CRP is an important factor affecting the timing of surgical drainage of ureteral calculi with upper urinary tract infection / 现代泌尿外科杂志

【Objective】 To explore the timing of surgical drainage for ureteral calculi with upper urinary tract infection. 【Methods】 Clinical data of 117 cases of ureteral calculi with upper urinary tract infection treated in our hospital during Jan.2018 and Jan.2020 were retrospectively analyzed. According to different treatment methods, the patients were divided into surgical drainage group and non-surgical drainage group. The patients’ age, gender, side of calculi, peak body temperature, time of onset, white blood cell (WBC) count, C-reactive protein (CRP) and other clinical indicators were compared between the two groups. The cutoff value of surgical drainage was determined with receiver operator characteristic (ROC) curve. 【Results】 The patients’ age, peak body temperature, WBC count and CRP level were the influencing factors of surgical drainage (P<0.05). Regression analysis showed that CRP (P<0.001), age (P=0.003) and WBC count (P=0.014) were independent risk factors for surgical drainage. The area under the ROC curve (AUC) of CRP, age, and WBC count were 0.923, 0.601, and 0.796, respectively. The cutoff value of CRP was 29.87 mg/L (sensitivity 79.4%, specificity 90.0%). Logistic regression model showed CRP was a significant clinical predictor. 【Conclusion】 Ureteral calculi with upper urinary tract infection need to be diagnosed and treated in time. Positive anti-infection should be performed during emergency treatment, and surgical drainage could be selected according to the value of CRP.

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review / Papel dos corticosteroides sistêmicos na celulite orbitária: uma metanálise e revisão da literatura ,

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.

Comparative Analysis of Amoebic Liver Abscess versus Pyogenic Liver Abscess on Clinical and Investigative Consequences

An attempt was made to compare the analysis of investigative parameters to distinguish Amoebic Liver Abscess (ALA) from Pyogenic Liver Abscess (PLA). This study was carried out at Calcutta National Medical College & Hospital, Kolkata 700014. Patients were included with signs and symptoms suggestive of Liver Abscesses. The investigations of Serological, Hematological, Biochemical, Radiological and CT scan were done. Antimicrobial Therapy, Image Guided Percutaneous Aspirations/Drainage or Open surgical Drainage was performed and checked in follow-up visits up to 3 months. The highest incidences of Liver Abscess (53.3%) were encountered in alcoholic male. Fever and Abdominal Pain were common in both ALA and PLA. Hepatomegaly was significantly high (p<0.05) in PLA (64.2%) than ALA (37.5%), but jaundice was only noted in PLA (22.2%). E coli, K pneumonia and S aureus were confirmed in PLA. Alkaline Phosphatase was significantly high (p<0.05) in PLA. Right sided pleural effusion was noted in Chest X-ray of 50% case . USG studies measured 70% Solitary Abscesses with 5-10 cm in the Right Lobe. Partial resolution occurred in 28.6% of PLA and 31.2% of ALA. USG and Serological Tests are recommended and Conservative Management should be followed for ALA and invasive treatment for PLA patients

Factors influencing paediatric neck abscess and treatment at Hospital Tuanku Jaafar, Seremban

@#Background: This is a descriptive study of in-patient paediatric population with the diagnosis of neck abscess. The objective of this study was to calculate the number of children who require conservative (antibiotic) management compared to surgery for neck abscess. A second objective was to identify the factors influencing the choice of the treatments selected. Methods: A retrospective review was performed on a group of paediatric population aged 0 till 12 years of age, with a history of admission to paediatric ENT ward from the year 2010 till 2015 in HTJS. Initially, 69 children with the diagnoses of various neck infections were identified. Then, the sample amount was narrowed to 30 patients with neck abscesses only. Results: The data analysis was performed using descriptive statistics, Chi-squared test and Fisher’s exact test. Twentyfive out of the 30 patients required operative drainage of abscess (83.3%). In this group, children aged ≤2 years old were the largest group to have undergone surgical drainage. Only five patients were successfully treated with antibiotic therapy alone. Nineteen children came only after developing neck swelling for more than a week, in which 18 of them required surgery. Conclusion: Younger group of children are more likely to undergo surgical drainage than older children for neck abscess. Also, children who came in after two weeks of symptoms have a higher probablity of requiring surgery than antbiotic alone. Nonetheless, every child who comes in with neck abscess should be evaluated and treated early to avoid any sinister complications.

