University Of California Davis Medical Center Research Articles

T03. Responsive Neurostimulation Device (RNS) vs. Multiple Hippocampal Transections (MHT) as treatments for refractory Temporal Lobe Epilepsy (TLE) – Outcomes from a single center, the University of California, Davis Medical Center (UCDMC)

Temporal lobectomy remains the gold standard for treatment of refractory TLE. However, patients with preserved or significantly asymmetric memory are not considered resection candidates due to the potential of memory deficits postoperatively. In our center these patients are offered placement of RNS or to undergo MHT. Some patients also undergo additional resection wherever possible. There are no head to head studies comparing these two procedures, we retrospectively compared clinical outcomes in patients with refractory TLE who have undergone RNS or MHT. 6 consecutive patients with the seizure onset zone in the dominant temporal lobe underwent either placement of RNS or had MHT at UCDMC. Of these patients, 2 had RNS placement, 2 had MHT only, and 2 had MHT plus resection of other temporal lobe structures. For these 6 patients, we analyzed post procedure clinical outcomes and presence of adverse effects. Median duration following intervention was 29 months in the RNS group and 5 in the MHT group. One of the RNS patients is seizure free 30 months after the implant, while the other showed no changes in seizure frequency or severity 28 months post implant. In that patient, the device was not capturing the seizures as determined by invasive monitoring which both RNS patients had prior to implantation. We were able to change the detection parameters; however not enough clinical data is currently available to determine if this lead to seizure reduction. Alternatively, 3 of 4 MHT patients had significant seizure reduction and 2 are seizure free at 4 and 6 months postoperatively. 2 patients had additional resection (amygdala ± temporal neocortex). 2 of the 4 MHT patients had invasive monitoring prior to the procedure; out of these, 1 is seizure free and 1 did not respond to the procedure. 2 of the 4 MHT patients self-reported word finding difficulties at the last follow up and 3 reported changes in mood and/or behavior. These were worse in the patients who had additional resection. Taking into consideration the limited size of our cohort and short study duration, our results suggest that in patients with refractory dominant TLE who are poor candidates for standard resection, MHT is more likely to lead to significant reduction in seizures; however was also associated with word finding difficulties and changes in mood and behavior. On the other hand, RNS did not result in any deficits and implanting the device offers more flexibility in terms of where the epileptic network maybe stimulated with a goal of optimizing clinical outcomes. Further observations of seizure frequency and standard assessments of higher integrative functions are needed to determine the long term impact of these procedures in order to better delineate who will benefit from one procedure over the other.

American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons

American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons Mohamed R. Ali, M.D.*, Fady Moustarah, M.D., Julie J. Kim, M.D., on behalf of the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee Department of Surgery, University of California-Davis Medical Center, Sacramento, California Faculty of Medical Sciences & Neuroscience Research Center, Lebanese University, Beirut, Lebanon Department of Surgery, Central Michigan University College of Medicine, Mount Pleasant, Michigan Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts Received December 16, 2015; accepted December 18, 2015

Radiation therapy practice patterns for elderly patients with early-stage breast cancer.

82 Background: Controversy exists regarding the benefit of whole breast radiation (RT) after breast conservation surgery (BCS) in elderly early stage breast cancer patients. We investigated the clinical and pathological characteristics that influence referral patterns and consent for RT. Methods: Between 2006 and 2011, 93 women, aged ≥ 70 were treated with BCS at the University of California Davis Medical Center (UCDMC). Electronic medical records were reviewed to identify pathological and clinical tumor characteristics, including stage, nodal involvement, lymphovascular invasion, margin status and molecular subtype. Patient factors including Karnofsky performance status, Charlson comorbidity index, and distance from UCDMC were recorded. Adjuvant therapy recommendations regarding RT, radiation dose and fractionation, hormonal and chemotherapy, and the ultimate treatment plan were noted. Descriptive statistics were used to characterize the referral pattern data. Patient and tumor characteristics were compared between those referred and not referred for RT using chi-square tests for categorical variables and Student’s t tests for continuous variables. Similar comparisons were also conducted for those who consented and declined RT. Results: Of the 93 women eligible for adjuvant whole breast radiation, 79 (85%) were referred to radiation oncology. Sixty five patients had stage I, 16 had stage II, and 4 had stage III breast cancer. Seventy four patients had a luminal A molecular subtype, 11 of whom declined RT. Hormonal therapy was recommended for 78 patients, of which 11 were not referred to RT. The mean age of those referred to RT was significantly less than those not referred, 76 vs. 81 years, P = 0.006. Mean distance to UCDMC was 17.2 miles for those not referred and 34.4 miles for those referred, P = 0.02. There were no significant correlation between stage, molecular subtype, margin status or lymph node involvement and referral to RT. Conclusions: The majority of elderly patients are referred to RT but increased age and comorbidity were associated with non-referral. Patients’ perception of their own comorbidity, previous experience with RT and the decision to pursue hormonal therapy contributed to patients’ decisions to decline RT.

