Demographic, Clinical, Laboratory and Management Profile in Patients of Amoebic Liver Abscess from Northern India

Background: Amoebic liver abscess (ALA) is a serious extra-intestinal manifestation of amoebiasis and a major problem in developing countries. Due to rapid urbanization, improved sanitation and hygiene in India, there has been a shift in disease epidemiology towards non-communicable disease, but recent changes in epidemiological and clinical pattern in ALA are not well studied. Aim: To evaluate recent demographic, clinical, laboratory and management profile in patient with ALA. Methods: It is a prospective observational study conducted in the Department of Gastroenterology, SMS medical college, Jaipur, Rajasthan from June 2018 to December 2020. A predesigned semi structured questionnaire consisting of socio-demographic factors, risk factors, clinical, laboratory and management profile was used to collect data. Result: A total 508 patients of amoebic liver abscess were analysed. Median age of presentation was 40 years, majority were males (90.4%) with chronic alcoholism (44.1%) and belonging to lower socio-economic class. Abdominal pain, fever and anorexia were the most common symptoms. A majority had right lobe involvement (77.6%) and solitary abscess in 67.5%. Most of the small liver abscesses (68%) were managed by medical treatment alone. Percutaneous needle aspiration was done in 62.6% patients, mostly for abscess size 5-10 cm (93%) with 90% success. A total of 24.6% patients underwent percutaneous catheter drainage, all successfully done. Intraperitoneal rupture was seen in 10% patient. Mortality was 1.5%. Conclusion: This is one of the largest cohorts of ALA which shows that a majority of cases are males from lower socioeconomic status with history of significant alcohol intake. Early initiation of a combined therapeutic approach leads to early symptomatic improvement, fewer complications and better outcomes.

Prognostic analysis for diabetic pyogenic liver abscess patients in different levels of haemoglobin treated with percutaneous catheter drainage / 中国介入影像与治疗学

Objective: To compare the prognosis of diabetic pyogenic liver abscess (PLA) patients with different levels of haemoglobin (HbA1c) treated with percutaneous catheter drainage (PCD), and to identify the predictors for overall recovery time (ORT) after PCD. Methods: Thirty-three diabetic PLA patients underwent PCD were retrospectively reviewed and divided into three groups based on HbA1c level, including group A (HbA1c<7%, n=11), group B (7%≤HbA1c<9%, n=9) and group C (HbA1c≥9%, n=13). The clinical success rate of PCD, ORT and recurrence rate of PLA were compared. Predictors of ORT were analyzed via univariate analysis (Log-rank test) and Cox multi-factor regression analysis. Results: The clinical success rate of PCD for treating PLA was 100% (33/33), with the mean ORT of (24.30±11.60) days. The mean catheter removal time and follow-up time was (27.76±12.03) days and (11.02±6.51) months, respectively. There was no significant difference of recurrence rate of PLA among three groups (P=0.140). However, significant difference of ORT (P=0.002) was found among three groups. Univariate analysis and multivariate analysis indicated that septic shock (hazard ratio [HR]=0.320, 95%CI [0.131, 0.777], P=0.012) and HbA1c≥7% (HR=0.249, 95%CI [0.104, 0.594], P=0.002) were predictors for ORT. Conclusion: For diabetic PLA patients, the higher level of HbA1c, the longer the ORT. Septic shock and HbA1c are predictors for ORT.

