In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous conditi...In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.展开更多
This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incid...This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.展开更多
Rationale:Abdominal pain is a common complaint with a broad differential diagnosis,including both intra-abdominal and abdominal wall pathologies.While visceral causes are frequently considered,abdominal wall condition...Rationale:Abdominal pain is a common complaint with a broad differential diagnosis,including both intra-abdominal and abdominal wall pathologies.While visceral causes are frequently considered,abdominal wall conditions are often overlooked,leading to diagnostic delays.Among them,umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.Patient’s concern:A 46-year-old woman presented with a one-week history of periumbilical pain unresponsive to analgesics.Diagnosis:Physical examination revealed localized tenderness and a positive Carnett’s sign.Computed tomographic images identified an umbilical abscess without evidence of urachal remnants,ruling out a urachal abscess.Interventions:The patient underwent abscess drainage and received cefalexin(1500 mg/day)for 28 days.Outcomes:The abscess resolved completely without recurrence.Lessons:Umbilical abscesses are rare and may be mistaken for urachal abscesses.A thorough clinical evaluation,including Carnett’s sign and imaging studies,is crucial for accurate diagnosis.Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.展开更多
Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of r...Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.展开更多
[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing ...[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing and reduce medical burden.[Methods]An observational cohort study was conducted,selecting 200 patients with perianal abscess who underwent surgery in Shenzhen Guangming District People's Hospital.They were randomly divided into a treatment group and an observation group,with 100 cases in each group.Both groups followed the same surgical and antibiotic treatment principles.Starting from the first postoperative day,the treatment group received fumigation and sitz bath with modified Sihu Powder for decoction twice daily;the observation group used Compound Huangbai Liquid for fumigation and sitz bath twice daily.Indicators including pain score,wound secretion score,wound granulation tissue growth score,multidrug-resistant bacterial infection clearance rate,antibiotic usage days,and wound healing rate were observed in both groups 7,14 and 21 d after operation.[Results]On postoperative day 7,the differences in postoperative pain score,wound secretions,and multidrug-resistant bacterial clearance rate between the treatment group and the observation group were statistically significant.On postoperative day 14,the differences between the two groups were significant in indicators including pain score,wound secretions,wound granulation tissue growth,multidrug-resistant bacterial clearance rate,and wound healing rate.On postoperative day 21,the difference in wound healing rate between the two groups was significant;furthermore,the antibiotic usage days in the treatment group were significantly fewer than those in the observation group.[Conclusions]Modified Sihu Powder for fumigation and washing can effectively alleviate postoperative pain in perianal abscess patients,inhibit the colonization and infection of multidrug-resistant bacteria at the wound site,accelerate wound healing,reduce antibiotic usage intensity and medical burden.It possesses advantages such as being economical,effective,safe,and easy to operate,making it worthy of clinical promotion.展开更多
BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in d...BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.展开更多
BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complicati...BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur....BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.展开更多
BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate th...BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.展开更多
AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vi...AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.展开更多
BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spin...BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.展开更多
BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man wh...BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy.He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis.Many painkillers were used to relieve his symptoms but the condition progressed.Seven months after surgery,he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess.One year after surgery,irreversible costal destruction was demonstrated.Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters(cm).The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess,drainage of the gastric fistula,partial gastrectomy and removal of damaged ribs,and was followed-up for more than 4 years without recurrence.It is well-known that gastric fistula usually has an acute onset and occurs early after surgery,while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.CONCLUSION This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula.We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.展开更多
BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli...BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.展开更多
BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to...BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.展开更多
“Ruyong(breast abscess)”has a high incidence rate.Traditional Chinese medicine(TCM)diagnosis and treatment of this condition demonstrate significant advantages,including diverse therapeuticmethods,outstanding effica...“Ruyong(breast abscess)”has a high incidence rate.Traditional Chinese medicine(TCM)diagnosis and treatment of this condition demonstrate significant advantages,including diverse therapeuticmethods,outstanding efficacy,and high safety.Based on TCM theory and combining relevant ancient texts and modern research,this paper systematically summarizes the different understandings of“Ruyong(breast abscess)”by physicians throughout history in terms of disease names,etiology,pathogenesis,and treatment.The ancient names for Ruyong(breast abscess)were varied,also referred to as“Duru(stagnation in breast)”or“Naichuang(breast sore)”.Its symptoms are diverse,with the main clinical manifestations being localized redness,swelling,heat,pain,and poor milk discharge in the affected breast.The etiology is primarily attributed to“milk stasis”“liver qi stagnation and stomach heat”and“exposure to external pathogens”.Additionally,this paper summarizes the treatment experiences from ancient and modern medical texts and highlights the complementary effects of internal and external therapies.This study provides a reference for modern clinical understanding and treatment of“Ruyong(breast abscess)”in the hope of further improvement of clinical efficacy.展开更多
AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in ...AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.展开更多
Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily...Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.展开更多
BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed...BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.展开更多
BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcome...BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.展开更多
BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecula...BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.展开更多
文摘In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.
