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Kaomba L, Ng'ombe J, Mulwafu W. Clinicopathological features and management of obstructive jaundice at Queen Elizabeth Central Hospital, Malawi. A retrospective cohort analysis. Surg Open Sci 2024; 20:14-19. [PMID: 38873332 PMCID: PMC11169461 DOI: 10.1016/j.sopen.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/24/2023] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction The diagnosis of obstructive jaundice (OJ) is a challenge and is often made late especialy in low-resource settings. There is a paucity of data on the aetiology and prognosis of patients with obstructive jaundice in Malawi and Sub-Saharan Africa. The objective of this study was to determine the aetiology, clinical presentations, and short-term treatment outcomes of patients managed for OJ in Malawi. Methodology A review of case notes of all patients admitted with a clinical diagnosis of OJ from 2012 to 2022 was done. We reviewed the clinical presentation, laboratory findings, management, intra and post-operative complications, and patient outcomes. Data was entered into an Excel spreadsheet and analysed using SPSS version 25. Results Of 26,796 patient admissions, 5339 (19.9%) were for non-trauma abdominal symptoms, of which 164 (0.6% of surgical admissions and 3% of abdominal symptoms) were for obstructive jaundice. Ages varied from 16 to 89 years. Females were 45 (58.4 %) of the population. The commonest presenting complaint was jaundice followed by abdominal pain and distention. The mean duration of symptoms at presentation was 8.5 weeks. The most frequent imaging modality was abdominal ultrasound 50(65 %). Twenty-six patients (33.8 %) were discharged with a diagnosis of obstructive jaundice of undetermined pathogenesis. The commonest diagnosis was pancreatic cancer 20(26.0 %) followed by Choledocholithiasis11(14.3 %). Patients younger than 50 years had the same likelihood of presenting with cancer as those older than 50 years. Conclusion It is important to have a high index of suspicion in all adult patients presenting with obstructive jaundice as patients younger than 50 years have a similar risk of malignancy as older patients.
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Affiliation(s)
- L. Kaomba
- College of Surgeons of East Central and Southern Africa (COSECSA)
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - J. Ng'ombe
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - W. Mulwafu
- College of Surgeons of East Central and Southern Africa (COSECSA)
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri, Blantyre 3, Malawi
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Bezabih YS, Gebremariam SN. Perioperative outcomes after open biliary bypass for malignant biliary obstruction (MBO) in resource-limited setups; a multicenter prospective cohort study, 2023. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108254. [PMID: 38457860 DOI: 10.1016/j.ejso.2024.108254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Obstructive jaundice is the most common symptom of malignant diseases of the extrahepatic biliary system and necessitates either non-operative or operative biliary bypass. Because of percutaneous and endoscopic approaches, the use of palliative surgical procedures has decreased in recent years. However, in resource-limited situations, open biliary bypasses remain a viable option. This study aimed to identify factors associated with adverse perioperative outcomes following open biliary bypass. METHODS From June 2022 to May 2023, 69 patients underwent open biliary bypass for malignant biliary obstruction. Postoperative morbidity and mortality within 30 days of surgery were assessed. A Kaplan-Meier was used for categorical variables, and a log-rank test was used to determine the statistically significant difference between variables. A Cox regression analysis was conducted to identify factors associated to time to develop complications. RESULTS The hazard of developing complications among those with preoperative cholangitis was 2.49 times higher than those without preoperative cholangitis (HR 2.49, 95% CI [1.06, 5.84]). For every hour increment in the length of surgery, the hazard of getting complications increased by 2.47 times (HR 2.47, 95% CI [1.28, 4.77]). As serum bilirubin increased by 1 mg/dl, the hazard of developing complications increased by 14% (HR 1.14, 95% CI [1.03, 1.17]). CONCLUSION Patients who had long operation times, preoperative cholangitis, and elevated total bilirubin levels are at increased risk for poor perioperative outcomes. Clinicians may use these results to optimize these patients to decrease their elevated risk of serious morbidity and mortality.