Piomiositis primaria del músculo esternocleidomastoideo: reporte de un caso y revisión de la literatura / Primary pyomyositis of the sternocleidomastoid muscle: a case report and review of the literature

RESUMEN La piomiositis es una infección bacteriana del músculo estriado, siendo extremadamente rara la afectación de la musculatura cervical. Se ha asociado en nuestro medio a enfermedades crónicas como la diabetes y a la inmunodepresión. Presentamos a un paciente de 67 años que acude al servicio de urgencias por tumoración laterocervical de rápido crecimiento, negando antecedentes de interés a excepción de diabetes mellitus tipo II. Se le realizó estudio de imagen con tomografía computarizada con contraste, observándose aumento de volumen del músculo esternocleidomastoideo izquierdo y se empezó tratamiento empírico con antibióticos endovenosos. Dada la evolución tórpida finalmente se realizó drenaje quirúrgico bajo anestesia general con mejoría de los parámetros clínicos y analíticos. La piomiositis de los músculos cervicales es muy rara (0,4%-1% de todos los casos) siendo el esternocleidomastoideo el músculo del cuello más frecuentemente afectado. La tomografía computarizada representa la prueba de imagen de elección, permitiendo un rápido diagnóstico llegando a poder diferenciar este cuadro de otros similares. Considerando que muchos de estos pacientes presentan comorbilidades asociadas y/o inmunosupresión, es de extrema importancia diagnosticarlos precozmente y empezar un tratamiento adecuado que dependerá del grado y extensión de la infección. A pesar de ser una entidad poco frecuente, su incidencia está en aumento en nuestro medio asociada a la infección por VIH y otras condiciones de inmunodepresión. Hay que tenerla en mente en el diagnóstico diferencial de las tumoraciones laterocervicales porque solo con una alta sospecha clínica se podrá llevar al cabo un diagnóstico precoz y un tratamiento adecuado.

ABSTRACT Pyomyositis is a bacterial infection of the striated muscle that may affect the cervical musculature in very few cases. In the occidental world it has been associated with chronic diseases as diabetes and immunosuppression. We present a 67 years old patient attended to the Emergency Department because of a laterocervical fast growth tumor, without an interesting clinical history with the exception of type II diabetes mellitus. A CT scan with contrast showed an increased volume in the left sternocleidomastoid muscle, so an empiric treatment with intravenous antibiotics was started. Because of a bad evolution we finally performed a surgical drainage of the abscess under general anesthesia with an improvement of symptoms and laboratory markers. The pyomyositis of cervical muscles is very rare (0.4-1% of all cases) and the sternocleidomastoid muscle is the most commonly affected cervical muscle. CT scan is the gold standard imaging technique, because it allows to diagnose this disease and rule out other similar entities. If we consider that many patients present with associated comorbidities and/ or immunosuppression, it's very important to perform a rapid diagnosis and to begin a correct treatment that depends on the grade and extension of the infection. Although polymyositis of the sternocleidomastoid muscle is rare, its incidence is increasing associated to HIV infection and other immunosuppressive conditions. We have to keep in mind this pathology in the differential diagnosis of laterocervical tumors because high clinical suspicion is necessary to make a rapid diagnosis and a correct treatment.

Abscesso hepático por Klebsiella pneumoniae e suas complicações sistêmicas / Liver abscess by Klebsiella pneumoniae and its systemic complication

Abscesso hepático por Klebsiella pneumoniae é incomum em países ocidentais e tem sido associado a complicações severas, sobretudo em pacientes diabéticos. A manifestação clínico-laboratorial da doença é inespecífica. Endoftalmite é uma rara complicação de septicemia por Klebsiella pneumoniae. Atraso terapêutico pode resultar em perda visual acentuada e irreversível. Relatamos um caso de abscesso hepático por Klebsiella pneumoniae complicado com endoftalmite, embolia pulmonar séptica e endocardite em homem diabético.

Klebsiella pneumoniae liver abscess is unco mmon in western countries and has been associated with severe complications, especially in diabetic patients. The clinical and laboratory manifestations of the disease are nonspecific. Endophthalmitis is a rare complication of septicemia due to Klebsiella pneumoniae. Therapeutic delay can result in severe and irreversible visual loss. We report a case of Klebsiella pneumoniae liver abscess complicated by endophthalmitis, septic pulmonary emboli and endocarditis in diabetic man.

