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Pyogenic liver abscesses: a comparison of older and younger patients.

ABSTRACT: BACKGROUND: Pyogenic liver abscess is a life-threatening disease. Few studies have specifically explored the way in which the clinical features and management of elderly patients with pyogenic liver abscess differ from those of younger individuals. METHODS: A retrospective study was undertaken to evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or whether their management and outcome differ from that of younger patients. A total of 133 patients with liver abscess treated in five hospitals during 13 years comprised two groups: 78 patients aged 60 years or above (older group) and 55 patients below age 60 years (younger group). Clinical features, laboratory data, imaging and microbiological findings, management and outcome were determined in each group. RESULTS: The older group contained more patients with associated diseases (p=0.03), nausea and vomiting at presentation (p=0.02), higher APACHE II (Acute Physiological and Chronic Health Evaluation II scale) score (p<0.001) and blood urea nitrogen (p<0.001) and serum creatinine levels (p=0.002). Multiple abscess (p=0.05) and bilobar (p=0.03) abscess were also commoner in this group. By contrast, in the younger group men predominated (p=0.01), and there was a higher overall complication rate (p=0.05).Time to diagnosis, hospital mortality rate and other variables analysed were similar in both groups. DISCUSSION: Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with a lower morbidity rate than in younger patients and no difference in the mortality rate.

SUBMITTER: Alvarez JA

PROVIDER: S-EPMC2020627 | biostudies-other | 2001

REPOSITORIES: biostudies-other

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Antibiotic treatment durations for pyogenic liver abscesses: A systematic review.

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Clinical significance of dynamic variation of low cholesterol and its prognostic value in patients with pyogenic liver abscesses: a retrospective study.

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Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance.

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Pyogenic liver abscess.

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Results After Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years: How Do They Compare With Younger Patients? A Systematic Review and Comparison With Younger Populations.

Project description:ContextAnterior cruciate ligament (ACL) reconstruction in older patients is a controversial topic among orthopaedic surgeons.ObjectiveTo determine the outcomes, failure, and morbidity associated with ACL reconstruction in patients older than 40 years and to compare it with nonoperative treatment as well as results of ACL reconstruction in a younger patient population.Data sourcesA systematic review of the literature from 1970 to 2015 was conducted utilizing MEDLINE, CINAHL, and the Cochrane Central Register databases using PRISMA guidelines.Study selectionInclusion criteria were studies with longer than 2-year follow-up of primary ACL reconstruction and minimum age of patients older than 40 years, inclusive of any graft type or source and of any concomitant meniscal pathology.Study designSystematic review.Level of evidenceLevel 4.Data extractionTwo independent reviewers collected demographic, preoperative, intraoperative, and postoperative data.ResultsTwelve studies with a total of 452 patients were included. The mean patient age was 47.8 years (range, 40-66 years) with a mean follow-up of 53.3 months (minimum, 24 months). Lysholm scores improved from 53.9 to 90.5 in the 11 operative studies. The only nonoperative study reported a mean Lysholm score of 82 after rehabilitation. International Knee Documentation Committee (IKDC) scores of A or B were found in 81%. Tegner activity scores averaged 4.7 preinjury, fell to 2.9 preoperatively, and returned to 4.7 postoperatively. The reported failure rate was 2.3%. There were few complications, and failure rate was similar in younger patients.ConclusionThe data confirm that ACL reconstruction can be recommended to patients older than 40 years who wish to maintain an active lifestyle or have symptomatic instability with daily activities. Patient-based outcomes scores were better in the operative studies compared with the single nonoperative study in this patient population.

| S-EPMC4789931 | biostudies-literature

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