CT-guided percutaneous aspiration and catheter drainage of pyogenic liver abscesses.

Surgical drainage has been the accepted method of treatment for pyogenic liver abscesses. Modern imaging techniques have revolutionized the diagnosis and management of liver abscesses. Percutaneous aspiration and drainage have been reported as a treatment modality of pyogenic liver abscesses in the literature before. We treated 15 patients with pyogenic liver abscesses by percutaneous aspiration and drainage. All patients responded except two. No mortality was observed. Review of the literature and our experience with 15 patients suggest that because of the high recovery rate and few complications percutaneous aspiration and drainage should be the first line of treatment in the management of pyogenic liver abscesses.

Primary gastric tuberculosis: a case report and literature review.

Gastric tuberculosis is a rare entity; it usually occurs secondary to another lesion(s), mainly in the lungs. Only a few cases of primary gastric tuberculosis have been reported in the literature. Most commonly, gastric tuberculosis lesion(s) is located in the lesser curvature of the antrum and prepylorus, so the clinical picture is similar to that of peptic ulcer, in addition to the constitutional symptoms seen in tuberculosis in general. We report a case of a young man presented with abdominal pain acute gastric outlet obstruction due to a large mass in the lesser curvature of the antrum and the pylorus. The histological examination revealed caseating granuloma with the presence of acid-fast bacilli. Partial gastrectomy with Bilroth II reconstruction was performed and the patient was put on antituberculosis medications. There was no evidence of the tuberculous lesion anywhere else. Patient's follow-up observation in the clinic was uneventful.

Small cell carcinoma of the esophagus. Report of three cases and review of the literature.

Small cell carcinoma has been described in the lung, stomach, pancreas, small intestine, larynx, hypopharynx, thymus, kidney, prostate, breast, cervix, skin, and esophagus. Our three cases and review of the literature confirm that the clinical presentation and eventual evolution of small cell carcinomas of the esophagus appear to be basically similar to those of the far more frequently occurring squamous and glandular carcinomas. However, certain differences in age and sex distribution of cases should be noted. Although squamous cell carcinomas occur three to four times more commonly in males, the male-to-female ratio in SCC in 1.6. Squamous cell carcinomas of the esophagus reach a peak in the fifth and sixth decades of life; SCC cases occur a decade later. All of our patients had history of heavy smoking more than 50 pack-years, a factor that has also been implicated in predisposition to squamous cell carcinoma of the esophagus. History of smoking to this extent was also mentioned in three other patients. There are also some differences in the location of the tumor. SCC rarely occurs in the upper third of the esophagus. The most common location of this tumor is the lower third where APUD cells are most abundant. On the other hand, a majority of squamous cell carcinomas of the esophagus are localized to the middle third, the upper and lower third being involved in equal proportions of the cases. Despite the above reported differences in clinical symptoms and course of these two tumors, their gross appearance is similar. Mean survival of both diseases also seems to be similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Composite (adenocarcinoid) tumors of the gastrointestinal tract.

Tumors of the gut with composite features of both adenocarcinoma and carcinoid have been recognized mainly in the appendix. There also have been isolated reports of similar tumors arising from other parts of the gastrointestinal tract. It is generally concluded that these tumors have better prognosis than adenocarcinomas of the gastrointestinal tract. We reported six patients with composite tumors arising from the stomach in one, small intestine in two, cecum in two, and rectum in one patient. Clinical presentations in each was suggestive of malignancy with extension to either serosa and/or lymph nodes. Metastasis to liver was present in two patients. Histologically, the tumor showed glands with surface microvilli resembling adenocarcinoma and also organoid pattern with neurosecretory granules in cells resembling carcinoid. Two patients died three and nine months after surgery. The clinical presentation, findings at operation, and the postsurgical course of these six patients reveal that these tumors behave more like an adenocarcinoma than carcinoid and do not appear to have a better prognosis than ordinary adenocarcinoma.

A new PGE1 analogue (CL115,574) III. Effects on gastric acid and mucus secretion in man.

CL115,574, an analogue of PGE1, is a potent inhibitor of gastric acid secretion in animals. The effects of this compound on gastric acid and mucus secretion were studied in 8 male volunteers. The compound was well tolerated, and its maximally effective antisecretory dose (750 micrograms) inhibited pentagastrin stimulated acid secretion by approximately 40% over a 2-hour period, with stimulation beginning one hour after the drug was orally administered. CL115,574 proved to have a significant and sustained effect upon the stimulation of mucus secretion into gastric juice. Considering the possible role that mucus may play in mucosal cytoprotection, CL115,574 because of its antisecretory and mucogenic actions may prove to be an important clinical anti-ulcer compound.

Nizatidine: a new histamine receptor blocker in the treatment of active duodenal ulcers.

Forty-three patients with newly diagnosed duodenal ulcers were treated with a new histamine blocker, nizatidine, and with placebo. The incidence of complete endoscopic healing was 38, 74, and 82% in the nizatidine treated patients compared with 25, 37, and 50% in the placebo treated group after 2, 4, and 8 wk of treatment, respectively. Nizatidine was clearly more effective than placebo after 4 wk of treatment. The size of unhealed ulcers decreased more than 50% in 62, 50, and 50% in the nizatidine treated groups versus 27, 25, and 40% in the placebo treated groups after 2, 4, and 8 wk of treatment, respectively. The difference between the two was not statistically significant for any given period. There was a significant correlation between day pain relief and ulcer healing in both treatment groups. Nizatidine significantly improved day pain relief only after 8 wk of treatment (p less than 0.01). No patient developed any side effects as a result of nizatidine treatment, except that the serum creatinine level rose from 1.05 to 1.1 mg/100 ml but still remained within the normal accepted range. This study demonstrated that nizatidine at 150 mg po bid could be effectively used in the treatment of duodenal ulcer disease.

Duodenal mucosal T cell subpopulation and bacterial cultures in acquired immune deficiency syndrome.

Enteric infections, chronic diarrhea frequently with no obvious etiology, and weight loss cause major morbidity and mortality in acquired immune deficiency syndrome (AIDS). Alterations in mucosal immunity may explain the increased incidence of enteric infections, and contamination of the upper small intestine with bacteria may be the cause of weight loss observed in these patients. To test this hypothesis we studied the mucosal T lymphocyte subset in duodenal mucosal biopsies in 14 AIDS and seven control patients. Duodenal fluid was also cultured for aerobic and anaerobic bacteria. There was a significant decrease among leu-3a T cells (helper/inducer) subset in AIDS. The proportion of mucosal T cells reacting with leu-2a (cytotoxic/suppressor) was significantly increased in AIDS patients. These patients also had a significant reversal of the normal mucosal helper/suppressor T cell ratio. There was no change in the number of leu-7 cells (cells mediate natural killer and antibody-dependent cellular cytotoxicity) as compared to controls. All patients with diarrhea and three of five patients without diarrhea had bacteria in their duodenal fluid. Mean number of organisms was 4.5 X 10(4)/ml. Cultures were negative in all control subjects. The results reveal that the abnormalities of T cell subpopulation in the blood of AIDS patients also occur in their duodenal mucosa. This immunological abnormality is associated with the bacterial colonization of upper gastrointestinal tract which may explain the diarrhea and weight loss observed in majority of our patients. The results also indicate that increased incidence of enteric infections in AIDS may be explained on the basis of altered mucosal immunity.

Identification of Campylobacter pylori by using the rapID NH system.

Campylobacter pylori has been associated with chronic active antral gastritis. The organism was isolated from 19 of 45 gastric mucosal biopsies on blood agar plates with increased CO2 at 35 degrees C. The RapID NH system, a set of dehydrated substrates for preformed enzymes, was used to assist in the identification of C. pylori. All C. pylori gave the same biochemical profile, and it was different from those of all other organisms in the profile index of the manufacturer. The RapID NH system is useful in the identification of C. pylori.