최근 9년간 발생한 화농성 및 아메바성 간농양의 비교 분석

김성준,이승철,신원창,이진호,김관엽 인제대학교 2000 仁濟醫學 Vol.21 No.2

Objectives: Liver abscess, especially pyogenic liver abscess is still a disease of high mortality in spite of remarkable progress in diagnostic and therapeutic methods. The initial clinical manifestation of pyogenic and amebic abscess is similar, but their treatment and prognosis are different. Recently, new therapeutic methods in pyogenic abscess were reported. The aim of this study is to know what the proper approach to the liver abscess is through the comparative analysis between pyogenic and amebic abscess. Methods: We reviewed the medical records of 70 patients treated for liver abscess at Sanggye Paik Hospital from August. 1989 to March, 1998 retrospectively. Results: Among 70 cases of liver abscess, 55(79%) were pyogenic and 15(21%) amebic. The male to female ratio was 1.1:1 in pyogenic, 2.8:1 in amebic, the mean age was 56.8±14.4 years in pyogenic. 52.9 ±16.1 years in amebic. The most commonly associated disease in pyogenic abscess was cholelithiasis. The laboratory finding in both kind of abscess was increment of alkaline phosphatase, leukocyte and transaminase. In bacteriologic study of pyogenic abscess, single organism was cultured in 78% and mixed organisms were cultured in 22%. Klebsiella pneumoniae and Escherichia coli was the most common organism cultured in the single and mixed organisms respectively. In the pyogenic abscess, 39 patients(74%) had single abscess and 14 patients(26%) had multiple abscesses. Thirty seven patients(70%) had abscess involving the right lobe, 15 patients(28%) involving the left lobe. In the amebic abscess, 11 patients(73%) had single abscess and involved the right lobe. 4 patients (7%) had multiple abscesses and involved the left lobe. The treatment of pyogenic abscess was antibiotics with single aspiration in 15 cases(27%) and antibiotics only in 15 cases(27%). Overall mortality rate was 7%. Mean duration of fever was 7.3±5.4 days, mean duration of hospital stay was 23.2±10.0 days. The treatment of amebic abscess was antibiotics with catheter drainage in 7 cases(47%). All of the patients was recovered completely. Mean duration of fever was 4.7±2.7 days, mean duration of hospital stay was 19.1±6.0 days. Conclusion: In order to avoid unnecessary complication of invasive aspiration and pigtail drainage, administration of broad spectrum antibiotics including metronidazole was required until the confirmation of liver abscess with serologic study. It is desirable that the aspiration or pigtail drainage should be done after identification of the result of serologic study.

Preoperative Gadolinium-enhanced Magnetic Resonance Images on Infectious Spondylitis

Kim, Seok-Won,Lee, Seung-Myoung,Shin, Ho The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.38 No.5

Objective : The purpose of this study is to analyze the patterns of intervertebral disc enhancement seen in infectious spondylitis, differentiate between two groups[tuberculous vs pyogenic spondylitis]. Methods : Between January 1994 and December 2002, 83patients underwent operative procedure with confirmed to histopathologic evaluation. Magnetic resonance[MR] images were obtained in all patients and were analyzed retrospectively. 57patients had tuberculosis and 26patients were infected by pyogens. The patterns of gadolinium enhancement of disc were classified into 4 types[post's classification] : Type I, non-enhancing; Type II, enhancement of the peripheral rim; Type III, Type II with central area and partial endplate; Type IV, general enhancement. Results : The enhancement patterns observed were as follows : Common pattern of tuberculous spondylitis was Type II, and pyogenic spondylitis was Type III. [p < 0.01] This difference may result from pathophysiologic varieties of organisms. Conclusion : Careful preoperative MR analysis of the patterns of disc enhancement occuring in infectious spondylitis can be useful for differentiating between the tuberculous and pyogenic spondylitis.

