Transrectal seminal vesiculography.

Lesions of the seminal vesicle can be evaluated by the transrectal needle approach. Biopsy, aspiration of contents for culture and cytology, injection of contrast medium for x-ray and drainage of cysts or abscesses can be done with this approach.     

Improved survival in 45 patients with pancreatic abscess.

The reported mortality due to pancreatic abscesses after acute pancreatitis has been 30 to 50%, a statistic that has remained unchanged for decades. This is a report of 45 patients treated over 10 years, showing a dramatic improvement in survival during that period. They represent 2.5% of admissions at the Massachusetts General Hospital for acute pancreatitis. The identifiable antecedents included alcohol (38%), gallstones (11%), and surgical trauma (16%), or were unknown in 24%. Computerized tomography (CT) was clearly the best means of specific diagnosis (unequivocal evidence in 74%, suggestive in 21%). Treatment in 44 patients was surgical debridement and catheter drainage, and in one it was resection of the pancreatic head. Multiple abscesses were present at the first operation in 21 patients. Seven had second drainage procedures for additional abscesses. In the first 5 years (1974-1978), 10 of 26 patients died (38%). In the second 5 years (1979-1983), one of 19 died (5%) (p less than 0.01). Postoperative complications (84%) included wound hemorrhage (9 of 26 vs. 1 of 19), systemic sepsis (7 of 26 vs. 1 of 19), pancreatic fistula (14/45, 13 of which closed spontaneously), colonic perforation (4), duodenal perforation (2), and gastric perforation (1). The causes of death were renal and respiratory failure with sepsis (7), hemorrhage (3), and pulmonary emboli (1). Analysis of the findings shows in the second 5-year period more frequent use of CT to certify the diagnosis of pancreatic abscess earlier, a more aggressive attitude producing earlier surgical intervention, and more extensive drainage and debridement of associated necrotic tissue. Transcatheter arterial embolization was used successfully to control postoperative hemorrhage from the abscess cavity. CT-guided percutaneous catheter drainage was used occasionally for drainage of recurrent abscesses. Neither open packing of major pancreatic abscesses nor lavage of the abscess cavity, as recently advocated, was necessary.     

改进后的肾囊肿CT引导下硬化剂治疗术

目的观察改进肾囊肿CT引导下硬化剂治疗术的疗效。方法386例肾囊肿经皮穿刺抽吸乙醇治疗,其中,单纯性肾囊肿243例,多发囊肿113例,双肾均有囊肿30例。囊肿直径1.5~7 cm。用9-14 G穿刺针穿刺抽吸,抽出囊液5~700 ml,注入99.7%无水乙醇保留而不抽出,乙醇量以抽出量的25%~50%计算。结果随访193例(251个囊肿),时间3个月~12个月,囊肿治疗有效率达98%以上,囊腔消失率达87%,并发症仅为局部腰部胀痛,无严重后遗症。结论改进后的CT引导下肾囊肿硬化剂治疗术是一种安全、并发症少,操作简单的有效治疗方法。     

Use of computerized tomography and echography in the diagnosis and treatment of abscesses of the abdominal cavity and retroperitoneal space

An analysis of complex use of computer tomography and echography for diagnostics, aimed biopsy and following measures in 32 patients with foci of purulent infection in organs of the abdominal cavity and retroperitoneal space has been made. In 11 patients with small abscesses not more than 5 cm in diameter percutaneous aimed punctures of the pus cavity were fulfilled followed by the aspiration of the content and introduction of an antibiotic. In 21 patients percutaneous drains were introduced into the abscesses by Seldinger's method or through a trocar. Curative punctures and percutaneous drainage in 85.7% of the patients gave successful results.     

The diagnosis and treatment of cystic diseases of the kidneys by using transcutaneous puncture methods under ultrasonic monitoring

Presented in the paper are the methods of ultrasonic diagnosis and percutaneous paracentetic treatment of cystic kidneys under ultrasonic monitoring. Paracenteses were performed in 172 patients: 59 with polycystic and 113 with cystic kidneys. If the cysts located in the middle or lower segments of posterior, lateral or inferior drainage that was pushed through the guide into the cyst lumen. A thin-needle aspiration was used and the drainage avoided if the cyst located in the anterior part of middle or upper renal segments. Cystography and cystomanometry associated with the determination of the cyst tension index followed elimination of the aspirates for cyto- and bacteriological investigations. Paracentesis was accomplished under the ultrasonic monitoring of the position of a needle tip. The cavity of the cyst was sclerosed with 96% spirit in 84 patients; strong radiopaque agents were used in 8 and medicinal cyanacrylate glue in 13 patients. The drainage of the cysts with a long-term exposure to sclerosing agents (from 2 to 24 hrs) was employed in 32 patients. Postaspiration relapses were documented in all the patients with intrasinus cysts and cysts, whose major portion was surrounded by parenchyma. In the patients with other patterns of cyst location, the postaspiration relapses were noted in 94.4 per cent. A four-year follow-up of 13 patients who sustained the glue application registered 2 relapses which were successfully cured by a repeat application of the glue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Needle aspiration of breast abscesses

