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PubMed2003

Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study.

Thirty-nine patients with amoebic liver abscess (ALA), admitted to the Central Hospital of Hué (Vietnam), were evaluated in a comparative, prospective and randomized study for the treatment of ALA. Adult patients with an abscess located in the right liver lobe and an abscess diameter of 6 to 10 cm were included. Bacterial abscesses were excluded by microbiological examination of abscess fluid in all patients. Nineteen patients were treated with metronidazole for 10 days alone and 20 patients were punctured under ultrasound guidance with aspiration of abscess fluid in addition to drug administration. The clinical symptoms fever, pain in right upper abdomen and liver tenderness, and the laboratory parameters erythrocyte sedimentation rate, white blood cells, haemoglobin and C-reactive protein and the abscess size were determined on the day of admission and followed during an observation period of 38 days. Improvement of liver tenderness was significantly faster in the aspiration group during the first 3 days (P < 0.001), whereas all the other parameters showed no differences between the two groups. This minor benefit is obviously not sufficient to justify routine needle aspiration and advocates drug treatment alone for uncomplicated amoebic liver abscesses with a diameter up to 10 cm located in the right liver lobe.

Adolescent↗
PubMed2002

Differential gene expression in Entamoeba histolytica isolated from amoebic liver abscess.

The majority of human infections with the intestinal protozoan parasite Entamoeba histolytica remain asymptomatic. In a small proportion of infections, however, E. histolytica trophozoites penetrate the intestinal mucosa and disseminate to other organs, most commonly to the liver, where they induce abscess formation. It is believed that the ability of E. histolytica trophozoites to destroy host tissues and to survive within the liver is accomplished by a strong adaptive response, which requires the specific regulation of a number of amoeba proteins. Using differential display polymerase chain reaction (DD-PCR), we compared RNA expression between E. histolytica trophozoites isolated from liver abscesses of infected gerbils and those grown under normal culture conditions. A total of 3000 cDNA-derived amplicons were compared between the two groups of amoebae, which were calculated to represent about one-third of all E. histolytica mRNA species (transcriptome). Among these, 55 were found to be specifically present or absent in abscess-derived amoebae, of which 42 were successfully cloned and sequenced. Database searches and Northern blot analyses revealed that the 42 amplicons correspond to 29 independent E. histolytica genes, of which at least seven are specifically upregulated and five are downregulated in abscess-derived amoebae. Specific expression of most of these genes was not simply the result of a heat shock response, which might be expected during abscess formation, as only five of the genes revealed an expression profile similar to that found in amoebae cultured under elevated temperatures. The two genes specifically downregulated in abscess-derived amoebae encode members of a family of so far unknown proteins, which contain repetitive stretches of sequences that are rich in lysine and glutamic acid residues. In contrast, a diverse set of genes is specifically upregulated, encoding ribosomal proteins (S30, L37A), cyclophilin, ferredoxin 2 and GTP-binding protein RAB7D, supporting the notion that liver abscess formation requires the regulation and concerted action of a variety of amoeba proteins. These proteins are associated with stress response, signal transduction, regulation of transcription and vesicular trafficking. However, transcriptome analysis will not be sufficient to identify all proteins specifically upregulated during abscess formation, as at least an increase in the expression of actin was found to be regulated at the post-transcriptional level.

Actins↗
PubMed2001

[Rational diagnosis of pediatric pharyngeal abscess].

BACKGROUND: Diagnostic procedures intend to differentiate superficial cervical abscesses from deep abscesses and uncomplicated lymphadenitis. They should provide identification of the causing agent, of the route of infection and of possible underlying diseases. Present techniques for examining pediatric cervical abscesses should be assessed. METHODS: Currently published data on diagnostic procedures in pediatric neck abscess from National Library of Medicine data files were evaluated. Moreover, clinical findings, diagnostic procedures, therapy and outcome of 47 children with cervical abscess treated from 1992-1996 were retrospectively evaluated. RESULTS: Studies providing appropriate evidence on the value of various diagnostic procedures in pediatric cervical abscesses were not found. In 47 patients with confirmed cervical abscess treated at our department, clinical examination, erythrocyte sedimentation rate and ultrasound examination of the neck were sufficient to establish the correct diagnosis. Additional investigations such as MRI or CT-scans, chest X-rays, Mendel-Mantoux test, various virus titres and other laboratory examinations were performed only in selected cases. The route of invasion (tonsil, dental or otogeneous) could be identified in 13 children. In 4 children an infected cervical cyst was found. CONCLUSIONS: Clinical examination, erythrocyte sedimentation rate and sonography are appropriate to establish the diagnosis of pediatric cervical abscess and in accordance with the principles of Managed Care.

