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PubMed2000

[Suburban amebiasis: the diagnostic aspects via computed tomography and echography and the percutaneous treatment of amebic liver abscesses].

INTRODUCTION: Liver is the most common site of extraintestinal amebiasis and hepatic abscesses are the most frequent symptom, occurring in 3-9% of patients with amebic infection. Several studies have shown that drug treatment is more efficacious when combined with percutaneous drainage of the abscess, yielding quicker recovery and a positive body response. We report our US and CT findings in 16 patients with amebic abscesses, 12 of whom lived in a temperate peripheral area north-east of Naples. All patients had a clinical-diagnostic condition that we called "suburban amebiasis". Finally we report our personal experience with the US-guided therapeutic drainage of amebic abscesses with repeated cavity washings, which is important for positive parasitology. MATERIAL AND METHODS: We retrospectively reviewed the findings of 16 patients (11 men and 5 women; age range 36-78 years; mean 52) with amebic abscesses of liver examined with US and CT. US with a 3.5 MHz transducer was the technique of choice in all patients. 94% of liver abscesses and some extraintestinal complications were easily shown with this technique. CT angiography was then performed to detail and clarify US findings. Abscesses over 4 cm in diameter were submitted to US-guided percutaneous treatment which permitted abscess drainage, the collection of material for parasitology and repeated cavity washings. RESULTS: US showed multiple liver abscesses in 12 patients, which were multiseptate and formed by multiple hypo-/hyperechoic microabscesses in 4 of them. Four non-European patients had a single abscess, which is typical of tropical endemic forms. CT showed the amebic abscesses as hypodense roundish masses with clear-cut outline most often localized in the right lobe in the 12 multiple cases. After percutaneous drainage 13/16 patients (81%) reported less pain in the right hypochondrium and had a lower temperature; their hospitalization was also shorter. DISCUSSION AND CONCLUSIONS: Combined US and CT assessment facilitated the diagnosis of amebiasis and its differentiation from pyogenic abscess and hepatoma. The combination of US-guided drainage and drug treatment provides better results than either treatment alone and quicker improvement of patient conditions, with fewer extraintestinal complications. Percutaneous drainage should be used in abscesses bigger than 4-5 cm, those with questionable clinical-laboratory findings and finally those failing to respond to drug treatment alone. Positive parasitology of abscess content is related to repeated cavity washings after percutaneous drainage, likely because peripheral layers are much richer in amebae.

Adult↗
PubMed1995

Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens.

A retrospective study on patients with pyogenic liver abscesses was conducted to clarify the different clinical presentations among patients with Klebsiella pneumoniae abscesses and those with non-K. pneumoniae abscesses. From 1981 to 1993, the medical records of 146 adults with culture-confirmed pyogenic liver abscesses who attended Tri-Service General Hospital in Taipei were studied. Abscesses due to K. pneumoniae accounted for 114 (78%) of pyogenic liver abscesses. When compared to patients with non-K. pneumoniae abscesses, patients with K. pneumoniae liver abscesses had significantly higher proportions of monomicrobial infections, unknown sources of infection and solitary abscesses. Patients with K. pneumoniae liver abscesses were found to have diabetes mellitus more often than patients with non-K. pneumoniae liver abscesses (66% vs 19%). Septicemia was found more frequently in patients with K. pneumoniae liver abscesses than in patients with non-K. pneumoniae liver abscesses (50% vs 27%). The clinical presentations among the two groups were, otherwise, not significantly different. Regardless of the microbial etiology, patients with diabetes mellitus had longer periods of fever after treatment and hospitalization than patients without diabetes. The reason for the high relative frequency of liver abscesses in Taiwan and its more frequent occurrence in diabetes mellitus remains unclear.

Adult↗
PubMed1993

[Ultrasonography in the diagnosis of liver abscesses. Apropos of 32 cases].

