超声引导经皮针吸治疗肝脓肿

报告超声引导经皮针吸治疗化脓性肝脓肿的经验，评估其安全性、有效性及其在肝脓肿治疗中的作用。回顾性分析21例患者，男女比例为2：1，平均年龄56．4岁，其中11例患Ⅱ型糖尿病。单一脓腔15例，多发脓腔6例，总共治疗脓肿30个，均由超声引导16GA套管针抽吸完成。21例患者经1—3次抽吸均成功治愈，治愈率100％，无并发症发生。抽吸后1—3天临床症状消失。研究证实，超声引导套管针抽吸配以全身抗感染治疗化脓性肝脓肿是安全、快捷、非常有效的，特别是对高龄且有严重并发症者，更是首选最佳疗法。     

Pyogenic Liver Abscess Presenting after Malignant Polypectomy

Streptococcus bovis bacteremia has been linked to the presence of occult colon cancer since 1977. We present a case of pyogenic liver abscess and bacteremia with a different Streptococcus viridans 1 week after colonic adenocarcinoma was removed via polypectomy, discuss the likely etiology and review whether there is evidence to support looking for colon cancer in patients who present similarly but have not already undergone screening.     

Liver abscess in patients with cirrhosis of the liver: a 12-year experience

Purpose. Liver abscess is rare in patients with cirrhosis of the liver. The aim of this retrospective study was to investigate the incidence, clinical presentation, causal pathogens, and outcome of liver abscess in cirrhotic patients. Methods. We collected 21 liver abscess specimens (from 14 male patients and 7 female patients; Child A: B: C, 4: 7: 10) from 22 731 admissions of 6450 cirrhotic patients, from 1986 through 1998. Results. The common clinical symptoms and signs included fever, chills, and abdominal tenderness. The major predisposing factors were biliary tract disease (52%) and diabetes mellitus (48%). The diagnosis rate with abdominal ultrasonography was 79%. Gram-negative aerobes were the predominant pathogens (Klebsiella pneumoniae, 66.7%; Escherichia coli, 23.8%), and occurred in 80% and 69% of blood and pus cultures, respectively, while 38% of cases showed polymicrobial pathogens. The location of the abscess was predominantly in the right lobe (71.4%), and 47.6% of patients had multiple abscesses. Six patients died (all with Child C cirrhosis). The overall mortality rate was 28.6% (6/21). Conclusions. The incidence of liver abscess in the cirrhotic patients was low, at 0.09% (21/22 731 admissions). The clinical presentations and pathogens were not different from those in noncirrhotic patients, except that in our cirrhotic patients, there was no significant difference in mortality between those with monomicrobial and those with polymicrobial abscess; nor was there a significant difference in mortality between those with single and those with multiple abscesses. The Child C patients were the high-risk group. Received: November 6, 2000 / Accepted: February 2, 2001     

A Gas-forming Liver Abscess with Massive Bleeding into the Abscess Cavity Due to a Ruptured Inferior Phrenic Artery

An 88-year-old woman developed a huge abscess, forming an air-fluid level in the right lobe of the liver. A pigtail catheter was placed and drained thick pus with putrid odor from the abscess cavity. Gram-positive rods were detected in the pus, which were subsequently determined to be Clostridium perfringens by culture. She developed hemorrhaging in the abscess cavity when the right inferior phrenic artery was damaged by inflammation that had spread from the abscess. Emergency transarterial embolization with gelatin sponges was performed, and the bleeding ceased. We herein report a rare case of liver abscess that caused inferior phrenic artery injury, resulting in bleeding.     

Huge Amoebic Liver Abscess in the Left Lobe Treated by Oral Administration of Metronidazole

A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.     

Clinical Characteristics and Complications of Pediatric Liver Biopsy: A Single Centre Experience

IntroductionPercutaneous liver biopsy (LB) is the gold standard method for evaluation and management of patients with liver disease. The purpose of this study was to characterize pediatric patients undergoing LB at British Columbia Children's Hospital, and to determine the rate and timing of complications following the procedure.Material and methodsThe medical records of all pediat-ric patients who underwent LB during a six-year retrospective study were reviewed to collect demographic and procedure-related data.Results223 LBs were performed, and 179 of these biopsies were percutaneous or transjugular. Elevated liver enzymes and cholestasis together accounted for almost 70% of the indications for LB, and the histological analysis of liver tissue yielded a specific diagnosis in 89 % of the cases. There were no deaths and no major complications related to LB. The most frequent minor complication was pain (59% of LBs) and the other complications were bleeding-related and classified as minor. The vast majority of complications (88%) were recognized within 8 h of the LB.ConclusionsLB is a valuable and safe procedure in pediatric patients with a low rate of complications. Pediatric patients can be discharged home safely should no complications occur within the first 8-12 h after the procedure.     

