Endoscopic Versus Laparoscopic Drainage of Pancreatic Pseudocysts: a Cost-effectiveness Analysis.

BACKGROUND: Both endoscopic and laparoscopic interventions have a high therapeutic success rate in the management of symptomatic pancreatic pseudocysts; however, neither has been established as the gold standard. METHODS: A decision tree analysis was performed to examine the costs and outcomes of intervening on pancreatic pseudocysts endoscopically versus laparoscopically. Within the model, a theoretical patient cohort was separated into two treatment arms: endoscopic drainage and laparoscopic drainage. Variables within the model were selected from the published literature. Medicare reimbursements rates (US$) were used to represent costs accumulated during a 3-month perioperative period. Effectiveness was characterized by quality-adjusted life-years (QALYs). A willingness-to-pay of $100,000 per 1 year of perfect health (1 QALY) gained was used as the cost-effectiveness threshold. The model was validated using one-way, two-way, and probabilistic sensitivity analysis. RESULTS: Endoscopic management of symptomatic pancreatic pseudocysts was the dominant strategy, producing 0.22 QALYs more while saving $23,976.37 in comparison to laparoscopic management. This result was further validated by one-way, two-way, and probabilistic sensitivity analysis. CONCLUSIONS: For patients presenting with symptomatic pancreatic pseudocysts amenable to either endoscopic or laparoscopic management, endoscopic drainage should be considered first-line therapy.

Visual hemifield loss in thalamic hematoma.

A 45 year old hypertensive patient presented to the emergency medical room (EMR) with sudden onset of severe headache, episode of vomiting, visual loss and confusion. A C.T scan and MRI brain was done revealing a large hematoma in the region of posterior part of left thalamus. The patient was disoriented in time, place and had right visual field hemianopia. The headache and higher functions became normal with control of intracranial pressure and supportive therapy. There were no motor or sensory symptoms or signs. This case is unique as a large thalamic hematoma presented with only visual field deficit and no sensory or motor system affection.