Abscesso hepático por klebsiella pneumoniae e suas complicações sistêmicas / Liver abscess by klebsiella pneumoniae and its systemic complications

Abscesso hepático por Klebsiella pneumoniae é incomum em países ocidentais e tem sido associado a complicações severas, sobretudo em pacientes diabéticos. A manifestação clínico-laboratorial da doença é inespecífica. Endoftalmite é uma rara complicação de septicemia por Klebsiella pneumoniae. Atraso terapêutico pode resultar em perda visual acentuada e irreversível. Relatamos um caso de abscesso hepático por Klebsiella pneumoniae complicado com endoftalmite, embolia pulmonar séptica e endocardite em homem diabético.

Klebsiella pneumoniae liver abscess is unco mmon in western countries and has been associated with severe complications, especially in diabetic patients. The clinical and laboratory manifestations of the disease are nonspecific. Endophthalmitis is a rare complication of septicemia due to Klebsiella pneumoniae. Therapeutic delay can result in severe and irreversible visual loss. We report a case of Klebsiella pneumoniae liver abscess complicated by endophthalmitis, septic pulmonary emboli and endocarditis in diabetic man.

Application value of fast-track surgery on liver transplantation / 器官移植

Objective To explore the impact of fast-track surgery (FTS)on prognosis of liver transplant patients.Methods Inclusion criterias:(1 )primary disease was cirrhosis or primary liver cancer meeting Milan criteria;(2)surgical method was modified piggyback orthotopic liver transplantation (OLT);(3)no liver transplantation operation was performed before.Exclusion criterias:(1 )age ≤ 1 6 years old;(2)receiving OLT more than 1 time;(3)transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation.From January 201 1 to December 201 3 in First Affiliated Hospital of Nanjing Medical University,52 patients meeting the criteria above were enrolled into this prospective random single-blinded study (all operations were performed by same team) .According to different peri-operative managements,they were divided into FTS group (n =21 )and non-FTS (NFTS)group (n =31 ).Protocol of FTS included comprehensive pre-operative education,no bowel preparation,no usage of nasogastric tube pre-operation and surgical drainage post-operation,prevention of hypothermic during operation, smaller incision,early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups.Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters,in order to analyze the impact of FTS on the prognosis of liver transplantation.Results Compared with NFTS group,operation time and anhepatic phase time decreased significantly in FTS group,as well as intra-operative bleeding and transfusion (all in P <0.05).Besides,intensive care unit (ICU)days and total length of stay in FTS group were shorter than those in NFTS group,which indicated a better prognosis of patients in FTS group (both in P <0.05 ).Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio:0.301 ,95% confidence interval:0.1 84-0.494,P =0.000)and total length of stay (odds ratio:0.1 48,95% confidence interval:0.085-0.257,P =0.000).Conclusions Application of FTS in perioperative period can improve the prognosis of liver transplant patients.

Drastic Therapy for Listerial Brain Abscess Involving Combined Hyperbaric Oxygen Therapy and Antimicrobial Agents

BACKGROUND: Listeria monocytogenes (L. monocytogenes) is a rare causative pathogen of brain abscess that is often found in immunocompromised patients. Although patients with supratentorial listerial abscesses showed a longer survival with surgical drainage, the standard therapy for patients with subtentorial lesions has not been established. CASE REPORT: We report herein a patient with supra- and subtentorial brain abscesses caused by L. monocytogenes infection. These abscesses did not respond to antibiotics, and his symptoms gradually worsened. Drainage was not indicated for subtentorial lesions, and the patient was additionally treated with hyperbaric oxygen therapy, which dramatically reduced the volume of abscesses and improved the symptoms. CONCLUSIONS: This is the first report of drastic therapy for a patient with listerial brain abscesses involving combined antibiotics and hyperbaric oxygen therapy. The findings suggest that hyperbaric oxygen therapy is a good option for treating patients with deep-seated listerial abscesses and for who surgical drainage is not indicated.

Comparison of percutaneous ultrasound guided needed aspiration and open surgical drainage in management of puerperal breast abscess.

, less morbidity and will allow the patient to carry on breast feeding. Aims & Objective: The aim of this study is to compare the management of puerperal breast abscess by percutaneous ultrasound guided needle aspiration versus open surgical drainage with special attention to resolution and complications. Material and Methods: In this interventional study, 70 puerperal breast abscess cases were randomly divided and undergone either percutaneous ultrasound guided niddle aspiration (Group A) or open surgical drainage (Group B) and results were compared. Results: Failure rate for aspiration therapy was17.14% with 06 patients requiring conversion to open surgical drainage after aspiration and were excluded from study. The resolution time was less in aspiration group. Painful and cumbersome daily changes of dressing, mammry fistula in 3 patients with ugly scar were the main drawback of open surgical drainage as compared to aspiration. However, there was high failure rate of aspiration therapy in abscesses presenting later than 5 days (45.83%) and those with >5 cm size (55.55%) on ultrasonography. Conclusion: Percutaneous ultrasound guided needle aspiration has acceptable failure rate and is an effective alternative to open surgical drainage of puerperal breast abscess especially for those present early and of small size.