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Todorov I, Trayanova D, Tsenovski Y. Short-term clinical outcomes of percutaneous biliary tract interventions: analysis of success and complication rates. Folia Med (Plovdiv) 2024; 66:46-58. [PMID: 38426465 DOI: 10.3897/folmed.66.e116660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Obstructive jaundice is a clinical syndrome that is commonly seen in gastroenterology. Endoscopic retrograde cholangiopancreatography (ERCP) has been recognized as a first-choice therapeutic approach, with percutaneous biliary interventions (PBIs) being a viable alternative. Recent data questions the performance and safety profile of PBIs.
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Yang J, Gong F, Shi X, Wang F, Qian J, Wan L, Chen Y, Chen H, Tong H. A nomogram based on lymphocyte percentage for predicting hospital mortality in exertional heatstroke patients: a 13-year retrospective study. World J Emerg Med 2023; 14:434-441. [PMID: 37969217 PMCID: PMC10632760 DOI: 10.5847/wjem.j.1920-8642.2023.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/28/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Exertional heatstroke (EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality. METHODS This is a single-center retrospective study. Clinical data from EHS patients admitted to the Intensive Care Unit (ICU) of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. Univariate and multivariate logistic regression were used to identify the factors for mortality. The prediction model was developed with the prognostic markers, and a nomogram was established. RESULTS The study ultimately enrolled 156 patients, and 15 (9.6%) of patients died before discharge. The lymphocyte count (Lym) and percentage (Lym%) were significantly lower in non-survivors (P<0.05). The univariate and multivariate logistic regression analyses indicated that Lym% at the third day of admission (Lym% D3) (OR=0.609, 95%CI: 0.454-0.816) and hematocrit (HCT) (OR=0.908, 95%CI: 0.834-0.988) were independent protective factors for hospital mortality. A nomogram incorporating Lym% D3 with HCT was developed and demonstrated good discrimination and calibration ability. The comparison between the prediction model and scoring systems revealed that the prediction model had the largest area under the curve (AUC) (0.948, 95%CI: 0.900-0.977), with 100.00% sensitivity and 83.69% specificity, and a greater clinical net benefit. CONCLUSION Severe EHS patients had a higher risk of experiencing prolonged lymphopenia. A nomogram based on Lym% D3 and HCT was developed to facilitate early identification and timely treatment of patients with potentially unfavorable prognoses.
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Affiliation(s)
- Jiale Yang
- Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Fanghe Gong
- Department of Neurosurgery, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Xuezhi Shi
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Fanfan Wang
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Jing Qian
- Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Lulu Wan
- Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Yi Chen
- Department of Intensive Care Unit, Dongguan Binhaiwan Central Hospital, Dongguan 523900, China
| | - Huaisheng Chen
- Department of Critical Care Medicine, Shenzhen People’s Hospital, Shenzhen 518020, China
| | - Huasheng Tong
- Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- Department of Intensive Care Unit, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
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Zhu Y, Jin H, Mao Y, Chen J, Qiu Y, Wang Z, He J. Unexplained Distal Obstructive Biliary Dilatation: A Magnetic Resonance Cholangiopancreatography (MRCP)-based Model to Discriminate Malignant From Benign Origins. J Clin Gastroenterol 2022; 56:724-730. [PMID: 34516461 DOI: 10.1097/mcg.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/28/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND The aim was to compare the differences of clinical-radiologic characteristics between malignant and benign causes of patients with unexplained distal obstructive biliary dilatation and to develop a logistic regression model (nomogram) based on those features to predict malignant causes preoperatively. PATIENTS AND METHODS Clinical-radiologic characteristics of 133 patients with unexplained distal obstructive biliary dilatation were analyzed. Multivariate logistic regression analysis was performed to construct a nomogram to predict malignant causes preoperatively. The developed nomograms were externally validated by assessing their predictive accuracy in an independent set of 90 patients. RESULTS Intrahepatic bile duct diameter, enlarged gallbladder, direct bilirubin, and carbohydrate antigen19-9 differed significantly between malignant and benign group. In the training set, the logistic regression model showed the discrimination between benign and malignant causes of distal obstructive biliary dilatation with an area under the curve of 0.965, an accuracy of 0.904, a sensitivity of 0.886, a specificity of 0.913. In the validation set, the model showed an area under the curve of 0.851, an accuracy of 0.837, a sensitivity of 0.897, a specificity of 0.750. CONCLUSIONS Preoperative clinical-radiologic characteristics differed significantly between malignant and benign group. Nomogram based on those features performed well in predicting the malignant causes of patients with unexplained distal obstructive biliary dilatation.