A retrospective series of 32 cases of hepatic abscess was collected in the radiology department of Ibn Roch University Hospital (Casablanca), over a period of 43 months (May 1989-September 1992). Among these 32 cases, 16 were amebic (based on the dysenteric syndrome and especially positive amebic serology) and 16 had pyogenic causes. All patients underwent ultrasound examinations. Only two cases had CT scan. The confirmation of the hepatic abscess was made by ultrasound guided percutaneous aspiration in 30 cases and laparotomy in 2 cases. The right lobe was concerned in all cases. The pyogenic abscesses were multiple in 62.5% cases, while the amebic abscesses were double in only one case. The amebic abscesses were larger than the pyogenic ones. The average volume was respectively 10.5 cm and 7 cm. Three ultrasound aspects were found. Hypoechogenic aspect was the most frequent (76% of amebic abscesses and 61% of pyogenic abscesses). The heterogenic aspect was found in 21% of amebic abscesses and in 36% of pyogenic abscesses. The anechogenic aspect was found in only one case of pyogenic abscess. A light and regular wall was found in 70% of amebic abscesses and in 51% of pyogenic abscesses. Referring to the literature, the various ultrasound signs of orientation towards an amebic or pyogenic etiology were found in this series, but we emphasize the very important role of ultrasound-guided percutaneous aspiration and amebic serology for the etiological diagnosis of hepatic abscess.

Adolescent↗
PubMed1985

Expanded criteria for percutaneous abscess drainage.

The original criteria for percutaneous abscess drainage were limited to simple abscesses (well-defined, unilocular) with safe drainage routes. We expanded these entry criteria to include complex abscesses (loculated, ill-defined, or extensively dissecting abscesses), multiple abscesses, abscesses with enteric fistulas or whose drainage routes traversed normal organs, as well as complicated abscesses (appendiceal, splenic, interloop, and pelvic). Using these expanded criteria, cure was achieved nonoperatively in 92 (73.6%) of 125 abscesses with ten deaths (9%), and 11 complications (9%). Cure was achieved in 82% of simple abscesses, but only 45% of complex abscesses. There was no correlation between size, depth, drainage route, or etiology of the abscess (spontaneous v postoperative) with either cure or complications. We recommend a trial of percutaneous drainage in all simple abscesses and most complex abscesses with clinical response as the key determinant of the need for operative intervention.

Abscess↗
PubMed1995

Primary vs secondary iliopsoas abscess. Presentation, microbiology, and treatment.

OBJECTIVE: To review the characteristics of patient presentation, microbiology, and treatment of primary iliopsoas abscess. DESIGN: A case series of patients with iliopsoas abscess diagnosed on computed tomographic scans from 1987 to 1994. SETTING: Tertiary care inner-city university hospital. PATIENTS: Eleven patients with secondary iliopsoas abscess, defined as being secondary to gastrointestinal or genitourinary causes or trauma, and seven patients with primary abscess, defined as the absence of the above causes. MAIN OUTCOME MEASURES: Patient characteristics, presenting symptoms and signs, microbiologic characteristics, treatment, and clinical course of patients with primary iliopsoas abscesses compared with those in patients with secondary abscesses. RESULTS: In the primary group, six patients (86%) were intravenous drug users and four (57%) were positive for human immunodeficiency virus. Staphylococcus aureus grew from cultures from five of seven patients with primary abscesses, whereas secondary abscesses had enteric flora. The typical patient presentation included fever, with complaints of pain in the flank, hip, or abdomen. Comparison of abscess drainage options showed shorter hospitalizations for surgical drainage than for percutaneous drainage (15.9 vs 28.5 days; P < or = .01). CONCLUSIONS: A patient who presents with pain in the flank, hip, or abdomen may have a primary iliopsoas abscess. Computed tomography is the standard method of diagnosis. Antibiotic regimens for patients with primary iliopsoas abscess should include coverage for S aureus, and patients with secondary abscesses should have antibiotic regimens tailored for enteric bacteria. Drainage of abscess is essential for appropriate treatment, and surgical drainage is superior to percutaneous drainage in achieving prompt recovery.

AIDS-Related Opportunistic Infections↗
PubMed1997

Perianal abscess in Crohn's disease.

