[Classical and laparoscopic therapeutic options in surgery for hepatic abscess]. / Optiuni terapeutice clasice si laparoscopice în chirurgia abceselor hepatice.

Although lots of modern surgical and imaging techniques have been developed and last generation antibiotics are in use, the difficulties in the diagnosis and treatment of hepatic abscesses are still a rather sombre reality. Our research concerning 14 patients submitted to surgery within the last ten years can be thought of as a record, considering the poor number of cases in the last decades. So, our study also includes the possible clinical or imaging errors, the technical details of the surgery, the attitude towards the abscess cavity and the still obscure etiology in most of the cases. The correlation between the surgical risk and the rest of the hepatic volume, evaluated by computed scanning technique, represents another objective of this paper. In the large or in the multiple disseminated abscesses, the small area of the remaining functional hepatic tissue, was correlated to the postoperative slow or even bad evolution in two cases. The radiological, ultrasound and scanner control showing the reducing or disappearing of the abscess cavity after drainage in all the cases, represent an argument of the correct therapeutic approach.

Clinical manifestations in the West Nile virus outbreak.

During the summer of 1996 an unusual clustering of meningoencephalitis cases was recorded in the Capital City, Bucharest, and in some areas from South-East Romania. After an initial suspicion of an enteroviral etiology was discarded, the West Nile etiology was confirmed by specific antibodies demonstration through hemagglutination-inhibition and ELISA tests. This study included 251 patients with the diagnoses of West Nile acute encephalitis (166 cases), acute meningitis (57 cases) and acute febrile disease (33 cases). The patients' age ranged from 1 to 89 years (mean 51.1 years). The most frequent clinical manifestations were: fever (95.7% of cases), cephalalgia (92.6%), stiffness of the neck (89.1%), vomiting (62.5%), marked asthenia (46.5%), myalgia (28.9%). In addition, patients with encephalitis exhibited: alteration of consciousness (89.2% of cases), tremor of extremities (40.4%), ataxia (44%), paralysis (15.1%). The fatality rate was 15.1% in acute encephalitis, 1.8% in acute meningitis and 0% in the acute febrile disease.