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Introduction. Ultrasound-guided (US-guided) percutaneous drainage (PD) of abdominal collections represents the first-choice alternative to surgical intervention. The aim of our study was to assess the efficacy and safety of PD of visceral and non-visceral abdominal collections by reviewing our personal experience over a period of 5 years. Material and methods. The present study included 66 patients who underwent PD under ultrasound guidance. We analyzed clinical variables (collection size, catheter diameter, collection type, microbiological analysis, antibiotic regimens) along with the outcomes of the procedure. Results. Visceral collections were predominant, encompassing 38 hepatic abscesses and 1 splenic hematoma. Microbiological analysis showed that the majority (54%) were monomicrobial. The most encountered pathogens were Klebsiella pneumoniae and Escherichia coli. Technical success was achieved in all cases and clinical success was observed in 84.6% of the cases. No immediate procedural complications were detected. There were 6 patients who needed reinterventions, either by catheter replacement or by surgical treatment. The mortality rate was 4.5%, due to patients’ poor overall status and oncological comorbidities. Conclusions. Percutaneous drainage under ultrasound guidance is a safe and effective procedure in the management of abdominal collections.

Objective. To analyze the possibilities and efficacy of application of the intervention sonography in complex surgical treatment of patients with bacterial hepatic abscesses. Materials and methods. Results of treatment of 39 patients with hepatic abscesses in Department of Surgery № 3 through period from 2012 till June 2019 yr was presented. The patients were treated, using the puncture aspiration or drainage of abscesses under sonographic guidance. In hepatic abscesses with diameter up to 40 mm a puncture sanation was applied. In all the patients transcutaneous drainage was performed, not depending from the abscesses dimensions and localization. Results. Treatment and application of the intervention sonography was effective in 37 (94.9%) patients. Postoperative complications have occurred in 4 (10.3%) patients: hemorrhage inside the abscess cavity (in 2), durable bile leakage via the drain (in 1), migration of the drain from the abscess cavity (in 1). Average stationary stay of the patients was (19,2 ± 1,6) bed-days. Conclusion. Application of the puncture-draining procedures under sonographic control in treatment of patients, suffering hepatic abscesses constitutes a method of choice, what is caused by their small traumaticity, availability of dynamical control and efficacy in 94.9% patients. But these procedures owe some limitations, connected by the abscesses quantity, their localization, as well as complex configuration and big possibility of presence of large sequesters of necrotized hepatic parenchyma.

Eine 33-jahrige Patientin stellte sich mit schwerem Krankheitsgefuhl und Leberabszessen vor. Erst der Nachweis von Epitheloidzellreaktionen im Abszesspunktat fuhrte letztlich serologisch zur Diagnose einer in Deutschland seltenen Tularamie beim Menschen. Durch eine zielgerichtete antibiotische Therapie konnte der wochenlange, schwere Krankheitsverlauf beendet werden. Wie eine gleichzeitig diagnostizierte Zoliakie zu der ungewohnlichen Manifestation einer Tularamie in der Leber beitrug, bleibt unklar.

Melioidosis, an underdiagnosed or an emerging infection in India, is mostly reported from Southern India. We report a case of splenic and hepatic abscesses with splenic vein thrombosis in a diabetic patient from Western India. Keywords: Melioidosis, Sepsis, Diabetes.

Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (

Resumen Introducción. El drenaje percutáneo de las colecciones intraabdominales, guiado por ultrasonografía o por tomografía computadorizada, ha sido el tratamiento de elección para los abscesos abdominales o pélvicos, entre otros. Objetivo. Describir la experiencia en el manejo percutáneo de colecciones abdominales en pacientes del Hospital Universitario San José de Popayán entre octubre de 2014 y abril de 2016. Materiales y métodos. Se trata de una serie de casos de 79 pacientes a quienes se les hizo manejo intervencionista de colecciones abdominales por medio de cirugía percutánea guiada por imágenes, los cuales cumplieron con los criterios de inclusión y exclusión. El análisis estadístico se hizo con el programa SPSS Statistics™. Resultados. Se realizaron 106 procedimientos percutáneos para drenar diferentes colecciones intraabdominales. La intervención más frecuente fue el drenaje de colecciones hepáticas (32,1 %), en su mayoría, abscesos hepáticos, seguida del drenaje de abscesos posquirúrgicos de cirugías abiertas o laparoscópicas. Conclusiones. Las técnicas intervencionistas en manos de un cirujano entrenado son un tratamiento eficaz y seguro para las diferentes colecciones intraabdominales. El procedimiento fue exitoso en el 99 % de los pacientes de la presente serie. Abstract Introduction: Percutaneous drainage of intraabdominal collections guided by ultrasonography or computerized axial tomography has been the treatment of choice for the management of abdominal or pelvic abscesses. Objective: To describe the experience with the percutaneous ultrasonography-guided drainage of abdominal collections in patients at the San José University Hospital in Popayán, Colombia, in the period October 2014 and April 2016. Materials and methods: This is a case series of 79 patients who underwent interventional management of abdominal collections by a percutaneous procedure guided by images; all patients met the inclusion and exclusion criteria. The statistical analysis was carried out with the SPSS Statistics program. Results: 106 percutaneous procedures were performed for drainage of different intra-abdominal collections. The most frequent intervention was the drainage of hepatic collections (32.1%), mostly hepatic abscesses, followed by drainage of postoperative abscesses following open or laparoscopic surgery. Conclusions: The management of interventional techniques in the hands of the trained surgeon is an effective and safe method for the treatment of different intra-abdominal collections. The procedure was successful in 99% of the patients.

El objetivo del estudio fue evaluar el peso corporal (PC), la edad y las variables digestivas en el rumen de los animales lidiados en eventos taurinos del estado de Tlaxcala durante un año. En veinte eventos taurinos se registró la procedencia (ganadería de Tlaxcala [GL]; ganadería fuera del estado de Tlaxcala [GF]) y la época de estudio (sequía y lluvia), registrándose las variables: PC, edad (dentición), peso de la digesta del rumen, contenido de la fibra detergente neutro (FDN), pH, ácidos grasos volátiles (AGV), conteo de protozoarios en rumen y la presencia de abscesos hepáticos. Los toros tuvieron mayor PC que los novillos (456 vs 361, p ≤ 0.05). En la estación de sequía se registró mayor PC (432 vs 405, p ≤ 0.05) que durante la estación de lluvia; presentando interacción estadística entre la clasificación (novillo o toro) y la estación (p ≤ 0.05). Los animales del GF tuvieron mayor contenido de la digesta que el GL (8.1 vs 7.25%, p ≤ 0.05). El pH ruminal fue menor en los novillos que en los toros (5.86 vs 6.54, p ≤ 0.05), al igual que el contenido de FDN (61.2 vs 64.7, p < 0.05). En conclusión, los novillos presentaron mayores problemas de acidosis ruminal que los toros. El reglamento taurino, con base al peso y edad de los animales, no es aplicado correctamente por las autoridades.

Made available in DSpace on 2021-06-25T10:26:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Additives used to improve feed efficiency of beef cattle on high-grain diets requires products that not only increase animal performance but also provide food safety for consumers. Since phytogenic additives such as essential oils (EO) are the main substitutes for monensin in the diet of cattle fed high-grain diets, this study aimed to evaluate, through meta-analysis, the effects of EO as an alternative to monensin in diets for beef cattle on feed intake, performance, carcass characteristics and ruminal fermentative parameters. Ten peer-reviewed publications with 27 treatment means were included in the data set. These effects were evaluated using random-effect models to examine the weighted mean differences (WMD) between EO treatment and control treatment (diets with monensin). Heterogeneity was explored by meta-regression and subgroup analysis. The substitution of EO for monensin did not affect methane production, ruminal pH values, average daily gain, feed efficiency or carcass weight. However, carcass dressing percentage (WMD = 0.38%; P = 0.03), ribeye area (WMD = 0.82 cm2; P < 0.0001) and subcutaneous fat thickness (WMD = 0.56 mm; P < 0.0001) values increased. Although the use of EO instead of monensin had no influence on the performance of beef cattle fed high-grain diets, the prevalence of hepatic abscesses increased 84.9% and the replacement of monensin by EO increased the risk ratio of hepatic abscess prevalence by 107%. Therefore, the use of EO in high-grain beef cattle diets was ineffective in protecting the liver against abscesses. Animal Unit of Digestive and Metabolic Studies Department of Animal Science School of Agricultural and Veterinary Sciences São Paulo State University (UNESP) Federal University of Piauí Department of Biological Safety German Federal Institute for Risk Assessment Federal University of Espírito Santo Department of Animal Science Animal Unit of Digestive and Metabolic Studies Department of Animal Science School of Agricultural and Veterinary Sciences São Paulo State University (UNESP)

Melioidosis is an infectious disease most commonly found in places with tropical climates. Definitive diagnosis can be confirmed by culture or pathological results of blood or infected organ. However, imaging study is helpful in providing early provisional diagnosis and guiding therapy. Point-of-care ultrasound can be currently performed bedside by non-radiological staff such as emergency physicians or intensivists. We present the case of a pediatric patient who got diagnosed with melioidosis after detection of multiple splenic and hepatic abscesses by point-of-care ultrasound, leading to early diagnosis and appropriate empirical antibiotic selection, resulting in good treatment outcome.

