Duration Of Catheter Drainage Research Articles

Minimally invasive approach with small diameter pleural drainage catheter (Easydren®) in malignant pleural effusions

Aim: Treatment of malignant pleural effusions is drainage and chemical pleurodesis. Our aim in this study is to investigate the success and complications of the procedure in patients who underwent drainage with an 8F pleural drainage catheter due to malignant pleural effusion, in the light of the literature.
 Material and Method: The study included 124 patients who underwent 8F pleural drainage catheter (Easydren®) for malignant pleural effusion between August 2020 and October 2022. Clinical, radiological and laboratory findings of all patients were obtained from the automation system and archive files. Age, gender, etiology, number and duration of catheter drainage, complications and hospital stay of the patients were recorded.
 Results: Of the patients, 67 (54.0%) were female and 57 (45.9%) were male. The mean age was 54 (31-87). A total of 136 pleural drainage catheters were applied to 124 patients. Drainage and complete reexpansion of the lung were successful in 125 (91.9%) of 136 procedures. No acute surgical complications were observed during the application of pleural drainage catheters. The mean drainage time was 4.6 days (3 – 11). The hospital stay was 5.7 days (4-12).
 Conclusion: We believe that small diameter pleural drainage catheters are as effective as conventional chest tubes for the drainage of malignant pleural effusion with greater patient comfort. Although it has the disadvantage of rarely occlusion during follow-up, it is less invasive and has fewer complications compared to tube thoracostomy.

Caudate lobe amebic abscesses: percutaneous image-guided aspiration or drainage.

Amebic liver abscess is the most common type of liver abscess on a worldwide basis, with caudate lobe being a relatively uncommon location for its occurrence. Abscess in caudate lobe of liver is often considered a challenging location for image-guided percutaneous drainage due to its difficult-to-access location along with close relationship with major vessels at porta hepatis. This study aims to demonstrate safety and efficacy of percutaneous drainage for caudate lobe amebic abscess. In this retrospective study, hospital database was electronically searched for patients having caudate lobe amebic abscess that underwent percutaneous catheter drainage/needle aspiration (PCD/PNA) between January 2016 and January 2021. The etiology, risk factors, microbiology, complications, different approaches for PCD/PNA, and their outcome were studied and reported. Of 30 patients having caudate lobe amebic abscess treated with PCD/PNA, solitary caudate lobe abscess was seen in 29, whereas one patient had more than one abscesses in caudate lobe. Contained and free intraperitoneal rupture of the abscess were seen in 9 (30%) and one patient, respectively. Ten (32%) patients had associated vascular thrombosis, while 2 patients were found to have abscess-biliary communication. Twenty-six (86.7%) patients were treated with PCD, while remaining 4 (13.3%) with PNA. On Univariate analysis, factors such as volume, multilocularity, and contained rupture of the abscess were found to be significantly increasing the duration of percutaneous drainage (PCD), while only multilocularity (p value 0.007) continued to show statistical significance on Multivariate analysis. Venous thrombosis and duration of catheter drainage were the two factors found to have significant influence on the length of hospital stay on Univariate as well as Multivariate analysis (p value 0.05 and 0.001, respectively). The rates of catheter manipulation were also significantly higher in patients with abscess showing complex internal configuration (heteroechoic contents and/or multilocularity). Technical and clinical success rates of 100% and 96.7% were achieved through percutaneous interventions (PCD/PNA), despite the complex location of abscesses and associated complications, with no incidence of vascular injury. Liver abscess in caudate lobe can be accessed by different routes for percutaneous drainage, despite being surrounded by large vessels and its deep location, without major complications. Thus, PCD/PNA may be considered as a first-line therapy for the management of caudate lobe amebic abscesses in adjunct to medical therapy.

