Ultrasound guided tube drainage of perinephric abscess: Experience of 70 cases.

Objective: To determine the efficacy of ultrasound guided tube drainage of Perinephric abscess. Study Design: Observational study. Setting: Surgical Unit-II and Urology Ward Ghulam Muhammad Mahar Medical College Teaching Hospital Sukkur & Mustafia Hospital Sukkur. Period: February 2016 to January 2020. Material & Methods: 70 cases with Perinephric abscess underwent ultrasound guided tube drainage. Diagnosis was established by history, clinical examination, investigations like ultrasound & CT scan. Patients with emphysematous kidney & chronic sinus formation and with small abscess were excluded from the study. Patients were followed up for 4 weeks for complete regression of abscess cavity on ultrasound. Results: Out of 70 Patients 61.4% were male and 35% were female. 58.5% of the patients had right sided Perinephric abscess. Majority of the patients(42.8%) belonged to age group 41-50 years. 31.4% of the patients were diabetic. Clinically 95.7% of the patients reported with fever and 88.5% with flank pain. Ultrasound guided tube drainage was successful in 65(92.8%) while in 5(7.1%) patients it failed and open drainage was performed. Conclusion: Ultrasound guided tube drainage is an effective way to treat Perinephric abscess with very few minor complications as compared to open drainage.

Umbolith: A Rare Case of Umbilical Lithiasis in Adult

A 20-year old non-diabetic non-hypertensive non-smoker male farmer presented with purulent umbilical discharge for one year. He used to live an unhygienic life. He had throbbing pain, intermittent fever preceded by chills and rigors for fifteen days. He was treated with various antibiotics, analgesics, antipyretics for a long time by local physicians. But he was not cured. The umbilical and periumbilical area were found inflamed, edematous and red with a palpable small hard infra umbilical mass. The mass was irreducible, non-pulsatile, non-compressible and not trans illuminating with no visible and no palpable impulse on coughing. Just prior to incision, a probe was introduced through the umbilicus that had not passed beyond the abdominal wall into the peritoneal cavity indicating that it was a sinus and not a fistula.The infra-umbilical smile incision was deepened and a flap was raised upwards until multiple small calculi of variable consistency were found at a depth. These were extracted. The sinus tract and the accompanying small abscess cavity were excised and sent to the laboratory for culture and sensitivity tests, histopathological examination and other relevant tests. The studies revealed Staphylococcus aureus sensitive to gentamycin and amikacin. The histopathological examination revealed acute inflammatory cells with no granuloma and no malignancy. The patient was given parenteral antibiotics as per the sensitivity test result plus metronidazole against possible anaerobic co-infection. The post-operative period was smooth and uneventful. We like to share our experience of managing this very rare disease of umbilical lithiasis. KYAMC Journal.2021;12(02): 111-113

The Rare Case of Perirenal Abscess in a Child—Possible Mechanisms and Methods of Treatment: A Case Report and Literature Review

Renal and perirenal abscesses are very rare in children. They can be present as an acute emergency condition or insidiously as a chronic disease. The diagnosis is not so obvious, and it is a big challenge, especially when it can simulate a kidney tumor. The treatment can be conservative, preferably with targeted antibiotics, or surgical, consisting primarily of drainage. This publication aims to present a clinical case in which both diagnosis and treatment were a big challenge for the entire treatment team. A 10-year-old male patient was admitted to the hospital because of mild abdominal pain and a temperature of 37.5 °C. The symptoms lasted for a week. In the computed tomography (CT), the lesion’s dimensions were 11.1 × 8.2 × 25 cm, and inflammation, abscess, cyst, and abdominal tumor have been suggested. The decision about surgical treatment was made. An enormous abscess near the right kidney was localized. The patient’s condition stabilized after surgery. Unfortunately, due to persistent purulent reservoirs, a second laparotomy was necessary. During the extensive diagnostic cystourethrography performed, vesicoureteral reflux was visualized. In conclusion, though a perinephric abscess is very rare in children, it should be taken into consideration in patients with non-specific abdominal symptoms. The imaging using ultrasound and CT scan with contrast enhancement is crucial to recognize and properly treat the condition. In terms of a small abscess, the only antimicrobial treatment using antibiotics of a broad spectrum can be considered. However, the drainage of an abscess, either percutaneous or open, should be used. For the large abscess, the open drainage seems to be a primary method of treatment. The importance of cooperation in a multidisciplinary team is crucial, as the diagnosis and treatment of underlying causes are essential.