文摘This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.
文摘Rationale:Abdominal pain is a common complaint with a broad differential diagnosis,including both intra-abdominal and abdominal wall pathologies.While visceral causes are frequently considered,abdominal wall conditions are often overlooked,leading to diagnostic delays.Among them,umbilical abscesses are rare but require distinction from urachal abscesses due to differences in management.Patient’s concern:A 46-year-old woman presented with a one-week history of periumbilical pain unresponsive to analgesics.Diagnosis:Physical examination revealed localized tenderness and a positive Carnett’s sign.Computed tomographic images identified an umbilical abscess without evidence of urachal remnants,ruling out a urachal abscess.Interventions:The patient underwent abscess drainage and received cefalexin(1500 mg/day)for 28 days.Outcomes:The abscess resolved completely without recurrence.Lessons:Umbilical abscesses are rare and may be mistaken for urachal abscesses.A thorough clinical evaluation,including Carnett’s sign and imaging studies,is crucial for accurate diagnosis.Prompt differentiation facilitates appropriate management and prevents unnecessary interventions.
文摘Introduction: Arteriovenous malformation is a rare pathology, often discovered accidentally in children. Generally, it presents as an intra-parenchymal hematoma following rupture of the affected vessels. The risk of rupture is linked to the volume of the malformation, its cortical location and venous drainage. In literature, few cases of rupture have been reported in cases of meningitis, but none are associated with a brain abscess. Objective: To report a case of an intraparenchymal hemorrhage due to rupture of an arteriovenous malformation with an associated brain abscess. Observation: The authors report the case of a 2-year-old child, admitted for impaired state of consciousness associated with a right hemiparesis and seizures in a febrile context. Clinical evaluation revealed a Blantyre score of 3, fever at 40˚C, divergent strabismus of the right eye, a right pyramidal syndrome and meningeal irritative syndrome. Cerebral CT scan revealed a left fronto-parietal intra-parenchymal hematoma and a right occipital ring-enhanced lesion, suggesting a brain abscess. An MRI suggested a probable rupture of an arteriovenous malformation resulting in the intra-parenchymal hematoma. Management consisted of craniotomy to evacuate the intra-parenchymal hematoma, antibiotic therapy with vancomycin and ceftriaxone at meningeal doses. Histopathological analysis of the intraoperative sample revealed an arteriovenous malformation. The postoperative course was marked by regression of hyperthermia, persistence of spasticity, irritability and clonic movement of the right lower limb. These were managed with baclofen, phenobarbital, and ergotherapy. We observed a regression of spasticity and improved motor skills in the right limbs. At 6 months follow-up, child could interact with his social environment despite aphasia, regression of spasticity and right hemiparesis. Conclusion: Rupture of arteriovenous malformations can be enhanced by neuro-meningeal infections and particularly brain abscesses. Cerebrovascular complications of these conditions mostly have unfavorable outcomes and neurological sequelae.
基金Supported by Shenzhen Guangming District Health System Scientific Research Project(2020R01120).
