Perkutaninė cholecistostomija – alternatyva, gydant sunkiomis gretutinėmis ligomis sergančius ligonius, kuriems diagnozuotas ūminis cholecistitas

Background / objective. Laparoscopic cholecystectomy is a safe procedure and the treatment of choice for acute cholecystitis. As an alternative treatment option in critically ill patients percutaneous cholecystostomy (PC) is performed.Methods. Retrospective review of patients who had undergone PC from 2008 to 2017 at the Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were reviewed for demographic features, laboratory tests, ASA class, complications, outcomes, hospital stay and mortality rate.Results. Fifty-four patients were included in the study. Forty patients (74%) were ASA III and ten patients (18.5%) – ASA IV. Statistically signi­ficant decrease in white blood cell count (from 14.26±6.61 to 8.65±5.15) and C-reactive protein level (from 226.22±106.60 to 51.91±63.70) following PC was observed. The median hospital stay was 13.06 (range 2–68) days and 30-day mortality rate 13%. There were no deaths directly related to procedure. For eleven patients (20.4%) delayed cholecystectomy was scheduled.Conclusions. PC is a reasonable treatment option for high-risk patients with acute cholecystitis and co-morbidities. It can be used as a temporizing treatment option or as a definitive treatment with a low number of delayed cholecystectomies. Įvadas / tikslas. Laparoskopinė cholecistektomija yra saugi operacija ir pirmo pasirinkimo gydymo metodas, gydant sergančiuosius ūminiu cholecistitu. Sunkiomis gretutinėmis ligomis sergančius pacientus, kuriems diagnozuojamas ūminis cholecistitas, galima gydyti suformuojant perkutaninę cholecistostomą.Metodai. Atliktas retrospektyvinis tyrimas, į kurį įtraukti pacientai, 2008–2017 m. gydyti Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų Chirurgijos klinikoje. Tiriamiesiems buvo suformuota perkutaninė cholecistostoma. Tirti ir vertinti pacientų demografiniai duomenys, laboratoriniai rodikliai, analizuota ASA klasė, komplikacijos, išeitys, gydymo trukmė ir mirštamumas.Rezultatai. Tyrime dalyvavo 55 pacientai. 47 pacientai (74 %) atitiko ASA III klasę, 10 pacientų (18,5 %) – ASA IV klasę. Suformavus perkutaninę cholecistostomą, pastebėtas statistiškai reikšmingas leukocitų skaičiaus (nuo 14,26±6,61 iki 8,65±5,15) ir C reaktyvinio baltymo koncentracijos (nuo 226,22±106,60 iki 51,91±63,70) sumažėjimas. Vidutinė gydymo trukmė – 13,06 (intervalas 2–68) dienų. Ankstyvas mirštamumas (30 dienų) siekė 13 proc. Mirčių, tiesiogiai susijusių su atlikta procedūra, nefiksuota. 11 pacientų (20,4 %) taikyta planinė cholecistektomija.Išvados. Perkutaninė cholecistostomija yra tinkama alternatyva didelės rizikos pacientams, kuriems diagnozuotas ūminis cholecistitas, gydyti. Šis gydymo metodas gali būti taikomas tiek kaip tarpinis, tiek kaip galutinis gydymo metodas

Management of major agricultural trauma in teenage boy: Case report

We describe a case report of a teenage boy who fell into the straw pellets machine. Despite the major agricultural injuries to all his body and internal organs, the patient lives a good quality life. Even though it is a success story, high agricultural injury related mortality and morbidity rates persist in children. Mostly it is high energy and unclean injuries demanding initial fast assessment and challenging management. For the best possible outcome, it is important to follow the advanced trauma life support (ATLS) guidelines and do not understate the importance of early rehabilitation

Volume, but Not the Location of Necrosis, Is Associated with Worse Outcomes in Acute Pancreatitis: A Prospective Study

Background and Objectives: The course and clinical outcomes of acute pancreatitis (AP) are highly variable. Up to 20% of patients develop pancreatic necrosis. Extent and location of it might affect the clinical course and management. The aim was to determine the clinical relevance of the extent and location of pancreatic necrosis in patients with AP. Materials and Methods: A cohort of patients with necrotizing AP was collected from 2012 to 2018 at the Hospital of Lithuanian University of Health Sciences. Patients were allocated to subgroups according to the location (entire pancreas, left and right sides of pancreas) and extent (50%) of pancreatic necrosis. Patients were reviewed for demographic features, number of performed surgical interventions, local and systemic complications, hospital stay and mortality rate. All contrast enhanced computed tomography (CECT) scans were evaluated by at least two experienced abdominal radiologists. All patients were treated according to the standard treatment protocol based on current international guidelines. Results: The study included 83 patients (75.9% males (n = 63)) with a mean age of 53 ± 1.7. The volume of pancreatic necrosis exceeded 50% in half of the patients (n = 42, 51%). Positive blood culture (n = 14 (87.5%)), multiple organ dysfunction syndrome (n = 17 (73.9%)) and incidences of respiratory failure (n = 19 (73.1%)) were significantly more often diagnosed in patients with pancreatic necrosis exceeding 50% (p 50% of necrosis were significantly (p n = 24 (41.4%)) and severe (n = 18 (72%)) AP. The number of surgical interventions (n = 18 (72%)) and ultrasound-guided interventions (n = 26 (65%)) was also significantly higher. In patients with whole-pancreas necrosis, incidence of renal insufficiency (n = 11 (64.7%)) and infected pancreatic necrosis (n = 19 (57.6%)) was significantly higher (p Conclusions: The clinical course and outcome were worse in the case of pancreatic necrosis exceeding 50%, rendering the need for longer and more complex treatment

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population