The Use of a Staged Drainage Seton for the Treatment of Anal Fistulae or Fistulous Abscesses

PURPOSE: The aim of this retrospective study was to evaluate the rate of recurrence and incontinence after the treatment of fistulae or fistulous abscesses by using the staged drainage seton method. METHODS: According to the condition, a drainage seton alone or a drainage seton combined with internal opening (IO) closure and relocation of the seton was used. After a period of time, the seton was changed with 3-0 nylon; then, after another period of time, the authors terminated the treatment by removing the 3-0 nylon. Telephone interviews were used for follow-up. The following were evaluated: the relationship between the type of fistula and recurrence; the relationship between the type of fistula and the period of treatment; the relationship between the recurrence and presence of abscess; the relationship between IO closure and recurrence; the relationship between the period of seton change and recurrence; reported continence for flatus, liquid stool, and solid stool. RESULTS: The recurrence rate of fistulae or suppuration was 6.5%, but for cases of horseshoe extension, the recurrence rate was 57.1%. The rate of recurrence was related to the type of fistula (P = 0.001). Incontinence developed in 3.8% of the cases. No statistically significant relationship was found between the rate of recurrence and the presence of an abscess or between the closure of the IO and the period of seton change or removal. CONCLUSION: In the treatment of anal fistulae or fistulous abscesses, the use of a staged drainage seton can reduce the rate of recurrence and incontinence.

Hemi-hepatectomia esquerda laparoscópica para o abscesso hepático piogênico: relato de caso / Lapaoscopic leftt hemi-hepatectomy for pyogenic hepatic abscess: a case report

Introdução. O tratamento padrão do abscesso hepático piogênico tem sido drenagem percutânea. Quando ocorre a falha desse método, a drenagem cirúrgica, ou mesmo a ressecção hepática, deve ser realizada. Atualmente, a via laparoscópica tem sido eleita como preferencial para as afecções hepáticas benignas devido à baixa morbidade e bom resultado estético. Relato do caso. Os autores relatam um caso de abscesso hepático piogênico tratado por hemi-hepatectomia esquerda laparoscópica. O doente apresentou evolução pós-operatória sem complicações. Não houve recidiva do abscesso no período de um ano de seguimento. Conclusão. O tratamento do abscesso hepático piogênico por hemi-hepatectomia esquerda laparoscópica representa um método seguro com baixa morbidade e bom resultado estético.

Introduction. Percutaneous drainage has been standard treatment for pyogenic liver abscess. When this approach fails surgical drainage or even hepatic resection should be performed. Nowadays, laparoscopic access has been chosen as preferential treatment for benign hepatic diseases due to both low morbidity and good cosmetic result.Case. The authors present a case of pyogenic hepatic abscess treated by means of laparoscopic left hemi-hepatectomy. The patient presented good postoperative evolution without complication. There was no abscess recurrence (one year follow-up period). Conclusion. Pyogenic hepatic abscess treatment by means of laparoscopic left hemi-hepatectomy represents a safe technique with both low morbidity and good cosmetic result.

Orbital abscess secondary to frontal mucocele successfully treated by surgical drainage: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report a case of left orbital abscess resulted from frontal sinus mucocele.METHODS: Case report.RESULTS: A 30-year-old Malay lady presented with left eye pain and swelling for three days associated with impairment of vision and proptosis. CT scan showed left frontal sinus mucocele that extended to the left orbit. Surgical drainage resulted in dramatic improvement of proptosis and vision.CONCLUSION: Orbital abscess can result from frontal sinus mucocele in patient without previous history of paranasal sinuses disease.

