Eighty-four-year old man who had lapalotomy for stomach ulcer perforation 35 years ago was admitted for left lower chest discomfort. Chest X-ray and CT showed a large mass with air fluid level in left lower lung field. The tentative diagnosis was infected bronchogenic cyst. After a thoracotomy, the mass was confirmed as elevated diaphragm and subphrenic abscess with a foreign body, retained surgical gauze. The pus and gauze were located between stomach and diaphragm. His hospital course was smooth and uneventful, he was discharged with good outcome on postoperative day 9.
Bronchogenic Cyst ; Diagnosis ; Diaphragm ; Foreign Bodies ; Lung ; Stomach ; Stomach Ulcer ; Subphrenic Abscess* ; Suppuration ; Thoracotomy ; Thorax

The authors report their experience with 22 cases of intracranial suppuration : 18 with brain abscess and four with subdural empyema. A small series of nine consecutive cases of intracranial suppuraion with one death is presented since Computed Tomographic brain scanning become a routine diagnostic procedure. These patient have been compared to 13 consecutive cases treated without benefit of CT analysis in order to determine the factors responsible for the recently improved prognosis. The mortality rate was 30.8% for al operated patients treated before availability of CT and 22.7% for the patient since advent of CT scan. Among the factors that may have contributed to the improved results for patients diagnosed with CT are : fewer patients with poor preperative clinical status, and a great incidence of total abscess removal. In addition, CT scanning provided more accurate diagnosis and localization of abscess and aided in the rapid detection of postoperative complication.
Abscess ; Brain ; Brain Abscess ; Diagnosis ; Empyema, Subdural ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Prognosis ; Suppuration* ; Tomography, X-Ray Computed

BACKGROUND: Peritonsillitis is a clinical condition of gross tonsillar infection in a septic patient with localized swelling in the peritonsillar region, and which encompasses both peritonsillar abscess and cellulitis. It is not rarely experienced in spite of decreasing incidence since the advent of antibiotic therapy. OBJECTIVES: Our objective was a clinical observation of many factors in relation to peritonsillitis. MATERIALS AND METHODS: A clinical observation was performed on 40 cases with peritonsillitis, who visited St. Benedict hospital during 3 years from February 1994 to March 1997. A needle aspiration was attempted at the point of maximum bulging using a 10cc syringe with an 18-gauge needle. RESULTS: Among 40 cases, 23 cases yielded pus. From those 23 cases, we could isolate 22 strains in 20 cases. Incision and drainage was performed only in cases of aspiration of pus(23 cases). There was no significant difference in duration of hospitalization between I & D group(7.17 days) and non-I & D group(6.71 days)(p>0.05). CONCLUSION: We conclude that I & D can't reduce the duration of hospitalization even though I & D is helpful for the relief of symptoms, and the adequate use of antibiotics is important for the treatment of peritonsillitis.
Anti-Bacterial Agents ; Cellulitis ; Drainage ; Hospitalization ; Humans ; Incidence ; Needles ; Peritonsillar Abscess ; Suppuration ; Syringes

The most common cause of chronic cutaneous sinus tract in the face and neck is chronically draining dental infection. The diagnosis is easily confirmed by dental examination and dental roentgenogram of the involved area, but this disease is frequently misdiagnosed and incorrectly treated in dermatologic department. We report four cases of cutaneous sinus tract of dental origin. First patient had a painful nodule with chronically draining pus and a dimple on the left cheek. Second patient had a dimple with draining bloody fluid on the right chin. Third patient had a pea-sized papule with draining serous fluid on the left chin. Fourth patient had a fluctuant erythematous plaque with draining pus and a dimple on the left buccal area. In all four patients radiologic examination of the maxillary and mandibular regions demonstrated radioluency at the apex of tooth consistent with periapical abscess.
Cheek ; Chin ; Diagnosis ; Humans ; Neck ; Periapical Abscess ; Suppuration ; Tooth

The subdural empyema is a rare disease characterized by a collection of pus in the subdural space. It usually occurs as a complication of otolaryngologic infections such as paranasal sinusitis, otitis media or mastoiditis. Although pus may localize anywhere in the subdural space, more than 90% of cases occur supratentorially. Infratentorial subdural empyema is rare, most of them otogenic, but subtentorially localized empyema is even rarer. It is considered as a neurosurgical emergency, but some authors have reported successful treatment of subdural empyema with conservative treatment. We have experienced a case of subtentorial subdural empyema resuting from chronic otitis media with cholesteatoma which was successfully treated with mastoidectomy, accompanied by the conservative treatment. In this paper, we report this case with a review of literature.
Cholesteatoma* ; Emergencies ; Empyema ; Empyema, Subdural* ; Mastoid ; Mastoiditis ; Otitis Media* ; Otitis* ; Rare Diseases ; Sinusitis ; Subdural Space ; Suppuration

