The usefulness of CT guided drainage of abscesses caused by retained appendicoliths.

OBJECTIVES: To determine the utility of percutaneous computed tomography (CT) guided drainage of abscesses formed secondary to retained appendicoliths. MATERIALS AND METHODS: A retrospective review was conducted over a 5-year period to identify patients who underwent CT guided drainage of abscesses related to retained appendicoliths. Inclusion criteria were a history of prior proven appendicitis treated by laparoscopic appendicectomy, identification of a post-operative abscess related to a visualised retained appendicolith and initial treatment by CT guided drainage. Data regarding initial technical success as well as long-term outcome was recorded in each case. RESULTS: In total, five patients were identified who underwent CT guided abscess drainage related to retained appendicoliths. There were three males and two females (age range 12-54 years). Initial drainage under CT guidance was technically successful in all cases with successful catheter placement and resolution of the abscess cavity. In all five cases however, there was recurrence of abscess formation following catheter removal. In one case, a second attempt with CT guided drainage was performed. Again this was initially successful with abscess recurrence following catheter removal. In all five cases, formal surgical drainage with removal of retained appendicolith resulted in a successful outcome. CONCLUSION: CT guided percutaneous drainage of intra abdominal abscess secondary to retained appendicoliths is only successful in the short term. Formal surgical drainage and removal of the appendicolith is required for long-term success.

Small bowel obstruction secondary to a giant enterolith complicating Crohn's disease.

BACKGROUND: Enterolith formation associated with Crohn's disease is a very uncommon clinical entity. AIM: To describe a case of sub-acute small bowel obstruction secondary to a giant enterolith in a patient with Crohn's disease. RESULTS: A 54-year-old male with a history of Crohn's disease presented with sub-acute small bowel obstruction secondary to a giant enterolith. The diagnosis was confirmed utilising plain film radiography and computed tomography CONCLUSION: Plain film radiography and computed tomography play a central role in establishing the diagnosis of this rare complication of Crohn's disease and assist in planning surgical intervention.

Vaccine induced HSV 1 antibodies fail to correlate with protection against HSV 2 in guinea pigs.

Guinea pigs immunised with HSV 1 subunit vaccine were bled, and subsequently challenged intravaginally with HSV 2. The clinical response to virus challenge was quantified, and correlations were sought between clinical score and virus-specific serum antibody titre in functional and binding assays (ELISA, neutralization, complement-mediated cytotoxicity and antibody-dependent cellular cytotoxicity). No significant relationships were found, and it was concluded that reactivity in the serological assays chosen did not correlate with protection against HSV 2 genital infection in vaccinated female guinea pigs.

Systemic and mucosal cell mediated immune responses against herpes simplex virus in vaccinated guinea-pigs detected by lymphocyte proliferation and monoclonal antibodies against macrophages and T cells.

Peripheral blood lymphocytes from guinea-pigs immunized with a herpes simplex virus (HSV) sub-unit vaccine (Skinner vaccine) were shown to produce an HSV antigen-specific lymphocyte proliferative response post vaccination. This response was associated with a reduction, compared with mock vaccinated and unvaccinated animals, in the clinical disease scores post intravaginal challenge. This reduction was not associated with the presence of macrophage or T cell infiltration in the vaginal mucosa postchallenge. In contrast mock vaccinated and unvaccinated guinea-pigs did not produce an HSV antigen-specific response post-vaccination but did demonstrate HSV antigen-specific lymphocyte proliferative responses post intra-vaginal challenge. The mock and unvaccinated animals had higher clinical disease scores postchallenge compared with sub-unit vaccinated animals and this was associated with the presence of cellular infiltrates in the vaginal mucosa. These results are discussed in relation to the immunopathology of the disease.

Mucosal antibody response to vaginal infection with herpes simplex virus in pre-vaccinated guinea-pigs.

The mucosal antibody response, in female guinea-pigs vaccinated with the Skinner herpes simplex virus vaccine, has been investigated. The HSV-specific secretory IgA response was assessed using the cross-reactivity of an antiserum raised against human secretory component. Animals vaccinated subcutaneously at a distant site were shown to respond to subsequent infection with HSV by the production of HSV-specific vaginal IgG and secretory IgA. No vaginal HSV-specific antibodies were found in infected, non-vaccinated animals.

A test for the relative potency of herpes simplex virus vaccines based upon the female guinea-pig model of HSV 2 genital infection.

An ELISA for total herpes simplex virus (HSV) 1 antigen content and a test of immunogenicity based upon the female guinea-pig model of HSV 2 genital infection were applied to two samples from batches of HSV 1 subunit ('Skinner') vaccine. The ELISA was reproducible within an approximately threefold limit of error and batches 1 and 2 were indistinguishable in antigen content. The effects of vaccination in the guinea-pig model were assessed by a statistical analysis of scores derived from the principal clinical signs, vaginal oedema and lesions on the external genitalia. The statistical power of the guinea-pig assay was such that reductions in the severity of illness approaching 40% would be significant (P less than 0.05) on 90% of occasions. The ability to make quantitative estimates of immunogenicity will prove useful in the quality control of HSV vaccine batches which are destined for clinical trials in man.