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CT-guided percutaneous aspiration and drainage of abscesses.

CT-guided procedures were attempted in 103 patients suspected of having abscesses. CT-guided procedures were performed for diagnostic specimens in 70 patients; they were successful in 30 of 34 sterile collections and 33 of 36 abscesses. In another 33 patients, diagnostic aspiration was performed and percutaneous drainage was attempted; aspirations were successful in 33 of 33 and drainage in 28 of 33 cases. Of the five not drained, four were undrainable because of anatomic extent or high viscosity of the purulent material. The fifth was a necrotic, squamous cell tumor erroneously thought to be an abscess. No complications were encountered. CT-guided procedures are an effective method for obtaining diagnostic specimens in selected patients.

Abscess↗

[Percutaneous drainage treatment of abscess and fluid retention following abdominal surgery].

61 patients with abdominal abscesses and fluid collections as a postoperative complication underwent percutaneous drainage. 60 abscesses, 11 haematomas, 3 steril seromas and 3 bile collections were drained. The fluid collections were associated with biliary or enteric fistulae in 16 cases. The percutaneous drainage was successful in 69%, additional surgery was required in 15%. The overall mortality rate was 13%. Reasons for drainage failure were infected clots, phlegmonic abscesses and pancreas involvement of the abscesses.

Abdomen↗

Continuing changing patterns of disease in pyogenic liver abscess: a study of 38 patients.

Changes in the etiology, clinical features, methods of diagnosis, and treatment of pyogenic liver abscess have occurred slowly but continuously over the past century. The earlier changes are well documented in the literature, and continuing variations in the classic patterns of disease are now evident. These include 1) a recent increase in incidence reflecting more accurate diagnostic techniques; 2) changes in bacteriology with a high incidence of Klebsiella infection; 3) a reduction in mortality, reflecting earlier diagnosis and more refined therapeutic methods; and 4) changes in the population at risk namely a large population of terminal cancer patients. Thirty-eight patients treated at the Mount Sinai Hospital over the past 16 years, 1967-1982, have been divided into two groups, each of 8 years duration, reflecting an earlier era before routine use of scanning procedures, and a later period when technetium, gallium, sonographic, and more recently CT imaging procedures were regularly done. During the latter period there was a significant increase in both the total number of liver abscesses diagnosed and in the number estimated as a proportion of all hospital admissions. Mortality has continued to fall to more acceptable levels with a 25% reduction overall. In the early era, extrahepatic intra-abdominal infection caused all four deaths. In the past 8 years obstructing or metastatic cancer has caused four of the five deaths. Bacteremia occurred in six of the nine deaths, five of these being of biliary origin. The decrease in mortality may reflect earlier diagnosis, an increase in the number of solitary abscesses, and better therapy.

Adult↗

Bacteria, toxins, and the peritoneum.

Intraperitoneal infections are caused by members of the gastrointestinal flora, mainly Escherichia coli, enterococci, Klebsiella, Enterobacter, Proteus, Bacteroides, anaerobic cocci, Clostridia, and Fusobacteria. The Gram-negative aerobic bacteria exert their pathogenic potential mainly through endotoxin which acts by way of mediators, causing systemic septic response and, initially, the local response of the peritoneal cavity. The main virulence factors of anaerobic bacteria are exoenzymes and capsular polysaccharides. Peritoneal infections are truly synergistic infections. The most important synergistic mechanisms are protection against host defense and creation of a suitable environment by one member of the flora for another. Aside from bacteria, certain adjuvant substances, i.e., bile, gastric juice, blood, and necrotic tissue, play a role in the pathogenesis of peritonitis. The peritoneum deals with an infection in 3 ways: first, the direct absorption of bacteria into the lymphatics via the stoma of the diaphragmatic peritoneum; second, the local destruction of bacteria through phagocytosis by either resident macrophages or polymorphonuclear granulocytes attracted to the peritoneal cavity; and third, the localization of the infection in the form of an abscess.

Bacteria, Aerobic↗

[Ultrasound-controlled minimally invasive surgical interventions in abdominal abscesses].

Results of ultrasound-controlled minimally invasive surgical interventions (UAMISI) for abdominal abscesses are analyzed. 84 operations were performed in 72 patients with good results. Puncture method was used in 12 patients, drainage operation--in 58, endoscopy-guided puncture method--in 2 patients. Indications for different ultrasonic-assisted interventions are developed. It is concluded that at present the UAMISI are the alternative to conventional "open" treatment of abdominal abscesses.

Abdominal Abscess↗