Auckland Hospital Research Articles

Changing patterns of severe craniomaxillofacial trauma in Auckland over eight years.

This study was performed to review the changing pattern of incidence of severe craniomaxillofacial (CMF) trauma in Auckland over 8 years (1989-1997) and to audit the involvement of the regional plastic surgery service. A review of prospectively collected admission data of patients admitted to the Auckland Hospital Department of Critical Care Medicine (DCCM) with severe CMF trauma during 1997. A comparison is made with similar data from 1989. Injury severity was defined using the Injury Severity Score (ISS). Twenty-six patients with severe CMF trauma were admitted to Auckland Hospital DCCM in 1997. Their average ISS was 35. Eighty per cent had a significant head injury. Sixty-two per cent had injuries due to road traffic accidents (RTA) and 42% had positive blood alcohol levels, including 37% of the RTA victims. Twenty-three per cent had their surgical care provided by the regional plastic surgery service. In 1989, 55 patients were admitted to DCCM with severe CMF trauma. The average ISS was 36. Ninety-five per cent had a significant head injury. Seventy-three per cent had injuries due to RTA and 55% had positive blood alcohol, including 60% of the RTA group. Patients with severe CMF trauma make up a significant proportion of trauma admissions to DCCM and have a high incidence of life-threatening injuries. A multidisciplinary approach is essential. The nature and severity of these injuries has not changed over the last decade. There has been a clear decrease in the incidence of these injuries. This seems to be due to a profound decrease in the rate of RTA associated with alcohol intoxication.

Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study

Objective: To assess whether a raised serum troponin T concentration would be an independent predictor of death in patients with an acute ischaemic stroke.Design: Observational study.Setting: Auckland Hospital, Auckland, New...

Pre- and post-transplant treatment of hepatitis C.

Journal of Gastroenterology and HepatologyVolume 15, Issue s2 p. E187-E193 Pre- and post-transplant treatment of hepatitis C Edward Gane, Edward Gane NZ Liver Transplant Unit, Auckland Hospital, Auckland New ZealandSearch for more papers by this author Edward Gane, Edward Gane NZ Liver Transplant Unit, Auckland Hospital, Auckland New ZealandSearch for more papers by this author First published: 04 January 2002 https://doi.org/10.1046/j.1440-1746.2000.02125.xCitations: 2 Correspondence: DrEdwardGane Hepatologist, 10th Floor, Auckland Hospital, Park Road, Private Bag 92024, Auckland, NZ. Email: e.gane@auckland.ac.nz Read the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume15, Issues2May 2000Pages E187-E193 RelatedInformation

The place of THAM in the management of acidemia in clinical practice.

Acta Anaesthesiologica ScandinavicaVolume 44, Issue 5 p. 524-527 The place of THAM in the management of acidemia in clinical practice M. H:son Holmdahl, M. H:son Holmdahl Department of Anesthesiology, Uppsala University, SwedenSearch for more papers by this authorL. Wiklund, L. Wiklund Department of Anesthesiology, Uppsala University, SwedenSearch for more papers by this authorT. Wetterberg, T. Wetterberg King Faisal Research Center, Riyadh, Saudi ArabiaSearch for more papers by this authorS. Streat, S. Streat Department of Critical Care, Auckland Hospital, New ZealandSearch for more papers by this authorS. Wahlander, S. Wahlander Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this authorK. Sutin, K. Sutin Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this authorG. Nahas, G. Nahas Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this author M. H:son Holmdahl, M. H:son Holmdahl Department of Anesthesiology, Uppsala University, SwedenSearch for more papers by this authorL. Wiklund, L. Wiklund Department of Anesthesiology, Uppsala University, SwedenSearch for more papers by this authorT. Wetterberg, T. Wetterberg King Faisal Research Center, Riyadh, Saudi ArabiaSearch for more papers by this authorS. Streat, S. Streat Department of Critical Care, Auckland Hospital, New ZealandSearch for more papers by this authorS. Wahlander, S. Wahlander Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this authorK. Sutin, K. Sutin Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this authorG. Nahas, G. Nahas Department of Anesthesiology and Critical Care, New York University Medical Center, USASearch for more papers by this author First published: 12 July 2008 https://doi.org/10.1034/j.1399-6576.2000.00506.xCitations: 23Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume44, Issue5May 2000Pages 524-527 RelatedInformation

Modelling of cogeneration systems Part 3: Application of steam turbine cogeneration analysis to Auckland Hospital cogeneration utility system

