Parenchyma-preserving hepatectomy based on portal ramification and perfusion of the right anterior section: preserving the ventral or dorsal area

2016 ◽  
Vol 23 (3) ◽  
pp. 158-166 ◽  
Author(s):  
Ami Kurimoto ◽  
Junichi Yamanaka ◽  
Seikan Hai ◽  
Yuichi Kondo ◽  
Hideaki Sueoka ◽  
...  
2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 228-228
Author(s):  
Satoru Imura ◽  
Shinichiro Yamada ◽  
Yu Saito ◽  
Shuichi Iwahashi ◽  
Tetsuya Ikemoto ◽  
...  

228 Background: Anatomical liver resection (ALR) has been performed widely for hepatocellular carcinoma (HCC). However, there are difficult cases with typical ALR, due to tumor location or anatomical variation. The aim of this study is to review the cases of atypical ALR and to investigate the validity of small ALR for HCC. Methods: From 2007 to 2017, hepatic resection less than 2 segments was performed to 252 patients with HCC. (1) We reviewed cases with atypical ALR (eg. posterior segment + anterior dorsal area, S4 + S8 ventral area, etc.), and (2) Regarding the validity of cone-unite resection for single HCC, we compared the clinicopathological outcome with subsegmentectomy as a control. Results: (1) Atypical ALR was performed in 10% (17/169) of ALR less than 2 segments. There were 7 cases of extended anterior segmentectomy or extended S8 resection for patients having anterior or S8 portal branch that perfused to the right side of the right hepatic vein. Most of such atypical ALR tended to be indicated in right-side hepatectomy. (2) Liver function was well preserved in both groups, and it was better in subsegment group (ICGR15: 10.5 vs. 12.3%, ALB: 4.1 vs. 3.9g/dL). Regarding the tumor factor, the diameter was larger in the subsegment group than in the cone-unite group (2.8 vs. 2.1cm), and the proportion in which subsegmentectomy was performed in the case more than 3 cm was high (32 vs. 11%). There was no difference in OS and DFS between the two groups. Even when the tumor diameter was 3 cm or less, there was no difference in DFS between subsegment (n = 28) and cone-unite resection (n = 40). Conclusions: There are a number of cases that typical ALR is difficult, especially in the right-side hepatectomy. There was no difference in the prognosis depending on the range of resection, if HCC could be resected of subsegment or less. Therefore, depending on age and comorbidity, it is necessary to determine the type of hepatectomy without sticking to the subsegmentectomy.


2019 ◽  
Vol 27 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Akinori Miyata ◽  
Junichi Arita ◽  
Chikara Shirata ◽  
Satoru Abe ◽  
Nobuhisa Akamatsu ◽  
...  

Background. Real-time virtual sonography (RVS) is a navigation system for liver surgery. In this study, the degree of misalignment of intraoperative RVS images with computed tomographic (CT) images was measured. Methods. Between December 2014 and July 2015, intraoperative RVS was performed in a total of 33 patients undergoing liver surgery. Reconstructed CT images, rendered like intraoperative ultrasonographic (IOUS) images, were adjusted with the IOUS images and visualized side by side. The degree of misalignment between the reconstructed CT images and IOUS images was measured at anterior section, posterior section, and left liver in each patient. Furthermore, the time required for the adjustment was measured as the “adjustment time.” Results. The degree of misalignment between the images could potentially be measured for a total of 96 points in the 33 patients. Of these, the actual measurement could not be conducted for 35 points due to poor visualization of the intrahepatic vasculature (n = 20) or to a large misalignment that hampered continuation of further adjustment (n = 15). The median degree of misalignment was 9.8 mm (range = 2.4-37.6 mm) in the right anterior section, 9.8 mm (range = 2.7-71.5 mm) in the right posterior section, and 9.5 mm (range = 0.9-37.6 mm) in the left liver. The median adjustment time was 105 seconds (range = 51-245 seconds). Conclusions. Although some misalignment occurred, it might be acceptable for selected situations. Further investigation is needed to reduce the frequency of adjustment failure.


