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PubMed1997

[Surgical treatment of biliary cystic fistula caused by hydatic cysts. Apropos of 83 cases].

The high number of BCF (10-24%) diseases with its direct link on post-surgical casualties require a very well structured therapy. A study over a period of 17 years on 479 patients, whose age ranged average 37 years, broLen into 52 female et 31 male, shows 83 cases of hydatic livercystis that were aggravated by a BCF. In 23 cases (27.7%) the BCF was large, minimal in 60 cases (72.3%) and for 72% the multivesicular hydatic cystis was altered by a pericystis, often sclerous and calcified. In 9 cases (11%) the main biliary duct was enlarged and showed hydatic remains. 3 patients were under radical treatment (3.6%), 2 (2.45%) underwent a total pericystectomy, and 1 (1.2%) a partial pericystectomy. The 80 other patients went through a saving approach treatment which involved. In 44 cases (55%) a flattening with a simple suture of BCF, in 11 cases (13.75%) a suture combined with an external bile drainage, in 5 cases (6.25%) a suture combined with an epiploic-plastic surgery, in 5 cases (6.25%) the suture was combined with the padding of the residual cavity, in 4 cases (5%) the epiploic plastic surgery was combined with an external bile drainage. In 7 cases (8.75%) a bipolar drainage was used and in 4 cases (5%) there was mobile drainage. For 50% of these patients the post surgical surgery was very simple; the most important aggravations were 12 FBK, 8 subphrenic abscess, 1 choleperitonitis. The average length of stay was 23 days. No death was accounted for. The aim was to assess the different technics proposed in the treatment of BCF and elaborate a therapeutical strategy.

Adolescent↗

PubMed1976

[Self-inflicted injuries by injecting contaminated solutions through the chest wall (author's transl)].

In the case of three prisoners, we observed the results of their attempt to induce an infection of the pleura and lungs by injecting themselves through the chest wall with a contaminated substance in order that they might be transferred to a sanatorium. Traces of the solution they had administered, which among other substances contained faeces, were found in the chest wall, in the pleural and subphrenic area, in the lungs and in the liver. The self-inflicted injuries described, led in the case of one of the prisoners to his death following a subphrenic abscess, a necrosis and abscess of the liver, septic shock and respiratory insufficiency. The clinically recognizable results of the injection only set in after a period of latency of several days. In one case there were still traces of stool in the liver 24 days after its initial introduction.

Adult↗

PubMed1998

[Perioperative care by internists in splenectomy].

Splenectomy (SE) is one of the surgical interventions requiring an increased internal care. The removal of the spleen which is an organ with an exceptional function can lead to complications even in people who are healthy in all other respects. The complications in coincidence with SE can arise early (up to 30 days after surgery) or later. Early complications can involve infections of the respiratory tract (especially bronchopneumonia), or subphrenic abscess. Thromboembolic complications occur not only in peri-operational period, but also in several weeks or months after SE. A severe complication resides in disseminated intravascular blood coagulation. Late complications represent a lifelong danger for asplenic patients. They include the fulminant sepsis, known as so-called OPSI syndrome (overwhelming postsplenectomy infection). The mortality rate in coincidence with the latter is very high despite intensive antibiotic therapy. The risk is especially high in children, in immuno-deficient states and immunosuppressive therapy. 60% of patients develop OPSI during the first two years, out of whom one third is afflicted in the first half of the year following SE. In more than 30% of patients OPSI manifests itself minimally 5 years later. The prevention of infection in coincidence with SE is performed by means of immunization, antibiotic prophylaxis and via education of patients. Immunization includes the administration of a polyvalent pneumococcus vaccine, in children it includes also the vaccine against Haemophilus inluenzae and Neisseria meningitidis. The appropriate antibiotic prophylaxis is represented especially by penicillin, amoxicillin, or amoxicillin with clavulanic acid. The children or other patients with disturbed immunity functions are administered with antibiotics in low doses per os for a long period. Antibiotics in the therapy of OPSI are administered in full doses together with immunoglobulin, both are applied intravenously. A specific approach is required in patients with autoimmune thrombocytopenia, in whom the increase in the number of thrombocytes prior to operation can be achieved by high intravenous doses of corticoids or immunoglobulin G. In this case, unless explicitly necessary, the transfusion of thrombocytes should not be performed prior to SE. The antithrombotic therapy is appropriate in patients at high risk of post-surgical thrombosis (e.g. hereditary haemolytic anaemias, myeloproliferative diseases, SE in coincidence with polytraumatism.

Humans↗

PubMed1976

Hydatid disease at Royal Prince Alfred Hospital, 1964 to 1974.

A survey of hydatid disease has been carried out at the Royal Prince Alfred Hospital over a ten-year period from 1964 to 1974. It would appear that there has been no change in incidence in hydatid disease in the last 25 years. Fifty per cent of the hydatid cysts dealt with in this series occurred in the liver, and 30% were in the lung. Forty per cent of patients with lung hydatid disease were found to harbour hydatid cysts in the liver as well, while 24% of those with hydatid disease in the liver were found to have co-existent lung cysts. Twenty per cent of patients with pulmonary hydatid cysts presented with urgent complications, while only 7% of those with liver hydatid cysts presented in this way. Twenty-four per cent of the patients in this series were born outside Australia, most of the rest having been born and having lived in New South Wales. In this State, the distribution of hydatid disease remains the same as it was in 1925. Of the serological tests, the Casoni intradermal reaction was positive in 67% of cases, while the complement-fixation reaction was positive in only 52%. Seventy-eight per cent of these patients came to operation; 50% were found to have viable cysts at operation. Morbidity was high from chest infection, prolonged drainage from the site of the cyst and subphrenic abscess. Since few viable cysts were found in patients over the age of 60 years, there is a strong case for conservatism in the treatment of elderly patient with an asymptomatic calcified hydatid cyst. The hydatid-dependent mortality rate in this series was 1-8%. Over a mean follow-up period of five years, in 5% of these patients, there was a proven recurrence of hydatid disease requiring further operation.

Adolescent↗

PubMed1969