Steam turbine cogeneration analysis (STuCA) is a quasi-static steam cogneration plant modelling tool, which has been developed and applied to the Auckland Hospital energy centre at Auckland, New Zealand. The STuCA code consists of four submodels, namely a load, a system, a plant and an economic model. The load model was developed using historical data and drove the system model, which consisted of heat exchangers. The system model output was then used to drive the plant model that modelled the turbine and boiler and predicted the primary energy flows and cash flows at the site. Economic analysis tools including thermodynamic, thermoeconomic and economic performance measures such as the payback period and the net present value used these data to analyse the economic performance measures such as the payback period and the net present value used these data to analyse the economic performance of the site. The STuCA model output correlated to site data to within 10 per cent and provided data that could be used by the economic analysis tools. The application of the STuCA model to the hospital site proved that it could be used to design cogeneration plants, to analyse retrofit, to upgrade proposals and to study the effects of changing site loads on plant performance.

“Happy Meals” in the Starship Enterprise: interpreting a moral geography of health care consumption

This paper extends earlier explorations of the use of metaphor in the marketing of the Starship Children's Hospital in Auckland, New Zealand, by examining controversy surrounding the opening of an in-hospital McDonalds fast-food outlet. The golden arches have become a key element of many children's urban geographies and a potent symbol of the corporate colonisation of the New Zealand landscape. In 1997 a minor moral panic ensued when a proposal was unveiled to open a McDonald's restaurant within the Starship. Data collected from media coverage, advertising and interviews with hospital management are analysed to interpret competing discourses around the issue of fast food within a health care setting. We contend that the introduction of a McDonald's franchise has become the hospital's ultimate placial icon, adding ambivalence to the moral geography of health care consumption. We conclude that arguments concerning the unhealthy nature of McDonald's food obscure deeper discourses surrounding the unpalatable character of the health reforms, and a perceived ‘Americanisation’ of health care in New Zealand.

Analyzing Prior Clinical Events at Presentation in 102 Women With Vulvar Carcinoma: Evidence of Diagnostic Delays

To investigate the conditions leading to development of vulvar carcinoma, the authors prospectively studied 102 patients with squamous cell carcinoma of the vulva who were seen in the gynecologic oncology clinic at National Women’s Hospital in Auckland, New Zealand. They were all evaluated by a single investigator, who obtained a detailed patient history and reviewed all previous medical records. Two of the 102 women, both >90 years old, were unable to give a reliable history and were not included in the study. Of the remaining 100 patients, 43 had stage I disease, 27 had stage II, 22 had stage III, and none had stage IV carcinoma (classified according to International Federation of Gynaecological and Obstetrics criteria). Twenty women were <50 years old, 43 were between 50 and 75 years of age, and 43 were >73 years old. Eighty-eight percent of the women reported experiencing vulvar symptoms for at least 6 months; these symptoms had been present for >5 years in 28 percent of the patients. Almost all (94 percent) of the patients reported a history of intermittent or constant vulvar irritation. Abnormal skin adjacent to the tumor was seen in 85 percent of the women. Thirty-one women had sought medical treatment for their vulvar symptoms at least three times >6 months before the cancer was diagnosed. Twenty-seven had been treated with topical estrogen or corticosteroids, and 25 had previously undergone biopsy. The patients who had undergone biopsy were significantly more likely to present with stage I disease (17 of 27, 68 percent) than those who had never undergone biopsy (26 of 73, 33 percent) (P < .01). Patient age was not associated with the duration of symptoms, length of clinical history, or number of medical consultations before diagnosis. J Reprod Med 1999;44:766–768

Lateral venous sinus thrombosis associated with MRI abnormalities in the mastoid air sinus.

P45 Background: Lateral venous sinus thrombosis can be associated with mastoiditis. We encountered several cases of lateral sinus thrombosis associated with MRI abnormalities in the ipsilateral mastoid air sinus that had no clinical evidence of mastoiditis. The relationship between lateral sinus thrombosis and mastoid abnormalities was evaluated systematically. Method: The clinical records and radiology of all adult cases of cerebral venous sinus thrombosis (CVT) diagnosed or treated at Auckland Hospital 1990–1999 were reviewed retrospectively. Results: Twenty-six cases of CVT were identified. Thrombosis was present in 23 lateral sinuses in 20 cases. Mastoid abnormalities were detected ipsilateral to nine of 23 thrombosed lateral sinuses (39%) and were associated with none of 29 unaffected lateral sinuses (p Conclusion: Lateral venous sinus thrombosis is commonly associated with ipsilateral MRI abnormalities in the mastoid air sinus. These abnormalities are most likely to be due to venous congestion as a consequence of venous thrombosis and do not inevitably represent infective mastoiditis. Patients presenting with lateral sinus thrombosis and mastoid congestion should have a thorough clinical assessment for the presence of mastoiditis. When there is no clinical evidence of infection, treatment should be directed at the underlying cerebral venous thrombosis; additional treatment with antibiotics is not required.

