RESUMO
INTRODUCCIÓN: El absceso renal es infrecuente en pediatría, con clínica y laboratorio inespecíficos. Ante su sospecha, es necesario realizar imágenes para establecer diagnóstico. Objetivo: Describir las características clínico-epidemiológicas, microbiológicas, diagnósticas y terapéuticas de abscesos renales en pediatría. PACIENTES Y MÉTODOS: Estudio retrospectivo, descriptivo, de pacientes internados con absceso renal, en seguimiento por Infectología del Hospital de Niños Ricardo Gutiérrez, durante 9 años. RESULTADOS: 15 pacientes (67% varones), mediana de edad 9 años (rango [r] 0,7-17). Cuatro pacientes con comorbilidades. El síntoma más frecuente fue fiebre seguido por dolor lumbar. El recuento medio de leucocitos en sangre fue de 15.700/mm3 (r: 7.100-45.000) y la PCR de 193 mg/L (r: 1-362). Cuatro pacientes presentaron urocultivo positivo: dos Escherichia coli, uno Klebsiella pneumoniae y E. coli y otro Candida albicans y K. pneumoniae. Ningún paciente presentó bacteriemia. El diagnóstico se confirmó por ecografía. Se realizó drenaje en siete pacientes, con aislamiento de Staphylococcus aureus en dos y Pseudomonas aeruginosa en uno. El tratamiento incluyó terapia combinada en 67%. Mediana de antibioterapia intravenosa fue 16 días (r: 7-49), total de 28 (r: 14-91). Un paciente requirió terapia intensiva y dos, nefrectomía. CONCLUSIÓN: Los abscesos renales son infrecuentes, con gran morbimortalidad. Sospechar en paciente con infección del tracto urinario (ITU) de evolución tórpida que persiste febril. En nuestro estudio, la alta sensibilidad de la ecografía renal permitió su diagnóstico precoz.
BACKGROUND: Renal abscesses are infrequent in pediatrics, with nonspecific clinical and laboratory findings. When suspected, imaging is essential to establish the diagnosis. Aim: To describe the clinical-epidemiological, microbiological, diagnostic and therapeutic characteristics of renal abscesses in pediatrics. METHODS: Retrospective and descriptive study of hospitalized patients with renal abscess, followed by Infectious Diseases Department of Ricardo Gutiérrez Children's Hospital during 9 years. Statistical analysis: Epi Info 7.2.2.6. RESULTS: 15 patients (67% male), median age 9 years (range [r] 0.7-17) were included. Four patients had underlying disease. The most frequent symptom was fever, with a median duration of 10 days (r:1-36), followed by lumbar pain. The median white blood cell count was 15,700/mm3 (r: 7,100-45,000) and CRP 193mg/L (r: 1-362). Four patients presented positive urine culture: 2 Escherichia coli, 1 Klebsiella pneumoniae and E. coli and 1 Candida albicans and K. pneumoniae. No patient had bacteremia. The diagnosis of abscess was confirmed by ultrasound. Surgical drainage was performed in 7 patients, with isolation of Staphylococcus aureus in 2 and Pseudomonas aeruginosa in 1. Empirical treatment included 3rd generation cephalosporin, combined in 67% of cases. The median of intravenous antibiotic therapy was 16 days (r: 7-49) with a total of 28 days (r:14-91). One patient required transfer to intensive care unit and 2 nephrectomy. CONCLUSION: Renal abscesses are infrecuent in pediatrics, but they present significant morbidity and mortality. It should be suspected in patients with urinary tract infection (UTI)with torpid evolution that persists with fever without antibiotic response. In our study, the high sensitivity of renal ultrasound allowed early diagnosis.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Abscesso/epidemiologia , Nefropatias/epidemiologia , Bactérias/isolamento & purificação , Infecções Urinárias , Urina/microbiologia , Drenagem , Estudos Retrospectivos , Abscesso/diagnóstico , Abscesso/microbiologia , Abscesso/terapia , Hospitais Pediátricos , Nefropatias/diagnóstico , Nefropatias/microbiologia , Nefropatias/terapia , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: Anal fistula treatment aims to eradicate the fistula, preserve the sphincter, prevent recurrence, and allow an early return to daily activities for the patient. Because of the difficulty of achieving these goals, stem cell-based therapy has emerged for the treatment of complex perianal fistula with promising results. OBJECTIVE: The objective of this study was to evaluate the safety of allogeneic mesenchymal stem cells in the treatment of complex anal fistula in patients without Crohn's disease. DESIGN: This was a prospective nonrandomized phase I clinical trial. SETTINGS: This study was conducted at a second-level hospital. PATIENTS: Twenty consecutive patients diagnosed with a complex fistula were included. INTERVENTIONS: All patients received 40 × 106 allogeneic mesenchymal stem cells. In patients with 2 tracts, 20 × 106 stem cells were applied on each tract. MAIN OUTCOME MEASURES: The patients were discharged 24 hours after the procedure and were evaluated at 1, 2, 4, 8, 16, and 24 weeks after the application. The long-term follow-up was performed 1 year after the procedure. RESULTS: The procedure was performed in a total of 20 patients from October 1, 2016, to October 31, 2017; 1 patient was eliminated from the final data analysis. No adverse effects were reported within the first 24 hours, and all the patients were discharged asymptomatic. Three patients (15%) presented with perianal abscess. In 1 patient, the abscess appeared at the fourth week, and, in the other 2 patients, the