Comparative scintigraphic study of 99mTc ciprofloxacin pharmacokinetics after intravenous and lymphotropic administration in experimental pulmonary suppuration

Intravenously injected 99mTc ciprofloxacin is rapidly accumulated and washed from the septic focus. Lymphotropic injections provide targeted and long-lasting effect of the antibiotic. After injection into the interspinous ligament the drug slowly enters the inflammation area (by-passing the urinary organs and liver), where it is maximally accumulated only after 24 h, which allows to reduce the number of injections and the total dose of the antibiotic.

Effectiveness of Intrapericardial Administration of Streptokinase in Purulent Pericarditis

BACKGROUND AND PURPOSE

Purulent pericarditis is very rare. However, among patients suffering from this disease the mortality rate is very high. The aim of this study was to evaluate the effectiveness and side effects of intrapericardial streptokinase administration in patients with confirmed purulent pericarditis.

PATIENTS AND METHODS

Three patients, one 50-year-old man and two women aged 64 and 40 years, who were admitted to the intensive care unit (ICU) due to purulent pericarditis, entered the study. In all three cases a subxiphoid pericardiotomy followed by insertion of a drainage line into the pericardial space was performed. Antibiotic therapy was started immediately on admission to the hospital. Despite continued antibiotic therapy in all three patients, daily drainage from the pericardium--during several days after surgery--staggered between 50-200 ml/day. Due to considerable purulent pericardial drainage loculations and/or fibrin deposits confirmed by echocardiography, streptokinase (500,000 IU dissolved in 50 ml of normal saline) was administered into the pericardial space over 10 min, using the previously inserted drainage catheter. This regimen was repeated after 12 and 24 h. The total dose of streptokinase was 1,500,000 IU.

RESULTS

The clinical effect of intrapericardial streptokinase administration was excellent. Several days after intrapericardial administration of streptokinase, drainage of purulent pericardial fluid stopped. No complications associated with intrapericardial streptokinase administration were observed. In the follow-up echocardiography (in two patients repeated 6 and 9 months after delivery of streptokinase), pericardial fluid and echocardiographic signs of pericardial constriction were not observed.

CONCLUSION

Intrapericardial administration of streptokinase in purulent pericarditis is effective and safe.

Ultrasound detection of pyometra at the time of embryo transfer after ovum retrieval for in vitro fertilization

OBJECTIVE

To report the detection of pyometra after ovum retrieval for IVF with the routine use of ultrasound-guided embryo transfer.

DESIGN

Case report.

SETTING

Tertiary fertility center.

PATIENTS

A 29-year-old woman who developed pyometra after ovum retrieval for IVF detected at the time of ultrasound-guided embryo transfer.

INTERVENTION(S)

Cancellation of the embryo transfer, cryopreservation of the embryos, treatment of the pyometra, and a successful frozen-embryo transfer.

MAIN OUTCOME MEASURE(S)

Normal uterine cavity after treatment and a delivered twin pregnancy.

RESULT(S)

A successful delivered twin pregnancy.

CONCLUSION(S)

Routine use of ultrasound-guided embryo transfer resulted in the rescue of the patient's embryos for cryopreservation, with a resulting ongoing pregnancy.

[Possibilities of x-ray computed tomography in the diagnosis and treatment of suppurative complications of acute pancreatitis]

The authors have analyzed results of the roentgen computed examination of 73 patients with acute pancreatitis and its complications. The potentialities of roentgen computed tomography (RCT) in diagnosing are shown as well as computed semiotics of acute pancreatitis and its complications. The authors consider that RCT makes the diagnosis substantially more exact and enables the complications to be detected much earlier. Systematization of the signs detected by RCT in acute pancreatitis in combination with the clinical symptoms gives the information necessary for correct strategy of surgical treatment.

Temperate pyomyositis in an injecting drug misuser. A difficult diagnosis in a difficult patient

The medical care of injecting drug misusers presents many challenges. Though they can be awkward and unreliable they are at risk of serious medical conditions not often seen in the general population. This case report illustrates some of the difficulties in the diagnosis and treatment of a patient with pyomyositis associated with heroin injection.