PURPOSE: Perianal disease is frequent in patients with Crohn's disease, and many of these patients will eventually have abscess formation. In a prospective follow-up study, we evaluated factors influencing the occurrence and recurrence of perianal abscesses. METHODS: Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic, 61 (48.4 percent) had at least one perianal abscess (mean follow-up, 32 +/- 17 months). In all, 110 episodes of an abscess with 145 anatomically distinct abscesses were documented. RESULTS: The occurrence of first abscesses was dependent on the type of anal fistula (ischiorectal, 73 percent; transsphincteric, 50 percent; superficial, 25 percent; P < 0.02). Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent) and led to inactivation in all patients. Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively. Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0 vs. 55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas). Only two abscesses recurred within one year after removal of seton drainage, whereas 13 abscesses recurred with the seton still in place. Neither intestinal nor rectal activity of Crohn's disease significantly influenced the occurrence of an abscess. During the study period, only two patients developed partial stool incontinence. CONCLUSION: Development of perianal abscesses in Crohn's disease depends on the fecal stream and the anatomic type of anal fistula. Seton and catheter drainage are safe and highly effective in treatment. Long-term use of setons to prevent recurrent abscesses is not supported by our data.

Abscess↗
PubMed1984

Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage.

The presenting features, modes of treatment and clinical course were reviewed for 55 patients with pyogenic liver abscess, seen at Duke University Medical Center over a 15-year period. Thirty-three patients had a solitary abscess and 22 had multiple abscesses. Most patients were between the ages of 40 and 60 years. Males predominated, 2.4:1. Major underlying conditions included biliary tract disease, malignancy and colonic disease. Eight patients, each with a solitary abscess, had no identifiable underlying condition. Symptoms and signs were nonspecific: fever, chills, focal abdominal tenderness and hepatomegaly were common. A raised serum alkaline phosphatase level was the most consistent abnormal laboratory finding. CT with contrast enhancement, radioisotope scanning and ultrasonography all accurately defined solitary hepatic abscesses. However, CT scan was more successful than other imaging techniques in detecting multiple abscesses. In seven patients the diagnosis was made only at laparotomy. Overall, a diagnosis of liver abscess was made in 50 living patients (91%). Microorganisms were recovered from pus and/or blood cultures of 44 patients (80%). Most common were enteric gram-negative facultative rods, anaerobic gram-negative rods, and microaerophilic streptococci. Single abscesses were more likely than multiple abscesses to contain more than one organism. All patients received antibiotics; the choice of antibiotic does not appear to be critical provided the regimen has a broad spectrum including activity against anaerobes. Surgical or percutaneous drainage was successful when attempted in all patients with a single abscess, but the outcome was less favorable in those with multiple abscesses. Percutaneous drainage is currently replacing open operative drainage as the method of choice. Overall mortality in patients with single abscesses was 15% (5/33) and in those with multiple abscesses 41% (9/22).

Adolescent↗
PubMed1995

Ultrasonographic findings in 11 cows with a hepatic abscess.

The livers of 11 cows with a hepatic abscess were examined ultrasonographically. An abscess was observed in only one intercostal space in three cows, in two spaces in five, in three spaces in two, and in four adjacent intercostal spaces in one cow. In three cows the abscess was imaged in the caudodorsal aspect of the liver in the 11th and 12th intercostal space, in five cows the abscess was visible in the central part of the liver in the ninth and 10th intercostal space and in the three other cows the abscess was observed in the cranioventral region of the liver in the sixth, seventh and eighth intercostal spaces. The abscess had a distinct and well developed capsule in nine cows. The content of the abscess was echogenic in six cows, anechoic in two, and echogenic with hyperechoic foci in three. In four cows, the content of the abscess was partitioned by echogenic septa. In one cow, the echogenic content of the abscess was surrounded by a narrow anechoic rim of fluid. The diameter of the abscess was 5 to 10 cm in four cows, 11 to 15 cm in four, and more than 15 cm in three. In every case the diagnosis was confirmed by centesis and aspiration of the abscess which yielded pus. Ten of the cows were slaughtered after being examined and the ultrasonographic findings were confirmed. In addition, 10 of the cows had other lesions which included traumatic reticuloperitonitis, abscessation of the reticulum, thrombosis of the caudal vena cava, bronchopneumonia with abscessation, reticulo-omasal stenosis, ascites and suppurative omental bursitis.

