Percutaneous cholecystostomy for acute cholecystitis: ten-year experience

PURPOSE

To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome.

MATERIALS AND METHODS

A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed.

RESULTS

Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001).

CONCLUSIONS

Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.

Eutrophication induced changes in benthic community structure of a flow-restricted tropical estuary (Cochin backwaters), India

The influence of anthropogenic loading on the distribution of soft bottom benthic organisms of a tropical estuary (Cochin backwaters) was examined. The industrial activities were found to be high in the northern and central part of the estuary, where dissolved inorganic nitrogen (DIN > 210 μM) and phosphorus (DIP > 6.5 μM) have caused high abundance of chlorophyll a (up to 73 mg m(-3)) and accumulation of organic carbon in sediments (up to 5%). Principal component analysis distinguished three zones in the estuary. The central zone (Z1) was characterized by organic enrichment, low species diversity, and increased number of pollution tolerant species. Long-term deterioration of the estuary is indicated by an increase in the nutrients and chlorophyll a levels by sixfold during the last few decades. Flow restrictions in the lower estuary have lead to a fourfold increase in sediment organic carbon over the period of three decades. The reduced benthic diversity followed by an invasion of opportunistic polychaetes (Capitella capitata), are indicative of a stress in the estuary.

Short-term variability of water quality and its implications on phytoplankton production in a tropical estuary (Cochin backwaters-India)

Changes in the phytoplankton biomass (chlorophyll a), production rate, and species composition were studied over two seasons using the time series measurements in the northern limb of the Cochin estuary in relation to the prevailing hydrological conditions. The present study showed the significant seasonal variation in water temperature (F=69.4, P<0.01), salinity (F=341.93, P<0.01), dissolved inorganic phosphorous (F=17.71, P<0.01), and silica (F=898.1, P<0.01) compared to nitrogen (F=1.646, P>0.05). The uneven input of ammonia (3.4-224.8 μM) from upstream (Periyar River) leads to the inconsistency in the N/P ratio (range 6.8-262). A distinct seasonality was observed in Si/N (F=382.9, P<0.01) and Si/P (F=290.3, P<0.01) ratios compared to the N/P ratio (F=1.646, P>0.05). The substantial increase in chlorophyll a (average, 34.8±10 mg m(-3)) and primary production (average, 1,304±694 mg C m(-3) day(-1)) indicated the mesotrophic condition of the study area during the premonsoon (PRM) and it was attributed to the large increase in the population of nanoplankton (size<20 μ) such as Skeletonema costatum, Thalassiosira subtilis, Nitzschia closterium, and Navicula directa. In contrast, during the post monsoon (PM), low chlorophyll a concentration (average, 9.3±9.2 mg m(-3)) and primary production (average, 124±219 mg C m(-3) day(-1)) showed heterotrophic condition. It can be stated that favorable environmental conditions (optimum nutrients and light intensity) prevailing during the PRM have enhanced the abundance of the nanoplankton community in the estuary, whereas during the PM, the light limitation due to high turbidity can reduce the nanoplankton growth and abundance, even though high nutrient level exists.

Does postoperative delirium limit the use of patient-controlled analgesia in older surgical patients?

BACKGROUNDPostoperative pain Is an independent predictor of postoperative delirium. Whether postoperative delirium limits patient-controlled analgesia (PCA) use has not been determined.

METHODS

The authors conducted a nested cohort study in older patients undergoing noncardiac surgery and used PCA for postoperative analgesia. Delirium was measured by using the Confusion Assessment Method. The authors computed a structural equation model to determine the effects of pain and opioid consumption on delirium status and the effect of delirium on opioid use.

RESULTS

Of 335 patients, 108 (32.2%) developed delirium on postoperative day (POD) 1, and 120 (35.8%) on POD 2. Postoperative delirium did not limit the use of PCA. Patients with postoperative delirium used more PCA in a 24-h period (POD 2) compared to those without delirium (mean dose of hydromorphone +/- SE adjusted for covariates was 2.24 +/- 0.71 mg vs. 1.25 +/- 0.67 mg, P = 0.02). Despite more opioid use, patients with delirium reported higher Visual Analogue Scale scores than those without delirium (POD 1: mean visual analog scale +/- SE at rest 4.2 +/- 0.23 vs. 3.3 +/- 0.22, P = 0.0051; POD 2: 3.3 +/- 0.23 vs. 2.5 +/- 0.19, P = 0.004). Path coefficients from structural equation model revealed that pain and opioid use affect delirium status, but delirium does not affect subsequent opioid dose.

