Outcome comparison between percutaneous cholecystostomy and cholecystectomy: a 10-year population-based analysis

Background

Controversy surrounding the role of percutaneous cholecystostomy (PC) is fed by the absence of large amounts of data concerning its outcomes, and many authors have maintained that there is no evidence to support a recommendation for PC rather than cholecystectomy (CCS) in elderly or critically ill patients with acute cholecystitis (AC).

Methods

We conducted this study by tracking trends in the utilization and outcomes of PC and CCS using longitudinal health research data in Taiwan.

Results

Analyses were conducted on 236,742 patients, 11,184 of whom had undergone PC and 225,558 of whom had undergone CCS. Average annual percentage changes (AAPCs) from 2003 to 2012 increased significantly by 18.34% each year for PC and by 2.82% each year for CCS. The subset analyzes showed that the mortality rates were far higher in patients underwent PC than in patients underwent CCS in all subgroups, which increased from a minimum of 1.45-fold to a maximum of 34.22-fold. The gap of the mortality rates between PC group and CCS group narrowed as the patients aged and with the seriousness of the diseases increased. Most patients with PC or CCS who died in-hospital or within 30 days after discharge were 70 years of age or older, and a large number of them received a CCI score of at least 1. The AAPCs of the overall mortality rates from 2003 to 2012 decreased by 6.78% each year for PC and by 7.33% each year for CCS. PC was related to a higher rate of cholecystitis recurrence and readmission for complications, but a lower rate of in-hospital complications and routine discharge than CCS, and 36.41% of all patients treated with PC underwent subsequent CCS. Additionally, the patients with PC experienced longer hospital stays and generated higher costs than the patients with CCS.

Conclusion

Patients who underwent PC demonstrated poorer prognoses than did patients who underwent CCS. The role of PC in the Tokyo guidelines may be overstated; it is not as safe as the Tokyo guidelines have suggested in moderate-grade cholecystitis cases, and it should be limited to only the elderly and sicker patients.

     

Evaluation of intraoral verticosagittal ramus osteotomy for correction of mandibular prognathism: a 10-year study.

PURPOSE: To identify intraoperative complications, neurosensory disturbance (NSD), and horizontal relapse after surgical correction of mandibular prognathism using bilateral intraoral verticosagittal ramus osteotomy (IVSRO). PATIENTS AND METHODS: Between 1995 and 2005, 237 Iranian patients underwent IVSRO to achieve mandibular setback. Their operation reports, cephalometric radiographs (2 weeks preoperatively and 12 months postoperatively), and neurosensory questionnaires were assessed to identify intraoperative complications, NSD of the inferior alveolar nerve (IAN), and horizontal relapse. RESULTS: Intraoperative complications occurred in 26 cases (11%). A total of 17 patients (7.2%) reported NSD of the IAN. The mean surgical setback was 7.99 mm at the B point, and the mean horizontal relapse was 2.16 mm at the B point (after 1 year). CONCLUSIONS: Considering our findings, the benefits of the IVSRO technique (eg, good contact between the 2 parts of the osteotomy, capacity for rigid fixation, low incidence of IAN injury) demonstrate that this technique can easily replace the intraoral vertical ramus osteotomy technique to treat mandibular prognathism and is a viable alternative to the sagittal split osteotomy technique to provide mandibular setback.     

Nasal tip surgery: a 30-year experience

An algorithm for an endonasal approach to most aesthetic problems of the nasal tip is presented.Endonasal surgery in this manner has been successful in the management of many thousands of cases through the years and effective for most variations of tip anatomy and appearance. Every attempt is made to maintain the pleasing, natural, and individual aesthetic elements of the tip while eliminating the offending features through minimally invasive techniques.     

Exomphalos and gastroschisis: a 10-year review.

Ninety-six cases of exomphalos or gastroschisis managed at The children's Hospital, Sheffield, during the period 1964-74 are analysed. There were 306 cases with minor lesions, 30 with major lesions, 27 with a ruptured exomphalos and only 3 with gastroschisis. The overall mortality rate was 46-9 percent. Survival could be closely correlated with the birth weight, the nature of the primary lesion, the presence or absence of liver within the sac and the presence and severity of associated congenital anomalies. A "scoring system" based on these criteria is proposed to predict the prognosis of an infant with an exomphalos.     

Liver trauma: a 10-year experience.