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer / 中国基层医药

Objective@#To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization(SPVCE) in the treatment of primary liver cancer.@*Methods@#A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study, and randomly divided into two groups according to the digital table, namely TACE(hepatic carcinoma arterial perfusion chemoembolization)+ SPVCE group and TACE group, with 59 cases in each group.In the TACE+ SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug-borne embolic agent, superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed, regional embolization was performed for liver cancer, and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared.@*Results@#The short-term objective(CR+ PR) efficiency of the TACE+ SPVCE group was 74.57%(44/59), which was significantly higher than that of the TACE group [54.23% (32/59)], the difference was statistically significant(χ2=5.323, P=0.021). The differences were statistically significant in the main indicators, such as the decrease of tumor lesion volume, the increase of liver volume without cancer, and the decrease of FAP(all P<0.05). The long-term objective efficiency of the TACE+ SPVCE group was 45.76%(27/59), which was also significantly higher than that of the TACE group[32.2%(19/59)], but the difference was no statistically significant(χ2=2.280, P=0.131). The TACE+ SPVCE group extended the median survival time by 3.5 months compared to the TACE group, there was statistically significant difference in median survival between the two groups(t=3.211, P=0.000). Major adverse reactions were compared between the two groups, the patients with decreased albumin in the TACE + SPVCE group was less than the TACE group, but there was no statistically significant difference(χ2=1.156, P=0.282), the patients with bone marrow inhibition in the TACE + SPVCE group decreased significantly compared with the TACE group, the difference was statistically significant(χ2=4.882, P=0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group, but there was no statistically significant difference(χ2=1.035, P=0.308).@*Conclusion@#Injection for drug carrier with lobaplatin with gelatin sponge embolism agent, percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization, is safe and effective, and can improve the curative effect of conventional TACE, and prolong survival, has important clinical value for advanced liver cancer patients that cannot be surgically removed.

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer / 中国基层医药

Objective To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization ( SPVCE) in the treatment of primary liver cancer.Methods A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study,and randomly divided into two groups according to the digital table ,namely TACE(hepatic carcinoma arterial perfusion chemoembo－lization)+SPVCE group and TACE group , with 59 cases in each group.In the TACE +SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug －borne embolic agent , superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed ,regional embolization was performed for liver cancer , and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared.Results The short－term objective(CR+PR) efficiency of the TACE+SPVCE group was 74.57%(44／59),which was significantly higher than that of the TACE group [54.23%(32／59)],the difference was statistically significant (χ2 ＝5.323,P＝0.021).The differences were statistically significant in the main indicators , such as the decrease of tumor lesion volume ,the increase of liver volume without cancer ,and the decrease of FAP(all P＜0.05).The long－term objective efficiency of the TACE +SPVCE group was 45.76%(27／59),which was also significantly higher than that of the TACE group [32.2%(19／59)],but the difference was no statistically significant (χ2 ＝2.280,P＝0.131).The TACE+SPVCE group extended the median survival time by 3.5 months compared to the TACE group,there was statistically significant difference in median survival between the two groups ( t＝3.211, P＝0.000).Major adverse reactions were compared between the two groups ,the patients with decreased albumin in the TACE +SPVCE group was less than the TACE group ,but there was no statistically significant difference (χ2 ＝1.156,P＝0.282),the patients with bone marrow inhibition in the TACE +SPVCE group decreased significantly compared with the TACE group ,the difference was statistically significant ( χ2 ＝4.882,P ＝0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group , but there was no statistically significant difference(χ2 ＝1.035,P＝0.308).Conclusion Injection for drug carrier with lobaplatin with gelatin sponge embolism agent , percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization,is safe and effective,and can improve the curative effect of conventional TACE ,and prolong survival ,has important clinical value for advanced liver cancer patients that cannot be surgically removed .

Effect of the proactive percutaneous catheter drainage strategy in the treatment of acute pancreatitis with infected necrosis / 局解手术学杂志

Objective To investigate the effect of the proactive percutaneous catheter drainage(PCD)strategy in the treatment of acute pancreatitis(AP)complicated with necrotic infection.Methods A total of 70 patients with AP complicated with necrotic infection and trea-ted by PCD from January 2016 to November 2017 were prospectively enrolled.The patients were randomly divided into the routine group(n=35)and the modified group(n =35)according to the random number table method.The same indication and principle were performed performed during the first time PCD in both of the two groups.However,the subsequent treatment strategy was different between the two groups.The routine group was given a maximum of 1 adjustment of the drainage tube position or another catheterization.If the drainage effect was still poor,the necrosectomy would be taken through laparoscope,nephroscope or laparotomy directly.While the modified group was given frequent and early drain revision and upsizing of drains in case of lack of clinical improvement.The general data,the total number of PCD pro-cedures,the maximal final drain size,the duration between the first two times of PCD,the total drainage duration,the number of patients need for necrosectomy,the length of hospital stay after drainage,the number of patients need for new ICU admission,the number of patients need for readmission,complications and mortality were compared between the 2 groups.Results The total number of PCD procedures and the maxi-mal final drain size of the modified group was significantly higher than that of the routine group(P<0.05 or P<0.01).The duration be-tween the first two times of PCD in the modified group was significantly shorter than of the routine group(P<0.01).The ratio of patients need for necrosectomy and suffered new-onset multiple organ failure significantly decreased in the modified group,and the difference was sta-tistically significant(P<0.05).There was no significant difference between the two groups in total days of drainage,length of hospital stay after drainage,number of patients need for new ICU admission,number of patients need for readmission,complications and mortality.Conclu-sion The proactive PCD strategy of frequent and early drain revision and upsizing of drains for patients with acute infected necrotizing pan -creatitis when lack of clinical improvement can reduce the proportion of recurrent multiple organ failure and the need for necrosectomy,and it does not increase the risk of related complications.

