[Show abstract][Hide abstract] ABSTRACT: Acute cholangitis (AC) and especially suppurative cholangitis due to biliary lithiasis is an emergency situation that requires urgent biliary decompression. The aim of the study is to present our policy for the treatment of AC due to choledocholithiasis, endoscopically.
In a 4-year period, 71 patients presenting AC, due to lithiasis, underwent endoscopic retrograde cholangio-pancreatography and endoscopic sphincterotomy (ES). All patients had fever, jaundice, abdominal pain, and in case of suppurative cholangitis hemodynamic instability. Most of them seemed to be high-risk candidates for surgery.
Forty-nine patients had AC and 22 patients had acute obstructive suppurative cholangitis (AOSC). ES (conventional or needle-knife biliary fistulotomy) was successful in 69 out of 71 (97%) patients. Two patients were eventually operated and were excluded from statistical analysis. Fifty of the 69 patients (72%) had a complete bile duct clearance in 1 session. Conventional ES, complete bile duct clearance, and other endoscopic maneuvers (balloon, basket, lithotripsy) were significantly more frequent in the AC group (P<0.001). Needle-knife biliary fistulotomy, and stent insertion were significantly more frequent in the AOSC group (P<0.001). Endoscopical treatment had low morbidity and total hospital stay time.
ES is the procedure of choice for the treatment of AC offering definite treatment with low morbidity and short hospitalization. Urgent biliary decompression with minimal endoscopic maneuvers is crucial for the outcome of patients having AOSC.
[Show abstract][Hide abstract] ABSTRACT: Endoscopic sphincterotomy (ES) is widely used for the treatment of residual bile duct stones in patients who had common bile duct (CBD) exploration and T-tube insertion.
In a 4-year period 45 patients were referred for endoscopic removal of residual bile duct stones. All patients had been operated 7-15 days earlier for choledocholithiasis and had a T-tube in the common bile duct (CBD).
Four patients were excluded. Three patients had a periampullary carcinoma and the fourth patient had no residual stone seen at cholangiography. All patients had a successful ES, conventional in 34, precut-knife in 3, and with the rendezvous technique in 4 patients. In 24 patients, all having stones distal to the T-tube, complete clearance of the CBD was achieved during one session and the T-tube was removed after 48 h. In the remaining 17 patients (15 having stones proximal to the T-tube), the T-tube had to be removed first and following stone extraction, a plastic stent was inserted in the CBD. Complete bile duct clearance and stent removal was achieved in a second session 3-4 weeks later. There were no serious complications or biliary related symptoms after the procedures and after a mean follow-up period of 18 months.
The endoscopic technique is safe and efficient for the treatment of residual stones after CBD exploration with a T-tube insertion, offering immediate cure compared to the percutaneous techniques. It is also an ideal method for the diagnosis of periampullary carcinomas.
Full-text · Article · Dec 2004 · Surgical Endoscopy
[Show abstract][Hide abstract] ABSTRACT: Quick detection of septicemia caused by yeasts and fungi is of critical importance for the patient. The most usual risk factors for the development of fungemia are: immunosuppression, neutropenia, prolonged intravenous catheterization, use of broad spectrum antibiotics, corticosteroid treatment, major surgical operations. Mycosis blood culture medium, used with the Bactec blood culture system, contains special nutrients that favour the growth of yeasts and fungi. In this study, 5400 Mycosis vials were checked within a period of two years. Blood was taken from patients with one or more risk factors mentioned above and inoculated into three blood culture vials for each patient: Aerobic, Anaerobic and Mycosis. The vials were then incubated in the BACTEC 9240 blood culture system. Fungi were detected in 27 cases (mainly Candida albicans), 12 of which were detected only by the Mycosis medium, while the other two vials, Aerobic and Anaerobic that were incubated simultaneously, were negative. The other 15 cases of fungemia were detected by both Mycosis and Aerobic or Anaerobic medium. Without the use of Mycosis fungi in blood would be detected in 7.5% of all positive blood cultures while with the use of this special medium this percentage is raised to 13.5%. Almost half of fungemia cases could not be diagnosed, a fact that makes Mycosis useful and important. The use of this special medium raises the cost for each patient. However, we consider that in hospitals with intensive care units, haematological departments, transplantation units there is certain indication for its use.
No preview · Article · Mar 2003 · Acta Microbiologica Hellenica
[Show abstract][Hide abstract] ABSTRACT: In our laboratory we tested 192 strains of 86 Gram (+) and 112 Gram (-) bacteria with PASCO MIC-ID System, VITEK System and API System as a reference method. Regarding API, the two above systems were found to identify Enterobacteriaceae 98,1% and non-fermenter bacteria 100% concerning the species Alcaligenes, Acinetobacter, Pasteurella, Stenotrophomonas. The VITEK system regarding API identified the Pseudomonas species 100% and the PASCO system identified the same species 60%. The VITEK system has an advantage over PASCO concerning firstly the time of identification and secondly the identification of Staphylococci and Streptococci, where we encountered difficulties in the identification, because of the heterogeny of Staphylococci and the general disagreement about the identification of Streptococci.
No preview · Article · Jan 2000 · Acta Microbiologica Hellenica
[Show abstract][Hide abstract] ABSTRACT: Systemic candidiasis consists a major problem for patients with certain predisposing factors: immunosuppression, transplantation, multiple injury, chemotherapy, corticosteroid therapy, premature birth are some of them. We studied Candida isolates from various clinics of our hospital within a period of six months. The yeast was found in blood, upper and lower respiratory duct (sputum, bronchoalveolar lavage), urine, stool pus and various excretions. The cases where Candida was considered to be colonisation were excluded and were not further evaluated. Specimens were inoculated in simple and selective substrates (Sabouraud with TTC) and incubated at 37°C for 1-7 days. Blood cultures were performed in Standard Aerobic and Mycosis culture vials in the Bactec 9240 System for 7-14 days. Identification and susceptibility tests followed, with the use of API and ATB Fungus (2-point method), by Bio Merieux. Candida was isolated in 122 cases, among which: 94 C. albicans (77%), 13 C. tropicalis (10,6%), 2 C. parapsilosis (1,6%), 2 C. lusitaniae (1,6%), 2 C. famata (1,6%) and 9 other various species (7,4%). Their distribution among the departments was: 40% at the Intensive Care Units, 25% at the Internal Medicine, 19,5% at the General Surgery and 15,5% at the Haematology Department. Their resistance to various antifungal agents, measured by the two-point test by Bio Merieux, was as follows: for C. albicans 7,4% to Amphotericin B, 11,7% to Flukytocine, 38% to Ketokonazole, 21% to Mikonazole, 40% to Ekonazole and 1% to Nystatine. Our results show that, in accordance with similar studies, C. albicans is the predominant microorganism among yeast infections and has low resistance to Amphotericin B. Resistance of Candida species to antifungal agents is pointed out.
No preview · Article · Jan 2000 · Acta Microbiologica Hellenica