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A study on laboratory diagnosis of liver abscess in Pondicherry.

A study was carried out to evaluate the role of laboratory investigations for diagnosis of liver abscess from the year 1976 to 1981. Bacteriological, parasitological, serological, haematological, histopathological studies and liver function tests were carried out in 240 confirmed cases of liver abscess during the study period. Out of 219 cases, pus culture for pyogenic bacteria was positive in 68 cases (including 27 cases of secondary bacterial infection of amoebic liver abscess) and sterile in 151 cases. Ent histolytica was demonstrated in pus of 24 cases. The diagnostic titre of 1:128 and above was detected in 137 sera by isohaemagglutination test. The liver function tests were of limited value. Albumin globulin ratio was altered in 91.25% cases and there was moderate increase in the levels of alkaline phosphatase. Histopathological studies demonstrated Ent histolitica in 2 cases only. Changes characteristic of pyogenic liver abscess were observed in 6 cases. Rest showed no specific changes.

Humans↗

Percutaneous aspiration and catheter drainage of abscesses.

Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.

Abdomen↗

The appearance of amebic abscess of liver on In-111-leukocyte scan.

A 25-year-old man had clinical features suggesting a diagnosis of amebic abscess of the liver. Ultrasound examination showed an encapsulated lesion in the right lobe of the liver consistent with amebic or pyogenic abscess. In-111-leukocyte scan of the liver showed a rim of increased activity surrounding a photopenic "cavity"; Tc-99m-sulfur colloid scan showed a larger defect. The combined appearance of the scans was thought to be typical of those expected for amebic abscess. Metronidazole therapy was started and the patient made a good recovery.

Adult↗

[Invasive amebiasis with detection of Entamoeba histolytica in rectal biopsies and liver abscesses].

A 45-years old man after having returned from Thailand was admitted to the hospital with a severe ulcerative, pyogenic colitis and multiple liver abscesses. In the endoscopically taken rectal biopsies as well as in the liver abscess aspirate gained by fine needle puncture Throphozoites of E. histolytica could be demonstrated. On the other hand stool specimens and serology were negative. The various diagnostic facilities in invasive Amebiasis are discussed. Because of the problems, which may arise from the examination of fresh stool specimens, the advantage of endoscopically gained biopsies in suspected amebic colitis is emphasized.

Amebiasis↗

Percutaneous drainage of hepatic abscesses: therapy does not differ for those with identifiable biliary fistula.

BACKGROUND/AIMS: Surgical drainage of pyogenic and amoebic hepatic abscesses has been an accepted therapy for decades. Modern imaging modalities have changed both the diagnostic and therapeutic management of many hepatic lesions, particularly abscesses. Specifically, percutaneous aspiration and drainage with either ultrasound or computed tomography guidance has been reported as an alternative treatment for hepatic abscesses in recent years. Little is known about aspiration of hepatic abscesses that communicate with the biliary tree. MATERIAL AND METHODS: Fifteen patients with hepatic abscesses treated by percutaneous aspiration and drainage are herein reported. Six had a demonstrable fistulous communication between the abscess and the biliary tree. RESULTS: During a four year period of follow-up, only two of these 15 patients experienced a recurrence. Neither had a biliary fistula complicating their abscess initially. CONCLUSIONS: Based upon this experience, it is suggested that percutaneous aspiration and drainage should be the initial treatment of choice of both pyogenic and amoebic liver abscesses even when large. Abscesses with demonstratable biliary fistulas have a larger mean volume than do those without fistulous involvement. The finding of a communication between the abscess and the biliary tree should not change this treatment approach.

Adult↗

[The association between human toxocariasis and pyogenic abscesses].

The association between hepatic abscesses and schistosomiasis mansoni was confirmed by clinical and experimental studies. Other parasites may cause systemic immunologic changes and local structural alterations in the affected organs that can facilitate the seeding of these areas by bacteria. Tropical pyomyositis, pyogenic liver and renal abscesses are frequent diseases in tropical areas. The visceral larva migrans syndrome is caused by the presence, in the human body, of larvae of worms that have other animals as their definitive host, most commonly being caused by Toxocara canis. The larvae migrate to various body organs leading to many inflammatory reactions in the form of granuloma and tissue necrosis. In this review we discuss the possible host-parasite-bacteria interactions that would favour the formation of abscesses in the organs involved by the larva of T. canis and present preliminary results of a clinical and experimental study undertaken during the last four years to define the role of this parasite in the pathogenesis of the abscesses.

Abscess↗

[Liver abscess of appendicular origin : an always possible complication (author's transl)].

