To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed.
Three patients that presented with fever and pain referred to ...the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy.
Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.
To report a new case of neuroendocrine renal cell carcinoma.
We report the case of a 76-year-old woman with neuroendocrine renal cell carcinoma who underwent radical nephrectomy without any further ...adjuvant treatment. We performed a bibliographic review about this rare renal neoplasia of which there are less than 20 published case reports.
Patient is asymptomatic four years after surgery, although she has local recurrence.
Small cell renal cell carcinoma is a very rare neoplasia, affecting people over the age of 60 years, large in size, and metastatic at diagnosis. It has bad prognosis, with short survival times. The most adequate treatment has not been determined due to the scarcity of published cases; the combination of surgery and chemotherapy is the most frequently used.
Abstract
Background
Evidence supporting combination treatment with a beta-lactam plus an aminoglycoside (C-BA) for endocarditis caused by viridans and gallolyticus group streptococci (VGS-GGS) with ...intermediate susceptibility to penicillin (PENI-I) is lacking. We assessed the clinical characteristics and outcomes of PEN-I VGS-GGS endocarditis and compared the effectiveness and safety of C-BA with third-generation cephalosporin monotherapy.
Methods
Retrospective analysis of prospectively collected data of a cohort of definite endocarditis caused by penicillin-susceptible and PENI-I VGS-GGS (penicillin minimum inhibitory concentration ranging from 0.25 to 2 mg/L) between 2008 and 2018 in 40 Spanish hospitals. We compared cases treated with monotherapy or with C-BA and performed multivariable analyses of risk factors for in-hospital and 1-year mortality.
Results
A total of 914 consecutive cases of definite endocarditis caused by VGS-GGS with complete or intermediate susceptibility to penicillin were included. A total of 688 (75.3%) were susceptible to penicillin and 226 (24.7%) were PENI-I. Monotherapy was used in 415 (45.4%) cases (cephalosporin in 331 cases) and 499 (54.6%) cases received C-BA. In-hospital mortality was 11.9%, and 190 (20.9%) patients developed acute kidney injury. Heart failure (odds ratio OR: 6.06; 95% confidence interval CI: 1.37–26.87; P = .018), central nervous system emboli (OR: 9.83; 95% CI: 2.17–44.49; P = .003) and intracardiac abscess (OR: 13.47; 95% CI: 2.24–81.08; P = .004) were independently associated with in-hospital mortality among PEN-I VGS-GGS cases, while monotherapy was not (OR: 1.01; 95% CI: .26–3.96; P = .982).
Conclusions
Our findings support the use of cephalosporin monotherapy in PEN-I VGS-GGS endocarditis in order to avoid nephrotoxicity without adversely affecting patient outcomes.
In a retrospective analysis of endocarditis due to viridans and gallolyticus groups streptococci, cephalosporin monotherapy was not associated with higher in-hospital mortality when the isolate showed intermediate susceptibility to penicillin.
Retroperitoneal Abscesses Manjón, Carlos Capitán; Sánchez, Ángel Tejido; Lara, José D. Piedra ...
Scandinavian journal of urology and nephrology,
2003, Volume:
37, Issue:
2
Journal Article
Objective: To analyze our experience with the management of retroperitoneal abscesses. Patients and methods: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at ...our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. Results: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 r cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. Conclusions: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Although
group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption.
We performed a ...retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or
group (SGG) was performed in a 1:2 matched analysis.
Of 5336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs 3.5%,
= .116); valve disorder, including perforation (22.2% vs 18.1%,
= .584), pseudoaneurysm (16.7% vs 8.3%,
= .108), or prosthesis dehiscence (1.4% vs 6.3%,
= .170); paravalvular complications, including abscess (25% vs 18.8%,
= .264) and intracardiac fistula (5.6% vs 3.5%,
= .485); heart failure (34.7% vs 38.9%,
= .655); or embolic events (41.7% vs 32.6%,
= .248). Indications for surgery (70.8% vs 70.8%;
= 1) and mortality (13.9% vs 16.7%;
= .741) were similar between groups.
SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG.
PDF
