RESUMEN
Cavernous hemangiomas are the most common benign tumors of the liver and are usually asymptomatic. On the other hand, giant hemangioma and diffuse hepatic hemangiomatosis may become symptomatic by causing compression on adjacent structures, rupture, or consumptive coagulopathy. The coexistence of these 2 entities in an adult is extremely rare, and the literature, especially on their management, is sparse. We report the case of a young woman who developed a rapidly growing recurrent giant hemangioma and diffuse hepatic hemangiomatosis with significant pressure effects, raising the suspicion of a malignant tumor. She had previously undergone a liver resection and an aborted attempt at liver transplant elsewhere. As a preoperative measure, with an aim to shrink the tumor, she underwent arterial embolization and chemotherapy. After this procedure, she underwent deceased donor liver transplant. Her postoperative period was uneventful, and she was well at her 6-month follow-up. We highlight the challenges involved and the need for a multidisciplinary approach in managing these lesions. Liver transplant is an excellent option for patients who develop life-threatening complications or poor quality of life due to these benign liver tumors.
Asunto(s)
Hemangioma Cavernoso , Hemangioma , Neoplasias Hepáticas , Trasplante de Hígado , Adulto , Femenino , Hemangioma/complicaciones , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/diagnóstico por imagen , Hemangioma Cavernoso/cirugía , Humanos , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Donadores Vivos , Calidad de Vida , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Hypersplenism due to splenic congestion is observed in portal hypertensive patients. This study was done to know the change in platelets count following early ligation of splenic artery during splenectomy in patients with thrombocytopenia due to portal hypertension with a hypothesis that splenic decongestion results in increased platelets count; thereby platelet transfusion can be avoided. MATERIALS AND METHODS: Patients with platelets count <100,000 per mm(3) due to portal hypertension were involved and we followed a protocol of ligating splenic artery first, followed by 30 minutes waiting period for splenic decongestion. Blood sample was collected at 5 and 30 minutes for the estimation of platelets count. RESULTS: Significant rise in platelets was observed after 5 and 30 minutes of early ligation of splenic artery with mean rise being 23735 ± 15417 and 35085 ± 20458 per mm(3), respectively. The rise in platelets at 30 minutes was significant when compared with 5 minutes rise with mean platelets count being 91661 and 103070 per mm(3) at 5 and 30 minutes, respectively. The platelets rise was equal to 4 and 6 units of platelets concentrates, respectively. CONCLUSION: Early ligation of splenic artery during splenectomy for portal hypertension results in significant rise in platelets after 5 and 30 minutes. This method conserves platelets and avoids platelets transfusion and its complications.
Asunto(s)
Hiperesplenismo/complicaciones , Hipertensión Portal/complicaciones , Esplenectomía/métodos , Arteria Esplénica/cirugía , Trombocitopenia/etiología , Adulto , Humanos , Hiperesplenismo/sangre , Hiperesplenismo/cirugía , Hipertensión Portal/sangre , Hipertensión Portal/cirugía , Periodo Intraoperatorio , Ligadura/métodos , Recuento de Plaquetas , Trombocitopenia/sangre , Trombocitopenia/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
Choledochal cysts are cystic dilation of extrahepatic duct, intrahepatic duct, or both that may result in significant morbidity and mortality, unless identified early and managed appropriately. The incidence is common in Asian population compared with western counterpart with more than two third of the cases in Asia being reported from Japan. The traditional anatomic classification system is under debate with more focus on etiopathogenesis and other aspects of choledochal cysts. Even though categorized under the same roof, choledochal cysts vary with respect to their natural course, complications, and management. In this review, with the available literature on choledochal cysts, we discuss different views about the etiopathogenesis along with the natural course, complications, diagnosis, and surgical approach for choledochal cysts, which also explains why the traditional classification is questioned by some authors.
Asunto(s)
Quiste del Colédoco , Adulto , Niño , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Quiste del Colédoco/diagnóstico , Quiste del Colédoco/etiología , Quiste del Colédoco/cirugía , Femenino , Humanos , Masculino , Pronóstico , Factores de RiesgoRESUMEN
BACKGROUND: Patients with diabetes have increased frequency of hospital admissions and longer lengths of stay compared to patients without diabetes. Our specialist diabetes inpatient service was reconfigured to deliver a proactive diabetes outreach service to improve the overall care of this population. AIMS: To ascertain the effect of a structured diabetes outreach service to acutely admitted patients with diabetes on avoidable admissions, delayed discharges and appropriate diabetes related follow-up plans. METHODS: Audits were carried out before and 4 months after the introduction of a diabetes outreach service. The proportion of patients under care of the diabetes team, avoidable admissions, delayed discharges and existence of effective follow-up plans were compared pre- and post-implementation of this outreach service. RESULTS: The number of inpatients with diabetes fell by 35% (83 on a typical day pre-outreach vs. 53 post-outreach) despite a similar number of total medical admissions in that month (1449 vs.1459). This was due to a reduction in those admitted with diabetes related (13 vs. 5) and general medical (29 vs. 10) problems whilst numbers requiring other specialist care (41 vs. 39) remained unchanged. The proportion of patients under the care of diabetes team rose (23% vs. 73%) while those with avoidable admissions (18% vs. 7%), delayed discharges (17% vs. 2%) and inappropriate discharge plans (65% vs. 11%) all fell. CONCLUSION: This reformatted service was associated with a marked improvement in a number of parameters relevant to inpatient care.
Asunto(s)
Atención a la Salud/normas , Diabetes Mellitus/terapia , Hospitalización/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Calidad de la Atención de Salud/normas , Anciano , Continuidad de la Atención al Paciente/organización & administración , Atención a la Salud/organización & administración , Femenino , Humanos , Tiempo de Internación , Masculino , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto , Calidad de la Atención de Salud/organización & administraciónRESUMEN
AIMS: To determine the utility of estimated glomerular filtration rates (eGFR) in predicting renal risk over and above currently available strategies that incorporate serum creatinine and microalbuminuria in a diabetes population. METHODS: Cross-sectional study of 4548 diabetic individuals attending a single centre over an 18-month period. Glomerular filtration rates were estimated using the Modification of Diet in Renal Disease (MDRD) equation. Microalbuminuria was measured using spot morning urine for albumin:creatinine ratio (ACR). SPSS was utilized for statistical analysis. RESULTS: Of the 4303 subjects with complete data, 373 (9%), 2634 (61%), 1197 (28%) and 99 (2%) individuals, respectively, had eGFR > 90, 90-60, 60-30 and < 30 ml/min per 1.73 m(2), respectively. Of those with clinically meaningful renal disease (eGFR < 60 ml/min per 1.73 m(2)), only 42% and 45%, respectively, were identified as at risk by clinical strategies utilizing serum creatinine and urine ACR individually. Even using the two together, 38% of the patients at risk would still not have been identified, since they had normal values of both. CONCLUSION: Current strategies utilizing serum creatinine and urine ACR are insufficient for the detection of renal disease in diabetes. Clinicians should consider monitoring GFR estimates in addition to assessing blood pressure, serum creatinine and urine albumin excretion in order to assess renal status and risk in adults with diabetes.