Surgery for hilar cholangiocarcinoma; a 10 year experience of a tertiary referral centre in the UK.

OBJECTIVE: To review the outcome of patients operated for hilar cholangiocarcinoma and analyse prognostic variables. PATIENTS AND METHODS: A prospectively collected database on patients with hilar cholangiocarcinoma, between 1992 and 2003, and relevant clinical notes were reviewed retrospectively. A total of 174 patients, 96 male, median age 63 years (27-86), were referred. Jaundice was the initial presentation in 167. RESULTS: ERCP was the initial interventional investigation at the referring centre in 150, of which only 30 were stented successfully. PTC and decompression was carried out on 120. In 17, combined PTC and ERCP were required for placement of stents. Seventy-two underwent laparotomy at which 27 had locally advanced disease. Forty-five had potentially curative resections. Extra hepatic bile duct resection was done in 14 patients of which four were R0 resections. Thirty-one had bile duct resection including partial hepatectomy with 19 R0 resections (P=0.042). Post-operative complications developed in 19 patients, and there were 4 30 day mortalities [hepatic insufficiency:/sepsis (n=3), thrombosis of the reconstructed portal vein (n=1)]. Among the patients with R0 resections, the cumulative survival rates at 1, 3, and 5 year; was 83, 58, 41%, respectively, and in those with R1 resections were 71, 24, 24%, respectively, (P=0.021). Overall survival was shorter in patients with positive perineural invasion (P=0.066: NS). There was no significant difference in survival between the node positive and negative group. Median survival of patients who underwent liver resection was longer than those with bile duct resection only (30 vs 24 months P=0.43: NS). CONCLUSIONS: ERCP was associated with a high failure rate in achieving pre-operative biliary decompression which was subsequently achieved by PTC. Clear histological margins were associated with improved survival and were better achieved by liver resection as compared to extra hepatic bile duct resection. Positive level I lymph nodes did not adversely impact survival.

[Use of laparoscopic trocars in chest tube insertion: a rapid and safe technique]. / Gögüs Tüpü yerlestirilmesinde laparoskopi trokarlarinin kullanimi: hizli ve güvenli bir teknik.

Insertion of chest drain is always a life saving procedure in emergent conditions. Especially in crowded traffic accidents more than one patient has brought to the emergency service. In this study we review our experience in chest drainage by using classic laparoscopic trocars. During the period between August 1997, and March 2000 chest tubes were inserted using laparoscopic trocars in 27 patients in emergency service, Yozgat State Hospital. We have no complications related to use of this technique. We concluded that use of laparoscopic trocars in chest tube insertion in emergency conditions is an safe and rapid procedure.

Family practice in Turkey.

Family practice is a very new medical specialty in Turkey. Family practice residency programmes have been attended since 1985 only in state hospitals and in 1995 departments of family practice will be funded in universities, too. In this article, we review the problems of family practice in Turkey and we mention our own opinions and comments about various aspects of it.