Animals↗
PubMed2000

Treatment of bacterial brain abscess by repeated aspiration--follow up by serial computed tomography.

Bacterial brain abscess often requires repeated aspiration before the abscess finally resolves. However, there are no guidelines for treatment by aspiration; for example, when should the abscess be tapped again, or when can an abscess be treated by antibiotics alone without further aspiration. Eleven patients with bacterial brain abscess treated by aspiration were evaluated to establish treatment guidelines for brain abscess, in particular the abscess size on serial computed tomography (CT) after aspiration. CT was performed about 24 hours after aspiration to evaluate the size of the abscess, and almost weekly during follow up. The diameter of the brain abscess before and after the initial and last aspirations were reviewed. In eight of the 11 patients, abscesses were aspirated repeatedly: two to three times in most patients. The diameter of the abscesses was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean 2.3 cm) after the last aspiration, or when continuous drainage was discontinued. Perifocal edema was moderately decreased within 3 weeks after the last aspiration by medical treatment alone, with a concomitant decrease in the volume of the abscess. There were no deaths, and most patients had a favorable outcome. These results suggest that after the diameter of the abscess becomes less than 2 to 3 cm and does not increase anymore on serial CT, medical treatment alone can be anticipated to give satisfactory results without further aspiration.

Adolescent↗
PubMed1984

Hepatic and systemic metabolic responses to aerobic and anaerobic intra-abdominal abscesses in a highly reproducible chronic rat model.

A single, uniform abscess was formed in 100% of the animals inoculated with a fecal pellet made of sterile rat feces, agar, and a known number and strain of bacteria. The effects of monoclonal Escherichia coli abscess (83 rats) were compared to those of sterile abscess (34 rats) and sham operation (35 rats without abscess). Bacteroides fragilis was added to the sterile pellet to study the effect of an anaerobic monoclonal abscess (16 rats) or of a biclonal abscess containing both aerobes and anaerobes (32 rats). After inoculation, a peritonitis stage with leucopenia, hypoglycemia, body weight loss, and slight fever was followed by the abscess stage with leucocytosis and a slight hyperglycemia. Mild hepatic energy charge deficiency and hepatic lactic acidosis were observed in sterile abscess rats, and slightly enhanced energy charge was seen in monoclonal E. coli abscess rats. The addition of B. fragilis to the sterile pellet, alone or together with E. coli, produced hepatic energy charge deficiency and hepatic lactic acidosis, which were significantly enhanced compared with the monoclonal E. coli abscess rats. The greatest effect was seen in the biclonal E. coli plus B. fragilis abscess, suggesting that anaerobic or combined aerobe and anaerobe abscesses may produce a greater hepatic injury than an aerobic organism abscess alone. This may account for the apparent synergic interaction between aerobic and anaerobic organisms.

Abdomen↗
PubMed1995

Intraperitoneal abscesses: diagnostic dilemmas and therapeutic options.

