Pleurobiliary fistula, a rare complication of hepatocellular carcinoma after locoregional chemotherapy: a case report

A rare complication of the compilation of high intrahepatic biliary pressure and the formation of a subdiaphragmatic abscess is that of pleurobiliary fistula. We present a case of 67-year-old male who presented with pleurobiliary fistula following transarterial chemoembolization in a patient with a large hepatocellular carcinoma, as well as the course of the diagnostic procedures and the therapeutics interventions which took place

Primary hepatic carcinoid; a diagnostic dilemma: a case report

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Obstructive Jaundice in Polycystic Liver Disease Related to Coexisting Cholangiocarcinoma

Although jaundice rarely complicates polycystic liver disease (PLD), secondary benign or malignant causes cannot be excluded. In a 72-year-old female who presented with increased abdominal girth, dyspnea, weight loss and jaundice, ultrasound and computed tomography confirmed the diagnosis of PLD by demonstrating large liver cysts causing extrahepatic bile duct compression. Percutaneous cyst aspiration failed to relief jaundice due to distal bile duct cholangiocarcinoma, suspected by magnetic resonance cholangiopancreatography (MRCP) and confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Coexistence of PLD with distal common bile duct cholangiocarcinoma has not been reported so far

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Selection of hypertensive patients for treatment: Experience from the use of the first medicament

Clinical and epidemiological observations made over the past 25 years provide compelling evidence for the heterogeneity of essential hypertension; the individualization of treatment based on special features is imperative. In order to correlate the response in every one of the antihypertensive drugs with the different characteristics - demographic and clinical - of the hypertensive group, we studied 700 patients in the Hypertensive Clinic of "Laiko" Hospital of Athens. The sample was divided into two subgroups regulated and unregulated patients. In each subgroup, the average value of age, body weight, diastolic and systolic blood pressures, as well as heart rate before treatment with every one of the most common antihypertensive drugs was calculated. Results: β-blockers are effective in 50% of hypertensives and their effectiveness is influenced by the level of diastolic blood pressure, the heart rate and sex. Diuretics are more effective in older women (rate 45,7%) and their effectiveness is diminished with the increased levels of diastolic blood pressure before treatment. The effectiveness of calcium channel antagonists and the converting enzyme inhibitors depends on sex and level of diastolic blood pressure. The response in the combination treatment with β-blockers and diuretics is better in the hypertensive group with low body weight. Finally, β-blockers are more effective than diuretics (50% versus 43,24%) and the combination treatment dominates to monotherapy in every stage of hypertension.Κλινικές και επιδημιολογικές μελέτες τα τελευταία 25 χρόνια παρέχουν σημαντικές ενδείξεις για την ετερογένεια της ιδιοπαθούς υπέρτασης. Αυτό κάνει επιτακτική την εξατομίκευση της θεραπευτικής αγωγής με βάση τα ιδιαίτερα χαρακτηριστικά των υπερτασικών. Με σκοπό να συσχετισθεί η ανταπόκριση σε κάθε ομάδα αντιυπερτασικού φαρμάκου με τα ιδιαίτερα χαρακτηριστικά - δημογραφικά και κλινικά - των υπερτασικών ασθενών, μελετήθηκαν 700 υπερτασικοί στο Υπερτασικό Ιατρείο της Α' Προπαιδευτικής Παθολογικής Κλινικής και Ειδικής Νοσολογίας του Λαϊκού Νοσοκομείου Αθηνών. Το δείγμα διαιρέθηκε σε ρυθμισθέντες και μη ρυθμισθέντες και υπολογίστηκε σε κάθε κατηγορία η μέση τιμή της ηλικίας, του σωματικού βάρους, της διαστολικής και συστολικής αρτηριακής πίεσης και της καρδιακής συχνότητας προ της ενάρξεως της θεραπείας με κάθε ένα από τα συχνότερα αντιυπερτασικά φάρμακα. Βρέθηκε ότι: Οι β-αποκλειστές είναι αποτελεσματικοί στο 50% των υπερτασικών και ότι η αποτελεσματικότητα τους επηρεάζεται από το ύψος της διαστολικής πίεσης, την καρδιακή συχνότητα και το φύλο. Τα διουρητικά είναι αποτελεσματικά στις γυναίκες με μεγάλη ηλικία (ποσοστό 45,7%) και η αποτελεσματικότητα τους μειώνεται όσο μεγαλύτερα είναι τα επίπεδα διαστολικής πίεσης πριν την έναρξη της θεραπείας. Η αποτελεσματικότητα των ανταγωνιστών ασβεστίου και των αναστολέων του μετατρεπτικού ενζύμου εξαρτάται από το φύλο και το ύψος της διαστολικής αρτηριακής πίεσης. Ενώ ευκολότερη είναι η ανταπόκριση στο συνδυασμό β-αποκλειστών με διουρητικά στους υπερτασικούς με χαμηλό σωματικό βάρος. Βρέθηκε επίσης ότι οι β-αποκλειστές είναι αποτελεσματικότεροι από τα διουρητικά (50% έναντι 43,24%) και ότι ο συνδυασμός υπερέχει της μονοθεραπείας σε όλους τους βαθμούς της υπέρτασης