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Diagnosis and Treatment of Splenic Abscess Report of 11 Cases

【摘要】目的探讨脾脓肿的易感因素、诊断与治疗。方法对1990年6月至2002年8月收治的11例脾脓肿患者资料进行回顾性分析。结果11例患者中8例行手术或穿刺治疗，3例保守治疗。10例患者治愈或好转出院，1例保守治疗无效死于败血症。结论加强对脾脓肿的认识是提高本病早期诊断的关键，脾切除是治疗脾脓肿的首选方式。

表现为局灶性癫痫发作的糖尿病合并脑脓肿一例

Severe cavitary pneumonia caused by Legionella pneumophila serotype 6: a case report and literature review

ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.

慢性胰腺炎患者术后并发盆腔腹膜后脓肿护理一例

RUPTURE OF LIVER ABSCESS:ANALYSIS OF 77 CASES

Rupture is one of main complications of liver abscess. Seventy-seven patients with rupture of liver abscess are reviewed. Liver abscess may freely rupture into adjacent structures or organs or serous cavities and cause vatious complications. The causative factors of rupture of liver abscess in this series were late medical consultation in the course of the disease, delayed treatment due to misdiagnosis, and improper treatment. Measures that prevent rupture of liver abscess include raising clinical awareness of early diagnosis and timely effective drainage. The authors consider that transperitoneal surgical drainage is the best approach. Most patients with rupture of liver abscess should be treated by surgical drainage togather with transomental or transumbilital veno-catheterization for antibiotic infusion. Patients with rupture of liver abscess usually present a poor prognosis and a high mortality rate. The mortality in this group was 35.1%(27/77), which is closely related to the complications of the rupture of liver abscess.

继发性纵隔脓肿的诊断与治疗

目的 探讨多种原因导致的继发性纵隔脓肿的诊断和综合治疗方法。 方法 回顾性分析1988年12月至2007年11月中国医科大学附属第一医院收治的23例继发性纵隔脓肿的临床资料，男18例，女5例；年龄13个月～76岁，平均年龄40.9岁。致病原因：食管穿孔或破裂14例（外伤致食管破裂7例、医源性食管破裂6例、自发性食管破裂1例），咽部脓肿5例，口底蜂窝组织炎2例，气管断裂2例。采取以外科手术治疗为主，辅以抗感染和营养支持治疗。行食管破裂修补术10例次，空肠或胃造瘘术6例次，脓胸纤维板剥脱术4例次，经颈部切口上纵隔引流术15例次，胸腔闭式引流术7例次，肺叶部分切除术2例次，心包引流术1例次，牙周和颌下切开引流术1例次。 结果 住院死亡5例，病死率21.7%（5/23），死于中毒性休克4例，静脉大出血1例。出院时完全治愈或病情稳定18例。随访16例，随访时间6～18个月，随访期间生存患者生活质量提高，死于脑血管意外1例；失访2例。 结论 继发性纵隔脓肿病情发展迅速，且病死率高，应早期诊断，充分的外科引流、合理使用抗生素和营养支持是治疗的关键。

妊娠期合并乳腺脓肿行引流术护理一例

全肺切除治疗肺毛霉菌病合并肺脓肿一例并文献复习

目的 探讨侵袭性支气管肺毛霉菌病合并毛霉菌肺脓肿内科治疗无效时外科手术的可行性。方法 报告1例2022年在解放军总医院第八医学中心住院的支气管肺毛霉菌病合并毛霉菌肺脓肿患者内科治疗及外科手术过程，并对外科手术在肺毛霉菌病治疗中的有关文献进行复习。结果 患者男性，29岁，某药厂排污厂房工人，既往患有糖尿病。因咳嗽，咳痰，咯血40余天，高热5天入院。经支气管镜活检诊断为左主支气管毛霉菌病，积极内科治疗无效时，行左全肺切除术，术后治愈出院。术后病理示支气管肺毛霉菌病并左下肺毛霉菌肺脓肿。文献复习显示外科手术是支气管肺毛霉菌病治疗手段之一，但目前肺毛霉菌病手术治疗多限于单纯孤立病灶和肺叶切除术，全肺切除术罕见。未检索到类似本例全肺切除治愈支气管肺毛霉菌病，毛霉菌肺脓肿的报告。结论 侵袭性支气管肺毛霉菌病，合并毛霉菌肺脓肿在内科治疗无效时，外科手术治疗亦应值得考虑。

膈肌结核性脓肿一例

Evidence-Based Evaluation on Global Clinical Research Literatures about Prostatic Abscess in the Past Decade

Objective　To review and evaluate the global clinical research literatures about the surgical management for prostatic abscess in the past decade, so as to provide useful information for clinical practice. Methods　Based on the principles of evidence-based medicine, and the methods of bibliometrics, the PubMed database was searched from January 1st 2000 to April 10th 2011. The literatures about prostatic abscess were screened according to the predefined inclusion and exclusion criteria, the quality was assessed, the valid data were extracted and then systematical evaluation was performed after the establishment of the database with OpenOffice.org 3.8 Calc. Results　a) A total of 205 articles were found initially and 81 were finally included with the total 388 cases involved (on average, 4.79 cases per paper). The patients’ ages ranged from 10 days to 83 years old. Two studies were diagnostic tests, and all the other 79 were surgical intervention studies; b) There was no controlled clinical trail. A total of 16 studies involving more than 5 cases for each and 311 cases in all which were retrospective case analyses, all the other 65 were individual case reports; c) American scholars published 13 papers (16.5%), ranked as the first. American and European scientists published 36 papers (44.44%). Chinese scholars published quite fewer studies, of which only 2 were in English; d) The incidence increased in younger patients gradually. The pathogens included fungi and bacteria. Most bacteria were gram-positive cocci (such as Staphylococci), followed by gram-negative bacillus (such as Klebsiella). There were also some minority pathogens. The pathogens were complex and quite diverse in different districts. The predisposing factors included both regional and systematic conditions, with diabetes mellitus, hepatocirrhosis, manipulations of lower urinary tract and urinary tract infections as the common; e) The diagnostic procedures included evaluation on symptoms and signs, physical examination, identification of pathogens, and medical imaging examinations (TRUS, CT, MRI). The therapeutic options included routine managements, conservative antibiotic therapies and surgical drainages. The surgical routes were transcutaneous, transperineal, transrectal, and transurethral. The fine needle aspiration, indwelling catheter drainage, or incision and drainage were performed under the guidance of TRUS, EUS or CT through transperineal or transrectal routes. The TUR, TURP or TUIP drainages were performed through transurethral route. The failed cases of fine needle aspiration were then treated by transurethral or transperineal incision and drainages, and some patients were also treated by urinary diversion; f) The best surgical method could not be concluded for lack of controlled data; and g) Few cases died from severe complications, and the outcomes of the majority cases were good. Conclusion　a) The literatures about prostatic abscess are abundant but of low quality, with all retrospective studies or individual case reports, and most are published by American and European scholars; b) The prostatic abscess affects all ages but tends to increase in the young. Most pathogens are the gram-positive cocci (such as Staphylococci) ranked as the top and followed by gram-negative bacillus (such as Klebsiella), and the pathogens are obviously diverse in different districts; c) The predisposing factors are commonly seen as diabetes mellitus, hepatocirrhosis, manipulations of lower urinary tract and urinary tract infections; ......