Single Abscess Research Articles

The Diagnosis and Treatment of Lung Abscess

Most classifications of lung abscesses are un-satisfactory and confusing. When the term is mentioned only one or two varieties generally come to mind, but if the literal definition of an abscess of the lung is adhered to, a much wider field would have to be considered. However, from the surgeon's point of view the only type that has to be considered in detail is the single pyogenic abscess which gives a fairly constant clinical picture. The toxic and fœtid character of this abscess has led to it being given the name of the solitary putrid abscess of lung. The immediate concern of surgery with this form should not be taken as implying that surgery has no place in the treatment of other varieties of abscess. Individual cases and pleural complications may require drainage, but apart from the putrid abscess, surgery is not often required. When considering the aetiology of putrid lung abscesses the contemporary weight of evidence seems to favour an inhalation or bronchial embolic causation rather than a blood b...

Pyogenic abscess of the liver: II. An analysis of forty-seven cases with review of the literature

<h2>Abstract</h2> <ul><li>1.1. An analysis is presented of 830 cases of pyogenic hepatic abscess collected from the world literature and a presentation of 47 additional cases is made.</li><li>2.2. During the ten-year period, 1928–1937 inclusive, there were 186 cases of abscess of the liver admitted to Charity Hospital and Touro Infirmary in New Orleans. Of this number, 139 (74.7 per cent) were amebic abscesses and 47 (25.2 per cent) were pyogenic. During this same period there were 540,776 total admissions to the Charity Hospital, among which there were 160 (0.029 per cent) abscesses of the liver, and 1,152 patients diagnosed as having liver disease, of which 10.2 per cent were amebic abscesses and 3.6 per cent were pyogenic abscesses. The sex incidence of pyogenic hepatic abscess reveals a preponderance of occurrence in the male, 67.4 per cent in the collected series and 70.2 per cent in the authors'. This is probably explained by the fact that the etiologic agents occur more frequently in the male. The greatest age incidence is from the third to the fifth decades. There is no significant racial predisposition.</li><li>3.3. Pyogenic liver abscess is primarily a complication of an intra-abdominal suppurative process with the antecedent lesions in the portal area. Of these lesions, suppurative appendicitis is the most frequent. Appendicitis was the etiologic agent in 34.2 per cent of the collected cases and 10.6 per cent of the authors' cases. This discrepancy is due to the fact that the majority of reports in the literature represented primarily the author's interest in pylephlebitis and liver abscess as complications of appendicitis. Pyogenic liver abscess can be caused also by direct extension from contiguous suppurative processes, trauma, and by transportation of microorganisms through the hepatic artery from distant foci. There is a relatively large group (59.5 per cent) of the authors' series termed "cryptogenic," idiopathic, or primary pyogenic hepatic abscess in which the antecedent lesion could not be determined.</li><li>4.4. The most frequently found organisms in pyogenic hepatic abscess are B. coli, streptococci, and staphylococci.</li><li>5.5. Pyogenic hepatic abscess may be multiple or single, and usually involves the right lobe. The abscesses were single in 28.8 per cent, multiple in 71.1 per cent, and involved the right lobe alone in 41.8 per cent of the collected cases. In the authors' forty-seven cases these incidences were 54.5 per cent, 45.4 per cent, and 68.1 per cent, respectively.</li><li>6.6. The principal symptoms and signs of pyogenic hepatic abscess are fever, pain and tenderness over the hepatic area, liver enlargement, chills, and jaundice. Characteristically, there is a leucocytosis with a proportionate increase in polymorphonuclear leucocytes. The characteristic roentgenologic changes are elevation and immobility of the diaphragm, usually the right. The diagnosis was positive in 82.1 per cent of 28 cases in the authors' series in which roentgenologic studies were made.</li><li>7.7. The prognosis in pyogenic hepatic abscess depends upon: (1) the multiplicity of the lesions; (2) the presence or absence of complications; and (3) the type of drainage instituted. Whereas of the twenty-four cases in the authors' series with single abscess of the liver nine (37.5 per cent) died, of the twenty cases with multiple abscesses, nineteen (95 per cent) died. The mortality rate was 90.9 per cent in those cases with complications and 36 per cent in the cases without complications. The total mortality rate was 79.6 per cent in the collected cases and 72.3 per cent in the authors' series. Whereas in those cases not operated upon the mortality rate was 100 per cent in both series, in the cases in which operation was performed the mortality was 50.9 per cent in the collected series and 64.8 per cent in the authors' series.</li><li>8.8. The complications of pyogenic hepatic abscess are usually the result of rupture or direct extension into one of the adjacent viscera.</li><li>9.9. The treatment of pyogenic hepatic abscess may be divided into: (1) prophylactic and (2) surgical. Prophylaxis is particularly applicable to multiple hepatic abscesses which are preceded by appendicitis and pylephlebitis, because once the development has proceeded to the stage of multiple abscess formation, surgical therapy offers only the slightest hope. The treatment of solitary pyogenic hepatic abscess consists of incision and drainage.</li><li>10.10. The employment of that type of drainage which completely avoids the slightest possibility of contamination of the peritoneal or pleural cavity is of paramount importance. The results obtained in the authors' series of cases clearly demonstrate this fact. Of the twenty-two cases in which the transperitoneal approach was employed for the institution of drainage, there were sixteen deaths (72.7 per cent). The transpleural method of drainage was used in nine cases with six deaths (66.6 per cent). In contrast to these high mortality rates is the 33.3 per cent mortality obtained in six cases in which the extraserous approach was used.</li></ul>