Child↗
PubMed2003

[Sonographically guided percutaneous needle aspiration of breast abscesses - a minimal-invasive alternative to surgical incision].

AIM: The current standard treatment of breast abscesses is surgical incision and drainage. This method, however, frequently yields poor cosmetic results. Sonographically guided percutaneous aspiration of breast abscesses and local antibiotic treatment need to be considered as an interesting alternative. The present study aimed to compare these treatment alternatives. METHOD: The patient population analysed comprised 24 patients with 28 breast abscesses who presented to the Department of Obstetrics and Gynaecology of Munich University Hospital Grosshadern between 12/1997 and 9/2002. 25 % of these patients (6/24) suffered from a puerperal and 75 % (18/24) from a non-puerperal breast abscess. The study group of surgically treated patients comprised 15 women (16 abscesses). Ten patients (10 abscesses) were treated with the novel, minimally invasive method. The treatment success was statistically analysed using chi (2)- and t-Tests (p < 0,05). RESULTS: The minimally invasive approach did not extend the length of intravenous antibiotic treatment or hospital stay and did not lead to an increase in the need for analgesic drugs. We encountered recurrent abscesses in 31 % (5/16) of the surgical treatment group, yet none in the group undergoing minimally invasive treatment. The aesthetic-cosmetic as well as the functional result in lactating patients was satisfactory in all cases. CONCLUSION: Sonographically guided percutaneous aspiration of breast abscesses represents a less invasive and very promising alternative to surgical incision, showing the following advantages: no general anaesthesia required, a superior cosmetic result and shorter hospitalisation. The method was highly accepted by all patients treated.

Abscess↗
PubMed1997

[Liver abscesses--complications after prosthesis and stent occlusions].

PURPOSE: Patients with malignant, unresectable biliary strictures and endoprosthesis or stents for drainage often develop liver abscess. The aim of the investigation was to assess the relationship and the factors causing the development of these abscesses. METHOD: 9 patients with a median age of 65.6 years, liver abscess and endoprosthesis or stents were studied retrospectively. The occlusions were made visible sonographically and by ERC or PTC. With sonography the abscess was diagnosed and punctured. RESULTS: 5 patients (56%) had a bile duct carcinoma, two patients had a distal tumor stenosis, one a tumor of the gallbladder and one an obstructive jaundice due to liver metastases. 8 patients required a percutaneous drainage (PTCD). 6 cases of occlusions were found. 1 patient had a biliary obstruction because of a broken endoprosthesis. On an average it took 11.6 months from the first endoprosthesis or stent placement to the formation of an abscess. Plastic endoprostheses tend to occlude more rapidly (5 months versus 17.6 with stents). After the sonographically guided puncture of the liver abscess, i.v. antibiotics were given for 5 to 14 days. The antibiotics were continued orally. Two cases required a sonographically placed percutaneous drainage. 78% of the abscesses could be cured. One patient died because of sepsis. CONCLUSIONS: Liver abscesses were connected with intrahepatic carcinomas (56%). In such cases drainage is difficult and requires many interventions. Furthermore, we find this especially after percutaneous transhepatic drainage and with plastic endoprostheses.

Adult↗
PubMed2003

Retroperitoneal abscesses--analysis of a series of 66 cases.

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 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.

Abdominal Abscess↗
PubMed2005

Pelvic abscess in intrauterine device users.

OBJECTIVE: To assess the causality between pelvic abscess formation and intrauterine device (IUD) use through a clinical study in a hospital. METHOD: Sixty-two pelvic abscesses were retrospectively evaluated over a 7-year period. Patient records retrieved for the women enrolled in this study consisted of demographic characteristics, duration of IUD use and clinical management details. RESULTS: All the women were monogamous Muslim women without any suspicious sexual contacts, immunosupressive states, or drug use at the time of IUD insertion. In 10 cases (16.1%), a history of pelvic surgery was present. The mean age of the women was 36.1 +/- 2.3 years (range 19-50 years). Of the 62 women, 14 (22.6%) were current IUD users. The mean time interval for women using IUD prior to the diagnosis of pelvic abscess was 5.7 +/- 1.2 years (range 1-14 years). In all cases, a pelvic mass and abdominal pain constituted the referral signs and symptoms. All women received an initial antibiotic regimen comprising penicillin (24 mU/day), clindamycin (900 mg/day) and gentamycin (240 mg/day) in divided doses. In 38 cases (61.3%), medical treatment yielded a satisfactory clinical outcome, defined as a decreas in mass volume together with pain relief and a decrease in leukocytosis. Twenty-four cases (38.7%) underwent a subsequent surgical procedure, either laparotomy (n = 19) or laparoscopy (n = 5). The type of surgery ranged from abscess drainage to more radical approaches such as total abdominal hysterectomy and/or unilateral or bilateral salpingo-oophorectomy. There were no differences between those women responding to medical therapy and those who did not respond in terms of mean age, percentage of past pelvic surgery, gravidity, parity and the size of pelvic abscess. CONCLUSIONS: A substantial number of women with an IUD were diagnosed as having a pelvic abscess within a 7-year period at the university clinic. Despite current knowledge that pelvic inflammatory disease and pelvic abscess are rarely encountered in long-term IUD users, the presence of an IUD should be investigated in cases with an initial diagnosis of pelvic abscess based on clinical and ultrasonographic evaluation, demonstrating mostly acquisition via sexually transmitted disease.

Abscess↗
PubMed2000

Diagnosis and treatment of intra-abdominal abscesses.

Despite recent advances in the diagnosis and management of intra-abdominal abscesses, these infections still cause substantial morbidity and mortality. Low pH, large bacterial inocula, poor perfusion, the presence of hemoglobin, and large amounts of fibrin (which impedes antibiotic penetration) make the abscess a cloistered environment that is penetrated poorly by many antimicrobial therapies. Therefore, management of these infections requires prompt recognition, early localization, and effective drainage, as well as appropriate antimicrobial use. Although various imaging techniques, such as ultrasonography, gallium scans, and indium-labeled white-blood-cell scans, can be used for the diagnosis and localization of intra-abdominal abscesses, computer-assisted tomography is the most useful study. Once the diagnosis is made and the abscess is localized, treatment should begin promptly. Percutaneous or open surgical drainage should be used. Broad-spectrum antibiotics should be given until culture and sensitivity data are obtained. Once these data are obtained, a therapy with appropriate coverage that is likely to work in the abscess environment should be chosen. Percutaneous drainage is inappropriate for abscesses in the posterior subphrenic space or in the porta hepatis, for those among loops of small bowel, for suspected echinococcal cysts, and for abscesses containing necrotic or neoplastic tissues. Finally, surgeons need to be cognizant of risk factors, such as advanced age, obesity, complex abscesses, and high Acute Physiology and Chronic Health Evaluation (APACHE) II or APACHE III scores, which correlate with poor outcomes for these patients.

Abdominal Abscess↗
PubMed1984

Two-dimensional echocardiographic recognition of aortic valve ring abscess.