abscess was diagnosed at week 8. Complete closure was achieved in 13 (69%) patients. LIMITATIONS: This was a nonrandomized controlled trial. CONCLUSION: The use of allogeneic mesenchymal stem cells as a treatment is a safe option for the management of complex perianal fistula not associated with Crohn's disease. See Video Abstract at http://links.lww.com/DCR/B443. SEGURIDAD DE LAS CLULAS MADRE MESENQUIMALES ALOGNICAS DERIVADAS DEL TEJIDO ADIPOSO PARA EL TRATAMIENTO DE FSTULAS PERIANALES COMPLEJAS NO ASOCIADAS CON LA ENFERMEDAD DE CROHN ENSAYO CLNICO DE FASE I: ANTECEDENTES:El tratamiento de la fístula anal tiene como objetivo erradicar la fístula, preservar el esfínter, prevenir la recurrencia y permitir un retorno temprano a las actividades diarias del paciente. Debido a la dificultad de alcanzar estos objetivos, ha surgido una terapia basada en células madre para el tratamiento de la fístula perianal compleja con resultados prometedores.OBJETIVO:El objetivo de este estudio fue evaluar la seguridad de las células madre mesenquimales alogénicas en el tratamiento de la fístula anal compleja en pacientes sin enfermedad de Crohn.DISEÑO:Este fue un ensayo clínico prospectivo no aleatorizado de fase I.AMBIENTE:Este estudio se realizó en un hospital de segundo nivel.PACIENTES:Veinte pacientes consecutivos diagnosticados de fístula compleja.INTERVENCIONES:Todos los pacientes recibieron 40 x 106 células madre mesenquimales alogénicas, en pacientes con dos tractos, se aplicaron 20 x 106 células madre en cada tracto.PRINCIPALES MEDIDAS DE RESULTADO:Los pacientes fueron dados de alta 24 horas después del procedimiento y fueron evaluados 1, 2, 4, 8, 16, 24 semanas después de la aplicación. El seguimiento a largo plazo se realizó un año después del procedimiento.RESULTADOS:El procedimiento se realizó en un total de 20 pacientes desde el 1 de octubre de 2016 al 31 de octubre de 2017; un paciente fue eliminado del análisis de datos final. No se informaron efectos adversos en las primeras 24 horas, todos los pacientes fueron dados de alta asintomáticos. Tres pacientes (15%) presentaron absceso perianal. En un paciente, el absceso apareció a la cuarta semana y en los otros dos pacientes el absceso se diagnosticó en la octava semana. El cierre completo se logró en 13 (69%) de los pacientes.LIMITACIONES:Este fue un ensayo controlado no aleatorio.CONCLUSIÓN:El uso de células madre mesenquimales alogénicas como tratamiento es una opción segura para el manejo de la fístula perianal compleja no asociada con la enfermedad de Crohn. Consulte Video Resumen en http://links.lww.com/DCR/B443.
Assuntos
Doenças do Ânus/microbiologia , Transplante de Células-Tronco Mesenquimais/métodos , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Fístula Retal/terapia , Abscesso/diagnóstico , Abscesso/epidemiologia , Adulto , Células Alógenas , Doenças do Ânus/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Células-Tronco Mesenquimais , Pessoa de Meia-Idade , Estudos Prospectivos , Fístula Retal/patologia , Segurança , Resultado do TratamentoRESUMO
OBJETIVO: El objetivo principal de este estudio fue determinar la incidencia de complicaciones post cirugía bucal. METODOLOGÍA: Se desarrolló un estudio observacional, descriptivo, con el uso del registro prospectivo de la totalidad de pacientes ingresados para cirugía bucal del Complejo Hospitalario San Borja-Arriarán durante doce meses de observación (abril 2017 a marzo 2018). RESULTADOS: La muestra estuvo conformada por 532 pacientes sometidos a procedimientos quirúrgicos de cirugía bucal y 29 casos de complicación postquirúrgica. La incidencia de complicaciones alcanzó un 5,5% y se observó de manera predominante en intervenciones de tipo exodoncia. La complicación mayormente observada fue la alveolitis alcanzando un 2,5% de las cirugías de terceros molares y un 3,7% de las exodoncias de otros dientes. Las hemorragias postoperatorias se observaron en un 1,1% de las cirugías de terceros molares. Otras complicaciones postquirúrgicas fueron abscesos de espacios faciales, parestesia del nervio alveolar inferior, hematomas, equimosis y periostitis. CONCLUSIÓN: Los resultados fueron similares a los reportados en la literatura tanto en su frecuencia como en el tipo de complicación.
OBJECTIVE: The main objective of this investigation was to determine the incidence of postoperative complications in oral surgery. MATERIALS AND METHODS: An observational and descriptive study was developed with the use of the prospective registry of the patients admitted for oral surgery in the San Borja Arriarán Hospital Complex for a twelve-month period of observation (April 2017 to March 2018). RESULTS: The sample consisted of 532 patients undergoing surgical procedures of oral surgery and 29 cases of postoperative complications. The incidence of complications reached 5,5% and it was observed predominantly in interventions of tooth extraction. The most commonly observed complication was dry socket, reaching 2,5% of third molar surgeries and 3,7% of extractions of other teeth. Postoperative hemorrhages were observed in 1,1% of third molar surgeries. Other postoperative complications were facial spaces abscesses, paresthesia of the inferior alveolar nerve, bruising, ecchymosis and periostitis. CONCLUSIONS: The results were similar to those reported in the literature both in their frequency and in the type of complication.
