Samar I. Jabbour-Khoury

Anaphylactic shock complicating laparoscopic treatment of hydatid cysts of the liver

Abstract. Hydatid cysts of the liver have been treated surgically for many years by several surgical techniques including evacuation, marsupialization, and filling the cyst with saline after evacuation of the endocyst. We have previously reported laparoscopic treatment of hydatid cysts using the same hydatid asepsis and surgical techniques as in open surgery, with comparable results. Spillage of hydatid fluid during open surgery has been shown to result in serious anaphylactic reaction. The present report describes the first case report of such a reaction during laparoscopic treatment of hydatid cyst of the liver.

Results of laparoscopic treatment of hydatid cysts of the liver

BackgroundWe have previously reported on the laparoscopic treatment of hydatid cysts of the liver. We now report the successful treatment of 18 cysts in 12 patients with a median follow-up of 12 months.MethodsThe standard treatment in the open technique was performed laparoscopically. The main concern was to prevent spillage of the hydatid fluid, for which the puncture and evacuation of the cyst is carried under scolicidal agents cover using 1% cetrimide, thus decreasing the chances of recurrence.ResultsIn this group of patients we had one biliary leak that ceased spontaneously and one recurrence of hydatid cyst but not in the same lobe.ConclusionsWe conclude that laparoscopic evacuation of hydatid cysts is a successful operation comparable to the open technique, with the added advantages of the laparoscopic approach.

Traumatic arteriovenous fistulae: “The Lebanese War Experience”

Over a 16-year period from January 1975 to December 1990, 823 patients with 840 vascular injuries were treated at the American University of Beirut Medical Center. Of these, 661 injuries involved peripheral vessels; 26 of which had 31 arteriovenous fistulae (AVF). Most of the AVF (80%) were diagnosed within 1 year from the injury. The most common presenting symptom was a thrill (74%) followed by a pulsating mass (32%). The most commonly affected vessels were the femoral and popliteal arteries. Angiograms were used preoperatively to delineate the extent and location of the fistulae. All patients except three, underwent surgical repair with excellent results with no limb loss. None of the patients developed late complications such as claudication or a vascular deficit in the involved limb. Arteriovenous fistula is a rare but challenging condition following vascular trauma. Its recognition and treatment give excellent results.

Laparoscopic treatment of hydatid cysts of the liver.

We report for the first time treatment of hydatid cyst of the liver laparoscopically. The patient is a 27-year-old man who presented to our hospital with a 6-week history of recurrent right-upper-quadrant pain with abdominal ultrasound findings compatible with hydatid cyst of the liver. The cyst was approached laparoscopically using the same hydatid asepsis as in open surgery. The cyst was evacuated laparoscopically and marsupialized, and its remaining cavity was packed with omentum. The patient did well postoperatively and was discharged home on the third postoperative day. He had minimal biliary leak that ceased spontaneously on the fifth postoperative day.

A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants

PurposeTo compare the ease of tracheal intubation without the use of muscle reiaxants following an alfentanil-lidocaine-propofol sequence vs a fentanyl-lidocaine-propofol sequence.Clinical featuresIn 80 ASA I and II adult patients undergoing elective laparoscopic surgery, we compared the intubating conditions following alfentanil 20μg· kg−1, lidocaine 1.5 mg· kg−1, propofol 3 mg· kg−1 (Group I;n = 40) vs fentanyl 2 μg· kg−1, lidocaine 1.5 mg· kg−1, propofol 3 mg· kg−1 (Group II;n = 40). The intubating conditions were scored by jaw relaxation, vocal cord position and response to intubation, as well as by blood pressure and heart rate changes. The intubating conditions were good or excellent in 95% of patients in Group I vs 62.5% of patients in Group II (P < 0.05), Blood pressure decreased from a preinduction value of 86 ± 13 mmHg to 72 ± 28 mmHg and 74 ± 19 mmHg in Group I, and from 85 ± 12 mmHg to 78 ± 15 mmHg and 78 ± 12 mmHg in Group II, one and five minutes following intubation (P < 0.05), This drop in blood pressure was not different between the two groups.ConclusionAn alfentanil-lidocaine-propofol sequence offers significantly better intubating conditions than a fentanyl-lidocaine-propofol sequence in healthy adult patients.RésuméObjectifComparer la facilité de l’intubation endotrachéale réalisée, sans recours aux myorelaxants, à la suite de l’administration de la séquence alfentanil-lidocaïne-propofol vs fentanyl-lidocaïne-propofol.Éléments cliniquesNous avons comparé, chez 80 adultes d’état physique ASA I et II devant subir une Intervention laparoscoplque réglée, les conditions d’intubation suivant l’administration de 20 μg· kg−1 d’alfentanil, 1,5 mg· kg−1 de lidocaine et 3 mg· kg−1 de propofol (Groupe I; n = 40) vs 2 μg· kg−1 de fentanyl, 1,5 mg· kg−1 de lidocdïne et 3 mg· kg−1 de propofol (Groupe II; n = 40). Les conditions d’intubation ont été cotées en fonction du relâchement de la mâchoire, de la position des cordes vocales et de la réponse à l’intubation, des changements de tension artérielle et de fréquence cardiaque. Ces conditions ont été bonnes ou excellentes chez 95% des patients du Groupe I vs 62,5 % du Groupe II (P < 0,05). Il y a eu une baisse de la tension artérielle, par rapport aux valeurs enregistrées avant l’induction de 86 ± 13 mmHg à 72 ± 28 mmHg et 74 ± 19 mmHg dans Se Groupe I, et de 85 ± 12 mmHg à 78 ± 15 mmHg à 78 ± 12 mmHg dans le Groupe II, une et cinq minutes après l’Intubation (P < 0,05). Cette chute de la tension artérielle ne présentait pas de différence intergroupe.ConclusionUne séquence d’alfentanll-lidocaïne-propofol offre des conditions slgnificativement meilleures qu’une séquence de fentanyl-lidocaïne-propofol chez des sujets adultes sains.