Sildenafil for Pediatric Orbital Lymphangioma

Orbital lymphangiomas, congenital hamartomas of the lymphovascular tissue, are often associated with significant ocular complications and can be challenging to treat. To date, therapeutic approaches have demonstrated variable results and have significant ocular and systemic risks. We present 2 cases of pediatric orbital lymphangioma that responded to treatment with oral sildenafil. This is a report of a series of 2 patients at the University of California-Davis Medical Center treated between March 2011 and October 2012. The first patient was a 12-month-old male infant whose extensive orbital and facial lymphangioma responded to sildenafil after repeated sclerosing and drainage procedures failed to achieve remission. The second patient was a 12-year-old boy whose orbital lymphangioma and associated ocular pain improved with sildenafil, making enucleation unnecessary. These reported cases demonstrate promise for sildenafil as a noninvasive therapy for pediatric lymphangioma. Larger clinical trials are needed to clarify the optimal length of treatment, use as monotherapy, and long-term adverse effects.

Verification of monoplex and multiplex linear-after-the-exponential PCR gene-specific sepsis assays using clinical isolates

To verify monoplex and multiplex gene-specific linear-after-the-exponential polymerase chain reaction (LATE-PCR) assays for identifying 17 microbial pathogens (i.e., Klebsiella sp., Acinetobacter baumannii, Staphylococcus aureus, Enterobacter sp., Pseudomonas aeruginosa, coagulase negative staphylococci, Enterococcus sp., Candida sp.) commonly associated with septicaemia using clinical isolates. Clinical isolates of each target pathogen were collected from the University of California, Davis Medical Center (UCDMC) microbiology laboratory. Five microlitres (μl) of each culture suspension (1 × 10(8) CFU ml(-1) ) were added to 20 μl of monoplex mastermix. DNA extracted from clinical isolates was tested in multiplex. Monoplex assays demonstrated 100% sensitivity at this input level, except Enterobacter cloacae (2.7%), Ac. baumannii (57%) and Ps. aeruginosa (97.8%). All clinical isolates were positive in multiplex, with the exception of two Ac. baumannii, two Klebsiella oxytoca and two Candida parapsilosis isolates. Sixteen pathogens can be identified by monoplex LATE-PCR assays with sensitivities ≥ 97.8%. The multiplex assay demonstrated 91.4% sensitivity when tested with DNA extracted from 70 different target strains. This study demonstrates the potential of LATE-PCR to serve as an adjunct to culture if the reagents are optimized for sensitivity. Results warrant further testing through analytical and clinical validation of the multiplex assay.

Newborn screening and cascade testing for FMR1 mutations

We describe an ongoing pilot project in which newborn screening (NBS) for FMR1 mutations and subsequent cascade testing are performed by the MIND Institute at the University of California, Davis Medical Center (UCDMC). To date, out of 3,042 newborns initially screened, 44 extended family members have been screened by cascade testing of extended family members once a newborn is identified. Fourteen newborns (7 males and 7 females) and 27 extended family members (5 males and 22 females) have been identified with FMR1 mutations. Three family histories are discussed in detail, each demonstrating some benefits and risks of NBS and cascade testing for FMR1 mutations in extended family members. While we acknowledge inherent risks, we propose that with genetic counseling, clinical follow-up of identified individuals and cascade testing, NBS has significant benefits. Treatment for individuals in the extended family who would otherwise not have received treatment can be beneficial. In addition, knowledge of carrier status can lead to lifestyle changes and prophylactic interventions that are likely to reduce the risk of late onset neurological or psychiatric problems in carriers. Also with identification of carrier family members through NBS, reproductive choices become available to those who would not have known that they were at risk to have offspring with fragile X syndrome.