Assuntos
Humanos , Masculino , Feminino , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Cirurgia Bucal , Epidemiologia Descritiva , Incidência , Hemorragia Pós-Operatória/epidemiologia , Abscesso/epidemiologia , Alvéolo Seco/epidemiologiaRESUMO
OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
Assuntos
Abscesso/epidemiologia , Doenças do Ânus/epidemiologia , Falência Renal Crônica/epidemiologia , Abscesso/complicações , Abscesso/cirurgia , Idoso , Doenças do Ânus/complicações , Doenças do Ânus/cirurgia , China/epidemiologia , Feminino , Fissura Anal/complicações , Fissura Anal/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva , Diálise Renal , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: We conducted this retrospective study to elucidate the clinical presentation and outcomes of anal abscess in chronic dialysis patients. METHODS: We performed a chart review of patients who were hospitalized for anal abscess from Jan. 2002 to Dec. 2015. A total of 3,074 episodes of anal abscess were identified. Of these, 43 chronic dialysis patients with first-time anal abscess were enrolled. Patients were divided into a surgical group and a nonsurgical group according to the treatment received during hospitalization. The baseline characteristics, clinical findings, treatments and outcomes were obtained and analyzed. The endpoints of this study were in-hospital mortality, one-year mortality and one-year recurrence. RESULTS: Of the 43 patients, 27 (62.7%) received surgical treatment, and 16 (37.2%) received antibiotic treatment alone. There was no significant difference in age, sex, body mass index, smoking habits, comorbidities, or dialysis characteristics between the two groups. Perianal abscess was the most common type of anal abscess, and 39.5% of patients experienced fistula formation. Most patients had mixed aerobic and anaerobic flora. Our data demonstrate that there was no significant difference in hospital stay, one-year survival or recurrence rate between the surgical group and nonsurgical group. However, there was a trend toward better in-hospital survival in patients who received surgical treatment (p=0.082). CONCLUSION: In chronic dialysis patients with anal abscess, there was no statistically significant difference in clinical presentation and outcomes between the surgical and nonsurgical groups, although the surgical group had a trend of better in-hospital survival.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças do Ânus/epidemiologia , Abscesso/epidemiologia , Falência Renal Crônica/epidemiologia , Doenças do Ânus/cirurgia , Doenças do Ânus/complicações , Recidiva , China/epidemiologia , Taxa de Sobrevida , Estudos Retrospectivos , Diálise Renal , Resultado do Tratamento , Abscesso/cirurgia , Abscesso/complicações , Fissura Anal/cirurgia , Fissura Anal/complicações , Hospitalização/estatística & dados numéricos , Falência Renal Crônica/complicações , Tempo de Internação/estatística & dados numéricosRESUMO
O presente estudo objetivou determinar a prevalência e distribuição de lesões abscedativas, identificação do agente etiológico e avaliação das lesões histológicas em caprinos e ovinos abatidos em um matadouro-frigorífico com Serviço de Inspeção Federal do estado da Bahia. Foram coletadas 153 amostras de vísceras e linfonodos com abscessos de 1.148 animais abatidos. A maior prevalência na espécie ovina foi em macho, com faixa etária de 12 meses, sendo os principais órgãos acometidos fígado (21,2%) e linfonodo pré-escapular (20,3%). Na espécie caprina, a prevalência maior foi em macho, com faixa etária de 30 meses, sendo os linfonodos retro faríngeo (25%) e pré-escapular os mais acometidos (25%). Isolou-se os seguintes micro-organismos das amostras: Corynebacterium pseudotuberculosis em 33,33%, Escherichia coli (19,61%), Proteus mirabilis (9,80%), Pseudomonas aeruginosa (7,19%), Trueperella pyogenes (5,22%), Streptococcusspp. (5,22%) e Staphylococcus aureus (4,57%). As lesões macroscópicas e histológicas dos abscessos coletados não apresentaram diferenças entre micro-organismos isolados.(AU)
The study aimed to determine the prevalence and distribution of abscessed lesions, etiologic agent identification and assessment of histological lesions in sheep and goats slaughtered in a slaughter plant refrigerator with Federal Inspection Service in the State of Bahia. The amount of 153 samples of viscera and lymph nodes with abscesses of 1.148 slaughtered animals were collected. The highest prevalence in sheep was in males, aged 12 months, as in liver (21.2%) and prescapular lymph nodes (20.3%) the main affected organs. The prevalence in goats in male, aged 30 months and in retropharyngeal (25%) and prescapular lymph nodes (25%). The following microorganisms were isolated from the samples: Corynebacterium pseudotuberculosis 33.33%, Escherichia coli 19.61%, Proteus mirabilis 9.80%, Pseudomonas aeruginosa 7.19%, Trueperella pyogenes 5.22%, Streptococcus spp. 5.22% and Staphylococcus aureus 4.57%. The macroscopic and histological lesions of abscesses collected presented no difference between isolated microorganisms.(AU)
