Magyar sebeszet最新文献

Introduction. A preoperative biliary stent is often inserted because of obstructive jaundice due to pancreatic head tumour. However, it can also be the source of complications too. Aim and method. We retrospectively analyzed our operations which were performed between 01.10.2017 and 31.12.2019 for pancreatic tumour in association with stent related mortality and morbidity. The multiresistant bacteria and the spectrum of microorganism of intraoperative bile samples were investigated. Results. 82 patients were operated on with pancreatic tumour. There were 63 pancreatic head resections, and 19 palliative operations. 63 pancreatic head resections were analyzed. There were 36 open and 27 laparoscopic operations. Extended operation was needed in 12 cases (5 portal vein resections, 2 splenectomies, 1 right hepatolobectomy, 1 right hemicolectomy, 2 liver metastasectomies and 1 hepatic artery resection). The average age of 36 stented patients of which 24 were men and 12 women were 65 and 64 years respectively. The average age of 27 non-stented patients of which 14 were men and 13 were women, were 67.9 and 58 years respectively. The bile culture proved to be positive 30/36(83%) in the stented group and 13/27(48%) in the non-stented group (P = 0.005). The 3 most common bacteria were E coli, Enterococcus fecalis and Klebsiella pneumoniae in both groups followed by the yeast of Candida. 8 multiresistant bacteria were noticed in the stented group. 6 were ESBL producing (P = 0.033) and 2 vancomycine resistant (P = 0.5) bacteria. 3 patients of the stented group and 2 patients of the non-stented group were lost during the first 30 days. There were 4/0 wound infections, 6/2 haemorrhages, 2/2 pancreatic fistulas, and 2/3 abdominal abscesses in the stented vs. non stented groups. The average length of stay was 19.47 days in the stented and 14.62 days in the non-stented groups (P = 0.14). Conclusion. With regard to the fact that biliary stent changes the bacterial flora it is important to choose the proper antibiotic prophylaxis to reduce morbidity. On the basis of our own results and the literature an effective antibiotic therapy is suggested against enterococcus and ESBL producing bacteria. The prophylaxis against yeast in particularly in immunocompromised cases should also be considered. Regular antibiotic resistance check-up is essential.

Introduction: The brachial artery aneurysm is a rare condition that accounts for 5% of peripheral aneurysms. Most are pseudoaneurysms that develop as a result of iatrogenic exposure or trauma. True brachial aneurysm can develop after an occluded dialysis fistula. The causes leading to this development are unclear, but steroid-containing and immunosuppressive drugs used after kidney transplantation, as well as increased flow during fistula function and increased mechanical effects on the vessel wall, may play a role. The authors report the case of a 43-year-old patient who underwent two kidney transplants and was hospitalized for acute left arm ischemia. Imaging studies (angiography, CT angiography) confirmed left brachial aneurysm and dilatation of the thrombotic venous stem of the previous brachiocephalic arteriovenous (AV) fistula, and peripheral embolization. The patient was successfully treated in our hospital with the involvement of several subspecialties. The outflow pathway was opened by minimally invasive catheter thrombolysis, the source of embolism was eliminated by conventional vascular surgery, aneurysm ligation, resection of occluded dilated venous stem, and autologous venous saphenous bypass. By describing the case, the authors would like to draw attention to the complex mindset leading to successful treatment.