Percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin-gentamycin in peripheral pyogenic lung abscess

Lung abscess are defined as localized suppurative necrotizing collection occurring within the pulmonary parenchyma. Some authors emphasized image-guided aspiration of lung abscess before antibiotics use in order to identify the pathogen. Antibiotic lavage is currently widely used in the treatment of patients with peritonitis, but not used previously in lung abscesses. Is to asses the role of percutaneous transthoracic needle aspiration, lavage and instillation of clindamycin-gentamycin on the treatment of peripheral pyogenic lung abscess. Twenty-six patients with peripheral pyogenic lung abscess are included in this study and classified into two groups. Group I received systemic empirical antibiotic, remod-ulated after the result of sputum culture and sensitivity. While group II underwent ultrasound guided percutaneous transthoracic needle aspiration, lavage and local instillation of antibiotics [clindamycin-gentamycin] associated with receiving systemic empirical parentral antibiotics, that were remodulated after the result of aspiration culture and sensitivity. Chest X-ray and chest ultrasound were done pre, post and after intervention by one week and before discharge. There was a statistically significant difference between group I and II as regard duration of systemic antibiotic use, duration of hospital stay, duration of radiological improvement, and size of abscess after intervention. Moreover complications occurred in group I were higher than in group II. Succeeded patients [according to clinical and radiological improvement of lung abscess] were more obvious among group II than group I. Aspirates culture and sensitivity revealed gram negative bacteria and anaerobic microorganisms, which are sensitive to local instillation of antibiotics [clindamycin-gentamycin]. Percutaneous aspiration of peripheral lung abscess has an accurate determination of the causative organisms inside the abscess. The resolution of the abscesses clinically and radiolog-ically was hastened by needle aspiration, lavage and instillation of clindamycin-gentamycin. Early intervention can improve symptoms, decrease morbidity and complications

effect of weight reduction versus reduction mammoplasty on the pulmonary function parameters and leptin level in obese-macromazia subjects

Background: Obese subjects with breast hypertrophy are suffering not only from cosmetic aspects but also negatively affecting the quality of their life so, the aim of this study was to evaluate the effect of weight reduction versus reduction-mammoplasty on pulmonary function parameters and serum-leptin level

Subjects and methods: Forty females with obesity and macromazia were enrolled into the study. They were classified into two groups, group [1] twenty females who were seeking reduction mammoplasty, and group [2] twenty females who refused surgery and were seeking diet-control regimen. Both groups were matched as regards age and body mass index [BMI]. Pulmonary function parameters [FVC%, FEV[1]%, FEV[1]/FVC and PEFR%] and serum leptin level were measured before starting the intervention in both groups and after starting it by three months

Results: Reduction mammoplasty significantly increases FVC% with non-significant improvement regarding BMI and serum leptin level. On the other hand, diet control regimen improves FEV[1]%, FVC%, FEV[1]/FVC and PEFR% with a significant reduction of BMI and serum leptin levels

Conclusion: Reduction mammoplasty can play a role in improving restrictive pulmonary function parameters while diet control regimen has a more significant improvement in both obstructive and restrictive pulmonary function parameters and in the reduction of BMI and serum leptin level in obese subjects with macromazia

Non-invasive assessment of hepatic blood flow in relation to agins

Forty healthy subjects were studied for changes in hepatic hemodynamics in the course of aging by measuring noninvasively the total hepatic flow. The 40 healthy subjects were divided into four equal age groups [<45 years, from 45-60 years, from 61-75 years and >75 years]. All the studied cases had no history of previous or active liver disease, cardiovascular disease, an average body weight and had no history of drug intake that might affect the hepatic blood flow at the time of the study. It was found that there was a statistically significant reduction in the hepatic artery flow, portal vein flow and total hepatic blood flow with the increasing age as measured noninvasively compared with the invasive procedures

Evaluation of three dimentional power doppler vascular sonography in screening of extracranial carotid artery stenosis