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Affiliation(s)
| | - Hailin Jin
- Digestive Endoscopy Center, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine
| | - Yingfan Mao
- Department of Radiology, The Second Affiliated Hospital of Nanjing Medical University
| | | | | | | | - Jian He
- Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Balogun OS, Atoyebi OA. Management of Malignant Obstructive Jaundice: Defining the Relevance of Various Palliative Surgical Options in Resource-Challenged Settings: A Review Article. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:111-119. [PMID: 36388748 PMCID: PMC9641745 DOI: 10.4103/jwas.jwas_22_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/31/2022] [Indexed: 06/16/2023]
Abstract
Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.
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Brewer SK, Patel P, Kesiry R. An Unusual Case of Obstructive Jaundice Secondary to Pyogenic Liver Abscesses. Cureus 2021; 13:e16409. [PMID: 34408957 PMCID: PMC8363172 DOI: 10.7759/cureus.16409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Pyogenic liver abscesses (PLA) are an uncommon, but potentially life-threatening infection. Although the link between amebic liver abscesses and obstructive jaundice is well documented, there are few cases of PLA leading to this complication. We present a case of multiple massive PLA and obstructive jaundice on initial presentation. The patient was treated for six weeks with antibiotics and percutaneous drains placed in the largest abscesses and was discharged after clinical improvement and resolution of the hyperbilirubinemia. This case highlights the importance of clinician awareness of other etiologies when evaluating patients with signs and symptoms of painful obstructive jaundice.
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Affiliation(s)
- Shannon K Brewer
- Internal Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Pranav Patel
- Internal Medicine, Medical City Weatherford, Weatherford, USA
| | - Riad Kesiry
- Internal Medicine, Medical City Weatherford, Weatherford, USA
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MS RN. Clinical spectrum of obstructive jaundice: a descriptive cross-sectional study. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. The objective of this study was to evaluate the clinical spectrum of obstructive jaundice in inflammation, stone disease, and malignancy. Methods. A descriptive observational study was done among 50 patients with the diagnosis of obstructive jaundice during the period 2012 to 2013. A detailed history and clinical examinations and radiological confirmation were done. Results. Among the participants, 74% participants had jaundice, 58% with vomiting as presenting complaints. Among benign cases, 60% were choledocholithiasis, 25% were common bile duct stricture, and 15% were choledochal cyst. Among malignant cases, 26.67% were periampullary carcinoma, 23.33% had carcinoma of the pancreas head, and 13.33% had D2 duodenal carcinoma. Conclusions. The etiology of obstructive jaundice was malignancy in the elderly male population. The most common presenting features were yellowish discoloration of skin and mucosa followed by vomiting and abdominal pain.