BACKGROUND: The diagnosis of intraperitoneal abscesses is difficult, resulting in delay in treatment and poor prognosis. Although recent advances in the management have led to significant improvement in prognosis, the choice of therapeutic modality is unclear. AIMS: The role of clinical features and investigations in the diagnosis of intraperitoneal abscesses was studied. The relation of prognosis to delay in diagnosis was also analyzed. Also assessed was the efficacy of various therapeutic modalities. METHODS: Thirty consecutive patients diagnosed to have intraperitoneal abscesses were analyzed. Abscesses were analyzed. Abscesses were divided on the basis of ultrasonography findings into simple and complex (with or without fecal fistula). The following points were evaluated: clinical features, and hematological, biochemical and microbiological reports, imaging findings and the role of therapeutic modalities like percutaneous aspiration (single or multiple), catheter drainage and operative drainage (transperitoneal, extraperitoneal and percutaneous). RESULTS: Clinical features and hematological investigations, though sensitive, were non-specific in diagnosis. Klebsiella was the commonest organism cultured, followed by Proteus, E coli and Pseudomonas. Blood culture was positive in only 6 percent of cases. Real-time ultrasonography had an accuracy of 84%. Contrast X-rays were required in 43% of cases. All the deaths (4 of 30) occurred when the diagnosis and treatment were delayed by more than 4 days. USG-guided aspiration (single and multiple) and USG-guided catheter drainage were effective in simple abscesses but failed in complex abscesses. Transperitoneal operative drainage was successful in 15 of 18 cases (6 of 8 simple abscesses and 9 of 10 complex abscesses). The mortality in patients with simple and complex abscesses was 2 of 17 and 2 of 13 respectively. CONCLUSIONS: Early detection with consequent early treatment is vital for good prognosis of intraperitoneal abscesses. Early diagnosis requires a high degree of clinical suspicion and appropriate use of imaging modalities. USG-guided percutaneous drainage is effective for simple abscesses whereas complex abscesses require operative drainage, sometimes in combination with initial USG-guided drainage.

Abscess↗
PubMed1996

Nonoperative management for intra-abdominal abscesses.

Percutaneous drainage of an intra-abdominal abscess is utilized frequently. To evaluate its effectiveness at our institution over 16 months, 18 patients (mean age 49 years) who underwent radiologically directed percutaneous drainage of intra-abdominal abscesses were retrospectively reviewed. The abscesses were postoperative in 14 patients (laparotomy, 5; appendectomy, 4; colectomy, 3; hysterectomy, 2). Primary abscesses were due to diverticular disease (3), perforated appendicitis (3), perforated colon carcinoma (1), and perforated peptic ulcer (1). Percutaneous drainage was ultimately established in all patients with complete resolution of the abscesses occurring in 12 patients (67%). The average duration for drainage was 5.5 days (range 1-23). Average length of hospital stay after the establishment of drainage was 14.6 days (range 1-48). Six patients required surgical procedures because of inadequate abscess drainage (4) or continued clinical deterioration (2). There were no deaths. A major complication (colon perforation, enteric fistula) occurred in two patients (11%). Catheter-related problems were common (7/18 patients), and included drain migration (3), inadequate drainage, and catheter obstruction(2). Four patients required multiple percutaneous drainage procedures. Despite technical feasibility and clinical success in the majority of patients, percutaneous drainage of these intra-abdominal abscesses had frequent catheter-related complications. One-third of patients (31.8%) required surgical intervention despite a prolonged period (average 15 days) of percutaneous drainage. Patients demonstrated to have nonresolving abscesses by computer tomography (CT), abscesses associated with colonic diverticular disease of colon cancer, and abscesses localized to the left lower quadrant were noted to have less successful percutaneous abscess drainage. Patients with a persistent of rising leukocyte count and/or an elevated APACHE II score prior to drainage should be routinely reevaluated at 4 days. Earlier surgical intervention is felt to be warranted because these two factors in this study were indicative of a low nonoperative success rate. Post-appendectomy abscesses uniformly demonstrated prompt response to percutaneous drainage. CT-directed percutaneous drainage of intra-abdominal abscesses provides an alternative to immediate surgical intervention. The preliminary findings from this study suggest a limited application of this intervention in one-third of patients. Further detailed analysis of this patient group is required to delineate guidelines for identifying those patients where percutaneous drainage is unlikely to be successful.

APACHE↗
PubMedDate not supplied

Specific enhancement of intra-abdominal abscesses with perfluoroctylbromide for CT imaging.