The clinical application of percutaneous puncturing drainage in treating bacterial liver abscess / 介入放射学杂志

Bacterial liver abscess is a rare and life-threatening disease, and, clinically, its incidence has gradually increased in recent years. In terms of its treatment, percutaneous puncturing drainage combined with antibiotics has been the first-line therapeutic means, and surgical procedures are often used for patients in whom the interventional drainage is ineffective or in whom the liver abscess is complicated by abdominal disease that needs surgical management. Percutaneous catheter drainage and percutaneous fine needle aspiration, regarded as the two most commonly used interventional drainage methods, have been widely employed in the treatment of bacterial liver abscess; and percutaneous catheter drainage is more commonly adopted in clinical practice. Although the prognosis of bacterial liver abscess has been improved significantly, there is still a certain fatality rate. There is still no a well-accepted consensus on treatment guidelines. Moreover, there are still many controversies over the indications of percutaneous puncturing drainage. Based on a comprehensive review of the domestic and foreign literature, this paper aims to make a detailed introduction concerning percutaneous puncturing drainage for the treatment of bacterial liver abscess, focusing on its development history, curative effect and prognosis, and, in order to guide the clinical practice, the principles of the use of antibiotics, the comparison of clinical effect with surgery and the therapeutic indications will be also discussed.

Necrotizing pancreatitis: description of videoscopic assisted retroperitoneal debridement (vard) technique with covered metallic stent / Pancreatite necrosante: descrição da técnica de debridamento videoendoscópico retroperitoneal (vard) assistida com stent metálico recoberto

ABSTRACT Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

RESUMO Racional: A pancreatite aguda é a terceira doença gastrointestinal mais comum que requer hospitalização nos Estados Unidos, com custos anuais superiores a $ 2 bilhões. A pancreatite necrosante grave é uma complicação potencialmente fatal, desenvolvida em aproximadamente 20% dos pacientes. A taxa de mortalidade varia de 15% em pacientes com necrose estéril para 30% no caso de uma infecção infectada com falência multiorgânica. As técnicas de tratamento menos invasivas são cada vez mais utilizadas. Elas podem ser realizadas em uma abordagem chamada "step-up". Objetivo: Apresentar a técnica de desbridamento retroperitoneal assistido com videografia (técnica VARD) com stent metálico coberto em pancreatite necrosante. Método: Um fio guia é inserido através do cateter anterior que foi removido no próximo passo. Depois, o trajeto é dilatado sobre o fio guia. Em seguida, um stent metálico parcialmente coberto é implantado. Uma câmera laparoscópica de 30º é inserida e a necrose removida com fórceps através do stent expandido sob visão direta. Finalmente, o stent é removido e um novo cateter deixado no lugar. Resultado: Esta técnica foi utilizada em um homem de 31 anos com dor aguda na parte superior do abdome e diagnosticado como pancreatite biliar aguda com necrose infectada. Ele foi tratado com drenos percutâneos nas semanas 3, 6 e 8. Devido à recuperação parcial, realizou-se um VARD lateral esquerdo (incompleto por tecido fixo e aderente) na 8ª semana. À medida que a resposta inflamatória do paciente foi reativada, uma segunda tentativa VARD foi realizada em três semanas mais tarde. Posteriormente, o paciente apresentou resolução clínica e de imagem completa. Conclusão: A necrosectomia retroperitoneal assistida em vídeo com stent metálico parcialmente coberto é uma técnica viável para pancreatite necrosante.