The management of 73 patients with liver trauma (58 male, 15 female; mean age 30 (range 6-68) years) presenting from January 1980 to August 1990 is reviewed. There were 29 cases of penetrating injury and 44 of blunt trauma. Seven patients were successfully managed without operation (five with blunt injury) and were discharged after a mean hospital stay of 8 days. Fifty-one cases were classified as simple injuries (grade I or II) and were managed by suture (with or without drainage) or required no intervention, with three deaths. Fifteen cases were classified as complex injuries (grade III or IV) and underwent one or more of the following: perihepatic packing, resectional debridement, hemihepatectomy and hepatotomy with direct suture ligation. Six of these patients died from uncontrolled haemorrhage. The continued use of suture for simple injuries and of resectional debridement and/or packing for complex injuries is supported. Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies.     

Neutropenic enteropathy: a 10-year review.

PURPOSE: With the advent of more aggressive chemotherapy, the incidence of neutropenic enteropathy is increasing. This review was performed to (1) determine which children are affected, (2) identify predisposing factors, and (3) assess efficacy of treatment. METHODS: A 10-year (1988 to 1997) review identified 33 children who had 38 episodes of neutropenic enteropathy. Each presented with fever, abdominal pain, and chemotherapy-induced neutropenia. All were treated with fluid resuscitation, bowel rest, and broad-spectrum antibiotics. Surgical intervention was reserved for children with bowel perforation. Results: Neutropenic enteropathy occurred in 24 children with hematologic malignancies and nine with solid tumors. This disease developed in three children after bone marrow transplantation for leukemia. All five patients in whom recurrent episodes developed were receiving chemotherapy for Burkitt's lymphoma. Cytosine arabinoside and VP16 were the most commonly implicated chemotherapeutic agents. Four children required laparotomy and right hemicolectomy, and all survived. Overall survival was 94%. CONCLUSIONS: Although previously described in children receiving chemotherapy for hematologic malignancies, neutropenic enteropathy also occurs in children who have solid tumors and after bone marrow transplantation. The use of cytosine arabinoside and VP16 may predispose patients to this disease. Children receiving chemotherapy for Burkitt's lymphoma are at increased risk for recurrent episodes. Excellent survival rate was attained with supportive care being used as the primary treatment modality.     

Endoscopic correction of vesicoureteric reflux: 10-year experience of a tertiary care center

Endoscopic treatment (ET) of vesicoureteric reflux (VUR) is becoming the new gold standard for surgical correction. ET for VUR using newly available bulking agents is a reliable and safe alternative procedure to open ureteral reimplantation for the treatment of VUR in children. We retrospectively reviewed our experience over 10 years of patients with primary VUR who underwent ET and had at least one year of follow-up at our center from 1998 to 2008. We looked at laterality, success rate, need for a second procedure and complication rate. We observed 321 patients with ET for VUR during this period; 115 (35.8%) of them were males and the total intervened ureters were 480. Correction of VUR was defined as either the resolution of reflux or a downgrading to grade 1 revealed with a follow-up voiding cystourethrogram and no ipsilateral renal or ureteric dilatation detected on renal ultrasound. At two to three months of follow-up, VUR was corrected in 393/480 (81.8%) refluxing ureters after a single endoscopic injection. With a second, repeated injection in the failed cases, VUR was corrected in a total of 418 (87.1%) refluxing ureters. Only three patients had post-operative complications (<1%). We conclude that our study suggests that the majority of patients will be cured after undergoing, as out-patients, this endoscopic procedure. We believe that the widely reported safety of bulking agents and the short learning curve will make ET the standard treatment for VUR once surgical correction is warranted.     

Primary carcinoma of the gallbladder: a 10-year experience.

New developments in the management of gallstone disease, and particularly percutaneous and extracorporeal treatments that leave the mucosa intact, have renewed interest in the relationship between cholelithiasis and carcinoma. These treatments are both available in our hospital and to examine this question we studied the patients presenting between 1980 and 1990 with gallbladder cancer. The study comprised 21 patients with histologically proven carcinoma. The M:F ratio was 1:4 with a mean age of 76 years. Gallstones were present in 18 patients (85.7%). Ten patients remain alive today and in the 11 who died the median survival was 4 months. A preoperative diagnosis was made by ultrasound in only two patients. The lack of a preoperative diagnosis in the majority of patients is clearly a cause for concern and while our figures, like other series, do not establish a causal relationship with gallbladder carcinoma, it is vital to be diligent in the follow-up of high-risk patients (stones greater than 3 cm) with intact gallbladder mucosa after the treatment of stone disease.     

