Subdiaphragmatic abscess in infants and children.
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The authors discuss the possibilities of ultrasonic tomography and subsequent performance of purposeful punctures for establishing the precise diagnosis of hepatic and perihepatic abscesses. In most cases the method helps in revealing the cavities measuring no more than 1.5-2.0 cm. The indications are determined, as well as the techniques of topical treatment with the use of single and multiple punctures and prolonged percutaneous drainage. Seventy-three patients (32 with hepatic and 41 with perihepatic abscesses) underwent clinical examination. Topical therapy was applied in 21 patients with discovered hepatic abscesses, 17 of them recovered. Operations were avoided in 25 in a group of 34 patients with perihepatic abscesses (in 7 the abscesses were not identified). The success of this treatment is determined by exact diagnosis and precise manipulations.
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Infectious complications remain an important source of postoperative morbidity and mortality. The prevention, diagnosis, and treatment of these problems can be extremely taxing, and skillful clinical judgment and surgery can frequently make the difference between survival or death.
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Management of septic pulmonary embolism now suggests a predictability of the clinical course which often allows an early decision regarding the need for definitive thoracotomy. Sixty patients have been treated within the past 5 years. Antibiotics were employed in all patients, administered whenever possible according to cultures. In 12 patients thoracotomy was required. This involved decortication and varying amounts of pulmonary resection from wedge excision to pneumonectomy. Early appreciation of septic pulmonary embolism and prompt thoracotomy can frequently obviate the need for tardy open drainage procedures with consequent prolonged recovery. Sources of emboli must be controlled. Interruption of the inferior vena cava, vein excision, aggressive control of peripheral abscesses, and excision of the tricuspid valve may be required. Reliance on antiocagulants alone to control emboli is dangerous, and proper surgical intervention and antibiotic therapy reduce the need for long-term anticoagulation.
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Twenty-two successive patients presenting with localised humps on the right hemidiaphragm or juxtadiaphragmatic masses, as revealed on standard chest radiographs, were submitted for ultrasound examination. These were carried out irrespective of the patient's symptoms. Ultrasonography provided a useful adjunct to conventional chest radiography and accurately defined the extent of diaphragmatic humps and the contents of diaphragmatic herniations and juxtadiaphragmatic masses, clearly defining their relationship to the adjacent organs. In most cases further radiological investigations were unnecessary.
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