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Mwachiro M, Chol N, Simel I, Lando J, Ngetich D, Parker R, Tanner P, Mellinger J, Hallett J, Topazian M, Burgert S. Establishment of an endoscopic retrograde cholangiopancreatography (ERCP) program in rural Kenya: a review of patient and trainee outcomes. Surg Endosc 2021; 35:7005-7014. [PMID: 33398556 DOI: 10.1007/s00464-020-08214-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2024]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is a leading modality for treatment of biliary and pancreatic disease but is not widely available in sub-Saharan Africa. We aimed to assess the development and outcomes of an ERCP service in southwestern Kenya, including case volumes, success rates, infrastructure, and training. METHODS We conducted a retrospective review of all ERCPs performed at Tenwek Hospital in Bomet, Kenya between January 1, 2011 and March 31, 2020. RESULTS In total 277 ERCP procedures were attempted during the study period. The commonest indication was obstructive jaundice: 91 patients (32.9%) had malignancy and 85 (30.7%) had choledocholithiasis. Overall clinical success rate was 76.1% and was the highest in patients with biliary stones (81.2%) and lowest in those with tumors (73.5%) (p = 0.094). Procedure-related adverse events occurred in 11.9%, including post-ERCP pancreatitis in 3.6%, with a procedure-related mortality rate of 1.4%. Annual case volumes increased, and mean procedure duration decreased from 162 to 115 min (p = 0.0007) over time. A previously- rained endoscopist initially performed all cases; two staff endoscopists were trained in ERCP during the study period, performing 130 and 89 ERCPs during training, with clinical success rates of 84% and 74% during their subsequent independent practice. CONCLUSION An ERCP service can be successfully developed at a rural African hospital, with acceptable success and adverse event rates. Biliary obstruction due to stones or tumors are the most common findings. While a previously trained endoscopist should initiate and champion the service, staff endoscopists can be successfully trained despite limited case volumes.
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Affiliation(s)
- Michael Mwachiro
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya.
| | - Nyail Chol
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya
| | - Ian Simel
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya
| | - Justus Lando
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya
| | - David Ngetich
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya
| | - Robert Parker
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya.,Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip Tanner
- Independent/Private Gastroenterologist, Sioux Falls, SD, USA
| | - John Mellinger
- Department of Surgery and Medical Education, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Mark Topazian
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Stephen Burgert
- Department of Surgery and Endoscopy, Tenwek Hospital, P.O Box 39, Bomet, 20400, Kenya
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Fadahunsi OO, Ibitoye BO, Adisa AO, Alatise OI, Adetiloye VA, Idowu BM. Diagnostic accuracy of ultrasonography in adults with obstructive jaundice. J Ultrason 2020; 20:e100-e105. [PMID: 32609962 PMCID: PMC7409548 DOI: 10.15557/jou.2020.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022] Open
Abstract
Aim of the study To determine the sensitivity and specificity of ultrasound for detecting the causes of obstructive jaundice. Materials and methods Eighty adult patients with clinical and biochemical features of obstructive jaundice were enrolled in this study. The causes, degrees and levels of ductal obstruction were evaluated sonographically via the transabdominal route. The ultrasonographic diagnoses were correlated with surgical findings and histopathological diagnoses. Results The age range was 16 to 82 years, with a mean of 51.06 ± 14.95 years. The peak age group was the sixth decade with 23 (28.8%) patients. There were nearly twice as many females as males, with 28 (35%) males and 52 (65%) females, giving a male to female ratio of 1:1.9. On ultrasound, pancreatic carcinoma (28.0%) and choledocholithiasis (21.3%) were the most common malignant and benign causes of obstructive jaundice, respectively. Hepatocellular carcinoma (1.3%) was the least common etiology. There was a strong correlation between the definitive diagnosis and the sonographic level of obstruction. The overall sensitivity of ultrasound for detecting the cause of obstruction was 76.6%, while the specificity was 98%. Conclusion Ultrasonography is a reliable imaging modality for diagnosing the cause and level of obstruction in surgical jaundice. The sensitivity is adequate to aid the early institution of surgical intervention, thereby preventing morbidity and mortality that may accompany late interventions in our setting.