Fusobacterium species is known for being a causative agent for Lemierre’s syndrome, which is characterized by thrombophlebitis of the jugular vein. However, Fusobacterium species causing Lemierre’s variant gastrointestinal syndrome has only been reported in case reports. We present a case of Fusobacterium causing hepatic vein pylephlebitis, multiple brain abscesses, and hepatic abscess. To the best of our knowledge, there have only been four other case reports of Fusobacterium causing hepatic abscesses with associated septic pylephlebitis in the literature.

To the best of our knowledge, this is the first case of multifocal hepatic abscesses in a young immunocompetent adult from India, which was successfully treated with hepatectomy and short course of oral antibiotic regimen. Publishing further such case reports will provide more clarity regarding the clinical significance of the disease, including associated risk factors and appropriate treatment.

Background The accurate classification of focal liver lesions (FLLs) is essential to properly guide treatment options and predict prognosis. Dynamic contrast-enhanced computed tomography (DCE-CT) is still the cornerstone in the exact classification of FLLs due to its noninvasive nature, high scanning speed, and high-density resolution. Since their recent development, convolutional neural network-based deep learning techniques has been recognized to have high potential for image recognition tasks. Aim To develop and evaluate an automated multiphase convolutional dense network (MP-CDN) to classify FLLs on multiphase CT. Methods A total of 517 FLLs scanned on a 320-detector CT scanner using a four-phase DCE-CT imaging protocol (including precontrast phase, arterial phase, portal venous phase, and delayed phase) from 2012 to 2017 were retrospectively enrolled. FLLs were classified into four categories: Category A, hepatocellular carcinoma (HCC); category B, liver metastases; category C, benign non-inflammatory FLLs including hemangiomas, focal nodular hyperplasias and adenomas; and category D, hepatic abscesses. Each category was split into a training set and test set in an approximate 8:2 ratio. An MP-CDN classifier with a sequential input of the four-phase CT images was developed to automatically classify FLLs. The classification performance of the model was evaluated on the test set; the accuracy and specificity were calculated from the confusion matrix, and the area under the receiver operating characteristic curve (AUC) was calculated from the SoftMax probability outputted from the last layer of the MP-CDN. Results A total of 410 FLLs were used for training and 107 FLLs were used for testing. The mean classification accuracy of the test set was 81.3% (87/107). The accuracy/specificity of distinguishing each category from the others were 0.916/0.964, 0.925/0.905, 0.860/0.918, and 0.925/0.963 for HCC, metastases, benign non-inflammatory FLLs, and abscesses on the test set, respectively. The AUC (95% confidence interval) for differentiating each category from the others was 0.92 (0.837-0.992), 0.99 (0.967-1.00), 0.88 (0.795-0.955) and 0.96 (0.914-0.996) for HCC, metastases, benign non-inflammatory FLLs, and abscesses on the test set, respectively. Conclusion MP-CDN accurately classified FLLs detected on four-phase CT as HCC, metastases, benign non-inflammatory FLLs and hepatic abscesses and may assist radiologists in identifying the different types of FLLs.

Background and objectives Prophylactic antibiotics are frequently administered for transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). In patients without previous biliary instrumentation, infection risk from TACE is low. We hypothesized that there is a negligible rate of infection in these patients without prophylactic antibiotics. Methods We reviewed consecutive patients undergoing TACE between 7/1/2013-6/15/2016. All patients had an intact Sphincter of Oddi, received no peri-procedural antibiotics, and had 30+ days follow-up. Level of arterial selection was recorded. Baseline Child-Pugh (CP) and Barcelona Clinic Liver Cancer (BCLC) scores were recorded. The primary outcome measure was the absence of clinical or imaging findings of hepatic abscess within 30 days. Results A total of 171 patients underwent 235 TACE procedures. CP scores were A (n = 109), B (n = 47), and C (n = 15). BCLC scores were 0 (n = 1), A (n = 108), B (n = 47), and C (n = 15). TACE was performed segmentally (n = 208) or lobar (n = 27). Three patients died of non-infectious causes before 30 days. No hepatic abscesses developed in evaluable patients: 0/232 infusions. Conclusions In patients with HCC and an intact Sphincter of Oddi, TACE was performed safely without prophylactic antibiotics. The majority of the patients were BCLC and CP A/B. Additional study of BCLC and CP C patients is warranted.