Assuntos
Animais , Ruminantes/lesões , Corynebacterium pseudotuberculosis , Infecções por Corynebacterium/veterinária , Abscesso/patologia , Abscesso/veterinária , Abscesso/epidemiologia , Fígado/microbiologia , Abscesso Hepático/veterinária , Linfonodos/microbiologia , Proteus mirabilis , Pseudomonas aeruginosa , Streptococcus , Escherichia coliRESUMO
O presente estudo objetivou determinar a prevalência e distribuição de lesões abscedativas, identificação do agente etiológico e avaliação das lesões histológicas em caprinos e ovinos abatidos em um matadouro-frigorífico com Serviço de Inspeção Federal do estado da Bahia. Foram coletadas 153 amostras de vísceras e linfonodos com abscessos de 1.148 animais abatidos. A maior prevalência na espécie ovina foi em macho, com faixa etária de 12 meses, sendo os principais órgãos acometidos fígado (21,2%) e linfonodo pré-escapular (20,3%). Na espécie caprina, a prevalência maior foi em macho, com faixa etária de 30 meses, sendo os linfonodos retro faríngeo (25%) e pré-escapular os mais acometidos (25%). Isolou-se os seguintes micro-organismos das amostras: Corynebacterium pseudotuberculosis em 33,33%, Escherichia coli (19,61%), Proteus mirabilis (9,80%), Pseudomonas aeruginosa (7,19%), Trueperella pyogenes (5,22%), Streptococcusspp. (5,22%) e Staphylococcus aureus (4,57%). As lesões macroscópicas e histológicas dos abscessos coletados não apresentaram diferenças entre micro-organismos isolados.(AU)
The study aimed to determine the prevalence and distribution of abscessed lesions, etiologic agent identification and assessment of histological lesions in sheep and goats slaughtered in a slaughter plant refrigerator with Federal Inspection Service in the State of Bahia. The amount of 153 samples of viscera and lymph nodes with abscesses of 1.148 slaughtered animals were collected. The highest prevalence in sheep was in males, aged 12 months, as in liver (21.2%) and prescapular lymph nodes (20.3%) the main affected organs. The prevalence in goats in male, aged 30 months and in retropharyngeal (25%) and prescapular lymph nodes (25%). The following microorganisms were isolated from the samples: Corynebacterium pseudotuberculosis 33.33%, Escherichia coli 19.61%, Proteus mirabilis 9.80%, Pseudomonas aeruginosa 7.19%, Trueperella pyogenes 5.22%, Streptococcus spp. 5.22% and Staphylococcus aureus 4.57%. The macroscopic and histological lesions of abscesses collected presented no difference between isolated microorganisms.(AU)
Assuntos
Animais , Ruminantes/lesões , Corynebacterium pseudotuberculosis , Infecções por Corynebacterium/veterinária , Abscesso/patologia , Abscesso/veterinária , Abscesso/epidemiologia , Fígado/microbiologia , Abscesso Hepático/veterinária , Linfonodos/microbiologia , Proteus mirabilis , Pseudomonas aeruginosa , Streptococcus , Escherichia coliRESUMO
OBJECTIVES: Odontogenic abscesses are one of the most common dental diseases causing maxillofacial skeletal lesions. They affect the individual's ability to maintain the dental structures necessary to obtain adequate nutrition for survival and reproduction. In this study, the prevalence and pattern of odontogenic abscesses in relation to age, sex, matriline, and living periods were investigated in adult rhesus macaque skeletons of the free-ranging colony on Cayo Santiago, Puerto Rico. MATERIALS AND METHODS: The skulls used for this study were from the skeletons of 752 adult rhesus macaques, aged 8-31 years, and born between 1951 and 2000. They came from 66 matrilines ranging from 1 to 88 individuals. Fistulae or skeletal lesions caused by odontogenic abscesses drainage, carious lesions, tooth fractures, tooth loss, and alveolar resorption were evaluated visually. RESULTS: Seventy-two specimens (9.57%) had odontogenic abscesses of varying severity. Males had a significantly higher prevalence than females. The prevalence of odontogenic abscesses in several matrilines was significantly higher than in the population as a whole. Animals born between 1950 and 1965 tended to have a higher prevalence of odontogenic abscesses than those born in later periods. DISCUSSION: These results suggest that oral pathologies, such as dental and periodontal abscesses in rhesus macaques are fairly common, which may indicate familial effects interwoven with ecological and social factors. The closeness of the rhesus and human genomes allows insights to understand of the epidemiology of these diseases in the human population. Further assessment of the role played by environmental and familial factors on rhesus oral health and disease are warranted.
