ABSTRACT
A 71-year-old man presented with the clinical and radiological features of metastatic liver disease but subsequently was found to have multiple liver abscesses caused by Fusobacterium necrophorum. At liver biopsy, pus was aspirated and Fusobacterium necrophorum was isolated from the pus. Serial blood cultures and urine cultures were sterile and negative for Fusobacterium spp. The patient made a complete recovery in response to treatment with penicillin and amoxicillin. This case illustrates the importance of liver abscesses as an uncommon but completely treatable differential diagnosis for the radiological appearances of multiple hepatic lesions.
Subject(s)
Fusobacterium Infections/diagnosis , Liver Abscess/diagnosis , Liver Abscess/microbiology , Aged , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Fusobacterium Infections/pathology , Fusobacterium necrophorum/isolation & purification , Fusobacterium necrophorum/physiology , Humans , Liver/pathology , Liver Abscess/drug therapy , Liver Abscess/pathology , Male , Penicillins/therapeutic useABSTRACT
To investigate the value of 50 mg of topical lidocaine spray in upper gastrointestinal endoscopy, a randomized double-blind placebo-controlled study was undertaken with 50 mg of lidocaine spray as the active treatment. All patients were sedated with diazepam after administration of the spray. Included in the study were 158 consecutive patients aged 18 years or older being treated at the endoscopy unit of Scunthorpe district general hospital. Tolerance to upper gastrointestinal endoscopy as assessed by endoscopists and patients was evaluated. Of the 158 patients, 85 received the placebo spray and 73 the lidocaine spray. Patient acceptability for upper gastrointestinal endoscopy was significantly greater in the lidocaine group than in the placebo group (p = 0.001), and tolerance to the procedure as assessed by the endoscopist was also significantly greater in the lidocaine group than in the placebo group (p = 0.008). We conclude that topical anesthesia with 50 mg of lidocaine spray facilitates upper gastrointestinal endoscopy for the endoscopist and increases patient tolerance for the procedure.
Subject(s)
Anesthesia, Local , Endoscopy, Digestive System , Lidocaine , Diazepam/therapeutic use , Double-Blind Method , Endoscopy, Digestive System/psychology , Female , Humans , Male , Middle Aged , Patient SatisfactionABSTRACT
This study was designed to test the hypothesis that the between-State variation in death rates from ischemic heart disease may be due in part to variation in the manner in which death certificates are completed or the diagnoses on them are assigned numerical codes. Random samples of 75 doctors who had recently completed a death certificate in an Australian State or in Auckland, New Zealand, as well as all doctors who had recently completed a death certificate in the Northern Territory were asked to participate. They were sent a book of 10 actual case histories and asked to complete a death certificate for each case. Seventy per cent of the doctors returned death certificates (range from 64% to 81%). Each certificate was coded by the Australian Bureau of Statistics (ABS) in the doctor's State of residence, or by the New Zealand Health Statistics Centre for Auckland respondents, and then coded again by the federal office of the ABS in Canberra. There was considerable variation in the codes assigned to each case history but systematic variation large enough to account for the variation in between-State ischemic heart disease death rates was not seen. There was little systematic variation between codes assigned in each State and by the federal ABS office, although a few isolated discrepancies were identified which need attention by the ABS.(ABSTRACT TRUNCATED AT 250 WORDS)
