Iliopsoas abscesses: diagnostic, aetiologic and therapeutic approach in five patients with a literature review.

OBJECTIVE: Iliopsoas abscess is a relatively rare disease. Many cases present atypical clinical characteristics. Iliopsoas abscess can be primary or secondary to gastrointestinal and genitourinary infections and in developed countries most of these abscesses are of non-tuberculous aetiology. A high index of clinical suspicion, the past and recent history of the patient and imaging studies can be helpful in diagnosing the disease. Early treatment with drainage, surgery or appropriate antibiotic therapy is necessary before the sepsis becomes lethal. The purpose of the study was to present five cases with iliopsoas abscesses based on the rarity of this clinical entity. MATERIAL AND METHODS: Five cases with iliopsoas abscess, treated during the past 10 years were analysed retrospectively, with emphasis on the diagnostic and therapeutic approach to the disease. RESULTS: Three out of five cases were primary abscesses; one was of tuberculous aetiology and one secondary to bowel perforation due to a tumour. Staphylococcus aureus was the main bacterium in primary abscesses. Percutaneous drainage with administration of appropriate antibiotics was the main treatment. The secondary psoas abscess was treated successfully with surgery. Owing to long-standing septic and atypical symptoms before admission, one case had a lethal course, despite the early hospital diagnosis and treatment. CONCLUSIONS: The aetiology of iliopsoas abscess can vary, disposing to a high index of suspicion. Imaging studies can confirm the diagnosis early, and differentiation between primary and secondary type determines the most appropriate kind of treatment.

Abscesses of the spleen: report of three cases.

Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The latter are more common in the presence of a different primary site of infection, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Moreover, immunosuppression is a major risk factor. Clinical examination usually reveals a combination of fever, left-upper-quadrant abdominal pain and vomiting. Laboratory findings are not constant. Imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. Treatment includes conservative measures, and surgical intervention. In children and in cases of solitary abscesses with a thick wall, percutaneous catheter drainage may be attempted. Otherwise, splenectomy is the preferred approach in most centers. Here, we present three cases of splenic abscess. In all three, splenectomy was performed, followed by rapid clinical improvement. These cases emphasize that current understanding of spleen abscess etiology is still limited, and a study for additional risk factors may be necessary.

Effects of mycophenolate mofetil vs cyclosporine administration on graft survival and function after islet allotransplantation in diabetic rats.

AIM: To develop an experimental model of islet allotransplantation in diabetic rats and to determine the positive or adverse effects of MMF as a single agent. METHODS: Thirty-six male Wistar rats and 18 male Lewis rats were used as recipients and donors respectively. Diabetes was induced by the use of streptozotocin (60 mg/kg) intraperitoneally. Unpurified islets were isolated using the collagenase digestion technique and transplanted into the splenic parenchyma. The recipients were randomly assigned to one of the following three groups: group A (control group) had no immunosuppression; group B received cyclosporine (CsA) (5 mg/kg); group C received mycophenolate mofetil (MMF) (20 mg/kg). The animals were killed on the 12th d. Blood and grafted tissues were obtained for laboratory and histological assessment. RESULTS: Median allograft survival was significantly higher in the two therapy groups than that in the controls (10 and 12 d for CsA and MMF respectively vs 0 d for the control group, P<0.01). No difference in allograft survival between the CsA and MMF groups was found. However, MMF had less renal and hepatic toxicity and allowed weight gain. CONCLUSION: Monotherapy with MMF for immunosuppression was safe in an experimental model of islet allotransplantation and was equally effective with cyclosporine, with less toxicity.

The effect of nitric oxide synthases inhibitors on inflammatory bowel disease in a rat model.

BACKGROUND/AIMS: Overexpression of nitric oxide (NO) has been implicated in the pathogenesis of experimental and clinical inflammatory bowel disease (IBD). NO is produced by two types of enzymes: constitutively expressed and inducible NO synthases (NOS). This study assessed N(W)-nitro-L-arginine methyl ester (L-NAME) and aminoguanidine (AMG), the most studied inhibitors of nitric oxide synthases, with regard to their effectiveness as modulators of inflammation in trinitrobenzene sulfonic acid (TNBS)-induced colitis in the rat. MATERIALS AND METHODS: Colitis was induced in Wistar rats. The colitis was treated everyday for 10 days with L-NAME and AMG. To assess the severity of the colitis, clinical (body weight), hematological (hematocrit and erythrocytes sedimentation rate-ESR) and morphological (gross and microscopic) criteria were used. RESULTS: The administration of both nitric oxide synthases inhibitors L-NAME and AMG proved to be beneficial in all the examined parameters compared with the control group. A statistically significant difference between the L-NAME and the AMG groups was observed only in macroscopic and histological grading. CONCLUSION: NOS inhibitors may be promising agents in preventing the onset, or mediating the symptoms, of inflammatory bowel disease.

A novel antioxidant non-steroidal anti-inflammatory agent protects rat liver against ischemia-reperfusion injury.

Liver ischemia followed by reperfusion is an important and common clinical event. A major mechanism is leukocyte adhesion to endothelium followed by release of reactive oxygen metabolites. The aim of this study was to determine the effects of a novel antioxidant ethylenediamine derivative with anti-inflammatory properties (compound IA) on an imitated clinical setting of acute hepatic ischemia-reperfusion injury. Eight groups of rats were subjected to a model of hepatic ischemia that was produced by occluding for 30 min the portal vein and hepatic artery. At the end of ischemia, compound IA was administered intravenously and the clamps were removed allowing reperfusion for 60 min or 24 h. The effect of compound IA was evaluated by histopathological examination, lipid peroxidation and plasma levels of liver enzymes. Administration of compound IA resulted in significantly less histological damage in liver tissue after 30-min ischemia followed by 60-min and 24-h reperfusion. Ischemia followed by 60 min of reperfusion increased lipid peroxidation compared to the sham-operated and the non-ischemic group. This increase was attenuated in the group treated with compound IA. Serum enzyme levels were significantly higher in the reperfusion groups compared to the non-ischemic groups and diminished after treatment. Compound IA exerted a protective effect on hepatic reperfusion injury in rats. Compound IA is believed to act by means of its potent antioxidant and anti-inflammatory activities.