Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Benefit of Contrast-Enhanced Ultrasound (CEUS) in the Follow-Up Care of Patients with Colon Cancer: A Prospective Multicenter Study

PURPOSE

According to the German guidelines on colorectal cancer, unenhanced ultrasound is recommended for follow-up. On the other hand, ultrasound and radiology societies specify the use of contrast-enhanced ultrasound for ruling out liver metastases. Studies focusing on the follow-up of cancer patients are lacking. The goal of this multicenter study initiated by the German Ultrasound Society (DEGUM) was to determine the potential benefit of contrast-enhanced ultrasound in the follow-up of patients with colon cancer.

MATERIALS AND METHODS

Follow-up patients with colon cancer (UICC > IIa) were investigated. As scheduled according to the German guidelines, unenhanced ultrasound was performed followed by contrast-enhanced ultrasound. All liver lesions were recorded. In case of additional metastases detected on contrast-enhanced ultrasound, contrast-enhanced CT, MRI or biopsy was performed to confirm additional liver metastases.

RESULTS

A total of 45 liver metastases were detected in 26/290 patients (= 9 %) using unenhanced ultrasound. A further 28 metastases were detected on contrast-enhanced ultrasound in these 26 patients. In 18 patients showing no liver metastases, 40 additional metastases were detected on unenhanced ultrasound. This means that 44 patients with a total of 113 liver metastases were detected on contrast-enhanced ultrasound (p = 0.0006).

CONCLUSION

Contrast-enhanced ultrasound should be recommended in the follow-up of patients with colon cancer in addition to unenhanced ultrasound - the up-to-date standard.

[Google translate is not sufficient to overcome language barriers in neonatal medicine]

Language barriers hinder the interaction with patients and relatives. The use of language services increases knowledge, satisfaction and the use of medical care and thus improves patient's clinical outcome. The recommended use of professional interpreters (PI) is not always feasible. We tested an online translation tool as an alternative for PI for the transla-tion of standardized sentences from a neonatal doctor-/nurse-relative-interview.Translation of 20 sentences from a German neonatal intensive care unit parent information brochure to English, Portuguese and Arabic, using Google Translate (GT). Assessment of accuracy concerning grammar and content, in a second step simplification of all incorrect sentences, translation by GT and critical re-assessment and evaluation.An average of 42% of the sentences was correctly translated concerning grammar and content. The proportion of incorrectly translated sentences varied between 45-70%. By simpli-fication another 23% were translated correctly.Translations by GT were often incorrect in content and grammar. We suppose that the design of GT, which is a statistical translation engine, might be an explanation for this phenomenon. Presently, GT cannot guarantee unambiguous translations and cannot substitute PIs, only in particular circumstances, the use of GT or similar engines may be justified. For future use of electronic translation services, we suggest to compile a catalogue of sentences containing central information, which can be translated into defined foreign languages without misinterpretation or loss of information.

Neuroendocrine tumour, mucinous adenocarcinoma and signet-ring cell carcinoma of the appendix: three cases and review of literature

Appendiceal neoplasms are relatively common tumours. Although these tumours are often associated with signs and symptoms of acute appendicitis, most appendiceal neoplasms are clinically silent. Appendiceal neoplasms are found in 0.7 to 1.4 per cent of all appendectomy specimens. The classification of these tumours is still confusing and precise treatment methods for these neoplasms remain unclear. First choice therapy of these neoplasms is still a surgical treatment and the type of operative procedure is determined by histology and metatstatic risk. Here, we report three cases of appendiceal neoplasms and make a short review of literature.

Clinical effects of STW 5 (Iberogast) are not based on acceleration of gastric emptying in patients with functional dyspepsia and gastroparesis

STW 5, a herbal extract, is effective for the treatment of symptoms in patients with functional dyspepsia (FD). However, its mode of action is still unclear and a modulation of gastric motility is hypothesized. This multicentre, placebo-controlled double-blind study addressed the question of whether STW 5 accelerates gastric emptying in patients with FD and gastroparesis. One-hundred and three patients diagnosed with FD were randomly assigned to a treatment with either STW 5 or a liquid placebo for 28 days. The primary end point of the study was a change of a validated gastrointestinal symptom (GIS) score under treatment. Additionally, patients underwent a (13)C octanoic acid breath test for the assessment of the gastric half-emptying time (t(1/2)). Patients with prolonged t(1/2) were diagnosed with gastroparesis and requested to repeat the test at the end of treatment. A change of t(1/2) was defined a secondary study end point. t(1/2) was prolonged in 48.6% of patients in the STW 5 group and in 43.8% of the placebo group. During treatment, t(1/2) increased non-significantly in patients treated with STW 5 (+23 +/- 109 min; P = 0.51) and slightly accelerated among patients in the placebo arm (-26 +/- 51 min; P = 0.77) (P = 0.49). The improvement of the GIS (P = 0.08) and the proportion of patients with a treatment response (P = 0.03) were more pronounced in the STW 5 group. Our findings suggest that the clinical effects of STW 5 in patients with FD and gastroparesis are not directly mediated by an acceleration of gastric emptying. A clear-cut correlation with symptom improvement is still lacking.

