The counterclock ‐ clockwise approach for central hepatectomy: A useful strategy for a safe vascular control

Author(s):  
Edoardo Maria Muttillo ◽  
Eric Felli ◽  
Lorenzo Cinelli ◽  
Fabio Giannone ◽  
Emanuele Felli
HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S830
Author(s):  
E. Felli ◽  
E.M. Muttillo ◽  
D. Mutter ◽  
P. Pessaux

2004 ◽  
Vol 171 (4S) ◽  
pp. 344-344
Author(s):  
Jonathan E. Bernie ◽  
Chandru P. Sundaram,

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 6-14 ◽  
Author(s):  
Edmonds ◽  
Foster

The diabetic ischaemic foot has become an increasingly frequent problem over the last decade. However, we report a new approach consisting of a basic classification, a simple staging system of the natural history and a treatment plan for each stage, within a multi-disciplinary framework. This approach of "taking control" consists of two parts: 1. long-term conservative care including debridement of ulcers (to obtain wound control), eradication of sepsis (micribiological control), and provision of therapeutic footwear (mechanical control), and 2. revascularisation by angioplasty and arterial bypass (vascular control). This approach has led to a 50% reduction in the rate of major amputations in patients attending with ischaemic ulceration and absent foot pulses from 1989 to 1999 (from 4.6% to 2.3% per year). Patients who underwent angioplasty increased from 6% to 13%. Arterial bypass similarly increased from 3% to 7% of cases. However, even with an increased rate of revascularisation, 80% of patients responded to conservative care alone. This,we conclude, is an essential part of the management of all patients with ischaemic feet.


2019 ◽  
Vol 67 (1) ◽  
Author(s):  
Hesham Mohammed Abdelkader ◽  
Mohamed Abdel-Latif ◽  
Mohamed Abdelsattar ◽  
Ahmed Abdelhaseeb Youssef

Abstract Background Hepatectomy in children deserves exhaustive preoperative and intraoperative tools to define the anatomy, minimize blood loss, and confirm adequacy of liver tissue left. The aim of this study is to report our experience in surgical management of liver tumors. Results All liver resections performed in Ain-Shams University Hospital, by the same team, between July 2013 and June 2018 were retrospectively reviewed. Data related to basic demographics, indication for resection, methods of parenchymal resection, blood loss, hospital stay, morbidity, and mortality was collected. The study included 27 patients who underwent different types of hepatectomies. There was a male predominance. Age ranged from 6 months to 13 years. Weight ranged from 5.7 to 33.7 kg. Total operative time ranged from 68 to 322 min, while resection time ranged from 34 to 144 min. Blood loss ranged from 53 to 259 ml. Surgical morbidities included five patients with minor biliary leak, three patients had surgical site infection, and one patient had torsion of the remnant liver necessitating repositioning. Recurrence of the mass was faced in three patients with hepatoblastoma. There were two mortalities; one occurred as a sequela of massive intraoperative bleeding and the other took place due to postoperative hepatic insufficiency. Conclusion For a safe hepatectomy, thorough familiarity of the hepatic segmental anatomy together with the various techniques for parenchymal resection and vascular control is fundamental. Complications such as biliary leak and torsion of remnant can be easily avoided by simple measures.


2020 ◽  
pp. 000313482095283
Author(s):  
Iswanto Sucandy ◽  
Andres Giovannetti ◽  
Janelle Spence ◽  
Sharona Ross ◽  
Alexander Rosemurgy

2021 ◽  
Vol 91 (4) ◽  
Author(s):  
Ken Min Chin ◽  
Yun‐Le Linn ◽  
Chin Kai Cheong ◽  
Ye‐Xin Koh ◽  
Jin‐Yao Teo ◽  
...  

2021 ◽  
Vol 121 (4) ◽  
pp. 1207-1218
Author(s):  
Josh T. Arnold ◽  
Stephen J. Bailey ◽  
Simon G. Hodder ◽  
Naoto Fujii ◽  
Alex B. Lloyd

Abstract Purpose This study assessed the impact of normobaric hypoxia and acute nitrate ingestion on shivering thermogenesis, cutaneous vascular control, and thermometrics in response to cold stress. Method Eleven male volunteers underwent passive cooling at 10 °C air temperature across four conditions: (1) normoxia with placebo ingestion, (2) hypoxia (0.130 FiO2) with placebo ingestion, (3) normoxia with 13 mmol nitrate ingestion, and (4) hypoxia with nitrate ingestion. Physiological metrics were assessed as a rate of change over 45 min to determine heat loss, and at the point of shivering onset to determine the thermogenic thermoeffector threshold. Result Independently, hypoxia expedited shivering onset time (p = 0.05) due to a faster cooling rate as opposed to a change in central thermoeffector thresholds. Specifically, compared to normoxia, hypoxia increased skin blood flow (p = 0.02), leading to an increased core-cooling rate (p = 0.04) and delta change in rectal temperature (p = 0.03) over 45 min, yet the same rectal temperature at shivering onset (p = 0.9). Independently, nitrate ingestion delayed shivering onset time (p = 0.01), mediated by a change in central thermoeffector thresholds, independent of changes in peripheral heat exchange. Specifically, compared to placebo ingestion, no difference was observed in skin blood flow (p = 0.5), core-cooling rate (p = 0.5), or delta change in rectal temperature (p = 0.7) over 45 min, while nitrate reduced rectal temperature at shivering onset (p = 0.04). No interaction was observed between hypoxia and nitrate ingestion. Conclusion These data improve our understanding of how hypoxia and nitric oxide modulate cold thermoregulation.


2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Teruo Komokata ◽  
Maki Inoue ◽  
Bibek Aryal ◽  
Hiroto Yasumura ◽  
Chinami Mori ◽  
...  

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