Perfluoroctylbromide (PFOB), a radiopaque reticuloendothelial system contrast media for computed tomography, has been shown to accumulate in macrophages. In the current study PFOB was tested in rabbits as an abscess imaging agent. Two abscesses were induced in each of 24 rabbits, one in the liver and the other in the peritoneal cavity. CT of the rabbit abdomen was performed four days later, two days after the administration of 5 gm/Kg of PFOB to 12 of these rabbits. The average enhancement of the wall of liver abscesses was by 140 Hounsfield units (HU) relative to the enhanced liver and peritoneal abscesses by 135 HU relative to the control group. This enhancement was secondary to the intense accumulation of PFOB filled macrophages in the abscess wall. In those rabbits where the liver abscess ruptured, the edges of the peritoneal collections enhanced by 147 HU. Regions of inflammation prior to liquifaction enhanced considerably. These areas could not be detected in the animals not receiving PFOB. Though the liquified center of liver abscesses could be seen in the absence of PFOB, none of the peritoneal abscesses could be detected in the animals not receiving PFOB. In contradistinction, all peritoneal abscesses enhanced considerably following PFOB allowing their prospective localization. In conclusion, PFOB accumulates in abscess walls and areas of inflammation producing marked CT enhancement of liver and peritoneal abscess collections. This enhancement allowed the differentiation of peritoneal abscess collections from adjacent bowel.

Abscess↗
PubMed1987

Sonographic features of amebic and pyogenic liver abscesses: a blinded comparison.

We blindly compared the sonographic findings in amebic (112 lesions) and pyogenic (30 lesions) liver abscesses. Two sonographic features were significantly more prevalent in amebic abscesses: the lesions had a round or oval shape and the lesions had an echogenicity that was lower than that of normal liver and were internally homogeneous on high-gain scans. Amebic abscesses were round or oval in 92 instances (82%), while 18 pyogenic abscesses (60%) (p less than .01) had these shapes. Fifty-nine (58%) of 101 amebic abscesses displayed low echogenicity and homogeneous internal echoes with high-gain settings compared with nine (36%) of 25 pyogenic abscesses (p less than .04). Despite these different sonographic patterns, image findings alone were inadequate in distinguishing pyogenic from amebic liver abscesses. However, when the sonographic findings were coupled with clinical and laboratory data, a correct diagnosis was possible in 83 (86%) of 96 patients with amebic abscess. It appears that, although some sonographic features of amebic abscess differ from those of pyogenic abscess, these differences are not sufficient to allow a specific diagnosis on the basis of sonography alone. Sonography can expedite abscess detection and, when coupled with clinical and laboratory data, can aid in differentiating pyogenic from amebic liver abscesses.

Humans↗
PubMed1986

Differentiation of pyogenic from amebic hepatic abscesses.

Recent immigration trends have resulted in an increased prevalence of amebic hepatic abscesses in southern states and in many northern American cities. Because amebic hepatic abscesses generally do not require drainage, differentiation from pyogenic hepatic abscesses is important. We, therefore, reviewed the records of patients admitted to the UCLA Medical Center from 1968 through 1983 to compare the clinical manifestations and to access the results of treatment of pyogenic and amebic hepatic abscesses. During this 15 year period, 82 patients (42 pyogenic and 40 amebic) with hepatic abscesses were admitted. Factors which distinguished patients with pyogenic abscesses included: age greater than 50 years; jaundice; pruritus; sepsis and shock; a palpable mass; elevated bilirubin level; elevated alkaline phosphatase level, and abnormal abdominal roentgenograms. Patients with amebic abscesses of the liver were more likely to have Mexican ancestry, recently traveled to an endemic area, abdominal pain, diarrhea, abdominal tenderness, hepatomegaly and positive amebic serology. Hepatic scans and ultrasonography were excellent methods of detecting the presence of but not the type of hepatic abscess. Over-all, the mortality was 40 per cent for patients with pyogenic abscesses whereas all 40 of the patients with an amebic abscess survived. However, operative mortality was only 4.5 per cent for the 22 patients with pyogenic abscess who were managed with systemic antibiotics and surgical drainage. We conclude that many clinical and laboratory parameters can aid in the differentiation and, as a result, management of patients with pyogenic and amebic hepatic abscesses.

