Pthc Collection 2010
Joseph Middlebrook
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Results: Median survival for hypothetical patients with PTHC and for controls without hepatitis was 11.25 and 11.75 years, respectively. Overall, 12.3 percent of patients receiving HCV-infective blood will develop chronic hepatitis, 9.3 percent will progress to liver failure, and 9. 25 percent will eventually die of liver disease after a median time of 20.75 years (range, 6-70). Ninety-one percent of the infected blood recipients had no reduction in life expectancy due to PTHC, and the average loss per patient was 0.754 years. The present value of the lifetime health costs incurred by patients with PTHC is $6330 per case. HCV antibody testing increases the patients' life expectancy by 20.4 hours per blood collection tested, and it results in net savings by decreasing the number of patients that will require treatment for liver disease in the future. Adding HCV NAT increases the patients' life expectancy by 0.08 hours per blood collection tested, at a cost-effectiveness ratio of $1,829,611 per QALY gained.
AbstractIatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.
Radiological studies are critical to both the diagnosis and management of iatrogenic biliary complications, as these studies are used to identify and define the extent of injury and assist in planning management. Cholescintigraphy using hydroxy iminodiacetic acid (HIDA) scan is a sensitive study for identifying the presence of bile leaks but has limited utility in planning management because of its inability to provide detailed anatomic information. Computed tomography (CT) and ultrasound are noninvasive, effective methods for detecting dilated biliary ducts; CT is particularly useful in identifying fluid collections and vascular injuries.[4] [7] [9] [13] [15] Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive method for defining biliary tract anatomy proximal and distal to an injury.[13] [16] [17] MRCP can demonstrate fluid collections and MR imaging with intravenous gadolinium contrast administration can identify an arterial injury. Hepatobiliary contrast agents (e.g., gadoxetate disodium) permit detection of bile leakage in nearly all patients with this complication and can accurately localize the lesion in more than 80% of cases. Improved imaging protocols have reduced the time needed to acquire MRCP images.[15] [18]
Endoscopic techniques such as stent placement are the primary form of management for pancreatic ductal injuries in patients with normal pancreatic anatomy. Interventional radiologic techniques for the treatment of pancreatic injuries are mostly limited to management of postoperative fluid collections, usually with the placement of drainage catheters (discussed in the next section).[25] Such techniques have played a significant role in reducing postoperative morbidity and mortality. In one study, interventional radiological procedures reduced the need for additional surgical intervention to 2.5%.[26]
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