predictive value of thrombocytopenia for bleeding or liver decompensation following percutaneous radiofrequency ablation therapy of hepatocellular carcinoma in patients with liver cirrhosis

To assess if thrombocytopenia has a predictive value for bleeding and/or liver decompensation following percutaneous radiofrequency ablation [RFA] therapy of hepatocellular carcinoma [HCC] in patients with liver cirrhosis. 64 consecutive patients with cirrhosis complicated by hepatocellular carcinoma, and associated with mild thrombocytopenia ranged from 37 to 99 x 10[9] platelets/L, and had undergone percutaneous RFA for treatment 86 hccs, were retrospectively studied. Nine possible factors were analyzed for their ability to predict bleeding or liver decompensation using the Cox proportional hazards regression model; Age, sex, Child-Pugh class, etiology of cirrhosis, platelet count, prothrombin activity, number of tumors, maximum size of the tumor, and type of electrode. It was shown that platelet threshold of 37 x 10[9]/L and the other variables were not significant risk factors of bleeding. Statistical [univariante and multivariente] analysis revealed that liver decompensation was clearly linked to prothrombin activity [p = 0,010 and p = 0.006, respectively] and < 63% of prothrombin activity was found to be a significant threshold for the occurrence of liver decompensation [p = 0.003] confirmed by Cox model [p = 0.05] Mild thrombocytopenia > 37 x 109/L is not an independent risk factor of bleeding or liver decompensation after RFA therapy of HCC in patient with cirrhosis. However, in such situation a significant higher risk of liver decompensation followed the procedure was found in cases of prothrombin activity < 63%.Radiofrequency ablation, hepatocellular carcinoma, thrombocytopenia, prothrombin activity, liver cirrhosis RFA= radiofrequency ablation, HCC = hepatocellular carcinoma, US = ultrasonography, CT = computed tomography

Outcome of double burr-hole craniotomy in patients with chronic subdural haematoma

Chronic subdural haematoma [CSDH] is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November 2006. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences