Objective: To compare the incidence of catheter-related infection in the bloodstream and non-infectious complication rate of Hickman catheter and peripherally inserted central venous catheter (PICC) in oncology patients. Methods: A retrospective study was performed of oncology patients who underwent Hickman catheter or PICC placement at the radiology department of a regional hospital in Hong Kong from January 2008 to December 2013. The catheter-related bloodstream infection rate, time to infection onset, and non-infectious complication rate of the Hickman group and PICC group were evaluated and compared. Results: During the study period, 161 Hickman catheters and 29 PICCs were inserted in oncology patients (n = 190). There were 38 cases of catheter-related bloodstream infection in the Hickman group and four cases in the PICC group. The catheter-related bloodstream infection rate for all catheters, Hickman group, and PICC group was 1.364, 1.340 and 1.654 per 1000-catheter-days, respectively. For non-infectious complications, 15 of 161 Hickman cases had complications (6 catheter blockage, 5 leakage, 4 migration and dislodgement). In the PICC group, 6 of 29 had complications (3 blockage, and 3 migration and dislodgement). There was, however, no statistically significant difference between the Hickman and PICC groups in terms of number of infections (p = 0.241), time to infection onset (p = 0.187), non-infectious complication rate (p = 0.101), and overall complication rate (p = 0.766). Conclusion: With the less invasive nature of PICC insertion, it provides a viable means of vascular access for oncology patients.
Liposarcomas of the spermatic cord are unusual and rarely reported in the literature. These tumours can sometimes be mistaken for the common scrotal swellings such as hydrocoeles and hernias. Careful clinical and radiological examination will help in appropriate preoperative planning and surgery by an experienced surgical team. We report our experience of two cases of such scrotal swellings.
Objective:To identify predictors of successful retrieval of inferior vena cava (IVC) filter by comparing patients with and without a retrieval request. Methods: Medical records of consecutive patients who underwent insertion / retrieval of the IVC Cordis OptEase retrievable filter via the femoral route between January 2008 and December 2014 at a regional hospital were reviewed. Results: 64 male and 93 female patients aged 15 to 94 (mean, 66.7) years were divided into those with (n = 37) or without (n = 120) a retrieval request. Compared with patients without a retrieval request, those with such a request were more likely to be aged <70 years (73.0% vs. 44.2%, p = 0.002), be scheduled for anticoagulation therapy on discharge (45.9% vs. 1.7%, p < 0.001), and have prophylactic filter insertion for surgery or high-risk patients (37.8% vs. 7.5%, p < 0.001), as well as less likely to have a history of malignancy (16.2% vs. 40.0%, p = 0.008) or any contraindication to anticoagulation therapy (70.3% vs. 92.5%, p = 0.001). Predictors for filter retrieval were patient age of <70 years (odds ratio [OR] = 3.55, p = 0.033), no history of malignancy (OR = 0.15, p = 0.010), scheduled for anticoagulation therapy on discharge (OR = 63.08, p < 0.001), prophylactic filter insertion for surgery or high-risk patients (OR = 14.57, p < 0.001), and contraindication to anticoagulation owing to postoperation within 2 weeks (OR = 6.19, p = 0.004). Only 23 of 37 patients with a retrieval request attempted retrieval, with 17 being successful. Compared with patients with failed retrieval, those with successful retrieval had a shorter mean retrieval interval (27.2 vs. 77.7 days, p = 0.014). The success rate was higher when retrieval was within 23 days of insertion compared with a longer time (100% vs. 53.8%, p = 0.019). Conclusion: Predictors for filter retrieval were patient age of <70 years, no history of malignancy, scheduled for anticoagulation therapy on discharge, prophylactic filter insertion for surgery or high-risk patients, and contraindication to anticoagulation owing to postoperation within 2 weeks. A shorter retrieval interval was associated with successful retrieval.
Pseudoaneurysm of the hepatic artery is at high risk of rupture, and thus requires early aggressive management. Patients usually present with haemobilia, upper gastrointestinal bleeding, and jaundice. Pseudoaneurysms are commonly caused by trauma, iatrogenesis, or vasculitis. Transcatheter embolisation is the mainstay treatment for intrahepatic pseudoaneurysm. We report a rare complication of migration of glue cast into the bile duct following embolisation of a hepatic pseudoaneurysm with glue.
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