[Analysis of parotid sialography and intervention in 78 cases of chronic pyogenic parotitis]

OBJECTIVE

To study the value of parotid sialography and intervention in the diagnosis and treatment of chronic pyogenic parotitis.

METHODS

Undertake the technique of parotid sialography with 48% Lipiodol ultra-fluide (France) under X-ray upon 78 patients who were given systemic anti-infections and supporting treatments only with non-obvious-results, and classify all the cases into chronic obstructive (21 cases) and nonobstructive parotitis (57 cases) according to the results of sialography through microcatheter, then go on with bacterial culture and drug sensitivity test. Filling treatments were carried out on obstructive parotitis cases through the duct with mixed liquor consisting of 2% lidocanine, 1% methylviolet. In the same way, alpha-chymotrypsin, amikacin, lidocaine was used in nonobstructive cases.

RESULTS

The cure rate of chronic obstructive parotitis was 80.95%, the cure rate of chronic nonobstructive parotitis was 87.72%.

CONCLUSION

The method of parotid sialography and intervention in the diagnosis and treatment of chronic pyogenic parotitis is an effective way to treat chronic pyogenic parotitis.

[The capacities of autoleukocyte-labelled scintigraphy in the detection of foci of inflammation and suppuration]

The diagnostics of occult inflammation foci up to day remains the major and complicated problem in almost each clinical discipline. Whole-body scintigraphy and SPECT studies with 99mTc-autoleucocytes show silent foci of inflammation and infection. 68 patients (24 females and 44 males) aged 14-59 years with non-localized inflammatory diseases were evaluated. Each patient underwent routine clinical and laboratory investigation. But because of the inadequacy of other diagnostic procedures, the Tc-99m-WBC scans may be of great clinical importance. For the determining of the SPECT of thorax were performed using Tc-99m-HMPAO (hexametylpropilenaminoxime) labeled autoleucocytes. In 1, 3 and 24 hours post injection inflammatory foci were seen as the areas of pathogenic activity. In 24 patients the circumscribed activity seen in relation to heart convincingly demonstrated endo- and/or myocarditis. 16 patients showed acute inflammation in postoperative wound, empyema of pleura and mediastinitis as the consequences of cardiosurgery. In 16 patients whole-body scanning and SPECT of the head revealed chronic infection in nasopharynx and accessory nasal sinuses dental infection and the rest 7 patients had abdominal and pelvic inflammatory diseases, such as ulcerative colitis, intraabdominal and retroperitoneal septic foci, tubo-ovarial inflammatory disease. The data demonstrated that Tc-99m-leucocytes imaging is a highly sensitive and specific for the detection of inflammatory diseases of different localization.

Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis

Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger. This finding was supplemented by a cadaveric and radiographic study to better delineate the anatomy of the index sesamoid and further explain the clinical presentation.

The use of ultrasonography as a diagnostic tool for superficial fascial space infections

PURPOSE

This study examined the value of ultrasonography as a diagnostic tool in the treatment of superficial acute odontogenic fascial space infections.

PATIENTS AND METHODS

The study group consisted of 50 patients in whom both radiographic and sonographic examinations, as well as a needle aspiration, were performed.

RESULTS

Purulent fluid was aspirated in 22 of the 50 patients. Six patients diagnosed as suffering from cellulitis had a repeated ultrasonography scan. In four, abscess formation was diagnosed on the third day.

CONCLUSIONS

Ultrasonography is an effective diagnostic tool to confirm abscess formation in the superficial fascial spaces and is highly predictable in detecting the stage of infection.

[Value of computed tomography in the differential diagnosis of infiltrative changes in the lungs]

Computed tomography (CT) was performed in 73 patients with pulmonary infiltrative changes of unknown etiology. Their preliminary clinical and X-ray studies suggested protracted pneumonia in 46.6%, malignant neoplasms in 27.4%, tuberculosis in 16.1%, and pyesis in 9.9%. The preliminary clinical and X-ray conclusion fully agreed with the verified diagnosis only in 31.5% of patients. The accuracy of CT in assessing infiltrative changes was much higher and ran to 89.1%. According to CT findings, nontumor diseases were found in 56 (76.7%) patients, malignant tumors in 17 (23.3%). Among inflammatory processes there were prevalent pyesis 23.3%), pulmonary tuberculosis (20.7%) and pneumonias (19.2%). In the group of 17 patients with neoplasms, 8 were found to have central cancer with hypoventilation of a lung portion, 4 had peripheral cancer, and 5 presented with bronchoalveolar carcinoma. The use of high-performance CT is of great importance.

Pyomyositis: diagnostic value of color Doppler sonography

The color Doppler sonographic appearance of pyomyositis and the usefulness of this technique in guiding needle aspiration of an intramuscular abscess in a 15-year-old diabetic girl are described.

Pyomyositis: characteristics at CT and MR imaging

PURPOSE

To establish imaging criteria for pyomyositis (PM).

MATERIALS AND METHODS

Twenty-seven computed tomographic (CT) scans and 11 magnetic resonance (MR) images obtained in 32 patients with PM were reviewed. Images in 10 patients with PM and 16 with soft-tissue masses were evaluated blindly.

RESULTS

At CT, all 27 patients had muscle enlargement with heterogeneous attenuation; 26 patients had a focal fluid collection, with rim enhancement in all 18 patients who underwent contrast material-enhanced CT. Twenty-four patients had cellulitis. At MR imaging, all 11 patients had both a subtle increase in signal intensity in the affected muscle(s) on T1-weighted images and cellulitis. Nine patients had a focal fluid collection, which had high signal intensity and a hypointense rim on T2-weighted images. In six patients, a rim of increased signal intensity was seen around the collection on T1-weighted images. Six gadolinium-enhanced examinations demonstrated rim enhancement. Eight patients had fluid in the distal joint. All patients with PM were correctly identified when evaluated with the control subjects; however, there were four false-positive results.

CONCLUSION

CT and MR imaging can help characterize changes that are suspicious for PM.

Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis

Seven cases of acute suppurative cholecystitis underwent percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy at the Tainan Municipal Hospital. All the patients had frank septic phenomena clinically, including fever, jaundice, leukocytosis and unstable blood pressure. Organisms were cultured from both blood and bile specimens. Ultrasound-guided transhepatic puncture of the gallbladder was performed for bile drainage, and laparoscopic cholecystectomy was subsequently performed two to five days later after the patients had stabilized. No procedure-related complications from either percutaneous transhepatic gallbladder drainage or laparoscopic cholecystectomy were observed. All patients had early recovery, shortened hospital stay and good cosmetic results. These preliminary results show that laparoscopic cholecystectomy is a safe method and can be employed in those patients with symptomatic gallstone associated with suppurative cholecystitis after preoperative biliary drainage.

Sphenoidotomy

Because of the complex anatomic relations of the sphenoid, the surgical approach to this sinus was only introduced 100 years ago. There are three approaches to the sphenoid sinus: transethmoidal, transseptal, and transpalatal. We present a case report, and discuss surgical anatomy, with attention to the important anatomic relationship of the cavernous sinus and its contents. A variant of the classical, sublabial, transseptal approach is described as follows: a window is created in the face of the sphenoid. This approach is particularly applicable to the surgery of mucoceles and allows easy postoperative inspection of the sphenoid sinus.

[Diagnostic and therapeutic aspects of antegrade ureteropyelography and percutaneous nephropyelostomy in childhood]

In a sample of 18 children aging one day to eighteen years 21 percutaneous nephrostomies and 27 antegrade pyelographies were performed using sonography and fluoroscopy. Thirteen patients had both nephrostomy and pyelography and 5 had only pyelography. Three of 13 patients needed bilateral nephrostomies. The results indicate that the combination of percutaneous nephrostomy and antegrade pyelography is helpful in diagnosis and treatment of various obstructive disorders of the urinary tract especially in the newborn period.

Radiologic intervention in oriental cholangiohepatitis

Interventional radiologic techniques can make a useful contribution to the management of patients with recurrent symptoms following surgical palliation of oriental cholangiohepatitis. Percutaneous removal of multiple, soft, pigmented biliary stones that form in this disease can be achieved by a combination of basket retrieval and crushing, as well as suction and irrigation techniques. Ducts that are obstructed by strictures can be drained by percutaneous catheters. Complete or partial symptomatic relief was obtained in six of eight patients, obviating additional surgical intervention.