Factors associated with the duration of breastfeeding

A cohort study of healthy term infants was conducted to identify factors associated with breastfeeding duration. Three hundred and fifty mothers delivering in one obstetric hospital in Auckland, New Zealand were recruited. Ninety‐five percent were followed up until 1 y. Breastfeeding was initiated by 97.4%, the median duration of breastfeeding was 7.6 mo, and 30% were continuing some breastfeeding at 12 mo. Adjusted risk ratios for shorter duration of breastfeeding were: maternal age &lt; 25 y, 2.33 (95% confidence interval = 1.33, 4.05); maternal age 25–34, 1.45 (1.01, 2.09) compared to maternal age ≥ 35; planning to cease breastfeeding ≤ 6 mo, 2.39 (1.65, 3.46); planning to breastfeed for as long as possible, 1.48 (1.00, 2.18), or not knowing plans 2.13 (1.36, 3.32) when compared to planning to cease breastfeeding after 6 mo; inverted nipples, 2.02 (1.26, 3.23), daily dummy use 1.62 (1.20, 2.18) or use of formula in the first month 2.79 (2.05, 3.80). Reporting mastitis, 0.67 (0.48, 0.94), and sharing the mother's bedroom at 3 mo, 0.69 (0.51, 0.92) were associated with a reduced risk for shorter duration of breastfeeding. We recommend that during the antenatal period attention be directed at mothers' plans for duration of breastfeeding, that mothers be encouraged to have their baby in their bedroom, and that the use of formula and dummies should be discouraged in the first months of life.

Cholecystostomy: a review of recent experience.

Operative (OC) and percutaneous cholecystostomy (PC) are rarely undertaken for severe acute cholecystitis in patients in whom cholecystectomy is technically difficult or those with significant comorbidity. A retrospective review was undertaken of the clinical, radiological and audit records of patients who were treated by cholecystostomy between 1988 and 1997 at Auckland Hospital. During the 10-year period 19 patients (eight male, 11 female; median age: 70 years, range: 35-90 years) had a cholecystostomy (OC: n = 8; PC: n = 11). The main indication for PC was high anaesthetic risk (10 cases). The main indication for OC was failed cholecystectomy (six cases). The patients undergoing PC tended to have a higher American Society of Anesthesiologists (ASA) grade than patients undergoing OC. The median delay from presentation to cholecystostomy was 3 days. More than half (11/19) were done during the 3 years (1992-94) after the introduction of laparoscopic cholecystectomy. The number of tube-related complications was significantly higher in PC patients (10/11 vs 3/8; P = 0.04), and the number of systemic complications was higher in the OC patients (4/8 vs 0/11; P = 0.018). The median duration of tube drainage was 17 days (range: 0-82 days) for OC and 24 days (range: 5-93 days) for PC. Four patients had stone extraction at the time of OC, including two who also had a partial cholecystectomy. One OC patient had stone extraction via the cholecystostomy tract. A cholecystectomy was performed in four patients. The data indicate that PC is a safe approach for high-risk patients. Operative cholecystostomy had a role following failed cholecystectomy. But PC might be safer in these patients if they could be identified pre-operatively.

Isolated pulmonary oedema associated with SCUBA diving

AbstractPulmonary oedema may be a presenting feature of the classical diving illnesses decompression illness and barotrauma, but it may also present as an isolated phenomenon. Possible causes include: salt water aspiration syndrome or near drowning (sometimes associated with faulty apparatus); and cold, immersion and exercise‐induced pulmonary oedema. The pathophysiology may involve peripheral vasoconstriction; changes in preload, afterload and circulating fluid volume; and pulmonary capillary fragility. A case that presented to Auckland Hospital is discussed, together with a review of the literature. In this case, treatment with continuous positive airway pressure ventilation proved highly effective. Guidelines for the use of continuous positive airway pressure ventilation in diving‐related accidents are presented.

Treatment of peritoneal dialysis related peritonitis--an Australian and New Zealand perspective.