[Vienna classification of Crohn's disease: helpful or dispensable? A critical view]

A short review of phenotypic classification of Crohn's disease is given. Pitfalls in a clinical system of disease classification into different phenotypes and limitations of the Vienna classification of Crohn's disease are discussed. The concept of distinctive patterns of disease "behaviour" is criticized. The disease behaviour is not a persistent phenomenon and changes in the long-term follow-up significantly. Factors not addressed in the Vienna classification but, of course, influencing presentation and progression of Crohn's disease such as influences of early childhood, smoking and use of non-steroidal anti-inflammatory drugs are mentioned. The need of the classification criterion "age" is questioned. It is criticized that the Vienna classification has (at least until now) no consequences for the management of Crohn's disease. Experimental treatment approaches follow the current genetic or microbiological hypotheses and do not consider the Vienna classification system. In view of the philosophy of science the need of phenotypic classification into subgroups, clarification of mechanisms and experimentation with drug treatments in the elaboration of disease causation is stressed. In recent years much progress has been made in clarifying Kirsner's "mysterious and multiplex" nature of inflammatory bowel disease. However, as physicians we have to focus on the "menace" of a chronic disease for the patient's life and not only to treat the hole of the patient with "biologicals" but rather to treat the whole patient in a bio-psycho-social approach.

Kontrastmittelgestützte „Low-MI-Real-Time”-Sonographie zur Beurteilung der Dignität fokaler Leberläsionen

PURPOSE

Contrast enhanced sonography using phase-inversion harmonic mode is a promising technique to detect and characterize hepatic lesions. Aim of the following study was to evaluate whether this technique can characterize liver tumors.

MATERIAL AND METHODS

During January and December 2004, 46 patients with a solitary liver lesion were examined. The age of the 21 women and 25 men ranged between 37 and 82 years. The tumor size was between 8 mm and 14.5 cm. First conventional B-mode sonography and color-coded sonography were performed, followed by intravenous injection of the contrast agent SonoVue and continuous sonographic examination over 5 minutes using "low MI real-time" phase-inversion mode. The examination was video taped. The enhancement was evaluated qualitatively.

RESULTS

Of the 21 malignant lesions, 20 could be correctly diagnosed as malignant. One of the malignant lesions was classified as benign. Of the 25 benign lesions, 21 could be classified correctly as benign, however, 4 lesions (2 hemangiomas, 1 adenoma, 1 teratoma) showed no enhancement in the portal and late phase and were incorrectly classified as malignant as well.

CONCLUSION

Using pulse-inversion harmonic US with SonoVue, liver lesions showing an isoechoic or hyperechoic enhancement can be classified as probably benign. Further work up is necessary in case of little or no enhancement on delayed phase imaging.

Pitfalls in der kontrastverstärkten Lebersonographie: Konsequenzen für die Praxis

Contrast-enhanced sonography performed as phase inversion harmonic imaging is a promising new technique for detection and characterization of hepatic foci. It has been reported that malignant liver tumors can be differentiated from benign entities with almost 100% sensitivity and that diagnosis of the type is possible with an accuracy of over 90%. The following report describes seven of our own cases and then compares the results we obtained with current knowledge, followed by a discussion. In summary, most hepatic lesions can be correctly characterized by supplemental use of enhanced sonography; practitioners should nevertheless be aware of atypical phenomena to be able to critically evaluate the findings.

[A consecutive study of patients with irritable bowel disease in two tertiary referral centers]

OBJECTIVES

We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS).

DATA

A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD).

METHODS

The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB).

RESULTS

We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc.

CONCLUSIONS

Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

Impaired health-related quality of life in inflammatory bowel diseases: psychosocial impact and coping styles in a national German sample

BACKGROUND

The purpose of this study is to give a detailed survey of the disease-specific and generic quality of life (HRQOL) of adult patients suffering from inflammatory bowel disease (IBD) in Germany.

METHODS

1322 patients suffering from IBD were examined in a cross-sectional study. A questionnaire assessing disease-specific and generic quality of life, coping, and hopelessness was sent to members of the German Crohn/Colitis association.

