Laparoscopic drainage of cryptogenic liver abscess.

BACKGROUND: To retrospectively compare the outcomes of percutaneously drained and laparoscopically drained liver abscesses. METHODS: Eight-five consecutive patients with radiological evidence of liver abscess were treated at National University Hospital of Singapore from 2005 to 2011. Multivariable logistic regression was used to identify failures of intervention. This was defined as persistent objective signs of sepsis. Complications, length of antibiotic therapy, and hospital stay were recorded but not used as indicators for failure of intervention. A propensity score analysis was used to adjust for possible confounders. RESULTS: Twenty-seven (40.3%) patients in the percutaneous group did not respond to primary intervention compared to 2 patients (11.1%) in the laparoscopic group (p = 0.020). Two patients within the percutaneous group died from progression of sepsis despite intervention. In the multivariate model with propensity score, laparoscopic drainage had a protective effect against failure compared to percutaneous drainage of liver abscess (odds ratio [OR], 0.03; 95% confidence interval [CI], [0-0.4]; p = 0.008). There were no differences in complications related to the intervention (p = 0.108). Mean duration of antibiotics (p = 0.437) and hospital stay (p = 0.175) between the groups was similar. CONCLUSIONS: Laparoscopic drainage of cryptogenic liver abscesses should be considered as an option for drainage of liver abscess.

Community Engagement in Support of Moving Toward Universal Health Coverage.

Community engagement describes a complex political process with dynamic negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. Though examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic, and sustained component of health systems. Through a series of case studies, this article explores the factors that enable community engagement particularly with a direct impact on health systems.

Prospective evaluation of argon gas probe delivery for cryotherapy of bone tumours.

INTRODUCTION: Cryosurgery for tumoural ablation traditionally involves instilling liquid nitrogen into a tumoural bed. The inability to control precise delivery can result in potentially disastrous consequences of skin necrosis and nitrogen gas embolism. In this study, we evaluated a probe-based closed cryosurgical system, which eliminates these risks. MATERIALS AND METHODS: We performed a prospective evaluation of 36 cases of bone tumours treated with a probe-based cryosurgical system at the National University Hospital, Singapore. Cases consisted of patients with benign aggressive tumours (42%), primary malignant bone tumours (25%) and bone metastases (33%). In primary bone tumours, the aim of therapy was cure. In bone metastasis, the aim of therapy was palliation defined as the relief of symptoms for the patients' remaining lifetime. RESULTS: In the primary bone tumour group, no recurrences were reported. In the metastases group, where the intention was palliation, there were 3 cases of radiological relapses (P = 0.02) and 2 clinical relapses. Kaplan-Meier evaluation showed a statistically significant tendency for radiological relapse in metastatic disease versus primary disease (P = 0.02). Median time for relapse free survival in the metastatic group was 17 months (P = 0.01). There were 4 deaths in the metastatic group due to progression of disease unrelated to the index region of cryosurgical treatment. There were no deaths in the primary bone tumor group. We had 2 complications from this therapy involving fractures through the cryoablated segments. One case healed spontaneously and the other was most expediently managed with a shoulder hemiarthoplasty. There were no skin burns or embolic complications. CONCLUSION: Good clinical efficacy with probe delivered cryotherapy has been shown in this group of 32 patients with cure in all primary disease. Relapse occurred in only a small proportion of patients with bone metastasis.

Connection tubing causing small bowel obstruction and colonic erosion as a rare complication after laparoscopic gastric banding: a case report.

INTRODUCTION: Laparoscopic adjustable gastric banding is the most frequently performed bariatric procedure for the treatment of morbid obesity and is associated with low morbidity and mortality. Complications related to obesity surgery are rare and their presentation is often non-specific. Thus, it is highly important for physicians who are practising bariatric surgery to be aware of complications described in single-case studies or series when they come across similar complications even years after the primary bariatric operation. CASE PRESENTATION: We report the case of a 47-year-old Malay woman who was admitted with symptoms and signs suggesting intestinal obstruction five years after gastric band placement. CONCLUSIONS: In our patient, the band connection wire tube was the cause of both small bowel obstruction and colonic erosion. Computed axial tomography is the cornerstone of the investigation of such patients. After surgical removal of the connecting tube, our patient recovered without sequelae.