A Case of Pyogenic Liver Abscess with Multiple Septic Metastatic Infections and Colon Cancer

Eun Jung Kang,Soung Won Jeong,Jae Young Jang,Hyun Gun Kim,Boo Sung Kim,So Young Jin 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.2

Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens to cause liver abscess. Because K. pneumoniae is highly virulent, it may cause embolic complications. The rate of metastatic infection has a range of 3.5% to 20%. Thus, a diagnostic work-up for metastatic complications should be employed in K. pneumoniae liver abscess cases, including chest radiography and computed tomography if chest radiographies are abnormal and ophthalmic examination in diabetic patients. Cryptogenic pyogenic liver abscess has been recently reported to potentially signal colorectal cancer, especially in female patients with diabetes. We present a case of liver abscess with endophthalmitis and septic pulmonary embolism, which is associated with silent colon cancer.

A Case of Postoperative Pyogenic Granuloma at the Middle Turbinate

이재훈 대한비과학회 2009 Journal of rhinology Vol.16 No.1

Pyogenic granuloma is a benign, vascular lesion of unknown etiology that occurs uncommonly in the nose. Trauma and hormonal factors are considered major causes of pyogenic granuloma. Nasal packing is a very common procedure in rhinology and this procedure might be related to the development of pyogenic granulomas. The most frequent symptoms of pyogenic granulomas are epistaxis and nasal obstruction. This report represents the second case of pyogenic granuloma occurring at the middle turbinate in the English literature and it may have arisen secondary to postoperative nasal packing or intraoperative trauma. Pyogenic granuloma is a benign, vascular lesion of unknown etiology that occurs uncommonly in the nose. Trauma and hormonal factors are considered major causes of pyogenic granuloma. Nasal packing is a very common procedure in rhinology and this procedure might be related to the development of pyogenic granulomas. The most frequent symptoms of pyogenic granulomas are epistaxis and nasal obstruction. This report represents the second case of pyogenic granuloma occurring at the middle turbinate in the English literature and it may have arisen secondary to postoperative nasal packing or intraoperative trauma.

Multiple pyogenic granulomas over previous treated area in a postmenopausal woman on hormone replacement therapy

( Jung Woo Lee ),( Geo Han ),( Hae Jun Song ),( Chil Hwan Oh ),( Jiehyun Jeon ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1

Pyogenic granuloma is a benign vascular tumor that is common in children but may occur at any age. Although the lesion usually presents as a solitary papule, the development of multiple satellite pyogenic granulomas has been rarely reported. A 53-year-old woman presented with easily bleeding sessile papule and surrounding reddish papules on scalp lasted for a year. The primary lesion had been treated by electrodessication 1.5 years ago but the lesion has been recurred with new multiple satellites. She was treated with hormone replacement therapy to improve menopausal symptoms for 3 years. The histological findings of the primary and satellite lesions showed many dilated capillaries and epidermal collarette which are consistent with pyogenic granuloma. Two consecutive excisions for remnants were done and all the specimens confirmed the diagnosis of pyogenic granuloma. Multiple pyogenic granulomas are known to develop around the recently treated areas and one of hypotheses proposes releasing of various endogenous substances including angiogenic factors by trauma. Furthermore, frequent development of pyogenic granuloma during pregnancy implies the hormonal factors as a major role. Therefore, postmenopausal women treated with hormonal therapy may be at increased risk for pyogenic granuloma. We report herein a rare case of multiple pyogenic granulomas over previous treated area, in a postmenopausal woman on hormone replacement therapy.