The surgical treatment of infection secondary to pancreatic and (or) peri-pancreatic necrosis / 中华肝胆外科杂志

Several minimally invasive techniques were used to treat infection secondary to pancreatic and (or peri-pancreatic) necrosis recent years,including percutaneous catheter drainage (PCD),endoscopic transluminal treatment,min-incision surgery,video-assisted minimally invasive technique and laparoscopic surgery.We should grasp the indication of each technique.PCD/ endoscopic transluminal surgery usually acted as initial therapy.Open surgery is still effective,and acts as a rescue operation when minimally invasive techniques fail.

A comparative study of different modalities of treatment of liver abscess.

Objective: To compare the effectiveness of conservative medical treatment versus minimal invasive surgical techniques like percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of liver abscess. Material and methods: All patients with liver abscess who were admitted in Surgery from October 2013 to June 2014 were included in this study and were exposed to four different treatment modalities. The patients were first treated with combination of medicine (Option-A). If they failed to respond to this treatment then they were subjected to ultrasound guided aspiration (Option -B). If Option - B failed they were exposed to pig tail catheter placement (Option -C). Final option was surgical drainage (Option - D) if it was rupture liver abscess and if the patient presented with co morbid conditions like septicaemia and peritonitis.PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Results: Out of 51 patients, 14 patients responded to drug therapy alone. 34 patients required ultrasound guided aspiration and Pig tail catheter placement and 3 patients required open surgical drainage. A combination of drug therapy and ultrasound guided needle aspiration was effective for majority of 83% patients Duration of hospital stay was similar in the two groups. Conclusion: Minimal surgical interventions like PCD and PNA are better than conservative treatment for the management of liver abscesses of size >5 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed. Pyogenic liver abscess are less common than amoebic liver abscess. Right lobe of the liver is most commonly involved in both types of abscesses. Radio-imaging techniques like ultrasonography (US) and computerized tomography (CT) are the modalities of choice for investigation purposes. Treatment modalities of these abscesses, first emphasizes on medical treatment, but if it is unsuccessful then only the surgical intervention should be taken up. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

Application of bedside ordinary-probe-guided free-hand percutaneous transhepatic gallbladder drainage in the treatment of severe cholecystitis / 实用医学杂志

Objective To evaluate the clinical effectiveness of percutaneous transhepatic gallbladder drainage introduced by bedside ordinary-probe-guidance with free-hand technique in severe cholecystitis. Methods 85 cases treated with the operation were observed and analyzed. Results Infectious bile was successfully drained in all cases without serious complications. 83 cases received satisfactory outcomes. 2 elderly patients died from MODS secondary severe infection. Conclusion Bedside ordinary-probe-guided free-hand percutaneous transhepatic gallbladder drainage is a safe and convenient treatment with minimal invasion for severe cholecystitis, which can be widely used in clinic.

Gallbladder perforation: a single center experience of 32 cases

BACKGROUNDS/AIMS: Gallbladder perforation is a rare but potentially fatal disease. We herein present our clinical experience in diagnosis and management of 32 cases of gallbladder perforation. METHODS: This retrospective study was conducted with inclusion of all cases of gallbladder perforation that presented to our hospital from January 2012 to November 2014. Cases of traumatic gallbladder perforation and patients younger than 12 years of age were excluded from this study. RESULTS: This study included 32 patients (13 males and 19 females). The mean age of patients was 55.9 years. Gallbladder perforation was most common in the 5th and 6th decade of life. The mean age of patients with type I, II, and III gallbladder perforation was 57.0 years, 57.6 years, and 49.8 years, respectively. The most common site of perforation was the fundus, followed by the body and Hartmann's pouch (24 : 5 : 2). Most of the type I gallbladder perforations were diagnosed intraoperatively, type II gallbladder perforations were diagnosed by enhanced abdominal computed tomography, and type III gallbladder perforations were diagnosed during laparoscopic cholecystectomy converted to open cholecystectomy for cholelithiasis. Mortality was highest in patients with type I gallbladder perforation. The mean hospital stay was 10.1 days, 6.4 days, and 9.2 days in patients with type I, II, and III gallbladder perforation, respectively. The histopathologic analysis in 28 patients who were operated on showed acute cholecystitis in 19 cases, acute-on-chronic cholecystitis in 4 cases, chronic cholecystitis in 4 cases, and mucinous adenocarcinoma of the gallbladder in a single case. CONCLUSIONS: Gallbladder perforation represents a special diagnostic and surgical challenge. Appropriate classification and management are essential.

Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.

Fatal liver injury complicated by percutaneous catheter drainage after distal pancreatosplenectomy in a patient with pancreatic cancer

Postoperative pancreatic fistula (POPF) combined with postoperative fluid collection, bleeding and abscess formation is one of the most critical morbidities after distal pancreatectomy or pancreaticoduodenectomy. Percutaneous catheter drainage has been commonly used for managing for the postoperative management of abnormal fluid collection. Removal of the catheter is rarely associated with occurrence of life-threatening complication such as serious liver damage. Herein, we report a case of unexpected fatal liver injury complicated by percutaneous catheter drainage treatment after distal pancreatosplenectomy in a patient with pancreatic cancer. We suggest that prudent decision for timing of catheter removal and meticulous care during procedure can reduce the possibility of major liver injury in patients with percutaneous transhepatic catheter drainage.

Uso de catéter venoso central de inserción periférica en pediatría / Central venous catether for peripheral insertion in pediatrics

Introduction: Central venous catheter of peripheral insertion (PICC) can stay installed from several days up to months without removal. It allows the administration of extreme pH and osmolarity solutions, irritating and/or vesicant drugs, parenteral nutrition and other medications for prolonged periods in patients with complicated peripheral venous access. Objective: To describe the experience with PICCs in hospitalized pediatric. Patients and Methods: Observational and descriptive study on 337 patients hospitalized in the Pediatrics Service of the Clinical Hospital of Catholic University of Chile between 2001 and 2011, who fulfilled the inclusion criteria and had a PICCs installed by trained nurses. Results: The patients' average age was of 36 months. Main indication for installing PICC was prolonged antibiotic therapy, in 67.1 percent of cases. The most widely used venous route was the upper limb, in 52.2 percent. The mean average time in which the PICC remained in the body was of 9 days, ranging between 1 and 90 days. The main cause for PICC withdrawal was the end of therapy in 75.3 percent. The observed complications were: occlusion and catheter associated infection in 8.9 percent and 2.9 percent respectively. Conclusion: PICC is an excellent alternative for prolonged intravenous therapy; but, it is very important to keep on a team of well-trained nurses, both in the insertion as well in the maintenance of the PICC during the time it remains in the body.

Introducción: El catéter venoso central de inserción periférica (PICC) puede permanecer desde días hasta meses instalado sin necesidad de recambio; permitiendo la administración de soluciones con pH y osmolari-dad extremas, medicamentos irritantes y/o vesicantes, nutrición parenteral u otros medicamentos por tiempo prolongado en pacientes con accesos venosos periféricos difíciles. Objetivo: Describir la experiencia del uso de PICCs en pacientes pediátricos hospitalizados. Pacientes y Método: Estudio observacional y descriptivo, donde se hizo un seguimiento a 337 pacientes con PICCs instalados por enfermeras capacitadas, en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile entre los años 2001 y 2011, que cumplieron con los criterios de inclusión. Resultados: La edad de los pacientes presentó una mediana de 36 meses. La principal indicación para la instalación del PICC fue la terapia antibiótica prolongada en el 67,1 por ciento. El acceso venoso más utilizado fue la extremidad superior en un 52,2 por ciento. El promedio de días de permanencia del catéter presentó una mediana de 9 días con un rango entre 1 y 90 días. El principal motivo para el retiro del PICC fue la finalización del tratamiento en el 75,3 por ciento. Las complicaciones presentadas fueron: oclusión e infección asociada al catéter con un 8,9 por ciento y 2,9 por ciento, respectivamente. Conclusión: El PICC es una excelente alternativa para la terapia endovenosa por períodos prolongados; sin embargo, es muy importante mantener un equipo de enfermería capacitado, tanto en la inserción como en la mantención del PICC durante su permanencia.