Experience of Maharaj Nakorn Chiang Mai Hospital in extravesical ureteral reimplantation for vesicoureteral reflux in pediatric patients

Objective: The most commonly used technique for vesicoureteral reflux (VUR) treatment in pediatric patients in Maharaj Nakorn Chiang Mai Hospital is extravesical ureteral reimplantation (EUR). This report describes our experience of clinical outcomes of this technique. Materials and Methods: A total of 30 children underwent EUR for unilateral and bilateral VUR between July 2007 and June 2015. We retrospectively reviewed their medical records. Patient characteristics, operative time, duration of catheter drainage, length of postoperative hospital stay, and perioperative complications were evaluated. Results: Twenty-two boys and 8 girls with a mean age of 4.4 years (range, 0.5-14.6) were included in the study. Reflux was graded 1 to 5. Fourteen unilateral and 16 bilateral procedures were performed. A Pfannenstiel incision was implemented in the first 20 cases and inguinal incision in the last 10 cases. Mean operative time was 115.5 minutes. Mean duration of catheter insertion was 5.7 days. Mean length of postoperative hospital stay was 6.1 days and mean estimated blood loss was 28.7 ml. Overall success rate was 90%. One patient (3.3%), developed a post- operative urinary tract infection, while 3 cases had persistent VUR after surgery. Acute urinary retention occurred in 1 patient (3.3%) on postoperative day 4 but following catheterization the patient was able to urinate by day 7. Conclusion: EUR for the treatment of VUR is a simple, safe, and effective procedure. The prevalence of postoperative urinary retention in bilateral reimplantation is low and transient. The inguinal approach is a viable option and as effective as classical procedures.

The application of virtual reality training for anastomosis during robot-assisted radical prostatectomy

ObjectiveTo investigate the application of virtual reality training in vesicourethral anastomosis during robot-assisted radical prostatectomy (RARP). MethodsThree certified robotic urologists who underwent virtual reality training were enrolled in the study group. The other three without training were enrolled in the control group. Parameters were recorded before and after the training. Then a total of 18 patients undergoing RARP were enrolled and randomized assigned to receive anastomosis procedures with certified urologists who either obtained or did not obtain training. The quality of the anastomosis was evaluated. ResultsFor the virtual training evaluation, the overall score was significantly improved from 65.0±10.8 to 92.7±3.5 (p=0.014); the time of anastomosis was shortened; the economy of motion improved; instrument collisions decreased after training (p<0.05). Besides, the effectiveness of the virtual training was evaluated in the 18 real anastomosis procedures which were completed either by three urologists with training or three urologists without training. Most intriguingly, the average time of anastomosis was shortened from 40.0±12.4 min to 25.1±7.1 min (p=0.015). The parameters including time of operation, creatinine level of drainage, postoperative hospital stay and duration of catheter drainage were comparable before and after training. Two leakages, which were observed in procedures by doctors without training, needed salvage sutures by a senior doctor. ConclusionsVirtual reality training enabled surgeons to become quickly familiar with robotic system manipulation, improved their skills for vesicourethral anastomosis and shortened the learning curve, thus helping them operate with high efficacy and quality.

Analysis of Risk Factors for Multiantibiotic-Resistant Infections Among Surgical Patients at a Children's Hospital.

Background: To identify the potential risk factors for multiantibiotic-resistant infections and provide sufficient evidence for multiantibiotic resistance prevention and control.Materials and Methods: We conducted a retrospective study of all patients in pediatric orthopedics, pediatric heart surgery, and pediatric general surgery at a level 3, grade A children's hospital from January to December 2016. The clinical laboratory information monitoring system and the medical record system were used to collect patient information regarding age, surgery type, preoperative length of stay, admission season, incision type, preoperative infection, intraoperative blood loss, postoperative use of invasive equipment, duration of catheter drainage, and timepoint of intraoperative prophylactic antibiotics administration. We used logistic univariate and multivariate regression analysis to analyze the potential risk factors for multiantibiotic-resistant infections among pediatric surgical patients. SPSS 21.0 and Excel software packages were used for the statistical analysis.Results: In total, 2,973 patients met the inclusion criteria: 1,247 patients in pediatric orthopedics, 1,089 patients in pediatric heart surgery, and 637 patients in pediatric general surgery. At the end of the study, 113 patients were multiantibiotic-resistant infection cases; the rate of multiantibiotic-resistant infections was 3.80%, and the detection rate was 84.79%. Multivariate analysis indicated that the multiantibiotic-resistant infection cases were influenced by age, department, admission season, incision type, preoperative infection, and duration of catheter drainage.Conclusions: Age, department, admission season, incision type, preoperative infection, and duration of catheter drainage may provide possible evidence for prevention and control strategies of multiantibiotic-resistant infections.

