Wait-and-see policy versus cholecystectomy after endoscopic sphincterotomy for bile-duct stones in high-risk patients with co-existing gallbladder stones: a prospective randomised trial

Endoscopic sphincterotomy [ES] is one of the most important advances in the treatment of common bile duct [CBD] stones. However, the use of ES to remove CBD stones in high-risk patients without cholecystectomy is still debatable. The aim of this study was to compare the efficacy of a wait-and-see policy versus cholecystectomy after ES for CBD stones in high-risk patients with co-existing cholelithiasis. A total of 162 patients after undergoing ES with the clearance of CBD stones were randomised after informed consent to cholecystectomy or conservative management of their gallbladder stones. The results indicated that cholecystectomy after ES for CBD stones significantly reduced the biliary complications in high-risk patients. Every patient who has both CBD stones and gallstones with significant co-morbid illnesses, after clearance of CBD stones by ES, should undergo early cholecystectomy

Outcome of in-hospital pediatric cardiac arrest

The outcome of pediatric cardiac arrest is poor, and attempts to improve it have not been very successful. The aim of this study was to analyze the outcome of a large number of in-hospital pediatric cardiac arrest patients, and to determine the factors that influence this outcome. The records of hospital in palients at King Faisal Specialist Hospital and Research Centre who received external cardiac massage as part of their cardiopulmonary resuscitation were reviewed. Success of resuscitation was analyzed as: 1] short-term [restoration of spontaneous circulation]; and 2] long-term [discharge from hospital]. Of 234 such patients, 171 [73.1%] survived the initial resuscitalion, and 66 [28.2%] were discharged from hospital. Success of outcome was not related to age, time of day, or location of arrest. Longer resuscitation time was associated with less chance of restoration of spontaneous circulation [P<0.001] and lower hospital discharge rate. Results for patients with congenital heart disease were similar to those with other medical or surgical conditions- Restoration of spontaneous circulation from asystole was more difficult when compared to other arrest rhythm, but once circulation was restored, long-term outcome was not influenced by rhythm. Asystole and longer resuscitation time are associated with poorer outcome, however, successful restoration of spontaneous circulation with long-term survival can be achieved after prolonged resuscitation