Outcome of percutaneous drainage for septic complications coexisted with COVID-19

BACKGROUND The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019(COVID-19)combined with viral load,and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.AIM To describe the clinical,radiological,and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their postprocedural outcomes.METHODS This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications.The mean age±SD of the patients was 48.5±14 years(range 30-72 years).Three patients underwent cholecystostomy for acute acalculous cholecystitis.Percutaneous drainage was performed in seven patients;two peripancreatic collections;two infected leaks after hepatic resection;one recurrent hepatic abscess,one psoas abscess and one lumbar abscess.One patient underwent a percutaneous nephrostomy for acute pyelonephritis.RESULTS Technical success was achieved in 100%of patients,while clinical success was achieved in 4 out of 11 patients(36.3%).Six patients(54.5%)died despite proper percutaneous drainage and adequate antibiotic coverage.One patient(9%)needed operative intervention.Two patients(18.2%)had two drainage procedures to drain multiple fluid collections.Two patients(18.2%)had repeat drainage procedures due to recurrent fluid collections.The average volume of the drained fluid immediately after tube insertion was 85 mL.Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients.There was no significant statistical difference(P=0.6 and 0.4)between the mean of WBCs and neutrophils count before drainage and seven days after drainage.The lymphocyte count shows significant increased seven days after drainage(P=0.03).CONCLUSION In this study,patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.

Surgical Treatment of Giant Cavernous Hepatic Haemangiomas

Background: Haemangiomas are the most common benign liver tumors. Treatment is indicated for symptomatic tumors, rapid increase in size, rupture or doubt in diagnosis. Objective: Evaluation the efficacy of surgical treatment of giant cavernous hepatic haemangioma in tertiary hepatobiliary center. Patients and Methods: Retrospective study of 34 patients with giant hepatic haemangioma operated upon. The diagnosis was proved preoperatively in 27 patients and confirmed by histopathology postoperatively in all patients. The indication of surgery was abdominal pain with large sizes tumors, rapid growth, and spontaneous rupture with haemoperitoneum. Surgical treatment either liver resection or living liver transplantation. Results: 23 cases (67.6%) were females & 11 cases (32.4%) were males, median age 38.8 years. Haemangiomas located in right lobe in 19 patients (55.9%), left lobe in 12 patients (35.4%) in both lobe in 2 patients (5.8%), scattered all over both lobe in one patient (2.9%), solitary in 27 cases (79.4%) and multiple in 7 patients (20.6%). The diameter was 8 - 27 cm, mean 18.6 cm in diameter. 33 patients had liver resection (29 elective resection and 4 emergent resection for rupture). One patient had haemangioma irresectable;the living liver transplant was performed. No mortality during 18 months follow up and complication occurred in 8 patients out of 34 patients. Conclusion: Hepatic resection is an effective treatment option for giant cavernous hepatic haemangioma, in selected patient living related liver transplantation may be the only therapeutic option.

Major Hepatic Resection in Hepatic Hydatidosis

Background: Ecchinococcal disease is still a serious problem in certain parts of the world, with liver as the most affected organ. Surgery remains the mainstay of treatment of hydatidosis, but the optimal surgical procedure remains unsettled. Objective: Safety and efficacy of major hepatic resection in multiple and giant hepatic hydatidosis. Patients & Methods: 63 patients had hepatic hydatidosis associated with spleen, lung, and suprarenal hydatidosis were managed by major hepatic resection between April 2005 to April 2011. 43 (68%) males and 20 (32%) females, age range 8 - 56 years. Cysts were found in the liver only in 51 (81%) patients, liver with spleen in 5 (8%), liver, spleen with lung in 2 (3.1%), liver and lung in 4 (6.3%), liver and suprarenal in one patient (1.6%). Results: Multiple cysts were found in 38 (60%) and solitary cyst in 25 (40%) with Cysts diameter ≤5 cmin 22 (35%), 5 - 10 cm in 16 (25%), and 10 - 38 in 25 (40%). Right hepatectomy in 24 (38%), right trisectionectomy in 2 (3.2%), right hepatectomy with Segment III in 4 (6.3%), right hepatectomy with Segment I in 2 (3.2%), left hepatectomy in 12 (19%), left lateral sectionectomy in 6 (9.5%), left hepatectomy with Segment VI in 3 (4.8%), left lateral sectionectomy with right posterior sectionectomy in 2 (3.2%), right hepatectomy with splenectomy in 7 (11%) and right hepatectomy with right suprarenal in one (1.6%) patient were performed. Hospital stay was 4.2 (3 - 13 days) There was one mortality and 12 (19%) morbidities. No recurrence on follow up period (8 - 60 months) was observed. Conclusion: Radical procedure is safe and effective option for hepatic hydatidosis and should be performed when the entire lobe is diffusely involved by huge or multiple hydatidosis with little healthy liver tissue.

