Amebic liver abscess: ultrasound and clinical follow-up of 20 patients

The objective of this study was to investigate the feasibility of developing a system whereby measurements taken on bulk tank milk samples could be used to monitor the level of subclinical mastitis in dairy herds. The variables that were examined were the logarithmically transformed total somatic cell counts and percentages of cell volume in channel 8 (volumes from 89.2 to 178.3 microm(3)), the presence or absence of Streptococcus agalactiae and various husbandry/management factors including herdsize and the use of teat dips. Each of the use of actual monthly and rolling average bulk tank cell count determinations was investigated. It was found that the inclusion of all variables resulted in a correct classification of approximately 85% of herds and that no improvement was achieved by the use of rolling as opposed to actual monthly values. The inclusion of various husbandry/management practices improved the percentage correct classification to some extent over that achieved by the sole use of total somatic cell counts and percentages of cell volume in channel 8 when the herds were grouped on the basis of quarter infection rate (<10%, >10%) but not in the case of the cow infection rate categories (<20%, >20%). The use of both total cell counts and percentages of cell volume in channel 8 did not improve the overall predictive value over that achieved by the sole use of percentage of cell volume in channel 8 in the case of the quarter infection rate groupings but did to some extent in the case of the cow infection rate groupings. When the classification functions were applied prospectively and considering combinations of the two cell count determinations only, it was found that they were able to correctly classify, on the basis of the quarter infection rate groupings, approximately 75% of the study herds. It is concluded that the system described herein has limited application as a basis for selecting problem herds.     

Amebic liver abscess of unusual presentation

A 35-year-old male who had travelled extensively in the tropics presented with severe anorexia and vomiting associated with fever of 39-40 degrees C during a 4-day period. The clinical findings were entirely negative. In 1973, he had been given metronidazole for amebic dysentery, since when recurrent attacks of diarrhea and abdominal pain had been treated with iodoquinoleines. Stool examination was negative for amebae. Liver scan revealed a suspect "expansive process" in the right lobe. The presumptive diagnosis of amebic abscess was made and metronidazole therapy was started. In less than 24 h the patient became afebrile. The abscess was confirmed by a further liver scan. The definitive diagnosis of amebiasis was established 16 days later when the immunofluorescence level, which had been previously negative, became positive 1/480. This case demonstrates the dangers of the indiscriminate use of iodoquinoleines in patients who have travelled in tropical countries. The amebic liver abscess may be silent locally while causing systemic manifestations such as fever. Early treatment of hepatic amebiasis is recommended even with a presumptive diagnosis. Serological tests during the development of an amebic abscess may be negative and should be repeated after several days of therapy.     

Pyogenic hepatic abscess. Changing trends over 42 years

OBJECTIVE: The authors document changes in the etiology, diagnosis, bacteriology, treatment, and outcome of patients with pyogenic hepatic abscesses over the past 4 decades. SUMMARY BACKGROUND DATA: Pyogenic hepatic abscess is a highly lethal problem. Over the past 2 decades, new roentgenographic methods, such as ultrasound, computed tomographic scanning, direct cholangiography, guided aspiration, and percutaneous drainage, have altered both the diagnosis and treatment of these patients. A more aggressive approach to the management of hepatobiliary and pancreatic neoplasms also has resulted in an increased incidence of this problem METHODS: The records of 233 patients with pyogenic liver abscesses managed over a 42-year period were reviewed. Patients treated from 1952 to 1972 (n = 80) were compared with those seen from 1973 to 1993 (n = 153). RESULTS: From 1973 to 1993, the incidence increased from 13 to 20 per 100,000 hospital admissions (p < 0.01. Patients managed from 1973 to 1993 were more likely (p < 0.01) to have an underlying malignancy (52% vs. 28%) with most of these (81%) being a hepatobiliary or pancreatic cancer. The 1973 to 1993 patients were more likely (p < 0.05) to be infected with streptococcal (53% vs. 30%) or Pseudomonas (30% vs. 9%) species or to have mixed bacterial and fungal 26% vs. 1%) infections. The recent patients also were more likely (p < 0.05) to be managed by percutaneous abscess drainage (45% vs. 0%). Despite having more underlying problems, overall mortality decreased significantly (p < 0.01) from 65% (in 1952 to 1972 period) to 31% (in 1973 to 1993 period). The reduction was greatest for patients with multiple abscesses (88% vs. 44%; p < 0.05) with either a malignant or a benign biliary etiology (90% vs. 38%; p < 0.05). Mortality was increased (p < 0.02) in patients with mixed bacterial and fungal abscesses (50%). From 1973 to 1993, mortality was lower (p = 0.19) with open surgical as opposed to percutaneous abscess drainage (14% vs. 26%). CONCLUSIONS: Significant changes have occurred in the etiology, diagnosis, bacteriology, treatment, and outcome patients with pyogenic hepatic abscesses over the past 4 decades. However, mortality remains high, and proper management continues to be a challenge. Appropriate systemic antibiotics and fungal agents as well as adequate surgical, percutaneous, or biliary drainage are required for the best results.     

Hodgkin's disease in a national and hospital population: trends over 20 years

The aim of the study was to investigate the incidence rate and time trends in a national registry population of Hodgkin's disease (HD) and the effects of selection in a hospital population. A national registry population of all HD patients from Norway and a hospital population of HD patients treated at the Norwegian Radium Hospital (NRH) were studied retrospectively from 1971 to 1993. The incidence of non-Hodgkin's lymphomas (NHL) in Norway increased steadily from 1961 in contrast to a stable incidence pattern for HD before 1980 and a decreasing incidence since 1980. Due to improved diagnostic tools after 1980, an increasing proportion of patients previously diagnosed as lymphocyte depleted and unclassified HD were classified as NHL. As these histologies are dominant in older patients, the incidence of older patients with HD and the total population of HD have decreased since 1980. As a result, the proportion of young adults with a favourable histology has increased. These changes may partly explain the increased patient survival observed both in the national and the hospital population. The hospital population comprised 92% of patients aged 15-39 years, 80% of patients aged 40-59 years and 53% of patients aged > 60 years in the national population. The selection of younger patients in the hospital material may explain a higher survival rate as compared with the national population.     

Intracranial abscesses: a review of treated patients over 20 years

A series of 49 consecutive patients with an intracranial abscess treated over a 20 year period is analysed and reported. The overall mortality was 28 per cent. The authors regard this figure as quite unacceptable and stress that the combination of isotope scans and computerized axial tomography (CAT) should allow an immediate reduction in mortality to around 10 per cent. The plea is made that whenever a primary source of infection is present the possibility that an intracranial mass could be an abscess is constantly borne in mind. Under such circumstances the patient should be referred immediately to a neurosurgical department (where computerised axial tomography is usually available) without a preceding lumbar puncture.     

Melanoma in Togo. A retrospective study over 20 years

INTRODUCTION: The malignant melanoma is a rare malignant tumour in black patients, but it is common in white patients. MATERIAL AND METHODS: Medical records were reviewed retrospectively during 20 years (1973-1992) to determine the epidemiological features of malignant melanoma in Togo. RESULTS: During this period 63 cases (31 males and 32 females) of malignant melanoma were histologically diagnosed; an average of 3.15 cases each year. The tumor takes place preferably on the feet 40 cases (63.49%), hands 15 cases (19.04%), legs and thigh 10 cases (15.87%). CONCLUSION: The results of this study confirm the particularity of malignant melanoma in black subjects: its rarity and the feet localizations.     

Validity of dietary recall over 20 years among California Seventh-day Adventists

Past dietary habits are etiologically important to incident disease. Yet the validity of such measurements from the previous 10-20 years is poorly understood. In this study, the authors correlated food frequency results that were obtained in 1994-1995 but pertained to recalled diet in 1974 with the weighted mean of five random 24-hour dietary recalls obtained by telephone in 1974. The subjects studied were 72 Seventh-day Adventists who lived within 30 miles of Loma Linda, California; had participated in a 1974 validation study; were still alive; and were willing to participate again in 1994. A method was developed to allow correction for random error in the reference data when these data had differentially weighted components. The results showed partially corrected correlation coefficients of greater than 0.30 for coffee, whole milk, eggs, chips, beef, fish, chicken, fruit, and legumes. Higher correlations on average were obtained when the food frequencies were scored simply 1-9, reflecting the nine frequency categories. The 95% confidence intervals for 15 of the 28 correlations excluded zero. Incorporation of portion size information was unhelpful. The authors concluded that in this population, data recalled from 20 years ago should be treated with caution but, for a number of important foods, that the degree of validity achieved approached that obtained when assessing current dietary habits.     