Adolescent↗
PubMed1993

Hepatic abscess in cancer patients. Characterization and management.

OBJECTIVE: To identify factors that may aid in the diagnosis and treatment of patients with malignant neoplasms in whom hepatic abscesses develop. DESIGN: Retrospective review of medical records. PATIENTS: Thirty-seven oncology patients in whom hepatic abscesses developed at the National Cancer Institute, Bethesda, Md, between June 1954 and October 1989. RESULTS: Among 37 cancer patients, bacterial abscesses developed in 17 and fungal abscesses developed in 20. Among the patients with bacterial abscesses, 12 (71%) had a solid-tissue malignant neoplasm, 10 (59%) had a prior invasive procedure, and six (35%) had prior chemotherapy. In comparison, among the patients with fungal abscesses, 15 (75%) had a hematologic malignant neoplasm and five (25%) had a solid-tissue malignant neoplasm (P2 = .014). Two patients with fungal abscesses (10%) had a prior invasive procedure (P2 = .004) and 19 (95%) had prior chemotherapy (P2 < .0001). As compared with fungal abscesses, bacterial abscesses were larger (P2 < .00001) and fewer (P2 = .004). Antibiotics and percutaneous or surgical drainage effectively treated bacterial abscesses. Amphotericin B usually eradicated hepatic fungal infections. CONCLUSIONS: The results of this study reveal the importance of the clinical setting in the diagnosis of hepatic abscesses in cancer patients. Aggressive treatment of these abscesses is indicated and is frequently effective.

Adult↗
PubMed1992

Breast abscesses and cigarette smoking.

An 11-year retrospective review of women with breast abscesses presenting to a district general hospital was performed. A total of 122 women were identified with a breast abscess: 85 (70 per cent) with non-lactational abscesses and 37 (30 per cent) with an abscess in the puerperium. Six of 37 lactational and 24 of 85 non-lactational abscesses recurred. Sixteen mammillary fistulae developed, all following incision and drainage of non-lactational breast abscesses. Women with non-lactational breast abscesses were more likely to smoke cigarettes (P less than 0.005). Breast abscesses containing anaerobic bacteria were significantly more likely to occur in current cigarette smokers (P less than 0.05). Women with non-lactational breast abscesses who were heavy cigarette smokers were more likely to suffer recurrent abscesses (P less than 0.01). There was histological evidence of duct ectasia on biopsy in 25 women with non-lactational abscesses and 21 of 25 were current smokers. Mammillary fistulae developed more frequently in current smokers (P less than 0.03). Cigarette smoking is important in the natural history of non-lactational breast abscesses and may predispose to anaerobic breast infections and the development of mammillary fistulae.

Abscess↗
PubMed1983

Percutaneous abdominal abscess drainage. Portland area experience.

After reviewing 21 patients who have had percutaneous abdominal abscess drainage, we believe that the procedure should be considered for those abscesses that are unilocular without septations, with safe access being a key variable dictating the use of percutaneous abdominal abscess drainage rather than surgery. A computerized tomographic scan of the abdomen should be employed at some stage of the percutaneous abdominal abscess drainage procedure to facilitate safe access to the abscess and to distinguish a synchronous abscess where present. In addition, we believe that percutaneous abdominal abscess drainage should be considered for postsurgical abscesses only and not those that are spontaneous in nature or where the original abnormality cannot be accurately surmised. With regard to catheter management, frequent irrigation of the catheter must be carried out at least every 4 to 6 hours, with high levels of antibiotics present in the blood before irrigation. This must be done to obviate the most frequent and potentially lethal complication of the procedure, namely sepsis. Percutaneous abdominal abscess drainage, although safe for the most part, is capable of inducing considerable morbidity. Our data suggest that percutaneous abdominal abscess drainage is not as efficacious as previous reports have suggested. Traditional surgical drainage techniques are best utilized for those abscesses that are multiple, highly viscous, inaccessible, spontaneous, or unresponsive to percutaneous abdominal abscess drainage.

Abdomen↗