1/6. A vanishing liver abscess complicated with klebsiella pneumoniae chest wall abscess: a case report.Septic metastasis is a unique feature of klebsiella pneumoniae liver abscess in taiwan. The case we report is a vanishing K. pneumoniae liver abscess with septic metastasis of the chest wall. The initial finding of a 36 year-old male with no previous medical history, was a huge hepatic mass presented on the sonography during a physical checkup. hepatitis b, C serology, tumor markers and evidence of metastatic diseases were all negative. A computerized tomography examination was also inconclusive about its nature. Due to the patient's refusal of a liver biopsy, only oral antibiotics were medicated at the outpatient department. Unexpectedly, the follow-up computerized tomography, taken 4 weeks later, demonstrated that the liver mass was nearly absent, while a protruding painful lesion developed over the right chest wall. Under sono-guided aspiration, the chest wall mass was proved to be a pyogenic abscess. The Gram stain revealed gram-negative bacilli and the bacterial culture yielded K. pneumoniae. Under the impression of K. pneumoniae liver abscess with chest wall septic metastasis, after performing percutaneous drainage of the chest wall abscess, the patient was only given parenteral antibiotics for treatment. Both the liver and the chest wall abscesses were at last completely eradicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Bacterial subretinal abscess: a case report and review of the literature.PURPOSE: To report a case of Klebsiella subretinal abscess with a successful visual outcome with treatment and to review the literature pertaining to focal intraocular infection in bacterial endophthalmitis. methods: Clinical data including medical history, findings on physical examination, blood cultures, and an abdominal computed tomographic scan were collected in a 32-year-old man with Klebsiella sepsis, liver abscesses, and a focal subretinal abscess. Ocular data including visual acuity, fundus photographs, fluorescein angiography, and ultrasound were evaluated, as were results of culture and histopathologic studies. RESULTS: Despite immediate intervention, including vitreous tap and intravitreal antibiotics, the eye deteriorated, with enlargement of the abscess. A pars plana vitrectomy was performed in which the subretinal abscess material was removed after an extensive retinectomy of the involved area in association with an endophotocoagulative barrier and intravitreal amikacin without gas or oil tamponade. culture confirmed Klebsiella subretinal infection. A retinal detachment occurred 1 month postoperatively and was successfully repaired. visual acuity was 20/30 and has remained stable for 14 months. CONCLUSION: Klebsiella endophthalmitis with subretinal abscess formation is a rare but devastating ocular condition. In the present case, prompt intervention with extensive retinectomy, complete abscess excision, and intravitreal antibiotic therapy resulted in unprecedented visual recovery.- - - - - - - - - - ranking = 19.923341402003keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Pyogenic liver abscesses in a child spreading to pulmonary and subcutaneous tissues: case report.Pyogenic liver abscess is a rare and life-threatening disease in children. Our case is noteworthy because of the rapid advancement of liver abscesses without any other systemic disorder. A 16-year-old girl was admitted to the hospital with fatigue, pallor, weight loss and high fever. In physical examination a fluctuating mass was observed under the scapular area and hepatosplenomegaly was found. In computed tomography, three septated cystic lesions which looked like abscesses were demonstrated in the liver. The abscess was drained through percutaneous route. Right pleural empyema with clinical features of adult respiratory distress syndrome appeared after the first day of treatment. bacteroides sp. was isolated from pus. On the twentieth day of the therapy, control abdominal computed tomography revealed two new abscesses in the liver. They were drained and the antibiotic therapy was continued with ticarcillin-clavulanate, fluconazole and levofloxacin. By the end of the first week of the therapy, the fever of the patient had abated. This therapy was continued for four weeks; 15 days after the end of the therapy there was prominent healing of the liver lesions with only one necrotic remnant 2 cm in diameter on abdominal computed tomography.- - - - - - - - - - ranking = 19.923341402003keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Therapeutic utilization of laparoscopy in liver abscess cases.Recently, the authors encountered a case of a bacterial pyogenic abscess of the liver in which the localization of a solitary abscess in the right hepatic lobe could be delineated on the basis of the findings of a physical examination, sonography, scintigraphy, computer tomography and selective angiography. The popularization of endoscopic surgery and chemotherapy encouraged us to attempt drainage of the pus out of the pyogenic abscess under laparoscopic observation. The patient has been progressing favorably thereafter and now about ten months have passed since he returned home. He is in good health. Clinical utilization of laparoscopy is possible from a therapeutic standpoint in solitary abscess of the liver.- - - - - - - - - - ranking = 19.923341402003keywords = physical examination, physical (Clic here for more details about this article) |
5/6. Pyogenic liver abscess involving actinomyces: case report and review.We report a case of isolated hepatic actinomycosis and review 35 previously reported cases. Three-fourths of the reported patients were male, and more than one-half were between 30 and 50 years of age. Although some patients had oral disease or intraabdominal infections, the majority of cases were cryptogenic. Common presenting symptoms included fever, abdominal pain, and anorexia with weight loss. Findings on physical examination included pyrexia, abdominal tenderness, and hepatomegaly. leukocytosis with a left shift, anemia, an elevated serum erythrocyte sedimentation rate, and an elevated level of alkaline phosphatase were almost universally present. diagnosis was frequently made at the time of exploratory laparotomy, but percutaneous diagnostic procedures obviated the need for surgery in many recent cases. Microbiological diagnosis involved visualization of branching gram-positive actinomyces organisms or recovery of organisms in anaerobic culture. Treatment most commonly consisted of prolonged administration of penicillin or tetracycline and was associated with an excellent outcome in the majority of cases.- - - - - - - - - - ranking = 19.923341402003keywords = physical examination, physical (Clic here for more details about this article) |
6/6. Successful interferon-gamma therapy in a chronic granulomatous disease (CGD) patient suffering from staphylococcus aureus hepatic abscess and invasive candida albicans infection.A 16-year old boy with an early history of recurrent lower respiratory tract infections exhibited symptoms of prolonged septic fever and liver abscess. Cultures from liver puncture were positive for staphylococcus aureus, and the patient initially responded to antibacterial therapy. After a period of 4 months, however, the infection relapsed, and further treatment with broad antibacterial, antifungal and tuberculostatic drugs was ineffective. Neither soluble nor particulate stimuli were found to elicit the respiratory burst response in granulocytes from the patient. Spectral analysis of granulocyte cytochrome-b confirmed the diagnosis of chronic granulomatous disease. Since the patient's physical condition deteriorated severely during the prolonged (10-week) septic course, immunosupportive interferon-gamma was added to the anti-microbial therapy. With this regime, the fever subsided and the general condition of the patient improved dramatically. He could be discharged from hospital 9 weeks after the introduction of interferon-gamma and was, at an elective follow-up control 1 month later, convalescing and showed no signs of active infection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |