Catheter drainage versus needle aspiration in management of large (>10 cm diameter) amoebic liver abscesses.

OBJECTIVES: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10 cm diameter) amoebic liver abscesses. METHODS: Eighty-two patients with amoebic liver abscess were randomly allocated to PCD (n = 42) or PNA (n = 40). Intervention was done under ultrasonography (US) [mainly] or computed tomography guidance within 24 h of admission. PNA was repeated every 3rd day if the cavity size had not reduced to 50% of the original size, for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Duration to attain clinical relief, duration of hospital stay, complications, treatment failure and deaths were recorded. RESULTS: PNA was successful in 32 (80%) patients (one aspiration in 4, two in 18 and three in 10 patients), while PCD was successful in 38 (90.5%) patients. Durations to attain clinical relief and parentral antibiotics required were significantly lesser in the PCD group. Hospital stay, although did not differ significantly, was lesser for PCD group. The only procedure-related complication due to PCD was rupture of abscess in two cases, leading to sepsis and death of one patient. Complications of PNA included pleural injury in one patient, and haemorrhage leading to subcapsular hematoma in another. CONCLUSION: PCD is a better treatment option than PNA for the management of large (>10 cm diameter) amoebic liver abscess, in terms of duration to attain clinical relief and duration for which parentral antibiotics were needed.

Laparoscopic transperitoneal pyelopyelostomy and ureteroureterostomy of retrocaval ureter: Report of two cases and review of the literature.

We report two cases of retrocaval ureter that were successfully treated by a laparoscopic transperitoneal approach. Presentation of both these cases was with flank pain. Ureteroureterostomy using an intracorporeal suture technique was performed for one, and pyelopyelostomy for the other case. Operative time was 120 min and 110 min, respectively. Pyelopyelostomy was technically easier to perform than ureteroureterostomy that required an extra fourth port insertion to facilitate dissection. With increasing experience with the intracorporeal suturing laparoscopic technique of either pyelopyelostomy or ureteroureterostomy should be the first choice for retrocaval ureter.

Laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: experience with 142 cases in a high-volume center.

BACKGROUND AND PURPOSE: Laparoscopic dismembered pyeloplasty (LDP) is a minimally invasive approach that is becoming standard management of ureteropelvic junction obstruction (UPJO). It provides similar results when compared with open surgery. The main goal of LDP is to meet the standard of open dismembered pyeloplasty with reduced trauma for the patients. The purpose of the study was to evaluate the postoperative and functional results of LDP. PATIENTS AND METHODS: We retrospectively reviewed and analyzed 142 cases of LDP performed at our center over a period of 7 years (January 2003 to December 2009) for UPJO with dilatation of the renal pelvis. Patients' profiles and perioperative, intraoperative, and postoperative parameters, such as time of surgery, blood loss, complications, duration of hospital stay, and outcomes of the procedure, were all evaluated and analyzed. RESULTS: The mean operative time for LDP was 145 minutes (range 110-180 min), and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 3.5 days (3-6 d). Two conversions to open surgery occurred because of difficulty to complete the anastomosis. In one patient, shock caused by bleeding from inferior epigastric vessels near the port site developed and had to be explored. The success rate was 96.8%. CONCLUSION: When performed by expert surgeons, LDP can safely achieve success rates that are comparable to those of open surgery described in the literature, with fewer complications and less morbidity to the patients. The few important difficulties with their management that we encountered are discussed.

Breast hamartoma with intrathoracic extension in a 13-year-old boy.

Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs.

Bladder injuries frequently missed in polytrauma patients.

Bladder injuries are very common in patients who have had road traffic accidents. The method of diagnosis and management of such injuries is well established and accepted. However, trauma to the bladder can be associated with other life-threatening injuries which are frequently missed, and often diagnosed during laparotomy for other reasons. The aim of this study was to diagnose bladder injury in polytrauma patients as early as possible, taking into consideration the fact that these patients are hemodynamically unstable and require rapid evaluation and management. In order to achieve our objective, we used bedside sonography with retrograde instillation of normal saline to diagnose bladder injury in addition to use of the conventional retrograde cystogram.