Introduction and objective We describe a series of cases of syphilis with atypical extracutaneous clinical presentation diagnosed in HIV-infected patients. Methods Retrospective observational study. All cases of syphilis diagnosed in HIV-infected patients during the period between June 2013 and June 2016 in a tertiary hospital of the Barcelona metropolitan area were analyzed. Results A total of 71 cases of syphilis were diagnosed, 32 of them presenting with clinical signs or symptoms. Seven of these cases (9.8% of the total and 21.8% of the symptomatic cases) had atypical presentations with extracutaneous involvement: ocular (4), gastric (1), multiple hepatic abscesses (1) and generalized adenopathies (1). Patients were treated with intramuscular or intravenous penicillin and the clinical and serological evolution was good in all of them. Conclusions Extracutaneous atypical clinical presentations were observed in 21.8% of symptomatic cases of syphilis in HIV+ patients with ocular involvement being the most frequent.

Gallbladder perforation is a complication of gallbladder disease. There are high morbidity and mortality rates, and it is believed that this is due to the delay in diagnosis and when the condition is managed conservatively. Sonography combined with computed tomography can be used to identify gallbladder perforation and the presence of hepatic abscesses. Sonographic findings for gallbladder perforation may include the presence of a stone outside of the gallbladder, an obvious defect in the gallbladder wall, and other signs such as distended gallbladder, thickened gallbladder wall, striated appearance of the gallbladder wall, gallstones, debris/sludge, and adjacent abscesses. It is important for a sonographer to recognize these signs so that prompt treatment can be initiated. This case presents the sonographic and computed tomography findings of a type II perforated gallbladder as a result of a large stone that eroded into the liver with the subsequent development of two hepatic abscesses.

Biliary strictures are an uncommon yet challenging clinical problem. They are often iatrogenic in nature, usually the consequence of hepatobiliary surgery. Although the etiology may be benign, the clinical consequences, if unrecognized, can progress to ascending cholangitis, sepsis, and hepatic abscesses. Optimal treatment requires expertise and input from multiple specialties, including gastroenterology, surgery, infectious disease, and interventional radiology. Currently, available interventional techniques play a critical role in the management of patients with benign biliary strictures.

Streptococcus mitis is a common pathogen causing infections in oncological patients. However, cases of abscesses caused by Streptococcus mitis in oncological patients have not been reported so far. We report on 5-year-old child with nephroblastoma and pulmonary and hepatic metastases at diagnosis who went into complete remission undergoing chemotherapy and nephrectomy, and who developed new round lesions in liver and lungs under continuous chemotherapy suggestive of new metastases. Biopsy of the lesions revealed abscesses with detection of Streptococcus mitis. The child was successfully treated with antibiotics, finished chemotherapy per protocol and has been in complete remission for 14 months. Infectious lesions involving organs of typical metastatic dissemination can easily be misdiagnosed as metastases, especially in the absence of symptoms. Histologic proof of lesions suspicious of metastases is mandatory if it leads to a change of prognosis and therapy. Streptococcus mitis can be a causative organism of pulmonary and hepatic abscesses in oncological patients.

Introduction Klebsiella pneumoniae is a pathogen commonly found in community-onset bacteremia. It causes an invasive syndrome that is frequently presented by metastatic infections and abscesses elsewhere and that is necessary for surgical or drainage intervention. To achieve a scoring algorithm to identify patients with community-onset K. pneumoniae bacteremia (CoKPB) who are at risk for abscess occurrences, a retrospective cohort study consisting of adults with CoKPB was conducted. Methods A 6-year cohort study consisting of adults having community-onset monomicrobial K. pneumoniae bacteremia was conducted. In addition to clinical variables collected from medical records, the hypermucoviscosity (HMV)-related gene (rmpA and magA) and an HMV phenotype were integrated into the proposed scoring algorithm. Results Of the 258 eligible adults, only 79 (30.6%) had abscesses related to bacteremia. Besides the presence of magA (ie, capsular serotype K1) and the HMV-phenotype, five clinical predictors were significantly associated with abscesses in a multivariate analysis: male gender, comorbidities with diabetes mellitus or neurological disorders, recent chemotherapy, and high c-reactive protein levels. Together, these predictors were used to calculate the CoKPB abscess score. Based on the scoring algorithm, a cut-off value of +2 yielded the high sensitivity (93.7%) and the acceptable specificity (50.8%); the area under the ROC curve was 0.83. Conclusion A simple scoring algorithm that has substantial sensitivity and satisfactory specificity was proposed and the importance of the HMV phenotype or capsular K1 serotype was emphasized. The proposed predictive model needs external validation, but this scoring algorithm might be convenient and useful for clinicians.

Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography (CECT). The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter (5 filter levels with sigma weighting ranging from 1.0 to 2.5). We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with one-way ANOVA followed by Tukey honestly significant difference (HSD) test. Diagnostic performance was evaluated using the receiver operating characteristic (ROC) curve analysis.There were significant differences in entropy and uniformity at all sigma weightings (P0.001) among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings (P=0.002-0.006). Tukey HSD test showed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers (P=0.000-0.004). Entropy (at a sigma 2.0 weighting) had the largest area under the ROC curve (0.888) in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.

Background: Hepatolithiasis is the presence of calculi in the intra-hepatic bile ducts. If left untreated, it may cause recurrent cholangitis, hepatic abscesses, cirrhosis, liver atrophy, ...

Parvimonas micra is an obligate anaerobic bacterium and a known commensal of the human oral cavity and gastrointestinal tract. It is rarely associated with infections outside the oral cavity. Recently it has been isolated as a causative agent in a variety of systemic infections, but it has never been previously identified to cause a hepatic abscess. We report a 90-year-old woman with multiple hepatic abscesses caused by P. micra.

Biliary cutaneous fistula or external biliary fistula is an abnormal communication between the biliary tree and the skin surface. We present here a very rare case of spontaneous biliary cutaneous fistula communicating with intrahepatic bile duct in a 6 years old child. The child suffered from chronic hepatic parenchymal disease and presented initially with abdominal wall abscess, right subdiaphragmatic collection and possible hepatic abscesses. The patient left the hospital against medical advice and returned back after 6 months with external biliary fistula in the epigastric region.

Background A delayed post pancreatoduodenectomy haemorrhage is associated with a significant increase in peri operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short and long term outcomes of this approach. A retrospective review over a 10 year period at a quaternary referral pancreatic centre was performed. Methods Between 2002–2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem.

Rationale: Pyogenic hepatic abscess in children is a rare clinical condition. Hepatic abscesses caused by methicillin resistant Staphylococcus aureus are extremely rare. Patient concerns: A 6-year-old boy was referred to a tertiary children's hospital for a 6-day history of right lower abdominal pain and fever. Radiographic findings showed hepatic abscesses and soft tissue abscesses around the left femur. Diagnoses: Bacteriology of blood, hepatic abscesses, and soft tissue abscesses showed methicillin resistant Staphylococcus aureus. Interventions: Our patient received adequate drainage of MRSA abscesses and a complete course of antibiotics. Outcomes: The hepatic abscesses were healed and no recurrence has been founded until now. Lessons: This report describes an extremely rare case of hepatic abscesses with soft tissue infection caused by MRSA. Adequate drainage and appropriate systemic antibiotics should be considered as a standard treatment of MRSA abscesses in order to reduce the mortality rate and improve the quality of life.

Amebiasis remains a major health problem in Mexico. Therefore, the search for better culture media and low-cost diagnostic and therapeutic tools is fundamental. We present a new culture medium forEntamoeba histolyticawhich allows the microbe to preserve its virulence factors and ability to induce hepatic abscesses in animal models. The novel CLUPS medium is an improved version of the PEHPS medium, previously designed in our laboratory. The main difference is the substitution of raw beef liver in PEHPS by raw beef lung in the CLUPS medium. To compare the performance of three-culture media (traditional TYI-S-33, PEHPS, and CLUPS),E. histolyticatrophozoites were cultured in quintuplicate, followed by the evaluation of phospholipase activity and the induction of liver abscesses in golden hamsters.E. histolyticatrophozoites grew significantly better in CLUPS medium than in TYI-S-33. Likewise, CLUPS-cultured trophozoites produced significantly more phospholipases than TYI-S-33-cultured trophozoites. Finally, trophozoites grown in any of the three tested media had similar potential to induce liver abscesses.