Differentiation between Tuberculous Spondylitis and Pyogenic Spondylitis on MR Imaging

박종한,신혜선,박종태,김태영,엄기성 대한척추신경외과학회 2011 Neurospine Vol.8 No.4

Objective: The objective of this study was to compare the magnetic resonance(MR) imaging of tuberculous spondylitis with pyogenic spondylitis. Methods: MR images of the spines of 41 patients with infectious spondylitis at our institution over 8-years of period were retrospectively reviewed. Eighteen patients with infective spondylitis were excluded because their results on the marrow biopsy and culture were negative. MR imaging findings in 6 patients with tuberculous spondylitis(3 male, 3 female) were compared with those of 17 patients(10 male, 7 female) with pyogenic spondylitis. Results: Two MR imaging findings were statiscally significant in differentiating the tuberculous spondylitis from pyogenic spondylitis: a well defined paraspinal abnormal signal and a thin and smooth abscess wall. There were no significant diffe- rences in the following MR imaging findings: paraspinal abscess or intraosseous abscess, subligamentous spread to three or more vertebra, involvement of multiple vertebra, hyperintense signal on T2-weighted images, heterogenous low signal on T1-weighted images, involvement of posterior element, epidural extension, involvement of intervertebral disk, disk space narrowing, rim enhancement of the abscess, skip lesion, and endplate destruction. Conclusion: MR imaging is an appropriate modality for differentiation of tuberculous spondylitis from pyogenic spondylitis. Objective: The objective of this study was to compare the magnetic resonance(MR) imaging of tuberculous spondylitis with pyogenic spondylitis. Methods: MR images of the spines of 41 patients with infectious spondylitis at our institution over 8-years of period were retrospectively reviewed. Eighteen patients with infective spondylitis were excluded because their results on the marrow biopsy and culture were negative. MR imaging findings in 6 patients with tuberculous spondylitis(3 male, 3 female) were compared with those of 17 patients(10 male, 7 female) with pyogenic spondylitis. Results: Two MR imaging findings were statiscally significant in differentiating the tuberculous spondylitis from pyogenic spondylitis: a well defined paraspinal abnormal signal and a thin and smooth abscess wall. There were no significant diffe- rences in the following MR imaging findings: paraspinal abscess or intraosseous abscess, subligamentous spread to three or more vertebra, involvement of multiple vertebra, hyperintense signal on T2-weighted images, heterogenous low signal on T1-weighted images, involvement of posterior element, epidural extension, involvement of intervertebral disk, disk space narrowing, rim enhancement of the abscess, skip lesion, and endplate destruction. Conclusion: MR imaging is an appropriate modality for differentiation of tuberculous spondylitis from pyogenic spondylitis.

Surgical Management of Pyogenic Discitis of Lumbar Region

Pramod Devkota,Krishnakumar R,Renjith Kumar J 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.2

Study Design: Retrospective review of patients who had pyogenic discitis and were managed surgically. Purpose: To analyze the bacteriology, pathology, management and outcome of pyogenic discitis of the lumbar region treated surgically. Overview of Literature: Surgical management of pyogenic discitis is still an infrequently used modality of treatment. Methods: A total of 42 patients comprised of 33 males and 9 females who had pyogenic discitis with a mean age of 51.61 years (range, 16−75 years) were included in this study. All the cases were confirmed as having pyogenic discitis by pus culture report and histopathological examination. The mean follow-up period was 41.9 months. Results: Debridement and posterior lumbar interbody fusion with autologous iliac bone graft was done in all cases. Thirteen (30.95%) patients had other medical co-morbidities. Five cases had a previous operation of the spine, and three cases had a history of vertebral fracture. Three patients were operated for gynaecological problems, and four cases had a history of urological surgery. L4−5 level was the most frequent site of pyogenic discitis. The most common bacterium isolated was Staphylococcus aureus (S. aureus). Radiologically good fusion was seen in the majority of patients. Conclusions: Pyogenic discitis should be suspected in people having pain and local tenderness in the spinal region with a rise in inflammatory parameters in blood. The most common bacterium was S. aureus, but there were still a greater number of patients infected with other types of bacteria. Therefore, antibiotics therapy should be started only after isolating the bacteria and making the culture sensitivity report.

