Incidence Of Liver Abscess Research Articles

Pyogenic liver abscess in children

Improvements in the medical and surgical care of pediatric patients have substantially reduced the incidence of pyogenic liver abscess, which is now a very uncommon condition in children. The purpose of this study was to review five cases of pyogenic liver abscess in children presenting to our hospital. Three patients were managed by percutaneous needle aspiration under ultrasonographic guidance together with antibiotic therapy. Two patients with multiple small abscesses were managed by prolonged antimicrobial treatment alone. All five patients survived. The etiology, diagnosis and medical and surgical management of liver abscess in children are discussed.

Incidência de ruminite e abscesso hepático em bovinos jovens confinados alimentados com dietas contendo aditivos alimentares

<p>O objetivo deste estudo foi avaliar o efeito da inclusão do preparado de anticorpos policlonais (PAP) e/ou de monensina sódica (MON) na morfologia das papilas ruminais, incidência de ruminites (IR) e abscessos hepáticos (AH) em bovinos jovens confinados. Foram utilizados 72 novilhos da raça Brangus, não castrados, com peso vivo inicial de 261,04 ± 34,73 kg, em 24 baias (3 animais/baia) com 6 repetições por tratamento. O delineamento experimental foi inteiramente casualizado em arranjo fatorial 2 x 2, sendo os fatores a adição ou não de MON e PAP. Após o abate foram realizadas as avaliações. No fígado tanto o percentual de AH quanto a severidade foram menores (P<0,01) nos animais que receberam PAP em relação aos que não receberam. A inclusão de MON foi apenas eficiente em reduzir (P<0,01) a severidade dos AH em relação ao tratamento sem o aditivo. Não houve efeito dos aditivos sobre o IR. O tratamento com MON resultou em maior (P=0,07) superfície de absorção/cm<sup>2</sup> de parede de rúmen e maior (P=0,10) área papilar em relação ao tratamento sem este aditivo. Número de papilas/cm<sup>2</sup> de parede e área média das papilas não apresentaram diferenças entre tratamentos. O uso de PAP foi eficiente na redução de AH bem como a severidade, porém não foi capaz de melhorar a forma e a estrutura das papilas ruminais, como o observado com o uso de MON.</p>

Clinical Characteristics and Outcomes of Pyogenic Liver Abscess in Elderly Korean Patients.

Incidence of pyogenic liver abscess (PLA) has been increasing worldwide, especially in the elderly population. Therefore, the aim of this study is to elucidate the clinical features and outcomes of PLA in elderly patients. A total of 602 patients diagnosed with PLA from January 2003 to January 2013 were analyzed retrospectively. The patients were divided according to two age groups;≥ 65 years (n=296) and <65 years (n=306). The mean age was 73.59 ± 5.98 (range, 65-93) years in the elderly group. Significantly higher incidence of females (52.4% vs. 29.1%, p<0.001), hepatobiliary disease (41.2% vs. 24.8%, p<0.001), hepatobiliary procedure (29.4% vs. 13.7%, p<0.001), underlying malignancy (18.2% vs. 4.6%, p<0.001), culture positivity of resistant organism (20.6% vs. 14.4%, p=0.047), occurrence of complication (19.6% vs. 12.8%, p=0.026), and higher white blood cell (13.44 ± 6.56 vs. 12.26 ± 5.89, p=0.021), but lower rates of right lobe abscess (67.2% vs. 80.4%, p<0.001), fever (68.6% vs. 79.3%, p=0.003), and lower CRP (16.79 ± 9.67 vs. 18.80 ± 9.86, p=0.012) was observed in elderly PLA patients, compared to younger patients. Regarding complications, elderly patients had higher incidence of septic shock (8.1% vs. 2.3%, p=0.001) and cardiovascular disease (2% vs. 0%, p=0.014). More atypical presentations and complications tend to occur in elderly PLA patients compared with younger patients. Clinicians should be aware of these age-related differences in PLA and devise management strategies accordingly.

