HCC : PE-053 ; Predicting risk factors and clinical features of liver abscess in HCC patients with postembolization syndrome after TACE

( Sung Bum Cho ),( Yen Joo Kim ),( Won Hyung Choi ),( Chung Hwan Cheon ),( Ki Hoon Lee ),( Nam Kyu Zang ),( Jin Woong Kim ),( Young Eun Joo ),( Sung Kyu Cho ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Liver abscess was very rare but serious complication lead to liver failure and fatal outcomes after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study was evaluated to clinical features of TACE related liver abscess and predicting risk factors among HCC patients who developed postembolization syndrome after TACE. Methods: From January 2008 to December 2010, 13 patients of liver abscess which was undergone percutanous drainage developed in 2582 sessions of TACE. There was retrospectively analyzed to clinical features and predicting risk factors of liver abscess compared with control group who was selected 181 patients with fever after TACE. Results: The incidence of liver abscess was 0.5%. The etiologic types were necrosis related abscess (7 cases, 54%), biloma related abscess (4 cases, 31%), indirect abscess (2 cases, 15%). The mean interval time between percutanous drainage and TACE was 51±38 days. The positive culture rate was 69 % (9 cases) and organisms were enterococcus (4), Klebsiella pnemumoniae (2), Escherichia coli (1), Citrobacter (1) and Clostridium difficile (1). Abscess group was more higher peak AST level, peak bilirubin level, single nodular type HCC, Choledocholithiasis, air forming tumoral necrosis than control group. Independent predicting risk factors to abscess was only large air forming tumoral necrosis. The overall mortality rate of abscess was 61%. 6 patients were died caused by directly related to abscess. Conclusions: TACE related liver abscess was fatal infectious complication related to extensive air forming tumoral necrosis. The clinician should be considered to possibility of developing abscess in HCC patient with high risk factors after TACE.

신 및 신주위 농양: 지난 10년간의 단일기관 경험

성병주,정재민,최성,류현열,이상돈 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.10

Purpose: We analyzed the clinical experiences of patients with renal, perinephric, and mixed abscesses during the last 10 years in a single center. Materials and Methods: We reviewed the medical records of 33 patients with renal, perinephric, and mixed abscesses treated at our hospital between January 1998 and March 2008. The medical records, including predisposing conditions, clinical manifestations, physical examination, laboratory and radiologic findings, duration of hospitalization, types of uropathogens, time to clinical improvement, time to laboratory improvement, treatment, and clinical outcomes, were retrospectively analyzed. Results: Renal, perinephric and mixed abscesses occurred in 22(66.7%), 4(12.1%), and 7(21.2%) patients. The most common predisposing conditions were diabetes mellitus(39.4%) and liver disease(27.3%). Flank pain (57.6%) and fever(54.5%) were the most common symptoms. Urine and blood cultures were positive in 23.3 and 19.2% of patients, respectively. The most common isolated uropathogen in the urine, blood, and purulent cultures was E. coli. The time to clinical and laboratory improvement was not significantly different between the patients with renal, perinephric, and mixed abscesses. Patients with renal, perinephric, and mixed abscesses received antibiotic therapy only in 59.1, 50.0, and 42.9% of cases, respectively. Similarly, patients with renal, perinephric, and mixed abscesses underwent percutaneous or surgical drainage in 22.7, 50.0, and 14.3% of cases, respectively. Patients required a nephrectomy in 18.2 and 42.9% of renal and mixed abscess cases, respectively. Most patients were cured(54.5%) or improved(42.4%) at the time of discharge from the hospital. Conclusions: We suggest that renal, perinephric, and mixed abscesses are successfully managed by proper medical or interventional treatment. However, the cases suspicious for renal cancer or with non-functioning kidneys must be evaluated carefully for nephrectomy. Purpose: We analyzed the clinical experiences of patients with renal, perinephric, and mixed abscesses during the last 10 years in a single center. Materials and Methods: We reviewed the medical records of 33 patients with renal, perinephric, and mixed abscesses treated at our hospital between January 1998 and March 2008. The medical records, including predisposing conditions, clinical manifestations, physical examination, laboratory and radiologic findings, duration of hospitalization, types of uropathogens, time to clinical improvement, time to laboratory improvement, treatment, and clinical outcomes, were retrospectively analyzed. Results: Renal, perinephric and mixed abscesses occurred in 22(66.7%), 4(12.1%), and 7(21.2%) patients. The most common predisposing conditions were diabetes mellitus(39.4%) and liver disease(27.3%). Flank pain (57.6%) and fever(54.5%) were the most common symptoms. Urine and blood cultures were positive in 23.3 and 19.2% of patients, respectively. The most common isolated uropathogen in the urine, blood, and purulent cultures was E. coli. The time to clinical and laboratory improvement was not significantly different between the patients with renal, perinephric, and mixed abscesses. Patients with renal, perinephric, and mixed abscesses received antibiotic therapy only in 59.1, 50.0, and 42.9% of cases, respectively. Similarly, patients with renal, perinephric, and mixed abscesses underwent percutaneous or surgical drainage in 22.7, 50.0, and 14.3% of cases, respectively. Patients required a nephrectomy in 18.2 and 42.9% of renal and mixed abscess cases, respectively. Most patients were cured(54.5%) or improved(42.4%) at the time of discharge from the hospital. Conclusions: We suggest that renal, perinephric, and mixed abscesses are successfully managed by proper medical or interventional treatment. However, the cases suspicious for renal cancer or with non-functioning kidneys must be evaluated carefully for nephrectomy.

HCC : PE-053 ; Predicting risk factors and clinical features of liver abscess in HCC patients with postembolization syndrome after TACE

( Sung Bum Cho ),( Yen Joo Kim ),( Won Hyung Choi ),( Chung Hwan Cheon ),( Ki Hoon Lee ),( Nam Kyu Zang ),( Jin Woong Kim ),( Young Eun Joo ),( Sung Kyu Choi ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Liver abscess was very rare but serious complication lead to liver failure and fatal outcomes after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study was evaluated to clinical features of TACE related liver abscess and predicting risk factors among HCC patients who developed postembolization syndrome after TACE. Methods: From January 2008 to December 2010, 13 patients of liver abscess which was undergone percutanous drainage developed in 2582 sessions of TACE. There was retrospectively analyzed to clinical features and predicting risk factors of liver abscess compared with control group who was selected 181 patients with fever after TACE. Results: The incidence of liver abscess was 0.5%. The etiologic types were necrosis related abscess (7 cases, 54%), biloma related abscess (4 cases, 31%), indirect abscess (2 cases, 15%). The mean interval time between percutanous drainage and TACE was 51±38 days. The positive culture rate was 69 % (9 cases) and organisms were enterococcus (4), Klebsiella pnemumoniae (2), Escherichia coli (1), Citrobacter (1) and Clostridium difficile (1). Abscess group was more higher peak AST level, peak bilirubin level, single nodular type HCC, Choledocholithiasis, air forming tumoral necrosis than control group. Independent predicting risk factors to abscess was only large air forming tumoral necrosis. The overall mortality rate of abscess was 61%. 6 patients were died caused by directly related to abscess. Conclusions: TACE related liver abscess was fatal infectious complication related to extensive air forming tumoral necrosis. The clinician should be considered to possibility of developing abscess in HCC patient with high risk factors after TACE.

소아 경부 감염의 임상 양상과 농양 형성의 예측 인자

공성호,최용준,유건희,김윤우,박주현,임윤성 대한이비인후과학회 2017 대한이비인후과학회지 두경부외과학 Vol.60 No.2

Background and Objectives Abscess of neck is a life-threatening disease in children. Detection of abscess is important because it is essential for the determination of surgical drainage. However, clinical diagnosis is difficult, because children are seldom able to verbalize their symptoms or cooperate with physical examination. This study aims to review the clinical characteristics of 157 pediatric patients with neck inflammation and investigate the relative risk factors for abscess. Subjects and Method Pediatric patients who were admitted to Dongguk University Hospital from January 2005 to July 2014 with acute neck inflammation were reviewed. All 157 pediatric patients were divided into two groups, based on radiologic findings with and without neck abscess. Results Of 157 patients, 53 children were diagnosed with neck abscess, and peritonsillar abscess was the most common type of neck abscess followed by submandibular abscess, retro·parapharyngeal abscess and posterior triangle & other abscess. The dominant pathogens, staphylococcal infection (≤2 yr) and streptococcal infection (>3 yr), was different for the different age group. The abscess group except for peritonsillar abscess was characterized by younger age, higher heart rate and WBC count, and longer hospital days than those without abscess (p=0.026, 0.026, <0.001, 0.007 respectively). Multivariate analysis revealed younger age (≤24 mo) and higher heart rate were independent predictors for abscess formation (odds ratio: 3.022, 2.923). Conclusion Pediatric patients with high heart rate & younger age are at risk for abscess formation; meticulous care and early imaging work up are required in younger children with deep neck infection, and especially with higher heart rate. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(2):76-82

