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Guo Y, Qin X, Chen S, Liu X, Gu P. Diagnosis efficacy of CEUS for hepatic inflammatory lesions. J Clin Lab Anal 2020; 34:e23231. [PMID: 32017229 PMCID: PMC7307339 DOI: 10.1002/jcla.23231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose In this study, the efficacy of US/CEUS and clinicopathologic parameters in differential diagnosis of hepatic inflammatory lesions were evaluated. Methods This was a retrospective study in which CEUS imaging was performed on 182 patients. Among these patients, 44 patients had hepatic inflammatory lesions and 138 patients had malignant lesions. The ultrasound (US), CEUS, and clinicopathologic parameters with respect to differential diagnosis of hepatic inflammatory lesions were analyzed. Results Irregular lesion shape and unclear margin were commonly seen in hepatic inflammatory lesions by US/CEUS examination. Hypoenhancement in arterial phase (AP) and portal venous phase (PVP), and isoenhancement in delayed phase (DP) were more commonly found in inflammatory lesions rather than malignant lesions [9% (4/44), 68% (30/44), and 16% (7/44) vs 2% (3/138), 11% (15/138), 1% (1/138), respectively; P < .05]. The enhancement coverage was also a significant indicator for the differentiation of inflammatory lesions and malignant lesions (P < .05). History of hepatitis or cirrhosis, and higher serum alpha‐fetoprotein (AFP) level were indicators for malignant lesions, while liver parasites and higher body temperature were indicators for inflammatory lesions. When the US/CEUS findings were combined with clinicopathologic parameters, the diagnostic accuracy of inflammatory lesions could reach 93.3%, with sensitivity, specificity, positive predictive value, and negative predictive value of 63.64%, 96.03%, 84.85%, and 88.32%, respectively. Conclusion The US/CEUS findings combined with clinical characteristics can accurately differentiate hepatic inflammatory lesions and malignant lesions. The results of study will improve the diagnostic confidence for hepatic inflammatory lesions.
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Affiliation(s)
- Yuanyuan Guo
- Department of Gynaecology and ObstetricsAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Xiachuan Qin
- Department of UltrasoundNanchong Central HospitalSichuanChina
| | - Shaoxian Chen
- Radiology DepartmentGaoping District People Hospital of NanchongNanchongChina
| | - Xuebin Liu
- Department of UltrasoundNanchong Central HospitalSichuanChina
| | - Peng Gu
- Department of UltrasoundAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
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Chen YH, Li YH, Lin YJ, Chen YP, Wang NK, Chao AN, Liu L, Wu WC, Lai CC, Chen TL, Chen KJ. Prognostic Factors and Visual Outcomes of Pyogenic Liver Abscess-Related Endogenous Klebsiella pneumoniae Endophthalmitis: A 20-year retrospective review. Sci Rep 2019; 9:1071. [PMID: 30705320 PMCID: PMC6355790 DOI: 10.1038/s41598-018-37643-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Endogenous K. pneumoniae endophthalmitis (EKE) has a higher incidence among East Asians, and the most common infectious source of EKE is pyogenic liver abscess (PLA). We investigate the risk factors for poor visual outcomes in patients with PLA-related EKE. The retrospective medical records of 104 patients (120 eyes) diagnosed with PLA-related EKE between 1996 and 2015. In univariate logistic regression analysis, the risk factors for poor visual outcomes were initial visual acuity (VA) worse than counting fingers (CF) (p < 0.001), eye pain (p = 0.013), hypopyon (p = 0.003), ocular hypertension (p = 0.003), positive intraocular fluids cultures (p < 0.001), subretinal abscess (p = 0.025), unilateral involvement (p = 0.017), delayed ophthalmologic visit (p = 0.022), initially presented with ocular symptoms ahead of systemic symptoms (p < 0.001), and corneal edema (p < 0.001). Intravitreal dexamethasone reduced the requirement of enucleation or evisceration (p = 0.01). The multivariate logistic regression revealed that poor initial VA worse than CF (p = 0.004) and initially presented with ocular symptoms ahead of systemic symptoms (p = 0.007) were the significant independent factors for poor visual outcomes. Early diagnosis and prompt treatment may salvage useful vision in some eyes.