Assuntos
Abscesso , Macaca mulatta , Doenças Estomatognáticas , Abscesso/epidemiologia , Abscesso/veterinária , Processo Alveolar , Animais , Feminino , Masculino , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Doenças Estomatognáticas/epidemiologia , Doenças Estomatognáticas/veterináriaRESUMO
BACKGROUND: Skin and soft tissue infections are common problems dealt with in emergency departments and medical offices. It is routine practice to prescribe antibiotic agents after incision and drainage of cutaneous abscesses. However, current evidence does not support prescribing oral antibiotic agents after surgical debridement. The aim of the present study was to determine the actual role of antibiotic agents after drainage of cutaneous abscesses. PATIENTS AND METHODS: This was a prospective study of patients undergoing incision and drainage (I&D) of a subcutaneous abscess. Patients were randomly assigned either to receive antibiotic agents (group 1) or placebo (group 2) after I&D. The primary end point was resolution rate of the abscess at the seventh day. Secondary end points were pain at the seventh day and total time to full healing of the wound. P value <0.05 was considered statistically significant. RESULTS: One hundred sixty-five patients were included for analysis. Age, gender, body mass index (BMI), and comorbidities did not differ substantially between groups. Chest and peri-anal abscesses were statistically more frequent in group 2, whereas neck abscesses were more frequent in group 1 (p = 0.02). Leukocyte count was also statistically higher in group 1 (p = 0.005). Resolution rate was 96% in group 1 and 93% in group 2, with no statistical difference between both (p = 0.28). Neither pain at seventh day nor time to full healing differed statistically between groups. CONCLUSIONS: Antibiotic agents are not necessary for uncomplicated subcutaneous abscesses after I&D. These cases can be managed safely on an outpatient basis without any increase in morbidity.
Assuntos
Abscesso , Antibacterianos/uso terapêutico , Drenagem/estatística & dados numéricos , Infecções dos Tecidos Moles , Abscesso/tratamento farmacológico , Abscesso/epidemiologia , Abscesso/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Renal transplantation is the treatment of choice for patients with stage V chronic kidney disease, which does not have contraindications to the procedure and is more cost-effective than dialysis treatments and provides better survival and quality of life. OBJECTIVE: The objective of this study was to evaluate the incidence of postoperative complications in kidney transplant recipients in a reference hospital. METHODOLOGY: This was a descriptive and retrospective study involving the analysis of patient records during hospitalization and outpatient treatment. We analyzed the demographics, clinical indicators, surgical techniques, and postoperative complications. RESULTS: In the analysis of 147 transplantations, there was a higher incidence of transplantation in female recipients, average age of 37 years with a predominance of cadaveric transplantation. Of all pretransplantation comorbidities, hypertension was the most frequent. The overall incidence of surgical complications was 29.9%, with an incidence of vascular complications of 12.7%, 13.4% of surgical site complications, 8.2% of urologic complications, and 3% of hemorrhagic complications. DISCUSSION: Vascular complications are serious complications and are associated with increased risk of graft loss (relative risk, 8.4), particularly arterial thrombosis. Patients with ureteral anastomosis using Lich-Gregoir technique showed lower urologic complications compared with patients with anastomosis by Leadbetter-Politano technique. CONCLUSION: Surgical complications have different clinical effects, depending on their category. The vascular complications are associated with graft lost.
Assuntos
Anastomose Cirúrgica/métodos , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Complicações Pós-Operatórias/epidemiologia , Trombose/epidemiologia , Abscesso/epidemiologia , Adulto , Transfusão de Sangue , Brasil/epidemiologia , Feminino , Humanos , Incidência , Hérnia Incisional/epidemiologia , Linfocele/epidemiologia , Masculino , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Qualidade de Vida , Diálise Renal , Reoperação , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Transplantados , Ureter/cirurgia , Obstrução Ureteral/epidemiologia , Fístula Urinária/epidemiologiaRESUMO
Abstract Introduction Perianal suppurations have an incidence of 1-2:10,000 inhabitants per year and represent about 5% of proctology consultations, more frequently in males, being rare in childhood. Although perianal or anorectal abscess is an entity of relatively simple diagnosis and treatment, in a considerable percentage of patients difficulties will be found, especially considering that the initial treatment of these patients is performed by non-specialist physicians. Objective This is a retrospective survey of cases of perianal and anorectal abscess operated in Santa Marcelina Hospital between October 2011 and December 2014. Patients and methods A retrospective study of patients operated on an emergency basis for perianal and/or anorectal abscess in Santa Marcelina Hospital between October 2011 and December 2014, being excluded patients with inflammatory bowel disease. Data of gender, age, clinical presentation, the season of the year in which the abscess occurred, time of progression of symptoms, comorbidities, signs of Systemic Inflammatory Response Syndrome (SIRS) on admission, surgeries carried out, reoperations and clinical outcome were analyzed. Results Electronic medical records of 52 patients (73.1% male) who underwent surgical treatment of anorectal and perianal abscess were analyzed. The mean overall age was 43.03 years, and all patients reported pain as the main symptom, with a mean time of symptoms of 6.5 days. As for the season of the year of onset and diagnosis of perianal abscess, 61.5% of patients had this pathology in the summer and spring months. Conclusion In our study, it can be observed a higher incidence of perianal abscess in males and in the warmer months; furthermore, just over half of the patients developed perianal fistula in their progression.