Though recognized and described in detail during the first decades of the century, liver abscess due to pyogens of appendicular origin appears to have been somewhat forgotten by contemporary physicians. This complication is still possible, however, and can disturb the postoperative course of an appendicectomy, as illustrated by the case reported. Previously of very poor prognosis, the outcome usually being fatal, this has been transformed by the availability of antibiotics and improvements in medico-surgical techniques.

Appendectomy↗

Is etretinate dangerous in Papillon-Lefèvre syndrome?

A 23-year-old girl affected by Papillon-Lefèvre syndrome developed, during Etretinate therapy (1 mg/kg/day), two liver abscesses caused by pyogenic bacteria and a subphrenic abscess. The immunological effects of retinoids may precipitate severe infections in patients with Papillon-Lefèvre syndrome, who probably have a basic, even though not always evident, defect of PMN chemotaxis.

Adult↗

Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage.

OBJECTIVE: This study was designed to determine and compare the efficacy of sonographically guided percutaneous needle aspiration and percutaneous catheter drainage in the treatment of liver abscesses. SUBJECTS AND METHODS: In a randomized study, 50 patients (38 males and 12 females; age range, 2-72 years; average age, 35 years) with liver abscesses (amebic, 20; pyogenic, 11; indeterminate, 19) underwent either percutaneous needle aspiration (n = 25) or catheter drainage (n = 25) along with appropriate antimicrobial therapy. In patients assigned to the needle aspiration group, an 18-gauge needle was used to aspirate the abscess cavity. Repeated aspiration was attempted only once in each patient not responding to the first aspiration; nonresponse to the second aspiration was considered failure of treatment, and these patients were given catheter drainage (however, these patients were not included in the catheter drainage group). For catheter drainage, 8- to 12-French catheters were introduced into the abscess cavity using the Seldinger technique. In patients with multiple abscesses (seven in aspiration group and five in catheter group), all the abscesses except those smaller than 3 cm were subjected to percutaneous treatment. Patients were followed up to assess the outcome of the percutaneous treatment, length of hospital stay, and development of any complications. Sonography was performed every third day during hospitalization. After discharge of the patient, periodic clinical and sonographic examinations were done until total resolution of abscesses was achieved. RESULTS: Although percutaneous needle aspiration was successful in only 15 (60%) of the 25 patients after one (n = 11) or two (n = 4) aspirations, catheter drainage was curative in all 25 patients (100%) (p < .05). Among the successfully treated patients, the average time for clinical improvement and the mean hospital stay were similar in the two treatment groups. Although the average time needed for a 50% reduction in the size of the abscess cavity was significantly (p < .05) greater in the aspiration group than in the catheter group (11 days versus 5 days), the average time taken for total resolution of abscess was the same (15 weeks) in both groups. No major complications were encountered. No relapse was documented on clinical and sonographic examination during follow-up, which ranged from 8 to 37 weeks. CONCLUSION: Our results show that percutaneous catheter drainage is more effective than needle aspiration in the treatment of liver abscesses. Needle aspiration, if limited to two attempts, has a high failure rate.

Adolescent↗

Hepatolithiasis and biliary parasites.

Hepatolithiasis, or the presence of intrahepatic stones, is prevalent in East Asia and is characterized by the finding of stones within the intrahepatic bile ducts proximal to the confluence of the right and left hepatic ducts. Bile stasis and bacterial infection have been incriminated as the major aetiopathogenic factors. Clinical features include recurrent pyogenic cholangitis, multiple liver abscesses, secondary biliary cirrhosis and cholangiocarcinoma. The goals of management include accurate localization of pathologies, control of biliary sepsis and the elimination of stones and stasis. Ultrasonography, computed tomography and direct cholangiography complement each other in defining the stones, strictures and degree of liver damage. Non-operative biliary decompression by endoscopy and interventional radiology is effective in controlling the infection, but surgery remains the mainstay for the treatment of stones and strictures. Intra-operative ultrasound and flexible choledochoscopy, combined with percutaneous transhepatic cholangioscopy and intraductal lithotripsy, facilitate stone removal. Balloon dilatation and biliary stenting serve to open the bile duct strictures. The creation of a hepaticocutaneous jejunostomy after conventional surgery allows atraumatic access to the biliary system for the removal of recurrent stones. The management of biliary parasites begins with conservative measures, including analgesics and anti-helminthic therapy. In refractory cases or patients with acute cholangitis, endoscopic biliary drainage and the extraction of worms may be necessary. Improvement in sanitation plays a crucial role in the epidemiological control of these biliary diseases.