Tropical liver abscess

Forty-one consecutive cases of liver abscesses seen at the National University Hospital, Singapore from 1988 to 1994 were reviewed. Twenty-seven cases (65%) were pyogenic, six (15%) amoebic, two (5%) tuberculous and six (15%) indeterminate. The predominance of pyogenic abscesses is in marked contrast to previous studies from the region a decade ago in which amoebic abscesses were the commonest type. The commonest pathogen causing pyogenic abscess was Klebsiella pneumoniae. Two cases were due to Mycobacterium tuberculosis, and this organism needs to be actively looked for in smears and cultures of aspirated material. As the majority of organisms isolated were resistant to ampicillin, empirical antibiotic treatment for suspected pyogenic abscess should include gentamicin or a cephalosporin. Percutaneous needle aspiration of the abscess was performed for 85% of pyogenic abscesses and surgery was necessary in only two cases because of complications. We found that percutaneous aspiration of liver abscess is helpful to confirm the diagnosis, provides a better bacteriological culture yield, gives a good outcome, and may uncover clinically unsuspected conditions like malignancy and tuberculoma which may mimic the presentation of liver abscesses. We recommend routine cytological examination of aspirated abscess material as well as stains and cultures for acid-fast bacilli.     

Stability and change in adult personality over 12 and 20 years.

Investigated the stability and change of 15 personality traits as measured by the Edwards Personal Preference Schedule over 20–40 yrs of age, using both a method combining correlational and mean level statistics to assess individual longitudinal changes and comparisons of longitudinal, cross-sectional, and age-cohort analyses to differentiate maturational and generational influences. A sample of 92 undergraduates tested in the late 1950's and 85 undergraduates tested in 1965 were retested by mail in 1978. 113 undergraduates were also tested in 1978. Longitudinally, substantial stability was reflected on several traits including deference and endurance, general increases on such traits as achievement and autonomy, general decreases on such traits as affiliation and abasement, and varied changes on a small number of traits. Maturational trends generally were similar for men and women, but generational trends differed between the sexes and resulted in a lessening or convergence of sexual differences in personality since the 1950's. The use of biographical data to suggest causal antecedents of personality change generally proved unsuccessful. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skin autografts in epidermodysplasia verruciformis: human papillomavirus-associated cutaneous changes need over 20 years for malignant conversion

Epidermodysplasia verruciformis (EV) is regarded as a model for cutaneous oncogenesis associated with specific human papillomaviruses (HPVs). Because genital HPV-associated carcinogenesis is a very long-lasting process requiring 20-30 years and epidemiological studies of this type for HPV-associated skin cancers are impossible in such a rare disease as EV, we observed for up to 20 years EV patients having surgery for carcinomas with consecutive autografts from uninvolved and non-sun-exposed skin. We noticed the appearance of premalignant and malignant changes around the grafts, whereas within the grafted skin, only benign macular lesions started to develop several years after transplantation. Thus, skin HPV-associated carcinogenesis appears to be a very slow process comparable to the genital carcinogenesis associated with high risk HPVs.     

Personal reminiscences of a psychologist married couple on changing perspectives in 20 years of professional psychology.

The authors describe their perspectives as a psychologist married couple and discuss some of the major trends that have affected their work in the last years, including the women's movement and new developments in the field of psychology. They note both positive and negative changes from the last 2 decades. Whereas there are many more new and exciting opportunities for psychologists today, there are also more pressures, more stringent training and credentialing requirements, more competition, and less mobility. Also discussed are some advantages to being married to another psychologist, including understanding each other's roles, combining social and professional lives, and expanding professional networks. They look to the future of psychology with optimism and hope that by examining and changing some of the restrictions on psychologists today, the field of professional psychology can be made more rewarding for future psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatic arterial chemotherapy for liver cancer over a period of 8 years

Hepatic arterial chemotherapy was performed for 27 patients with primary (3), metastatic liver cancer (21), and 3 other cases, over a period of 8 years. Chemotherapy was performed by intermittent hepatic arterial infusion of 5-FU or FAM (in case of metastatic tumor from colorectal cancer), FAM (from gastric cancer), and CDDP or Farmorubicin (HCC). Hepatic resection was performed in 10 cases of metastatic tumor from colorectal cancer, and 8 cases of 10 were curative operation. The 5-year survival rates of curative liver resection group, and non-curative liver resection or non-resection group were 57.1% and 12.5%, respectively. As is the case with metastatic cancer from gastric cancer, pancreatic cancer, and hepatocellular carcinoma (HCC), the prognosis was poor except for one CR case of HCC. We concluded that hepatic arterial chemotherapy may be recommended for a curative resected case of liver metastasis from colorectal cancer.     

Changes in psychiatric admission MMPI profiles over a period of 15 to 20 years

An attempt was made to compare admission MMPI profiles of a matched sample of psychiatric inpatients over a 15- to 20-year period. For both males and females, significant decreases in MMPI indices of psychopathology occurred. Possible reasons for this decrease are presented.