Resumo Introdução As supurações perianais apresentam uma incidência de 1-2:10000 habitantes por ano e representam cerca de 5% das consultas proctológicas, com maior frequência no sexo masculino, sendo raras na infância. Embora o abscesso perianal ou anorretal seja de diagnóstico e tratamento relativamente simples, uma percentagem considerável representa maior dificuldade para tal, notadamente pelo fato do atendimento inicial desses pacientes ser realizado por médicos não especialistas. Objetivo Levantamento retrospectivo dos casos de abscesso perianal e anorretal operados no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014. Casuística e método Estudo retrospectivo de pacientes operados em caráter de urgência por abscesso perianal e/ou anorretal no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014, excluídos portadores de doença inflamatória intestinal. Analisaram-se dados de sexo, idade, quadro clínico, época do ano da ocorrência do abscesso, tempo de evolução dos sintomas, comorbidades, sinais de Síndrome da Resposta Inflamatória Sistêmica (SIRS) na admissão, cirurgias realizadas, reoperações e desfecho clínico. Resultados Foram analisados prontuários eletrônicos de 52 pacientes submetidos à tratamento cirúrgico de abscesso anorretal e perianal, dos quais 73,1% pertenciam ao sexo masculino. A média de idade geral foi de 43,03 anos e todos os pacientes relataram dor como sintoma principal com média de tempo de sintomatologia de 6,5 dias. Quanto à época do ano do aparecimento e diagnóstico do abscesso perianal, 61,5% dos pacientes apresentaram a patologia nos meses de verão e primavera. Conclusão Em nosso trabalho, pode-se observar maior incidência de abscesso perianal no sexo masculino e nos meses mais quentes e que pouco mais da metade dos pacientes desenvolveram fístula perianal na evolução.
Assuntos
Humanos , Masculino , Feminino , Doenças do Ânus/epidemiologia , Abscesso/cirurgia , Abscesso/epidemiologia , Canal Anal/patologia , Fístula Retal , Síndrome de Resposta Inflamatória SistêmicaRESUMO
AIM: We analyzed data from 71 patients with chronic granulomatous disease (CGD) with a confirmed genetic diagnosis, registered in the online Latin American Society of Primary Immunodeficiencies (LASID) database. RESULTS: Latin American CGD patients presented with recurrent and severe infections caused by several organisms. The mean age at disease onset was 23.9 months, and the mean age at CGD diagnosis was 52.7 months. Recurrent pneumonia was the most frequent clinical condition (76.8%), followed by lymphadenopathy (59.4%), granulomata (49.3%), skin infections (42%), chronic diarrhea (41.9%), otitis (29%), sepsis (23.2%), abscesses (21.7%), recurrent urinary tract infection (20.3%), and osteomyelitis (15.9%). Adverse reactions to bacillus Calmette-Guérin (BCG) vaccination were identified in 30% of the studied Latin American CGD cases. The genetic diagnoses of the 71 patients revealed 53 patients from 47 families with heterogeneous mutations in the CYBB gene (five novel mutations: p.W361G, p.C282X, p.W483R, p.R226X, and p.Q93X), 16 patients with the common deletion c.75_76 del.GT in exon 2 of NCF1 gene, and two patients with mutations in the CYBA gene. CONCLUSION: The majority of Latin American CGD patients carry a hemizygous mutation in the CYBB gene. They also presented a wide range of clinical manifestations most frequently bacterial and fungal infections of the respiratory tract, skin, and lymph nodes. Thirty percent of the Latin American CGD patients presented adverse reactions to BCG, indicating that this vaccine should be avoided in these patients.
Assuntos
Doença Granulomatosa Crônica , Glicoproteínas de Membrana/genética , Mutação , NADPH Oxidases/genética , Sistema de Registros , Abscesso/epidemiologia , Abscesso/etiologia , Abscesso/genética , Adolescente , Idade de Início , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Diarreia/genética , Feminino , Doença Granulomatosa Crônica/complicações , Doença Granulomatosa Crônica/epidemiologia , Doença Granulomatosa Crônica/genética , Hispânico ou Latino , Humanos , Lactente , Recém-Nascido , Doenças Linfáticas/epidemiologia , Doenças Linfáticas/etiologia , Doenças Linfáticas/genética , Masculino , NADPH Oxidase 2 , Osteomielite/epidemiologia , Osteomielite/etiologia , Osteomielite/genética , Otite/epidemiologia , Otite/etiologia , Otite/genética , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumonia/genética , Sepse/epidemiologia , Sepse/etiologia , Sepse/genética , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Dermatopatias/genética , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/genéticaRESUMO
Skin popping refers to the act of subcutaneous injection of intravenous drugs, a practice that often results in the development of cellulitis and the formation of soft tissue abscesses. Although the foot and ankle represent common injection sites, few data have described the presentation and natural history of this pathologic entity. The objective of the present study was to retrospectively assess the descriptive demographic data of a patient cohort admitted for lower extremity skin and soft tissue infection caused by intravenous drug abuse. Fifty skin popping lesions in 49 patients were identified during a 733-day data collection period (August 1, 2010 to August 31, 2012) that had been treated by the in-patient podiatric surgical service for lower extremity infection caused by intravenous drug abuse at an urban, level-one trauma center. With respect to patient race, our hospital has a typical in-patient census of 55% black patients and 25% white patients. The present patient cohort consisted of 12% black patients and 65% white patients. The mean length of stay was 5.71 ± 3.56 days, and 42 patients (85.71%) underwent some form of surgical debridement, with 31 (63.27%) having undergone a formal procedure in the operating room. Six patients (12.24%) left the hospital against medical advice or refused intervention at some definitive point of care, and 36 (73.47%) did not return for scheduled outpatient follow-up visits. Three cases (6%) resulted in minor amputation. The microbiologic culture data and common antibiotic prescriptions used in the diagnosis and treatment, respectively, of these patients have been summarized. We hope these original descriptive data can be used by other physicians treating patients at similar urban practices to improve the care of these sometimes difficult-to-treat patients and better serve this population as a whole.