2D-echocardiography was performed in 42 consecutive patients with suspected aortic endocarditis who subsequently underwent surgery. On surgery, 12 patients had perivalvular aortic abscesses: in the posterior part of the ring (7) with extension to the aorto-mitral fibrous trigone or pseudo-aneurysm of the aortic wall; in the anterior part of the ring (3), with extension toward the interventricular septum; or with near complete aorto-left ventricular disruption (2). Perivalvular abscess was seen on 2D-echo in 8 patients: echo-free cavity located in the aortic ring, beyond the sigmoid valvulae and sometimes containing necrotic material. In 4 patients, the abscess was not diagnosed on 2D-echo; 2 had small, localized abscesses but the remaining 2 had large abscesses developed around previously implanted mechanical prostheses, which considerably impeded echographic examination. One additional patient with acute aortic regurgitation and fever had an image of posterior abscess, but on surgery, the posterior wall of the aorta appeared inflammatory and oedematous without perivalvular abscess. Accurate topographic diagnosis was made in 6 of the 8 patients, while in 2 the abscess was located more to the left than considered on 2D-echo. Generally, 2D-echo tended to underestimate the importance and extension of the lesions. It is concluded that 2D-echo is helpful to diagnose perivalvular aortic infection.

Abscess↗
PubMed1981

Antibiotic levels in infected and sterile subcutaneous abscesses in mice.

The pharmacokinetic properties of 10 antimicrobial agents were examined in sterile and infected encapsulated subcutaneous abscesses in mice. The inoculum for sterile abscesses was autoclaved cecal contents; that for infected abscesses was autoclaved cecal contents combined with Bacteroides fragilis. The antimicrobial agents examined were rosaramicin, clindamycin, chloramphenicol, metronidazole, and six beta-lactam antibiotics. All antimicrobial agents entered abscesses, produced peak levels of biological activity that were somewhat delayed in comparison to serum levels, and were present in negligible levels 8 hr after administration. The highest concentration in abscesses was achieved with rosaramicin and clindamycin, with peak levels of 43%--63% of the peak serum level. Peak levels of other antimicrobial agents in sterile abscesses were 13%--27% of the peak serum level. Levels of biologically active during were significantly lower in infected abscesses than in sterile abscesses for antimicrobial agents that are inactivated by B. fragilis beta-lactamase.

Abscess↗
PubMed1993

The effect of zinc on microbial growth and bacterial killing by cefazolin in a Staphylococcus aureus abscess milieu.

Microbial growth and antimicrobial bacterial killing are both diminished in abscesses. It was postulated that zinc depletion in abscesses, perhaps secondary to a neutrophil protein resembling calprotectin, may be partly responsible for these effects. In a rabbit tissue-cage abscess model, pooled abscess supernatant concentration of zinc was < 1.53 microM. The addition of 41.7 microM zinc had no effect on Staphylococcus aureus growth or the bacterial killing effect of cefazolin in serum. In abscess fluid supernatants, bacterial growth without antibiotic and bacterial killing by cefazolin were both enhanced by the addition of zinc. Fractionation of the abscess fluid with ultrafiltration membranes showed that these effects could be reproduced with the fraction between 30 and 50 kDa. These findings suggest that a protein in abscess fluid supernatants that resembles the neutrophil protein calprotectin may, through its zinc binding effects, inhibit microbial growth within an abscess but also inhibit the activity of bactericidal antibiotics.

Abscess↗
PubMed1989

The pharmacokinetics and therapeutic efficacy of fleroxacin and pefloxacin in a rat abscess model.

The penetration, pharmacokinetics and therapeutic efficacy of fleroxacin and pefloxacin were investigated in a rat abscess model. Abscesses were induced by implanting a dialysis tube unit contaminated with Serratia marcescens in the subcutaneous tissue. Simultaneous serum, interstitial fluid (IF) and abscess fluid concentrations of the investigated antibiotics were measured 24 and 96 h after implantation. The concentrations were determined at various time intervals after the last intramuscular administration of each drug (20 mg/kg). Peak fleroxacin and pefloxacin concentrations in the serum of the infected animals were 14.6 +/- 4.7 mg/l and 13 +/- 2.9 mg/l respectively, peak fleroxacin and pefloxacin abscess fluid concentrations after 24 h were 12.3 +/- 2.5 mg/l and 8.9 +/- 2.2 mg/l, respectively (85% and 68% of peak serum concentrations). Abscess fluid concentrations at 96 h were: fleroxacin 4.7 +/- 2.6 mg/l and pefloxacin 4.5 +/- 1.7 mg/l. Both antimicrobials persisted significantly longer in the abscess fluid than in serum. Both drugs failed to sterilize the abscesses following a single administration; however after four consecutive administrations all abscesses became sterile. We conclude that fleroxacin and pefloxacin may be suitable for the therapy of closed space infections caused by susceptible micro-organisms.