Use of gadobenate dimeglumine dynamic MRI for detection of early hepatocellular carcinoma in atypical hepatic focal lesions

Aim: Gadobenate dimeglumine (multihance) is a contrast medium which can be used not only as an extracellular contrast agent for dynamic imaging of the liver, but also as a liver specific agent for the acquisition of hepatobiliary-phase images which are more helpful in evaluation of small atypical hepatic focal lesions equal or less than 3 cm. The authors tried to evaluate multihance dynamic magnetic resonance imaging (MRI) as a new modality in early detection of hepatocellular carcinoma (HCC). Methods: Thirty cirrhotic patients with small hepatic focal lesions (less than 3 cm in diameter), detected by imaging (ultrasound and triphasic computed tomography) were subjected to dynamic MRI with multihance contrast. All patients had a liver biopsy stained with heat shock protein 70, glypican 3, and glutamine synthetase to confirm the diagnosis of HCC. Results: Eight out of 30 patients (26.6%) with atypical focal lesions proved to have HCC by histology, whereas 7 out of 8 histologically proven HCC patients (87.5%) were shown to have typical criteria on Multihance imaging. Conclusion: Multihance dynamic MRI is a promising diagnostic modality for detection of early HCC, however, future studies on large numbers of patients are warranted to precisely detect the sensitivity and specificity of this new modality.

Association of serum levels of epidermal growth factor with disease severity in patients with unresectable hepatocellular carcinoma

Aim:Epidermal growth factor(EGF)is a mitogen for hepatocyte grown in vitro,and its expression is up-regulated during liver regeneration.EGF also plays an important role in tumor initiation and progression.The goal of this study is to assess whether EGF is associated with advanced hepatocellular carcinoma(HCC)and also whether it is a predictive factor of shortened survival.Methods:Serum EGF levels were evaluated in a total of 151 subjects:51 patients with unresectable HCC,(21 of them were eligible for transarterial chemoembolization(TACE)and serum EGF levels were measured before and 1 week after TACE),40 patients with chronic hepatitis without cirrhosis,40 patients with cirrhosis,and 20 healthy controls.Patient demographic and laboratory variables were evaluated as predictive factors of survival in a Cox regression multivariate analysis using SPSS software.Results:The mean serum level of EGF in patients with HCC was 784.49 pg/mL,which was significantly higher(P<0.05)than all other groups.Mean EGF level in cirrhotic patients was 144.69 pg/mL;in those with chronic hepatitis C without cirrhosis,it was 338.64 pg/mL;and in healthy controls,it was 297.15 pg/mL.In group Ia patients who underwent TACE,the mean serum level of EGF was 759.76±287.88 pg/mL before TACE,and 801.14±276.12 pg/mL 1 week after treatment(P=0.34).On multivariate Cox regression analysis only age(P=0.03)and higher serum EGF level(P=0.005),were inversely correlated with overall survival.Conclusion:EGF levels were found to be significantly higher in HCC patients and together with age were the only predictors of poor survival in these patients.There was an increase in EGF levels 1 week after TACE in response to hypoxia;however,this increase was not statistically significant.