ABSTRACT
BACKGROUND: Antibiotic prophylaxis to prevent bacterial endocarditis is recommended in high-risk patients undergoing esophageal dilation, a high-risk procedure. Some studies suggest that the oropharynx is the source of bacteremia. A topical antibiotic mouthwash, which reduces bacterial colonization of the oral flora, might decrease bacteremia rates and would be an attractive alternative to systemic administration of antibiotics. METHODS: Adults undergoing outpatient bougienage for a benign or malignant esophageal stricture were randomized in a clinician-blinded fashion to either pre-procedure clindamycin mouthwash or no treatment. Subjects were stratified by type of dilator used. Blood cultures were obtained immediately after the first esophageal dilation and 5 minutes after the last dilation. RESULTS: Fifty-nine patients were enrolled: 30 in the treatment arm and 29 in the no-treatment arm. There were 7 positive blood cultures: 5 in the treatment arm and 2 in the no-treatment arm. The identified organisms were Streptococcus viridans (2), Staphylococcus mucilaginous (2), Lactobacillus (2), and Actinomyces odontolyticus (1). Patients with bacteremia reported greater subjective difficulty with dysphagia (p = 0.01) irrespective of stricture diameter, procurement of biopsies, or dilator type. CONCLUSIONS: The percentage of cases with bacteremia for all dilations performed in this manner was 12% (95% CI [5.3, 23.6]), much lower than previously cited. All organisms in this study were oral commensals. There appears to be no effect of a clindamycin mouthwash on reducing bacteremia after esophageal dilation.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis , Bacteremia/prevention & control , Clindamycin/administration & dosage , Dilatation/adverse effects , Esophageal Stenosis/therapy , Mouthwashes , Aged , Bacteremia/microbiology , Bacteria/isolation & purification , Dilatation/instrumentation , Female , Humans , Male , Middle Aged , Mouth/microbiology , Prospective Studies , Single-Blind MethodABSTRACT
Primary malignant liver neoplasms of the adult are discussed with emphasis on hepatocellular carcinoma, the most common neoplasm. The clinical and pathologic aspects of the following neoplasms are correlated with imaging features: hepatocellular carcinoma, fibrolamellar carcinoma, intrahepatic cholangiocarcinoma, angiosarcoma, epithelial hemangioendothelioma, other sarcomas, and lymphoma. The complementary role of ultrasound, CT, and MR imaging in characterizing these lesions and determining resectability is highlighted.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Liver Neoplasms/diagnosis , Liver/pathology , Magnetic Resonance Imaging , Adult , Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic/pathology , Diagnostic Imaging , HumansABSTRACT
We report a case of unilateral agenesis of the internal carotid artery with intercavernous anastomosis, a rare development anomaly. MR and carotid ultrasound, in association with clinical awareness, can be used to diagnose this condition.
