Can percutaneous cholecystostomy be a definitive treatment in the elderly?

Aim: The aim of the present study was to discuss our experience with percutaneous cholecystostomy (PC), analysing the outcomes and investigating the clinical factors, which might predict the future need for surgery. Patients and Methods: Forty-two patients with acute calculous cholecystitis underwent PC over a 122-month period at a single institution. Patients' demographics, clinical features and management were retrospectively analysed. Results: There were 20 females (47.6 per cent) and 22 males (52.4 per cent), with a median age of 83 years (interquartile range: 75\u201387 years). The American Society of Anesthesiologists (ASA) score was III for 7 patients and IV for 35 patients. Thirty-one patients (71.4 per cent) had moderate cholecystitis, and 11 (26.2 per cent) had severe cholecystitis. During the index admission, six patients (14.2 per cent) required endoscopic retrograde cholangiopancreatography (ERCP), cholecystectomy was performed in three (7.2 per cent) and four patients (9.5 per cent) died due to septic shock. Nine patients were readmitted for recurrent biliary symptoms, and six of them underwent cholecystectomy. All patients who underwent cholecystostomy and ERCP did not have any recurrence and/or cholecystectomy. The Charlson Comorbidity Index score was significantly higher in patients who did not have subsequent surgery (9 vs 7, P = 0.02). Conclusions: PC can be a valuable treatment option for high-risk patients, and a definitive treatment for the elderly with high CCI. Patients who have undergone PC and ERCP might have a lower probability to develop recurrent biliary symptoms than those who have undergone PC alone. \ua9 2016 College of Surgeons of Hong Kon

Emulsion sheet doublets as interface trackers for the OPERA experiment

New methods for efficient and unambiguous interconnection between electronic position sensitive detectors and target units based on nuclear photographic emulsion films have been developed. The application to the OPERA experiment,that aims at detecting Vμ⇋Vτoscillations in the CNGS neutrino beam,is reported in this paper. In order to reduce background due to latent tracks collected before installation in the detector,on-site large-scale treatments of the emulsions (“refreshing”) have been applied. Changeable Sheet (CSd) packages,each made of a doublet of emulsion films,have been designed,assembled and coupled to the OPERA target units (“ECC bricks”). A device has been built to print X-ray spots for accurate interconnection both within the CSd and between the CSd and the related ECC brick. Sample emulsion films have been extensively scanned with state-of-the-art automated optical microscopes. Efficient track-matching and powerful background rejection have been achieved in tests with electronically tagged penetrating muons. Further improvement of in-doublet film alignment was obtained by matching the pattern of low-energy electron tracks. The commissioning of the overall OPERA alignment procedure is in progress