Management of retroperitoneal infected necrotic tissues in pelvic cavity in patients with severe acute pancreatitis / 中华消化外科杂志

Objective To investigate the management of retroperitoneal infected necrotic tissues in pelvic cavity in patients with severe acute pancreatitis (SAP).Methods The clinical data of 5 patients with SAP complicated with retroperitoneal infected necrotic tissue in the pelvic carvity who were admitted to the General Hospital of Nanjing Military Area from December 2009 to February 2012 were retrospectively analyzed.Systemic comprehensive treatement combined with local management were applied to all the patients.Results Systemic comprehensive treatment:all the 5 patients were treated by enteral nutrition,3 by mechanical ventilation and 3 by continuous blood purification.All the retroperitoneal infected necrotic tissues in the pelvic carvity were treated by computed tomography (CT)-guided percutaneous catheter drainage,and then the patients were converted to open surgery for further drainage.Four patients had complication of infected pancreatic necrosis bleeding,and they were treated by arterial embolism and (or) sandwich therapy.Local management:5 patients with retroperitoneal infected necrotic tissues received CT-guided percutaneous catheter drainage via buttocks.The average time of puncturation after illness was 38.4 days,and the average CT density of infected necrotic tissue was 24.4 Hu (20-28 Hu).Catheterization was successfully done in the open surgery for all the 5 patients,and the average time of abdominal drainage was 21 days.The body temperature and white blood cell count were decreased after puncturation.The average duration of intensive care unite stay,the average time of hospital stay and the average cost of hospitalization were (47 ± 20 )days,(88 ±34 )days and (186 342 ± 15 467 )yuan.All the patients were followed up till May 2012,no recurrece of the retroperitoneal infected necrotic tissue was detected.Conclusion CT-guided percutaneous catheter drainage via buttocks is effective for the treatment of retroperitoneal infected necrotic tissue in the pelvic cavity in SAP patients.

Percutaneous catheter drainage and negative pressure irrigation for severe acute pancreatitis (SAP) patients with infective pancreatic necrosis / 中华胰腺病杂志

Objective To observe the clinical effectiveness of percutaneous catheter drainage ( PCD ) and PCD + negative pressure irrigation ( PCD + NPI ) for treatment of severe acute pancreatitis ( SAP ) patients with infective pancreatic necrosis (IPN).Methods Data of 71 IPN patients admitted from January 2010 to December 2011 were included and retrospectively analyzed.They were divided into two groups by the different treatment choices:PCD group (52 patients) and PCD + NPI group (19 patients).In PCD group,percutaneous pig-tail drainage catheter was inserted for intermittent IPN drainage,and in PCD + NPI group,negative pressure irrigation catheter was inserted for continuous IPN drainage.The indication for laparotomy surgery was no improvement after PCD or PCD + NPI for 3 days,or septic shock,abdominal cavity bleeding,digestive tract fistula occurred,the area of IPN decreased less than 1/2.Results The surgery rate of PCD +NPI group was 15.8％,which were significantly lower than that in PCD group (48.1％,P ＜0.05).7(36.8％ ) patients in PCD + NPI group received endoscopic drainage,which were significantly higher than that in PCD (0,P ＜0.05).The time interval between initial tube placement and operation in the PCD + NPI group was (22 ± 11 ) d,which were significantly longer than that in PCD group [ ( 10 ± 6 ) d,P ＜ 0.05 ].The difference of mean session and number of tube placement,number of laparotomy surgery,complications of laparotomy surgery in the two groups was not statistically significant.The mortality rate in the PCD + NPI group was 15.8％,which was not significantly higher than that in PCD group ( 13.5％ ).The ICU days,length of hospital stay and hospital costs in PCD + NPI group were lower than those in the PCD group,but the difference between the two groups was not statistically significant.Conclusions PCD + NPI can effectively reduce operation rate for patients with infective pancreatic necrosis.