Abscess↗
PubMed2004

Differentiating pyopneumothorax and peripheral lung abscess: chest ultrasonography.

BACKGROUND: Differentiation between pyopneumothorax and lung abscess can be difficult but has important therapeutic consequences. The role of chest ultrasonography in this issue remains undetermined. Sonographic features of hydropneumothorax and/or pyopneumothorax are characteristic and not difficult to recognize. In this study, the authors evaluate the usefulness of a panel of sonographic findings characteristic of hydropneumothorax in distinguishing pyopneumothorax from lung abscess. METHODS: This series included 16 patients with lung abscess and 19 with pyopneumothorax. A diagnosis of lung abscess or pyopneumothorax was based on the following criteria: pus aspiration from the lesion, appropriate clinical setting, thoracic computed tomographic findings, serial follow-up of chest radiograms, and consistent clinical course. The panel of sonographic features suggestive of hydropneumothorax, including the presence of air-fluid level, the curtain sign, loss of gliding sign above the air-fluid level, and the suspended microbubble sign, were recorded and analyzed by a consensus of blinded readers. In addition, sonographic features used to differentiate empyema and lung abscess were also evaluated. RESULTS: The results indicated that the presence of air-fluid level, the curtain sign, loss of gliding sign above the air-fluid level, and the suspended microbubble sign were valuable in distinguishing pyopneumothorax from lung abscess. All four sonographic findings were observed in 17 of 19 patients with pyopneumothorax. In contrast, two or fewer sonographic findings were seen in 16 patients with lung abscess. Our results confirmed that the wall characteristics, shape of the lesion, chest wall angle, and pleural separation were also useful. CONCLUSIONS: The panel of sonographic findings is of considerable value in differentiating pyopneumothorax and lung abscess.

Adult↗
PubMed1984

The diagnosis and treatment of pyogenic liver abscesses.

Pyogenic liver abscesses in 106 adult patients at The New York Hospital were reviewed to define optimum treatment. Mortality in the surgically treated patients was 26% (17/65), while those treated nonsurgically had a fatality rate of 95% (39/41). Multiple abscesses treated surgically had a surprisingly low mortality of 29% (5/17). Modern noninvasive tests are highly sensitive in diagnosing liver lesions greater than 2 cm. Difficulty remains in identifying small hepatic abscesses and differentiating large abscesses from tumor. Most liver abscesses have an identifiable source outside the liver. The most common source (31%) was cholangitis secondary to extrahepatic biliary obstruction. Multiple abscesses, mixed organisms, hyperbilirubinemia, and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor determining survival. Most patients who have the underlying pathogenesis of the abscess controlled will survive surgical treatment. Transperitoneal surgical drainage and antibiotics remain the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.

Adult↗
PubMed1985

Computed tomography and the prediction of pancreatic abscess in acute pancreatitis.

Pancreatic abscess has become the most common cause of death from acute pancreatitis. Since computed tomography (CT) permits noninvasive imaging of the peripancreatic anatomy, the relationship of early CT findings to late pancreatic sepsis has been evaluated in 83 patients with acute pancreatitis. Pancreatic abscesses developed in 18 patients and were responsible for five of the six deaths in this study. Initial CT findings were graded: A = normal, in 12 patients; B = pancreatic enlargement alone, in 19; C = inflammation confined to pancreas and peripancreatic fat, in 17; D = one peripancreatic fluid collection, in 12; and E = two or more fluid collections, in 23. The incidence of pancreatic abscess in grades A and B was 0%; in grade C, 11.8%; in grade D, 16.7; and in grade E, 60.9%. The severity of pancreatitis was also graded by previously reported prognostic signs as "mild" (0-2 signs) in 56 patients, "moderate" (3-5 signs) in 22, and "severe" (greater than or equal to 6 signs) in five patients. The incidence of abscesses in mild disease was 12.5%; in moderate, 31.8%; and in severe, 80%. Fluid collections on CT resolved spontaneously in 19 of 35 (54.3%) patients. Abscess developed in two patients with no fluid collections on initial CT study. No abscess occurred in 31 patients with CT grades A or B, and in one of 22 patients (4.5%) with CT grade C or D and less than three positive prognostic signs. Among 30 patients with CT grade E or CT grade C or D and three or more positive prognostic signs, 17 (56.7%) developed abscesses. All deaths were in patients with five or more positive prognostic signs. Early imaging of the pancreas by CT identifies a group of patients with increased risk of pancreatic abscess. Identification of this group is improved further by use of early objective prognostic signs.

Abscess↗
PubMed1985

Improved survival in 45 patients with pancreatic abscess.

The reported mortality due to pancreatic abscesses after acute pancreatitis has been 30 to 50%, a statistic that has remained unchanged for decades. This is a report of 45 patients treated over 10 years, showing a dramatic improvement in survival during that period. They represent 2.5% of admissions at the Massachusetts General Hospital for acute pancreatitis. The identifiable antecedents included alcohol (38%), gallstones (11%), and surgical trauma (16%), or were unknown in 24%. Computerized tomography (CT) was clearly the best means of specific diagnosis (unequivocal evidence in 74%, suggestive in 21%). Treatment in 44 patients was surgical debridement and catheter drainage, and in one it was resection of the pancreatic head. Multiple abscesses were present at the first operation in 21 patients. Seven had second drainage procedures for additional abscesses. In the first 5 years (1974-1978), 10 of 26 patients died (38%). In the second 5 years (1979-1983), one of 19 died (5%) (p less than 0.01). Postoperative complications (84%) included wound hemorrhage (9 of 26 vs. 1 of 19), systemic sepsis (7 of 26 vs. 1 of 19), pancreatic fistula (14/45, 13 of which closed spontaneously), colonic perforation (4), duodenal perforation (2), and gastric perforation (1). The causes of death were renal and respiratory failure with sepsis (7), hemorrhage (3), and pulmonary emboli (1). Analysis of the findings shows in the second 5-year period more frequent use of CT to certify the diagnosis of pancreatic abscess earlier, a more aggressive attitude producing earlier surgical intervention, and more extensive drainage and debridement of associated necrotic tissue. Transcatheter arterial embolization was used successfully to control postoperative hemorrhage from the abscess cavity. CT-guided percutaneous catheter drainage was used occasionally for drainage of recurrent abscesses. Neither open packing of major pancreatic abscesses nor lavage of the abscess cavity, as recently advocated, was necessary.

Abscess↗
PubMed1996

Pyogenic hepatic abscess. Changing trends over 42 years.

OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14% vs. 26%). CONCLUSIONS: Significant changes have occurred in the etiology, diagnosis, bacteriology, treatment, and outcome patients with pyogenic hepatic abscesses over the past 4 decades. However, mortality remains high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results.

Age Distribution↗
PubMedDate not supplied

Computed tomographic evaluation of an experimental model for pyogenic liver abscesses.

Computed tomography (CT) was used to evaluate 15 rabbits with experimentally induced liver abscesses. The animals were examined both before and after intravenous contrast injection. After sacrificing the animals, postfreeze CT scans were made to mark the abdomen for 1-cm thick whole body sections for correlating the gross pathology with the results of the CT scans. CT detected 15 abscesses in 13 of the 14 rabbits with true positive lesions. Ten abscesses less than 1.4 cm in diameter were not detected by CT. Contrast agent enhancement was helpful in 70% of the studies. These abscesses have characteristics similar to human liver abscesses, but there was more gas and calcium in the experimentally induced abscesses than is encountered in humans with hepatic abscesses. The model and its CT characteristics appear well suited for future studies in the diagnosis and treatment of liver abscesses.

Animals↗