scholarly journals Successful Non-surgical Treatment of an Acute Calculous Cholecystitis in a Myeloma Patient with Covid-19: Case Report

2021 ◽  
Vol 3 (2) ◽  
pp. 666-669
Author(s):  
Andy Sing Ong Tang ◽  
Tze Shin Leong ◽  
Lee Ping Chew ◽  
Hock Hin Chua
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Myeloma Patient ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

Mortality Risk Estimation in Acute Calculous Cholecystitis: Beyond the Tokyo Guidelines

2021 ◽  
Author(s):  
Ana-María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background: Acute Calculous Cholecystitis (ACC) is the second most frequent surgical condition in Emergency Departments. The recommended treatment is the Early Laparoscopic Cholecystectomy, however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patients for surgical treatment. The objective of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification.Methods: retrospective unicentric cohort study of patients emergently admitted with and ACC during January 1, 2011 to December 31, 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confunding factors comparing surgical treatment and non-surgical treatment.Results: the overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66:95%CI: 1.7-12.8 P=0.001), dementia (OR 4.12;95%CI: 1.34-12.7 P=0.001), age > 80 years (OR 1.12:95% CI: 1.02-1.21 P=0.001) and the need of preoperative vasoactive amines (OR 9.9:95%CI: 3.5-28.3 P=0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P=0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%).Conclusions: mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME could allow us to create a new alternative guideline to TG for treating ACC.Trial Registration: retrospectively registered and recorded in Clinical Trials (NTC 0474441).

scholarly journals Non-surgical Treatment of Condylar Fracture in an 11-Year-Old Patient: a Case Report

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Angela Pia Cazzolla ◽  
Graziano Montaruli ◽  
Nunzio Francesco Testa ◽  
Gianfranco Favia ◽  
Maria Grazia Lacaita ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Condylar Fracture ◽  
Non Surgical Treatment

Severe Necrotizing Periodontitis in HIV‐Infected Patient: Case Report and Non‐Surgical Treatment

2020 ◽  
Author(s):  
Ricardo R. S. Fonseca ◽  
Carlos A. Carvalho ◽  
Tânia M. S. Rodrigues ◽  
Rosely M. S. Cavaleiro ◽  
Silvio A. F. Menezes ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Infected Patient ◽  
Patient Case ◽  
Non Surgical Treatment

Surgical treatment of acute calculous cholecystitis followed by one-day discharge of patients

2019 ◽  
pp. 32
Author(s):  
F. S. Kurbanov ◽  
M. A. Chinikov ◽  
Yu. G. Aliev ◽  
R. Kh. Azimov ◽  
L. R. Alvendova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

THE PRINCIPLES OF DIAGNOSIS AND SURGICAL TREATMENT OF COMPLICATED FORMS OF GALLSTONE DISEASE

Vestnik ◽  
2021 ◽  
pp. 391-394
Author(s):  
В.М. Мадьяров ◽  
М.М. Сахипов ◽  
Г.Р. Жапаркулова
Keyword(s):  
Surgical Treatment ◽  
Gallstone Disease ◽  
Pathological Process ◽  
Abdominal Complications ◽  
Acute Calculous Cholecystitis ◽  
Results Of Treatment ◽  
Calculous Cholecystitis

Проанализированы за последние три года результаты оперативного лечения 200 больных с осложненными формами желчнокаменной болезни. Доказано, что риск возникновения гнойно-деструктивных форм острого калькулезного холецистита зависит от характера патологического процесса в желчном пузыре. По поводу гнойно-деструктивных форм заболевания при острого калькулезного холецистита оперировано 79,7% больных и 38,9% при необструктивной форме холецистита. Риск интраабдоминальных осложнений зависит от наличия обструкции, выявленное у 18,1% больных с обтурационнной и 5,6% у пациентов с необтурационнной формой. Госпитализация при гнойно-деструктивных формах 63,5% пациентов в первые 2 часа и 85,7% в первые 6 часов от момента заболевания, дает возможность своевременно оперировать больных до развития его интраабдоминальных осложнений. The results of treatment of 200 patients with complicated forms of gallstone disease were analyzed. It is proved that the risk of purulent-destructive forms of acute calculous cholecystitis depends on the nature of the pathological process in the gallbladder. For purulent-destructive forms of the disease in acute calculous cholecystitis, 79.7% of patients and 38.9% of patients with non-obstructive form of cholecystitis were operated on. The risk of intra-abdominal complications depends on the presence of obstruction, identified in 18.1% of patients with obstructive and 5.6% in patients with non-obstructive form. Hospitalization with purulent-destructive forms of 63.5% of patients in the first 2 hours and 85.7% in the first 6 hours from the time of the disease makes it possible to timely operate patients before the development of its intra-abdominal complications.

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