Medical management of pyogenic liver abscesses.
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Biomedical subjects
Publications and source records attributed to F Simmons.
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A 67-year-old woman receiving ketoconazole, 200 mg daily for two months, had progressive jaundice, anorexia, and malaise develop. She had greatly elevated liver enzyme levels on hospital admission, and she died as a result of rapidly progressive liver failure. Histologic findings at autopsy disclosed acute hepatic necrosis. There was no clinical or serologic evidence of viral hepatitis. It is suggested that ketoconazole therapy was a causal factor in this case of fatal hepatic failure.
This study used 30 tape-recorded sentences taken from the Carrow Auditory Visual Abilities Test, then time-compressed by the Lexicon Varispeech II to 50%, in order to investigate age-related changes in auditory discrimination. Each sentence offers one or more phonemic contrasts (manner or place of articulation, voicing, frequency, or some combination). Overall group mean performance was not different between 6-yr-olds (N:14) vs 8-yr-olds (N:20), or between 10-yr-olds (N:16) vs 15 young adults, but the 2 older groups were each significantly better than each of the 2 younger groups. The ontogenetic progression of this auditory processing ability seems to mature in the early part of the second decade of life. Of 5 feature contrasts, only place of articulation was significantly more difficult, for all ages. Of 6 frequency contrasts, only that for high frequencies was significantly more difficult, for all groups, possibly due to an as yet undocumented damping of high frequencies by the time-compression apparatus.
Eleven consecutive patients with pyogenic liver abscesses were seen in a 20-month study period. Ten patients were treated with antibiotics alone. All ten had abscesses demonstrated by hepatic scintigraphy or sonography. In six patients purulent material was obtained by percutaneous aspiration of the liver. Blood-cultures were positive in each of the nine patients in whom they were obtained. Nine of the ten patients treated with antibiotics alone were cured; one died from complications of a liver biopsy. These results indicate that pyogenic liver abscesses can be effectively managed by medical therapy and that surgery is rarely required.
In vitro gentamicin treatment stimulates State 4 mitochondrial respiration and inhibits State 3 and DNP-uncoupled respiration. These effects are qualitatively similar in both hepatic and renal mitochondria. Threshold gentamicin concentrations for these effects were between 1 and 2 mM for renal mitochondria while hepatic mitochondria were slightly more sensitive. Neomycin, kanamycin, and streptomycin had effects qualitatively similar to those of gentamicin on State 4, State 3, and DNP-uncoupled respiration. The potency of the aminoglycosides in producing these effects strongly correlated with the number of ionizable amino groups present on the aminoglycoside molecule suggesting that cationic charge is an important molecular determinant of aminoglycoside-induced mitochondrial toxicity.
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