CONCLUSIONS

Postoperative delirium did not limit PCA use. Despite more opioid use, visual analog scale scores were higher in patients with delirium. Future studies on delirium should consider the role of pain and pain management as potential etiologic factors.

Synthesis and magnetic studies of Co-Ni-Zn ferrite nano crystals

This paper reports the investigation on synthesis and magnetic characterization of Ni substituted Co0.8Zn0.2Fe2O4 nano-particles. The nano-particles of Co(0.8-x)Ni(x)Zn(0.2)Fe2)O4 (x = 0.15, 0.20, 0.35, 0.50, 0.65) were prepared by co-precipitation method. The X-ray diffraction analysis confirmed the formation of single-phase face centered cubic (fcc) spinal structure. The lattice parameter decreased as Ni concentration increased from x = 0 (a = 8.388 A) to x = 0.65 (a = 8.3612 A). The morphology of the particles examined through high-resolution TEM showed a well-isolated and less agglomerated homogeneous distribution of nano-particles which suggests that co-precipitation method is beneficial for magnetic nano-materials synthesis and their characterization. The influence of Ni on magnetic behavior (saturation magnetization and 4piMs) of Co(0.8-x)Ni(x)Zn(0.2)Fe2O4 nano-materials have been evaluated and discussed.

Acute profound thrombocytopenia after abciximab therapy during coronary angioplasty

Since the extensive use of abciximab, a potent antiplatelet agent directed against GP IIb/IIIa platelet receptors, to prevent ischemic complications of percutaneous transluminal coronary angioplasty, few cases of thrombocytopenia have been observed. This paper reports a case of acute profound thrombocytopenia (platelet count: 800/mm3) occurring 16 h after abciximab therapy during coronary angioplasty. As thrombocytopenia occurrence is not predictable, platelet count should be evaluated periodically after drug administration. Mechanisms of this adverse effect remain unknown. Platelet transfusion results in a rapid and sustained improvement of platelet count, avoiding the occurrence of major hemorrhagic complications.

Recovery of an estuary in the southwest coast of India from tsunami impacts

Water quality in the Cochin Estuary, southwest coast of India during the tsunami attack was assessed and compared with the pre and post tsunami characteristics. From the results obtained, it is evident that a drastic change in hydrography has been inflicted by the energy transferred through the tsunami, which disturbed the entire estuarine embayment. However, the post tsunami water quality showed normal levels indicating that the region has recovered from the tsunami impacts.

Clinical impact of obesity on stability following revision total hip arthroplasty

Similar outcomes have been reported for obese and nonobese patients after primary total hip arthroplasty (THA), indicating obesity is not a contraindication to total hip arthroplasty. However, obese patients may develop implant failure and require revision THA. We compared the outcomes of revision THA in a matched cohort of obese and nonobese patients. Patients were stratified into two groups according to BMI (body mass index, kg/m2): Group 1 included 31 obese patients (BMI > 35), and Group 2 included 62 nonobese patients (BMI < 30) matched on age, gender, and type of revision procedure. Obese patients had increased total operating room time, a higher rate of discharge to a skilled nursing facility, and a higher dislocation rate (p < 0.05). Seven patients in the obese group underwent revision surgery, six of whom underwent additional reoperations to treat recurrent postoperative dislocation. Obese patients should be counseled about the increased risk of dislocation that can occur after revision THA.

Necrotizing stomatitis in the developed world

We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. Patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.

Witkop tooth and nail syndrome: a case report

Witkop tooth and nail syndrome is an autosomal dominant ectodermal dysplasia characterized by hypodontia and nail dysplasia. Mutations in MSX-1 have been identified as being involved in the syndrome. Mandibular incisors, secondary molars and maxillary canines are the most frequently missing teeth. Tooth shape may vary, and conical and narrow crowns are common. Nail dysplasia affects finger- and toenails, and is often more severe in childhood. Nails may be spoon-shaped, rigid, slow-growing and easily broken. The clinical and radiographic features of a mother and child presenting with this rare condition are described.

