A clinical study on pyogenic liver abscesses: the changes in the clinical features during the recent 12 years / 대한내과학회지

BACKGROUND/AIMS: The clinical features of pyogenic liver abscess have changed after the introduction of antimicrobial agents and intervention. This study was conducted to clarify the changes in the clinical features of pyogenic liver abscess during the recent 12 years. METHODS: We reviewed the medical records of 157 cases with pyogenic liver abscesses that were treated at our hospital between January 1995 and July 2006. The period was divided to 1 (1995-2000; 72 cases) and 2 (2001-July 2006; 85 cases). RESULTS: Prevalence of patients with an age over 70 increased significantly in period 2 compared to period 1 (p=0.019). The biliary tract was the most common portal of entry during the 12 years, and biliary procedures were the important causative factors. Compared to the non-biliary group, the biliary group was older and it had a higher frequency of recurrent abscess, Escherichia coli infection, and air-biliary gram (p<0.05). Klebsiella pneumoniae was the most common pathogen, and the frequency of E. coli was increased in period 2 compared to period 1 (p=0.045). Only 6.9% and 1.2% of the patients during period 1 and 2, respectively, were treated surgically. The overall mortality was 0.6% (0% vs. 1.2%, respectively). The interval from onset to admission, the size of the abscess cavity, the time to defervescence and the hospital stay were shorter in period 2 than in period 1 (p=0.044, p=0.013, p=0.02 and p=0.0002, respectively). CONCLUSIONS: Recently, pyogenic liver abscess affects the elderly, and biliary procedures are its important causative factor. E. coli is still a common pathogen in relation to the biliary portal of entry. The elderly patients with biliary problems need better medical attention to avoid the development of pyogenic liver abscess, and for making an early diagnosis and achieving a better outcome.

Patterns of Posterior Chest Leads (V7, V8, V9) ECG in Normal Adults

BACKGROUND AND OBJECTIVES: Recently many studies have confirmed positive identification of patients with posterior infarction through ST segment elevation in the electrocardiogram of posterior chest leads V7 through V9. However, the ECG patterns from posterior chest leads in normal adults have not been investigated, so this study was designed to examine such patterns. SUBJECTS AND METHODS: We studied 100 patients with normal conventional 12-lead ECG, normal physical examination and without any history of cardiovascular disease. Leads V7, V8 and V9 were recorded immediately after routine 12-lead ECG at the same horizontal level as that of V6 on the posterior axillary line (lead V7), the posterior scapular line (lead V8), and the left border of the spine (ead V9). RESULTS: The upright P waves in leads V7, V8 and V9 were 99%, 99% and 95% upright, respectively, while the other P waves were isoelectric and none were inverted. The T waves were all upright in leads V7 and V8, while in lead V9, 98% were upright, 2% were isoelectric and none were inverted. None of the subjects had a Q wave duration greater than 0.04 second in any of the 3 leads. At 0.08 second after the J point, only 2 subjects (2%) showed 0.5 to 1.0 mm ST segment elevation, but ST segment elevation was not greater than 1.0 mm in any of the subjects. CONCLUSION: P wave and T wave inversion were absent in all 3 leads. Q wave duration of greater than 0.04 second was also absent in all 3 leads. ST segment elevation was not greater than 1.0 mm in any of the subjects.