TREATMENT OF ACUTE PULMONARY ABSCESS

This discussion will have to do with single (including multilocular) abscesses and does not include those due to tuberculosis, bronchiectasis and new growths. The subject has been frequently discussed in medical literature, but in my opinion the difference in treatment to be directed to the acute in contradistinction to the chronic process has not been sufficiently stressed. The importance of postural drainage in the treatment of the acute condition has received little more than casual mention. Although the treatment of acute lung abscess is relatively simple, it is apparently unfamiliar to the very class of physicians who should be able to apply it early and to carry it to a successful conclusion in more than 50 per cent of the cases; i. e., the general practitioner. Many patients with chronic pulmonary abscess who are seen have never received any treatment during the acute stage other than rest in bed, cough

Injections of Caffeine and Adrenalin and Subsequently Staphylococcus Aureus Suspensions on Myocardium and Endocardium.

Fleisher and Loeb have shown that a single intravenous injection of a mixture of .025 gm. caffeine sodium benzoate and .2 cc. adrenalin chloride causes a gross myocardial lesion in the left ventricle and papillary muscle of the left ventricle in rabbits, in about 60 per cent of cases. We have confirmed their observations, and have in addition observed a lesion in the left auricle which follows these injections in some cases. In order to rule out the possibility that these may be spontaneous lesions, and in order to analyse the functional effects of these myocardial changes, a series of rabbits was examined electrocardiographically before and after these injections. We may only state here that the cardiac condition is not the result of previous spontaneous myocardial disease. Experiments were carried out to determine whether this lesion produced by caffeine and adrenalin injections would render the rabbit's heart more susceptible to abscess formation when, subsequently, a pyogenic organism in culture is injected intravenously. For this purpose 24 rabbits were injected with a single dose each of the caffeine and adrenalin mixture. Then at varying periods afterwards, each was injected with 1 cc. of a 48 hour bouillon culture of a laboratory strain of living Staphylococcus aureus of a sufficient virulence to cause the production of abscesses in the kidneys in a large number of cases without causing the death of the animals within the following three weeks. The rabbits were killed at varying periods following these injections and the organs examined grossly and microscopically. Twenty-three of the 24 animals showed the gross myocardial lesion which usually follows caffeine and actrenalin injections. In addition, 8 had abscesses in the myocardium. Of these 8, 6 showed a single abscess in or in very close proximity to the caffeine and adrenalin lesion in the myocardium of the left ventricle.

ON THE TECHNIQUE OF PNEUMOTOMY.

While the surgical principle, "<i>Ubipus, ibi evacua</i>," is nowadays held up more than ever before even in those parts of the human body that are accessible only under great difficulties, there seems to be some exception in regard to pus accumulations in the lungs, although they are by no means of rare occurrence. This lack of enthusiasm in attacking lung abscesses by the surgical knife is apparently caused by the widespread prejudice that they are all of a tubercular character and could consequently not be cured by simple evacuation. But while there is no doubt that the presence of one tubercular abscess necessarily presupposes the affection of a more or less extensive area of lung tissue, the nature of which would certainly be but little influenced by the opening of the single abscess, still there are many abscesses which are caused by preceding inflammatory processes, by suppurative bronchitis, bronchiectasy, etc.