RESUMO
BACKGROUND AND AIM: The aim of this study was to report our 44-year experience (1963-2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center. MATERIAL AND METHODS: There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years. RESULTS: Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. CONCLUSIONS. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.
RESUMO
OBJECTIVE: To find out what effect whole blood and leucocyte-depleted blood transfusions had on the healing process of intestinal anastomoses in rats. DESIGN: Experimental study. SETTING: Teaching hospital, Greece. SUBJECTS: 100 Wistar rats in five groups of 20 each. INTERVENTIONS: Small and large bowel anastomoses were made and the five groups were given normal saline, homologous whole blood, heterologous whole blood obtained from PVG rats, homologous leucocyte-depleted blood or heterologous leucocytedepleted blood during the operation. MAIN OUTCOME MEASURES: Bursting pressures of anastomoses on the third and seventh postoperative days and infective complications. RESULTS: The groups given whole blood transfusions had significantly more anastomotic abscesses than controls (p = 0.003 compared with heterologous, p = 0.05 compared with homologous for the small bowel, and p = 0.007 for the large bowel). The pressure measurements indicated a significant reduction in anastomotic strength in the same groups compared with the control group (p = 0.0001/p = 0.001 on the third postoperative day, and p = 0.00001/p = 0.0004 on the seventh postoperative day for small and large bowel, respectively). There was no reduction in anastomotic strength in the leucocyte-depleted blood groups. CONCLUSIONS: Transfusion of leucocyte-depleted blood does not seem to impair intestinal anastomotic healing and carries an acceptable incidence of postoperative complications.