RESULTS

Compared to the general population, the generic HRQOL in IBD patients is significantly reduced. Active coping has a negative influence on patients' generic physical HRQOL during an active phase (beta = -0.31), while this association is not present in the case of patients in remission (beta = -0.02, interaction: P = 0.0003). Depressive coping is strongly and negatively associated with assessment of the physical (beta = -0.39, P < 0.0001) and mental (beta = -0.66, P < 0.0001) HRQOL. Disease-specific burdens are mainly reported in the physical dimension.

CONCLUSION

The pattern of psychosocial impact of disease in German IBD patients is largely congruent with the one observed in the USA and Canada, but shows some specific differences. The a priori unexpected finding that active coping was associated with poor HRQOL in active IBD status illustrates the importance of considering different determinants of HRQOL in terms of their mutual interaction.

Diagnosis of symptomatic intestinal metastases using transabdominal sonography and sonographically guided puncture

OBJECTIVE. We studied the sonographic findings of symptomatic intestinal metastases and the use and safety of subsequent sonographically guided 22-gauge fine-needle aspiration or 18-gauge core biopsy. CONCLUSION. Symptomatic intestinal metastases can be diagnosed by transabdominal sonography. Extensive hypoechoic segmental bowel wall thickening with loss of stratification and intussusception can be observed. Sonographically guided fine-needle aspiration or 18-gauge core biopsy performed at the end of the examination allows definite diagnosis and is a safe procedure.

[Pyostomatitis vegetans and Crohn's disease. A specific association of 2 diseases]

HISTORY AND CLINICAL FINDINGS

A 27-year-old man was referred to the dermatological out-patient clinic because of inflammatory changes in the oral mucosa of unknown cause. 5 months earlier he had been diagnosed as having Crohn's disease of the terminal ileum. On both sides of the buccal mucosa there were rough erythematous vegetations and disseminated miliary abscesses, which extended to the labial gingiva and the soft palate. Further physical examination was unremarkable.

INVESTIGATIONS

Several inflammatory parameters were increased: C-reactive protein 100 mg/l, erythrocyte sedimentation rate 55/88 mm, eosinophilic cationic protein 35.8 ng/ml (normal range 2.3-16 ng/ml). White cell count was normal (7,25/nl), with a lymphocytopenia of 11.9%. There was no eosinophilia. Haemoglobin was reduced to 11.6 g/dl and the platelets raised to 526/nl. Smears of the oral mucosa showed no fungal, viral or bacterial infection. Biopsy revealed leucocytic microabscesses in the epithelium, granulation tissue and flat ulcerations with adjoining superficial necrotic zones.

DIAGNOSIS, TREATMENT AND COURSE

The clinical and histological picture as well as the association with Crohn's disease (CD) suggested pyostomatitis vegetans (PV). The PV was treated with disinfectant mouth washes which improved the subjective findings. Budesonide was given for CD.

CONCLUSION

PV is a rare and usually isolated condition, but it can also occur in association with a chronic gastrointestinal disease such as ulcerative colitis and Crohn's disease. The diagnosis of PV indicates a thorough gastroenterological investigation.

[What is the onset of primary biliary liver cirrhosis?]

The medical records of 49 consecutive patients with primary biliary cirrhosis of the liver were screened for informations about medical examinations during the years before the diagnosis was established. In 15 cases previous medical reports could be found. Evidence of liver disease (slight elevation of transaminases and gamma-GT) was documented up to 18 years before the diagnosis was proven. In 6 patients liver biopsies had been performed: normal 1 x, fatty liver 1 x, fibrosis 1 x, non-specific hepatitis 1 x, chron. pers. Hep. 2 x. The characteristic increase of alkaline phosphatase often occurred within a few months. Antimitochondrial antibodies became positive independent of the beginning of cholestasis. It can be concluded that early stage primary biliary cirrhosis must be considered in patients with long standing slight elevation of liver enzymes even without cholestasis when other causes can be excluded.

[Diagnosis of pleural effusions and atelectases: sonography and radiology compared]

In a prospective study it was shown that chest ultrasonography is superior to conventional x-ray diagnosis of recumbent patients in diagnosing pleural effusion and lung atelectasis. In 110 supine radiographs we found a sensitivity of 47% and a specificity of 71% for right pleural effusions and a sensitivity of 55% and a specificity of 93% for left pleural effusions in comparison to 110 sonographic examinations. The results of supine radiographs in detection of atelectasis were less efficient: sensitivity for the right side: 7%; sensitivity for the left side: 13.5%. Hence, the knowledge of chest ultrasonographic diagnosis can improve the interpretation of supine radiographs.