BACKGROUND: Traditional treatment of breast abscesses involves incision and drainage, with and without ultrasound guidance. These procedures cause considerable discomfort and morbidity for the patient. This study was conducted to determine whether needle aspiration of breast abscesses without ultrasound guidance was an effective treatment modality. METHOD: In our prospective study, 30 patients with 33 breast abscesses were treated by needle aspiration of pus, oral antibiotics, and repeat aspiration, if necessary. All were outpatients, and ultrasonography was not used. Twenty-five of the 30 patients were lactating. RESULTS: Eighteen patients required only a single aspiration, 9 patients required multiple aspirations, and 6 patients required incision and drainage (overall cure rate, 82%). Those patients in whom needle aspiration was successful had a significantly smaller volume of pus on initial aspiration (4.0 mL versus 21.5 mL, P = 0.002) and were more likely to have presented earlier than those not cured by aspiration (5.0 days versus 8.5 days, P = 0.006). CONCLUSION: Needle aspiration without ultrasound guidance is an effective treatment for breast abscesses.     

Balloon Catheter for Cyst Aspiration in a Thoracoscopic Resection of Mediastinal Cysts

In a thoracoscopic resection of mediastinal cysts, aspiration of the cyst contents at the beginning of the procedure is often helpful because it allows the cyst to be more easily grasped and manipulated. Spillage of the cyst contents into the thoracic cavity may, however, occur during aspiration when an ordinary aspiration needle is used. If the cyst contents are infective, then a subsequent contamination of the thoracic cavity may develop. We therefore use a specially designed double-balloon catheter for aspiration to minimize spillage of the cyst contents into the thoracic cavity. We describe herein the usefulness of this aspiration technique. Received: March 24, 2000 / Accepted: September 26, 2000     

Liver abscess: a clinicopathological analysis of 82 cases

Liver abscesses are a common pathology in India, but a strategy for effective treatment has not been established. Eighty-two patients with liver abscess were studied over a 4-year period. Clinical features, ultrasound findings, laboratory studies, and outcome of therapy were evaluated. Treatment options were antibiotics alone, needle aspiration, catheter drainage, or open surgical drainage; 51.2% of all abscesses were amebic, 23.2% were pyogenic, and 25.6% had unknown causes. A total of 75.6% of the abscesses were solitary, with 62.2% confined to the right lobe. Pyogenic abscesses were more likely to have anemia, leukocytosis, and deranged liver function. Amebic abscesses tended to have a larger volume. Patients undergoing catheter drainage showed a more rapid reduction in initial abscess volume, whereas resolution of the abscess cavity took longer with antibiotic therapy alone. Ultrasound-guided needle aspiration and catheter drainage are safe and effective in the management of liver abscess. Drug therapy alone may be useful only in select cases.     

CT-guided stereotactic aspiration of brain abscesses

The effective treatment of intracranial abscess remains controversial. Progress in technology, linked with the development of neuronavigational systems, has made stereotactic aspiration and drainage of intracerebral abscesses effective and valid alternatives to traditional methods, namely, conservative medical treatment or open surgical excision. Between 1995 and 2002, 12 patients at our hospital underwent drainage of intracerebral abscesses under stereotactic guidance. Ten patients had solitary lesions and two had multiple abscesses. The appropriate antibiotic schemes were administered following culture of the aspirated material. The size of the abscess, the mass effect, and response to antibiotic treatment were followed up by repeated CT scans. All patients showed improvement and, at the end of treatment, returned to their previous activities. There were neither deaths nor any postoperative complication. A second aspiration was required in one patient due to recurrence of the abscess. The CT-guided stereotactic aspiration of brain abscesses helps achieve all treatment goals. It drains the contents of the abscess, reduces mass effect, and confirms diagnosis. It is minimally invasive, carries minimal morbidity and mortality, and can be performed on compromised patients under local anesthesia.     

