[Postoperative subdiaphragmatic abscess].
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When employed in the study of peripheral infections, 67Ga scanning is sensitive and accurate. When used as a diagnostic tool for suspected abdominal abscesses, it locates and delineates abscesses in somewhat over half the cases. Moreover, the true-negative rate is high and the false-positive rate is acceptably low. Gallium scans should be interpreted with all available clinical information. The coexistence of noeplasm is a problem which at present is not completely resolved.
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The radiologic diagnosis of perihepatic abscess is one of the most important diagnoses the radiologist is called upon to make. The author defines, simply and accurately, the spaces around the liver, and simplifies the radiologic diagnosis of abscesses within these spaces. He establishes a radiologic routine which aids in this task.
1. Hepatic carbohydrate metabolism was studied by an intravenous galactose test in control patients, malnourished non-septic patients, patients with prolonged severe sepsis and patients after recovery from sepsis. 2. Blood galactose half-life was not significantly increased in the septic group despite abnormal liver-function tests, whereas it was approximately doubled in the malnourished patients. 3. The rise in blood glucose after galactose injection was less in both the septic and malnourished groups, as compared with that in the control subjects. 4. Fasting blood glucose, lactate and pyruvate concentrations were similar in all groups, whereas blood ketone bodies were increased in the malnourished and septic groups, and blood alanine was decreased only in the septic group. 5. The changes in hepatic metabolism and function were reversible on recovery from sepsis. 6. It is suggested that alterations in hepatic blood flow and the metabolic fate of galactose within the liver may explain the changes in the metabolic response to galactose observed in malnourished or septic patients.
The problem of surgical infections is discussed, special attention being paid to the commonest bacterial agents, particularly those extremely serious forms induced by gram negative and anaerobic microorganisms. After an introduction regarding isolation methods and respective therapeutic programmes, attention is turned to the case of a young woman observed after an operation for perforated appendicular abscess later complicated by stercoraceous peritonitis. After initial antibiotic treatment, which was without effect, an association comprising Clindamycin, penicillin and gentamycin was employed. In just a few days this led complete remission of symptoms.