Forty-two patients with necrotizing soft tissue infection are reviewed. Bacterial culture revealed between two and seven types of micro-organism in each patient. All patients were treated with radical surgical debridement and a combination of antibiotics. In 30 patients, early diagnosis and treatment resulted in only two deaths. Delayed surgical intervention in 12 patients transferred from outside hospitals was followed by nine deaths. Predisposing factors and site of infection did not affect outcome. Of 26 patients with systemic manifestations of sepsis, 16 survivors responded well to initial surgical debridement.

A consecutive series of 227 patients with hydatid disease of the liver is reported. During the first period when marsupialization or drainage of the cyst was applied, long hospitalization and bilious leakage were reported. During the second period omentoplasty superseded the above methods. As a result, hospitalization was lowered from 36 or 52 to 12 days, while the incidence of biliary leakage was minimized from 25.2 or 60.7 per cent to 2.5 per cent respectively. The overall mortality is about 3.5 per cent. Consequently omentoplasty is considered the treatment of choice when dealing with hydatid cyst of the liver. Marsupialization or partial hepatectomy is the alternative for huge, infected cysts. ECHINOCOCCOSIS is a well‐known disease, but its surgical treatment has markedly changed during the past years. The word ‘echinococcus’ is Greek in origin and means ‘hedgehog berry’. Hydatid disease of the liver was known to Hippocrates, who refers to a ‘liver full of water’. It was not until 1782 that Goeze recognized microscopically the small taenias with their characteristic hooklets. Since then numerous reports have made absolutely clear both the pathology and epidemiology of the disease. In Greece, with a population of up to 8 million, an average of 500 cases yearly are reported, i.e., a frequency of 6 per 100,000 inhabitants (Toole, 1969).

Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%). This resulted in effective bile drainage, obviating the need for emergency surgery in all patients. No procedure-associated morbidity or mortality was found. Following clinical remission, elective treatment consisted of ESWL/direct stone dissolution (n = 10) or elective surgery (n = 3). Three patients received no further therapy. Our results show that endoscopic gallbladder drainage may be a valuable alternative to emergency surgery in high risk patients with acute obstructive cholecystitis.

Background/Aims: To study the demographics, signs and symptoms, causes, risk factors, imaging findings, bacteriologic profile, treatment and outcome of patients with splenic abscess. Method: The medical records of 17 patients with splenic abscess at two tertiary-care hospitals between 1989 and 1997 were retrospectively reviewed. The demographic data, physical and radiological findings, treatment, bacteriology reports and outcome of treatment were reviewed. Results: The mean age of patients was 43 years (range 7–79 years). Fever and abdominal pain were the most prominent signs. Seven patients were immunocompromised, three had abscessed hydatic cysts, two were drug users and three suffered from splenic trauma, infarction, and endocarditis, respectively. No predisposing factor was identified in 2 patients. In all cases, CT demonstrated the splenic lesion(s). Staphylococcus species and Bacteriodes were the most common microbes, identified in the blood and abscess cultures. Thirteen patients underwent splenectomy, two medical therapy and two no therapy with respective survival rates of 92, 100 and 0%. Conclusion: Splenic abscess is a rare surgical entity encountered mostly in immunocompromised patients. CT scan is the gold standard for the definite diagnosis. Splenectomy is the treatment of choice, while medical therapy should be reserved for unusual pathogens provided that an effective antimicrobial agent is available.