CT-guided stereotactic aspiration of brain abscesses

The effective treatment of intracranial abscess remains controversial. Progress in technology, linked with the development of neuronavigational systems, has made stereotactic aspiration and drainage of intracerebral abscesses effective and valid alternatives to traditional methods, namely, conservative medical treatment or open surgical excision. Between 1995 and 2002, 12 patients at our hospital underwent drainage of intracerebral abscesses under stereotactic guidance. Ten patients had solitary lesions and two had multiple abscesses. The appropriate antibiotic schemes were administered following culture of the aspirated material. The size of the abscess, the mass effect, and response to antibiotic treatment were followed up by repeated CT scans. All patients showed improvement and, at the end of treatment, returned to their previous activities. There were neither deaths nor any postoperative complication. A second aspiration was required in one patient due to recurrence of the abscess. The CT-guided stereotactic aspiration of brain abscesses helps achieve all treatment goals. It drains the contents of the abscess, reduces mass effect, and confirms diagnosis. It is minimally invasive, carries minimal morbidity and mortality, and can be performed on compromised patients under local anesthesia.     

Rate of malignancies in breast abscesses and argument for ultrasound drainage

BACKGROUND: Biopsy of a breast abscess wall has been performed for years without evidence. Aspiration of breast abscesses has been increasing in popularity without widespread acceptance. METHODS: A 10-year retrospective review of 206 surgical biopsies after incision and drainage of breast abscesses. A literature review of breast abscess treated with ultrasound-guided aspiration. RESULTS: Over 10 years, 4.37% (9/206) patients were diagnosed with malignancy in the abscess cavity wall tissue. None of the 197 patients with a negative biopsy returned with breast cancer. Single, multiple, and combined aspiration success rates of 79.8% (364/458), 11.0% (50/458), and 90.9% (482/532) with surgical intervention necessary in 9.1% (50/532). Ultrasound versus hand guidance (92.5% versus 81.9 %, P < .01) improved success rate. CONCLUSIONS: The rate of associated malignancies with breast abscess is very low and does not warrant mandatory surgical drainage. The use of ultrasound-directed aspiration of breast abscesses is effective and should be first-line therapy.     

Interactive magnetic resonance imaging-guided management of intracranial cystic lesions by using an open magnetic resonance imaging system.

OBJECT: The authors present their experience with neurosurgical procedures requiring real-time imaging feedback such as aspiration of a cystic structure or abscess cavity, decompression of hydrocephalic ventricles, management of arachnoid cysts, and installation of permanent or temporary drainage conduits, in which interactive magnetic resonance (MR) imaging guidance was used to monitor structural alterations associated with the procedure. METHODS: Drainage of eight intraparenchymal brain abscesses in seven patients, decompression of space-occupying cystic or necrotic brain tumors in four patients, and endoscopic management of hydrocephalus associated with arachnoid cysts in three patients were performed using MR imaging-guided frameless stereotaxy in an open-configuration 0.5-tesla superconducting MR imaging system. Intraoperative MR imaging guidance provided accurate information on the course of the surgical procedure and associated intraoperative changes in tissue position, such as the degree of cyst aspiration, the presence or absence of hemorrhage or induced swelling, and changes associated with decompression of adjacent brain parenchyma and the ventricular system. No clinically significant complications were encountered in any patient. There were no targeting errors, and procedural objectives were accomplished in all cases. CONCLUSIONS: Drainage of brain abscesses, punctures of cystic or necrotic intracranial lesions with subsequent aspiration, and management of hydrocephalus can be performed safely and accurately by monitoring the procedure using real-time MR imaging to obtain immediate feedback on associated dynamic tissue changes.     

Transcutaneous drainage of pancreatic pseudocysts

The clinical study includes 76 pancreatic pseudocysts localized in the head (24), body (37), and tail (15). The effect of treatment by means of a single or repeated purposeful aspiration in ultrasonic control is discussed. Recovery occurred in 83.3% of cases with cysts measuring up to 5 cm, in 61.3% in those with cysts measuring from 5 to 10 cm, and in 11.1% of cases in which the cysts measured more than 10 cm. As the result of 15 draining manipulations of cysts which were irresponsive to aspiration (9 of them measuring from 5 to 10 cm and 6 larger than 10 cm) complete recovery occurred in 13 cases. The authors discuss the indications for single, two, and many punctures on basis of a complex appraisal of the gland, the size and type of the cyst, and the cytologic results. The indications for percutaneous drainage, the period and techniques of its performance and preliminary and postmanipulation treatment with drugs are determined and the occurring complications are shown.     

Management of lactational breast abscesses

The purpose of the present prospective study was to compare incision and drainage against needle aspiration for the treatment of breast abscesses in lactating women. During the 3-year study period, patients with breast abscesses were randomized 1:1 to undergo either incision and drainage (23 patients) or needle aspiration (22 patients). Ultrasound guidance was not used for any of these patients. Age, parity, localization of abscess, whether or not nipples were cracked, duration of symptoms and lactation, abscess diameter, pus culture results, breast infection history during any previous period of lactation, healing time, recurrence, cosmetic outcome in the case of incision and drainage, and volume of pus removed and number of aspirations needed in the case of aspiration were recorded. The treatment value of each of these techniques was investigated. Student's t-test, Fisher's exact test, a Chi-square test and the Mann-Whitney U-test were used for statistical analysis. In the incision and drainage group all patients were treated successfully, but 1 patient (4%) had a recurrence 2 months after complete healing and 16 patients (70%) in this group were not pleased with the cosmetic outcome. In the needle aspiration group, overall 3 patients were treated with a single aspiration and 10 patients (45%) with multiple aspirations, but 9 patients (41%) did not heal following needle aspiration and subsequently required incision and drainage in addition. No recurrences were observed in the needle aspiration group during the follow-up period. The risk factors for failure of needle aspiration for breast abscesses were abscesses larger than 5 cm in diameter, unusually large volume of aspirated pus, and delay in treatment. In conclusion, breast abscesses smaller than 5 cm in diameter on physical examination can be treated with repeated aspirations with good cosmetic results. Incision and drainage should be reserved for use in patients with larger abscesses.     

Extracorporeal shock wave lithotripsy produces a lower stone-free rate in patients with stones and renal cysts

BACKGROUND: Renal cysts have a space-occupying effect and therefore can distort the pelvicalyceal anatomy. This distortion often produces abnormalities in normal urinary drainage. In the same way, it may effect the ability of the kidneys to become stone free after extracorporeal shock wave lithotripsy (ESWL). The purpose of the current study is to evaluate the effect of renal cysts on the outcome of ESWL. METHODS: We studied 15 patients who had renal stones and coexistent renal cysts. Four patients had polycystic disease, five patients had multiple cysts and six patients has solitary ones. All cysts produced a distortion to the calyceal system of the kidneys, a fact confirmed by intravenous urography (IVU) and computed tomography (CT). All patients underwent ESWL and their stone-free status was evaluated 1 month later by ultrasound and plain kidney ureter bladder (KUB) X-ray. RESULTS: We had a total 60% (9/15) stone-free patients in our study group and a stone fragmentation rate of 100%. Patients with more cysts had lower stone-free rates. Patients with polycystic kidneys had a 25% (1/4) stone-free rate, while patients with multiple cysts and solitary cysts had, 60% (3/5) and 83.3% (5/6), respectively. These results are lower than the rates reported in patients without renal cysts. CONCLUSIONS: We believe that renal cysts may interfere with the passage of stone fragments, due to the impediment of drainage and urinary stasis from the stretching and distortion of the calyceal system by the renal cysts.     

Open drainage versus overlapping method in the treatment of hepatic hydatid cyst cavities.

In order to compare the results of open drainage and overlapping methods, 58 consecutive patients with uncomplicated hepatic hydatid disease were investigated between January 1990 and January 1997. The cavities were obliterated by overlapping method in 26 patients and were left open into the peritoneal cavity following partial pericystectomy in 32 patients. Postoperative complications and follow-up results of ultrasonography (US) and computed tomography (CT) were compared between the two groups. In total, there were 56 cysts in the obliterated group and 83 cysts in the open drainage group. There was no significant difference in age, sex, mean diameter of the cysts, US features of the cysts according to the Gharbi classification, and median follow-up. Mean hospital stay was 10 days in the overlapping group and 7.5 days in the open drainage group (P = 0.033). No postoperative complication was observed in the obliterated group and nearly half of the cyst cavities could not be detected in the early postoperative period by US and CT. Pleural effusion (n = 1) and biliary fistula (n = 1) were detected in the open drainage group which disappeared spontaneously. In the open drainage group, US and CT surveillance revealed that the cyst cavities were reduced in size and the echo pattern was changed in the early postoperative period, whereas the appearance changed into pseudotumor view in the late postoperative period. In conclusion, the cyst cavities disappear perfectly in the overlapping group. Treating the cyst cavity by open drainage is an easy, effective and safe technique. Open drainage can be a 'method of choice' for patients with multiple hydatid cysts and for cysts where management is difficult or unamenable to other methods, but the residual cyst cavities may be misinterpreted as a new cyst by an inexperienced radiologist.     

