IS EMERGENCY CHOLECISTOSTOMY STILL VALID IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS? ANALYSIS OF OUR EXPERIENCE IN A SERIES OF 145 PATIENTS

Abstract INTRODUCTION Laparoscopic cholecystectomy may not be suited in elderly patients with comorbidities. Our objective is to evaluate whether our indication for cholecystostomy is in accordance with the 2018 Tokio Guidelines and to determine the clinical-epidemiological and analytical characteristics as well as the clinical results depending on the treatment (surgical, conservative or cholecystostomy). MATERIAL AND METHODS Retrospective observational study with patients diagnosed with acute cholecystitis between the 25/01/2019 and the 13/03/2020. RESULTS Out of 145 patients, 87 (60%) underwent cholecystectomy (average age 63 years), 47 (32,4%) treated conservatively (74,8) and 11 (7,6%) by cholecystostomy (85,8). The multivariate analysis showed that suffering from cardio and cerebrovascular diseases, CKD, taking anticoagulants and altered levels of creatinine, Quick or CRP, multiplies by 5.2, 6.4, 10.9, 4.6, 1.2 and 1.1 the probability of cholecystostomy versus cholecystectomy (p < 0,005). Both the time of admission and of antibiotic treatment was longer in the cholecystostomy group (15.2 and 11.5 days) compared to conservative (7 and 9) and surgical (5.3 and 5.8) (p = 0,000 and p = 0,011). Only one patient in the cholecystostomy group underwent subsequent surgery compared to 50% in the conservative group. The mortality rate did no differ. Out of 11 cholecystostomies, 6 met the Tokio Guidelines criteria. CONCLUSIONS 1. Patients undergoing cholecystostomy are older, multipathological and present greater systemic involvement (KD, coagulopathy and elevated APR). They require a longer hospital stay and duration of antibiotic treatment. 2. 54,54% of the cholecystostomies performed were adapted to the 2018 Tokio Guidelines. 3. Conservative treatment means higher long-term complication rates.

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Long-Term Outcome of Patients with Acute Cholecystitis Receiving Antibiotic Treatment: A Retrospective Cohort Study

World Journal of Surgery ◽

10.1007/s00268-013-2311-3 ◽

2013 ◽

Vol 38 (2) ◽

pp. 347-354 ◽

Cited By ~ 13

Author(s):

Chih-Hung Wang ◽

Hao-Chang Chou ◽

Kao-Lang Liu ◽

Wan-Ching Lien ◽

Hsiu-Po Wang ◽

...

Keyword(s):

Cohort Study ◽

Acute Cholecystitis ◽

Antibiotic Treatment ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Term Outcome ◽

Long Term Outcome

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Clinical Impact of Intravascular Ultrasound Guidance During Endovascular Treatment of Subclavian Artery Disease

Journal of Endovascular Therapy ◽

10.1177/1526602817722996 ◽

2017 ◽

Vol 24 (5) ◽

pp. 731-738 ◽

Cited By ~ 1

Author(s):

Wen-Jung Chung ◽

Yoshimitsu Soga ◽

Yusuke Tomoi ◽

Masahiko Fujihara ◽

Shinya Okazaki ◽

...