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Affiliation(s)
- Yi-Hua Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Han Li
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Ophthalmology, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY, 10032, United States
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Lam MMC, Wyres KL, Duchêne S, Wick RR, Judd LM, Gan YH, Hoh CH, Archuleta S, Molton JS, Kalimuddin S, Koh TH, Passet V, Brisse S, Holt KE. Population genomics of hypervirulent Klebsiella pneumoniae clonal-group 23 reveals early emergence and rapid global dissemination. Nat Commun 2018; 9:2703. [PMID: 30006589 PMCID: PMC6045662 DOI: 10.1038/s41467-018-05114-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/31/2018] [Indexed: 01/14/2023] Open
Abstract
Severe liver abscess infections caused by hypervirulent clonal-group CG23 Klebsiella pneumoniae have been increasingly reported since the mid-1980s. Strains typically possess several virulence factors including an integrative, conjugative element ICEKp encoding the siderophore yersiniabactin and genotoxin colibactin. Here we investigate CG23's evolutionary history, showing several deep-branching sublineages associated with distinct ICEKp acquisitions. Over 80% of liver abscess isolates belong to sublineage CG23-I, which emerged in ~1928 following acquisition of ICEKp10 (encoding yersiniabactin and colibactin), and then disseminated globally within the human population. CG23-I's distinguishing feature is the colibactin synthesis locus, which reportedly promotes gut colonisation and metastatic infection in murine models. These data show circulation of CG23 K. pneumoniae decades before the liver abscess epidemic was first recognised, and provide a framework for future epidemiological and experimental studies of hypervirulent K. pneumoniae. To support such studies we present an open access, completely sequenced CG23-I human liver abscess isolate, SGH10.
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Affiliation(s)
- Margaret M C Lam
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Kelly L Wyres
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Sebastian Duchêne
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Ryan R Wick
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Louise M Judd
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Yunn-Hwen Gan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Chu-Han Hoh
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Sophia Archuleta
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - James S Molton
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore, 169608, Singapore
| | - Tse Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore, 169608, Singapore
| | - Virginie Passet
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, 75015, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, 75015, Paris, France
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, 3010, Australia.
- The London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.
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Ahmed S, Chia CLK, Junnarkar SP, Woon W, Shelat VG. Percutaneous drainage for giant pyogenic liver abscess--is it safe and sufficient? Am J Surg 2016; 211:95-101. [PMID: 26033361 DOI: 10.1016/j.amjsurg.2015.03.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/22/2015] [Accepted: 03/03/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Large size is a predictor of failure of percutaneous drainage (PD) for pyogenic liver abscess (PLA). This article serves to establish the safety and sufficiency of PD in giant PLA (GPLA). METHODS A retrospective review of all GPLA patients treated at a tertiary care academic hospital from 2001 to 2011 was performed. A GPLA is defined as an abscess greater than or equal to 10 cm size based on imaging. RESULTS Forty patients (24 men, 60%) were treated for GPLA. All but 1 patient (98%) was managed with PD and the mean duration of drainage was 9 days (range 1 to 23 days). One patient underwent operative drainage. Three patients (7.7%) needed secondary procedures after the initial PD. One patient (2.6%) failed PD and subsequently underwent operative drainage. Among the patients who underwent PD, the overall morbidity was 25%; the median length of hospital stay was 13 days (range 5 to 31 days) and 1 (2.6%) mortality. CONCLUSIONS Large size itself is not a contraindication for PD. PD is safe and sufficient even in GPLA patients.
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Affiliation(s)
- Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; Ministry of Health Holdings, 1 Maritime Square, Singapore, Singapore
| | - Clement L K Chia
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; Ministry of Health Holdings, 1 Maritime Square, Singapore, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Winston Woon
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
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Kotenko OG, Gomoliako IV, Gusev AV, Klochkova NE, Petrishche II, Minich AA. [Morphological substantiation for the surgical treatment of chronic hepatic abscess]. Klin Khir 2011:34-37. [PMID: 21695969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The results of histological investigation, conducted in 27 patients, operated on for chronic hepatic abscess, are presented. Macroscopic and microscopic characteristic of all zones of hepatic affection is adduced, the mechanisms of formation of pyogenic membrane, zones of infiltration and fibrosis in chronic hepatic abscess formation are delineated.
