Transient increase of CA 19-9 serum concentrations in a liver transplant recipient with cystic fibrosis and hepatic abscess: a case report and brief literature review.

CA 19-9 (carbohydrate antigen 19-9) is a tumor marker widely used for surveillance of patients with pancreatic cancer. However, even high levels of CA 19-9 may not necessarily be cancer-associated thereby complicating the diagnosis. This case report highlights a transient increase of CA 19-9 in a triple transplanted patient with cystic fibrosis and continuous immunosuppression for 20 years who was under antibiotics. This case emphasizes the need for a balanced interpretation of biological results, especially in cases where many confounding factors are present such as diabetes, chronic renal failure, cystic fibrosis and infections. This case also provides an opportunity to formulate a number of recommendations for the interpretation of tumor marker results in order to avoid long and costly further investigations.

Isolates and antibiotic susceptibilities of endogenous bacterial endophthalmitis: A retrospective multicenter study in Japan.

Endogenous bacterial endophthalmitis, also called metastatic endophthalmitis, is a rare bacterial endophthalmitis derived from distant infectious foci via the bloodstream. This infection can potentially cause not only severe visual disturbance, but also loss of the eyeball or death, as most patients are immunocompromised. This retrospective Japanese multicenter study analyzed 32 eyes in 25 definitive cases. Twelve patients (48.0%) had diabetes mellitus. Typical ocular findings were vitreous haze (87.5%), cells in the anterior chambers (62.5%) and retinal infiltrates (50.0%). Elevated body temperature (64.0%), high serum C-reactive protein (96.0%) and leukocytosis (52.0%) were also frequently observed. Culture positivity rates for intraocular fluid were higher in the vitreous (62.5%) versus aqueous humor (28.6%). High positivity rates were also observed for blood (57.1%) and central venous catheters (100%). The most common pathogen was Staphylococcus aureus (10 cases), including methicillin-resistant S. aureus (4 cases). The next most common pathogen was Klebsiella pneumoniae (7 cases), which was highly associated with liver abscess. Compared to a previous 1991 national multicenter study, there has been a fourfold increase in the ratio of S. aureus. Antibiotic susceptibility tests revealed that all Gram-positives were susceptible to vancomycin and all Gram-negatives were susceptible to third-generation cephalosporins, imipenem/cilastatin, gentamycin and levofloxacin. Prognostic factors influencing poor visual outcome included poor initial visual acuity (p < 0.01), K. pneumoniae (p = 0.027) and gram-negative bacteria (p = 0.014) as the causative bacteria. Intravitreal antibiotic injection in combination with vancomycin and ceftazidime may be applicable for use as part of the standard treatment regimen for EBE.

Pseudomonas aeruginosa liver abscess as the first manifestation of X-Linked agammaglobulinemia with a novel mutation

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[Bile duct lesions repaired with peritoneal tube grafts]. / Reparación de colédoco con autoinjerto de peritoneo.

BACKGROUND: A significant number of people suffer iatrogenic bile duct injury during laparoscopic cholescystectomy. Biliary-digestive bypass may be complicated by stenosis and biliary sepsis, affecting both quality of life and life expectancy. To avoid bypass synthetic grafts have been used, which are expensive. OBJECTIVE: Evaluating autologous implantation of peritoneus as alternative of bile duct repair. METHODS: Under general anesthesia, ten New Zealand adult rabbits were operated, common bile duct approached and sectioned underneath the cystic duct followed by a liver biopsy. An autologous graft was built of peritoneum and graft-bile duct proximal and distal end-to-end anastomosis done. Animals were followed-up by weekly bilirrubin and transferases. Rabbits were scheduled euthanized and a liver biopsy done for histological examinations. RESULTS: Autologous graft was easy to create and all rabbits survived. They did not develop jaundice or alterations in their normal habits. At necropsy, autologous grafts were removed and no signs of occlusion were noticed. Moderate short-term liver damage was observed but long-term damage was negligible. Bileoma and pyogenic liver abscess were observed in two animals, respectively. DISCUSSION: Our results favourably match well-known procedures used for bile duct repair, especially in cases of severe injury (Bismuth-Strasberg E1-3): it seems less complicated than biliary-digestive bypass, not as expensive as synthetic grafts, and much easier to build than human amnion graft. CONCLUSION: Interposing an autologous graft of peritoneum is an easy-to-create surgical procedure and circumferential bile duct injuries were adequately repaired.

