Safety and Utility of Liver Biopsy After Pediatric Hematopoietic Stem Cell Transplantation
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Liver dysfunction is common after pediatric hematopoietic stem cell transplantation (HSCT) and liver biopsy may be necessary to diagnosis the cause of liver dysfunction and institute therapy. We report our liver biopsy experience in 356 consecutive patients. During the study period, 16 (4.5%) patients underwent 18 biopsies, all after allogeneic HSCT. The median time from HSCT to biopsy was 205.5 days. All patients had transaminase elevation and 67% had hyperbilirubinemia. The most commonly used method of biopsy was the imaging-guided percutaneous approach, performed in 12 of 18 cases. Five biopsies were done transjugularly and 1 was performed during laparotomy. In all the cases a histopathologic diagnosis was made. The most common diagnosis was graft-versus-host disease (GVHD) followed by iron overload. In 12 cases, management was modified based on biopsy results. Complications occurred after 5 biopsies, 4 of which were performed transjugularly. The most common complication was hemorrhage. Two patients required transfer to the intensive care unit for related complications. No complications were observed after percutaneous biopsies. In 2 cases a second procedure was required to manage the complication. We conclude that while liver biopsy yields a high-rate of diagnoses, it is accompanied by high rates of complications, particularly when the transjugular approach is used.【Objective】To probe the reasons of conversion to laparotomy during gynecological laparoscopic surgery. 【Methods】Clinical records of 36 cases of conversion to laparotomy out of 1143 cases of gynecological laparoscopic surgery from January 2000 to December 2007 were analyzed retrospectively. 【Results】The rate of conversion to laparotomy was 3.15%. The reasons of conversion to laparotomy were pelvic adhension in 23 cases, technical difficulty and complication in 8 cases, malignant tumor in 3 cases. The rate of conversion to laparotomy in patients with a history of laparotomy was significantly higher than that without a history of laparotomy. The rate of conversion to laparotomy in early stage of developing laparoscopy was significantly higher than that in other stages. 【Conclusions】Pelvic adhension is the primary reason of conversion to laparotomy during gynecological laparoscopic surgery. Improving ability of performance and selecting appropriate indications prcan decrease the rate of conversion.
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To compare the results, complications, and hospital charges associated with laparoscopy versus laparotomy in second-look operations for epithelial ovarian cancer. We conducted a retrospective chart review of 109 patients with invasive epithelial ovarian cancer who underwent a second-look operation between July 1, 1992, and June 30, 1995. Thirty-one patients (28.4%) underwent laparoscopy, 70 patients (64.2%) underwent laparotomy, and eight patients (7.3%) underwent both procedures at the same operation. The majority of patients (60.6%) presented with stage IIIC disease. Persistent ovarian cancer was found in 65 of 109 (59.6%) patients, including 17 of 31 (54.8%) evaluated by laparoscopy, 43 of 70 (61.4%) by laparotomy, and five of eight (62.5%) by both procedures. Significantly lower mean blood loss was noted in patients undergoing laparoscopy (27 mL) compared with laparotomy (208 mL) (P < .01). In addition, the mean operating time for laparoscopy (129 minutes) was significantly shorter than that for laparotomy (153 minutes) (P < .01), and mean hospital stay was shorter for patients undergoing laparoscopy (1.6 days) compared with laparotomy (6.8 days) (P < .01). All intraoperative and immediate postoperative complications were noted in patients who underwent laparotomy. There was no difference in day of surgery charges between the two procedures; however, total hospital charges were significantly lower for patients undergoing laparoscopy ($9448) compared with laparotomy ($17,969) (P < .01). With a median follow-up of 22.0 months, recurrence after negative second-look surgery was noted in four of 27 (14.8%) patients evaluated by laparotomy and two of 14 (14.3%) patients evaluated by laparoscopy. Laparoscopy may be an acceptable alternative to second-look laparotomy for interval evaluation of epithelial ovarian cancer. Second-look laparoscopy probably results in less morbidity, shorter operating time, shorter hospital stay, and lower total hospital charges. These results require confirmation in a randomized clinical trial.
