Conservative Management of MRSA Periaortic Graft Abscess

Following repair of ruptured abdominal aortic aneurysm a patient developed methicillin-resistant Staphylococcus aureus perigraft abscess. The patient's clinical condition did not permit conventional open surgical correction. Ultrasound-guided aspiration and insertion of percutaneous drain enabled local antibiotic irrigation accompanied by systemic therapy. At 2 years follow-up the patient remains well with no evidence of sepsis.     

前列腺脓肿外科处理的系统评价

目的：系统评价近10年前列腺脓肿诊治,为临床提供参考。方法：检索PubMed2000．0l～2011．04前列腺脓肿诊治文献,纳入合格文献,系统评价其外科处理。结果：病例数≥5例16个研究纳入行定量荟萃分析,均为回顾性病例分析,研究质量低。总计311例（5～77）患者,年龄分布10天～83岁,发病低龄化。病原体包括真菌、细菌两类,后者以G＋球菌（葡萄球菌属）为主,次为p杆菌（克雷伯菌属）,少见病原体亦有发病．地区差异明显。易感因素概括为局部与全身因素两类,分别以糖尿病、肝硬化与下尿路操作、尿路感染最常见。诊断涉及症状评估、体格检查、病原体鉴定、影像学检查（TRUS、骨盆CT、MRI）等。治疗包括一般处理、抗生素疗法与外科引流。手术径路有经皮经会阴、经直肠与经尿道。经会阴／经直肠行EUS、TRUS或c’F引导下细针穿刺抽吸、留置导管引流或切开引流;经尿道行TUR、TURP或TuIP引流;穿刺抽吸失败转为经尿道或经会阴切开引流;部分病例行尿流改道。无对比研究而未能比较何种术式更优。除死于严重并发症外,均结局良好。结论：应基于临床评估,结合TRUS／盆腔CT与实验室检查确诊前列腺脓肿。抗生素使用宦有病原学依据。视具体情况个体化处理：保守治疗;EUS、TRUS或CT引导下穿刺抽吸、留置导管引流;经尿道微创引流;若脓肿穿破前列腺包膜或肛提肌宜经会阴切开引流。外科引流以“准确、彻底、无残留”为原则。术后应密切随访。     

Subphrenic Abscess: Comparison Between Operative and Antibiotic Management

Subphrenic abscess is still a significant hazard which complicates surgical procedures as well as certain abdominal catastrophes. This is a report of 88 patients with subphrenic abscess at St. Vincent's Hospital and Medical Center of New York from 1954 through 1971. There were 46 males and 42 females, ranging from 2 to 88 years. Operations on the stomach, duodenum and biliary tract were the major causes. The causative organisms in order of frequency were: E coli (41.6%), Staphylococcus (41.6%), Aerobacter aerogenes (23.3%), Proteus (20%), Streptococci (18.3%) and Pseudomonas (8.3%). Penicillin and tetracycline, the antibiotics most commonly chosen on an empiric basis, proved effective in only 38% of cases. On the other hand, kanamycin, chloramphenicol and cephalothin were effective in 90%, 85% and 70% of cases respectively. The overall mortality rate was 15%. Nine of the 21 patients (42.8%) treated with antibiotics alone died while 11 of 67 patients (10.6%) treated with antibiotics and surgical drainage died. Some of the latter deaths occurred in patients treated with prolonged antibiotic therapy and operated on only as a last resort. In this series subphrenic abscess was best treated by early surgical drainage combined with the use of appropriate antibiotics.