Prescriber Compliance with a New Computerized Insulin Guideline for Noncritically III Adults

In March 2008, the University of California, Davis Medical Center (UCDMC), implemented a guideline for the inpatient management of diabetes in noncritically ill adults. In accordance with national guidelines, all patients with type 2 diabetes are prescribed basal, nutritional, and correctional insulin. The guideline was added to the electronic medical record as a standardized physician order set in April 2008 and provider training on the insulin guideline occurred in May 2008. To evaluate provider compliance with a new electronic standardized insulin order set in a hospital setting. All patients with insulin orders admitted to the general internal medicine service between June 1, 2008, and November 1, 2008, were evaluated in this single-center retrospective chart review at UCDMC in Sacramento. Patients older than 18 years with a history of type 2 diabetes were included in the analysis. Insulin orders were categorized as preferred (followed the guideline) or nonpreferred regimens (did not follow all components of the guideline). A total of 265 patients were identified during the study period. The preferred regimen was ordered in 82 (30.9%) of the evaluated patient admissions. Of the 183 (69.1%) nonpreferred regimens, more than half (54.6%) contained correctional insulin alone; 84.2% of patient admissions prescribed nonpreferred regimens lacked nutritional insulin. Average admission blood glucose readings were higher in the preferred versus nonpreferred regimen group (224.4 vs 164.8 mg/dL, p < 0.001). The preferred regimen was not prescribed for the majority of patients admitted with a history of type 2 diabetes, despite computerized decision support. Nutritional insulin was the most common missing component in the nonpreferred regimens. Baseline clinical factors, educational modalities, and guideline content may have influenced prescribing patterns.

Outcomes of Video Capsule Endoscopy in the Veterans Population

Purpose: Video capsule endoscopy (VCE) is a widely utilized, minimally-invasive imaging modality for the small bowel (SB). Much research has focused on optimization of diagnostic yield and minimization of incompletion rates through careful patient selection. Current data support diabetes and hospitalization as risk factors for incomplete studies and there is emerging evidence that obesity may too be an independent risk factor. Elderly patients have been shown to have a higher diagnostic yield in the general population. However, it is unclear if these data are applicable to the Veterans Affairs (VA) population. Here we evaluate VCE outcomes in the VA population. Methods: VCE studies from the Sacramento VA for 275 consecutive patients between 2006-2009 were retrospectively reviewed. Results were compared to the pre-existing University of California Davis (UCD) Medical Center retrospective database of 250 consecutive patients reviewed between 2008-2009. Completion rates and diagnostic yield were evaluated as primary outcome measures. Results: Among the 275 patients reviewed at the VA, there were a significant number of male patients, 246 (89%) at the VA vs. 107(43%) at UCD, p=0.0001. There were also significantly more elderly, hospitalized and diabetic patients at the VA, p=0.0001, 0.003 and 0.004 respectively. The VA had significantly more patients with hypertension, hyperlipidemia, and coronary artery disease p=0.0001, 0.0001, 0.004 respectively. There was no significant difference in the number of obese patients between the two populations. Gastric transit times were insignificant, but SB transit times were significantly longer in the VA, p=0.0001. No significant difference in study completion rates was observed, p=0.48. There were significantly more clinically relevant SB findings in the VA population, 103 (37%) vs. 71 (28%) at UCD, p=0.03. No major difference in the ability of VCE to guide further intervention was observed. Conclusion: VCE is an efficacious imaging modality for the SB at the VA. Interestingly, there was no significant difference in study completion rates between the VA and UCD Medical Center despite a significantly higher prevalence of diabetics and hospitalized patients. This suggests that there may be additional risk factors, such as obesity, contributing to incomplete examinations. That diagnostic yield in the VA population was greater than the UCD population perhaps reflects the increased prevalence of co-morbidities in this unique group of patients. Further characterization of specific contributing comorbidities will require further investigation. Efforts should be made to maximize the utilization of VCE in the VA population.