Occult purulent pericarditis detected by indium-111 leukocyte imaging

Leukocyte imaging with indium-111 is a relatively new technique which, to this point in time, has been discussed almost exclusively in the radiologic literature. Although this procedure has been used mainly to detect intra-abdominal infection, the thorax is routinely imaged along with the abdomen, and therefore detection of cardiac disease may be feasible. This case report is of a young woman after liver transplantation who developed occult purulent pericarditis initially detected by a leukocyte scan with indium-111. This case demonstrates that striking pericardial uptake on a whole-body indium-111 leukocyte scan can occur with purulent pericarditis, and it reemphasizes how insidiously purulent pericarditis may present in an immunosuppressed patient.

111In-labelled leucocyte and 99mTc-methylene diphosphonate bone scanning in pelvic osteomyelitis

A positive 99mTc-methylene diphosphonate bone scan was obtained in a case of pelvic osteomyelitis in a 15-year-old girl. An 111In-labelled leucocyte scan confirmed the presence of pus, gave a more accurate anatomical location than was obtained by the bone scan, and enabled the most suitable surgical route to be selected.

[Diagnosis of infectious spondylitis following urological interventions]

Spread of infection to the spine following urological surgery is extremely rare. The diagnosis is therefore often made at a late stage resulting in delayed treatment. Four patients observed by the authors are described and the diagnosis is discussed.

CT in pyogenic osteomyelitis of the spine

Six patients with bacteriologically proven pyogenic osteomyelitis of the spine were followed serially with computed tomography (CT). Initial evaluation of the involved vertebral bodies and adjacent soft tissues showed a drop in CT numbers when compared to normal cancellous bone and soft tissues. A soft-tissue mass was seen in all cases. After appropriate antibiotic therapy, all six patients showed an increase in bone density and a diminution of the soft-tissue mass (p less than 0.05). Five of the six patients showed a further decrease in soft-tissue CT numbers.

[Computed tomography guided percutaneous aspiration and drainage of thoracic and abdominal fluid collections (author's transl)]

Computed tomography can be of value in guiding percutaneous aspiration and drainage of thoracic and abdominal fluid collections of various origins and localizations. Puncture-aspiration is of diagnostic importance when computed tomography findings are non-pathognomonic. Techniques employed for percutaneous drainage of infected fluid are described. Puncture-aspirations and percutaneous drainage of infected fluid are described. Puncture-aspirations and percutaneous drainage under computed tomography guidance are free from major complications, and represent a more valid therapeutic method than surgery, being simpler to perform and supplying identical results.

[Diagnostic value of the CT scan in suppurative abdominal lesions (author's transl)]

Computed tomography, a relatively non-aggressive method of radiological investigation, can establish diagnosis, and, more particularly, define the site of suppurative lesions in the peritoneal cavity, the retroperitoneal space, and in solid organs (liver, kidneys, spleen). This method was employed to explore the abdomen in 52 patients. Intraperitoneal suppurations were diagnosed in 15 cases after demonstration of a low density mass, which may contain clear pockets of gas or be limited by a higher density wall. In 4 cases, a retroperitoneal lesion was detected (psoas or perinephric abscess). A parenchymatous abscess was present in 6 cases, 4 in the liver, one in the kidneys, and one in the spleen. Using the angioscan technique, after a bolus injection of an iodised contrast medium, improved definition of the limits of the abscess can be obtained. Differential diagnosis of intraperitoneal suppurative lesions in cases of developing haematomas, or in the presence of an intrahepatic abscess, which may be confused with necrotic metastases or post-traumatic ischaemic foci, may be difficult.

Pyogenic sacroiliitis

Two cases of pyogenic sacroiliitis are reported and the literature reviewed. Gluteal pain, tenderness in the sacroiliac area, and pain elicited by maneuvers which stress the joint are characteristic. Delay in diagnosis may result from failure to suspect the sacroiliac joint. Onset is acute in 86% with fever, severe pain, and inability to walk. A bone scan is useful for localization. Blood cultures are positive in one-third. Definitive diagnosis can be established by needle aspiration of the joint, a technically difficult procedure. Therapy is discussed.