A comparative study of chronic subdural hematoma in three age ranges: Below 40 years, 41–79 years, and 80 years and older

ObjectiveTo investigate clinical characteristics and outcomes of chronic subdural hematomas (CSDHs) in different age ranges. Patients and methodsA retrospective collection of data from CSDH patients ≤40 years, 41–79 years, and ≥80 years of age between August 2011 and May 2017 was performed. The differences and similarities of clinical data and outcomes among three groups were analyzed. ResultsA total of 1118 CSDH patients were included. We found that 64.5% patients had arachnoid cyst/ventriculoperitoneal shunt in patients ≤40 years, 4.3% in the 41–79 years group, and 3.2% in the ≥80 years group (P < 0.001). Headache was the most frequent symptom in the ≤40 years group (88.2%) and the 41–79 years group (60.9%), while the most frequent symptom in the ≥ 80 years group was limb weakness (80.4%). The history of head trauma was not significantly different between the three groups. After burr hole drainage craniostomy, the disappearance or alleviation of symptoms, duration of catheter drainage, and length of hospital stay were not significantly different, while the recurrence rate was also not significantly different between the three groups. Post-operation complications are an independent risk factor contributing to the death of patients of 41–79 years (P < 0.001, B = 3.140, Exp (B) = 23.103, 95% CI = 5.142–103.809) and of ≥ 80 years (P = 0.001, B=2.831, Exp (B) = 16.970, 95% CI = 3.365–85.567). The history of antithrombotic drug was an independent risk factor of complications in patients of 41–79 years (P = 0.042, B =1.341, Exp (B) =3.823, 95% CI = 1.048–13.942) and patients of ≥ 80 years (P = 0.026, B=1.399, Exp (B) = 4.052, 95% CI = 1.178–13.933), while complications were also an independent risk factor contributing to the outcome in patients of 41–79 years (P < 0.001, B =2.254, Exp (B) =0.314, 95% CI = 0.089–1.103) and patients of ≥ 80 years (P = 0.006, B=2.074, Exp (B) = 7.953, 95% CI = 1.791–35.313). In the ≤40 years group, all patients had a good outcome (MRS score 0–3), while 98.2% (851/867) of the cases in the 41–79 years group and 94.3% (149/158) of the cases in the ≥ 80 years group saw a good outcome (P = 0.001). ConclusionsOur results clearly display the common and different clinical data of CSDH in all age ranges, which is crucial to improve the management and treatment of patients with CSDH.

Comparison of drainage efficiency between unilateral and bilateral external ventricular drainage in intraventricular hemorrhage with hydrocephalus

Objective To explore the differences of the drainage efficiency between unilateral external ventricular drainage and bilateral external ventricular drainage in surgical treatment of intraventricular hemorrhage. Methods The clinical data of 56 patients with intraventricular hemorrhage treated by unilateral and bilateral external ventricular drainage were retrospectively analyzed. 24 cases were treated by unilateral external ventricular drainage (unilateral group), 32 cases were treated by bilateral external ventricular drainage (bilateral group). The hematoma clearance rate, duration of catheter drainage, the average daily cerebrospinal fluid (CSF) drainage volume, the times of injecting the urokinase and the average hospital days in the intensive care unit (ICU) were recorded, and compared between two groups. Results In the group of unilateral drainage tube and group of bilateral drainage tube, the clearance rate of hematoma was (74.6±8.7)% and (78.5±12.5)%, comparison between the two groups was not statistically significant(t=1.308, P=0.196); the daily CSF drainage volume was (124.6±40.2) ml and that was (139.6±41.7) ml, comparison between the two groups was not statistically significant(t=1.353, P=0.182); the times of injecting the urokinase was (4.42±1.26) and (4.06±1.39), comparison between the two groups was not statistically significant (t=0.998, P=0.323); the hospital stay in the ICU was (10.6±3.6) days and (13.3±5.0) days respectively, there was a significant difference between the two groups (t=2.243, P=0.029). The duration of catheter drainage in group of unilateral drainage tube was (5.0±1.7) days, and that was (6.6±2.2) days in group of bilateral drainage tube, and there was significant difference between the two groups (t=2.959, P=0.005). Conclusion The bilateral external drainage can not improve the hematoma clearance rate, reduce the times of injecting the urokinase and lower the hospitalization days in the ICU of the patients. Key words: Intraventricular hemorrhage; External ventricular drainage; The hematoma clearance rate

Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: A safe alternative to surgery

Interventional radiology plays an important role in the management of deep pelvic abscesses. Percutaneous drainage is currently considered as the first-line alternative to surgery. A transgluteal computed tomography (CT)-guided approach allows to access to deep infected collections avoiding many anatomical obstacles (vessels, nerves, bowel, bladder). The objective of this study was to assess the safety and efficacy of a transgluteal approach by reviewing our clinical experience. We reviewed medical records of patients having undergone percutaneous CT-guided transgluteal drainage for deep pelvic abscesses. We focused on the duration of catheter drainage, the complications related to the procedures and the rate of complete resolution. Between 2005 and 2013, 39patients (27women and 12men; mean age: 52.5) underwent transgluteal approach CT-guided percutaneous drainage of pelvis abscesses in our department. The origins of abscesses were postoperative complications in 34patients (87.2%) and infectious intra-abdominal disease in 5patients (12.8%). The mean duration of drainage was 8.3days (range: 3-33). Laboratory cultures were positive in 35patients (89.7%) and Escherichia coli was present in 71.4% of the positive samples. No major complication was observed. Drainage was successful in 38patients (97.4%). A transpiriformis approach was more significantly associated with intra-procedural pain (P=0.003). Percutaneous CT-guided drainage with a transgluteal approach is a safe, well-tolerated and effective alternative to surgery for deep pelvic abscesses. This approach should be considered as the first-line intention for the treatment of deep pelvic abscesses.

Risk Factors for Catheter Associated Urinary Tract Infections in a Pediatric Institution

Catheter associated urinary tract infections are an essential measure for health care quality improvement that affects reimbursement through hospital acquired condition reduction programs in adult patients. With the mounting importance of preventing such infections we evaluated risk factors for acquiring catheter associated urinary tract infections in pediatric patients. All catheter associated urinary tract infections were identified at 1 pediatric institution from September 2010 to August 2014 from a prospective database maintained by the infection control office. To identify risk factors patients with a catheter associated urinary tract infection were individually matched to control patients with a urinary catheter but without infection by age, gender, date and the hospital location of the infection in 1:2 fashion. A total of 50 patients with catheter associated urinary tract infection were identified and matched to 100 control patients. Compared to controls the patients with infection were more likely to have a catheter in place for longer (2.9days, OR 1.08, 95% CI 1.01, 1.15, p = 0.02). They were also more likely to be on contact precautions (OR 4.00, 95% CI 1.73, 9.26, p = 0.001), and have concurrent infections (OR 3.04, 95% CI 1.39, 6.28, p = 0.005) and a history of catheterization (OR 3.24, 95% CI 1.55, 6.77, p = 0.002). Using a conditional multivariate regression model the 3 most predictive variables were duration of catheter drainage, contact isolation status and history of catheterization. Longer duration of urinary catheter drainage, positive contact precautions status and a history of catheterization appear to be associated with a higher risk of catheter associated urinary tract infection in hospitalized pediatric patients. Physicians should attempt to decrease the duration of catheterization, especially in patients who meet these criteria, to minimize the risk of catheter associated urinary tract infection.