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Surgical stress
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Mini laparotomy is technical for the resection of colorectal cancer (CRC) in selected patients. The aim was to compare clinical outcomes of mini laparotomy with conventional laparotomy in CRC patients.Between january 2007 and june 2010, 138 patients and 117 patients underwent elective resection using either mini laparotomy or conventional laparotomy respectively. Mini laparotomy involved a colorectal resection performed through a skin incision ≤8 cm in length. Clinicopathological factors, operative procedure and postoperative course were retrospectively analyzed to compare clinical outcomes between the two groups.Mini laparotomy seems to be an attractive alternative for resection of CRC in selected patients. Clinicopathological and histopathological features were similar between both groups, whereas intraoperative blood loss, operative time and harvested lymph-node numbers in conventional laparotomy were significantly greater (p=0.003, p=0.008 and p=0.024, respectively). Postoperative relapse, complications and hospitalization were significantly better in the mini laparotomy (all p<0.001). In comparison of postoperative complications between convention and mini laparotomy, ileus was more frequently encountered in conventional group (p=0.001). Interestingly, the disease-free survival and overall survival in mini laparotomy group were significantly better than control group (p=0.001 and p=0.017, respectively).Compared to conventional laparotomy, mini laparotomy seems a feasible, minimally invasive and attractive alternative in selected patients.
Ileus
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Penetrating Trauma
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Objective To explore the pathogeny and treatment of hyperbilirubin after liver transplantation. Method Clinical data of 33 patients after liver transplantation was retrospectively analyzed to summarize the pathogeny and prevention and treatment of the hyperbilirubin. Result The pathogeny of hyperbilirubin after liver transplantation included biliary complication (36?%, n=12), intrahepatic cholestasis (30?%, n=10), acute rejection (54?%, n=18), blood vessel complication (30?%, n=10), infection complication (57?%, n=19), toxic response of drugs (24?%, n=8) and relapse of primary disease (24?%, n=8). Conclusion Biliary complication is the key pathogeny of hyperbilirubin after liver transplantation.
Liver disease
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Objective To evaluate the opportunity of converted to laparotomy in laparoscopic cholecystectomy(LC).Methods There were 548 cases from february 2002 to february 2011 received LC in department of general surgery of our hospital and they were retrospectively analyzed.The operation effect was observed in 7 cases converted to laparotomy of the 548 cases.Results Six cases were converted to laparotomy initiatively in time when abnormal occurrence presence in LC.Except 1 case were converted to laparotomy because of mechanical trouble.All the patients were cured and no complication.Conclusion It is a judicious choice when unexpected or difficult condition appearance in LC,we should not keep on operating by force for the success of LC,but initiatively and resolutely converted to laparotomy in time.
Case selection
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Objective To study the opportunity of conversion to laparotomy during laparoscopic cholecystectomy.Methods Five hundred and thirty-six cases received laparoscopic cholecystectomy,among which 29 cases were converted to laparotomy.Results Nine cases(8.824%) converted to laparotomy in the early period of laparoscopic cholecystectomy.Thirteen cases(5.804%) converted to laparotomy in the middle period.Seven cases(3.333%) were converted to laparotomy in the late period.Conclusion It's necessary to convert to laparotomy to ensure patients' safety and improve the quality of the operation if it's difficult to complete the laparoscopic cholecystectomy.The conversion to laparotomy is important to patients' safety.
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Purpose Negative laparotomy in patients with abdominal penetrating injuries (APIs) is associated with deleterious outcomes and unnecessary expense; however, the indications for laparotomy in hemodynamically stable patients with ambiguous computed tomography (CT) findings remain unclear. This study aimed to identify the factors associated with negative laparotomy. findings Methods Data of patients who underwent laparotomy for APIs between 2011 and 2019 were retrospectively reviewed. Patients who presented with definite indications for laparotomy were excluded. The patients were dichotomized into negative and positive laparotomy groups, and the baseline characteristics, laboratory test results, and CT findings were compared between the groups. Results Of 55 patients with ambiguous CT findings, 38 and 17 patients were assigned to the negative and positive laparotomy groups, respectively. There was no significant difference between the groups with respect to the baseline characteristics or the nature of the ambiguous CT findings. However, the laboratory test results showed that there was a difference in the percentage of neutrophils between the groups (negative: 55.6% [range 47.4â66.1%] vs. positive: 79.8% [range 77.6â88.2%], p<0.001), although the total white blood cell count was not significantly different. The mean duration of hospital stay for the negative laparotomy group was 13.1 days, and seven patients (18.4%) experienced complications. Conclusions Diagnostic factors definitively indicative of laparotomy were not identified, although the percentage of neutrophils might be helpful. However, routine laparotomy in patients with peritoneal injuries could result in instances of negative laparotomy. Keywords: Abdominal injuries; Wounds, penetrating; Laparotomy
Abdominal computed tomography
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