(In)appropriate neurosurgical consultation

Objectives Whether or not a patient could benefit from a computed tomography (CT) scan and/or the evaluation by a neurosurgeon requires judgment by a clinician of the risk of clinical deterioration. To assess this clinical process we aimed to determine how many of the consultations to the Neurosurgical department (NSG) of UC Davis are appropriately indicated for neurosurgical input or management. Secondly, we investigated how CT is used in the University of California Davis Medical Center (UCDMC) in NSG consults of head injured patients compared to a validated and highly sensitive decision making tool, the Canadian CT Head Rule (CCHR). Patients and methods Patients were enrolled in this prospective study if they presented to a department of UCDMC other than neurosurgery and when, consequently, the NSG was consulted. The emergency consultations were categorized into three groups: head injury, spine injury and others. Subsequently, the appropriateness of the consultations was evaluated based on the need for evaluation determined by the likelihood of clinically important intracranial lesions for head injury and by the likelihood of clinically important spinal cord injury or spinal cord instability for spine injury. Of the head injured patients with a CT scan the appropriateness of the scan was determined by way of the CCHR. Results Between 21 July and 15 August 2008 99 consultations were included: 32 patients with head injuries, 29 with spine injuries, 34 with other diseases and 4 not sufficiently documented patients. 23 classified inappropriate, 69 appropriate and 7 remained unclassified. Of the head injured patients, 10 (31.2%) had gotten a CT scan that was classified inappropriate. Conclusion NSG receives 3–4 requests for consultations per day from the other services of UCDMC, of which one is of questionable validity and one of the three CT scans for head injury is not necessary. These results suggest the use of the CCHR in UCDMC would improve patient care and could result in large health-care savings, while there would also be less radiation exposure.

Comparative Analysis Using the 80-Lead Body Surface Map and 12-Lead ECG With Exercise Stress Echocardiograms

This retrospective study constituted of 144 patients who were recruited at the University of California Davis Medical Center (UCDMC) Echo and Stress Laboratory during a 10-month period by referrals for standard ESE to assess for CAD. Participation criteria included referral for a standard ESE, age older than 18 years, and the same criteria as standard stress tests. Standard stress test exclusion criteria were applied as well (Table 1).12 All patients gave informed consent. The study group, called the 80-lead BSM group, consisted of 72 participants. Seventy-two random participants comprised the 12lead ECG group (see Table 2). Twenty-two participants in the 80-lead group had poor image quality ESE or incomplete data for exercise cessation and/or image acquisition real time; as a result, these participants were excluded from the study. None of the ESE of the 12-lead ECG group was considered of poor image quality, nor were any data incomplete. STRESS ECHOCARDIOGRAMS

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Sinonasal Undifferentiated Carcinoma with Intracranial Extension

To report our experience in the management of sinonasal undifferentiated carcinoma (SNUC) over a period of 15 years. A retrospective case review of 13 patients with SNUC treated at the University of California, Davis, Medical Center (UCDMC) Center for Skull Base Surgery, over the past 15 years. Most tumors arose in the ethmoid sinuses. All but 1 patient had a combined intracranial-extracranial resection through the anterior fossa-transcranial route and postoperative irradiation. The 13th patient had a transfacial subcranial approach. There are 6 who have survived free of disease at 14 years' to 8 months' follow-up. The average follow-up was 6 years, 3 months. One patient died of a pulmonary embolism in the first postoperative week, a second died of a bowel infarction 3 months postoperatively. Three patients died of their disease at 20, 18, and 8 months postoperatively: 1 with local recurrence and distant metastasis and the other 2 with local control but distant disease. The 6 survivors are at 8, 20, 28, 62, 84, and 105 months. SNUC is a rare malignancy of the paranasal sinuses with a poor prognosis. Radical surgery and adjunctive therapy can achieve good survival in a significant proportion of patients who would hitherto have seemed incurable.

Pursuing Clinical and Operational Improvement in an Academic Medical Center

An academic medical center in an increasingly competitive market, the University of California-Davis Medical Center in Sacramento started working with a consulting firm in 1995 to reduce overall operational costs and costs for the clinical processes involved in treating patients with specific conditions. Twelve operational efficiency (OE) teams and five clinical teams were commissioned, with a combined total of nearly one-half of the target cost reduction. The second wave of six clinical teams was simultaneously initiated in late spring 1996. The quality improvement process for clinical improvement teams included the review and inquiry method, which enables many pilot experiments to be conducted in parallel by work groups and coordinated by the main task team. Within six weeks of launching, the 12 OE teams achieved their goals and identified savings opportunities of more than $27 million. One OE team, medical records, had set a goal of $514,000 in cost reduction for a three-year period and achieved the first-year goal of $190,000. For a clinical team on interventional cardiology, the clinical benchmark data revealed that the cost per case of providing cardiac catheterization was greater than for all three benchmark groups. These patients, including 270 patients per year, showed a possible savings through process improvement of nearly $1.4 million. From January 1996 through March 1997, the rate of occurrence of complications decreased from 5.5% to 3%. Physicians gradually accepted more responsibility and accountability for controlling and reducing costs, while maintaining their traditional role as advocates for improved patient care.

