INTRA-ABDOMINAL INFECTIONS: SUBPHRENIC ABSCESS

Subphrenic abscesses most commonly develop after surgery involving the duodenum, stomach, biliary tract, or appendix, or after rupture of a hollow viscus, such as a perforated peptic ulcer or acute appendicitis. Patients may present with fever and abdominal pain in the right or left upper quadrants. Other symptoms may include hiccups, jaundice, shoulder pain, chest pain, cough, dyspnea, or a pleural effusion.

 The syndrome may be an acute, febrile illness, or a more chronic, insidious process with intermittent fevers, weight loss, and other constitutional symptoms. The chronic form develops most often in patients who have previously received antibiotics. The diagnosis of subphrenic abscess should always be considered in patients presenting with fever of unknown origin, especially if they have a history of abdominal surgery within the preceding few months.Computed tomographic scan and ultrasonography are the best methods for diagnosing a subphrenic abscess. An initial plain radiograph may give clues to the diagnosis, often showing a pleural effusion, an elevated hemidiaphragm, and concomitant lower lobe atelectasis or pneumonia.The primary treatment is drainage, via either a percutaneous procedure or an open laparotomy. Empiric antibiotic therapy is aimed at the organisms likely to be involved, depending on the mechanism of infection, and is the same as that recommended for secondary 

THE EXPLANATION FOR LINGERING BACTERIAL PROSTATITIS

One of the explanations for lingering bacterial prostatitis may be the presence of infection in tiny stones, called calculi, in the prostate. Prostatic calculi (the prostate’s version of gallstones or kidney stones) are quite common—about 75 percent of middle-aged men and 100 percent of elderly men have them. They can be detected with an imaging process called transrectal ultrasound.

 They’re usually small, found in grapelike clusters, and, most important, harmless. But when they get infected—as they often do in men with chronic bacterial prostatitis—prostatic calculi can cause an infection to persist, and symptoms of urinary tract infections and prostration to return again and again. (What causes calculi? Molecular analysis has shown that these stones contain ingredients generally found in urine but not prostatic secretions—which suggests they form when urine somehow “backs up,” or refluxes, into the prostate.)

When a man has both prostatic stones and a history of chronic bacterial prostatitis, it’s pretty safe to assume that the stones are infected. The significance of this is that infected calculi have never been cured by medication alone, although antibiotics can certainly treat the symptoms. The only way to cure infected prostatic stones permanently is to remove them surgically, by a procedure known as transurethral resection of the prostate.

COMBATTING ASTHMA IN CHILDREN: ANTI-INFLAMMATORY DRUGS

These drugs are offsprings of adrenelin, the major hormone produced by the adrenal gland, and act directly on particular sites called receptors or nerve cells of sympathetic nervous system. There are three main types of receptor sites called alpha, beta-1 and beta-2. These receptor sites are located in the airways, but they are also found in other parts of the body such as the inside of heart muscles, and muscles in the arms and legs. Some of these drugs act on all three types of receptor sites, but others are more selective.

The most effective adrenergic bronchodilator drugs are called beta-2 agonists, or simply beta agonists. They primarily influence the beta-2 receptors which are present only in the bronchial airways. These drugs are preferred because of their property to selectively relax bronchial muscles only, without stimulating muscles in the heart or other body areas.

 They cause fewer side effects. Examples of these drugs are salbutamol and terbutaline. They are available in tablet form as well as in aerosols in metered-dose inhalers and nebulizers. However care should be taken not to overuse these drugs during an attack. If their use does not provide adequate relief, it is an indication that some other group of drugs should also be added.


Beta-2 agonists also provide more rapid action with inhalers rather than with oral intake. While salbutamol or terbutaline may provide more or less immediate relief through inhalation, it may take upto three hours to obtain similar relief through the oral route.