Pancreatic pseudocysts located in the liver: a systematic review of the literature.

BACKGROUND: Pancreatic pseudocysts (PC) are a common complication of both acute and chronic pancreatitis. Most pancreatic pseudocysts are located within the head and the body of the pancreas, but 20% of them are extrapancreatic (pleura, mediastinum, pelvis and spleen). The location of a pseudocyst in the liver is an exceptional event, only thirty three cases are reported in the literature. AIM: This article aimed to report a new case of PC located in the liver combined with a systematic review of reported cases published in peer-reviewed journals. METHODS: A new case of PC located in the liver was reported. An extensive electronic search of the relevant literature since 1990 was carried out using Medline. We retained only the articles reporting one or several cases. When the article was unavailable, we considered the relevant abstracts which should report clinical patterns and therapeutic modalities. Reviews of the literature, systematic reviews, letters to editors and incomplete abstracts were excluded. A descriptive analysis of the collected sample including our case was performed. Morphological, therapeutic and outcome variables were reported. RESULTS: The analysis of 22 cases reported in the literature and our observation provided the following data: 17 men and 6 women with a mean age of 51 +/- 3.2 years. Seventeen patients presented an acute pancreatitis, complicating a chronic pancreatitis in seven cases, alcoholic in six cases, biliary in three cases and traumatic in one case. Six patients presented a chronic pancreatitis. The PC was located in the left lobe of the liver in 12 cases, in the right lobe in 6 cases and interested the two lobes in 5 cases. The lesion was unique in 8 patients and multiple in 15 patients. Fifteen patients were treated by Ultrasound or CT guided percutaneous drainage. Four patients were managed surgically. Three patients had no specific treatment. One patient was successfully treated by endoscopic transpapillary drainage. The evolution was favourable for all patients except in three patients who died. CONCLUSIONS: Pancreatic pseudocyst located in the liver is an exceptional event, commonly following acute pancreatitis, rising in older male, involving the left lobe of the liver and treated by percutaneous drainage.

[Anaesthetic security: evolution of ideas]. / La sécurité anesthésique: evolution des concepts.

BACKGROUND: The concept of risk has not clear neither in the media nor in the medical field. It appears important to us to bring details relating some definitions in the field of anaesthesia safety. AIM: This work aims to clarify the concepts of safety, of risk in a medical activity like the Anaesthesia. METHODS: A search was carried out on Medline with the following key words: Risk anaesthetic, anaesthetic Safety, anaesthetic mortality. RESULTS: The definitions of risk, of acceptable risk taking account of social and economic considerations are brought in this text. The ways to evaluate safety and the methods to achieve it was developed. DISCUSSION: The indicator of quality more used to evaluate safety is anaesthetic mortality. Many difficulties exist with the interpretation of data on mortality. The standards of care are normally established according to the degree of necessary safety. Concurrently to these standards exist certainly the human error which is a phenomenon towards which must direct all the efforts of improvement of safety but more especially the errors of system which are found regularly in the analysis of accidents and incident. CONCLUSION: The identification of the failures is the mandatory step to achieve safety.