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Affiliation(s)
- Olufunke O Fadahunsi
- Department of Radiology1 Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State , Nigeria
| | - Bolanle O Ibitoye
- Department of Radiology1 Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State , Nigeria
| | - Adewale O Adisa
- Department of Surgery2, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State , Nigeria
| | - Olusegun I Alatise
- Department of Surgery2, Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State , Nigeria
| | - Victor A Adetiloye
- Department of Radiology1 Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife, Osun State , Nigeria
| | - Bukunmi Michael Idowu
- Department of Radiology, Union Diagnostics and Clinic Services Plc , Yaba, Lagos , Nigeria
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Asare O, Osei F, Appau AY, Sarkodie B, Tachi K, Nkansah A, Acheampong T, Nwaokweanwe C, Olayiwola D. Aetiology of Obstructive Jaundice in Ghana: A Retrospective Analysis in a Tertiary Hospital. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:36-39. [PMID: 35720953 PMCID: PMC9202603 DOI: 10.4103/jwas.jwas_46_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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Ahmetasevic E, Rifatbegovic Z, Ahmetasevic D, Tursunovic A, Musanovic N, Avdagic H, Kovacevic M. Influence of Preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) on Bacterial Colonization of Biliary Tract in Patients Surgically Treated for Obstructive Jaundice. Mater Sociomed 2019; 31:45-48. [PMID: 31213955 PMCID: PMC6511382 DOI: 10.5455/msm.2019.31.45-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cancelling elective procedures on the day of surgery presents a constant problem in all higher-level medical facilities, and the research of causes, consequences and possible solutions is the duty of every facility in order to enhance the quality of healthcare services. METHODS This prospective study included all patients that were scheduled for surgery from March 2016 to November 2018 in the operating rooms at our Department of Surgery, including both performed and cancelled cases. Cases by different surgical departments (general surgery, gynecology, orthopedics, urology, plastic surgery, ophthalmology and otorhinolaryngology) were all included. RESULTS Out of 8201 planned elective procedures from March 2016 to November 2018 at the General Hospital "Abdulah Nakas", 7825 cases were performed and 376 cases (4.58%) were cancelled on the day of surgery. The most common reasons for cancelling a surgical procedure on the day of surgery were: lack of time to perform surgery, (33.51%), surgery cancelled due to medical/anesthetic reasons, (31.38%), surgical procedure cancelled by the surgeon on the day of surgery, (11.97%). CONCLUSION This study has shown that the percentage of elective cases cancelled on the day of surgery at our institution stands at an acceptable 4.58%. The most common reasons for case cancellation on the day of surgery were identified. The majority of reasons for cancellation were avoidable, which means that appropriate steps could contribute to lowering the percentage of cancelled elective cases and an improved quality of healthcare services.
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Affiliation(s)
- Emir Ahmetasevic
- Surgery Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Zijah Rifatbegovic
- Surgery Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Dzenita Ahmetasevic
- Clinic for Anesthesiology and Reanimatology, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Amir Tursunovic
- Surgery Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Nermin Musanovic
- Surgery Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Harun Avdagic
- Clinic for Cardiovascular Surgery, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Maja Kovacevic
- Surgery Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina
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Zhou T, Zu G, Zhou L, Che N, Guo J, Liang Z. Ginsenoside Rg1 prevents cerebral and cerebellar injury induced by obstructive jaundice in rats via inducing expression of TIPE-2. Neurosci Lett 2016; 610:193-9. [PMID: 26592478 DOI: 10.1016/j.neulet.2015.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/03/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
The aim of the study was to analyze the effect of Ginsenoside Rg1 (Rg1) on cerebral and cerebellar injury in experimental obstructive jaundice (OJ). OJ was done by ligature and section of extrahepatic biliary duct. Rg1 was injected intraperitoneally (10 mg kg(-1)d(-1) or 20 mg kg(-1) d(-1)). Comparison of serum total bile salts (TBA), total bilirubin (TBil), direct bilirubin (DBil), TNF-α, IL-6 and IL-1β among groups. Malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were determined, also apoptosis and mRNA and protein levels of TIPE2 (TNF-α-inducible protein 8-like 2) were tested in cerebrum and cerebellum. Our results showed that Rg1 reduced MDA and apoptosis in cerebrum and cerebellum induced by OJ, also GSH and antioxidant enzyme activity were raised obviously in rats treated with Rg1. Moreover, decreased mRNA and protein levels of TIPE2 in OJ rats and Rg1 could improve the decreased mRNA and protein levels of TIPE2 in OJ rats. In conclusion, Rg1 decreased oxidative stress and apoptosis, also recovered the antioxidant status and mRNA and protein levels of TIPE2 in the cerebrum and cerebellum of OJ rats.