Australian and New Zealand Journal of MedicineVolume 29, Issue 4 p. 552-555 Treatment of peritoneal dialysis related peritonitis—an Australian and New Zealand perspective B. F. MURPHY, Corresponding Author B. F. MURPHY Director of Nephrology, St Vincent's Hospital, Melbourne, VicDepartment of Nephrology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic. 3065.Search for more papers by this authorD. C. H. HARRIS, D. C. H. HARRIS Associate Professor of Medicine, Westmead Hospital, Sydney, NSWSearch for more papers by this authorA. DISNEY, A. DISNEY Deputy Director of Nephrology, Queen Elizabeth Hospital, Adelaide, SASearch for more papers by this authorL. S. IBELS, L. S. IBELS Director of Nephrology, Royal North Shore Hospital, Sydney, NSWSearch for more papers by this authorD. SALTISSI, D. SALTISSI Director of Nephrology, Royal Brisbane Hospital, Brisbane, QldSearch for more papers by this authorR. RIGBY, R. RIGBY Deputy Director of Nephrology, Princess Alexandra Hospital, Brisbane, QldSearch for more papers by this authorM. SURANYI, M. SURANYI Director of Nephrology, Liverpool Hospital, Sydney, NSWSearch for more papers by this authorJ. COLLINS, J. COLLINS Director of Nephrology, Auckland Hospital, Auckland, NZ.Search for more papers by this author B. F. MURPHY, Corresponding Author B. F. MURPHY Director of Nephrology, St Vincent's Hospital, Melbourne, VicDepartment of Nephrology, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Vic. 3065.Search for more papers by this authorD. C. H. HARRIS, D. C. H. HARRIS Associate Professor of Medicine, Westmead Hospital, Sydney, NSWSearch for more papers by this authorA. DISNEY, A. DISNEY Deputy Director of Nephrology, Queen Elizabeth Hospital, Adelaide, SASearch for more papers by this authorL. S. IBELS, L. S. IBELS Director of Nephrology, Royal North Shore Hospital, Sydney, NSWSearch for more papers by this authorD. SALTISSI, D. SALTISSI Director of Nephrology, Royal Brisbane Hospital, Brisbane, QldSearch for more papers by this authorR. RIGBY, R. RIGBY Deputy Director of Nephrology, Princess Alexandra Hospital, Brisbane, QldSearch for more papers by this authorM. SURANYI, M. SURANYI Director of Nephrology, Liverpool Hospital, Sydney, NSWSearch for more papers by this authorJ. COLLINS, J. COLLINS Director of Nephrology, Auckland Hospital, Auckland, NZ.Search for more papers by this author First published: 25 March 2008 https://doi.org/10.1111/j.1445-5994.1999.tb00757.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume29, Issue4August 1999Pages 552-555 RelatedInformation

Use of complementary treatment by those hospitalised with acute illness

AIMTo determine the frequency of use of complementary treatment and measure its impact on clinical outcomes in a hospitalised general paediatric population.METHODSA population based random sample of children admitted to...

Adult splenic injuries: treatment patterns and predictive indicators.

With the trend towards conservation in splenic trauma, the ability to identify a group of patients for whom we can safely offer conservative treatment becomes an important factor. Data were reviewed from the trauma register at the Auckland Hospital, Auckland, New Zealand, in an attempt to isolate any predictive factors that may allow more appropriate allocation of treatment modalities in the future. Methods of treatment were determined and the success or failure of conservative management noted. Differences in the demographics, Injury Severity Score (ISS) and computed tomographic (CT) findings were particularly sought. Over a period of 111 weeks 48 patients were admitted with splenic injuries. Fifteen (31.2%) had immediate splenectomy, 27 (56.2%) were initially treated non-operatively and six (10.1%) died pre-operatively. Of the non-operative group eight (29.6%) failed this management at an average of 4.125 days into their hospital stay. No differences were found in age, mechanism, gender or ISS between the failed and successfully treated group. Using the Buntain classification of CT-graded splenic injury, 13 (87%) who had successful non-operative treatment had a grade II or III compared with six (86%) who failed this management being grade IV. Although these results did not reach statistical significance, by coupling the trends seen together with other work, CT grading of splenic injury is a predictive indicator and does appear to have a role in the early allocation of patients to appropriate treatment plans.