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7
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Abstract
BACKGROUND/AIMS No large-scale population-based study has ever been conducted to examine the relationship between cryptogenic pyogenic liver abscesses (PLA) and the subsequent risk of colorectal cancer. This study aimed to estimate the risk for colorectal cancer following a diagnosis of cryptogenic PLA over a 5-year period. METHODS The study group comprised 274 patients who visited an outpatient care centre or were hospitalized with a diagnosis of cryptogenic PLA between 2001 and 2003. The comparison group included 1370 randomly selected subjects. Cox proportional hazard regressions were performed to compare the 5-year colorectal cancer-free survival rates for these two groups. RESULTS Of the total sample, 40 patients from the study group (2.43%) had colorectal cancer during the 5-year follow-up period: 15 (5.45% of those with cryptogenic PLA) and 25 from the comparison group (1.82% of the comparison group). After adjusting for patients' age, sex, monthly income, level of urbanization and geographical location, the hazard of colorectal cancer during the 5-year period was 3.36 times greater for patients with cryptogenic PLA than for the comparison group [95% confidence interval (CI)=1.72-6.56, P<0.001]. The adjusted hazard of colorectal cancer during the 5-year follow-up period was 5.54 times higher for cryptogetic PLA patients with diabetes (95% CI=2.11-14.56, P<0.001) than the comparison group and 2.64 times higher among PLA patients without diabetes (95% CI=1.19-5.85, P<0.05). CONCLUSIONS We conclude that cryptogenic PLA is an alarm that may signal colorectal cancer, especially among female patients with diabetes.
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Affiliation(s)
- Hsueh-Chou Lai
- Department of Internal Medicine, Division of Gastroenterology, China Medical University Hospital, Taichung, Taiwan
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8
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Chuang HC, Chen TL, Chiang DH, Lee YT, Huang LJ, Wang FD, Fung CP, Liu CY. Clinical and bacteriological characteristics of pyogenic liver abscess in non-diabetic patients. J Microbiol Immunol Infect 2009; 42:385-392. [PMID: 20182667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus is an important risk factor for Klebsiella pneumoniae liver abscess, but many patients with pyogenic liver abscess (PLA) do not have diabetes. This study was conducted to compare the clinical characteristics and prognostic factors of K. pneumoniae PLA with that caused by other organisms in non-diabetic patients. METHODS The medical charts of patients with a diagnosis of PLA were retrospectively reviewed from January 2005 to December 2007. The clinical symptoms and signs, laboratory data, and risk factors were analyzed. RESULTS There were 50 patients in the K. pneumoniae group and 34 patients in the non-K. pneumoniae group. The clinical presentations did not differ between the 2 groups. The patients in the non-K. pneumoniae group had a higher prevalence of malignant disease than those in the K. pneumoniae group (58.8% vs 6.0%; p < 0.001). Non-K. pneumoniae PLA was strongly associated with hepatobiliary tumor (p = 0.015). Among the non-K. pneumoniae isolates, Escherichia coli was the most common pathogen (n = 20; 58.8%). Forty seven K. pneumoniae isolates (94%) were susceptible to all tested antimicrobial agents except ampicillin, while the non-K. pneumoniae Gram-negative pathogens had greater resistance to first-generation cephalosporins. Poor prognostic factors included chronic renal failure (p = 0.005), abscess rupture (p = 0.036), and right lower lung infiltration (p = 0.049). CONCLUSIONS Hepatobiliary malignancy and newly diagnosed malignancy were risk factors for non-K. pneumoniae liver abscess in non-diabetic patients. Physicians should ascertain the presence of underlying malignancy in patients with non-K. pneumoniae PLA.
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Affiliation(s)
- Han-Chuan Chuang
- Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan
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9
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Abstract
We describe an 83-year-old woman who developed a pyogenic liver abscess complicated with early bile duct carcinoma. After percutaneous abscess drainage, endoscopic retrograde cholangiography revealed a filling defect in the extrahepatic bile duct suggestive of a bile duct tumor. Resection of the extrahepatic bile duct with regional lymph node dissection was carried out. The resected specimen showed a polypoid tumor in the middle bile duct and histologic examination revealed well-differentiated tubular adenocarcinoma limited to the mucosal layer. These findings suggest that careful investigation of the biliary tract is necessary in patients with pyogenic liver abscess, because of the possible association of bile duct cancer.