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Affiliation(s)
- Tingting Zhou
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, PR China
| | - Guo Zu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, PR China
| | - Lu Zhou
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, PR China
| | - Ningwei Che
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, PR China
| | - Jing Guo
- Department of Surgical Operation, Dalian Medical University, Dalian 116044, PR China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, PR China.
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Saboor M, Zehra A, Qamar K, Moinuddin. Disorders associated with malabsorption of iron: A critical review. Pak J Med Sci 2015; 31:1549-53. [PMID: 26870134 PMCID: PMC4744319 DOI: 10.12669/pjms.316.8125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/15/2015] [Accepted: 08/30/2015] [Indexed: 01/20/2023] Open
Abstract
Malabsorption is a disorder of the gastrointestinal tract that leads to defective digestion, absorption and transport of important nutrients across the intestinal wall. Small intestine is the major site where most of the nutrients are absorbed. There are three main mechanisms of malabsorption; premucosal, mucosal and postmucosal. Premucosal malabsorption is the inadequate digestion due to improper mixing of gastrointestinal enzymes and bile with chyme. This could be because of surgical resection of the small intestine or a congenital deficiency of the enzymes and bile responsible for digestion e.g. postgastrectomy, chronic pancreatitis, pancreatic cancer, cystic fibrosis, gallstones, cholangitis etc. Mucosal malabsorption occurs in celiac disease, tropical sprue, Crohn's disease etc. Postmucosal condition arises due to impaired nutrients transport e.g. intestinal lymphangiectasia, macroglobulinemia etc. Disorders of malabsorption lead to decreased iron absorption and produce iron deficiency anemia. Using the index terms malabsorption, postgastrectomy, chronic pancreatitis, pancreatic cancer, cystic fibrosis, gallstones, cholangitis, celiac disease, tropical sprue, Crohn's disease intestinal lymphangiectasia, macroglobulinemia and iron deficiency anemia the MEDLINE and EMBASE databases were searched. Additional data sources included bibliographies and references of identified articles.
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Affiliation(s)
- Muhammad Saboor
- Dr. Muhammad Saboor, Ph.D, MLS(ASCP)SH. Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
| | - Amtuz Zehra
- Dr. Amtuz Zehra, MBBS. Department of Pathology, Baqai Medical University, Karachi, Pakistan
| | - Khansa Qamar
- Dr. Moinuddin FRCP (C), FRCP (E). Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
| | - Moinuddin
- Khansa Qamar, M.Phil. (Hematology). Baqai Institute of Hematology, Baqai Medical University, Karachi, Pakistan
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15
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Wang SB, Wu HB, Wang QS, Zhou WL, Tian Y, Ji YH, Lv L. 18F-FDG PET/CT in differentiating malignant from benign origins of obstructive jaundice. Hepatobiliary Pancreat Dis Int 2015; 14:516-22. [PMID: 26459728 DOI: 10.1016/s1499-3872(15)60392-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The various origins of obstructive jaundice make the diagnosis of the disease difficult. This study was undertaken to evaluate the role of 18F-FDG PET/CT in differentiating malignant from benign origins of obstructive jaundice and to quantify the added value of 18F-FDG PET/CT over conventional imaging (enhanced CT and/or MRI). METHODS Eighty-five patients with obstructive jaundice who underwent 18F-FDG PET/CT within 2 weeks after enhanced CT and/or MRI were reviewed retrospectively. All 18F-FDG PET/CT images were independently evaluated by 2 nuclear medicine physicians who were unaware of other imaging data; differences were resolved by consensus of the physicians. All conventional imaging interpretations, according to the medical records, were reviewed by 2 radiologists to determine the potential value. Final diagnoses were based on histological or surgical findings. RESULTS Sixty-six patients were diagnosed with malignancies, and 19 patients with benign lesions. The maximum standardized uptake values for malignant and benign lesions causing biliary obstruction were 8.2+/-4.4 and 4.0+/-5.0, respectively (P<0.05). The sensitivity, specificity, and overall accuracy for differentiating malignant from benign origins with 18F-FDG PET/CT were 86.4% (57/66), 73.7% (14/19), and 83.5% (71/85), respectively. 18F-FDG PET/CT in conjunction with conventional imaging changed the sensitivity, specificity, and overall accuracy of conventional imaging alone from 75.8% (50/66) to 95.5% (63/66) (P<0.05), 68.4% (13/19) to 57.9% (11/19) (P>0.05), and 74.1% (63/85) to 87.1% (74/85) (P<0.05), respectively. CONCLUSIONS 18F-FDG PET/CT is of great value in differentiating malignant from benign origins of obstructive jaundice and is a useful adjuvant to conventional imaging. 18F-FDG PET/CT should be recommended for further etiological clarification.