Eitrige Leberabszesse – weniger ist mehr: Review für Internisten Zusammenfassung. Eitrige Leberabszesse (PHAa) sind selten, aber fatal, wenn unbehandelt. Fortschritte in der diagnostischen und interventionellen Radiologie haben das Management der PHAs erleichtert. Dennoch sind Abszesse im Lobus caudatus eine Herausforderung, vor allem für die allgemeine Internisten, die zum Übertherapieren neigen. Literatur über diese spezifische Form der Leberabszesse ist insuffizient. Der Zweck dieses Artikels ist es, einen Überblick über die vorhandene Datenlage zu PHAs im Allgemeinen und insbesondere im Lobus caudatus zu verschaffen, sowie die Aufmerksamkeit der allgemeinen Internisten auf diese wichtige Differenzialdiagnose zu richten und die Therapiewahl zu erleichtern. Wir betonen, dass eine Position im Sinne des «Weniger ist mehr»-Konzeptes für die Qualität der PHA-Therapie empfehlenswert ist.

Gemella haemolysans is a rare cause of human disease, namely infective endocarditis and brain abscesses. We report herein a case of Gemella haemolysans liver abscess in an immunocompetent adult patient secondary to blunt liver trauma and successfully managed by medical-surgical approach.

Clostridium perfringens (CP) bacteremia is a rare but rapidly fatal infection. Only 36 cases of CP bacteremia with gas containing liver abscesses on image studies have been reported in the literature since 1990. In this report, we describe a 65-year-old diabetic male with CP bacteremia which progressed into fulminant hepatic failure with subsequent fatal cerebral edema.

Cholecystectomy is the gold standard surgical treatment for acute calculous cholecystitis. Only approximately 0.4 % of these patients subsequently develop choledocholithiasis. The incidence of hepatic abscesses in these patients is unknown, but is likely low, considering there are approximately 2–15 cases of hepatic abscesses per 100,000 people in the US. The authors report the case of a 62-year-old man whose CT scan revealed hepatic abscesses secondary to choledocholithiasis, eight years after a cholecystectomy.

Hepatic abscesses are uncommon in non-human primates and usually occur as multifocal microabscesses originating from bacteremia. Necropsy, histopathology, and bacterial cultures were performed on five subadult to adult female rhesus macaques (Macaca mulatta) that died spontaneously. Necropsy findings included cavitating abscesses in the right central liver lobe of all five animals, with intralesional plant material in four animals. This is the first report of cavitating hepatic abscesses with intralesional plant material in non-human primates.

Aim To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differentiation of hepatic abscesses from non-infected fluid collections. Materials and methods In this retrospective study, 22 hepatic abscesses and 27 non-infected hepatic fluid collections were examined in 27 patients who underwent abdominal MRI including DW-MRI. Two independent observers reviewed T2-weighted + DW-MRI and T2-weighted + contrast-enhanced T1-weighted (CET1W) images in two sessions. Detection rates and confidence levels were calculated and compared using McNemar's and Wilcoxon's signed rank tests, respectively. Apparent diffusion coefficient (ADC) values of abscesses and non-infected fluid collections were compared using the t -test. Receiver operating characteristic (ROC) curves were constructed. Results There was no statistically significant difference in the accuracy of detecting abscesses using T2-weighted + DW-MRI (both observers: 21/22, 95.5%) versus T2-weighted + CET1W images (observer 1: 21/22, 95.5%; observer 2: 22/22, 100%; p 0.01). Mean ADC values were significantly lower with abscesses versus non-infected fluid collections (0.83 ± 0.24 versus 2.25 ± 0.61 × 10 −3 mm 2 /s; p 0.001). With ROC analysis there was good discrimination of abscess from non-infected fluid collections at a threshold ADC value of 1.36 × 10 −3 mm 2 /s. Conclusion DW-MRI allows qualitative and quantitative differentiation of abscesses from non-infected fluid collections in the liver.

We receive around 60 cases of hepatic abscess in a year. The commonest diagnosis reached at the time of discharge is amoebic liver abscess. The diagnosis of amoebic liver abscess is mostly presumptive and thus the patients are usually given a mixed treatment with injection ceftriaxone and tablet metronidazole. Here we report three cases of hepatic abscess diagnosed recently, where ascariasis was the probable etiology. Ascariasis may be a much commoner cause of hepatic abscesses in this region than we think.