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Affiliation(s)
- Chiah-Yang Chai
- Department of Surgery, Taipei Medical University Hospital, Taiwan
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10
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Hui JYH, Yang MKW, Cho DHY, Li A, Loke TKL, Chan JCS, Woo PCY. Pyogenic Liver Abscesses Caused byKlebsiella pneumoniae: US Appearance and Aspiration Findings. Radiology 2007; 242:769-76. [PMID: 17325065 DOI: 10.1148/radiol.2423051344] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively compare the ultrasonographic (US) appearance and amount of pus obtained at initial aspiration for liver abscesses caused by Klebsiella pneumoniae with those for liver abscesses caused by other bacterial pathogens. MATERIALS AND METHODS This study had medical ethics committee approval; informed consent was not required. Asian patients with pyogenic liver abscesses in a 5-year period were included. Abscess clinical, laboratory, and microbiologic characteristics and treatment and outcome were analyzed. US images were classified according to the size of the largest liver abscess, the echogenic pattern of the lesion, the presence of any echogenic debris within the lesion, increased through transmission in the posterior aspect of the lesion, and the lesion margin. Clinical and US characteristics of patients with K pneumoniae monomicrobial liver abscesses and those with non-K pneumoniae monomicrobial or polymicrobial liver abscesses were compared. The chi(2) or Fisher exact test was used for categorical variables; the Student t test was used for continuous variables. RESULTS There were 120 patients with pyogenic liver abscesses. Median patient age was 69 years (range, 13-94 years). Fifty-nine patients were male, and 61 were female. Fifty patients with K pneumoniae monomicrobial and 33 patients with non-K pneumoniae monomicrobial or polymicrobial liver abscesses underwent US. K pneumoniae monomicrobial liver abscesses were associated with diabetes mellitus (P < .001), higher blood glucose levels at admission (P < .05), predominantly solid US appearances (P < .001), irregular or indistinct lesion margins (P < .05), less than 2 mL of pus aspirated (P < .001), and longer duration of antibiotic treatment (P < .05). CONCLUSION A predominantly solid appearance at US is associated with K pneumoniae monomicrobial liver abscess. K pneumoniae liver abscess is associated with a much smaller quantity of pus at initial aspiration.
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Affiliation(s)
- Joyce Y H Hui
- Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
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Giorgio A, de Stefano G, Di Sarno A, Liorre G, Ferraioli G. Percutaneous needle aspiration of multiple pyogenic abscesses of the liver: 13-year single-center experience. AJR Am J Roentgenol 2006; 187:1585-90. [PMID: 17114554 DOI: 10.2214/ajr.05.1104] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to report 13 years of experience in the management of multiple pyogenic liver abscesses with only percutaneous needle aspiration of the abscess cavities under sonographic guidance. MATERIALS AND METHODS From December 1991 to October 2004, 39 consecutively registered patients (29 men and 10 women; age range, 37-82 years; mean age, 64 years) with 118 pyogenic liver abscesses were treated with sonographically guided percutaneous needle aspiration at our institution. The number of pyogenic liver abscesses per patient ranged from two to 15 (mean, 3.0). RESULTS Eighty-seven percutaneous needle aspirations were performed on 39 patients with 118 pyogenic liver abscesses (range, 1-4 aspirations per patient; mean, 2.2 aspirations per patient). Because they were close to another aspirated abscess in the right lobe of the liver, 31 (26.3%) of 118 abscesses were aspirated without removal of the needle from the liver. Thirty-six (92.3%) of 39 patients were treated with a single aspiration of an abscess in a single session. The other three patients needed two aspiration sessions. No patient needed imaging-guided percutaneous catheter drainage or open surgical drainage. Complete reconstitution of liver parenchyma occurred within a maximum of 80 days. No abscesses recurred during the follow-up period, which ranged from 7 to 42 months (mean, 18 months). CONCLUSION Percutaneous needle aspiration of multiple pyogenic abscesses under sonographic guidance is a safe, effective, and low-cost procedure. In our experience, percutaneous needle aspiration was acceptable to patients. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound in Infectious Diseases Unit, D. Cotugno Hospital, Via Quagliariello 54, 80131 Naples, Italy
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Toshikuni N, Kai K, Sato S, Kitano M, Fujisawa M, Okushin H, Morii K, Takagi S, Takatani M, Morishita H, Uesaka K, Yuasa S. Pyogenic liver abscess after choledochoduodenostomy for biliary obstruction caused by autoimmune pancreatitis. World J Gastroenterol 2006; 12:6397-400. [PMID: 17072969 PMCID: PMC4088154 DOI: 10.3748/wjg.v12.i39.6397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 68-year-old man underwent cholecystectomy and choledochoduodenostomy for biliary obstruction and nephrectomy for a renal tumor. Based on clinical and histopathologic findings, autoimmune pancreatitis (AIP) was diagnosed. The renal tumor was diagnosed as a renal cell cancer. Steroid therapy was started and thereafter pancreatic inflammation improved. Five years after surgery, the patient was readmitted because of pyrexia in a preshock state. A Klebsiella pneumoniae liver abscess complicated by sepsis was diagnosed. The patient recovered with percutaneous abscess drainage and administration of intravenous antibiotics. Liver abscess recurred 1 mo later but was successfully treated with antibiotics. There has been little information on long-term outcomes of patients with AIP treated with surgery. To our knowledge, this is the second case of liver abscess after surgical treatment of AIP.
