Management of Hepatic cysts by percutaneous drainage and instillation of tetracycline hydrochloride

This paper reports two cases of benign hepatic cysts successfully treated by the instillation of tetracycline hydrochloride. The patients presented with solitary large symptomic hepatic cysts and underwent ultrasound guided needle aspiration followed by the instillation of tetracycline hydrochloride. The cyst size diminished without complication and the patients have remained symptom free. We review the treatment of this uncommon entity and propose that injection of tetracycline hydrochloride is an effective non-operative treatment of symptomatic solitary hepatic cysts. (AU)

Chronic Relapsing Pancreatitis in a Child: Use of the Puestow Procedure to Achieve Ductal Drainage

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.(Au)

Thyroid surgery without drainage: 15 years of clinical experience

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. The largest series to date of non-drainage in thyroid surgery is presented, comprising 260 patients over a 15-year period. No case selection for non-drainage was employed. Two hundred and fifty-nine cases were not drained and included toxic goitres, and bilteral and redo procedures. There was one thyroid storm and two cases of subcutaneous fluid collection, treated by needle aspiration. No cases of recurrent laryngeal nerve injury, airway obstruction or death were recorded. This study strongly demonstrates the safety of non-drainage in routine thyroid surgery (AU)

Routine drainage in thyroid surgery: is this practice obsolete? - abstract

Thyroid surgery without drainage is thought by many surgeons to be a practice with potentially catastrophic consequences. This thinking which evolved from the late nineteenth century view of absolute prescription of thyroidectomy because of bleeding has been questioned in recent papers. Our experience at surgery also led us to doubt the necessity of routine drainage, and so, since 1976, we practised non-drainage prospectively in 248 consecutive thyroidectomies. Subtotal lobectomy was done in 56 cases, unilateral lobectomy in 115 and bilateral subtotal thyroidectomy in 77 cases. This is the largest such series reported to date. In only one case was drainage considered necessary, and the only complication attributable to non-drainage was minor subcutaneous fluid collection (2 cases). In thyroid surgery, following meticulous haemotasis, routine drainage is not necessary (AU)

Clinical aspects of pyogenic liver abscess: the University Hospital of the West Indies experience

Twenty-four cases of pyogenic liver abscess admitted between 1977 and 1986 are presented. A mean age of 43 years (range 5-78) with a 3:1 male:female ratio and 25 percent mortality were noted. Fever and abdominal pain were encountered in over 80 percent of cases and anorexia and malaise in over 60 percent. Hepatomegaly and right upper quadrant tenderness were the commonest signs. Leucocytosis, raised alkaline phosphatase and y-glutamyl transpeptidase, and hypoalbuminaemia were each noted in roughly 80 percent of cases. None of these showed any prognostic significance. Predisposing factors were noted in 11 cases. No cases of associated biliary disease were noted. Multiple polymicrobial, aerobic and mixed aerobic/anaerobic abscesses were associated with a high mortality. Patients aged over 50 years or more also had a higher mortality (P<0.05). Anaerobic abscesses were often solitary and were associated with a lower mortality (P<0.05). Surgical drainage and guided precutaneous drainage showed no difference in morbidity. (AU)

Bile duct surgery without tubes or stents

A review of personal experience with 56 cases of bile duct surgery done without T-tubes or stents is presented. There have been no post-operative complications attributed to biliary leak or sepsis. All deaths were due to malignancies or sepsis unrelated to the biliary tree. In a follow-up of the cases, up to 13 years in one instance, there have been no late sequelae such as strictures, residual stones or cholangitis. It is concluded that bile duct surgery without tubes is safe as regards postoperative complications and, although a longer study is needed, it appears safe in the long term as well (AU)

Spontaneous rupture of the liver in pregnancy

A case of spontaneous rupture of the liver is presented, including the first English Language report of hepatic resection for this condition. The aetiology, pathogenesis, diagnosis, and treatment is reviewed. Hepatic artery ligation, evacuation of the subcapsular haematoma, excision of Glisson's capsule and drainage is suggested as the best initial approach. Hepatic resection is reserved for patients in whom this fails (AU)

Massive pancreatic ascites

A case of massive bloody ascites is described. This was associated with a benign pseudocyst of the pancreas of undetermined etiology. The ascites recurred after drainage but has not recurred after drainage of the pseudocyst (AU)

The graphic recording of the rate of drainage of blood from the veins of the legs

The purpose of this technique was to devise a method to study certain aspects of the aetiology of varicose veins in pregnancy and whether the developing foetus causes a mechanical obstruction of the venous drainage of the lower limbs. Such a technique might be of use in the study of other clinical conditions. The technique to be described is for the graphic recording of the rate of venous drainage from the legs by gravity. The procedure involves the use of a tilting table and a limb plethysmograph. The initial angle of the limb volume change following the completion of the tilting was recorded and from this the venous drainage rated was calculated. The results indicate the freedom with which venous drainage occurs and the lack of resistance that exists to the venous outflow from the lower limbs. The validity of the measurements derived from the technique was examined by causing venous obstruction by a positive Valsalva procedure and by examining the records during and after pregnancy. Other techniques have been evolved to investigate the part played in the production of varicose veins by: (1) changes in venous valvular competency and (2) venous tone (AU)

Anomalous pulmonary venous drainage through a persistent left superior vena cava: Report of a case

A 31 year old Negro is described in whom total pulmonary venous drainage through a persistent left superior vena cava into the left innominate vein was demonstrated. (AU)

Self-clearing sea heads for low drainage through surf and consequent effects on the incidence of malaria

The development of self-cleaning seaheads and methods of construction are discussed. Their effect on the reduction of malaria incidence in the County of St. David, Trinidad, British West Indies, is outlined in a review of the incidence of malaria in the county. Phenomenal results have been obtained in the lowering of the malaria incidence in this county(AU)