Relações de poder no manejo do cateter percutâneo por enfermeiras / Relations of power during the handling of the percutaneous catheter by nurses

Este estudo cuja temática trata das relações de poder durante o manejo do cateter percutâneo por enfermeiras neonatologistas, parte do pressuposto de que existem conflitos durante o procedimento, mediadas pelas relações de poder entre os profissionais da assistência e a administração destas unidades. O trabalhador da saúde não consegue sozinho dar conta do complexo objeto do ato de cuidar, ele sempre depende de um sistema de troca com os outros para que este trabalho se concretize. Desta forma, existe uma pactuação do processo de trabalho entre os sujeitos envolvidos, que resulta em disputas, produto da correlação de forças que se estabelece neste processo, que se expressam sob a forma de relações de poder. Pela importância de tal tema, realizou-se o presente estudo exploratório de abordagem qualitativodescritiva com o objetivo de compreender as relações de poder vivenciadas por enfermeiras durante o manejo do cateter, identificar como são estabelecidos os limites profissionais sobre este procedimento, descrever as relações de dominação ou de resistência vivenciadas pelas enfermeiras durante o manejo do cateter. Para orientar esta investigação, adotou-se como eixo de sustentação teórica o pensamento de Michel Foucault para o estudo das relações de poder, com maior ênfase para os dispositivos disciplinares. A coleta de dados processou-se em uma Unidade de Terapia Intensiva Neonatal de uma Maternidade de Referência da cidade de Salvador/BA através de uma entrevista semi-estruturada, gravada. Foram sujeitos da investigação, treze enfermeiras assistenciais, especialistas, habilitadas para o manejo do cateter percutâneo que estavam em pleno exercício de suas atividades. Sob a ótica da Análise do Conteúdo, os resultados geraram um conjunto de três categorias de estudo: A disciplina no manejo do cateter percutâneo por enfermeiras, a ambiguidade do saber: poder e resistência e a presença de um poder soberano. A partir dos discursos das enfermeiras, pode-se perceber como a disciplina esquadrinha o agir destas profissionais, que mesmo possuindo o saber teórico e prático sobre o procedimento contraditoriamente, não exercem este poder/saber ou o exercem de forma velada, com resistência fraca, permitindo que estas relações se manifestam sob a forma de conflitos com uma tendência das enfermeiras se submeterem à dominação médica para bom andamento do serviço. Estas observações sugerem a necessidade da adoção de uma postura crítica frente ao contexto desta prática e de um maior aprofundamento desta temática por parte das organizações, das trabalhadoras e das instituições de ensino.(AU)

A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

OBJECTIVE: We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. MATERIALS AND METHODS: From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. RESULTS: Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). CONCLUSION: This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis.

Analysis of Results after Percutaneous Catheter Drainage for Anastomotic Leakage

PURPOSE: Anastomotic leakage is a serious and life- threatening complication after colorectal surgery. The management of clinical anastomotic leakage remains largely operative. The aim of this study was to analyze the clinical characteristics and the natural history of percutaneous catheter drainage (PCD) for anastomotic leakage after colorectal surgery. METHODS: Twenty patients who were managed by PCD after anastomotic leakage between January 2002 and December 2006 were studied. Charts were reviewed for information on clinical characteristics and biolologic finding prePCD and postPCD. RESULTS: Anastomotic leakage was managed by using only PCD in 16 of 20 patients (80%), and twenty percent of patients (4/20) were managed by using a loop ileostomy after PCD. Nine patients (45%) had peritoneal drains left in place at diagnosis. Before PCD, the mean of the peak white blood cell (WBC) was 12,800/mm3, and the mean period of fever (>38degrees C) was 3.4 (2~5) days. After PCD, the mean time until the body temperature dropped below 37oC was 3.1 (1~5) days, the mean time until the WBC count dropped below 10,000/mm3 was 3.2 (0~6) days, the mean duration of ileus and diarrhea was 3.3 (0~6) days, the mean total amount of drainage during 6 days was 880 cc, and the mean length of stay after PCD was 14.9 days. CONCLUSIONS: PCD is a safe and effective method for treating anastomtic leakage in patients without sepsis or diffuse peritonitis and with CT scans that reveal no diffuse fluid collection.

A Case of Term Delivery in Patient with Perirenal Abscess / 대한산부인과학회잡지

Acute abdominal pain during pregnancy may be urologic origin. In this report, perinephric abscess was treated by percutaneous catheter drainage until a term delivery was achieved. We have experienced a case of perinephric abscess of pregnancy and reported with brief review of related literatures.