Animals↗

Benign liver and biliary tract masses in infants and toddlers.

There is a remarkable diversity of conditions encompassed by benign liver masses in infants and toddlers. The most common benign hepatic tumor in this age group is infantile hepatic hemangioendothelioma. Other commonly seen benign tumors are mesenchymal hamartoma and focal nodular hyperplasia. Hepatic adenoma is almost exclusively a disease of older children; primary hepatic teratoma is exceedingly rare. There are several distinguishing characteristics of these benign tumors on radiographic evaluation; however, imaging techniques such as ultrasound scan, computed tomography, and angiography are not always reliable in differentiating benign from malignant tumors. The differential diagnosis of benign hepatic tumors includes nonneoplastic cystic masses including biliary and simple hepatic cysts, hematoma, parasitic cysts, and pyogenic and amebic liver abscess. Choledochal cyst presents with a classic triad of abdominal pain, cholestatic jaundice, and a palpable abdominal mass. They are classified anatomically into 5 subtypes with the most popular types being type I and type IV. Treatment is with complete cyst excision with hepaticojejunostomy reconstruction.

Choledochal Cyst↗

[Echographic diagnosis of hepatic abscess (General Referral Hospital, Gbadolite, northern Zaire)].

The two most important liquefying liver diseases are the pyogenic and the amoebic liver abscess. The clinical, pathomorphological and ultrasonographic evolution is of some regularity. So a classification in three stages is of practical usefulness. The ultrasonographic characteristics of those stages for the two forms of liver abscess are presented as well as their specific treatment.

Democratic Republic of the Congo↗

[Reinterpretation of the hepatic abscess, a new dimension in abdominal digestive surgery].

Pyogenic abscess of the liver is viewed here as a surgical disease, which appears to raise doubts as to its actual identity. Though located in a given abdominal organ, such abscesses find it hard to recognize this as their exclusive setting and attempt to shrug off these traditional confines. They aspire, rightly or wrongly perhaps, to symbolize a splanchnic context, though, in actual fact, the latter--at least for contingent, doctrinal reasons--is confined to the bipolar liver-bowel system. This context presents its candidacy as playing a leading role in a disease of such importance as to be regarded almost as the "Caudine Forks" of the very process of "surgical" dying. Liver abscess and multiorganic or multisystemic organ failure (MOF or MSOF) might thus be viewed as the two opposite poles (taxonomically definable) of a single clinical condition, which fans out over a broad area and for the most part is only barely known to us. Though is characterized by its abdominal location, it would be all too simple to define the condition as abdominal. In this case, in fact, the abdomen speaks an unusual language, not the habitual, traditional, "spatial" language of location, but the as yet uncertainly articulated "biological" or, why not, even "biosurgical" language of mediation. Is this then a turning point in the pathological field? No, if by that we mean a new concept of the problem. In effect, the concept dates back several centuries and, moreover, darries a heavy burden of responsibility, such as, for instance, having induced the Nobel Prize-winner Elie Metcknicoff (Metcknicoff E., The prolongation of life. London, Heinemann, 1907) to come up with theories appropriated and implemented surgically by Sir William Arbutnot Lane, gaining him nothing but sad notoriety (Gordon R., Great Medical Disasters, Hutchinson, London-Melbourne, 1983). "Concept" is a euphenism, and a more appropriate term might be simply "intuition". The real innovation lies in reviving this old intuition, reinterpreting it now, in fact, as a "concept". The code for this modern interpretation has barely been sketched out in its essentials, but is daily going from strength to strength.(ABSTRACT TRUNCATED AT 400 WORDS)

Endotoxins↗

[Hepatic abscesses caused by Streptococcus intermedius].

Pyogenic abscess of the liver is uncommon child's pathology. The authors briefly describe a clinical picture characterized by beginning of an hepatic abscess dues to a germ that is not usually pathogen for men. It is often a mouth saprophyte.

Child↗

[Modern views concerning surgical treatment of psychogenic chronic hepatic abscesses].

A case of paracholecystic pyogenic abscess of the liver discovered intraoperatively in a patient with calculous cholecystitis is reported. Successful management was obtained by means of extensive resection of the protruding cap, scrapping of the wall and suture of the parenchyma, coupled with cholecystectomy. The literature on treatment of liver abscesses is reviewed. The conclusion is drawn that radical removal, with respect for the parenchyma, is best employed in chronic, restricted forms. The pus must, of course, be cultured and an antibiogram run on the germs isolated, as a prelude to planned antibiotic management after surgery.

Cholecystectomy↗