The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: A retrospective cohort study.

BACKGROUND: The common bile duct (CBD) stones passage in patients with cholangitis was unclear.This study aimed to evaluate the effect on CBD stone sizes and predicting factors on spontaneous passage in patients with cholangitis. METHOD: The medical records of cholangitis at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to December 2019 were retrospectively reviewed. Patients with acute cholangitis from CBD stones underwent ERCP in the same admission were enrolled. RESULT: Of the 96 patients, The rate of spontaneous passage of CBD stones was 19.8%. By univariate analysis, factors significantly associated with a predictor of spontaneous CBD stone passage in patient with cholangitis were single CBD stone (p = 0.001), CBD stone diameter < 5 mm (p < 0.001), and clinical symptom improved before ERCP procedure (p = 0.004). Multivariate logistic regression analyses also revealed that these three factors were significantly associated with spontaneous passage. From ROC curve analysis, stone size of less than 4.85 mm was more likely to pass spontaneously with acceptable sensitivity (81.8%) and specificity (78.9%). CONCLUSIONS: CBD stone diameter < 5 mm, single CBD stone and improved clinical symptom before ERCP procedure are key predictors of spontaneous CBD stone passage in cholangitis.

Effectiveness of transcatheter arterial embolization for patients with shock from abdominopelvic trauma: A retrospective cohort study.

BACKGROUND: Transcatheter arterial embolization (TAE) is a useful endovascular technique for controlling hemorrhage in blunt abdominopelvic trauma without shock. However, several studies have reported that TAE is safe and effective for controlling hemorrhage in hypovolemic shock. OBJECTIVE: To evaluate the effectiveness of TAE for patients with shock from abdominopelvic trauma. METHOD: The medical records of patients with abdominopelvic trauma at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University from January 2014 to January 2019 were retrospectively reviewed. We enrolled patients with shock caused by injury to solid organs or pelvic fractures who underwent TAE. RESULT: Of the 320 patients, 14 patients with shock underwent TAE. A total of 78.6% were male. The mean age was 37.5 years. The average injury severity score was 31.3. The most common mechanism of injury was traffic accidents (85.7%). Embolization was performed for 8 liver injuries, 5 pelvic fractures and 1 splenic injury. The treatment time for TAE was approximately 47.9 ± 33.2 min. The mean length of hospital stay was 21.3 ± 15.9 days. Two patients died (14.3%). There were no embolization-related complications. A significant improvement in systolic blood pressure (p = 0.028) and a decrease in heart rate (p = 0.001), lactate concentration (p = 0.011), and crystalloid fluid (p = 0.001) and blood transfusion requirements (p = 0.002) were observed after TAE. CONCLUSIONS: TAE is a safe and effective method for treating shock patients with a rapid or transient response to resuscitation. For patients who are nonresponsive to resuscitation, TAE is an additional useful option for arterial hemorrhage control in abdominopelvic trauma.

Intrahepatic Sarcomatous Cholangiocarcinoma: Case Report and Review of the Literature.

The authors report a case of a patient with intrahepatic sarcomatous cholangiocarcinoma. A 45-year-old Thai man presented with a 3-month history of right upper abdominal pain. CT scan revealed hepatomegaly with a 6.5 cm hypovascular soft tissue density mass in the right lobe and showed mild delayed enhancement. On exploratory laparotomy, the tumor adherent to right diaphragm was found. We performed right hepatectomy, partial resection of right diaphragm, and cholecystectomy. The immunohistological results suggested "sarcomatous intrahepatic cholangiocarcinoma." The tumor was recurrent in 5 months after operation and unresectable. Therefore, the treatment in this patient was supportive care. He died 11 months after his initial presentation. The literature reviews showed that intrahepatic sarcomatous cholangiocarcinoma is aggressive malignant with poor prognosis. Early detection, radical resection, and careful follow-up would be the treatment for the favorable prognosis.

Risk Factors for Post Endoscopic Retrograde Cholangiopancreatography Cholangitis

Background: Cholangitis is the one of complications in post endoscopic retrograde cholangiopancreatography (post- ERCP). Few studies investigated risk factors for post-ERCP cholangitis and the results showed different outcomes. Objective: The aim of the study was to determine the contributing risk factors for post-ERCP cholangitis. Material and Method: The medical records of patients who underwent ERCP from January 2013 to December 2015 were retrospectively reviewed. We excluded patients who had cholangitis before ERCP. All patients received intravenous prophylaxis antibiotic before the procedure. Demographic data, interested factors and result were collected. Univariate and multivariate analysis were used to identify risk factor for post-ERCP cholangitis. Results: 227 patients enrolled where 204 (89.9%) of them were receiving therapeutic procedure. 156 (68.7%) patients were performed by high experience endoscopists (performing >50 ERCPs per year). The success rate was 87.7%. Post-ERCP cholangitis occurred in 20 (8.8%) patients as a result of therapeutic procedures. By univariate analysis, 8 variables were identified. They were male sex, age >60 year, no epigastric pain, albumin <2.5 gm/dL, bile duct cancer, common bile duct stones, change and remove bile duct stent. Multivariate analysis showed that age >60 year, albumin <2.5 gm/dL and remove bile duct stent were significantly associated with post-ERCP cholangitis. Conclusion: Age >60 year, albumin <2.5 gm/dL and remove bile duct stent are three major risk factors for post-ERCP cholangitis.

The Effects of Single-Dose Preoperative Intravenous Dexamethasone on Clinical Outcome after Laparoscopic Cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is one of the most common procedures in surgery. Post-operative pain and post- operative nausea and vomiting (PON) are frequently events after laparoscopic cholecystectomy and cause distress to patients. Dexamethasones are known for analgesic, anti-inflammatory, immune-modulating and anti-emetic effects. Therefore, preoperative dexamethasone administration may reduce postoperative pain and postoperative nausea vomiting after laparoscopic cholecystectomy. OBJECTIVE: This study aims to determine the effects of single-dose preoperative intravenous dexamethasone on clinical outcome such as postoperative pain nausea and vomiting in patients undergoing laparoscopic cholecystectomy. MATERIAL AND METHOD: This is a prospective randomized controlled trial study. Eighty patients undergoing elective laparoscopic cholecystectomy were randomized to dexamethasone group and control group. Dexamethasone group received 8 mg (2 ml) of intravenous dexamethasone 60-90 minute before surgery whereas control group received 2 ml of normal saline 60-90 minute before surgery. Patients received a similar standardized anesthesia, surgical and multimodal analgesic treatment. The pain score, nausea and vomiting at 1, 6, 24 hours after surgery and before discharge including analgesic consumption and antiemetic required was recorded in both groups. Preoperative and postoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. RESULTS: No significant difference existed between two groups regarding age, sex, previous operation, operation time and hospital stays. All of the patients had no postoperative complication. Postoperative pain score, nausea and vomiting at 1st and 6th hours in dexamethasone group were significantly reduced in comparison with control group. Analgesic consumption, antiemetic requirement and CRIP postoperative were significantly decreased in dexamethasone group. CONCLUSION: Single-dose preoperative dexamethasone 8 mg 60-90 minute before induction of anesthesia improved clinical outcome in terms of significantly less nausea, vomiting, pain at first 6 hours and less inflammatory response after laparoscopic cholecystectomy compared to placebo. The preoperative dexamethasone should be used as routine in patients undergoing laparoscopic cholecystectomy.