Two Cases of Fournier's Gangrene / 대한피부과학회지

Fournier's gangrene is a form of necrotizing fasciitis of the perineal, genital or perianal region due to perianal infection, urinary tract infection or local trauma. Even though many patients may present with minor skin lesions in the early stages of the disease, the natural course of this necrotizing disease is rapid progression of gangrene, eventually resulting in sepsis and death. Therefore, rapid and accurate diagnosis is the most important factor for a successful outcome. We report two cases of Fournier's gangrene in a 21-year-old and 24-year-old male, both of whom commonly presented with painful swelling and tenderness of the scrotum. Although one man showed a rapidly-spreading erythema and induration to the flank and lateral chest, they were both successfully treated with early antibiotic therapy and surgical drainage.

Surgical Management of Primary Iliopsoas Abscess

PURPOSE: An Incidence of primary iliopsoas abscess is extremely rare. So it's clinical features are unclear. We reported the clinical features and treatment of primary iliopsoas abscess with reference review. METHODS: The ten cases of primary iliopsoas abscess from January 1999 to August 2003 were included in this study. We analyzed clinical manifestation, diagnostic modality, treatment and prognosis retrospectively. Microbiologic study and imaging study were performed in all patients. The treatments included surgical drainage, percutaneous drainage, and systemic antibiotics only were performed. RESULTS: In demographics of patient, the sex ratio was equal and mean age was 51.8 years old with predominant elderly (more than 60 years old). The abscess was confirmed by computed tomography in 8 patients, magnetic resonance imaging in 1. One abscess was found after laparotomy. The one side iliopsoas abscess was found in eight cases (right 4 cases and left 4) and bilateral abscess was in two cases. All cases were multilobulated abscess. After failure of percutaneous drainage, surgical drainage with retroperitoneal approach was performed in 8 patients. Transperitoneal drainage and systemic antibiotics therapy without drainage was respectively performed in one case. One case of abscess was recurred due to early removal of drain and insufficient antibiotics therapy. Other nine patients were completely resolved without complication or mortality. CONCLUSION: The diagnosis of primary iliopsoas abscess requires a high index of suspicion due to its rarity. If we consider that most iliopsoas abscess was multi-lobulated, early surgical drainage with sufficient administration of systemic antibiotics is an effective treatment modality.

A Case of Psoas Muscle Abscess in Crohn's Disease / 대한소화기내시경학회지

Psoas abscess, complicating Crohn's disease, is a rare condition. Typical symptoms and signs are fever, abdominal tenderness and limb pain. Our patient had fever and abdominal tenderness. The diagnosis is made by abdominopelvic CT scan. Medical therapy with antibiotics, surgical resection of the affected bowel segment with end to end anastomosis and surgical drainage of focus are treatment of choice. We have experienced one case of psoas abscess with Crohn's disease in 28-year-old male patient. He visited our hospital due to diarrhea and lower abdominal pain. The colonoscopy revealed active stage of Crohn's disease. Then he has taken methyl prednisolone and mesalazine. During the hospitalization, we detected anal fistula and psoas abscess on abdominal CT. He was managed with antibiotics and surgical drainage after colectomy. We present the case with brief review of the articles.

A comparative study between active closed drainage and passive open drainage systems in urologic surgery

OBJECTIVE: To compare the clinical efficacy/significance and incidence of exposure to body fluids between the active closed drainage system and passive open drainage system in patients who underwent urologic surgeryMATERIALS AND METHODS: Patients who underwent elective and emergency open urologic surgery that required wound drainage were included. A daily data collection completed by the medical and the nursing staff was performed. Patients with dirty wounds were excludedRESULTS: Sixty-four patients were entered in the study. After exclusion, 56 patients [Group I (Passive drainage) = 27; Group 2 (Active drainage) = 29)] were evaluated for the performance of wound drainage systems. The drain-related complications of group 1 and group 2 were 26 percent and 10 percent, respectively [P 0.5 (NS)]. Change of dressing was more frequent in group 1 than in group 2 patients [P .000 (S)]. There were 567 (group 1CONCLUSION: The clinical efficacy of passive open drain and active closed drain systems were comparable. The risk of exposure of healthcare personnel to potentially harmful body fluids was less when closed suction drain was used in patients who underwent urologic surgery. (Author)

Intracranial Subdural Empyema: Report of 2 Cases

Subdural empyema is a neurosurgical emergency the mortality of which continues to be as high as 40% in modern reported series. It is also a curable lesion, and the outcome of treatment has been demonstrated to be directly related to the promptness of diagnosis and appropriate surgical drainage. Recently, we have operated upon two cases of intracranial subdural empyema secondary to acute facial furuncle and postoperative craniectomy. Reviewing these two cases and other literatures, we are going to describe about cases, symptoms and signs, and methods of diagnosis and treatment of subdural empyema.