Author(s):  
I. V. Gunas ◽  
A. V. Chernysh ◽  
V. G. Cherkasov ◽  
O. V. Cherkasova

In spite of the existence of numerous developed methods of cephalometric analysis, which should help to choose the right direction of orthodontic treatment, usually the doctor has to act intuitively, based on his experience, because their development didn’t take into account numerous factors (ethnicity, age, gender, etc.). Improving these techniques, considering the above-mentioned factors, would significantly increase their effectiveness, and hence the quality of providing dental care to the population. The purpose of the work is to construct and analyze a regression model of teleroentgenographic indicators used in the method of C. J. Burstone in young men and women with normal occlusion close to orthognathic bite and harmonic face. Primary side teleroentgenograms of 38 young men (aged 17-21 years) and 55 young women (aged 16-20 years) with normal occlusion close to orthognathic bite and harmonic face, obtained from the Veraviewepocs 3D device, Morita (Japan), taken from the bank data of research center of National Pirogov Memorial Medical University, Vinnytsya. Cephalometric measurements were performed according to the recommendations of C. J. Burstone. All indicators were divided into three groups: 1 - metric characteristics of the skull, which usually do not change during surgical and orthodontic treatment; 2 - indicators of the tooth-jaw system, the definitions of which most often need to be guided by the orthodontic treatment of growing patients and orthodontic surgery, which allows people with already formed bone skeleton to change the width, length, angles and position of the bones of the upper and lower jaws; 3 - indicators that actually characterize the position of each individual tooth relative to each other, to the bony cranial structures and face profile. Regression models of individual teleroentgenographic indicators used in the method of C. J. Burstone, built using the licensed package “Statistica 6.0”. Constructed all 6 reliable models of indicators included in the second group (anterior lower facial height ANS-Gn/Me, maxillary length ANS-PNS, ramus length Ar-Go, mandibular length Go-Pog, anterior upper facial height N-ANS and posterior upper facial height PNS-N) depending on the indicators of the first group (posterior section of cranial base Ar-Pt, anterior skull base length N-CC, angle of the cranial tilt POr-NBa, anterior section of cranial base Pt-N and distance P-PTV); as well as all 7 reliable models of indicators included in the third group (distances 1u-NF, 1l-MP, 6u-NF, 6l-MP and angles OP-HP, Max1-NF/Max1-SpP, Mand1-Mp/Mand1-MeGo) depending on the indicators of the first and second (distance A-B, A-NPog, Gо-CF, Max-Mand, N-A, N-B, N-Pog and Xi-Pm and angles MeGo-NPog, MP-HP, NAPog, N-ANS-Pog, N-CF-A, NPog-POr, POr-CFXi і POr-ANSPNS) groups. It was established that in young men the model of telerentgenographic indices included in the second group depending on the indicators of the first group and included in the third group, depending on the indicators of the first and second groups, have a higher determination coefficient than in young women (R2 from 0.806 to 0.918 in young men and from 0.510 to 0.768 for young women, and from 0.750 to 0.993 for young men and from 0.510 to 0.986 for young women). In the analysis of entering into the regression models of the relevant predictors found that in young men among the teleroentgenographic indicators of the first group included in the models of indicators of the second group most often included - distances P-PTV (33.3%), Pt-N and N-CC (by 25.0%); and in young women– distances N-CC (38.5%) and P-PTV (30.8%). It was also found that among young men among the teleroentgenographic indicators of the first and second groups that were included in the models of the third group of indicators most often included - distance ANS-Gn/Me (12.8%), the magnitude of the angles NAPog, POr-CFXi and POr-ANSPNS (by 9.4%); and in young women– distance ANS-Gn/Me (13.2%), distances А-В and PNS-N and the magnitude of the angle NAPog (by 7.9%).


2020 ◽  
Vol 25 (3) ◽  
pp. 140
Author(s):  
Ionel Campeanu ◽  
Irinel Popescu ◽  
Liviu Mosoia ◽  
Florin Botea
Keyword(s):  

2009 ◽  
Vol 209 (2) ◽  
pp. e8-e11 ◽  
Author(s):  
Guido Torzilli ◽  
Fabio Procopio ◽  
Angela Palmisano ◽  
Matteo Cimino ◽  
Daniele Del Fabbro ◽  
...  

Author(s):  
Santiago López-Ben ◽  
Maria Teresa Albiol ◽  
Laia Falgueras ◽  
Celia Caula ◽  
Francesc Collado-Roura ◽  
...  

Author(s):  
J. Anthony VanDuzer

SummaryRecently, there has been a proliferation of international agreements imposing minimum standards on states in respect of their treatment of foreign investors and allowing investors to initiate dispute settlement proceedings where a state violates these standards. Of greatest significance to Canada is Chapter 11 of the North American Free Trade Agreement, which provides both standards for state behaviour and the right to initiate binding arbitration. Since 1996, four cases have been brought under Chapter 11. This note describes the Chapter 11 process and suggests some of the issues that may arise as it is increasingly resorted to by investors.


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