Subcutaneous and muscular lagochilascariasis in a cat from Rio Grande do Sul, Brazil

ABSTRACT: A domestic cat was submitted to necropsy with a small abscess within the subcutaneous tissue and skeletal muscles dorsal to the left ear. It contained multiple 0.8 to 1.2 cm-long adult nematodes and was drained by two cutaneous fistulae. On histopathology, multiple cavitary areas within the skeletal muscles and subcutaneous tissue contained adult nematodes and were surrounded by thick fibrotic and chronic-active inflammatory reaction. The parasites were externally lined by a smooth cuticle and had two prominent lateral alae. They contained an intestinal tract and a pseudocoelom. A prominent polymyarian-coelomyarian musculature and two large lateral chords were identified, and some sections contained a uterus with multiple non-operculated eggs. Lagochilascariasis should be considered a differential diagnosis for cervical skin abscesses in domestic cats from Southern Brazil. This article brings important contributions to the clinical and anatomopathologic diagnosis of this rare zoonotic disease.

Outcome of management of brain abscess in children

Objective: To find out the outcome of management of brain abscess in children. Methods: This is prospective observational study conducted in the Department of Paediatric Neurosurgery at Children’s Hospital and Institute of Child Health, Multan from July 2014 to June 2017. Children up to the age of 14 years suffering from brain abscess were admitted. After taking clinical history, general and systemic physical examination and necessary investigations, abscess was evacuated and abscess wall excised after performing craniotomy. Data was collected on a predesigned performa. Results were analyzed and compared with national and international literature through statistical package for social sciences (SPSS-20). Results: Twenty five patients up to 14 years of age were included. Seventeen (68%) were male and eight (32%) female. Fever and vomiting were present in all 25 (100%) patients. Paranasal sinusitis was predisposing causative factor in 9(36%) followed by otitis media in 7 (28%). Abscess was present in frontal lobe in 9 (36%), temporoparietal region in 8 (32%), posterior fossa in 5 (20%) and multiple abscesses in 3 (12%). Craniotomy was performed, pus evacuated and abscess wall excised in all 25 (100%) patients. Three (12%) patients expired. Conclusion: Incidence of brain abscess can be decreased by treatment of its predisposing causes as sinusitis and otitis media. Small abscess less than 2cm can be treated with antibiotics. Complete evacuation of pus and excision of abscess wall after performing craniotomy along with appropriate antibiotics is gold standard management of brain abscess in children. doi: https://doi.org/10.12669/pjms.36.3.1087 How to cite this:Khan IU, Latif A, Ashraf M, Chishti MK, Sadiq S. Outcome of management of brain abscess in children. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1087 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

MynxGrip for Closure of Antegrade Puncture After Peripheral Interventions With Same-Day Discharge

Background: This was the first prospective study to assess the safety and efficiency of MynxGrip vascular closure device (VCD) in peripheral interventions with antegrade access. Methods and Results: We enrolled 66 consecutive patients from 1 center. All patients were discharged home on the day of procedure and were observed for adverse events at 1 and 30 days of follow-up. No major complications were observed. The rate of minor complications (conversion to manual or mechanical compression) was 7.6%. Postdischarge, 3% of patients experienced minor complications—small abscess, ipsilateral deep vein thrombosis. In 1 patient, a second VCD was deployed after device failure. The derived device failure rate was 5.9%. No patients required hospitalization. No late bleeding and no hematomas >6 cm were noted. The mean time to discharge was 4 hours and 5 minutes. Conclusion: The MynxGrip was safe and effective in sealing access sites after antegrade femoral artery puncture with same-day discharge.