To Boldly Go? Place, Metaphor, and the Marketing of Auckland's Starship Hospital

In this paper, we place the naming of the Starship Children's Hospital in Auckland, New Zealand, within the context of increasingly consumer-oriented health care provision. This use of metaphor alludes to the hospital's distinctive design features and represents an attempt to de-emphasise connotations associated with institutionalised medicine, thus normalising the place for children. However, those naming the hospital had more than children in mind. Rather, there was a dual intent: to market the hospital as a distinctive place for monetary donors, as well as promoting a more therapeutic environment for youthful users. Through the vehicle of our case study, we raise questions concerning the competition by health care services for public and private funds. We conclude that there is a need to move beyond viewing hospitals as service entities and equating health care consumption with utilisation behaviour. Rather, a merging of insights from the political economy of health care and new cultural geography literatures can aid the development of more finely textured understandings of the meaning of contemporary health care, and the role of metaphor and marketing in selling places of health care consumption.

Atrial fibrillation: prevalence and management in an acute general medical unit.

Atrial fibrillation (AF) is a common comorbid condition in patients admitted to hospital. In managing patients with AF, recent research has highlighted the importance of heart rate control, cardioversion, maintenance of sinus rhythm and anticoagulation for the prevention of thromboembolism. To determine the prevalence of AF in patients admitted acutely to the general medical service at Auckland Hospital and to assess the adequacy of heart rate control, the number cardioverted and the use of warfarin to prevent thromboembolism. Prospective review of all acute admissions to the general medical service over a 12 week period. Information was collected from hospital notes on the patients' present and past medical conditions, admission and discharge cardiac medication and the use of investigations, particularly thyroid function tests and echocardiography. The heart rate on discharge, number cardioverted either during the admission or after discharge and the number given warfarin and aspirin were recorded. One hundred and forty-seven patients (aged 38-96, mean age 76 years and 52% male) were admitted in AF 165 times out of the 1637 admissions over the study period (a prevalence of 10.4%, 95% CI 8.6-11.5%). The main causes of admission were heart failure (23%), pneumonia or sepsis (17%), cerebrovascular accident (CVA) or transient ischaemic attack (TIA) (14%) and ischaemic heart disease (11%). Past medical history included hypertension (46%), ischaemic heart disease (39%), congestive heart failure (58%), valvular heart disease (12%), chronic obstructive airways disease (24%), CVA, TIA or thromboembolic event (24%) and diabetes (17%). Thyroid function tests were performed in 50% of patients and echocardiograms in 38%. Heart rate control at discharge could not be assessed, as this was not recorded prior to any patient's discharge. Seventy-eight per cent of patients were discharged on digoxin but only 29% on drugs that control the heart rate with exercise. Five patients out of 11 considered for cardioversion had a successful cardioversion in hospital and two were later cardioverted as outpatients. Twenty-eight per cent were discharged on warfarin, 33% on aspirin and one patient on both. Fifty-two per cent were considered to have contraindications to warfarin therapy. Prescribing rates for warfarin did not vary according to the patients' clinical risk for thromboembolism. AF is a common comorbid condition in the acute general medical ward. Standard investigations were under-utilised. Attention needs to be paid to the recording and control of heart rate at rest and on exercise. Cardioversion is considered infrequently. This patient group had a high risk for thromboembolism and after excluding the large group in whom warfarin was contraindicated, warfarin was still under-utilised.

Factors associated with the duration of breastfeeding.

A cohort study of healthy term infants was conducted to identify factors associated with breastfeeding duration. Three hundred and fifty mothers delivering in one obstetric hospital in Auckland, New Zealand were recruited. Ninety-five percent were followed up until 1 y. Breastfeeding was initiated by 97.4%, the median duration of breastfeeding was 7.6 mo, and 30% were continuing some breastfeeding at 12 mo. Adjusted risk ratios for shorter duration of breastfeeding were: maternal age <25 y, 2.33 (95% confidence interval = 1.33, 4.05); maternal age 25-34, 1.45 (1.01, 2.09) compared to maternal age > or =35; planning to cease breastfeeding < or =6 mo, 2.39 (1.65, 3.46); planning to breastfeed for as long as possible, 1.48 (1.00, 2.18), or not knowing plans 2.13 (1.36, 3.32) when compared to planning to cease breastfeeding after 6 mo; inverted nipples, 2.02 (1.26, 3.23), daily dummy use 1.62 (1.20, 2.18) or use of formula in the first month 2.79 (2.05, 3.80). Reporting mastitis, 0.67 (0.48, 0.94), and sharing the mother's bedroom at 3 mo, 0.69 (0.51, 0.92) were associated with a reduced risk for shorter duration of breastfeeding. We recommend that during the antenatal period attention be directed at mothers' plans for duration of breastfeeding, that mothers be encouraged to have their baby in their bedroom, and that the use of formula and dummies should be discouraged in the first months of life.