Amebic Liver Abscess: A 15-Year Experience

Amebic liver abscess is increasingly common in the United States, particularly in the West and Southwest, due to increased immigration from Southeast Asia, Mexico, and Central America. The presentation, course, and treatment of 50 patients treated for amebic liver abscess at a county-community hospital in San Jose, California, between 1974 and 1988 is reviewed. The typical patient is an immigrant, usually a Hispanic male, 20-40 yr old, who presents with fever, right upper quadrant pain, leukocytosis, abnormal serum transaminases and alkaline phosphatase, and a defect on hepatic imaging study. Available serologic testing (i.e., indirect hemagglutinin antibody) is sensitive and confirms the diagnosis. Most patients respond rapidly and completely to oral metronidazole. The data, compared with other studies, indicate no major change in presentation or management, except for decreasing need to aspirate the abscess for diagnosis.     

糖尿病合并肺炎克雷伯杆菌性肝脓肿的临床特点及误诊分析

目的提高对糖尿病合并肺炎克雷伯杆菌肝脓肿的诊治水平。方法回顾性分析16例糖尿病合并肺炎克雷伯杆菌性肝脓肿的临床资料。结果糖尿病合并肺炎克雷伯杆菌性肝脓肿占同期收治糖尿病性细菌性肝脓肿的57.1%。临床主症有畏寒、发热、乏力,腹痛、肝区叩击痛。脓肿多为单发、局限于右肝。首诊确诊率仅37.5%,首次B超误诊率37.5%。本组在有效抗生素及B超引导下经皮肝脓肿穿刺抽脓/置管引流后均好转,无一例死亡。结论糖尿病并发肺炎克雷伯杆菌肝脓肿的临床表现不典型,易漏诊误诊。及时超声引导下行肝脓种穿刺引流,缩短疗程,预后佳。     

CASE REPORT: Spontaneous Gas-Forming Liver Abscess Caused by Salmonella Within Hepatocellular Carcinoma: A Case Report and Review of the Literature

In conclusion, pyogenic liver abscess in hepatocellular carcinoma is unusual. Most of the reported cases occurred after a treatment such as transcatheter arterial embolization or percutaneous ultrasound-guided ethanol injection. Salomonella very rarely causes pyogenic liver abscesses. Only 14 cases have been reported in the English literature since 1911. Salmonella liver abscess occurring within a primary neoplasm is even rarer. There were only two such cases described in patients with hepatocellular carcinoma before. The present case is the third one, but it may be the first case of obvious spontaneous gas-forming liver abscess caused by Salmonella within hepatocellular carcinoma.     

Surgery for Aortic Root Abscess: A 15-Year Experience

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death.Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years.There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up.After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.     

阿米巴肝脓肿患者血清sIL－2R水平与红细胞免疫功能相关性的研究

本文检测了３２例阿米巴肝脓肿患者的血清可溶性白细胞介素２受体（ｓＩＬ─２Ｒ）水平及红细胞免疫功能,并分析ｓＩＬ─２Ｒ与红细胞免疫功能之间的相关性。结果显示,阿米巴肝脓肿患者的ｓＩＬ─２Ｒ水平显著地高于正常对照组,而红细胞免疫功能则显著地低于正常对照组。经流式细胞仪测定,患者ＣＤ４细胞减少、ＣＤ８细胞增高,ＣＤ４／ＣＤ８比值下降。相关分析表明,血清ｓＩＬ─２Ｒ水平与红细胞Ｃ３ｂ受体花环率（ＲＢＣ─Ｃ３ｂＲＲ）呈显性负相关。阿米巴肝脓肿患者血清ｓＩＬ─２Ｒ水平的升高可能是导致患者红细胞免疫功能低下原因之一。     

Diagnosis and Management of Atypical Hemolytic Uremic Syndrome In Children: Single Centre Experience

Atypical hemolytic uremic syndrome (aHUS) although rare is the commonest cause of acute renal failure (ARF) in children and has poor prognosis. We present single centre experience of aHUS. Thirty six children (29 males, 7 females) with mean age, 7.9 years presented with ARF, 2 children also had tonic–clonic type convulsions. Their hematology examination revealed hemolytic anemia with s. creatinine (SCr), 5.54 mg/dl. Acute HUS was observed in 75 %, acute on chronic HUS in 19.4 % and patchy cortical necrosis (PCN) in 5.6 % biopsies. Mean 5.4 plasma exchanges (PE) were carried out. Supportive management of anti-hypertensives and prednisone was also given. Recovery end points were establishment of urine output, improvement of SCr and hematological profile. Hematology and renal function profile improved variably in all children, 5.6 % died, relapse was observed in 80.5 % over mean 70 days; 13.9 % children are doing well over mean follow-up of 268.8 days. Thus poor prognosis was observed in 86.1 % children. Children with acute on chronic HUS and PCN did not recover. Six children who recovered had acute HUS. aHUS in Indian children occurs at an older age of around 8 years and chronic/irreversible changes on histopathology examination are harbingers of poor prognosis. PE is life-saving however further research for developing strategies to improve long-term survival is needed.