Tuberculous abscess on the chest wall

A 58-year old patient on dialysis for four years due to chronic renal failure presented with complaints of painless, continuously growing swelling on the left of his back and coughing, symptoms evolving over a period of approximately 3 months. Physical examination revealed a soft fixed mass of 10 x 10 x 4 cm on the left infrascapular area on the chest wall. The sample taken from the inflammation on the chest wall was analyzed with PCR method which resulted positive for Acid Fast Bacilli (AFB), tissue biopsy showed dermatitis with granulomata and sputum was positive for AFB. Thoracic MR, performed for the purpose of detecting the relationship between the lesion on the lung and the one on the chest wall, detected changes in the inflammatory soft tissues and multiple small abscess formations on the chest wall. There was no pathological signal in the bone structures of the chest wall. This case underlines the necessity to include “Empyema necessitatis’’ in the preliminary diagnosis when there is a soft tissue swelling on the chest wall without inflammatory signs in patients with reduced immune defences.

Diverticulitis and Colitis

Diverticulitis and colitis (which may be broadly grouped into inflammatory, infectious, and ischemic categories) are commonly encountered in the emergency department, and patients’ conditions can range from mild to severe. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment, dispositions and outcomes of diverticulitis and colitis. Figures include a computed tomographic scan showing diverticulitis, a bedside sonogram of a patient with diverticulitis, an ultrasound showing bowel wall thickening, a plain abdominal film showing grossly dilated small and large bowel (as seen in toxic megacolon in a patient with inflammatory bowel disease), a computed tomographic image of a patient presenting with known Crohn disease showing thickening of the distal ileum and a small abscess formation, and a computed tomographic image of a patient with ischemic colitis showing air in the small bowel. Tables list the Hinchey classification and the modified Hinchey classification showing stages of diverticulitis, differential diagnosis of left lower quadrant pain, empirical coverage for diverticulitis, indications for surgical treatment for acute diverticulitis, and differential diagnosis of colitis. This review contains 6 highly rendered figures, 5 tables, and 105 references.

Diverticulitis and Colitis

Diverticulitis and colitis (which may be broadly grouped into inflammatory, infectious, and ischemic categories) are commonly encountered in the emergency department, and patients’ conditions can range from mild to severe. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment, dispositions and outcomes of diverticulitis and colitis. Figures include a computed tomographic scan showing diverticulitis, a bedside sonogram of a patient with diverticulitis, an ultrasound showing bowel wall thickening, a plain abdominal film showing grossly dilated small and large bowel (as seen in toxic megacolon in a patient with inflammatory bowel disease), a computed tomographic image of a patient presenting with known Crohn disease showing thickening of the distal ileum and a small abscess formation, and a computed tomographic image of a patient with ischemic colitis showing air in the small bowel. Tables list the Hinchey classification and the modified Hinchey classification showing stages of diverticulitis, differential diagnosis of left lower quadrant pain, empirical coverage for diverticulitis, indications for surgical treatment for acute diverticulitis, and differential diagnosis of colitis. This review contains 6 highly rendered figures, 5 tables, and 105 references.

Tubercular mastitis - A case report with uncommon presentation

Tuberculosis of the breast is significant due to its rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. It typically affects young lactating multiparous women and can present either as an abscess or as a unilateral, painless breast mass. A case of 22 year unmarried female presented with discharge breast and a small abscess. Radiological and cytological methods remained nonspecific and tubercular mastitis was diagnosed on Zeihl Neelsen staining and culture for Mycobacteria. A multifaceted approach is needed to reach the correct diagnosis. DOI: http://dx.doi.org/10.3126/ajms.v6i1.10143 Asian Journal of Medical Sciences Vol.6(1) 2015 119-121