Liver abscess: a changing entity.

Over the past 12 years, 25 patients with liver abscess have been treated at the Medical University of South Carolina. Their clinical course was compared with a previous series of 22 patients from this institution reported in 1968. Our findings were discussed in the light of clinical aspects of liver abscess reported in the surgical literature over the past four decades. These comparisons show a diminishing role of amebic infection and appendicitis as etiologic factors in the development of liver abscess. Immunologic deficiencies are emerging as an important etiologic category. Over the past decade, anaerobic organisms have demonstrated a more obvious role in this infection. The clinical presentation of these patients in recent years has been characterized by an increasingly chronic pattern rather than the frequent septic presentation of the preantibiotic era. Over the past two decades, the mortality of liver abscess has diminished markedly in spite of few changes in operative approach. This is partly due to earlier, accurate diagnosis with the use of liver scanning. Hopefully, this trend will continue with the more frequent use of new diagnostic techniques, such as computerized axial tomography, and with improvement of pre- and postoperative care.

Removal of a common duct stone with a "filet" T-tube.

In a patient who had had cholecystectomy, a common duct stone was removed with a filet T-tube, the open limbs of the tube closing around the stone so that it could be pulled out along the track of the T-tube stem. The maneuver was successfully repeated in a dog. The use of the filet tube is recommended when a T-tube is to be placed in the common duct.

Canine kidney preservation: comparison of "intracellular", "extracellular," and high molecular weight dextran flushing solutions.

The effects of modified Collins-2 solution, adjusted lactated Ringer's solution, and a solution containing dextran 70 on kidney preservation and red blood cell (RBC) washout in dogs were evaluated. Excised kidneys were stored on ice for 24 hours and then reimplanted, at which time the contralateral kidney was removed. RBC washout from the preserved kidneys was measured at the time of initial cold flush. For 20 days after transplantation, serial measurements were made of serum creatinine, blood urea nitrogen, creatinine clearance, serum and urine osmolality, blood pH, and dog weight. No one solution cleared RBCs from the kidneys better than the other solutions. Renal function was significantly better in transplanted kidneys flushed and preserved with the Collins-2 solution than that in kidneys flushed and preserved with the other two solutions. There was generally no significant difference in function between kidneys preserved with dextran and those preserved with lactated Ringer's solution. Our findings suggest that the electrolyte composition of the flush solution may be more important than maintaining a high osmolality in the flush solution in the preservation of renal function during 24 hours' cold storage.