Pyogenic abscess of the psoas muscle results from primary suppuration or direct extension of intraabdominal infection. The etiology varies with the country of origin. Our experience with 9 cases prompted a review of 367 cases from the world literature. A total of 286 primary abscesses occurred mainly in developing nations (200 cases), although 74 were reported from the United States. Younger patients predominated in developing nations (81.4% <20 years old), while only 47.8% from the United States were younger than 20 years. PureStaphylococcus aureus was commonly cultured (88.4%); simple incision and drainage cured 97.3% of patients with primary psoas abscess. Of 7 (2.5%) patients who died, 6 were from the United States; therapy was inadequate or delayed in all 7 patients. Ninety secondary abscesses appeared almost exclusively in reports from Europe, the United States, and Canada. Crohn's disease was the most common etiology followed by appendicitis and colon inflammation or cancer; mixed enteric infections predominated (55.7%). Although rare during the first decade, distribution was otherwise relatively even across all age groups. Simple drainage succeeded in only 49% of cases. Higher mortality accompanied secondary abscess (17 cases, 18.9%). The etiology of pyogenic psoas abscess guides the selection of proper medical and surgical therapy. While primary abscess is the likely etiology in developing nations and secondary abscess in Europe, either may occur in the United States. Early diagnosis and proper therapy are necessary to reduce mortality.

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Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

In patients not undergoing beta-blocker therapy, large AAA expand at a significantly greater rate than smaller AAA. Large aneurysms that rupture show more rapid expansion than those AAA that do not rupture. We have demonstrated a significantly reduced rate of expansion of large AAA in patients receiving beta-blockade.