Early experience in our institution suggests that early pelvic packing with subsequent angiography if needed is as good as angiography with embolization in treating patients with hemodynamically unstable pelvic fractures.
Transarterial embolization (TAE) can achieve good hemostasis, though low albumin level, which reflects poor liver reserve, may predict early mortality. Portal vein thrombosis should not be regarded as an absolute contraindication for TAE. Staged surgical resection after embolization is safe and produces a good survival outcome.
Aim: Laparoscopic cholecystectomy is regarded as the gold standard treatment for gallstones. Conversion to open cholecystectomy is still common, and preoperative factors to predict conversion are useful in clinical practice. The aim of this study was to evaluate preoperative factors that could predict conversion in acute cholecystitis. Methods: This is a retrospective review of 83 patients with a diagnosis of acute cholecystitis who had laparoscopic cholecystectomy carried out as an emergency operation. Clinical, biochemical, and operative factors were analyzed for association with conversion. Results: A total of 83 patients were recruited to this study. The overall conversion rate was 33.7% (28/83). A longer duration of symptoms before presentation (P = 0.005) and surgery that was carried out over 48 h after admission (P = 0.022) were associated with a higher conversion rate. Emergency operations that began between 20.00 hours and 08.00 hours were also associated with a higher rate of conversion (P = 0.003). Other factors that were associated with conversion included male sex (P = 0.004), low albumin level upon admission (P = 0.024), prolonged prothrombin time (P = 0.040), and a raised serum total bilirubin level (P = 0.024). ASA scores were found to be similar in both groups (P = 0.509). Multivariate analysis by logistic regression showed that the independent risk factors for conversion in emergency laparoscopic cholecystectomy were surgery >48 h after admission (P = 0.028), emergency operation started between 20.00 hours and 08.00 hours (P = 0.026), and longer duration of symptoms before presentation (P = 0.034). Conclusions: Laparoscopic cholecystectomy should be carried out within 48 h of the patient being admitted for acute cholecystitis. The operation should be carried out during the daytime.
Radiofrequecy ablation is useful tool in treating patients with HCC with high successful rate. However, intrahepatic recurrence is common and a well designed post ablation follow up protocol based on a sound knowledge of recurrence pattern is vital.
Aim:To review the management and clinical outcomes of patients with pyogenic liver abscess in Queen Elizabeth Hospital. Methods: This is a retrospective review of the management of patients with a diagnosis of pyogenic liver abscess in Queen Elizabeth Hospital from 2000 to 2004. Results: From 2000 to 2004, 143 patients with a diagnosis of pyogenic liver abscess were managed in Queen Elizabeth Hospital. Procedure-related complications were 6/143 (4%). The success rate from percutaneous intervention was 122/143 (85%). The overall in-hospital mortality was 18/143 (13%). Mean hospital stay was 30.1 days and the median was 23 days. Multivariate logistic regression analysis on risk factors for in-hospital mortality showed high white cell count, large size abscess and prolonged activated prothrombin time as independent risk factors.
Conclusion:In the present series, high white cell count, large size abscess and prolonged activated prothrombin time predicted poor outcomes in patients with pyogenic liver abscess.
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