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Affiliation(s)
- Nobuyuki Toshikuni
- Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1 Shimoteno, Himeji 670-8540, Japan.
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Hsieh CB, Tzao C, Yu CY, Chen CJ, Chang WK, Chu CH, Chou SJ, Tung HJ, Yu JC. APACHE II score and primary liver cancer history had risk of hospital mortality in patients with pyogenic liver abscess. Dig Liver Dis 2006; 38:498-502. [PMID: 16702033 DOI: 10.1016/j.dld.2006.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 03/01/2006] [Accepted: 03/20/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Acute Physiology and Chronic Health Evaluation II classification system has been extensively used for predicting the patient mortality in various diseases. However, its utilisation on the pyogenic liver abscess has not yet been well studied. AIMS The purpose of this study was to validate this system on this high death rate disease. PATIENTS A retrospective study was conducted to assess 314 patients with pyogenic liver abscesses admitted to tertiary medical centre in past 12 years. METHODS The outcome measurement was the in-hospital mortality. A multiple logistic regression model was used to assess the association between mortality and Acute Physiology and Chronic Health Evaluation II score while controlling for the potential confounding factors. RESULTS The overall in-hospital mortality was 8.3%. The mean Acute Physiology and Chronic Health Evaluation II score of the expired patients was higher (P<0.0001). The mortality rate increased rapidly when Acute Physiology and Chronic Health Evaluation II score >or=15. After controlling for the potential confounding factors, patient with high admission Acute Physiology and Chronic Health Evaluation II score >or=15 had a higher chance of in-hospital mortality (P<0.01). In addition, the primary liver cancer history is also a risk factor (P=0.03). CONCLUSIONS The Acute Physiology and Chronic Health Evaluation II score and the primary liver cancer history predict the in-hospital mortality of the pyogenic liver abscess patient.
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Affiliation(s)
- C-B Hsieh
- Department of Surgery, Division of General Surgery, National Defence Medical Center, Tri-Service General Hospital, 325, Sec. 2, Cheng-Kung Road, 114 Taipei, Taiwan
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Abstract
Multiple pyogenic liver abscesses have been rarely described. We report a fatal case of multiple pyogenic liver abscesses affecting a 38-year-old woman requiring surgical drainage. Evolution was marked by occurrence of a septic shock with multi-organ system failure. The patient died 48 h after surgery. Causes, therapeutics and outcome of the disease are discussed.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation médicale, Hopital Habib Bourguiba, Route el Ain Km 1 3029 Sfax, Tunisie.
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Abstract
Pyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus (DM). The pathogen in the patient with DM was Klebsiella pneumonia (KP). In both of the patients, ileus developed about two to three weeks after the diagnosis of liver abscess. Colonoscopy revealed large polypoid tumors with pathological findings of tubulovillous adenoma in both cases. Two lessons were learned from these two cases: (1) an underlying cause should be aggressively investigated in patients with cryptogenic liver abscess; (2) DM could be one of the etiologies but not necessarily the only cause of KP liver abscess.