Extracranial carotid atherosclerosis is a major cerebrovascular events. Color Doppler sonography has find considerable recognition as a noninvasive method to detected carotid artery disease and to assess the carotid artery stenosis. However, results are highly operator-dependent and cannot be presented as survey images. The purpose of this study was to evaluate the contribution of 3-dimentional [3D] power Doppler sonography for non-invasive detection of extracraneal carotid artery stenosis in atherosclerosis. We prospectively study 110 patients for extracranial carotid artery disease using both conventional color Doppler sonography and 3D power Doppler sonography. The results from the 2 modalities were compared. A total of 220 common carotid arteries, and 220 extracraneal internal carotid arterial segments were examined utilizing a 7.5-MHz linear-array transducer Siemens Elegra. From 440 examined internal carotid and common carotid arterial segments, fourteen arteries were excluded due to calcified circular plaques and/or invitable artifacts. 3D power Doppler sonography detected 296 normal study or arteries without stenosis from total included 426 examined arterial segments. The residual 130 arteries with segmental stenosis showed 57 arterial segments with mild [1-49%] stenosis, 38 arterial segments with moderate[50-69%] stenosis, 29 segments with severe [70-99%] stenosis and 6 arteries with occlusions. The degree of stenosis determined by color Doppler sonography correlated with that determined by 3D power Doppler sonography [r 0.980-0.996]. Moreover, there was a good correlation between the measurments for both the length of the lesion and its distance from the bulb as determined by the 3D volume surveys and by color Doppler sonography [r = 0986]. The interobserver variability rate was 3.7% +/- 0.5%. Generally, the acquisition and reconstruction of the 3D data took about 3 minutes. Three dimensional power Doppler sonography is easy to perform and is an accurate method in screening for atherosclerotic lesions of the carotid arteries. Moreover, it provides 3D volume surveys that may be helpful in the planning and follow up of surgical treatment

Retroperitoneal pus collection: image guided percutaneous versus primary surgical drainage

Retroperitoneal infection is an uncommon entity, mostly presents as psoas abscess. This may be primary with no definite aetiology mostly caused by staphylococcus aureus, or secondary to tuberculosis of the spine or infection of adjacent retroperitoneal organs. Clinical diagnosis is difficult because of non-specific symptoms, resulting in delayed discovery and high morbidity and mortality. Modern imaging diagnostic techniques such as ultrasound and computerized tomography have allowed for a refinement in both the aetiologic diagnosis and the treatment by means of CT-guided or ultrasound-guided percutaneous drainage of the abscess, thus avoiding surgical drainage in many cases. This study included 29 cases [20 males and 9 females, ratio 2.2: 1], studied Between August 1995 and August 2001. Their age ranged from 10 to 77 years [mean 43 years]. Pus collection was located on the right side in 17 cases, on the left side in 7 cases and bilateral collection was reported in 5 cases. Out of the 29 patients included in the study 15 cases [52%] had primary psoas abscess while the remaining 14 cases [48%] had retroperitoneal infection secondary to T.B. spine [5 cases], appendicitis [3 cases], pancreatitis [one case], and kidney disease [5 cases]. The main presenting symptoms were abdominal pain [86%], fever [83%] and swelling [62%]. Patients were classified into two groups: group [A] included 13 cases and were subjected to primary surgical drainage under general anaesthesia, and group [B] included 16 patients who were treated by image [U/S and or CT scan] guided percutaneous drainage under local anaesthesia. Patients were followed for a period of 6 to 72 months with a mean follow up period of 36 months. Surgical drainage was successful in all cases with one postoperative mortality and no relapses on long term follow up [92% overall success]. While the localization of pus using image guidance was successful in all cases in-group B but follow up revealed recollection in 3 cases [19%] that required surgical intervention [81% overall success]. Immediately on diagnosis of retroperitoneal pus collection prompt treatment is necessary. Percutaneous drainage should be performed whenever possible and in case of failure, surgical drainage should be done. Surgical drainage has the advantage of dealing with the offending organ and can properly drain a multi-locular and rigid walled abscess. Image guided drainage can be used in critically ill patients not fit for anaesthesia and for primary unilocular thin walled abscess. It is a safe procedure with lower morbidity and mortality, shorter drainage time, better patient acceptance, easier nursing care, less hospital stay and more cost effective than open surgical drainage