Paul S F Lee | Search PubMed

PubMed2004

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

Adult↗

PubMed2004

Primitive neuroectodermal kidney tumour.

Renal primitive neuroectodermal tumour (PNET) is a rare malignant tumour of paediatric patients. We describe the important imaging findings, including the ultrasound, CT and MRI of a case of renal PNET in a teenager. To our knowledge, some findings have not been described previously. Some features that have been considered as characteristic are not present in our case, and it is, to our knowledge, the first documented case with such extensive tumour thrombus. We also demonstrate the importance of including PNET as a differential diagnosis because combined chemotherapy is thought to be the best first-line treatment in most cases. Histological diagnosis can be determined by a minimally invasive procedure instead of laparotomy or open biopsy.

Adolescent↗

PubMedDate not supplied

Pitfalls in diagnosis of early stage malignant peritoneal mesothelioma: a case report.

Malignant peritoneal mesothelioma (MPM) is a rare condition with an overall incidence of one to two cases per million [Arch. Surg. 123 (1988) 765.]. It is a tumour that arises from the mesothelium of a serosal cavity. While simultaneous peritoneal and pleural involvement is found in 30-45% of cases of mesothelioma, solitary peritoneal involvement is found only in 10-20%. The disease usually presents late. As a result, most reported cases in the radiological literature describe features of the advanced disease only. We report the radiological findings in early stage of MPM in a patient who was successfully treated by surgery. The diagnostic pitfalls in early stage disease are discussed and the radiological literature of MPM is reviewed.

Female↗