한국에서 발생하는 아메바 간농양의 최근 동향: 화농성 간농양과의 비교

김은주,박동희,김경중,김태오,박승하,박종하,최준혁,이진,박용은,오은혜,황준성,허내윤 대한소화기학회 2020 대한소화기학회지 Vol.76 No.1

Background/Aims: With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess. Methods: Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period. Results: Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. Conclusions: Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.

Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases

( Bong Eun Lee ),( Hee Yun Seol ),( Tae Kyung Kim ),( Eun Young Seong ),( Sang Heon Song ),( Dong Won Lee ),( Soo Bong Lee ),( Ihm Soo Kwak ) 대한내과학회 2008 The Korean Journal of Internal Medicine Vol.23 No.3

Background/Aims: The aim of this study was to examine the recent clinical trends and antibiotic susceptibilities of the causative microorganisms in renal and perirenal abscesses, and to elucidate the factors associated with treatment strategies. Methods: We retrospectively analyzed 56 patients who were diagnosed with renal and perirenal abscesses at our hospital from January 2000 to September 2007. Results: The mean age of the patients was 53.5 years, and a female predominance of patients (75%) was observed. Diabetes mellitus (44.6%) was the most common predisposing condition. The mean duration of symptoms before diagnosis was 11.6 days, and fever (75%) was the most common symptom. Escherichia coli (44%) and Klebsiella pneumoniae (28%) were common pathogens, and the rates of susceptibility of E. coli isolates to ampicillin, cephalothin, cefotaxime, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and imipenem were 18.2%, 27.3%, 72.7%, 72.7%, 63.6%, 63.6%, and 100%, respectively. Abscesses were classified according to the location as follows: renal abscess (n=31, 55.4%) and perirenal abscess±renal abscess (n=25, 44.6%). In the renal abscess group, the infection rate of gram-negative organisms was higher than in the perirenal abscess group. Patients were also divided according to the treatment modality: antibiotics only (n=20, 35.7%) and percutaneous intervention or surgery (n=36, 64.3%). Patients who had a perirenal abscess or a large renal abscess required more invasive treatment. Conclusions: This study revealed somewhat different results from those of previous studies. Clinical and microbial differences were observed between the renal and perirenal abscess groups. Abscess location and the size of the renal abscess were the factors associated with treatment strategies.

청색형 선천형 심장질환과 관련된 뇌농양에 대한 임상적 고찰

정영섭,김동호,정희원,한대희 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.1

Fourteen cases of brain abscess with cyanotic congenital heart disease operated during 10 years from 1974 to 1983 were reviewed. The abscess associated with cyanotic congenital heart disease constituted 21.8% (14/64) of total brain abscesses during this period. Brain abscess occurred in 1.8% (14/784) of the patients with cyanotic congenital heart disease. Of 14 cases, 12 had a tetralogy of Fallot and others were transposition of the grear vessels and pulmonary atresia. A peak in the age distribution was seen at 5 to 11 years of age and the preponderance of males was present(2:1=M:F). The major symptoms and signs were due to the increased ICP and 21.4 %(3/14) of the abscesses was nonfebrile. All of the abscesses were supratentorial and located in temporal, parietal, occipital, frontal area in order of frequency. In one case multiple abscess was present. Sterile cultures were obtained in 57.1% (8/14) of the abscesses. Anaerobic streptococcus, bacteroides, streptococcus, staphylococcus, G(-) rods were cultured. All of the abscesses were treated by surgical management with the overall mortality of 14.3% (2/14). Total excision of the abscess generally resulted in better outcome. Patients were operated upon in the stabilized stage of the disease clinically with the aid of serial CT scan evidence. The introduction of CT scan has facilitated early diagnosis, location, and investigation of the evolution of a abscess to obtain a better postoperative result. However, recent progress in neurosurgery and cardiac surgery has made it possible to extend the normal life of these patients. Therefore we should have to give our attention to the surgical management of the brain abscess associated with cyanotic congenital heart disease seriously.

