Audit is an important tool in surgical quality assurance for DIH. Small changes in practice with adherence to good protocols can have a marked effect on patients' experience.
Twenty-five patients with liver cirrhosis and portal hypertension were admitted for creation of a transjugular intrahepatic portosystemic shunt (TIPS). The procedure was successful in 22 patients (technical success 88%). The mean portal pressure gradient was lowered from 24.5 mmHg before to 11.4 mmHg after TIPS. Two early and three late occlusions were observed (primary patency rate 78%). The rate of secondary interventions was 41%. Five times a hepatic vein stenosis was dilated and stented, two times an occluded shunt was recanalized, two times a new shunt was created parallel to an occluded (secondary patency rate within a maximum of 16 months 95%). In two patients sepsis occurred which was effectively treated with antibiotics, two patients died shortly after TIPS due to hepatorenal syndrome and hepatic failure, respectively. There was no recurrent bleeding. Two patients developed hepatic encephalopathy; both improved after protein restriction. The authors conclude that TIPS is an alternative procedure to shunt surgery, especially for patients who cannot benefit from sclerotherapy.
SUMMARYHospital in a state of collapse and upper abdominal pain.A case of ruptured pancreaticoduodena~ artery Subsequent rigidity of the right side of the abdomen and aneurysm diagnosed by arteriography and success-absent bowel-sounds led to a tentative diagnosis of perforated peptic ulcer being made, though no free gas was visualized under the diaphragm on an erect abdominal fully treated surgically is presented.radiograph. At laparotomy free blood was found in the peritoneal cavity and there was a haematoma behind the ANEURYSM of the pancreaticoduodenal artery is un-head of the pancreas extending into the lesser omentum. common; West, Bernhardt, and Bowers (1968) The source of bleeding could not be identified and a new
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