Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Ultrasonido en el punto de atención: reporte de un caso de absceso hepático / Point of care ultrasound diagnostic: a case report of a hepatic abscess

Resumen El ultrasonido en el punto de atención es una herramienta diagnóstica que ha tomado relevancia en el escenario intra y extrahospitalario, al tratarse de un estudio no invasivo que permite que los hallazgos clínicos se correlacionen directamente con los signos y síntomas que presenta el paciente. El objetivo del presente trabajo es evidenciar la utilidad clínica aplicada al caso de una paciente con una bacteremia persistente, en la cual se identificó el foco de infección por evaluación ultrasonográfica, para dirigir posteriormente la terapia. Presentamos un caso clínico en el que, por medio de esta herramienta, se estableció el diagnóstico de un absceso hepático insospechado clínicamente; se demuestra su utilidad clínica como extensión de la valoración médica especializada al obtener una experiencia favorable de su correcta utilización en un caso complejo.

Abstract Point of care Ultrasound is a diagnostic tool that has gained relevance in the hospital and outpatient setting, as it is a non-invasive study that allows direct correlation of clinical findings and the signs and symptoms that the patient presents. The objective of this paper is to show its clinical utility evident as applied to a female patient who had persistant bacteremia, in which the site of infection was identified through ultrasound evaluation. We present a clinical case whose diagnosis of hepatic abscess was possible by the use of ecography and shows its usefullness as an extension of specialized medical evaluation by showing a favorable experience of its correct use in a complex case. We present a clinical case in which the diagnosis of a clinically unsuspected liver abscess was obtained using this tool.

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

Hepatic eosinophilic abscess presenting as a single nodular mass / 대한간학회지

No abstract available.

Situs inversus totalis with liver abscess

A case of multiple liver abscesses in a patient with situs inversus totalis is presented. Initially the patient was treated conservatively and remained symptom free for 4 days of hospital stay. On a follow up visit after 1 week the patient had high grade spiking fever and ultrasonography showed expanding multiple abscesses. The patient was restarted on intravenous antibiotics which resolved the disease

The Expression of p53, p16, Cyclin D1 in Esophageal Squamous Cell Carcinoma and Esophageal Dysplasia / 대한소화기학회지

BACKGROUND/AIMS: p53 is known to play a central role in sensing and signaling for the growth arrest and apoptosis in cells with DNA damage. Mutation of p53 is a frequent event in esophageal squamous cell carcinoma (ESCC). p16 protein binds to cyclin dependent kinase 4 (CDK4) inhibiting the ability of CDK4 to interact with cyclin D1, and stimulates the passage through the G1 phase of cell cycle. We observed the expression patterns and frequencies of p53, p16, and cyclin D1 in esophageal dysplasia and in esophageal squamous cell carcinomas. METHODS: In 15 patients of ESCC, 5 patients of esophageal dysplasia and 5 volunteers with normal esophagus, tissue specimens were taken from esophageal lesions during the operation or endoscopic examination. We used specific monoclonal antibodies for p53 protein, p16INK4 protein and cyclin D1. Immunoreactivity was scored. RESULTS: Mean age of all groups was 66 years old (range 47-93) and men to women ratio was 19:1. p53 mutation was observed in 87% (13/15) of ESCC, in 80% (4/5) of esophageal dysplasia, in 0% (0/5) of normal mucosa (p=0.001). p16 expression was seen in 40% (2/5) of esophageal dysplasia, 27% (4/15) of ESCC and 100% (5/5) of normal mucosa (p=0.016). Cyclin D1 expression was not significantly different among 20% (1/5) of esophageal dysplasia, 53% (8/15) of ESCC and 20% (1/5) of normal mucosa. Either the expression of p53 mutation or the loss of p16 occurred in 80% (4/5) of esophageal dysplasia and in 93% (14/15) of ESCC. CONCLUSIONS: The expression of p53 mutation and the loss of p16 might play a central role in the pathogenesis of esophageal squamous cell carcinoma (ESCC), and contribute to the development of precancerous lesion such as dysplasia. In addition, there is a possibility that the mutations of p53 and p16 silencing would be the early events in ESCC development.

Laparoseopic drainage of ruptured liver abscess

To assess and analyze the therapeutic efficacy of laparoscopic drainage of ruptured liver abscess as a treatment modality, in terms of hospital stay, pain and other complications. Design: Descriptive study. Period: The study was conducted in the Department of General Surgery Ward-26, Jinnah Postgraduate Medical Centre, Karachi over a period of 4' years from January, 1998 to June, 2002. This study included 12 patients, with clinical features of peritonitis and evidence of leaking liver abscess or free fluid in the peritoneum. All the patients undergoing laparoscopic drainage recovered completely with no mortality. Mean stay in hospital was 12-days. Pleural effusion and residual abscesses were seen in two patients who had to stay in the hospital for 20 days. Laparoscopic drainage of ruptured liver abscess is an effective mode of treatment and we recommend its use as an alternative to laparotomy

Clinical presentation of liver abscess

Liver abscesses is a common problem in developing countries especially with poor hygiene and water supply. A retrospective study was conducted to review the records of cases of liver abscesses treated at Jinnah postgraduate medical centre Karachi from September 1996 to July 2001. The objective being to see the most common clinical presentation of liver abscess. A total of 158 cases 136 male and 22 female were admitted and treated. The most common clinical features were fever, pain right upper abdomen and hepatomagally. Ultrasound diagnosed 96.8% of cases. 56 patients were treated with antibiotics, 79 had aspiration and 17 had exploratory laparatomy. There was no mortality in our study

Ultrasonographic guided percutaneous needle aspiration and laparoscopic drainage of liver abscesses

This study included thirty patients [seventeen males and thirteen females], their ages ranged from 3 to 65 years with mean age 24.5 years. All patients were complaining of fever and Rt upper abdominal pain. The findings of this study have suggested that the medical treatment alone was attempted in patients with abscesses lesser than 2 cm, while, ultrasonographic guided percutaneous aspiration in combination with systemic antibiotics considering suitable, easy, cheep and reproducible method was used for cure abscesses from 2 to 20 cm or multiloculated abscesses

Aspiration of liver abscess: a study of 200 cases at Liaquat medical college, Jamshora, Hyderabad, Pakistan

To assess the various risk factors and prognosis of ultrasound guided aspiration of liver abscesses. Design: Study of 200 cases admitted in Surgical Unit-Ill and Medical wards of Liaquat Medical College Hospital over a period of five years [Jan. 1991-Dec. 1995]. Surgical Unit-Ill and Medical wards-I-II-III-IV of Liaquat Medical College Jamshoro, Hyderabad. 200 patients diagnosed to have liver abscesses during a period of five years and admitted in surgical unit-III and Medical wards of Liaquat Medical College Jamshoro. Needle was successfully inserted in all 200 cases in first attempt. No preparation was required in 191 patients, while the remaining 9 patients were children below seven years of age, therefore the procedure was carried out after sedation. In majority of patients the entire pus was aspirated from the cavity in single aspiration, while few needed 2nd or 3rd aspiration. All abscess in this study were cured without open surgery. The use of ultrasound guided aspiration is much easier, economical and causes much less distress to the patients as compared to surgical removal. Moreover side effects of open surgery and anaesthesia are avoided

Hepatic abscess at computed tomography and ultrasound

10 cases suffering from primary and secondary hepatic abcesses were examined sonographically and by CT. The sonographic findings were pointed out and correlated with CT results. CT guided liver needle aspiration was performed in some cases