文摘[Objectives]To investigate the use of the classical Chinese medicine formula Sihu Powder modified decoction for postoperative fumigation and sitz bath in patients with perianal abscess,aiming to promote wound healing and reduce medical burden.[Methods]An observational cohort study was conducted,selecting 200 patients with perianal abscess who underwent surgery in Shenzhen Guangming District People's Hospital.They were randomly divided into a treatment group and an observation group,with 100 cases in each group.Both groups followed the same surgical and antibiotic treatment principles.Starting from the first postoperative day,the treatment group received fumigation and sitz bath with modified Sihu Powder for decoction twice daily;the observation group used Compound Huangbai Liquid for fumigation and sitz bath twice daily.Indicators including pain score,wound secretion score,wound granulation tissue growth score,multidrug-resistant bacterial infection clearance rate,antibiotic usage days,and wound healing rate were observed in both groups 7,14 and 21 d after operation.[Results]On postoperative day 7,the differences in postoperative pain score,wound secretions,and multidrug-resistant bacterial clearance rate between the treatment group and the observation group were statistically significant.On postoperative day 14,the differences between the two groups were significant in indicators including pain score,wound secretions,wound granulation tissue growth,multidrug-resistant bacterial clearance rate,and wound healing rate.On postoperative day 21,the difference in wound healing rate between the two groups was significant;furthermore,the antibiotic usage days in the treatment group were significantly fewer than those in the observation group.[Conclusions]Modified Sihu Powder for fumigation and washing can effectively alleviate postoperative pain in perianal abscess patients,inhibit the colonization and infection of multidrug-resistant bacteria at the wound site,accelerate wound healing,reduce antibiotic usage intensity and medical burden.It possesses advantages such as being economical,effective,safe,and easy to operate,making it worthy of clinical promotion.
基金Supported by Suqian Science and Technology Project Contract,No.S201910。
文摘BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.
文摘BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a prevalent liver infection with gradual onset and severe symptoms,including fever,abdominal pain,jaundice,and vomiting.Complications like sepsis or toxic shock can also occur.AIM To investigate the clinical value of early ultrasound-guided percutaneous drainage(PCD)in PLA patients,specifically those with non-liquefied abscesses,and evaluate the feasibility of early intervention.METHODS This retrospective analysis included 143 patients with PLA who were admitted to the Department of General Surgery between January 2018 and March 2023.All patients underwent ultrasound-guided PCD.Based on the liquefaction status of the abscess,patients were divided into two groups:Liquefied group and nonliquefied group.Clinical outcomes,including puncture success rate,puncture duration,length of hospital stay,time to fever resolution,abscess shrinkage rate,and complication rates,were compared between the two groups.RESULTS The puncture success rate for all patients was 99.3%,with a postoperative complication rate of 5.59%,and no intraoperative deaths occurred.Compared to the liquefied group,the non-liquefied group had significantly shorter hospital stays(3.9±1.8 days vs 5.1±2.7 days),faster fever resolution(2.4±1.1 days vs 4.9±2.2 days),and quicker abscess shrinkage(>50%)(4.7±1.5 days vs 8.6±3.3 days)(P<0.05).There were no significant differences in puncture success rates or complication rates between the two groups.CONCLUSION Early ultrasound-guided PCD can be safely and effectively performed in PLA,even when the abscess is not fully liquefied or is non-liquefied,supporting the clinical feasibility of early intervention.
文摘BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.
文摘AIM:To report the demographic and systemic characteristics of patients,clinical progression of endophthalmitis,and the efficacy of various treatment strategies,with a focus on identifying key factors for preserving vision in eyes with endogenous endophthalmitis due to Klebsiella pneumoniae(K.pneumoniae)liver abscess.METHODS:In this single-center,retrospective case series of 18 patients with endogenous endophthalmitis due to K.pneumoniae liver abscess were analyzed.Ophthalmologic features of endophthalmitis at early,intermediate and advanced stages were obtained from eyes with endophthalmitis of different severities.Prompt vitrectomy was considered primarily for all eyes except for very early endophthalmitis.Intravitreal injections of antibiotics were performed in eyes with endophthalmitis in the very early stages and in eyes where vitrectomy was not available,and additional control of infection was needed after vitrectomy.Evisceration was performed in eyes with corneoscleral perforation,advanced endophthalmitis,perforation with preseptal or orbital cellulitis,uncontrolled infection,or severe pain with no vision.RESULTS:Mean(±standard deviation)age of the 18 patients with endophthalmitis was 64.5±12.2(range:32-84)y,and 14 patients(77.8%)were males.Endophthalmitis tended to involve the retinal parenchyma first and then progressed into the vitreous cavity and anterior segments.However,it presented a tendency to cause massive subretinal abscesses even after vitrectomy with silicone oil tamponade.Very high intraocular pressure with new vessels on the iris(41.7%)were also commonly observed.Although all but three patients had systemic disease such as diabetes or hypertension,visual prognosis after treatment did not appear to depend significantly on underlying comorbidities.A final best-corrected visual acuity better than 20/60 was achieved only when lesions were detected very early,with relatively good initial visual acuity,likely reflecting lower bacterial inoculation in the eye.CONCLUSION:Detection of early endophthalmitis lesions appears to be the only way to preserve good vision in patients with K.pneumoniae liver abscesses.Therefore,proper guidelines for ophthalmologic screening remain to be established for subjects at a high risk of endophthalmitis.
文摘BACKGROUND An epidural abscess is a rare but serious medical condition where a pocket of pus forms in the epidural space—the area between the outer covering of the spinal cord(the dura mater)and the bones of the spine.It’s usually caused by a bacterial infection,most commonly Staphylococcus aureus.The infection can spread to this area from other parts of the body,through the bloodstream,or it may be intro-duced directly during spinal procedures like epidural injections or surgery.Symptoms often include severe back pain,fever,and neurological deficits like weakness or numbness,which can progress quickly if untreated.It's considered a medical emergency because if the abscess compresses the spinal cord,it can lead to permanent paralysis or even death.Treatment usually involves antibiotics and,in many cases,surgical drainage.CASE SUMMARY Spinal epidural abscess(SEA)represents a rare yet potentially severe infection affecting the epidural space.We present the following case of a 54-year-old Hispanic white male who initially presented to the emergency department with acute deteriorating symptoms of bilateral lower extremity weakness,which subsequently progressed to involve the upper extremities.However,further evaluation uncovered additional notable symptoms,including urinary inconti-nence and decreased appetite.Further investigation broadened the differential diagnosis,including meningitis,spinal cord compression,acute pyelonephritis,osteomyelitis,bacteremia,torticollis,and acutely progressive ascending bilateral lower extremity weakness,raising the concern for possible Guillain-Barre syndrome.Diagnostic imaging,including magnetic resonance imaging of the spine,confirmed the presence of C5-C6 osteomyelitis and a C6-C7 spinal epidural abscess with severe canal narrowing.The patient underwent an emergency evacuation of epidural abscess with a C6 corpectomy and C5-C7 cervical fusion,followed by an 8-week course of intravenous antibiotics.Cultures from the abscess and bone revealed Staphylococcal aureus.The patient was discharged after 54 days with significant improvement in power and function.CONCLUSION This case highlights the importance of maintaining a high index of suspicion for SEA in patients presenting with atypical symptoms,even in the setting of seemingly unrelated conditions.Early recognition and prompt intervention are crucial to prevent permanent neurological deficits and improve outcomes in patients with SEA.
文摘BACKGROUND Although laparoscopic gastrolithotomy had been widely used in clinical practice,uncommon postoperative complications still require vigilance by medical staff.CASE SUMMARY Here we report a 67-year-old man who suffered for 18 months and underwent surgery several times due to a rare and undetected complication of laparoscopic gastricolithotomy.He presented to multiple hospitals because of sustained left upper quadrant abdominal pain one month after laparoscopic gastricolithotomy due to a large gastric bezoar caused by unrestrained eating of black dates and was diagnosed with possible intercostal neuritis.Many painkillers were used to relieve his symptoms but the condition progressed.Seven months after surgery,he was hospitalized as skin ulceration occurred in the left upper abdominal wall and was subsequently diagnosed with a massive thoracoabdominal wall abscess.One year after surgery,irreversible costal destruction was demonstrated.Both lesions were finally proved to be secondary damage due to a rare chronic gastro-abdominal wall fistula related to laparoscopic gastricolithotomy and the diameter of the gastric fistula reached 2 centimeters(cm).The patient was ultimately cured but underwent multi-regional incisions and drainage of the abscess,drainage of the gastric fistula,partial gastrectomy and removal of damaged ribs,and was followed-up for more than 4 years without recurrence.It is well-known that gastric fistula usually has an acute onset and occurs early after surgery,while chronic gastro-abdominal wall fistula especially with secondary massive thoracoabdominal wall abscess and costal destruction has rarely been reported.CONCLUSION This may be the first reported case of a chronic thoracoabdominal abscess and costal destruction caused by an undetected chronic gastro-abdominal wall fistula.We believe that this is a novel type of gastric fistula and the diagnosis and treatment were challenging.