Child Abuse and Dissociation in Patients with Complex Regional Pain Syndrome

&gt;OBJECTIVE: In the absence of a proven medical explanation for the chronic pain syndrome Complex Regional Pain Syndrome type I (CRPS I), this study explored a hypothetical link between childhood physical and sexual abuse, and the subsequent development of CRPS I. The hypothesis predicts the existence of a subpopulation of CRPS I patients with a high frequency of dissociative experiences corresponding to a history of childhood trauma.DESIGN: To test this theory, CRPS I patients attending the Auckland Hospital Pain Clinic, Auckland, New Zealand were assessed by self‐report questionnaires for their frequency of dissociative experiences and for a history of childhood abuse. The data were compared with those of a low back pain control group and a healthy, pain‐free control group.RESULTS: CRPS I patients were not unusually dissociative and had not experienced significantly higher rates of childhood abuse than the general population. Two of the 18 CRPS I patients were highly dissociative; both reported childhood sexual abuse.CONCLUSIONS: A trauma‐dissociation pathway to CPRS I was not found. The desirability of screening for that subpopulation of CPRS I sufferers who may have been abused is discussed.

An audit of pancreatic pseudocyst management and the role of endoscopic pancreatography.

A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary with the increasing availability of radiological, surgical and endoscopic methods of treatment. A retrospective audit of the management and outcome of all patients who presented with symptomatic pancreatic pseudocysts to the Auckland Hospital over a 9-year period (1988-96) was made. There were 44 patients (28 men, 16 women; median age 50; range 18-81) in this series. Initial management was not based on pseudocyst size, duration, location, wall thickness, the patients' symptoms and comorbidity, or the aetiology of pancreatitis. Of the 27 patients who had initial conservative management, 15 pseudocysts (56%) completely resolved. Of the 17 patients who were initially or subsequently treated with percutaneous catheter drainage (PCD), 10 pseudocysts (59%) completely resolved without additional treatment. Of the 13 patients initially or subsequently treated by surgery, all but one completely resolved after the first procedure. Two patients were successfully treated with endoscopic pancreatic stent placement. Complications arose in eight patients treated with PCD (47%) and four patients treated with surgery (31%). There was no mortality. The decision for active treatment was not preceded by delineation of the pancreatic duct by ERCP (endoscopic retrograde cholangiopancreatography) in 60% of patients. More than one-third of all patients with symptomatic pancreatic pseudocysts can be managed conservatively. Surgery yields excellent results but PCD has a high failure rate in patients with an underlying pancreatic duct stricture. A rational management algorithm is presented, based on pre-intervention ERCP, which should improve patient selection and outcome.

AN AUDIT OF PANCREATIC PSEUDOCYST MANAGEMENT AND THE ROLE OF ENDOSCOPIC PANCREATOGRAPHY

Background: A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary with the increasing availability of radiological, surgical and endoscopic methods of treatment. Methods: A retrospective audit of the management and outcome of all patients who presented with symptomatic pancreatic pseudocysts to the Auckland Hospital over a 9‐year period (1988–96) was made. Results: There were 44 patients (28 men, 16 women; median age 50; range 18–81) in this series. Initial management was not based on pseudocyst size, duration, location, wall thickness, the patients' symptoms and comorbidity, or the aetiology of pancreatitis. Of the 27 patients who had initial conservative management, 15 pseudocysts (56%) completely resolved. Of the 17 patients who were initially or subsequently treated with percutaneous catheter drainage (PCD), 10 pseudocysts (59%) completely resolved without additional treatment. Of the 13 patients initially or subsequently treated by surgery, all but one completely resolved after the first procedure. Two patients were successfully treated with endoscopic pancreatic stent placement. Complications arose in eight patients treated with PCD (47%) and four patients treated with surgery (31%). There was no mortality. The decision for active treatment was not preceded by delineation of the pancreatic duct by ERCP (endoscopic retrograde cholangiopancreatography) in 60% of patients. Conclusions: More than one‐third of all patients with symptomatic pancreatic pseudocysts can be managed conservatively. Surgery yields excellent results but PCD has a high failure rate in patients with an underlying pancreatic duct stricture. A rational management algorithm is presented, based on pre‐intervention ERCP, which should improve patient selection and outcome.