria, subserosa, or both, and no granulation tissue: 65 cases, 32.5%. Group 3: appendices with granulation tissue: 15 cases, 7.5%. Complicated appendicitis was excluded. Data on the duration of the clinical symptoms were derived from the clinical history. The differences between the mean duration time of groups 1 and 2, and of groups 2 and 3 were statistically significant. The findings support the contention that a mixed infiltrate of lymphocytes and eosinophils represents a regression phase of acute appendicitis.
Acute Disease↗
Necrotizing gastritis and phlegmonous gastritis--are they separate entities?
Phlegmonous gastritis, although a rare condition, is a submucosal bacterial infection strictly confined to the stomach with characteristic macroscopic and histological findings. A case of necrotizing gastritis with perforation is presented, and another similar case is reviewed, in which the gross and microscopic features are considerably different from those ascribed to classical phlegmonous gastritis. There was no evidence of an infectious aetiology in either case, and the predominant feature was necrosis. It is proposed that this variant may represent a separate disease entity of unknown aetiology. A combination of early radical gastric resection and vigorous antibiotic therapy appears to be the treatment of choice in both classical phlegmonous gastritis and necrotizing gastritis.
Adult↗
Emergency operation for phlegmonous gastritis.
Phlegmonous gastritis is a rare inflammatory lesion in which bacterial infection occurs in the gastric wall. A case of phlegmonous gastritis producing an intramural filling defect in the stomach is presented. Endoscopy showed edematous and reddened gastric mucosa with a mass lesion in the gastric body and antrum. An abdominal CT scan showed diffuse and irregular thickening of the gastric wall. At emergency operation, a total gastrectomy with splenectomy was performed. The most important differential diagnosis is carcinoma, especially scirrhous-type gastric cancer. Radiographic findings of phlegmonous gastritis resemble those of scirrhous gastric cancer. More frequent recognition of this disease, early diagnosis and prompt institution of treatment is essential.
Aged↗
Phlegmonous gastritis associated with Kaposi sarcoma: a case report and review of the literature.
We report a case of phlegmonous gastritis associated with Kaposi sarcoma in a 37-year-old, human immunodeficiency virus (HIV)-positive man who presented with an acute abdomen. Computed tomographic scan revealed free fluid in the abdominal cavity and a thickened gastric wall. A partial gastrectomy was performed. The resected portion of stomach had a hemorrhagic, necrotic thickened wall and showed extensive, acute suppurative inflammation, especially in the submucosa, with focal transmural involvement. Beneath an area of healing ulceration, a focus of Kaposi sarcoma was present. Group A beta-hemolytic streptococcus was grown from peritoneal fluid, and treatment with numerous antibiotics was initiated. After a difficult postoperative course that responded to 8 weeks of antibiotic therapy, the patient was medically stable and discharged from the hospital on antiretroviral therapy for HIV. Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the gastric wall. Kaposi sarcoma is one of the most common malignancies in HIV-positive patients, and gastric involvement is relatively common in those patients with systemic Kaposi sarcoma. To our knowledge, this is the first reported case of phlegmonous gastritis associated with Kaposi sarcoma, and it represents a rare survival following surgical and antibiotic therapy.
Adult↗
[The monitoring of immunological indices in odontogenic abscesses and phlegmons and their differential diagnostic meaning].
The immune homeostasis parameters have been monitored in 31 patients with odontogenic abscesses and phlegmons. Immunological values possessing differential diagnostic significance have been detected. Activation of phagocytosis, spontaneous and stimulated activity of phagocytes in parallel with a moderate decrease in the cellular functional reserve, increased immunoregulatory index, and moderate shifts in the concentrations of IgG and IgM are characteristic of odontogenic abscesses, while odontogenic phlegmons are characterized by deep depression of the phagocyte function and failure of cellular and humoral immunity. The disorders in the immune functions of patients with odontogenic phlegmons normalized 2 weeks later than in those with odontogenic abscesses. Both diseases run a wave-like course and are characterized by phasic changes in immunological parameters, which is significant for determining pathogenesis and choosing appropriate immunocorrective therapy.
Abscess↗