MP54-06 RISK FACTORS FOR CATHETER-ASSOCIATED URINARY TRACT INFECTION IN A PEDIATRIC INSTITUTION

MP54-06 RISK FACTORS FOR CATHETER-ASSOCIATED URINARY TRACT INFECTION IN A PEDIATRIC INSTITUTION

Ten-year Experience of Adult Hypospadias Repairs at a Single Center

Purpose: We retrospectively evaluated the results and complications of urethroplasty in adult patients with hypospadias. Materials and Methods: Between February 1997 and June 2007, 21 adult patients with hypospadias underwent urethroplasty. The types of hypospadias were as follows: megameatus intact prepuce (MIP; n=4), subcoronal (n=5), distal penile (n=3), midshaft (n=2), penile (n=2), penoscrotal (n=2), and scrotal (n=3). Among the 21 patients, 13 were in the primary operative (group A) and 8 were in the re-operative (group B). Results: The mean age of the patients was 32.4±6.4 years (group A, 33.1±6.0 years; group B, 31.1±7.8 years). The mean duration of catheter drainage was 8.0±2.4 days (group A, 7.9±1.8 days; group B, 8.0±2.1 days). The surgical procedures included tubularized incised plate urethroplasty (n=14), Thiersch-Duplay (n=3), pyramid (n=3), and transverse preputial island flap (n=1). The overall success rate was 61.9% (group A, 92.3%; group B, 12.5%). Urethrocutaneous fistulas and a meatal stricture occurred in 6 and 1 patients, respectively, with both occurring in 1 patient (38.1% overall complication rate). Fistula repairs were performed successfully in 4 patients and another fistula resolved spontaneously. The meatal strictures were treated with simple dilatation. Conclusions: Our data demonstrated a very high success rate in the treatment of primary adult hypospadias. And more careful surgical procedure is needed in patients who had history of previous failure more than 2 times because of significantly high complacation rate. (Korean J Urol 2008;49:1144-1148) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Retropubic versus perineal radical prostatectomy in early prostate cancer: Eight‐year experience

Prostate cancer is the most common malignancy in men and the second leading cause of cancer death. A randomized study was performed on patients with localized prostate cancer and treated with radical prostatectomy using the perineal or the retropubic approach comparing oncological outcomes, cancer control, and functional results. Between 1997 and 2004, in a randomized study 200 patients underwent a radical prostatectomy performed by retropubic (100 patients) or perineal (100 patients) approach. Differences between hospital stay, duration of catheter drainage, intraoperative blood loss, and transfusion requirements were statistically significant in favor of perineal prostatectomy. Differences between positive surgical margins and urinary continence in the two groups were not statistically significant at 6 and 24 months. Differences between erectile function at 24 months were statistically significant in favor of retropubic prostatectomy. Radical perineal prostatectomy is an excellent alternative approach for radical surgery in the treatment of early prostate cancer.

Sterile Fluid Collections in Acute Pancreatitis: Catheter Drainage Versus Simple Aspiration

To compare the clinical outcome of needle aspiration versus percutaneous catheter drainage of sterile fluid collections in patients with acute pancreatitis. We reviewed the clinical and imaging data of patients with acute pancreatic fluid collections from 1998 to 2003. Referral for fluid sampling was based on elevated white blood cell count and fevers. Those patients with culture-negative drainages or needle aspirations were included in the study. Fifteen patients had aspiration of 10-20 ml fluid only (group A) and 22 patients had catheter placement for chronic evacuation of fluid (group C). We excluded patients with grossly purulent collections and chronic pseudocysts. We also recorded the number of sinograms and catheter changes and duration of catheter drainage. The CT severity index, Ranson scores, and maximum diameter of abdominal fluid collections were calculated for all patients at presentation. The total length of hospital stay (LOS), length of hospital stay after the drainage or aspiration procedure (LOS-P), and conversions to percutaneous and/or surgical drainage were recorded as well as survival. The CT severity index and acute Ransom scores were not different between the two groups (p = 0.15 and p = 0.6, respectively). When 3 crossover patients from group A to group C were accounted for, the duration of hospitalization did not differ significantly, with a mean LOS and LOS-P of 33.8 days and 27.9 days in group A and 41.5 days and 27.6 days in group C, respectively (p = 0.57 and 0.98, respectively). The 60-day mortality was 2 of 15 (13%) in group A and 2 of 22 (9.1%) in group C. Kaplan-Meier survival curves for the two groups were not significantly different (p = 0.3). Surgical or percutaneous conversions occurred significantly more often in group A (7/15, 47%) than surgical conversions in group C (4/22, 18%) (p = 0.03). Patients undergoing catheter drainage required an average of 2.2 sinograms/tube changes and kept catheters in for an average of 52 days. Aspirates turned culture-positive in 13 of 22 patients (59%) who had chronic catheterization. In group A, 3 of the 7 patients converted to percutaneous or surgical drainage had infected fluid at the time of conversion (total positive culture rate in group A 3/15 or 20%). There is no apparent clinical benefit for catheter drainage of sterile fluid collections arising in acute pancreatitis as the length of hospital stay and mortality were similar between patients undergoing aspiration versus catheter drainage. However, almost half of patients treated with simple aspiration will require surgical or percutaneous drainage at some point. Disadvantages of chronic catheter drainage include a greater than 50% rate of bacterial colonization and the need for multiple sinograms and tube changes over an average duration of about 2 months.

Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases.

To assess the effectiveness of a computed tomographic (CT) image-guided transgluteal approach for percutaneous drainage of deep pelvic abscesses as an alternative to surgical drainage. The medical records of 140 patients who underwent percutaneous CT-guided transgluteal drainage of 154 deep pelvic abscesses were reviewed to determine the origins, location, and size of the abscesses; volume of initial aspirate; organisms identified in fluid culture; duration of catheter drainage; incidence of catheter-related pain and procedure-related complications; and short- and long-term outcomes. The resultant data were analyzed with a Fisher exact test for difference in the incidence of postprocedural catheter-site pain between transpiriformis and infrapiriformis approaches. The origins of the pelvic abscesses included postoperative fluid collection (n = 115), perforating appendicitis (n = 6), diverticulitis (n = 16), tubo-ovarian inflammation (n = 5), Crohn disease (n = 10), and internal bowel fistula due to irradiation (n = 2). The abscesses were 4-12 cm in diameter. The volume of the aspirate was 5-310 mL. Laboratory cultures of the aspirate grew mixed flora, but the organism most frequently isolated was Escherichia coli. Catheters were removed after a mean of 8 days. In 134 (96%) of 140 patients, there was complete resolution of the abscess following transgluteal drainage, without subsequent surgery. In six of 140 (4%) patients, incomplete resolution necessitated subsequent surgery for postoperative fluid collection (n = 3), diverticulitis (n = 2), or perforating appendicitis (n = 1). Complications of transgluteal drainage were rare and included hemorrhage in three (2%) of the 140 patients. There was no procedure-related mortality. A transpiriformis approach was significantly more likely to be associated with postprocedural pain (P <.001) than was an infrapiriformis approach. Percutaneous CT-guided transgluteal drainage is a safe and effective alternative to surgery for deep pelvic abscesses. Major complications are rare.

Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage.

To evaluate the effectiveness of simple percutaneous catheter drainage in the treatment of postoperative lymphocele. Percutaneous catheter drainage of 23 symptomatic lymphoceles was performed with ultrasonographic (US) guidance in 20 patients who had undergone radical pelvic lymphadenectomy because of uterine malignancy. All lymphoceles were diagnosed on the basis of biochemical and cytologic findings in aspirated fluid. The drainage catheter was removed when the amount of daily drainage was less than 10 mL per day and when the lymphocele was seen at imaging to have resolved. Follow-up US was performed at 1, 3, and 6 months after catheter removal. The results were classified as success, partial success, or failure. Lymphoceles ranged in size from 5 x 4 x 3 to 25 x 10 x 10 cm. Mean total drainage volume was 2,012 mL (range, 300-17,240 mL). Fluid from 10 lymphoceles (43%) was positive at Gram staining and bacteriologic culture; fluid from 13 (57%) was sterile. Duration of catheter drainage was 3-49 days (mean, 22 days). Twenty (87%) lymphoceles resolved completely; three (13%) recurred. Two recurrent lymphoceles were again treated with percutaneous catheter drainage; the third resolved spontaneously 5 months after catheter removal. Successful treatment was ultimately achieved in all patients. Postprocedural complications occurred in four patients. One had a secondary infection of lymphocele; one, catheter dislodgment; and two, skin infection at the site of catheter insertion. Percutaneous catheter drainage is safe and effective for treatment of symptomatic postoperative lymphoceles.