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Intravascular Ultrasound ◽

Subclavian Artery ◽

Primary Patency ◽

Secondary Patency ◽

Complication Rates ◽

All Cause Mortality ◽

Artery Disease

Purpose: To evaluate the short- and long-term efficacy of intravascular ultrasound (IVUS) guidance during endovascular treatment (EVT) of subclavian artery disease. Methods: The multicenter SCALLOP registry (SubClavian Artery disease treated with endovascuLar therapy; muLticenter retrOsPective registry) was interrogated to identify 542 patients who underwent successful EVT for SCAD between January 2003 and December 2012. Lesions were classified according to the use of IVUS guidance: 177 patients (mean age 68.9±8.6 years; 149 men) with and 373 patients (mean age 69.9±8.7 years; 275 men) without. The main outcome was the difference in primary patency; secondary outcomes were differences in assisted primary patency, secondary patency, overall survival, freedom from major adverse cardiovascular events [MACE; all-cause mortality, myocardial infarction (MI), and stroke], and freedom from major adverse events (MAE). Multivariate analysis of the IVUS+ group was performed to identify predictors of failure; results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: In total, 538 (97.8%) lesions were treated with stents and 12 lesions by balloon angioplasty alone. Periprocedural and in-hospital overall complication rates did not differ significantly between IVUS+ (10.2%) and IVUS– (8.8%, p=0.617). Long-term follow-up demonstrated no significant difference between IVUS+ and IVUS– groups in 5-year all-cause mortality (p=0.37), MI (p=0.07), stroke (p=0.31), or MACE (p=0.07). However, 5-year primary patency was significantly higher in the IVUS+ group (88.5% vs 77.7%, p=0.03). There were no group differences in 5-year assisted primary patency (90.4% vs 89.9%, p=0.81) or secondary patency (99.4% vs 97.1%, p=0.25). Multivariate analysis of the IVUS+ group identified in-hospital stroke (HR 16.92, 95% CI 3.60 to 79.42, p<0.01) and combined use of balloon-expandable and self-expanding stents (HR 5.59, 95% CI 1.22 to 25.65, p=0.02) as independent negative predictors of primary patency. Conclusion: These results suggest that IVUS guidance can significantly improve long-term primary patency following endovascular treatment of subclavian artery disease.

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Long-term Outcome of Patients with Acute Cholecystitis Receiving Antibiotic Treatment: A Retrospective Cohort Study

World Journal of Surgery ◽

10.1007/s00268-013-2344-7 ◽

2013 ◽

Vol 38 (2) ◽

pp. 355-356 ◽

Cited By ~ 1

Author(s):

Paul N. Rogers

Keyword(s):

Cohort Study ◽

Acute Cholecystitis ◽

Antibiotic Treatment ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Term Outcome ◽

Long Term Outcome

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Clinical results of lyophilized human cadaver dura transplantation

Journal of Neurosurgery ◽

10.3171/jns.1971.34.6.0770 ◽

1971 ◽

Vol 34 (6) ◽

pp. 770-773 ◽

Cited By ~ 34

Author(s):

William M. Abbott ◽

Emmett L. Dupree

Keyword(s):

Clinical Results ◽

Complication Rates ◽

Human Cadaver ◽

Content Type ◽

Dural Closure ◽

Long Term Storage ◽

Freeze Dried ◽

Neurosurgical Patients ◽

Term Storage

✓ The clinical results of lyophilized human cadaver dura transplantation in 170 neurosurgical patients show that it is a safe and effective material for dural closure. It is associated with low complication rates and minimal cortical scarring and adhesions. The successful results have been attributed to the minimal foreign body reaction stimulated by freeze-dried tissue. These factors plus its capacity for safe and convenient long-term storage at room temperature make lyophilization the method of choice for preserving dura mater.

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Stent-assisted embolization of 100 middle cerebral artery aneurysms

Journal of Neurosurgery ◽

10.3171/2013.1.jns121298 ◽

2013 ◽

Vol 118 (5) ◽

pp. 950-955 ◽

Cited By ~ 25

Author(s):