Profiles of functional recovery in fifty traumatically brain-injured patients after acute rehabilitation.

Research to demonstrate the efficacy of head injury rehabilitation is important at a time when cost-containment efforts are intensifying. A useful tool that would predict the functional improvement during hospitalization and length of stay (LOS) of persons with traumatic brain injury would be of benefit to patients and their families, insurance carriers, and rehabilitation specialists. This study examines functional improvements made by 50 traumatic brain-injured patients admitted to the rehabilitation unit at the University of California, Davis, Medical Center (UCDMC) as measured by the UCDMC Davis Functional Status Measure (DFSM), which was adapted from the Functional Independence Measure (FIM). The DFSM incorporates additional items to provide a more thorough measure of skills to be rehabilitated. The purpose of this study was to compare scores and profiles on the DFSM items obtained by patients with LOS greater than and less than and equal to the median rehabilitation LOS (23 days). Relationships were explored among admission DFSM scores, LOS for rehabilitation, discharge destination, and functional outcome. Results indicate that patients admitted to the rehabilitation unit attained a similar profile or level of function by discharge, regardless of admission Glasgow Coma Scale scores or admission DFSM scores. There were no significant differences in admission Glasgow Coma Scale score, age, acute LOS, or discharge disposition between the LOS groups. There was a significant difference in median admission DFSM score in 26 of 31 categories between the LOS groups. There was a significant difference in median DFSM change (admission to discharge) in 24 of 31 categories between the LOS groups. The admission DFSM total score was inversely proportional to the length of stay, with a correlation coefficient of 0.78. DFSM change and admission to discharge was linearly correlated with LOS (R = 0.66). The DFSM documents functional outcome and measures gains during inpatient rehabilitation. The DFSM profile is helpful in predicting the LOS needed to achieve those gains.

Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization.

To assess short-term and long-term complication rates after trauma laparotomy in a group of health maintenance organization (Kaiser Permanente) patients. Retrospective cohort study of patients belonging to Kaiser Permanente. Eighty Kaiser patients who underwent a negative or nontherapeutic laparotomy for trauma at a Level I trauma center (University of California, Davis Medical Center (UCDMC)) between April 1989 and May 1994 were identified. Demographic data, past medical history, mechanism of injury, indications for surgery, findings at laparotomy, and short-term complications were abstracted from the UCDMC record. Long-term complications were taken from the Kaiser record. Long-term complications, including small bowel obstruction, hernia, and cosmesis. Short-term complications, including pneumonia, cellulitis, wound infection, prolonged ileus, and urinary tract infection. The single death in the early postoperative period was not related to the laparotomy. Mean follow-up was 36 +/- 2 months (median, 36 months); 86% had follow-up of at least 1 year. The incidence of short-term complications was 43% in patients with associated extra-abdominal injuries and 20% in patients without associated extra-abdominal injuries (p = 0.17). On long-term follow-up, there were no small bowel obstructions, incisional hernias, or cosmetic problems requiring correction. One patient developed a stitch abscess 6 weeks after the operation. The incidence of long-term complications after negative or nontherapeutic laparotomy for trauma is low.

Fine-needle aspiration cytology of sarcoma: retrospective review of diagnostic utility and specificity.