Asymptomatic hydropneumothorax after therapeutic thoracentesis for malignant pleural effusions.

The purpose of this study was to document in a historical cohort the incidence and clinical observations of pneumothorax ex vacuo after therapeutic thoracentesis for malignant pleural effusions in patients with underlying parenchymal lung disease. Forty pneumothoraces resulted from 512 therapeutic thoracentesis performed for malignant pleural effusions over a 3-year period. Twenty-nine patients with pneumothoraces underwent catheter placement in the pleural space for treatment. Of these, 12 pneumothoraces resolved and 17 remained unchanged. We reviewed the charts of these 17 patients to document the cause of malignant pleural effusion, presence of underlying malignant parenchymal disease, volume of fluid aspirated, and improvement in symptoms. Clinical outcome was then evaluated, including size of residual pneumothorax, duration of catheter drainage, and reaccumulation of effusion. No patients' lungs reexpanded despite insertion of large-bore (16- to 35-French) chest tubes. All had pneumothoraces that occupied at least 30% of the hemithorax; all were asymptomatic; all had underlying parenchymal disease and noncompliant lungs. Pleural effusion reaccumulated in all 17 after removal of the chest tube. A subgroup of patients with malignant lung parenchymal disease who undergo therapeutic thoracentesis will develop asymptomatic hydropneumothoraces due to poor lung compliance. These patients do not require further catheter drainage. Pleural effusion will reaccumulate in the residual space over a variable period of time.

Treatment of traumatic pancreatic pseudocysts in children: the role of percutaneous catheter drainage

Six cases of successful percutaneous catheter drainage (PCD) of pancreatic pseudocysts in children ages 3–13 years are presented. All cases involved blunt abdominal trauma and presented with abdominal pain, vomiting, epigastric tenderness without a palpable mass, and elevated serum amylase. Indications for PCD were an enlarging pseudocysts and marked abdominal pain. Catheter placement was accomplished using CT guidance 15.3±1.8 days (mean ± SEM) following injury. Two patients had transgastric PCD. None of the pseudocysts were infected. Catheters were left in place until the drainage ceased, the serum amylase approached normal, the pseudocyst resolved on ultrasound, and the asymptomatic patient tolerated enteral feedings with the catheter clamped. The mean duration of catheter drainage was 18.3±3.7 days. At the time of catheter insertion, the range of serum amylase values was 242–2810 IU/l, while discharge values were 50–147 IU/l (normal: 16–108 IU/l). The mean hospital stay was 36.2±3.8 days and the mean length of total parenteral nutrition was 27.5±4.5 days. All pseudocysts were treated successfully without complication. PCD of traumatic pancreatic pseudocysts in children was performed safely and effectively in our study. Use of this therapeutic modality allowed earlier treatment, decreased the duration of symptoms, and avoided abdominal operation. PCD may prove to be the treatment of choice for pancreatic pseudocysts in children.

Percutaneous drainage of postoperative abdominal and pelvic lymphoceles.

Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.

Urinary tract infection in clinical renal transplantation.

The histories of 72 recipients of renal transplants who had been followed three months to seven years or until death, were reviewed to determine the incidence of urinary tract infection. This review was made to evaluate the role of primary diagnosis, donor source, technique of urinary drainage, urologic complications, and duration of catheter drainage in the occurrence and persistence of urinary tract infection. Definitions A urinary tract infection was defined as a quantitative determination on urine culture of greater than 100,000 pathogenic organisms per milliliter from a voided urine or catheter specimen. Repeated counts of less than 100,000 per milliliter of the same pathogen were interpreted as significant and are included as positive. Random urinary cultures of 100,000 per milliliter or less of nonpathogenic organisms such as diphtheroids, micrococcus, or Doderlein's bacillus, combined with several negative reports in the same patient, were interpreted as insignificant. Recipients of renal grafts with