A study of root canal morphology of human primary molars using computerised tomography: an in vitro study

Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp cavity during treatment. This study was carried out to investigate the applicability of Computed Tomography in studying the root canal morphology of the primary molars. A total of 60 primary molars.without any macroscopic root resorption were collected and divided into four groups. The samples were arranged in wax block and then scanned for evaluation in the CT Scanner both in axial and coronal plane. The results obtained from the scanned images were statistically analyzed to know the frequency, mean and standard deviation for all the groups. The images showed the complexity of the root canals of the primary molars and also several capabilities of the CT Scan in advance Endodontic research in primary teeth were observed.

Oral health status of 5 years and 12 years school going children in Chennai city--an epidemiological study

India, a developing country, faces many challenges in rendering oral health needs. The majority of Indian population resides in rural areas of which more than 40% constitute children. The purpose of this study was to assess the oral health status of 5 years and 12 years school going children in Chennai city. The study population consisted of 1200 school children of both the sexes (600 private and 600 corporation school children) in 30 schools, which had been selected randomly. The survey is based on WHO, 1999 Oral Health Assessment, which has been modified by including gingival assessment, enamel opacities/ hypoplasia for 5 years. Evaluation of the oral health status of these children revealed, dental caries is the most prevalent disease affecting permanent teeth, more than primary teeth and more in corporation than in private schools, thereby, correlating with the socioeconomic status. It may be concluded that the greatest need of dental health education is at an early age including proper instruction of oral hygiene practices and school based preventive programs, which would help in improving preventive dental behaviour and attitude which is beneficial for life time.

A compound composite odontoma associated with unerupted permanent incisor--a case report

Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Frequently it may interfere with the eruption of the teeth. This is a case report of a compound composite odontoma in a 9 year old girl, which results in failure of eruption of the permanent upper right central incisor while the contralateral tooth had erupted. A calcified mass was seen in the radiograph and was provisionally diagnosed as odontoma following which the odontoma was enucleated. Routine follow up was done for more than a year and no recurrence was seen. This case report indicates that early diagnosis and management ensures better prognosis.

Comparative evaluation of glass ionomer and resin based fissure sealant using noninvasive and invasive techniques--a SEM and microleakage study

The efficacy of using invasive and non-invasive techniques was assessed by Scanning electron microscopy, and by microleakage of Glass ionomer (GC VII, Fuji) and Resin based sealant (Helioseal-F, Ivoclar Vivadent). 100 young premolars were used for this study, and they were divided into four groups: Group I: non-invasive technique GC VII, Group II: Invasive GC VII, Group III: Non-Invasive Helioseal-F, Group IV: Invasive, Helioseal-F. 5 teeth from each group were evaluated under SEM. It was seen that the flow and adaptation of GC VII was slightly better than Helioseal F, and the invasive technique provided the best flow and adaptation. For microleakage analysis 5% methylene blue was used. It was seen that minimal microleakage was seen in Group IV (P<0.01). Considering the recent controversies using resin based sealants, it can be said that GC VII can be a viable alternative for pit and fissure sealants.

Randomised Controlled Trial to Evaluate the Efficacy of TachoComb H Patches in Controlling PTFE Suture–hole Bleeding

OBJECTIVE

Suture-hole bleeding is a considerable problem in vascular procedures using polytetrafluoroethylene (PTFE) grafts. This study aimed to study the efficacy of TachoComb H patches in controlling suture-hole bleeding.

DESIGN

Prospective randomised controlled trial. Materials and methods. Patients undergoing femoral anastomosis and femoral or carotid patch angioplasty with PTFE grafts were prospectively randomised to TachoComb H patches or standard compression with surgical swabs.

RESULTS

Twenty four patients were randomised (12 patients in each treatment group). The median time to haemostasis was 300 (range 180-600)s in patients treated with TachoComb H and 660 (range 180-1200)s in the control group. The log rank test of equality over treatments based on the 22 patients with assessment of time to haemostasis showed statistical significance (p=0.0134). There were no serious complications associated with use of TachoComb H patches.

CONCLUSION

TachoComb H patches were found to be safe and effective for the control of suture-hole bleeding in patients undergoing vascular reconstruction with PTFE grafts.