Antecedentes: un número significativo de individuos sufrirá daño por iatrogenia del colédoco durante colecistectomías laparoscópicas. Las derivaciones bilio-digestivas pueden complicarse con estenosis y sepsis biliar y afectar la calidad y expectativa de vida. Para evitar la derivación se utilizan injertos sintéticos. Objetivo: evaluar el implante autólogo de peritoneo en la reparación de colédoco. Material y métodos: estudio experimental efectuado en 10 conejos Nueva Zelanda adultos a los que se les resecó un segmento del colédoco y para la reparación término-terminal de la vía biliar se construyó un neo-conducto con peritoneo parietal como auto-injerto. Se vigilaron con ontroles semanales de bilirrubinas y transaminasas. A la necropsia programada se estudió el segmento injertado, se realizó biopsia epática durante el procedimiento y la autopsia. Resultados: los animales no mostraron alteraciones en sus hábitos normales, la herida quirúrgica no tuvo complicaciones, no cursaron con ictericia y a la necropsia el segmento injertado se apreció totalmente integrado. En dos animales hubo como complicación un bilioma y un absceso hepático. El daño hepático observado inicialmente fue disminuyendo a lo largo del seguimiento. Discusión: nuestros resultados se equiparan con ventaja con los métodos conocidos de reparación de vías biliares, especialmente en lesiones severas (Bismuth-Strasberg E1-3). Adolece de las complicaciones de las derivaciones bilio-digestivas, no es caro como los injertos intéticos y es de mucho más fácil construcción que el injerto de amnios humano. Conclusiones: el auto-injerto de peritoneo es un procedimiento adecuado como alternativa para tratar lesiones circunferenciales de colédoco.

[Antibacterial therapy in surgical treatment of chronic hepatic abscess].

The results of surgical treatment of 58 patients for chronic hepatic abscess were presented. In patients of the main group hepatic resection was performed and in a control one--sanation and drainage of the abscess cavity. Antibacterial therapy was conducted in patients of both groups before and after operative treatment. The peculiarities and common efficacy of antibacterial therapy depending on the operative treatment kind were noted.

¿Es el absceso hepático de origen hídatídico un factor de riesgo para el desarrollo de complicaciones postoperatorias en pacientes intervenidos por hidatidosis hepática? / Liver abscess of hydatid origin as a risk factor for postoperative complications in hydatidosis

Background: Cyst infection and subsequent abscess formation is considered a complication of hepatic echinococcosis (HE). Aim: To determine whether liver abscess of hydatid origin (LAHO) is a risk factor for the development of postoperative complications (POC) in patients operated by HE. Material and Methods: Prospective cohort study. Patients consecutively operated by HE between 2000 and 2007 were studied. LAHO was considered as exposure and POC as outcome. Results: Fifty two patients with LAHO, aged 50 +/- 21 years (52 percent females) and 126 without LAHO, aged 48 +/- 20 years (56 percent females) were studied. Patients with LAHO had a higher frequency of coexistent cyst lesions and a lower frequency of biliary communications. The frequency of complications was 28.9 and 11.1 percent among patients with and without LAHO, respectively (p < 0.01, crude risk ratio of 2.6, 95 percent confidence intervals 1.4-5.0). Logistic regression showed a significant interaction of alkaline phosphatases with risk calculation. The risk ratio, adjusting by this variable, changed to 2.45 (95 percent confidence intervals 1.3-5.0). Conclusions: LAHO is a risk factor for the development of POC in patients operated by HE.

Introducción: La infección del quiste y subsiguiente formación de un absceso hepático de origen hidatídico (AHH) constituye una complicación evolutiva de la hidatidosis hepática (HH). Objetivo: Determinar si el AHH constituye un factor de riesgo (FR) para el desarrollo de complicaciones postoperatorias (CPO) en pacientes intervenidos por HH. Material y Método: Estudio de cohorte prospectiva. Se estudiaron pacientes intervenidos consecutivamente entre 2000 y 2007. La variable de exposición fue tener AHH y la variable resultado, el desarrollo de CPO (considerada de forma dicotómica). El tamaño de la muestra se calculó considerando nivel de significación de 5 por ciento, potencia de 80 por ciento, riesgo de CPO en pacientes con AHH de 24,4 por ciento y sin AHH de 6,5 por ciento; relación paciente con AHH: sin AHH de 1: 2; lo que determinó una muestra de 52 pacientes con AHH y 104 sin AHH. Se aplicaron análisis bivariados paramétricos y no paramétricos. Se calculó incidencia de CPO, riesgo relativo (RR) e intervalos de confianza del 95 por ciento (IC 95 por ciento); y se controló el efecto de variables clínicas, de laboratorio, evolutivas del parásito y quirúrgicas, aplicando modelos de regresión logística. Resultados: Las cohortes se conformaron por 52 pacientes con AHH y 126 sin AHH, con una mediana de edad de 45 años (59 por ciento de género femenino). La distribución de las variables categóricas fue similar en las cohortes en estudio, a excepción de "lesiones quísticas coexistentes" y "comunicaciones biliares". La incidencia de morbilidad fue 28,9 por ciento para la cohorte con AHH, y de 11,1 por ciento para la cohorte sin AHH (p = 0,0036; RR crudo de 2,6 [IC 95 por ciento 1,4 - 5,0]). El modelo de regresión logística permitió constatar que la variable "fosfatasa alcalina", interactuaba en la asociación en estudio (p = 0,018), razón por la que se controló por ésta, obteniéndose un RR ajustado de 2,45 con IC 95 por ciento de 1,3-5,0. Conclusión: Se...

Microbiology of liver abscesses and the predictive value of abscess gram stain and associated blood cultures.

Although rare, pyogenic liver abscesses are potentially fatal. We evaluated the predictive value of Gram stain of liver abscess aspirates and temporally associated blood cultures. Gram stains detected bacteria in 79% of the liver abscesses tested. The sensitivity and specificity of Gram stain of the liver abscesses were 90% and 100% for Gram-positive cocci (GPC) and 52% and 94% for Gram-negative bacilli (GNB). The sensitivities of the blood cultures for any GPC and GNB present in the liver abscess were 30% and 39%, respectively. Although, Gram stains and blood cultures offer incomplete detection of the microbial contents of pyogenic liver abscesses, both tests should always accompany liver abscess cultures.

A man with fever, rigors, and poor oral hygiene.

A 62-year-old man presented to the emergency department with a one-week history of subjective fever and rigors. He had had epigastric pain for three weeks, for which he was taking ranitidine, and in the past two to three months had experienced night sweats, a nonproductive cough, nausea, vomiting, and a 30-lb weight loss. He denied dsypnea, chest pain, hematochezia, melena, or any change in bowel habits.

[Determination of trace elements Cu, Zn, Mg, Cr, Mn in serum of people with hepatoma, cirrhosis, hepatapstema disease].

Using AAS method, we detected serum Zn, Cu, Mn, Cr, Mg in the people with hepatoma, cirrhosis and hepatophyma disease. The results showed that the level of serum Cu of people with hepatoma and cirrhosis were significantly higher than those in the healthy control and with hepatophyma disease (P < 0.01). The levels of serum Mn, Cr of those with hepatoma and cirrhosis disease were significantly lower than those with hepatophyma and the healthy control (P < 0.01). It is concluded that determination of Cu, Mn, Cr may be one of the methods to diagnose hepatoma and cirrhosis disease.

Absceso hepático piogeno. A propósito un caso / Hepatic abces. report of a case

Los abscesos hepáticos se relacionan a 2 grupos diferentes: Bacterias Piogenas y Entomoeba Histolitica. Con diferentes manifestaciones clínicas y tratamiento. El absceso hepático tiene una frecuencia de 0, 36 por ciento de Necropsia y ocurre en 6t§ y 7mo. decenios, sin predilección de sexo o raza. Los reportes residentes indican que la colangitis secundaria a cálculos o carcinoma, Septicemia generalizada y apendicitis aguda perforada son las causas más frecuentes. El 80 por ciento de los cultivos son positivos a Scherichia Coli, Staphilococus Aureus, Streptococos Hemolitico, Proteus, Klepsiella Bacteriodes y Anaerobios, estos últimos son cada ves más frecuentes

Prognostic factors for pyogenic abscess of the liver.

BACKGROUND: Percutaneous drainage and antibiotics for pyogenic abscess are well established therapeutic modalities. However, the mortality rate for hepatic abscess of liver remains high. STUDY DESIGN: Three hundred fifty-two cases of pyogenic hepatic abscesses were studied to evaluate prognostic factors. RESULTS: Using univariate analysis, the following factors were associated with a high mortality rate: patient age, gas-forming abscess, rupture of abscess, bilobe involvement, clinical sepsis, bilirubin (more than 2 mg per dL), blood urea nitrogen (more than 20 mg per dL), serum creatinine (more than 2 mg per dL), aspartate aminotransferase (more than 100 U per L), and albumin (less than 2.5 gm per dL). Using multivariate analysis, the following were independent significant factors in predicting mortality: patient age (more than 60 years), blood urea nitrogen (greater than 20 mg per dL), serum creatinine (greater than 2 mg per dL), total bilirubin (greater than 2 mg per dL), and albumin (less than 2.5 gm per dL). CONCLUSIONS: Systemic effects of hepatic abscess with sepsis and multiple organ failure were significant factors in predicting mortality. Local findings, such as rupture of the abscesses, multiple abscesses, and gas-forming abscesses, were not independent factors. Percutaneous drainage is always considered if the condition of the patient can not be improved with antibiotic therapy. Operative treatment is indicated if the patient is unresponsive to medical treatment and percutaneous drainage or if the patient has complications of biliary tract stone or rupture of the abscess.

Gas-containing liver abscess: radiological findings and clinical significance.

Sixty-two cases of verified gas-containing pyogenic liver abscess were reviewed to study the radiological and clinical prognostic factors. A mortality rate of 37.1% (23 cases) was observed. Among these patients, the survival time of 13 patients with alveolar gas pattern or pneumoperitoneum (6.15 +/- 7.36 days) was significantly shorter than that of the other 10 patients (17.70 +/- 13.32 days) despite immediate diagnosis and aggressive treatment. The poor radiological prognostic signs were: (1) alveolar gas pattern and pneumoperitoneum as viewed on radiographs; and (2) globular configuration, shaggy margin, alveolar internal structure, and total gas content on computed tomographic (CT) scans. High serum creatinine and glucose levels and a short time to diagnosis were the poor clinical prognostic factors. The aggressive treatment did not change the outcome. We conclude that, in addition to the clinical evaluation, meticulous radiological study of the abscess morphology should be done in cases of gas-containing liver abscess in an effort to provide further aggressive treatment for those patients with poor radiological prognostic signs.

Ultrasonography and determination of proteins and enzymes in blood for the diagnosis of liver abscesses in intensively fed beef cattle.

The concentrations of plasma proteins and the activities of liver enzymes were measured every 2 weeks from weaning to slaughter in 21 beef cattle, and their livers were examined ultrasonographically every 4 weeks. Eight of the 9 cases of single or multiple liver abscesses were detected by ultrasonography but some individual abscesses, particularly those in the left side of the liver, remained undetected. The time at which the abscesses were first detected ranged from 4 to 20 (mean 12.5) weeks. There were only slight variations in the blood constituents and they were of no significant value in the diagnosis of the liver abscesses.

Correlation of serum concentration of alpha 1-acid glycoprotein with lymphocyte blastogenesis and development of experimentally induced or naturally acquired hepatic abscesses in cattle.

Changes in serum alpha 1-acid glycoprotein (alpha 1AG) concentration in cattle with hepatic abscesses were observed, and function of alpha 1AG was evaluated, particularly its influence on cellular immune response. Test cattle (n = 4) were inoculated with Fusobacterium necrophorum, control cattle (n = 2) were inoculated with inactivated bacteria, and naturally affected cattle (n = 11) were found in a slaughterhouse. Determination of alpha 1AG was made by use of a single radial immunodiffusion method. The action on lymphocyte blastogenesis was determined by [3H]thymidine incorporation. Cultured lymphocytes from healthy cattle were treated with variable concentrations of alpha 1AG purified from serum obtained from cattle with hepatic abscesses and suppression of blastogenesis stimulated by each of 3 mitogens was measured. In cattle with experimentally induced abscesses, serum alpha 1AG concentration increased for 7 to 10 days after F necrophorum inoculation, its change being parallel to that of sialic acid. High concentration of alpha 1AG was found in naturally affected cattle and was highly correlated to sialic acid concentration. Suppression of lymphocyte blastogenesis in cattle with experimentally induced hepatic abscesses was highly correlated to serum alpha 1-AG concentration.