Clinical Characteristics of Amebic Liver Abscess in Pyogenic Liver Abscess Dominant Area

( Dong-hee Park ),( Nae-yun Heo ),( Seung Ha Park ),( Joon Hyuk Choi ),( Young Soo Moon ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: With improvement of hygiene, the incidence of amebic liver abscess is known to be decreasing in South Korea. There is little data for the current status in amebic liver abscess compared with pyogenic liver abscess. Methods: This is a cross-sectional study about the amebic liver abscess in a university hospital. We compared the clinical characteristics of amebic liver abscess with those of pyogenic liver abscess in the same period. Results: According to ICD code, all the clinical and laboratory data about the patients who were diagnosed as liver abscess between March 2010 and October 2016 were investigated. Four hundred thirteen patients with liver abscess were identified. Among them, the serologic test for Entamoeba histolytica was performed in 209 patients in which the cause of liver abscess was indefinite at initial evaluation. IgG anti-E. histolytica was positive in 15, and equivocal in 1 patients, which was classified as amebic live abscess group, and the others as pyogenic liver abscess group. Procalcitonin was lower in amebic liver abscess than pyogenic liver abscess (median (range); 1.27 ng/mL (0.12-8.58) vs. 3.07 ng/mL (0.05-119.95), P<0.01). Age, gender, WBC, CRP was comparable between both groups. The number of abscess pockets, the maximal diameter of largest lesion, the frequency of percutaneous drainage, and hospital stay were not different between both groups. Amebic abscess showed the higher proportion of right lobe lesions compared with pyogenic liver abscess (87.5% vs. 63.7%, P=0.019), Four patients with amebic liver abscess showed the mixed infection with K. pneumoniae. None of amebic live abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. Conclusions: Among crytogenic liver abscesses in initial assessment, amebic liver abscess occupied 7.7%. It is difficult to discriminate amebic liver abscess from pyogenic liver abscess according to clinical and laboratory findings. However, all the patients with amebic liver abscess successfully recovered antibiotics and/or percutaneous drainage which was the same treatment in pyogenic liver abscess.

간농양의 임상적 고찰

이옥재(Ok Jae Lee),김영채(Young Chai Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

N/A Liver abscess had been described as fatal disease before the turn of the century. There are two kinds of liver abscess, the etiology, clinical course, diagnosis, and management are different be- tween pyogenic and arnebic abscess. With the advent of antibiotics and the development of newer imaging t,echniques, marked changes in diagnosis, treatment and prognosis have been reported. In this study, a detailed review was perforrned in 74 patients treated for pyogenic or amebic liver abscess at the Gyeongsang I%ational University Hospital frorn January, 1987 through June, 1993. Among 74 cases of liver abscess, 66(89.2%) were pyogenic and 8(10.8%) amebic. The male to female ratio of liver abscess was 1.1:1 in pyogenic, 7:1 in amebic, the peak inci- dence was in the 6th decade in pyogenic and 5th, 6th decade in amebic abscess. The rnost com mon portal of entry in pyogenic abscess was biliary tract(71.2%). Liver scan, abdominal ul- trasound and CT scan was performed in 18.9%, 100%, 77% each with the each positive rate was 100%, 81.1%, and 98.2%. The most common organism of the pyogenic abscess was E. coli(46.3%). Secondary infection of amebic abscess was occurred in 1 case(12.5%). 1n the amebic abscess, antibody t.o ameba was positive in 6 cases(75%) and pus revealed chocolate brown or anchovy paste like color in 7 cases(87.5%). In the pyogenic abscess, su.'gical drain- age, percutaneous drainage or antibiotics alone was tried in 50.2%, 25.8%, 21.2% E.'ach and the each cure rate was 89.5%, 88.6% and 28.6%. The patients with amebic abscess were cured by amebicides alone(62.5%) or percutaneous aspiration(37.5%). The mortality rate of liver abscess was 12.1% in pyogenic and 0% in amebic. The factors influencing mortality in the pyogenic abscess were nonbliary origin, underlying malignancy, multiplicity of abscess, large abscess cavity(>10cm), involvement of both lobe and hypoalburninemia(K3g/dl).(Ko rean J Gastroenterol 1994; 26: 506 520)

영아에서 항문주위농양의 치료 -절개배농술과 절개배농술 후 치루절개술 혹은 음와절개술의 술 후 결과 비교-

안상욱,이남혁,김상윤 대한대장항문학회 1995 Annals of Coloproctolgy Vol.11 No.3