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Affiliation(s)
- Shao-Bo Wang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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16
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Tang C, Lin H, Wu Q, Zhang Y, Bie P, Yang J. Recombinant human augmenter of liver regeneration protects hepatocyte mitochondrial DNA in rats with obstructive jaundice. J Surg Res 2015; 196:90-101. [PMID: 25818977 DOI: 10.1016/j.jss.2015.02.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hepatocyte mitochondrial DNA (mtDNA) damage is an important cause of mitochondrial and hepatic function impairment in obstructive jaundice (OJ). This study investigated the protective effect of recombinant human augmenter of liver regeneration (rhALR) on hepatocyte mtDNA in rats with OJ. MATERIALS AND METHODS Wistar rats were randomly divided into three groups as follows: sham-operation, biliary obstruction and recanalization with rhALR treatment (BDO-RBF-rhALR), and BDO-RBF-Vehicle (n = 48 per group). After biliary obstruction, rats were intraperitoneally injected with 40 μg/kg rhALR in BDO-RBF-rhALR group and same volume of normal saline in other two groups once every 12 h, until sacrifice. Mitochondrial transcription factor A (mtTFA) and nuclear respiratory factor-1 (NRF-1) expression in hepatocytes were detected by real-time reverse transcription-polymerase chain reaction and Western blot. Hepatocyte mtDNA damage was evaluated by real-time-polymerase chain reaction. Mitochondrial and hepatic functions were also assessed. RESULTS After biliary obstruction, hepatic function was clearly impaired, as shown by the increases in serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels, and the decrease in albumin level. Mitochondrial respiratory control ratio, phosphorus oxygen ratio, and ATP levels (all indicators of mitochondrial function) were decreased. The relative amount of total mtDNA, mtTFA, and NRF-1 expression in rat liver tissues were decreased, whereas the relative amount of deleted mtDNA was increased. However, the damage was significantly improved in the BDO-RBF-rhALR group. After recanalization, these changes were gradually restored, but the recovery was faster in the BDO-RBF-rhALR group than in BDO-RBF-Vehicle group. CONCLUSIONS rhALR may protect and improve mitochondrial and hepatic functions in rats with OJ by promoting the expression of mtTFA and NRF-1 and by protecting and repairing damaged mtDNA.
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Affiliation(s)
- Chun Tang
- Department of Hepatobiliary Surgery, Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Heng Lin
- Department of Hepatobiliary Surgery, Institute of Hepatobiliary Surgery Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Qiao Wu
- Department of Hepatobiliary Surgery, Institute of Hepatobiliary Surgery Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Yujun Zhang
- Department of Hepatobiliary Surgery, Institute of Hepatobiliary Surgery Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Ping Bie
- Department of Hepatobiliary Surgery, Institute of Hepatobiliary Surgery Southwest Hospital, The Third Military Medical University, Chongqing, China.
| | - Juntao Yang
- Department of Hepatobiliary Surgery, Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing, China.
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Hung LN, Le Huong NT, Thuy An NT. Jaundice in Adult in-Patients at a Tertiary General Hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jbm.2015.32001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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