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INTRODUCTION: The aim of this work is to demonstrate perioperative and postoperative complications after percutaneous transhepatic drainage of the biliary tract and, on the basis of our own experience, to show the possibilities of solving these complications within hospital care as well as the ways of preventing such complications in outpatient and home care where the role of home care nurses is very important. MATERIAL AND METHODS: At the Department of Radiology in F.D. Roosevelt Teaching Hospital Banska Bystrica, more than 100 percutaenous transhepatic biliary tract drainage procedures are performed every year. In 2013, 105 such procedures were performed. Indications included nonresectable cholangiocarcinomas of the biliary confluence (Klatskin tumours) or common bile duct as well as benign bile obstructions in which endoscopic drainage could not be performed (benign stenosis of thecommon bile duct, stenosis of biliodigestive anastomosis, intrahepatic biliary stones). Between 2009 and 2013, 151 patients with percutaneous transhepatic drainage of the biliary tract were hospitalised at the Department of Surgery in F.D. Roosevelt Hospital Banska Bystrica,of whom 98 had malignant obstruction and 53 benign obstruction. RESULTS: In 151 patients hospitalised at the Department of Surgery, the following postoperative complications occurred: catheter obliteration in 6.6%, biliary peritonitis in 2%, sepsis with cholangitis in 3.3% and haemorrhage in 4.6% of all patients. Mortality directly related to the PTD procedure was 0.66% (1 patient). CONCLUSION: Percutaneous transhepatic biliary tract drainage requires a skilled radiologist who is able to manage all perioperative complications. At the same time, experienced medical staff are needed who are able to treat the drainage catheters correctly and are able to recognize severe complications in time. Complications after PTD occur also during home care of the patients; therefore, cooperation of home care nurses with hospitals where PTD is performed is therefore important. Catheter flushing should be included in the catalogue listing home care procedures.
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Colestasis/cirugía , Drenaje , Complicaciones Posoperatorias , Bilis , Femenino , Humanos , MasculinoRESUMEN
Transjugular liver biopsy is an alternative of percutaneous biopsy in collection of hepatic tissue for histological examination. It is used when percutaneous biopsy is contraindicated, or involves great risk, i.e. in particular in patients with severe ascites and severely impaired blood coagulation. According to worldwide statistics it occurs in about one third of hepatological patients. The authors present a group of 16 patients who had transjugular biopsy and report on the high yield and low risk of the method. A representative histological sample was obtained in 100%, there were no complications in the investigated group. The authors give an account of the indications and description of the method, its possible complications. They compare their results with data in the literature. Their initial experience confirms that the inclusion of transjugular biopsy among hepatological examination methods is justified.
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Biopsia con Aguja/métodos , Hígado/patología , Adulto , Femenino , Humanos , Venas Yugulares , Masculino , Persona de Mediana EdadRESUMEN
Malignant melanoma of soft parts (MMSP) is a rare tumor originally described by Enzinger in 1965 as clear cell sarcoma of tendons and aponeuroses because of its affinity to tenosynovial structures. Tumors are found predominantly at the extremities. First visceral case was described in 1993 in the duodenum. We describe the case of 64-years old man with malignant melanoma of soft parts in the stomach, in the pancreas, in the mesocolon, in the left thigh and in the left axilla. This patient was successfully treated surgically by the resection of the stomach, resection of the pancreatic head, extirpation of the tumor from mesocolon, from the left thigh and from the left axilla. In all these localisations the tumor was histologically and imunohistochemically proved to be MMSP (positivity: s-100 protein, vimentin, HMB-45 and negativity CK, EMA, desmin, actin). This multivisceral occurrence is extremely rare and according to the review of literature this is probably the first published case of MMSP in the stomach and in the pancreas.
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Neoplasias Primarias Múltiples , Sarcoma de Células Claras , Axila , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/cirugía , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Sarcoma de Células Claras/diagnóstico , Sarcoma de Células Claras/patología , Sarcoma de Células Claras/cirugía , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , MusloRESUMEN
The paper summarizes experience with diagnosis and surgical treatment of insulinomas of the pancreas. Experience with three patients subdued to surgical treatment at the Department of Surgery of F.D. Roosevelt Hospital in Banská Bystrica confirm the rules of effective treatment of insulinomas: importance of neurological symptoms in early diagnosis, importance of angiography as the best method for localization of insulinomas in comparison with ultrasonography and CT. In addition, algorithm of the surgical treatment of insulinomas together with the specificity of the surgical technique were confirmed.
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Insulinoma/cirugía , Neoplasias Pancreáticas/cirugía , Adulto , Femenino , Humanos , MasculinoRESUMEN
Primary aldosteronism (Conn's syndrome) forms about 2% of disease in patients with arterial hypertension. Primary aldosteronism is in 50% of patients caused by aldosteron producing adenoma. Surgical treatment of these adenomas is excellent, or with complete disappearance of the disease, or with simple drug control of the symptoms after adrenalectomy. In the diagnostic process we can meet also seemingly divergent results of investigations. In these cases diagnosis usually requires the catheterization of adrenal veins with selected sampling of aldosteron level and thus determines the localisation of the tumor. Localised adenomas are indicated for surgical treatment. The best approach seems to be the abdominal transperitoneal incision with removal the whole adrenal gland. In this paper authors describe their experience with 5 patients treated at the F.D. Roosevelt Hospital in Banská Bystrica. (Tab. 1, Fig. 2, Ref. 25.)
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Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirugía , Neoplasias de la Corteza Suprarrenal/diagnóstico , Neoplasias de la Corteza Suprarrenal/cirugía , Adenoma Corticosuprarrenal/diagnóstico , Adenoma Corticosuprarrenal/cirugía , HumanosRESUMEN
The authors present a group of 14 patients (9 men and 5 women) aged 38-76 years (mean age 59 years) who were hospitalized during the five-year period between 1984 and 1988 at the medical department A of the Regional Institute of National Health in Banská Bystrica on account of acute dissection of the aorta. The authors describe clinical manifestations which can lead to suspicion of this serious disease. They make the readers familiar with their experience with ultrasonic and X-ray examination (in particular aortography and computed tomography). They analyze their contribution to the diagnosis of acute dissection of the aorta.