Radionuclide imaging in pyogenic vertebral osteomyelitis

Five cases of pyogenic vertebral osteomyelitis diagnosed clinically and with radioisotope studies are reported. All patients presented with symptoms of back pain, an elevated erythrocyte sedimentation rate, and a normal leukocyte count. Three had positive blood cultures and four had changes on plain radiographs. All five had positive phosphate bone and Ga-67 imaging, and two showed paravertebral uptake of gallium giving a "butterfly"-like appearance.

The respective roles of gallium 67 citrate scanning and diagnostic ultrasound in detecting suppurations in renal allograft recipients

The authors report their experiments relative to the advantage of using gallium 67 scanning in the diagnosis of suppurative lesions in renal allograft recipients. Nineteen cases suggesting abscess were analyzed. In 7 cases in which abnormal isotope uptake was noted, a suppuration was detected in the area where the gallium 67 had accumulated. In 2 cases, the abnormal image corresponded to the location of a healing drained abscess, and, in 1 case of pathological uptake at the level of the graft, it was determined that the cause was chronic rejection without suppurative lesion. In 9 cases in which no abnormal focus of uptake was noted, the symptomatology suggesting abscess was eventually attributed to nonsuppurative causes (rejection, urinary fistula, etc.). It is concluded that gallium 67 scanning is a useful means of detecting suppurations in immunodepressed patients undergoing treatment with steroids which prevent the usual signs of suppuration from appearing. Generally, it can be said that diagnostic ultrasound, performed with respect to the area of abnormal gallium 67 uptake, permits optimum determination of the possibilities of an abscess existing.

Computed tomographic brain scanning in intraparenchymal pyogenic abscesses

Retrospective analysis of 25 pyogenic brain abcesses diagnosed by computed tomography (CT) revealed relatively specific morphologic characteristics of these infections. The ability to obtain an early accurate diagnosis resulted in a dramatic decrease in patient morbidity and mortality. Repeated examinations by CT permitted close monitoring of the response of the abscess to antibiotic therapy. In some instances the need for surgical intervention was eliminated or the surgical approach was modified as a result of these studies.

Interhemispheral subdural empyema

Five cases of localized interhemispheral suppuration are reported. A short description of the 'falx syndrome' is given. The angiographic features of the cases are described.

The sesamoid bones of the hands and feet: participators in arthritis

The sesamoids generally appear as small ovoid bones adjacent to articulations or at sites where tendons are angled about osseous surfaces. At either location they participate in joint afflictions, the pattern of abnormality being remarkably constant and predictable. Sesamoids may demonstrate osseous erosion in rheumatoid arthritis, bony proliferation or "whiskering" in rheumatoid variants, joint space narrowing and bony ankylosis in septic arthritis, and eburnation and osteophyte formation in osteoarthritis and diffuse idiopathic skeletal hyperostosis. These changes become particularly important when they occur in the absence of significant adjacent articular disease. In these instances, recognition of sesamoid abnormalities allows accurate radiographic diagnosis.

Sonographic-radiographic correlations of renal and perirenal infections

Sonograms of 43 patients with intrinsic and perirenal infectious processes are reviewed. Fourteen had acute pyelonephritis; three, suppurative pyelonephritis; two, focal pyelonephritis; six, renal abscesses; three, infected cysts; six, perinephric abscesses; six, pyonephrosis; and three, chronic pyelonephritis. Sonography had little diagnostic value except for the patients with perinephric abscess. However, it proved valuable as a guide for a percutaneous approach to obtain cells for histologic diagnosis, to obtain fluid to determine chemotherapy, and to perform antegrade pyelography and percutaneous nephrostomy.

Pyarthrosis complicating rheumatoid arthritis. Roentgenographic evaluation of 5 patients and review of the literature

Five patients with pyarthrosis complicating rheumatoid arthritis are described. Only minimal clinical signs may be seen in such patients, making accurate diagnosis of this occasional complication difficult. Roentgenographic abnormalities include a rapidly enlarging joint effusion and progressive cartilage and bone destruction. Fistulas may develop. The principal differential diagnoses include exacerbtion of rheumatoid arthritis and alterations in the rheumatoid joint following trauma.