文摘BACKGROUND In recent years,there has been a significant increase in pyogenic liver abscesses(PLAs)caused by multidrug-resistant(MDR)Gram-negative bacteria(GNB),pre-dominantly Klebsiella pneumoniae and Escherichia coli.AIM To clarify the clinical characteristics and risk factors associated with MDR-GNB-related PLAs,develop a predictive nomogram for personalized risk assessment,and enhance the timeliness of empirical antibiotic selection.METHODS Based on the antibiotic susceptibility profiles,enrolled patients were divided into two groups:A MDR group com-prising 105 individuals and a non-resistant group comprising 163 individuals.A systematic collection of demo-graphic characteristics,laboratory findings,and prognostic indicators was performed.A predictive nomogram was established using multivariate stepwise regression modeling.Model effectiveness was evaluated by examining its discriminative capability,calibration accuracy,and clinical utility through receiver operating characteristic curves with corresponding area under the curve values,calibration graphs,and decision curve analysis.Continuous data were analyzed using the independent-sample t-test if they met normality criteria;otherwise,the Wilcoxon rank-sum test was adopted.For categorical data,Fisher’s exact test was chosen when the expected count in any cell was below five;in all other instances,theχ2 test was applied.RESULTS This retrospective study analyzed clinical and laboratory data from 268 patients diagnosed with Gram-negative PLA at a major healthcare facility from January 2019 to February 2025.Among these,105 cases(39%)were asso-ciated with MDR-GNB,primarily Klebsiella pneumoniae(43%)and Escherichia coli(42%).Mixed infections were rare,accounting for only 3%of cases.Multivariate regression revealed five independent predictors of MDR-GNB liver abscesses:Age≥60 years,diabetes,presence of a malignant tumor,lower C-reactive protein levels,and prolonged prothrombin time.These variables were integrated into a nomogram to facilitate individualized risk assessment.CONCLUSION The results imply that being aged over 60,diabetes,malignant tumor,lower C-reactive protein levels,and higher prothrombin time levels can accurately forecast MDR-GNB infections in PLAs,highlighting the importance of early screening to enable more targeted antibiotic treatments.However,as this was a single-center study without external validation,the generalizability of our model remains limited.Future multicenter,multi-ethnic prospective studies are needed to validate and extend these findings.
文摘BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.
基金supported by 2024 Henan Provincial Special Research Project on Traditional Chinese Medicine(2024ZY2158)Henan Provincial Key Discipline Construction Project of Traditional Chinese Medicine{Yuwei Traditional Chinese Medicine Science and Education[2024]No.1}+1 种基金Key Disciplines of History and Literature of Chinese Medicine in Henan University of Chinese Medicine for the Year 2025{Henan Traditional Chinese Medicine Office[2025]No.13}National Chinese Medicine Advantage Specialty Construction Project{Chinese Traditional Chinese Medicine Political Letter(2024)No.90}.
文摘“Ruyong(breast abscess)”has a high incidence rate.Traditional Chinese medicine(TCM)diagnosis and treatment of this condition demonstrate significant advantages,including diverse therapeuticmethods,outstanding efficacy,and high safety.Based on TCM theory and combining relevant ancient texts and modern research,this paper systematically summarizes the different understandings of“Ruyong(breast abscess)”by physicians throughout history in terms of disease names,etiology,pathogenesis,and treatment.The ancient names for Ruyong(breast abscess)were varied,also referred to as“Duru(stagnation in breast)”or“Naichuang(breast sore)”.Its symptoms are diverse,with the main clinical manifestations being localized redness,swelling,heat,pain,and poor milk discharge in the affected breast.The etiology is primarily attributed to“milk stasis”“liver qi stagnation and stomach heat”and“exposure to external pathogens”.Additionally,this paper summarizes the treatment experiences from ancient and modern medical texts and highlights the complementary effects of internal and external therapies.This study provides a reference for modern clinical understanding and treatment of“Ruyong(breast abscess)”in the hope of further improvement of clinical efficacy.
文摘AIM: To determine the predictive factors for early aspiration in liver abscess. METHODS: A retrospective analysis of all patients with liver abscess from 1995 to 2004 was performed. Abscess was diagnosed as amebic in 661 (68%) patients, pyogenic in 200 (21%), indeterminate in 73 (8%) and mixed in 32 (3%). Multiple logistic regression analysis was performed to determine predictive factors for aspiration of liver abscess. RESULTS: A total of 966 patients, 738 (76%) male, mean age 43 ± 17 years, were evaluated: 540 patients responded to medical therapy while adjunctive percutaneous aspiration was performed in 426 patients. Predictive factors for aspiration of liver abscess were: age ≥ 55 years, size of abscess ≥ 5 cm, involvement of both lobes of the liver and duration of symptoms ≥ 7 d. Hospital stay in the aspiration group was relatively longer than in the non aspiration group. Twelve patients died in the aspiration group and this mortality was not statistically significant when compared to the non aspiration group. CONCLUSION: Patients with advanced age, abscess size > 5 cm, both lobes of the liver involvement and duration of symptoms > 7 d were likely to undergo aspiration of the liver abscess, regardless of etiology.