A comparison of gout in men and women. A 10-year experience

The clinical features of gout in men and women are compared in a retrospective study of hospital patients and outpatients attending an arthritis clinic. Men had a readily recognized pattern of disease in terms of age of onset, duration of disease, and tophaceous gout. Recurrent mono-arthritis of the big toe metatarsophalangeal joint culminating in tophaceous polyarticular gout after many years was a stereotyped pattern. In women, polyarticular/tophaceous disease was often the first manifestation of gout, and a preceding recurrent mono-arthritis was found in joints other than the big toe. The duration of disease before tophi appeared was shorter. The use of diuretics was commonplace, and associated disease such as hypertension or chronic renal failure is frequent in women.     

Sorin Bicarbon bileaflet valve: a 10-year experience.

OBJECTIVE: To present a large 10 year experience of a collaborative evaluation of the Sorin Bicarbon (SB) mechanical prosthesis carried out in 14 centers in eight Western European countries. METHODS: Between 4/90 and 12/96, 2078 SB valves were implanted in 1875 patients aged 4-84 years (mean 58), 1108 males and 767 females. The valves inserted were 1026 aortic valve replacement (AVR), 656 mitral valve replacement (MVR) and 203 double valve replacement (DVR), additional procedures performed in 467 patients (282 coronary artery bypass grafting). RESULTS: Early mortality was 97 (5%), overall survival at 8 years was 71.8% AVR, 69.4% MVR, 81.4% DVR. Total late valve-related deaths were 55; overall freedom from valve-related death at 8 years was 95%. New York Heart Association (NYHA) status after surgery: 78% improved and 17% unchanged. Twenty-two valve thrombosis were observed, one fatal; overall freedom from thrombosis at 8 years was 98.5%. Embolism occurred in 95 patients, 77 cerebral events (16 deaths), overall freedom from embolism was 90.7% at 8 years. Six hemolytic events and 26 non-structural dysfunction (all periprosthetic leaks) were reported. Major bleeding occurred in 66, with mortality rate of 32% mainly when intracerebral. Overall freedom from bleeding was 90.8% at 8 years. Endocarditis occurred in 31 patients, 29% were fatal; overall freedom from endocarditis was 97.8% at 8 years. Reoperation was performed in 49 cases--periprosthetic leak 20, infective endocarditis 14, thrombosed valve 13 (and non-valve related-2). Mortality (early and late) occurred in three reoperated patients. CONCLUSIONS: This is a durable and effective mechanical valve substitute with low morbidity and mortality and good functional results.     

凸侧共平面矫形技术与凹侧平移技术对特发性胸椎侧凸的矫形效果比较

目的 :比较凸侧共平面(Coplanar)矫形技术与传统凹侧平移技术治疗特发性脊柱侧凸(idiopathic scol-iosis,IS)胸弯患者的远期随访结果,评估凸侧Coplanar矫形技术在IS胸弯患者矫形中的临床疗效。方法:2008年6月～2012年9月分别应用凸侧Coplanar技术(Coplanar组)和凹侧平移技术(传统组)行后路矫形术治疗IS胸弯患者94例。Coplanar组47例,其中女42例,男5例,年龄17.9±6.5岁,术前主弯Cobb角72.8°±14.8°,Risser征3.7±1.5,随访时间82.0±5.9个月。传统技术组47例,其中女43例,男4例,年龄16.1±5.7岁,术前主弯Cobb角75.4°±15.4°,Risser征3.5±1.3,随访时间76.0±7.2个月。记录两患者初诊、术后及末次随访时的主弯Cobb角、胸椎后凸角(TK),术前和术后时的椎体旋转角(RAsac)、顶椎区椎体胸廓比(AVB-R)、剃刀背(RH),以及手术时间、出血量和术后并发症等,并进行统计学分析。结果:两组患者的年龄、初始主弯Cobb角、Risser征、随访时间等均相匹配。两组手术时间、术中出血和术后并发症等均无显著性差异(P0.05)。Coplanar组术后主弯Cobb角20.7°±8.9°,矫正率为71.6%,末次随访矫正丢失率为6.6%;传统组术后主弯Cobb角为22.3°±7.8°,矫正率为70.4%,末次随访时矫正丢失率为5.2%,两组矫正率和矫正丢失率均无显著性差异(P0.05)。Coplanar组术前RAsac、AVB-R、RH分别为33.6°±15.6°、1.8±0.5、43.0±15.8mm,术后分别为14.2°±16.2°、1.2±10.3、15.2±16.8mm;传统组术前分别为28.4°±14.9°、1.7±0.4、39±14.6mm,术后分别为17.3°±6.9°、1.1±0.4、18.3±7.2mm;两组术后RAsac和RH有显著性差异(P0.05)。Coplanar组术前、术后和末次随访时的TK分别15.8°±12.4°、27.4°±11.4°和25.8°±12.5°;传统组分别为17.8°±13.4°、20.2°±11.6°和9.3°±12.1°,两组术后和末次随访时均存在显著性差异(P0.05)。结论:与传统凹侧平移技术相比,应用凸侧Colpanar矫形技术治疗IS主胸弯患者可获得与其相似的冠状面矫形,并能更好地去旋转和更好地重建矢状面平衡,长期随访结果满意。     

Combined Rastelli and atrial switch procedure: a 10-year follow-up.