Immunohistochemical Evaluation of Angiogenesis Related Markers in Pyogenic Granuloma of Gingiva

Seyedmajidi, Maryam,Shafaee, Shahryar,Hashemipour, Golnarsadat,Bijani, Ali,Ehsani, Hodis Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.17

Background: Pyogenic granuloma is a common non-neoplastic connective tissue proliferation. ICAM-1 and VCAM-1 are vascular adhesion molecules and CD34 is a marker for evaluation of angiogenesis. The purpose of this study was to compare the immunohistochemical expression of ICAM-1, VCAM-1 & CD34 in oral pyogenic granuloma and normal gingiva. Materials and Methods: This study was performed on thirty five formalin-fixed, paraffin embedded samples of gingival pyogenic granuloma. Also we used thirty five paraffined blocks of normal gingiva as control group which were taken from crown lengthening surgery. We employed immunohistochemistry staining for our prepared microscopic slides using monoclonal mouse anti-human antibodies against ICAM-1 (CD54), VCAM-1 (CD106) and CD34. Slides were examined under light microscope and then the mean amount of stained vessels also known as microvascular density (MVD) in highly vascularized areas (hot spots) was measured. Paired t-test and repeated measures ANOVA were used to compare the difference between quantitative variables and Chi-square test for qualitative variables in different groups. Pearson correlation coefficient was used to compare relations between quantitative variables. P<0.05 was considered significant. Results: The mean of MVD for ICAM-1, VCAM-1 and CD34 was significantly higher in pyogenic granuloma than normal gingiva (p<0.001 & p<0.001 & p<0.001, respectively). Expression of CD34 in pyogenic granuloma was significantly higher than ICAM-1 and VCAM-1 (P<0.001). Besides, expression of ICAM-1 in normal gingiva, was significantly lower than two other markers (p<0.001). Conclusions: Regarding the results, it seems that ICAM-1, VCAM-1 and CD34 are useful biomarkers in evaluation of vascular and inflammatory lesions such as gingival pyogenic granuloma and the results indicate the role of these biomarkers in pathogenesis of oral pyogenic granuloma.

Is Titanium Mesh Cage Safe in Surgical Management of Pyogenic Spondylitis?

Heo, Won,Kang, Dong-Ho,Park, Kyung-Bum,Hwang, Soo-Hyun,Park, In-Sung,Han, Jong-Woo The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.50 No.4

Objective : To report our experience with pyogenic spondylitis treated with anterior radical debridement and insertion of a titanium mesh cage and to demonstrate the effectiveness and safety of the use of a titanium mesh cage in the surgical management of pyogenic spondylitis. Methods : We retrospectively analyzed the clinical characteristics of 19 patients who underwent surgical treatment in our department between January 2004 and December 2008. The average follow-up period was 11.16 months (range, 6-64 months). We evaluated risk factors, cultured organisms, lab data, clinical outcomes, and radiographic results. Surgical techniques for patients with pyogenic spondylitis were anterior radical debridement and reconstruction with titanium mesh cage insertion and screw fixation. All patients received intravenous antibiotics for at least 6 weeks postoperatively, and some patients received oral antibiotics. Results : The infections resolved in all of the patients as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. The mean pain score on a Visual Analog Scale was 7.8 (range, 4-10) before surgery and 2.4 (range, 1-5) after surgery. The Frankel grade was improved by one grade in seven patients. After surgery, the average difference of the angle was improved about $6.96^{\circ}$ in all patients. At the last follow-up, the mean loss of correction was $4.86^{\circ}$. Conclusion : Anterior radical debridement followed by the placement of instrumentation with a titanium mesh cage may be a safe and effective treatment for selected patients with pyogenic spondylitis. This surgical therapy does not lead to recurrent pyogenic spondylitis.