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Affiliation(s)
- Hsueh-Chou Lai
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, China
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Abstract
OBJECTIVE To evaluate the effect of ischemic preconditioning (IPC) in an experimental setting of extended liver resection with 30 minutes of inflow occlusion in rats. SUMMARY BACKGROUND DATA IPC has been proven an effective strategy against hepatic ischemia-reperfusion injury in both animal and human studies. However, decreased protective effects in terms of transaminase levels were found in patients with larger resection volume, questioning the benefit of IPC in case of small liver remnants. METHODS Rats undergoing 90% hepatectomy under strict inflow occlusion for 30 minutes were subjected to either receive or not receive an IPC period (5 minutes of ischemia followed by 30 minutes of reperfusion). In addition to 10-day survival rate, laser Doppler flowmetry of hepatic blood flow and fluorescence microscopic analysis of the hepatic microcirculation were performed to assess the effect of IPC on initial microvascular reperfusion of liver remnants after 90% resection. Moreover, regeneration capacity of livers undergoing IPC and 70% resection was studied over 7 days by means of histology and immunohistochemistry. RESULTS Ten-day survival of rats which underwent IPC and 90% hepatectomy was 0 out of 10 animals versus 1 out of 10 animals without IPC. Hemodynamic and microcirculatory analysis revealed signs of hyperperfusion during initial reperfusion of preconditioned liver remnants in 90% hepatectomized animals. In addition to increased transaminase levels, IPC impaired hepatic proliferative response after 70% organ resection, as indicated by both a significant reduction in mitotic figures and Ki-67 nuclear staining of hepatocytes, as well as a decrease in restitution of liver mass. CONCLUSIONS Though portal hypertension reflecting shear stress has been reported to trigger liver regeneration, remnant liver tissue after major hepatectomy may not benefit from hyperperfusion-induced trigger for cell cycle entry but is rather dominated from hyperperfusion-induced local organ injury. Further studies are required to finally judge on the harmfulness of IPC in extended liver resection.
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Affiliation(s)
- Yu-Meng Tan
- From the Department of Surgery, Singapore General Hospital Department of Surgical Oncology, National Cancer Center, Singapore.
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Yokota T, Iwamoto K, Watanabe Y, Yamauchi H, Kikuchi S, Hatori M. Pyogenic liver abscesses secondary to carcinoma of the sigmoid colon: a case report and clinical features of 20 cases in Japan. Ups J Med Sci 2005; 110:241-4. [PMID: 16454162 DOI: 10.3109/2000-1967-070] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We report a case of liver abscesses associated with sigmoid colon cancer in an 81-year-old woman. The patient was referred to our hospital because of a tumorous lesion of the sigmoid colon. Five days before the scheduled operation, she presented abdominal pain, fever and chill. Imaging scans revealed multiple liver abscesses in both lobes, which were successfully treated with intravenously administered antibiotics. Two weeks later, the patient underwent laparoscopic-assisted sigmoidectomy. Nineteen cases of liver abscess associated with colonic cancer have been reported during the past ten years in Japan, and we report the clinical features of these cases in this paper. An aggressive search for the underlying cause of pyogenic liver abscess should be an integral part of the definitive treatment of this disease.
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Affiliation(s)
- Takashi Yokota
- Department of Surgery, National Sanatorium Tohoku Shinseien, Miyagi, Japan.
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Kalita NI, Nichitaĭlo ME, Kotenko OG, Gusev AV, Moshkovskiĭ GI, Vasil'ev OV, Popov AO, Korshak AA. [Etiology, pathogenesis and clinic-diagnostic aspects of hepatic abscess]. Klin Khir 2004:54-8. [PMID: 15628243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Nah BK, Kim YS, Moon HS, Park KO, Kim SM, Lee YS, Yang HW, Seo SW, Kim SH, Lee BS, Kim NJ, Lee HY. [Recent changes of organism and treatment in pyogenic liver abscess]. Taehan Kan Hakhoe Chi 2003; 9:275-83. [PMID: 14695694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND/AIMS With the advance of antibiotics and the development of newer imaging techniques, marked changes in etiology, diagnosis, treatment and prognosis of liver abscess have been reported. METHODS We reviewed the clinical data related to 94 patients with pyogenic liver abscess. RESULTS Of the 94 patients in the study group, the male to female ratio was 1.4:1 and the peak incidence of liver abscess was in the 7th decade. About three quarters (74.5%) of the abscesses were of unknown origin. The predominant location was in the right lobe (70.3%). Single lesion was found in 80 patients and multiple lesions in 14 patients. Pathogens were identified in 67 patients, of which Klebsiella pneumoniae (65.7%) and E. coli (16.4%) were the most common. The modalities of treatment were percutaneous drainage with antibiotics (73.4%), percutaneous aspiration with antibiotics (16.0%), or antibiotics alone (8.5%). The case fatality rate, mainly from associated underlying diseases, was 9 cases (9.6%). Associated diseases were diabetes mellitus (14.9%) and malignancy (10.6%). CONCLUSIONS Our study revealed that the most common organism was Klebsiella pneumoniae and percutaneous needle aspiration and/or catheter drainage were safe and effective treatment modalities for pyogenic liver abscess. Prognosis was determined by the underlying condition.
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Affiliation(s)
- Byung Kyu Nah
- Department of Internal medicine, Chungnam National University College of Medicine, Daejeon, Korea
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