Abstract:
INTRODUCTION:Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management. METHODS:A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates. RESULTS:Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic. CONCLUSIONS:Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Flexer SM,Peter MB,Durham-Hall AC,Ausobsky JRdoi
10.1308/003588414X13814021679799subject
Has Abstractpub_date
2014-04-01 00:00:00pages
229-33issue
3eissn
0035-8843issn
1478-7083journal_volume
96pub_type
杂志文章abstract::The recording of medical data has developed from crude non-specific classifications to complex systems tailor-made for individual practices. The development of the Read Clinical Classification has produced a complex classification which is user friendly and covers the whole of medicine. The classification allows uniqu...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract::Despite published criteria predicting poor survival after operation for ruptured abdominal aortic aneurysm (RAAA), little is known about the factors which influence surgeons not to operate. Questionnaires were sent to all 404 members of the Vascular Surgical Society of Great Britain and Ireland, posing questions about...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1998-05-01 00:00:00
abstract::Developments in anaesthesia for intracranial surgery over the past 35 years are illustrated by a comparison of personal practice in 1943-45 and in 1977-79, with some reference to techniques developed during the intervening years. ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract:INTRODUCTION:Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/rcsann.2020.0122
更新日期:2020-10-01 00:00:00
abstract:INTRODUCTION:Screening for prostate cancer with serum prostate specific antigen (PSA) remains a controversial topic. The UK NHS Executive has issued extensive guidance stressing the importance of adequate counselling prior to performing this test. This study aims to assess men's knowledge of the PSA test at the time of...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588406X98685
更新日期:2006-05-01 00:00:00
abstract:AIMS:To compare the effect of buffered commercial 1% xylocaine (with 1:200,000 adrenaline) and the unbuffered commercial 1% xylocaine (with 1:200,000 adrenaline) preparation on pain during infiltration and procedure. PATIENTS AND METHODS:A randomised, double blind controlled trial involving 85 patients who underwent b...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1308/003588404323043382
更新日期:2004-05-01 00:00:00
abstract::INTRODUCTION Reporting surgeons' outcomes has recently been introduced in the UK. This has the potential to result in surgeons becoming risk averse. The aim of this study was to investigate whether reporting outcomes for abdominal aortic aneurysm (AAA) surgery impacts on the number and risk profile (level of fitness) ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2017.0005
更新日期:2017-02-01 00:00:00
abstract::Pseudoaneurysm is a rare complication of surgery or trauma around the knee. A 30-year-old man presented 10 days following anterior cruciate ligament repair with a 2 cm pulsatile swelling on the medial side of the knee. Angiography demonstrated a pseudoaneurysm of the medial inferior genicular artery. Surgical explorat...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Ureteric lithiasis is a common urological problem in Kuwait. Because of the different interventional approaches, we carried out an audit on the morbidity associated with the surgical management of the disorder. PATIENTS AND METHODS:The surgical records were reviewed of all patients with the diagnosis of ure...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588403769162477
更新日期:2003-09-01 00:00:00
abstract::This is a report of a 2-year experience with the management of penetrating injury of the cervical trachea. There were 29 cases. The respiratory status of the patient on admission dominated the initial management: 12 patients required emergency intubation and were immediately taken to operation, while 17 patients were ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1997-05-01 00:00:00
abstract::The effects on pelvic visceral function of radical operations for carcinoma of the lower part of the rectum and of operations for inflammatory bowel disease have been determined by studying bladder, sexual and rectal function. Denervation of the bladder was diagnosed in 15% of patients who had undergone sphincter-savi...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1984-01-01 00:00:00
abstract:INTRODUCTION:Complications of epidural catheterisation can cause significant morbidity. Epidural abscess following epidural catheterisation is rare and the reported incidence is variable. The purpose of this study was to review the incidence of epidural abscess in patients undergoing open abdominal aortic aneurysm (AAA...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588410X12518836438886
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Admission for overnight or longer hospital stay from a day-case unit is an unwelcome event. This audit was designed to identify the incidence of unplanned admissions and also to detect the potential factors for such overstays. PATIENTS AND METHODS:Details of plastic surgical day-case patients were obtaine...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588405X60560
更新日期:2005-11-01 00:00:00
abstract::A prospective survey was carried out in West Dorset to determine the incidence of postoperative wound infection. A total of 1242 patients were included in the survey (1086 inpatients and 156 day cases). The overall infection rate was 6.7%. Although the incidence of infection was consistent with that reported by other ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1990-05-01 00:00:00
abstract::The prevalence of HIV in the UK has been estimated to be 1 in 1000 of the population. Surgeons are at particular risk of occupational transmission from infected blood. To determine the effect of HIV on surgical practice we sent a questionnaire to 681 general surgeons in England and Wales; 450 replied (66%). Of those w...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1990-09-01 00:00:00
