Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Progress in pathogenesis of adverse pregnancy outcomes induced by group B Streptococcus / 中华微生物学和免疫学杂志

Group B Streptococcus ( GBS) is a leading infectious cause of adverse pregnancy out-comes such as preterm birth. GBS colonizes the vagina during pregnancy and can ascend into the uterus and then infect the fetus. It encodes a series of virulence factors such as adhesion and invasion factors, hemolytic pigments and hyaluronidase, which are important to vaginal colonization and immune evasion. Immune re-sponses to GBS cause the release of a multiple of inflammatory mediators, leading to the premature rupture of membranes, preterm birth and fetal injury. This paper reviews the pathogenesis of GBS vaginal colonization and ascending infection causing adverse pregnancy outcomes.

How to Make the Blockage between the Nasal Cavity and Intracranial Space in Craniofacial Surgery

Craniofacial surgery for facial advancement or correction of severe craniofacial malformations such as orbital hypertelorism, Crouzon's disease and Apert's syndrome may bring about great risk. Especially postoperative infection in the craniofacial surgery is a life threatening complication. Ascending infection via nasofrontal communication in frontofacial monobloc advancement, intracranial Le Fort III osteotomy, correction of hypertelorism(intracranial approach) and acute trauma of cribriform plate can lead to life threatening meningitis and meningoencephalitis. A 4 layer sealing technique for the closure of nasofrontal communication using Gelfoam , the inferiorly based, galeo-pericranial flap, rib bone graft, Tissel is a very effective method. Until the rib bone graft is completely uptaken, Gelfoam is used as a temporary blockage of bony defect and prevents displacement of rib bone graft. We used galeo-periosteal flap for the sufficient blood supply to the rib bone graft. And Tissel is used as a biologic adhesive and blockage of the surrounding gaps.

A Study on the Usefulness of ERCP in Patients with Pyogenic Liver Abscess / 대한소화기내시경학회지

BACKGROUND/AIMS: This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. METHODS: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69 :1, and the peak incidence was in the sixth decade. RESULTS: The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. CONCLUSIONS: The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess.