Invasive treatment of pancreatic fluid collections with surgical and nonsurgical methods

Article Abstract:

Patients with pancreatitis (inflammation of the pancreas) may develop pancreatic fluid collections; these collections of fluid are usually treated before complications can develop. Surgical drainage or resection has been the traditional surgical treatment, although there is the risk of significant complication or death. Newer, invasive but nonsurgical techniques have been developed, as radiologic or endoscopic guided percutaneous (through the skin) drainage. The medical records of 114 patients with the possible diagnosis of pancreatic fluid collection were studied to determine which groups of patients would benefit from these new techniques. Sixty-five patients underwent at least one drainage procedure; there were 35 men and 30 women with an average age of 54.6 years. Eighty percent of the patients were initially treated without surgery. The average time from diagnosis to procedure was 35 days. Fifty-nine patients were followed for an average of 10.2 months after the drainage procedure. Of these patients, 25 had nonsurgical drainage, 22 had nonsurgical drainage plus surgery, and 12 had only surgery. The nonsurgical drainage only group had 20 percent morbidity, 8 percent mortality and 92 percent successful drainage. The nonsurgical drainage plus surgery group had 20 percent morbidity, 5 percent mortality and 82 percent success rate. The surgery only group had 24 percent morbidity, no deaths, and an 83 percent success rate. It is concluded that nonsurgical drainage techniques are useful in managing patients with pancreatic fluid collections. In particular, patients with pancreatitis not related to alcohol use or to the biliary tract and without a cyst wall identifiable by X-ray tend to benefit from these nonsurgical techniques. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Pancreas, Drainage, Surgical, Drainage (Surgical), Pancreatitis, Pancreatic secretions

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Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection

Article Abstract:

For the treatment of early breast cancer, tylectomy (simple removal of the tumor, or lumpectomy) with removal of the axillary (arm pit) lymph nodes and radiation therapy is an accepted alternative to modified radical mastectomy (breast removal). These two methods of treatment have resulted in equal survival rates after five and eight years. A study was undertaken to compare the rates of wound complications following these two operations, and to identify possible risk factors for the development of wound complications. Medical records of 560 patients were reviewed; 387 underwent modified radical mastectomy and 173 underwent lumpectomy and axillary node dissection with radiation. The rates of infection, hematoma (swelling filled with blood), seroma (collection of blood serum), and epidermolysis (loosening of the outer layer of skin) were determined. The results indicated a higher rate of wound complications in the modified radical mastectomy group than in the lumpectomy group (49 percent versus 35 percent). Seromas developed in 29 percent of the mastectomy group compared with 18 percent of the lumpectomy group, and epidermolysis occurred in 18 percent of mastectomy patients and did not occur in any lumpectomy patients. In the mastectomy group, patient age of 60 or older was associated with a higher incidence of seroma, and smoking was associated with a higher incidence of epidermolysis. In the lumpectomy group, wound infection was associated with obesity. These results indicate that lumpectomy is as safe as modified radical mastectomy with respect to wound complications, and lumpectomy has a lower risk of seroma and epidermolysis than does modified radical mastectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Breast cancer, Lymph nodes, Mastectomy, Lumpectomy, Lymph node excision

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Cholecystectomy provides long-term symptom relief in patients with acalculous gallbladders

Article Abstract:

Positive conformation of stones in the gallbladder must often wait until the patient undergoes surgery for removal of the organ (cholecystectomy). The surgeon can be faced with a situation where the operation has been performed on a patient with signs indicating stones prior to surgery, but gallstones are not found. Alternatively, a patient may have stones that are not diagnosed before surgery. To determine the effect of cholecystectomy on patients with biliary colic (pain of the sort usually caused by gallstones), but without gall stones, a review of the records of 60 patients (average age, 48) who had undergone elective cholecystectomy was carried out. These patients had been operated upon to prevent biliary colic. Long-term relief of symptoms was evaluated by means of a questionnaire or telephone interview. Several kinds of preoperative assessment, including ultrasonography (US), upper gastrointestinal series, and other examinations, had been performed. Results showed a 6 percent complication rate and no deaths. Of the 43 patients available for follow-up, 34 reported complete symptom relief. The remaining nine subjects reported partial or no relief. Disease of the gallbladder wall was more common in patients without stones than in a group with similar symptoms who also had stones. Although preoperative testing is useful for selecting cholecystectomy candidates, a complete history of biliary colic remains the best way to predict successful patient outcome with this procedure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Physiological aspects, Gallstones, Gallbladder diseases, Cholecystectomy, Gallbladder

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