Different modalities of hepatic resection in liver diseases

Blood loss and bile leak remain major issues during liver resection. We aimed to compare the efficacy of two commonly used transaction techniques; the ultrasonic-dissector [UD] and ultrasonic-coagulation-shears [UCS]. 143 consecutive patients were enrolled into a prospective, observational, non-randomized, comparative study, performed from the March 2008 till end of May 2009, in Liver Unit, Queen Elizabeth Hospital, University of Birmingham, UK. Outcomes looked at are blood-loos, speed of transaction and morbidity. Study groups are comparable except that there are more major resections in the UD than in the UCS, [86.9 and 42.4% respectively, p=0.04]. There is no statistically significant difference [SSD] in the mean surface areas of resected liver specimens between the two groups [114 [ +/- 11] versus 94 [ +/- 9] cm[2] [p=0.06]. there is no SSD in the amount of lost blood, amount of blood loss per square centimeters of resection surface area, amount of blood transfused or the percentages of patients, who required blood transfusion, intra- or post-operatively, between the groups. There are no SSD in the mean transaction time, haemostatsis times, mean transaction and haemostasis speeds. The overall "identification of landmarks" score is 4/5 for UD and 3/4 for UCS which is not SSD. The Pringle manoeuvre was resorted to in significantly more patients in the UD than in the UCS [17 [20.2%] and 5 [8.5%] respectively, p=0.03], with mean ischaemic time significantly more in the UD [17 +/- 3] versus 4 [ +/- 4] minutes respectively, p=0.02]. There is no SSD in the magnitude of post-operative liver cell injury reflected by the mean of ALT, AST, bilirubin and INR peak values. There is also no SSD among the two groups regarding postoperative minor [grade 1 and 2] or major [grade 3, 4, and 5] complications, median ICU and hospital stays. This study confirms that both instruments of transaction can be used safely in elective liver resection and it is not possible to recommend any of these two instruments over the other

Spontaneous pneumothorax referred for surgery

Spontaneous pneumothorax is a one that is not due to trauma. It can be either primary where no cause can be found, or secondary to diseases like COPD and tuberculosis. It presents usually with chest pain and it can be accompanied by pleural effusion or haemothorax. ten patients of recurrent pneumothorax were operated on and then observed for a period up to nine months. During this period, data related to causes, risk factors, nature of pneumothorax and operation done were collected and analyzed. Patients were generally young, tall, and thin with slight male predominance. Pneumothorax was on the left side in half of the cases. The remainders were split between bilateral and right side. The commonest presenting symptom was chest pain followed by cough and shortness of breath. T.B. was the commonest cause of secondary pneumothorax in males while SLE was the commonest cause in females. findings of this study matched well with the findings of previous studies in the characteristics of patients. Yet, it showed that the most common cause of secondary spontaneous pneumothorax was T.B. in males and SLE in females. It also showed a good index of safety and a good prognosis in those treated surgically via classical thoracotomy. It was concluded that recurrent spontaneous pneumothorax is a disease that that can be treated easily and safely by surgery. Yet, meticulous look up and subsequently treatment of an underlying cause is an essential step of management as in the majority of cases recurrent spontaneous pneumothorax was merely a presentation of either a local or a systemic disease