Assuntos
Abscesso/epidemiologia , Celulite (Flegmão)/epidemiologia , Extremidade Inferior , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Abscesso/etnologia , Adulto , Celulite (Flegmão)/etnologia , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Estudos Retrospectivos , Infecções dos Tecidos Moles/etnologia , Abuso de Substâncias por Via Intravenosa/etnologia , Adulto JovemRESUMO
Disadvantaged children suffer because tooth cavities are not being treated and their clinical consequences not being surveyed. The present study aimed to assess the prevalence and severity of clinical consequences of untreated dentine carious lesions in schoolchildren from a deprived area of Brazil and to investigate the determinants of the pufa index. A sample of 835 children aged 6-7 years, from six public schools, was examined by 3 calibrated examiners. Clinical consequences of untreated dentine carious lesions in primary teeth were diagnosed using the four codes of the pufa index: 'p' (pulpal involvement), 'u' (ulceration), 'f' (fistulae), 'a' (abscess). Effects of gender, age, school, history of extraction, and toothache on the prevalence of pufa codes were tested. The prevalence of pufa codes was 23.7%. The mean pufa score was 0.4 ± 0.9. Code 'p' was the most prevalent (19.5%), whereas code 'u' was least prevalent (0.1%). Children with a history of extracted primary teeth due to caries had a 2.7 times higher chance to have a pufa code than children with no previous extraction. Children with toothache had a 5.6 times higher chance to have a pufa code than children without toothache. The prevalence of clinical consequences of untreated dentine carious lesions was moderate and the severity was low. The pufa index is an epidemiological tool complementary to existing caries indices aimed to assess dental caries. However, there appears to be no need to include code 'u' nor to score codes 'f' and 'a' separately.
Assuntos
Cárie Dentária/epidemiologia , Dentina/patologia , Populações Vulneráveis/estatística & dados numéricos , Abscesso/epidemiologia , Fatores Etários , Brasil/epidemiologia , Criança , Fístula Dentária/epidemiologia , Índice de Placa Dentária , Exposição da Polpa Dentária/epidemiologia , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Úlceras Orais/epidemiologia , Índice Periodontal , Prevalência , Fatores Sexuais , Extração Dentária/estatística & dados numéricos , Dente Decíduo/patologia , Odontalgia/epidemiologiaRESUMO
Gram-positive organisms are the most common infectious etiologic agents in skin abscesses. Empiric antimicrobial treatment choices are influenced by this knowledge. In this report, we describe a high prevalence of Proteus mirabilis, a Gram-negative bacillus, in skin abscesses of the axilla, which has potential implications for selection of antimicrobial therapy.
Assuntos
Abscesso/microbiologia , Infecções por Proteus/epidemiologia , Proteus mirabilis/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Abscesso/epidemiologia , Abscesso/terapia , Adolescente , Axila , Feminino , Humanos , Masculino , Prevalência , Infecções por Proteus/terapia , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/terapiaRESUMO
A cluster of surgical site infection cases after arthroscopic and laparoscopic procedures occurred between 2005 and 2007 in Goiânia, in the central region of Brazil. Nontuberculous mycobacteria (NTM) were isolated from samples (exudates from cutaneous abscesses) from 18 patients of seven private hospitals. There were no reports of post-surgical arthroscopic and laparoscopic mycobacterial infections in Goiânia apart from this period. The 18 isolates were identified as Mycobacterium massiliense by PCR-restriction digestion of the hsp65 gene, pulsed-field gel electrophoresis (PFGE) comparisons, and rpoB partial gene sequencing. All isolates were typed as a single clone, indicating that they have the same origin, which suggests a common source of infection for all patients.
Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Mycobacterium/epidemiologia , Mycobacterium/isolamento & purificação , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso/epidemiologia , Abscesso/microbiologia , Adulto , Idoso , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Chaperonina 60 , Chaperoninas/genética , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , DNA Bacteriano/genética , RNA Polimerases Dirigidas por DNA/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium/genética , Infecções por Mycobacterium/microbiologia , Polimorfismo de Fragmento de Restrição , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
In a study of injection drug users (IDUs) in Tijuana, Mexico, logistic regression identified factors associated with injection of colored vs. clear methamphetamine in the prior six months (N = 613). Colors injected most often were clear (50%), white (47%), yellow (2%), and pink (1%). IDUs injecting colored meth were more likely to experience recent abscesses (34%) compared to those injecting clear meth (24%; p = 0.008), an association that persisted after adjusting for confounders. Market characteristics, possibly relating to purity or adulterants, may be associated with abscesses among methamphetamine injectors. Further study is needed to confirm and determine the mechanism of this association to better inform prevention messages.
Assuntos
Abscesso/epidemiologia , Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Estimulantes do Sistema Nervoso Central/toxicidade , Contaminação de Medicamentos/estatística & dados numéricos , Drogas Ilícitas/toxicidade , Metanfetamina/toxicidade , Dermatopatias Bacterianas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abscesso/etiologia , Adulto , Estudos de Coortes , Cor , Comparação Transcultural , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , México , Estudos Prospectivos , Medição de Risco , Dermatopatias Bacterianas/etiologia , Fatores Socioeconômicos , Estados UnidosRESUMO
Outbreaks of rapidly growing mycobacteria have been occasionally described. The article reports an outbreak of cutaneous abscesses due to Mycobacterium chelonae following mesotherapy in Lima, Peru. From December 2004 through January 2005, 35 subjects who had participated in mesotherapy training sessions presented with persistent cutaneous abscesses. Thirteen (37%) of these suspected cases consented to undergo clinical examination. Skin punch-biopsies were collected from suspicious lesions and substances injected during mesotherapy were analyzed. Suspected cases were mainly young women and lesions included subcutaneous nodules, abscesses and ulcers. Mycobacterium chelonae was isolated from four patients and from a procaine vial. In conclusion, it is important to consider mesotherapy as a potential source of rapidly growing mycobacteria infections.
Assuntos
Abscesso/epidemiologia , Surtos de Doenças , Contaminação de Medicamentos , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium chelonae/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Abscesso/microbiologia , Adulto , Terapias Complementares/efeitos adversos , Técnicas Cosméticas , Feminino , Humanos , Injeções/efeitos adversos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/etiologia , Peru/epidemiologia , Dermatopatias Bacterianas/etiologiaRESUMO
CONTEXTO: Infecções profundas do pescoço têm um potencial alto para complicações graves e morte, se não corretamente diagnosticadas e tratadas. A diferença entre resultados de avaliação clínica e tomográfica pode demonstrar que a avaliação clínica isolada subestima a extensão de doença, o que pode conduzir a tratamento conservador e a pior prognóstico. OBJETIVO: Comparar achados clínicos à tomografia computadorizada de pescoço em relação aos espaços cervicais envolvidos e determinar as características clínicas e radiológicas principais associadas com infecção de espaço profundo de pescoço. TIPO DE ESTUDO: Estudo retrospectivo não randomizado. LOCAL: Departamento de Otorrinolaringologia - Cabeça e Pescoço, Universidade Estatal de Campinas, Brasil, um centro universitário, terciário. MÉTODOS: Foi avaliado prontuário médico de 65 pacientes com infecções profundas de pescoço. Foram analisados idade, gênero, queixas clínicas, exames físicos, resultados de raios-x e tomografia computadorizada, microbiologia, tratamento e resultados. Foram avaliados os sinais clínicos e sintomas, estratificados em ordem de freqüência. A freqüência de espaços cervicais profundos envolvidos nesta infecção também foram avaliados clínico e tomograficamente. Todos resultados clínicos e tomográficos foram comparados com a observação cirúrgica em relação aos espaços cervicais afetados por infecção. RESULTADOS: Os resultados clínicos mais freqüentes foram inchaço cervical, dor local, eritema cutâneo local e aumento localizado de temperatura. O local mais afetado de acordo com a avaliação física foi o triângulo de submandibular (49,2%), mas, à tomografia computadorizada cervical, foi o espaço látero-faríngeo (65%). Mais de um espaço cervical profundo foi acometido, de acordo com a tomografia computadorizada cervical, em 90% dos pacientes, como demonstrado pela extensão do edema e aumento de captação de tecidos moles, e em geral apenas um espaço à avaliação clínica isolada. DISCUSSAO: Os sintomas clínicos mais freqüentes das infecções cervicais profundas foram dor cervical, aumento de volume cervical e febre. Sinais importantes da tomografia computadorizada, para avaliação desta infecção, foram aumento de captação de contraste em tecidos moles do pescoço e edema. O espaço profundo do pescoço mais afetado pela infecção foi o laterofaríngeo, pela tomografia computadorizada do pescoço. O espaço...
Assuntos
Humanos , Masculino , Feminino , Abscesso , Pescoço , Infecções dos Tecidos Moles , Tomografia Computadorizada por Raios X , Abscesso/epidemiologia , Abscesso/cirurgia , Brasil/epidemiologia , Drenagem , Cervicalgia , Pescoço/cirurgia , Estudos Retrospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/cirurgiaRESUMO
Bites by many species of venomous snake may result in local necrosis at, or extending from, the site of the bite. The use of prophylactic antibiotics to prevent infection as a complication of local necrotic envenoming is controversial. A double-blind randomized controlled trial was carried out to assess whether antibiotic therapy is effective in this situation. Two hundred and fifty-one patients, with proven envenoming by snakes of the genus Bothrops, admitted to two hospitals in Brazil, between 1990 and 1996, were randomized to receive either oral chloramphenicol (500 mg every six hours for five days) or placebo. One hundred and twenty-two of these patients received chloramphenicol (group 1) and 129 were given placebo (group 2). There were no significant differences between the groups at the time of admission. Necrosis developed in seven (5.7%) patients in group 1 and in five (3.9%) patients in group 2 (P>0.05) while abscesses occurred in six patients (4.9%) in group 1 and in six (4.7%) patients in group 2 (P>0.05). In conclusion, the use of orally-administered chloramphenicol for victims of Bothrops snake bite with signs of local envenoming on admission, is not effective for the prevention of local infections.