Fine-needle aspiration cytology (FNA) is useful because of its low cost, quick turn around time, and low incidence of complications. This study investigates the role FNA plays in the evaluation of sarcoma. We reviewed all the pathologic material from patients with sarcoma or a FNA diagnosis suggestive of sarcoma at the University of California-Davis Medical Center (1985-1994). Fifty-two of 196 patients identified (26.5%) were evaluated with FNA exhibiting 46 soft tissue and 6 bone lesions located in the extremities (19), trunk (19), head and neck (8), retroperitoneum (3), and abdominal cavity (3). Among 196 patients identified, those evaluated by FNA had soft tissue rather than bone lesions (P < .001) and primary sites other than in the extremities (P < .001). The primary neoplasms for the 52 FNA patients included 47 sarcomas (10 malignant fibrous histiocytomas and 16 other types), 1 intramuscular myxoma, 2 lymphomas, and 2 spindle cell (sarcomatoid) carcinomas. In 43 patients (22% of total), FNA was used first, before a primary diagnosis. The FNA report showed the correct specific neoplasm in only 20.9%. However, the FNA reports reflected an effective positive diagnosis leading to appropriate diagnostic biopsy in 88.4%, while only 7.0% were misleading (benign or inflammatory) and 4.6% inadequate. Review of FNA slides for 32 of 43 patients in which FNA was used first, in a blinded fashion, exhibited 21.9% specificity for the specific neoplasm, and 88.4% effective positive diagnoses. In 9 patients, FNA was utilized to investigate recurrence. Five out of 5 instances of recurrent sarcoma were identified by FNA. However, FNA misidentified recurrence in 3/4 instances, exhibiting suspicious cells from regenerating skeletal muscle (2) and a traumatic neuroma (1). The specific diagnosis for sarcomas is challenging even with surgical material. FNA usually does not provide a specific diagnosis (only in 20.9% of cases) and review of routinely prepared slides showed the same specificity as reflected by the original FNA report, at times formulated with the benefit of immunohistochemistry or electron microscopy. FNA effectively evaluated lesions in 45 of 52 patients (86.5%), confirming the useful screening role for this technique in sarcomas.

Internal Carotid Artery Resection for Invasion of Malignant Tumors

To study the preoperative investigation and outcome of patients who underwent resection of the internal carotid artery for malignant disease. A retrospective analysis using a chart review of these patients was performed, and the results were analyzed. All patients were treated by one of us (U.K.N.) at the University of California-Davis Medical Center, Sacramento. A population of 18 patients who underwent a transcervical, transpetrosal, or petrocavernous resection of the internal carotid artery from 1976 to 1993 was studied. Preoperative study consisted of four-vessel arteriography, balloon test occlusion, electroencephalographic intraoperative monitoring, and, after 1990, single-photon emission computed tomographic scanning. Disease-free interval and neurologic complications were assessed. Two patients were alive and well without disease at 6 and 9 months postoperatively. One patient was alive and well at 12 months, and three have survived more than 2 years without recurrent tumor. Eleven patients died within 1 year of surgery (three postoperatively, six of recurrent disease, and two of unknown causes). One patient died of disease at 14 months. Internal carotid artery invasion by malignancy portends a poor prognosis. Carotid artery resection can provide reasonable palliation. Early results of skull-base surgery on patients with intrapetrous and petrocavernous carotid artery involvement are encouraging. Balloon test occlusion and single-photon emission computed tomographic scanning provide a valuable assessment of contralateral cerebral blood flow.

Career activities of women involved in two California pharmacy associations

Journal Article Career activities of women involved in two California pharmacy associations Get access Barbara L. Sauer, Pharm.D., Barbara L. Sauer, Pharm.D. Vice Chairwoman and Assistant Clinical Professor Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco (UCSF), and Assistant Chief Pharmacist, Department of Pharmaceutical Services, University of California Davis Medical Center (UCDMC), Sacramento Search for other works by this author on: Oxford Academic Google Scholar Mary Anne Koda-Kimble, Pharm.D. Mary Anne Koda-Kimble, Pharm.D. Vice Chairwoman and Clinical Professor Division of Clinical Pharmacy, and Associate Dean, Student Affairs, School of Pharmacy, UCSF Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 46, Issue 9, 1 September 1989, Pages 1826–1828, https://doi.org/10.1093/ajhp/46.9.1826 Published: 01 September 1989

Pyogenic liver abscess. Diagnostic and therapeutic strategies.

A retrospective review of 26 adult patients admitted to University of California, Davis, Medical Center (UCDMC) with pyogenic liver abscess (1980-1986) was performed to ascertain the impact of rapid diagnosis and percutaneous drainage. Ultrasonographic examinations and computed tomography (CT) scans were highly sensitive and noninvasive imaging modalities. Sixteen patients had solitary abscesses and seven had multiple microscopic abscesses. The median time interval from admission to diagnosis and therapy was 2 and 3 days, respectively. Origin of the abscess was determined in 22 patients, the biliary tree being the most common source. Medical therapy was successful in three patients with microabscesses but failed in two. Nine patients had percutaneous drainage; two required repetitive percutaneous catheter placement, and two proceeded to surgical drainage. Twelve patients had surgical drainage; one required repetitive surgical drainage. Postdrainage complications were minimal in all groups. Overall mortality role was 11.5% (two patients). Deaths were related to delay in diagnosis, gram-negative sepsis at presentation, and biliary origin of the abscess.