Successful management of hepatic abscesses by percutaneous catheter drainage in chronic granulomatous disease

Chronic granulomatous disease (CGD) is a disorder of polymorphonuclear leukocytes that can cause multiple recurrent hepatic abscesses in 40% of those patients with the disorder. The mortality rate from this complication of CGD is estimated at 27%. Treatment has consisted of extensive surgical debridement and drainage and prolonged antibiotic therapy; however, this approach is accompanied by high morbidity and the frequent need for reoperation. Successful percutaneous drainage of multiple hepatic abscesses in a patient who had previously undergone 10 operative procedures to manage hepatic abscesses is reported. With the development of imaging and percutaneous drainage techniques, as well as the recurrent nature of this problem, percutaneous management should be given consideration in appropriate patients with CGD with hepatic abscesses.     

Risk-taking behavior and accidents in adolescence in developed countries

Injuries due to accidents are the primary cause of fatalities among adolescents. Between the ages of 10 and 19, mortality caused by accidents augments significantly, and there is an excess of male mortality, increasing with age. This mortality has remained virtually unchanged over the past 25 years, except for a small narrowing of rate differences by sex. Traffic accidents, particularly those involving motorcycles, are the leading cause of accident fatalities. Though not easily assessed, morbidity due to accidents is probably very high, especially among males. Sports accidents are the most frequent. Adolescents appear to be particularly exposed to some risks, but also tend to be careless about safety. Risk-taking is a source of rewards: pleasure, self-affirmation, sense of independence; but it is described by some authors as self-destructiveness, death from accidents reflecting suicidal tendencies. Paradoxical results of prevention have been observed in this age group.     

Endogenous inhibitory system in pain

Electrical stimulation of several brain sites produces profound analgesia in humans, and inhibits nocifensor reflexes in animal studies. Responses of the dorsal horn nociceptive neurons evoked by stimulation onto the receptive fields are also inhibited by brain stimulation. These brain sites are Periaqueductal Gray Matter (PAG), Nucleus Raphe Magnus (NRM), Nucleus Reticularis magnocellularis (NRmc), Locus Coeruleus (LC), Lateral Hypothalamus, and others. We have explained in a general way the mechanism of these stimulation produced analgesia. The mechanism of PAG stimulation analgesia is partly due to an activation of serotonin containing neurons which descend from NRM to the spinal dorsal horn and activated by PAG stimulation. Activation of NRM neurons may produce inhibition of the nociceptive neurons of the dorsal horn by the mechanism of direct postsynaptic inhibition. Currently there is no evidence to support the theory of presynaptic inhibition. Endogenous opioid peptides do not play an important role in PAG stimulation analgesia. On the other hand, the mechanism of NRmc or LC stimulation analgesia may be due to an activation of noradrenaline containing neurons which similarly inhibit the dorsal horn nociceptive neurons in the spinal cord. At present, it still remains unknown whether endogenous opioid peptides play an important role in this type of analgesia.