BACKGROUND: The mortality of liver abscess markedly decreased because of the improvement of diagnosis and treatment modalities, however, the incidence is still high and various complications have been developed. Our study was to clarify the clinical features, complications, changing patterns of causative organisms and predicting parameters for development of complications in liver abscess. METHODS: We reviewed 197 cases of pyogenic and amebic liver abscesses treated at Chonnam University Hospital from January 1989 to March 2003. These cases were divided into subgroups by time of occurrence, and the data was reviewed comparatively. Predicting parameters for development of complications in recent 5 years were also analyzed. RESULTS: The male to female ratio was 1.59 : 1 and the peak incidence age of liver abscess was in the 7th decade. There were no significant interval changes in incidence of pyogenic liver abscess (96.4%) and amebic liver abscess (3.6%) from January 1989 to March 2003. The most common infection route in pyogenic liver abscess was biliary tract (45.8%), followed by cryptogenic cause (44.2%), pulmonary disease (2.6%), hematogenous (2.1%) and abdominal trauma (1.5%). The pus culture came out positive in 50.4% of pyogenic liver abscess. Klebsiella pneumoniae was the most commonly isolated organism in pyogenic liver abscess (32.9%). The significant predicting parameters for development of complications were age (>or=60), systemic inflammatory response syndrome (SIRS, >or=2 factors), C-reactive protein (CRP, >or=8 mg/dL), bilirubin (>or=2 mg/dL), albumin (<3 g/dL) and AST (>or=200 IU/L, p<0.05). CONCLUSION: There were no significant interval changes in etiologies and predisposing conditions of liver abscess in Gwangju-Chonnam Province from January 1989 to March 2003. Age, SIRS, CRP, bilirubin, albumin and AST were considered as significant predicting parameters for development of complications in liver abscess.
Biliary Tract ; Bilirubin ; C-Reactive Protein ; Diagnosis ; Female ; Humans ; Incidence ; Jeollanam-do ; Klebsiella pneumoniae ; Liver Abscess* ; Liver Abscess, Amebic ; Liver Abscess, Pyogenic ; Liver* ; Lung Diseases ; Male ; Mortality ; Suppuration ; Systemic Inflammatory Response Syndrome

Antibiotic treatment for chronic middle ear infections has reduced the incidence of otogenic intracranial complication. Since CT scan became available for the diagnosis, the mortality rate was reduced to about 10%. Nevertheless, intracranial complications are among the most significant life-threatening complications of chronic middle ear infection. Early diagnosis by careful neurootologic, radiologic examination and aggressive medical and surgical treatment are required for successful management. There have been no reports in the Korean literature on otogenic intracranial complications without any preoperative symptoms or signs of intracranial spreading of infection. We experienced `silent' subdural abscess incidentally during a revision mastoidectomy for chronic otitis media with cholesteatoma. The patient was treated by removing abscess and dural repair following mastoidectomy. We report this case with a review of literatures.
Abscess* ; Cholesteatoma* ; Diagnosis ; Ear, Middle ; Early Diagnosis ; Empyema, Subdural ; Humans ; Incidence ; Mortality ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Tomography, X-Ray Computed

BACKGROUND: Lung abscess is an accumulation of pus within a destroyed portion of the lung. Antibiotic therapy and postural drainge has proven to be an effective method of treatment for the majority of patients with pyogenic lung abscess. When medical therapy fails, thoracotomy and pulmonary resection are the current therapies. Empyema is pus in the pleural space, and this term is reserved for effusions on which the Gram stain of the pleural fluid is positive. Initially, such collection may be drained via chest tube. Recently, in patients who are judged to be unsuitable for surgery and are in poor condition, percutaneous drainage using pig-tail catheter has been performed. We report our experience with 10 cases of lung abscess and 23 cases of empyema who were treated by percutaneous pig-tail catheter drainage. SUBJECTS AND METHODS: Our study included 10 patients with lung abscess and 23 patients with empyema who were treated by percutaneous pig-tail catheter drainage, from January, 1990, to May, 1996, at Hanyang University then a pig-tail catheter was inserted into the abscess or the site of empyema under fluoroscopic and ultrasonograpic guidance. Following aspiration, the catheter was sutured into the skin, and connected to the suction tip. Catheter drainage was discontinued when the abscess or empyema was resolved in radiologically and clinically. RESULTS: There were 2 cases of lung abscess caused by Staphylococcus aureus and Klebsiella pneumoniae and 14 cases of empyema caused by M. tuberculosis. The others were unknown. The duration of drainage was 1-2 weeks in 7 cases of lung abscess and 14 cases of empyema. In the 29 of 33 patients, percutaneous drainage were carried out successfully. 20 of the 29 cases rapidly improved. CONCLUSION: Percutaneous drainge is effective and relatively safe for management of lung abscess or empyema refractory to medical therapy or poor candidates for surgical treatment.
Abscess ; Catheters* ; Chest Tubes ; Drainage* ; Empyema* ; Humans ; Klebsiella pneumoniae ; Lung Abscess* ; Lung* ; Skin ; Staphylococcus aureus ; Suction ; Suppuration ; Thoracotomy ; Tuberculosis

Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97 percent to 2.54 percent. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)
AUDIOMETRY AUDIOMETRY ; PURE-TONE OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE LOGISTIC MODELS HEARING TESTS SUPPURATION

No abstract available.
Drainage* ; Lung Abscess* ; Lung* ; Pneumothorax* ; Suppuration*