Andrew K. Johnson ◽

Daniel M. Heiferman ◽

Demetrius K. Lopes

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Clinical Results ◽

Complication Rates ◽

Complete Occlusion ◽

Neurological Morbidity ◽

Middle Cerebral Artery Aneurysms ◽

Vessel Reconstruction

Object The introduction of intracranial stents to aneurysm treatment allows endovascular repair of nearly all aneurysms, but the safety and durability of stent-assisted embolization of middle cerebral artery (MCA) aneurysms is unclear. Methods Ninety-one patients with 100 complex MCA aneurysms not amenable to simple coiling were treated with stent-assisted embolization as a first option. Technical and clinical results, initial follow-up imaging, and long-term annual MR angiography (MRA) were reviewed. Results Intracranial stents were successfully deployed in all 100 aneurysms. There was 1 case of significant neurological morbidity (1%) and 1 case of death (1%) related to treatment. Initial posttreatment angiography revealed complete occlusion of 48 aneurysms (48%), a residual neck in 21 (21%), and residual aneurysm filling in 31 (31%). Follow-up imaging performed in 85 (90.4%) of a possible 94 aneurysms showed complete occlusion of 77 aneurysms (90.6%), residual neck in 3 (3.5%), and residual filling in 5 (5.9%). Four aneurysms (4.7%) required retreatment. Long-term MRA follow-up revealed stability or progressive thrombosis in 47 (97.9%) of 48 aneurysms. In 11 patients Y-configuration stenting caused only 1 minor complication and provided durable occlusion in all cases. Conclusions Stent-assisted techniques increase the number of aneurysms that may be treated endovascularly and represent an acceptable alternative to craniotomy. Stents provided adequate vessel reconstruction, low complication rates, and good long-term occlusion.

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Long-term Functional and Radiographic Outcome of a Mobile Bearing Ankle Prosthesis

Foot & Ankle International ◽

10.1177/1071100716661477 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1292-1302 ◽

Cited By ~ 26

Author(s):

Yvonne R. A. Kerkhoff ◽

Nienke M. Kosse ◽

Wieneke P. Metsaars ◽

Jan Willem K. Louwerens

Keyword(s):

Postoperative Complications ◽

Clinical Outcome ◽

Heterotopic Ossification ◽

Clinical Results ◽

Long Term Results ◽

Complication Rates ◽

Failure Rates ◽

Ankle Arthroplasty

Background: Total ankle arthroplasty is an accepted alternative to arthrodesis of the ankle. However, complication and failure rates remain high. Long-term results of the Scandinavian Total Ankle Replacement (STAR) are limited, with variable complication and failure rates observed. This prospective study presents the long-term survivorship and postoperative complications of the STAR prosthesis. Methods: Between May 1999 and June 2008, 134 primary total ankle arthroplasties were performed using the STAR prosthesis in 124 patients. The survivorship, postoperative complications, and reoperations were recorded, with a minimum follow-up period of 7.5 years. Clinical results were assessed using the Foot Function Index and the Kofoed score. The presence of component migration, cysts, and radiolucency surrounding the prosthesis components, heterotopic ossification, and progression of osteoarthritis in adjacent joints were determined. Results: The cumulative survival was 78% after the 10-year follow-up period. An ankle arthrodesis was performed in 20 ankles (14.9%) that failed. Fourteen polyethylene insert fractures occurred (10.4%). Other complications occurred in 29 ankles (21.6%), requiring secondary procedures in 21 ankles (15.7%). Nevertheless, the postoperative clinical results improved significantly. Osteolytic cysts were observed in 61 ankles (59.8%) and the surface area of these cysts increased during follow-up, without any association with the prosthesis alignment or clinical outcome. Heterotopic ossification at the medial malleolus was present in 58 cases (56.8%) and at the posterior tibia in 73 cases (71.6%), with no effect on clinical outcome. Osteoarthritis of the subtalar and talonavicular joint developed in 9 (8.8%) and 11 cases (10.8%), respectively. Conclusion: The long-term clinical outcomes for the STAR were found to be satisfactory. Although these results are consistent with previous studies, the survival and complication rates are disappointing compared to knee and hip arthroplasty. Higher rates of successful outcomes following ankle arthroplasty are important, and these results highlight the need for further research to clarify the origin and significance of the reported complications. Level of Evidence: Level II, prospective comparative study.

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Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽

10.1024/0301-1526.31.1.36 ◽

2002 ◽

Vol 31 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

. Bucek ◽

Hudak ◽

Schnürer ◽

Ahmadi ◽

Wolfram ◽

...

Keyword(s):

Success Rate ◽

Clinical Stage ◽

Ankle Brachial Index ◽

Clinical Situation ◽

Clinical Results ◽

Transluminal Angioplasty ◽

Term Outcome ◽

Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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