Abdominal abscess drainage under radiologic guidance: causes of failure.

The results of percutaneous drainage of abdominal abscesses in 136 patients are analyzed, revealing a failure rate of 23% (31 patients). The mortality rate was 1.4% (two patients); the rate of serious complications was 5% (seven patients). Failure rate was lowest in critically ill patients having palliative drainage only (12%), emphasizing the importance of immediate drainage to stabilize such patients. The low mortality rate is also attributed to prompt palliative drainage. Technical errors were most commonly responsible for failure of procedures (14%), especially failure to recognize and respond to loculation or subseptation, premature withdrawal of drains (12 patients), and inappropriate approach to the abscess (nine patients). Assignment of patients to a clinical interventional radiology service for the duration of this treatment may greatly facilitate management.

Chronic, recurrent small-vessel cutaneous vasculitis. Clinical experience in 13 patients.

The clinical experience in 13 patients with small-vessel cutaneous vasculitis limited to the skin is presented. Within the spectrum of what is referred to as "hypersensitivity vasculitis," this group of patients represents a distinctive clinical entity characterized by (1) clinical, laboratory, and histopathologic features of the hypersensitivity vasculitis group; (2) chronic and recurrent isolated cutaneous vasculitis eruptions; (3) absence of disease progression to systemic involvement during long-term follow-up; and (4) relative unresponsiveness to immunosuppressive therapy, including treatment with corticosteroids (prednisone) and cyclophosphamide. Because this disease remains limited to the skin, potentially toxic immunosuppressive regimens with prolonged daily corticosteroids or cytotoxic agents should be avoided. Treatment of local symptoms, particularly lower extremity pain, remains a difficult treatment problem in some patients.