Splenectomy Correlates With Increased Risk of Pyogenic Liver Abscess: A Nationwide Cohort Study in Taiwan

ObjectivesLittle is known about the risk of pyogenic liver abscess in patients with splenectomy. We explored the relationship between splenectomy and pyogenic liver abscess in Taiwan.MethodsWe conducted a nationwide cohort analysis using the hospitalization dataset of the Taiwan National Health Insurance Program. We included 17 779 subjects aged 20–84 years who underwent splenectomy in 1998 to 2010 (splenectomy group) and 70 855 randomly selected subjects without splenectomy (non-splenectomy group). Both groups were matched by sex, age, other comorbidities, and hospitalization year of receiving splenectomy. The incidence of pyogenic liver abscess at the end of 2011 was measured. The multivariable Cox proportional hazard regression model was used to estimate the hazard ratios and 95% confidence intervals for pyogenic liver abscess associated with splenectomy and other comorbidities.ResultsThe overall incidence rate was 3.75-fold higher in the splenectomy group than that in the non-splenectomy group (2.15 vs 0.57 per 1000 person-years; 95% confidence interval, 3.57–3.94). After controlling for potential confounding factors, the adjusted hazard ratio of pyogenic liver abscess was 3.89 in subjects with splenectomy (95% confidence interval, 3.20–4.72) when compared with subjects without splenectomy. In further analysis, the hazard ratio markedly increased to 14.34 for those with splenectomy and having any of the assessed comorbidities, including alcoholism, biliary stone, chronic kidney disease, chronic liver diseases, and diabetes mellitus (95% confidence interval, 10.61–19.39).ConclusionsPatients with splenectomy are at an increased risk of developing pyogenic liver abscess, particularly when they have comorbid conditions.

Epidemiology and clinical outcome of pyogenic liver abscess: an analysis from the National Health Insurance Research Database of Taiwan, 2000-2011.

The epidemiology of pyogenic liver abscess continues to change and the issue of antimicrobial therapy is controversial. This study investigated the epidemiology and clinical outcomes of antimicrobial therapy. The annual incidence rates, demographic data, underlying diseases, complications, length of stay, mortality rates, and antimicrobial therapy were analyzed using the data retrieved from the Longitudinal Health Insurance Database 2000, Taiwan, from 2000 to 2011. The annual incidence of pyogenic liver abscess for all age groups increased gradually in Taiwan from 10.83 per 100,000 person-years in 2000 to 15.45 per 100,000 person-years in 2011. Pyogenic liver abscess occurred more commonly in patients with male sex, of older age (>50years), and lower family income. Among the 1522 adult patients with pyogenic liver abscess, 537 (35.3%) patients had diabetes mellitus, 165 (10.8%) patients had complications, 234 (15.4%) patients received mechanical ventilation, and 361 (23.7%) patients had a stay in intensive care; the mortality rate was 8.2% (125/1522). There were 426 (28%) patients treated with cefazolin and 158 (10.4%) patients treated with extended-spectrum cephalosporins. There were no statistically significant differences in the length of stay and mortality rates between these two groups (20.2days vs. 23.1days; and 7.5% vs. 10.1%, respectively). The clinical outcomes of pyogenic liver abscess treated with cefazolin were comparable to those treated by extended-spectrum cephalosporins. Extended-spectrum cephalosporins should be used for severe complications, such as meningitis and endophthalmitis. Further surveillance of epidemiology and cohort analysis of antimicrobial therapy are important.

Spontaneous Enterobacter Cloacae Pyogenic Liver Abscess

Introduction: Pyogenic liver abscess is associated with significant morbidity and mortality. The overall case fatality rate for pyogenic liver abscess is 5.6%. The incidence of pyogenic liver abscess in North America has steadily increased over the past decade, is currently estimated to be 2.3 cases per 100,000, and is higher among men than women. Case Report: A 51-year-old white female with past medical history of hypertension presented to the primary care clinic with a 2-week history of abdominal pain and generalized malaise. She denied any history of recent travel, intravenous drug abuse, alcoholism, recent surgical or endoscopic procedures. She was noted to be febrile, and abdominal examination revealed right upper quadrant tenderness. She was then transferred to the emergency department, where laboratory work-up revealed an elevated white blood cell count of 18 x 109 cells. Contrast enhanced computerized tomographic (CECT) scan of the abdomen showed multiple peripherally enhancing lesions in both lobes of the liver, suggestive of multiple liver abscesses. The largest collection measuring 7 cm in the right posterior lobe was drained using a CT guided pig tail catheter insertion. Gram stain and culture of the aspirate grew Enterobacter cloacae. She was treated with intravenous piperacillin-tazobactam for 4 weeks, followed by oral levofloxacin and metronidazole for another 4 weeks. Follow-up evaluation at 6 weeks after treatment completion showed complete radiographic resolution. Discussion:Enterobacter cloacae is a gram-negative, facultative anaerobic, rod-shape bacteria found as a normal gut flora in many human beings. In the U.S., the more commonly identifiable organisms in patients with pyogenic liver abscess are E.coli and Streptococcus species. However, Asian and African countries report a higher prevalence of parasitic and Klebsiella infections. Enterobacter cloacae infections are commonly seen in patients with an underlying hepato-biliary or pancreatic disease, recent surgical procedure, or with an underlying malignancy, especially colon cancer. To our knowledge, this is the first reported case of Enterobacter cloacae infection causing a clinically significant pyogenic liver abscess in a patient with no identifiable risk factors. The exact mechanism of the spread of this organism is uncertain, but spontaneous bacterial translocation seems to be the most likely explanation. This is particularly worrisome, as significant antimicrobial resistance exists within this group of species. Our patient was treated with a CT-guided drainage in combination with prolonged antibiotics in a relatively large size abscess (>5 cm) with good outcome and avoiding a surgical intervention.

English

OBJECTIVES: To analyses the clinical profile, diagnosis and management of liver abscesses. MATERIALS AND METHODS: A prospective study of 30 patients (28 male; 2 females; Age range of: 10-80 years (with a mean age of 43 years) with liver abscesses were studied for their clinical profiles diagnosis and management. The study was carried out from Jan. 2013 to May 2014. 7/30 (23.3%) patients were managed conservatively. 21/30 (70%) patients underwent percutaneous aspiration/pigtail catheter insertion. Laparotomy was done on 2/30 (6.7%) cases. RESULTS: Liver abscess most commonly occurs between 40-60 years. Males were affected more than females. Fever was the most consistently occurring symptom (96.7% of cases). Alcohol consumption was the single most important etiological factor for causation of liver abscess. Alkaline-phosphatase is the most consistently elevated, abnormal liver function test (76.6% of cases). Most liver abscess present as solitary lesions (70%) and most of them occur in right lobe (90).Mortality rate was 3.3%. INTRODUCTION: Liver abscess is a common condition in India. India has 2 nd highest incidence of liver abscess in the world. Liver abscesses are caused by bacterial, parasitic or fungi infection. Pyogenic abscesses account for three quarters of hepatic abscess in developed countries. While amoebic liver abscess cause two third of liver abscess in developing countries. 1 The World Health Organization reported that Entamoeba Histolytica causes approximately 50 million cases and 100,000 deaths annually. 2 In last few years there is a change in trend in etiology and treating these abscesses more conservatively and by less traumatic means compared to open surgical procedures. The primary mode of treatment of amoebic liver abscess is medical. However, as many as 15% of amoebic abscesses may be refractory to medical therapy. In such patients and in patients with pyogenic liver abscesses, surgical drainage has been the traditional mode of treatment. However operative drainage is associated with significant (10-47%) morbidity and mortality. In recent years imaging guided percutaneous drainage using catheters has been increasingly used to treat liver abscesses with reported success rates ranging from 70-100%. Also few studies have shown therapeutic needle aspiration to be a simpler and less costly mode of treatment, but needs repeated aspiration, with more failure rates. Though every abscesses should be treated on its individual merits, there is a need to define indications to adopt particular method of treatment so as to reduce morbidity, avoid mortality, make the treatment affordable and to achieve a highest cure rate. Through this study, it is aimed to develop management protocol for patients with liver abscess in our setting.

Epidemiology and mortality of liver abscess in end-stage renal disease dialysis patients: Taiwan national cohort study.

Background and ObjectivesTo determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis.Design, Setting, Participants, & MeasurementsUsing Taiwan’s National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models.ResultsOf the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years). The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%.ConclusionsThe incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.

Liver Abscess After Transarterial Chemoembolization in Patients With Bilioenteric Anastomosis: Frequency and Risk Factors

The purpose of this study was to clarify the frequency of and risk factors for liver abscess formation after transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma or metastatic hepatic tumors after undergoing bilioenteric anastomosis. From January 1996 to June 2012, 25 patients (21 men, four women; age range, 34-74 years) with hepatocellular carcinoma (n = 12) or metastatic hepatic tumors (n = 13) with an underlying bilioenteric anastomosis underwent 65 TACE procedures. The incidence of liver abscess, predisposing factors (diabetes, Child-Pugh class, leukopenia, tumor number, tumor size, tumor burden, tumor type, portal vein thrombus, lipiodol dose, particulate embolization, embolization selectivity, oily portogram, antibiotic prophylaxis, and occurrence of liver abscess at initial TACE), and clinical outcome were evaluated. Statistical analysis for relations between liver abscess and predisposing factors was performed by Fisher exact test and linear-by-linear association. Liver abscess developed after 17 of 65 (26.2%) TACE procedures performed on 12 of 25 (48%) patients. Two patients died of progression of liver abscess into sepsis. Univariate and multivariate analyses showed that leukopenia (p = 0.029), occurrence of liver abscess at initial TACE (p = 0.082), and particulate embolization or oily portogram (grade 2) (p = 0.001) were associated with a higher incidence of liver abscess. The incidence of liver abscess was high among patients with bilioenteric anastomoses who underwent TACE. Leukopenia, occurrence of liver abscess at initial session of TACE, and particulate embolization or oily portogram (grade 2) were associated with the development of liver abscess.

Two hepatic abscesses of biliary origin: interest of echography

The annual incidence of non-parasitic liver abscess is low with 2.3 per 100 000. The biliary abscesses are usually secondary to biliary obstruction; with gallstones is by far the most common. In ultrasound, the early phase: abscess may appear hyperechoic, the liquefaction phase: anechoic with internal echoes, contours are usually irregular. The treatment of abscess hepatic are based on the puncture echo guided, and by broad-spectrum antibiotics guided by susceptibility of germ, surgical treatment is reserved for failures puncture, if not endoscopic sphincterotomy. We report a woman aged 85 years, coronary heart disease followed for his five years with ejection fraction 35%, cholecystectomized seven years ago, admitted to the ICU for fever, pain right upper quadrant. Abdominal ultrasound showed a dilated principal bile duct to 1.7 cm diameter with gallstone a 1.8/1.7cm, two liver images: segment VII and V with 6.1/5cm and 6.3/5.6 cm diameter, fuzzy aspects, without clear boundary with the liver parenchyma, with an anechoic center associated with some hyperechoic image in favor of liquefaction abscess stage, of biliary origin. Amoebic serology was negative. The drainage echo guided was made with empirical antibiotic, and guided after by a susceptibility which the germ was a streptococcus. The patient was referred for possible endoscopic sphincterotomy after seven days, given the high anesthetic risk for surgical drainage of the bile duct.

A Case of Clostridium septicum Liver Abscess Associated with Malignancy

Purpose: A 53-year-old Caucasian man is brought to the emergency room after being found unresponsive at his group home. On arrival, he is hypotensive but regains consciousness after fluid resuscitation. He reports noticing increasing abdominal girth over past week, bloating, lower extremity swelling, weight loss, decreased appetite, several months of hematochezia and diarrhea. His medical history is limited to schizophrenia, since he lacks medical follow-up. On physical examination, he appears jaundiced, cachectic, and uncomfortable. His abdomen is soft but distended with significant hepatomegaly and liver edge extending 7 finger-breaths below the right costal margin. Rectal exam reveals fullness with brown guaiac positive stool. Other pertinent findings include temporal wasting, sclera icterus, dry mucus membranes, bilateral crackles and bilateral lower extremity pitting edema. On CT scan, the liver is enlarged, diffusely heterogeneous with multiple discrete masses. Several areas of gas and debris are present in the hepatic parenchyma. Rectosigmoid thickening is noted. He is placed on mechanical ventilatory support for hypoxic respiratory failure from septicemia. Antibiotic therapy with intravenous tigecycline and clindamycin is initiated. He underwent CT-guided percutaneous abscess drainage. The blood and abscess culture reveal Clostridium septicum, high CEA and Ca19-9 markers. He remained hypotensive requiring multiple agents for vasopressor support, and became hypothermic and anuric. Family withdrew care on the 5th day of hospital stay. Autopsy revealed a primary rectal adenocarcinoma with liver metastasis. Pyogenic liver abscess has been described since the time of Hippocrates (400 BC). The incidence of pyogenic liver abscess is estimated to be 8-15 cases per 100,000 persons. Fatalities can range from 3 to 30%. The risk factors associated with mortality have included age, bacteremia, and comorbities such as cirrhosis, renal failure and malignancy. Clostridium septicum is an anaerobic gram-positive spore forming bacillus. C. septicum sepsis is often fulminant with reported mortality rates of approximately 60%. A relationship between C. septicum infection and malignancy, especially hematologic or colonic malignancy has been suggested. One explanation as to why Clostridium infections are present in malignancy is that anaerobic glycolysis of the tumor provides a hypoxic and acidic environment that may be conducive to spore germination thus leading to infection. An early diagnosis is critical in choosing appropriate antibiotic and surgical intervention for treatment of C. septicum related sepsis.

Liver Abscess Following Transarterial Chemoembolization

Transarterial chemoembolization (TACE) alone or in combination with thermoablation is commonly used in treating primary and secondary liver malignancies.1,2 It has proven to be safe and effective in treating hepatocellular carcinoma (HCC), neuroendocrine tumors, ocular melanoma, cholangiocarcinoma, and sarcoma. Known complications from hepatic embolization include the self-limiting postembolization syndrome (i.e., pain, nausea, vomiting, fever), liver infarction, liver failure, liver abscess, biloma formation, gastrointestinal bleeding, tumor rupture, septicemia, and pulmonary embolism. Approximately 5% of patients will have serious adverse events after chemoembolization, with the most common being liver abscess or liver infarction.1 This case reviews the incidence, risk factors, diagnosis, and treatment of liver abscess following chemoembolization as well as prophylactic measures to prevent its occurrence.

Wheat distillers grains in feedlot cattle diets: Feeding behavior, growth performance, carcass characteristics, and blood metabolites1,2

A study was conducted to evaluate feed intake, ADG, carcass quality, eating behavior, and blood metabolites in feedlot beef steers fed diets that varied in proportion of wheat dried distillers grains with solubles (DDGS) replacing barley grain or barley silage. Two hundred crossbred steers (BW = 489 ± 30 kg) were blocked by BW and randomly allotted to 20 pens (5 pens per treatment). Steers were fed 1 of 4 diets: control without DDGS (CON), 25% (25DDGS), 30% (30DDGS), or 35% (35DDGS) wheat DDGS (DM basis). The CON diet consisted of 15% barley silage and 85% barley-based concentrate; the 3 wheat DDGS diets were formulated by substituting 20% barley grain and 5, 10, or 15% silage, respectively, with 25, 30, or 35% wheat DDGS so that the 35DDGS diet contained no silage. The diets were formulated such that wheat DDGS was substituted for both barley grain and barley silage to evaluate whether wheat DDGS can be fed as a source of both energy and fiber in feedlot finishing diets. Dry matter intake of steers fed 25DDGS was greater (P < 0.01), but final BW, ADG, and G:F were not different compared with steers fed CON diet. Carcass characteristics and liver abscess score were not different between CON and 25DDGS. Steers fed 25DDGS had longer eating time (min/d; P < 0.01), greater meal frequency (P < 0.04), but a slower eating rate (P < 0.04). Replacing barley silage with increasing amounts of wheat DDGS (from 25DDGS to 35DDGS) linearly reduced (P < 0.01) DMI. Final BW, ADG, and G:F were not affected by increasing amounts of wheat DDGS. Carcass traits were not different, whereas liver abscess scores linearly (P < 0.01) increased as more barley silage was replaced by wheat DDGS. Eating time (min/d) and duration of each meal linearly (P < 0.02) decreased, whereas eating rate (min/g of DM) linearly (P < 0.01) increased with increasing replacement of barley silage. Blood urea N was doubled (P < 0.01) compared with CON by inclusion of wheat DDGS. Results indicate that wheat DDGS can be used effectively in feedlot diets, decreasing the need for barley grain or silage without negatively affecting growth performance and carcass characteristics. A reduction in the amount of roughage required to maintain growth performance is a potential advantage in feedlot operations because forage is costly and often of limited availability. Thus, DDGS can be a possible alternative as long as they are available and cost effective; however, increased incidence of liver abscess and increased N content of manure need to be considered when greater amounts of wheat DDGS are included in finishing diets.

Liver abscess presentation and management in Saudi Arabia and the United Kingdom

BACKGROUND AND OBJECTIVES:Liver abscess (LA) is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom (UK).DESIGN AND SETTING:Retrospective review of LA patients from three tertiary care centers (2 from Saudi Arabia and 1 from the UK) over a period of 10 years, from 1995 to 2005.PATIENTS AND METHODS:Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome.RESULTS:A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean (SD) age was 45.2 (20.3) years for those from Saudi Arabia and 55.4 (18.8) years for those from the UK (P=.022). The majority of the patients were males (70% from Saudi Arabia and 80% from the UK). Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 (80%) patients. Organisms were isolated in 43 (52%) cases and the majority of these were coliforms (58%). Amebic liver abscesses occurred in 19 (23%) patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 (80%) patients with aspiration and/or antibiotics, and 9 (10.8%) patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome (P=.008, .029 and .001, respectively).CONCLUSIONS:Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas.

UNILATERAL VERSUS BILATERAL DRAINAGE USING SELF‐EXPANDABLE METALLIC STENT FOR UNRESECTABLE HILAR BILIARY OBSTRUCTION

There is no consensus on the choice of either unilateral or bilateral drainage in stent placement for patients with unresectable hilar biliary obstruction. The aim of the present study was to clarify which drainage method is superior. We retrospectively reviewed 82 patients with hilar biliary obstruction who underwent metallic stenting. These patients were divided into a unilateral drainage group (Uni group) and a bilateral drainage group (Bi group). There was no significant difference between the groups in median survival time, median stent patency period, and median complication-free survival time. The most frequent complication was stent obstruction, followed by cholangitis. Liver abscess was found at a higher frequency in the Bi group (17.6%) than in the Uni group (1.5%) (P=0.0266). There was no significant difference between the groups in the occurrence of two or more complications (P=0.247), life-threatening severe complications (P=0.0577), and stent obstruction by sludge (P=0.0912). When compared with bilateral biliary drainage, unilateral biliary drainage is associated with a lower incidence of liver abscess as well as a comparable outcome of stent patency time and complication-free survival. We therefore propose that hilar biliary obstruction can be treated first by unilateral drainage with a metallic stent and by bilateral drainage only in patients who develop cholangitis in the contralateral biliary tree.

Evaluation of dried distillers grains and roughage source in steam-flaked corn finishing diets1

Two studies were conducted to evaluate effects of dried distillers grains with solubles (DDGS) and alfalfa hay (AH) or corn silage (CS) on feedlot performance, carcass characteristics, ruminal fermentation, and diet digestibility in cattle fed steam-flaked corn (SFC) diets. In trial 1, crossbred heifers (n = 358; BW = 353 +/- 13 kg) were used in a finishing trial to evaluate interactions between corn-DDGS and roughage source (AH or CS) in terms of impact on feedlot performance and carcass characteristics. Experimental diets (DM basis) consisted of SFC and 11% CS without DDGS (SFC-CS), SFC and 11% CS with 25% DDGS (DDGS-CS), SFC and 6% AH without DDGS (SFC-AH), and SFC with 25% DDGS and 6% AH (DDGS-AH). Heifers were fed for ad libitum intake once daily for 97 d. Results indicated no interaction between DDGS and roughage source with respect to animal performance. Feeding DDGS did not affect ADG (P = 0.19), DMI (P = 0.14), or feed conversion (P = 0.67). Heifers fed CS had greater DMI than those fed AH (P = 0.05), but ADG (P = 0.56) and G:F (P = 0.63) were not different. There were no differences among treatments with respect to HCW, dressing percentage, subcutaneous fat thickness, quality grades, or yield grades (P > 0.20). Cattle fed CS tended (P = 0.10) to have greater marbling scores than those fed AH. There was an interaction (P = 0.02) between roughage and DDGS with respect to incidence of liver abscess. The greatest incidence was observed in cattle fed diets without DDGS when CS was fed, and the least was observed in cattle fed diets without DDGS when AH was used. In the second trial, ruminal fermentation characteristics and diet digestibility were examined in 12 cannulated Holstein steers fed similar diets to those fed in the finishing trial. Ruminal pH for all treatments was below 5.8 for 14 h after feeding. Acetate:propionate ratios were less (P = 0.02) in steers fed 25% DDGS but had greater (P = 0.02) ruminal lactate concentrations compared with cattle fed 0% DDGS. Feeding 25% DDGS decreased (P < 0.01) ruminal ammonia concentrations, and digestion of DM and OM was less (P < 0.01) compared with diets without DDGS. The decrease in digestibility was largely attributable to decreases in digestion of CP (P = 0.03) and NDF (P < 0.01). Feeding strategies aimed at increasing ruminal pH and ruminally available protein may improve digestion of DDGS in steam-flaked corn-based finishing diets.

Gonadectomy inhibits development of experimental amoebic liver abscess in hamsters through downregulation of the inflammatory immune response

Incidence of amoebic liver abscess (ALA) in human males is considerably higher than in females, suggesting a role for sex hormones in this parasite infection. We describe here the effect of hamster gonadectomization on the development of ALA. After monitoring the decrease of oestradiol in females and testosterone in males to undetectable levels by ELISA and Radio Immuno Assay (RIA) in serum, hamsters were intraportally infected with Entamoeba histolytica trophozoites and killed 7 days later. ALA was absent in 50% of male and 15% of female gonadectomized (Gdx) hamsters, in comparison with 100% infection in non-Gdx controls. This protection against ALA in Gdx hamsters was concomitant to a comparatively scarce inflammatory infiltrate and necrosis surrounding clusters of trophozoites in the liver tissue, as well as to a lack of response of spleen cells to Con A, evaluated in proliferation assays. As tissue damage in ALA has been associated with a local inflammatory Th1 response, we determined the profile of response in hamsters by immunohistochemistry on liver sections. In contrast to strong Th1 responses in non-Gdx animals, Gdx females and males exhibited Th2 and Th3 profiles of cytokines, respectively, suggesting that protection against ALA following gonadectomization, could be related to downregulation of liver Th1 response during amoebic infection.

Dried corn germ in natural finishing programs reduces incidence of liver abscess

Introduction Changes in consumer preference for beef produced without growth promotants, ionophores, or antibiotics and consumers’ willingness to pay price premiums for such products have led some producers to begin raising beef under “natural” feeding regimens. Some natural programs prohibit use of injectable antibiotics, feed additive drugs, or growth promoting implants throughout the life of the animal. This creates challenges for maintaining efficient growth and preventing disease or metabolic disorders.

Pyogenic Liver Abscess as Endemic Disease, Taiwan

Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiella pneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not significantly change death rates for the 506 patients from the hospital.

The Impact of Donor Variables on the Outcome of Orthotopic Liver Transplantation for Hepatitis C

Morphologic characteristics of the graft have been proposed as a major contributor to the long-term outcomes in orthotopic liver transplantation (OLT). Our objective was to determine the impact of donor variables, including donor age, donor-recipient HLA match, and type of donation (DCD vs donation after brain death [DBD]), on the outcome of OLT in 192 patients with hepatitis C virus (HCV). Fourteen patients underwent OLT from donation after cardiac death (DCD) donors and 188 from DBD donors. Mean donor age, warm ischemia time at recovery, and cold ischemia time were similar between the groups. Overall graft survival rate at 1 year (55% DCD vs 85% DBD) and 5 years (46% DCD vs 78% DBD) was significantly lower in the DCD group ( P = .0003). Similarly, patient survival rate at 1 year (62% DCD vs 93% DBD) and 5 years (62% DCD vs 82% DBD) was significantly lower in the DCD group ( P = .0295). Incidences of hepatic artery thrombosis, portal vein thrombosis, and primary nonfunction were similar between the DCD and DBD groups. The incidence of liver abscess with ischemic-type biliary stricture was higher in recipients from DCD as compared with DBD (42% vs 2%). A trend toward lower graft survival was noted in recipients from donors older than 60 years of age in the HCV population ( P = .07), with statistically lower patient survival ( P = .02). Donor- recipient HLA matching did not appear to correlate with OLT outcome in patients with HCV. DCD donors and donors older than 60 years of age significantly impact patient and graft survival. Lower graft and patient survival in recipients from DCD donors does not appear to be related to early disease recurrence.