文摘Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA.
文摘BACKGROUND Hepatic abscesses represent infections of the liver parenchyma from bacteria,fungi,and parasitic organisms.Trends in both abscess microbiology and manage-ment of abscesses(infective collections)have changed over the past decade.There is a paucity of published data regarding the clinicopathological features of liver abscesses in sub-Saharan Africa and other low-income and middle-income coun-tries.AIM To evaluate the clinical presentations of liver abscesses and hydatid liver disease at two South African tertiary-level hospitals.METHODS Information accessed from electronic discharge summaries of patients from two South African referral hospitals in Johannesburg,South Africa from January 2016 to December 2020 were reviewed and analyzed.All patients older than 13 years presenting with infective liver collections(pyogenic,amoebic)and hydatid di-sease were included.Clinical findings and laboratory,microbiology,and radio-logy results and outcomes were collated and analyzed.RESULTS In total,222 patients were included.There were 123 males(55.41%)and 99 females(44.59%),with a median age of 48 years.Comorbidities included HIV(24.23%),hypertension(20.57%),and diabetes mellitus(16.83%).The majority(74.77%)of abscesses were pyogenic,while amoebic and hydatid abscesses represented 16.22%and 9.01%,respectively.The predominant etiology of the pyogenic liver abscesses(PLA)was biliary-related disease.WBC and C-reactive protein were significantly higher in the pyogenic group(P<0.0002 and P<0.007,respectively)when compared to the amoebic and hydatid groups.In patients with PLAs,organisms were cultured on blood in 17.58%and abscess fluid in 56.60%.Klebsiella,Escherichia coli and Streptococci were the most cultured organisms.Sixteen percent of the cultures were polymicrobial.In the overall group,76.00%(n=169)of patients requiring drainage had a percutaneous transhepatic catheter drain placed,while 8.76%(n=19)had open surgery.The median length of hospital stay was 13 days.The mortality rate was 3.02%.CONCLUSION In this study,the most common type of liver abscess was PLAs of biliary origin in middle-aged males.The microbiology was similar to those described in Asian populations,and non-surgical management via percutaneous drainage was sufficient in the majority of cases with acceptable morbidity and mortality.
基金Supported by 2024 Zhejiang Province Traditional Chinese Medicine Science and Technology Plan,No.2024ZL1129,No.2024ZL1130.
文摘BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.
基金supported by Hunan Province Key Research and Development Program(2020SKC2004).
文摘BACKGROUND:Xuebijing(XBJ)can alleviate the inflammatory response,improve organ function,and shorten the intensive care unit(ICU)stay in patients with pyogenic liver abscess(PLA)complicated with sepsis,but the molecular mechanisms have not been elucidated.This study aimed to explore the molecular mechanism of XBJ in treating PLA complicated with sepsis using a network pharmacology approach.METHODS:The active ingredients and targets of XBJ were retrieved from the ETCM database.Potential targets related to PLA and sepsis were retrieved from the GeneCards,PharmGKB,DisGeNet,Online Mendelian Inheritance in Man(OMIM),Therapeutic Targets Database(TTD),and DrugBank databases.The targets of PLA complicated with sepsis were mapped to the targets of XBJ to identify potential treatment targets.Protein-protein interaction networks were analyzed using the STRING database.Potential treatment targets were imported into the Metascape platform for Gene Ontology(GO)functional enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Molecular docking was performed to validate the interactions between active ingredients and core targets.RESULTS:XBJ was found to have 54 potential treatment targets for PLA complicated with sepsis.Interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor(TNF)were identifi ed as core targets.KEGG enrichment analysis revealed important pathways,including the interleukin-17(IL-17)signaling pathway,the TNF signaling pathway,the nuclear factor-kappa B(NF-κB)signaling pathway,and the Toll-like receptor(TLR)signaling pathway.Molecular docking experiments indicated stable binding between XBJ active ingredients and core targets.CONCLUSION:XBJ may exert therapeutic eff ects on PLA complicated with sepsis by modulating signaling pathways,such as the IL-17,TNF,NF-κB,and TLR pathways,and targeting IL-1β,IL-6,and TNF.
