4 research outputs found
Predictive risk factor for difficult elective laparoscopic cholecystectomy in HUSM
No full textBackground : Laparoscopic cholecystectomy (LC) is a gold standard management for
symptomatic cholelithiasis. However, LC might be difficult due to the various risk factors.
Preoperative risk factors are very important for the surgeon and patient in anticipating of difficulty
during surgery. The aim of this study to identify clinical, radiological, and perioperative risk factor
with difficult elective laparoscopic cholecystectomy patient in HUSM.
Methods: This is a retrospective record review of patients who underwent elective laparoscopic
cholecystectomy from 2013 to 2018 in Hospital Universiti Sains Malaysia.
The patient’s characteristics, clinical history, laboratory data, ultrasonography results and
intraoperative details were retrospectively analyzed to evaluate predictors of difficult LC.
Results: A total of 154 patients whom underwent elective laparoscopic cholecystectomy and
fullfill the criteria were included in this study. The conversion rate to open surgey was 4.5%, the
mean operative length was 91.71 minutes and the mean hospital stay post operative was one day.
The prevalence of difficult elective laparoscopic cholecystectomy in HUSM was 55.2% (95% CI
= 47.3, 63.0). Multivariate analysis showed that history of cholangitis , history of ERCP , thick
gallbladder wall on ultrasound , dense adhesion and fibrosed Calot’s triangle intraoperatively had
significant association with difficult laparoscopic cholecystectomy.
Conclusion: From this study, it is concluded that patient’s history of cholangitis, history of ERCP,
thick gallbladder wall on ultrasound, dense adhesion and fibrosed Calot’s triangle intraoperatively
were found to be the predictive factors of difficult LC
Empyema necessitans secondary to tuberculosis: a case report
No full textEmpyema necessitans (EN) is a sporadic disease in the 21st century. It is a condition where the empyema has diffused and is loculated in the extrapleural space. It is usually caused by Tuberculosis (TB) infection or immunocompromised condition. Its manifestation, which is often vague in the beginning, leads to diagnostic dilemmas and delays in management. This has considerably affected patients adversely and incurred avoidable healthcare costs. We describe a rare case of empyema necessitans secondary to pulmonary tuberculosis in a 43-year-old male who presented to the emergency department with right anterior chest wall swelling, which was associated with pain, lethargy, malaise and significant loss of weight. Targeted ultrasonography of the anterior chest wall revealed a right anterior chest wall collection with intrathoracic extension. Contrast-enhanced computed tomography of the chest showed a multiloculated right chest wall collection with intrathoracic extension. Percutaneous drainage of the collection was performed, and the pus sent for Mycobacterium tuberculosis culture was positive. This case highlights the importance of a high index of suspicion and clinical awareness for this dangerous and silent disease
Malignant neck mass in disguise - atypical presentation of extraskeletal Ewing's sarcoma
No full textEwing’s sarcoma is the second most malignant bone tumour and commonly occurs in paediatric patients. Extraskeletal Ewing’s sarcoma can arise from the head and neck as the primary site of origin of the tumour despite being rare. This soft tissue tumour morphologically mimics Ewing’s sarcoma of bone. We report a case of extraskeletal Ewing’s sarcoma of the neck region in a 53-year-old lady who presented to the emergency department with a rapidly growing mass over three weeks associated with pain over the posterolateral neck region. It is challenging to reach the diagnosis at the first encounter as this lesion is found at an uncommon location and presented with a sebaceous cyst-like physical appearance
Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
No full textWe aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.sponsorship: This trial was registered at clinicaltrials.gov (NCT04509986). Funding was provided by the: National Institute for Health Research (NIHR) Global Health Research Unit; Association of Coloproctology of Great Britain and Ireland; Bowel and Cancer Research; Bowel Disease Research Foundation; Association of Upper Gastrointestinal Surgeons; British Association of Surgical Oncology; British Gynaecological Cancer Society; European Society of Coloproctology; Medtronic, NIHR Academy; Sarcoma UK; Urology Foundation; Vascular Society for Great Britain and Ireland; and Yorkshire Cancer Research. The views expressed are those of the authors and not necessarily those of the funding partners. No other competing interests declared. (National Institute for Health Research (NIHR) Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, NIHR Academy, Sarcoma UK, Urology Foundation, Vascular Society for Great Britain and Ireland, Yorkshire Cancer Research, Academy of Medical Sciences (AMS)|AMS-SGCL13-Saratzis, British Heart Foundation|CH/17/1/32804, National Institute for Health Research|DRF-2018-11-ST2-028, National Institute for Health Research|NF-SI-0515-10084, National Institute for Health Research|ACF-2014-06-007, National Institute for Health Research|CL-2014-11-001, National Institute for Health Research|ACF-2020-12-004, National Institute for Health Research|NIHR300175, National Institute for Health Research|15/20/01, Grants-in-Aid for Scientific Research|20K09242)status: Publishe