결핵성 척추염과 화농성 척추염의 감별 진단

구기형,이혁진,염진섭,박건우,이춘기,장봉순 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.2

Study Design: This is a retrospective study Objectives: We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the clinical and MRI findings. Summary of the Literature Review: Making an early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis is essential to start prompt and proper treatment. However, the clinical symptoms and MRI findings of both these illnesses can vary considerably. Material and Method: Ninety-five patients (49 men and 46 women, mean age: 54.5) who were treated from January 2001 to February 2007 and whose diagnosis was confirmed by laboratory or pathological studies were retrospectively reviewed. 50 patients with tuberculous spondylitis and 45 patients with primary pyogenic spondylitis were included. The patients with combined infection or an uncertain diagnosis were excluded. We compared the medical records and MRI findings between the different groups of patients. Results: The patients with tuberculous spondylitis were younger (48.2 years vs. 61.5 years, respectively) and they had a longer symptom duration (4.3 months vs 1.8 months, respectively). The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level were significantly higher in the patients with pyogenic spondylitis (71.3/49.6 mm/hr and5.74/2.98 mg/dl, respectively). A high fever above 38 degree was more frequent in the patients with pyogenic spondylitis. Intraosseous abscess, epidural abscess, a well-definded paraspinal abscess, focal enhancement and severe destruction of the vertebral body on MRI were more frequent in the patients with tuberculous spondylitis. Four parameters such as a symptom duration longer than 3 months, no fever higher than 38 degree, a well-defined paravertebral abscess and an intraosseous abscess were selected. 42 patients in the tuberculous group had 3 or more of these four parameters. The sensitivity and specificity of these combined 4 parameters were 84% and 97.8%, respectively, for making the differential diagnosis between these 2 maladies. Conclusion: These diagnostic criteria might be useful to discriminate between tuberculous spondylitis and pyogenic spondylitis even without definite laboratory or pathological results. 연구계획: 후향적 연구 연구목적: 결핵성 척추염과 화농성 척추염의 감별은 조기 진단 및 치료에 중요하나 임상 경과 및 방사선학적 소견이 다양하여 감별이 어려운 경우가 많다. 임상 소견 및 자기 공명 영상 소견을 비교 분석하여 이들을 감별하고자 하였다. 대상 및 방법: 2001년 1월부터 2007년 2월까지 감염성 척추염으로 수술적 치료를 시행하고 술 중 균배양 및 조직학 적 검사로 확진된 환자 95명을 대상으로 하였다. 남자가 49명, 여자가 46명이었고 평균 연령은 54.5(14~86)세이었다. 각 군에서 성별, 나이, 침범 추체수, 증상 발현 기간, 술전 임상 병리 검사 결과, 동통, 발열, 신경학적 증상 등의 임상 양상과 자기 공명 영상 소견을 비교하여 분석하였다. 결과: 결핵성 척추염이 50례, 화농성 척추염이 45례이었다. 결핵성 척추염에서 평균 연령이 48.2세로 화농성 척추염 의 61.5세에 비하여 조기에 발병하였으며, 평균 발병 기간은 4.3개월로 화농성 척추염의 1.8개월에 비하여 길었고, C 반응성 단백(CRP), 적혈구 침강 속도(ESR)는 화농성 척추염에서 5.74 mm/hr, 71.3 mg/이으로 결핵성 척추염의 2.98 mm/hr, 49.6 mg/이에 비하여 유의하게 높았고, 38도 이상의 고열도 화농성 척추염군에서 유의하게 많았다. 자기 공명 영상 소견에서 추체내 농양, 경막 주위 농양, 경계가 분명한 추체 주위 농양, 추체의 심한 파괴는 결핵성 척추염에서 유의하게 많았으며 조영 증강시 부분적이고 다양한 조영 증강 소견을 보이는 경우가 많았다. 3개월 이상의 이환 기 간, 38도 이상의 발열이 없는 경우의 임상 소견과 경계가 분명한 척추 주위 농양, 추체내 농양과 같은 방사선학적 소 견을 종합하여 이러한 4가지 항목 중 3가지 이상을 만족시키는 경우가 결핵성 척추염으로 진단된 50례 중 42례이었 고 진단의 민감도는 84%이었고, 특이도는 97.8%이었다. 결론: 이러한 진단 기준은 배양 검사나 조직학적 검사가 불확실한 상황에서의 감염성 척추염의 감별 진단에 유용하 게 이용될 수 있을 것으로 생각된다.