Mediastinal lymph node staging with transesophageal echography in cancer of the lung

Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologically enlarged. In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum including the subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9) of enlarged lymph nodes diagnosed by CT were detected by TEE. A pathological study in 9 patients demonstrated true positive findings in 2 vs 1, true negatives in 4 vs 5, false positives in 3 vs 2 and false negatives in 0 vs 1 comparing TEE with CT. From these preliminary data, we conclude that TEE, although still experimental, is equal or superior to CT in detecting enlarged nodes in the lower mediastinum, specifically in the aortopulmonary window but clearly inferior in the upper mediastinum and the hilar region. Additional information on central tumors and infiltration of the heart or great vessels can be clarified. In addition, data on hemodynamics and cardiac status can be obtained. TEE seems to be a promising tool in the preoperative staging of lung cancer.

[The results and complications of 616 percutaneous transhepatic biliary drainages]

During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.

[Liver CT with portal vein administration of a contrast medium]

Contrast administration through the superior mesenteric or splenic arteries provided additional information in 22 out of 31 patients, when compared with intravenous contrast bolus for CT of the liver. In 11 patients, the demonstration of a tumour lead to a change in treatment. False positive findings occurred in four of the 31 patients. In 2 patients intrahepatic lesions were overlooked, but were found during angiography carried out at the same examination. The diagnosis of intrahepatic space-occupying lesions is discussed as well as the CT appearances of portal-venous liver perfusion.

[Focal nodular hyperplasia of the liver in 930 patients]

Analysis of 930 patients with focal nodular hyperplasia of the liver (FNH), including 23 seen by the authors, showed the following results: 82.2% of patients were female, 37.8% of these had taken female steroidal hormones. There was no preference for a particular lobe of the liver. 57.7% of FNH were subcapsular, 33.7% were intrahepatic and 8.8% were pedunculated. Average size was 5.9 cm, 80.8% of the patients were asymptomatic. In 93.5% (115 out of 123) a space-occupying lesion in the liver could be demonstrated by sonography. In 13%, second or multiple tumours were missed by sonography. CT without enhancement demonstrated FNH in 90.4% (94 out of 104 patients). A rapid, marked increase in density after contrast was seen in 64 out of 68 lesions (94.1%). Colloid scintigraphy showed normal uptake in 34.9% of patients. Hepato-biliary functional scintigraphy demonstrated 32 out of 35 lesions (91.4%). In 97.3% (183 out of 188) FNH was demonstrated by angiography, in 95.4% as a highly vascular tumour.

Detection of aortic dissection by transoesophageal echocardiography

The diagnostic value of a combination of transoesophageal and transthoracic echocardiography was evaluated in 21 patients with dissection of the aorta. The results were compared with those of computed tomography, aortography, and with findings at operation or necropsy or both. Transthoracic echocardiography identified three of the four patients with type I dissection, two of the five patients with type II dissection, and one of the 12 patients with type III dissection. When transoesophageal echocardiography was used as well the degree of aortic dissection was identified correctly in all 21 patients. In one patient with type I and in eight patients with type III dissection spontaneous echocardiographic contrast with a mural thrombus within the false lumen could be detected. Computed tomography was unable to demonstrate an intimal flap in one of two patients studied with type I dissection, in two of three patients with type II dissection, and in one of nine patients with type III dissection. Aortography was negative in one of two patients studied with type I dissection, two of four patients with type II dissection, and in one of eight patients with type II dissection. The whole thoracic aorta can be imaged by a combination of transthoracic and transoesophageal echocardiography. The addition of transoesophageal echocardiography to transthoracic echocardiography improves the recognition of aortic dissection. Furthermore, this examination can be performed at the bedside and the findings can be used as a basis for treatment.

[Acute fatty liver of pregnancy. A case report of the differential diagnosis of pregnancy-associated liver diseases]

Acute fatty liver of pregnancy (AFLP) is a rare, but often fatal disorder in the third trimester of pregnancy. We report on a patient with AFLP complicated by acute hemorrhagic diathesis, who survived after early diagnosis and adequate treatment. On electronmicroscopy, the characteristic microvesicular fatty deposits in the centrolobular hepatocytes could be demonstrated.

[Combination of color Doppler and transesophageal echocardiography in emergency diagnosis of type I aortic dissections]

We report on the use of colour Doppler- and transesophageal echocardiography in 2 patients with acute type I aortic dissection according to DeBakey. Using transesophageal echocardiography we obtained information on the extension and the entry site of the dissection without interfering with respiration and external thorax configuration. Using colour Doppler we were able to differentiate between the true and false lumen in the thoracic and abdominal aorta due to characteristic phasic flow patterns. In one patient the site of the entry tear of the intimal flap was localized by this method. Furthermore, a noninvasive semiquantitative evaluation of accompanying aortic regurgitation was possible. Colour Doppler gives additional information in the emergency diagnosis of patients with aortic dissection.

Aortic dissection detected by transoesophageal echocardiography

The diagnostic value of transoesophageal echocardiography was evaluated in 24 patients with aortic dissection and compared to transthoracic two-dimensional echocardiography, computer tomography, aortography, surgery and autopsy. Using transoesophageal echocardiography we found in 5 patients a type I dissection, in 5 patients a type II and in 14 patients a type III dissection. Transthoracic two-dimensional echocardiography was positive in 3/5 type I, 2/5 in type II and 2/14 in type III dissections. Computer tomography was unable to demonstrate an intimal flap in 1/2 patients with type I, 2/3 type II and 1/11 type III dissections. Aortography was negative in 1/4 type I, 3/5 type II and 3/12 patients with type III dissection. Additional information concerning thrombus formation, localisation of the entry tear, differentiation between true and false lumen, flow dynamics within the true and false lumen as well as accompanying aortic regurgitation may be obtained by transoesophageal echocardiography.

[Percutaneous drainage of abdominal abscesses. II. Value in comparison with septic surgery]

Based on the review of the literature and experience with own cases the current status of the therapy of abdominal abscesses by percutaneous catheter drainage is described. Indications, reasons for failure, complications, and mortality are presented in detail. Compared with surgery percutaneous abscess drainage (PAD) seems to have better results; however, this statement should be viewed with caution since the input of modern imaging techniques might have improved current surgical success rates. A trial of PAD can be recommended in all feasible cases because it offers high curability with little morbidity.

[Percutaneous drainage of abdominal abscesses. I. Technic and results]

88 intraabdominal abscesses in 77 patients were treated by percutaneous drainage. Patients were cured in 63 percent. Complications were observed in 11 percent followed by surgery in two instances. Ten out of 75 patients (13 percent) died in the postprocedural course from multiple organ failure or postoperative complications. A fatal outcome, however, was never attributable to the percutaneous procedure. Technical considerations of percutaneous abscess drainage are described in detail. Its similarities with open drainage and advantages over septic surgery are discussed.

[Spontaneous echocontrast, recorded by transesophageal echocardiography in type III aortic dissection]

Spontaneous echo contrast has been described in cardiac chambers and large vessels during decreased blood flow. We report on a patient with type III aortic dissection and spontaneous echos in the false lumen of the thoracic aorta. Both aortic dissection and spontaneous echos were verified by transesophageal echocardiography but not by transthoracic.

[Diagnosis of cavernomatous transformation of the portal vein]

In 10 patients at the age of 17 to 59 years the diagnosis of a cavernomatous transformation of the portal vein primarily was made by sonography and was confirmed by computer tomography and angiography, respectively. These findings were seen by chance when an abdominal ultrasound was performed in order to clarify splenomegaly or esophageal varices. The characteristics of the disease are the positive proof of a convoluted agglomeration of racemose venous structures that have replaced the normal single portal vein and signs of portal hypertension. The sonographic figures are so typical that ultrasound is the decisive procedure in its diagnosis and that direct or indirect splenoportography is not necessary. The present results show that clinical manifestations of cavernomatous transformation of the portal vein are delayed sometimes in to adolescence and that invasive diagnostic methods are only necessary when shunt operation is planned.

[Sonographic diagnosis of Budd-Chiari syndrome]

In a 28-year-old female patient a diagnosis of Budd-Chiari syndrome was established post partum on the basis of characteristic ultrasonographic findings. The results permit establishment of the syndrome in the early phase of the disease. Early diagnosis of hepatic vein occlusion is particularly important because directed therapeutic regimes may lead to revascularisation of hepatic veins and may thus prevent liver cell necrosis and subsequent hepatic failure.

Diagnosis and therapy of liver abscess by ultrasonographic imaging, puncture and drainage

Liver abscesses in 19 patients were primarily diagnosed by real-time ultrasound. Characteristic features and changes in the course of disease are described. Fine needle puncture under ultrasonographic guidance confirmed the diagnosis and permitted bacteriologic examination. Ultrasonographically guided abscess drainage dramatically improved the clinical condition, and can be recommended as an alternative to surgical drainage.