abstract:INTRODUCTION:The aim of this study was to identify whether clinicians are obtaining a valid consent for surgery, and ascertain the parents' perception of parental responsibility when giving consent for their children. PATIENTS AND METHODS:Adults consenting for 100 children were questioned about the possession of paren...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588407X205332
更新日期:2007-09-01 00:00:00
abstract::During a 10-year period (December 1984 to December 1994), 1500 cases of frostbite were treated at a tertiary care medical facility. They were all males with their ages ranging from 17 to 43 years. All the patients sustained the frostbite injury in the northeastern part of Pakistan known as the Karakoram range of mount...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1998-03-01 00:00:00
abstract::Analysis of the primary fellowship results showed that on average candidates were scoring a significantly higher mark in the MCQ than in the essay or viva. The level of MCQ marking has therefore been reset to the standards of the other parts of the examination. The need for continually monitoring the results of all ex...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract::Jehovah's Witnesses do not permit the use of allogeneic blood products. An increasing number of patients are refusing blood transfusion for non-religious reasons. In addition, blood stores are decreasing, and costs are increasing. Transfusion avoidance strategies are, therefore, desirable. Bloodless surgery refers to ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:10.1308/1478708051414
更新日期:2005-01-01 00:00:00
abstract::Thyroidectomy is associated with certain known complications, including recurrent laryngeal or superior laryngeal nerve injury and hypocalcaemia due to hypoparathyroidism. Other much rarer complications include oesophageal injury with oesophageal fistula formation. In this report, we describe the clinical course of a ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588414X13946184902640
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:For patients with gastric cancer intraoperative macroscopic serosal change is not always consistent with pathological T stage. We investigated whether macroscopic serosal change is associated with unfavourable prognosis of patients with gastric cancer. METHODS:We reviewed 856 patients with stage T3 gastric ...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2018.0217
更新日期:2019-04-01 00:00:00
abstract::The results of the secretin-pancreozymin test, duodenal aspirate cytology and hypotonic duodenography (the Triple Test), performed during a single duodenal intubation in patients with pancreatic or ampullary carcinoma, chronic pancreatitis and non-pancreatic disease were analysed retrospectively. Thirty-five of 36 car...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1983-05-01 00:00:00
abstract::Retroperitoneal abscesses can be gastrointestinal, urological or vascular in origin, and can spread via the retrofascial compartment through the psoas muscle to the lower limb. We describe the case of a 73-year-old woman with right knee pain for three weeks, a cellulitic right thigh and cholestatic liver function test...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/rcsann.2020.0137
更新日期:2020-11-01 00:00:00
abstract::This report is based on a Hygienist Panel Meeting held at St Anne's Manor, Wokingham on 24-25 June 2009. The panel agreed that greater use should be made of antiseptics to reduce reliance on antibiotics with their associated risk of antibiotic resistance. When choosing an antiseptic for clinical use, the Biocompatibil...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 共识发展会议,杂志文章
doi:10.1308/003588410X12699663905276
更新日期:2010-09-01 00:00:00
abstract:INTRODUCTION:The national abdominal aortic aneurysm (AAA) screening programme measures internal wall diameter; however, current UK intervention criteria use external wall diameter. Our aim was to determine the clinical significance of the difference between these two measurements. PATIENTS AND METHODS:Fifty patients o...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588410X12699663903430
更新日期:2010-09-01 00:00:00
abstract::Pain arising from the abdominal wall has been implicated as a cause of non-specific abdominal pain (NSAP), and the presence of abdominal wall tenderness (AWT) has been proposed as an accurate diagnostic test for NSAP. One hundred and fifty eight patients admitted to hospital with abdominal pain were tested for the pre...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1988-07-01 00:00:00
abstract::We report a 91% accuracy with fine needle aspiration cytology in 46 patients found to have a mass in the pancreas at laparotomy. Results were compared with conventional biopsy at operation which was accurate in only 56% of an earlier group of 48 patients with a localised mass compared with 97% in 33 patients with diss...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract:INTRODUCTION:Suspected testicular torsion (TT) is a surgical emergency, usually requiring urgent scrotal exploration. Provision of urology on-call cover varies widely between hospitals and often falls under the remit of the general surgical team. The purpose of this study was to investigate whether the management of su...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,多中心研究
doi:10.1308/003588410X12771863937007
更新日期:2010-11-01 00:00:00
abstract::Oesophageal cancer is an increasingly common disease in the UK. Sadly, the overall results of treatment remain poor with overall 5 year survival of approximately 10%. More than 50% of patients receive purely palliative care from the outset. Of those having potentially curative treatment, 40% will not survive the first...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章,评审
doi:
更新日期:1999-11-01 00:00:00
abstract::We describe three cases that presented with symptoms suggestive of appendicitis but were found at operation to have an inflamed solitary caecal diverticulum. All were treated successfully with diverticulectomy or inversion of the diverticulum. We wish to highlight this diagnosis and its surgical management so that inf...
journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
doi:10.1308/003588406X149336
更新日期:2006-11-01 00:00:00