Review of pyogenic liver abscess at the Royal Adelaide Hospital 1980-1987

Pyogenic liver abscess is an uncommon condition which carries substantial morbidity and mortality if untreated. A review was undertaken of 31 patients who were admitted to the Royal Adelaide Hospital (RAH) between January 1980 and December 1987 and who were diagnosed as having pyogenic liver abscess. The aims of the study were to review the aetiology, current methods of investigation and treatment of the disease, and to formulate a management plan based on the findings. Hypoalbuminaemia, leukocytosis and elevated alkaline phosphatase were the most common findings. Hyperbilirubinaemia was not a usual feature. Computerised tomography (CT) scanning and ultrasound were the most useful imaging modalities in identification of the abscess. The sensitivity of CT scanning in evaluating the size of abscesses was lower than anticipated and this may lead to a higher than necessary rate of surgical drainage. A case is presented to illustrate this. Most abscesses were secondary and frequently due to extension of infection from biliary structures. Diseases causing diminished resistance to bacterial infection had a significant role in the pathogenesis. The overall mortality rate was 25%. Risk factors increasing mortality included advanced age, multiplicity of abscesses, depressed immune status and the presence of complications due to the abscess. Of patients who survived, four were treated with antibiotics alone, eleven with percutaneous drainage and antibiotics, and eight with surgery and antibiotics. We conclude that patients with hepatic abscesses should be managed initially by CT or ultrasound-guided aspiration. If pus is obtained a percutaneous drain should be inserted into the cavity and systemic antibiotics administered.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outpatient treatment of non-lactational breast abscesses.

Eighteen consecutive patients with non-lactational breast abscesses have been treated by aspiration (ten patients), surgical drainage after application of local anaesthetic cream (seven patients) or a combination of aspiration and local anaesthetic cream drainage (one patient) combined with a 2-week course of either amoxycillin and clavulanic acid or cephradine and metronidazole. All abscesses resolved completely within 2 weeks of treatment and all 18 patients expressed satisfaction with the method of treatment used. The majority of patients with breast abscesses can now be managed as outpatients.     

CT-guided stereotactic surgery of brain abscess

Seven patients with brain abscess underwent CT-guided stereotactic aspiration using Iseki's stereotactic apparatus. Three of them were under the age of fifteen and four were older than thirty. The lesions were single and round in four cases, multilobular in two and multiple in one patient. Operations were performed after systemic administration of antibiotics for more than two weeks and after capsule formation was confirmed on CTs. Preoperative volume of the abscesses was estimated from CTs. The target point chosen was the center of the ring of the largest diameter in the enhanced lesion. Abscess was aspirated under monitoring with intraoperative CT scan. No continuous drainage was performed and no antibiotics were given directly into the abscess cavity. In all cases the center of the abscess was punctured with a single trial. Average volume of the preoperative brain abscesses was 18.8ml. Aspirated volume at the time of the operation averaged 16.9ml and all the abscesses decreased to unmeasurable size on CTs. In five of seven patients abscesses were cured after a single aspiration, and in one case after the second operation. One case required extirpation of the lesion. During the follow-up period of four months to five and a half years six patients showed no recurrence. One patient died of unrelated cause four and a half years after the operation. No operative complication was noted. There was no operative morbidity or mortality. Using a CT guided stereotactic method, brain abscess is punctured so accurately, regardless of its location and size, that damage to the surrounding brain during operation can be minimized. Therefore it is highly possible to aspirate abscesses completely.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous management of pyogenic hepatic abscesses

Twelve patients (9 men, 3 women) with a mean age of 65 (54-78) years, with pyogenic hepatic abscesses were managed by percutaneous drainage between 1979 and 1987. Biliary origin was most common (4 patients), followed by hepatic abscesses as a late postoperative complication (seen in 3 patients) and hepatic abscesses occurring in association with acute appendicitis (2 patients). The origin was unknown in 3 patients. Diagnosis was reached by computed tomography or ultrasonography with a diagnostic delay of in mean 11 days. Seventeen abscesses were found among the 12 patients. The median abscess size (maximal diameter) was 7 (1-12) cm. Nine patients were treated with percutaneous drainage with an indwelling catheter within the abscess cavity for up to 3 weeks, while 3 patients were managed with percutaneous puncture and aspiration alone. The most commonly isolated organism from the drained hepatic abscess was E. coli. The course following percutaneous treatment was uneventful, without mortality and recurrence of the hepatic abscess during follow-up. One patient required surgical drainage of an additional hepatic abscess. Percutaneous drainage of hepatic abscesses, independent of origin, thus seems as a safe and reliable method, which should be considered as the treatment of choice if facilities and knowledge of percutaneous management are provided.