Tuberculous hepatic abscess occurs rarely. most of these being associated with tuberculosis at other sites. Only I I reports of isolated tuberculous hepatic abscess have been made in the English literature. A further case of isolated tuberculous hepatic abscess is reported with particular emphasis on the difficulty that may be eirountered in reaching the correct diagnosis.
Fifteen cases of duodenal trauma that presented to westmead hospital between 1979 and july 1986 are reviewed. There were 12 blunt injuries, nine caused by motor vehicle accidents. Three patients sustained penetrating injuries, two due to stab wounds. Repair for blunt laceration or incised wound was by primary closure or serosal patch repair, most often with decompressive t‐tube duodenostomy. No leak from the duodenal repair occurred in any patient. Two patients died. This was not due to complications of the duodenal injury. Pyloric exclusion, duodenal diverticulization or pancreaticoduodenectomy was not considered necessary in any patient. Morbidity of duodenal haematoma in the form of continuing abdominal pain may be avoided by intra‐operative drainage.
Background: Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries. Methods: A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings. Results: Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9). Conclusions: We found that older adolescents (≥14 y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12 y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population. Level of Evidence: Level—IV.
Records of all patients with liver abscess who presented to a teaching hospital between 1979 and 1986 were reviewed in order to determine prognostic factors and optimal treatment. Of 32 patients, the diagnosis was made ante‐mortem in 30, and 24 patients survived. Patients who died tended to be older and more likely to exhibit confusion and other features of systemic toxicity at presentation. Fine needle aspiration, guided by computerized tomography, provided the correct diagnosis in 18 of 19 patients. Of 24 patients with isolated abscesses (1 or 2) 22 survived, whereas six of eight patients with multiple (more than 2) abscesses died (P < 0.001). Aspirates from patients who survived appeared to grow anaerobes more commonly (NS), whereas those from non‐survivors more often grew multiple organisms which usually included Gram‐negative bacilli (P < 0.01). All patients received broad spectrum antibiotics and a drainage procedure was carried out in 26. Of 19 patients treated by percutaneous drainage, 12 recovered, one required hepatic resection before recovering, and six died (four with multiple abscesses). Of nine patients (all with 1–2 abscesses) treated by open drainage, all eventually recovered, but three needed additional procedures. Six of eight non‐survivors compared with four of 24 survivors had predisposing biliary sepsis (P < 0.01). It is concluded that isolated liver abscesses are relatively benign, commonly grow anaerobes, and are usually resolved with antibiotics and drainage (closed or open), whereas multiple abscesses occur in sicker, older patients who are usually jaundiced with uncontrolled biliary sepsis. The prognosis in patients with multiple liver abscesses is poor irrespective of treatment.
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