We performed a combined atrial (Mustard) and ventricular (Rastelli) repair on a previously palliated patient with situs inversus, atrioventricular discordance, ventricular septal defect, and pulmonary atresia. The suitability and durability of this operative strategy is supported by the satisfactory hemodynamic and functional status of the patient 10 years later.     

Alveolar proteinosis: diagnosis and treatment over a 10-year period.

Ten years' experience of using bronchoalveolar lavage in the treatment of 10 patients with alveolar proteinosis is reported. The diagnosis was often missed. The interval between onset of symptoms and diagnosis varied from six weeks to six years (median 2 years), so that the start of treatment was often delayed. Some patients experienced severe progressive disability before they had treatment. Whole-lung lavage proved to be a safe, repeatable procedure which provided symptomatic, physiological, and radiological improvement and allowed all 10 patients treated to return to full-time employment.     

Vascular access surgery: a 2-year study and comparison with the Permcath.

The results of a 2-year prospective study of primary and secondary vascular access surgery for haemodialysis have been compared with a retrospective study of central venous access via a flexible silicone catheter (Permcath). Cumulative patency for 61 primary fistulae in 57 patients was 64.8% at 1 year and 57.7% at 2 years. The patency of 55 secondary procedures in 43 patients was 48.1% at 1 and 2 years. Cumulative survival of 64 Permcaths inserted into 51 patients was 74% at 1 year and 43% at 2 years. Surgical complications included explorations for bleeding (2), haematomas (4), swollen arms (4), and inadequately dilated veins (4). Permcath complications included explorations for bleeding (3) and a temporary recurrent laryngeal nerve palsy (1). Exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively, but 20.6% of septicaemic episodes occurred in a patient who refused catheter removal. For haemodialysis, the Permcath is comparable with secondary vascular access. The Permcath may have a primary access role in patients with limited life expectancy.     

Near-hanging injuries: a 10-year experience

OBJECTIVE: To review the injury patterns and analyse outcomes in patients who present after near-hanging. METHODS: This is a trauma registry study that included all patients who were admitted to an academic Level I trauma centre with the diagnosis of attempted suicide by hanging between January 1993 and December 2003. All patients who were dead on arrival or in cardiopulmonary arrest were excluded. Data regarding demographics, injuries, and outcomes were examined. Independent risk factors for poor outcome were identified. RESULTS: During the 10-year study period, 63 patients were admitted after near-hanging. A total of 12 patients (19%) had 17 injuries. Cervical spine fractures occurred in nearly 5% of cases. Four factors were found to be significantly associated with poor outcome: systolic blood pressure <90, Glasgow coma score < or =8, anoxic brain injury on computed tomography (CT) scan, and injury severity score >15. However, logistic regression analysis found only anoxia on CT scan to be independently associated with poor outcome (p < 0.01). CONCLUSION: Injuries commonly occurred after near-hanging. Liberal screening using CT scans is warranted. The prognosis is favorable, even with patients who arrive with a GCS < or =8. Overall survival was 90% and only 3.5% were discharged with severe or permanent disability.     

Chronic bronchitis: a 10-year follow-up

A 10-year follow-up of 327 civil servants with bronchitis (301 men and 26 women) is presented. A further 14 were lost sight of during the period, so that the follow-up was 96% complete. More than one half (54%) of the men died during the 10-year period, some 57% of the deaths being attributed to respiratory causes and a further 8% to carcinoma of the bronchus. Mortality from these diseases was higher than among the general population, but other causes of death showed the normal pattern. The degree of dyspnoea noted at the first interview gave a useful estimate of prognosis, the mild, moderate, and severe groups showing progressively higher death rates. Neither the length of history nor the age at onset of symptoms could be related to mortality. The proportion of smokers among the patients was greater than expected in the general population, and although this may have been a factor contributing to the excess mortality of the group as a whole, it was not possible to determine any effect of smoking within this study.