scholarly journals NEOADJUVANT TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION FOR BILIARY TUMOR THROMBOSIS: A RETROSPECTIVE STUDY

2016 ◽  
Vol 32 (4) ◽  
pp. 212-217
Author(s):  
Yangyang Shen ◽  
Pang Li ◽  
Kai Cui ◽  
Zhendan Wang ◽  
Fachang Yu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Resection ◽  
Median Survival ◽  
Curative Resection ◽  
Transcatheter Arterial Chemoembolization ◽  
Surgical Morbidity ◽  
Tumor Thrombosis ◽  
Group A ◽  
Group B ◽  
Arterial Chemoembolization

Objectives: Curative hepatectomy and tumor thrombectomy for hepatocellular carcinoma with complicating biliary tumor thrombosis (HCC/BTT) is associated with high surgical morbidity and mortality. This retrospective study evaluated the effectiveness and safety of neoadjuvant transcatheter arterial chemoembolization (TACE) in HCC/BTT patients scheduled for curative resection.Methods: Thirty consecutive patients with diagnosed HCC/BTT were hospitalized for neoadjuvant TACE and elective curative liver resection (group A; n=20) or curative liver resection alone (group B; n=10). The primary outcome measure was median survival.Results: Group A had a significantly shorter overall operative time (160±25 versus 190±35 min; p < .01) and duration of inflow control (14.3±3.6 versus 25.1±5.1 min; p < .01) and significantly less intraoperative blood loss (150±35 versus 520±75 ml; p < .01) and transfusion (100±40 versus 375±55 ml; p < .01) as compared to group B. Among patients undergoing both thrombectomy and curative resection, the median survival of group A was significantly longer than that of group B (28.5 [9–54] versus 21.5 [6–39] months; p < .01); among those who received thrombectomy alone, the median survival of group A was also significantly longer than that of group B (12.8 [6–25] versus 4.5 [2–7] months; p < .01).Conclusions: Neoadjuvant TACE significantly reduced the surgical risk of curative liver resection and significantly prolonged median survival in HCC patients with complicating BTT.

scholarly journals Comparison of local recurrence in transcatheter arterial chemoembolization of hepatocellular carcinoma with or without accumulation of iodized oil beyond corona enhancement area: Short-term results

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Yukinobu Watanabe ◽  
Masahiro Ogawa ◽  
Masahiro Kaneko ◽  
Mariko Kumagawa ◽  
Midori Hirayama ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Transcatheter Arterial Chemoembolization ◽  
Local Tumor ◽  
Iodized Oil ◽  
Recurrence Rates ◽  
Local Tumor Recurrence ◽  
Group A ◽  
Group B ◽  
Corona Enhancement ◽  
Arterial Chemoembolization

Abstract Background Local tumor recurrence of hepatocellular carcinoma (HCC) often occurs in blood drainage areas. Corona enhancement is determined by computed tomography during hepatic arteriography (CTHA) and is considered to represent the blood drainage area. This study aimed to investigate the relationship between embolization of corona enhancement area and local tumor recurrence of patients with HCC who underwent transcatheter arterial chemoembolization (TACE). Patients and methods The study retrospectively selected 53 patients with 60 HCC nodules that showed corona enhancement area on late-phase CTHA and showed homogenous accumulation of iodized oil throughout the nodule on non-contrast-enhanced CT performed immediately after TACE. We divided the nodules into two groups, according to whether the accumulation of iodized oil covered the entire corona enhancement area (group A) or not (group B). Local tumor recurrence was compared between the two groups. Results The cumulative local tumor recurrence rates for group A (n = 36) were 2.8%, 2.8%, 8.3% at 3, 6, and 12 months, respectively, whereas the recurrence rates for group B (n = 24) were 20.8%, 45.8%, 75% at 3, 6, and 12 months, respectively. The cumulative local tumor recurrence rates for group A were significantly lower than those for group B (hazard ratio, 0.079; 95% confidence interval, 0.026–0.24; p < 0.001). Conclusions The results of the study suggest that the corona enhancement area may be an accurate safety margin in TACE which should be performed until the embolic area covers the entire corona enhancement area.

Do we need 30 min cortisol measurement in the short synacthen test: a retrospective study

2019 ◽  
Vol 96 (1138) ◽  
pp. 467-472
Author(s):  
Rajeev Kumar ◽  
Peter Carr ◽  
Kimberley Moore ◽  
Zeeshan Rajput ◽  
Louise Ward ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Adrenal Insufficiency ◽  
Late Response ◽  
Inadequate Response ◽  
Insufficient Response ◽  
Group A ◽  
Synacthen Test ◽  
Cortisol Levels ◽  
Group B ◽  
Short Synacthen Test

ObjectiveThe short synacthen test (SST) is widely used across the UK to assess adrenal reserve but there remains no consensus on the timing of cortisol sampling to help diagnose adrenal insufficiency. The main objective of our study was to see if both 30 and 60 min sample are required following administration of synacthen to investigate suspected adrenal insufficiency (AI).DesignThis was a single-centre retrospective study of 393 SSTs measuring 0, 30 and 60 min cortisol levels after administration of 250 µg of synacthen.Patients and methodsAll the SSTs for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. The tests were performed as per our hospital protocol. A post-adrenocorticotropic hormone (ACTH) cortisol response of 420 nmol/L at any time point was considered adequate to rule out AI. The data were analysed to ascertain the proportion of patients who achieved this level at 30 and/or 60 min.ResultsA total of 393 SST results were included in this study. Patients were divided into two groups depending on whether (group A) or not (group B) they were on steroids. Overall, a total of 313 (79.6%) subjects achieved cortisol level of ≥420 nmol/L at 30 and 60 min while 19 (4.8%) had late response (ie, insufficient 30 min cortisol levels, rising to ≥420 nmol/L at 60 min). Another 61 subjects (15.5%) showed insufficient response at both 30 and 60 min (ie, failed to achieved level of ≥420 nmol/L). Importantly, there was no patient in either group who had adequate response at 30 min and then failed at 60 min. Patients in group A were more likely to have inadequate response at both 30 and 60 min while patients in group B were more likely to have normal response at both time points.ConclusionsOur results suggest that about 5% of people undergoing SST may be inappropriately diagnosed as having AI (and subjected to long-term unnecessary steroid treatment) if the 60 min sample is not maintained. We suggest that 30 min sample does not add any additional diagnostic utility and can be omitted thus simplifying SST even further and saving on cost and resources. We propose that single measurement after 60 min of administration of synthetic ACTH is a sufficient screening test for AI.

200 A Retrospective Study of Thoracolumbar Burst Fractures Treated with Fixation and Non-fusion Surgery of Intra-vertebral Bone Graft Assisted with Balloon Kyphoplasty

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 254-254
Author(s):  
Chengmin Zhang ◽  
Paul M Arnold ◽  
Qiang Zhou
Keyword(s):  
Retrospective Study ◽  
Bone Graft ◽  
Balloon Kyphoplasty ◽  
Posterior Fixation ◽  
X Rays ◽  
Vertebral Height ◽  
Fusion Surgery ◽  
Vertebral Bone ◽  
Group A ◽  
Group B

Abstract INTRODUCTION horacolumbar fractures are common spinal injuries. Posterior fixation and fusion is the primary treatment, although this may sacrifice range of motion (ROM) to achieve stability, rather than treating the fracture itself. Two issues addressed when treating thoracolumbar fractures include: 1) replacing the fractured vertebrae, especially the upper endplate of the injured vertebrae, and 2) provide strong fixation with biomechanical stability and flexibility. METHODS This retrospective study included 75 consecutive patients with thoracic or lumbar fractures treated from October 2010 to May 2014. A total of 61 patients met inclusion criteria. Patients were divided into one of two groups: group A, intra-vertebral bone graft with balloon kyphoplasty (non-fusion surgery); and group B, traditional posterior fixation and fusion surgery. The Visual Analog Scale (VAS) was done preoperatively as well as at three months, one year, and two years. X-ray, CT, and MRI were done preoperatively. X-rays were done postoperatively at three months and two years. Postoperatively at 3 months, CT was used to confirm healing of the vertebral fracture. RESULTS >Patient demographics and baseline characteristics were similar in the two groups. All fractures in both groups were reduced successfully, deformity was improved, and the anterior vertebral height restoration (AHR) was 98.76% ± 3.78% of PDS group and 95.38% ± 5.07% of Fusion group. After removal of hardware in group A, ROM at the injury level recovered (mean ROM 8.57°), and at 2 years, there was no loss of vertebral height or recurrence of deformity. There was no hardware failure in group A, but there was evidence of screw loosening three screws in group B. CONCLUSION Non-fusion treatment of intra-vertebral bone graft assisted with balloon kyphoplasty demonstrated good fracture reduction, deformity correction, fracture healing, and ROM maintenance. There were no complications associated with the implant. With the continued development of surgical techniques and materials, we believe that an increasing number of spinal fracture patients can avoid spinal fusion.

Preventative effects of prostaglandin E1 in combination with iodized olive oil on liver fibrosis after transcatheter arterial chemoembolization in a rabbit model of CCl4-induced liver fibrosis

2015 ◽  
Vol 93 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Shuqiang Jin ◽  
Haili Cao ◽  
Kaibing Wang ◽  
Ying Li ◽  
Bin Bai
Keyword(s):  
Liver Fibrosis ◽  
Olive Oil ◽  
Body Mass ◽  
Prostaglandin E1 ◽  
Transcatheter Arterial Chemoembolization ◽  
Rabbit Model ◽  
Serum Levels ◽  
Group B ◽  
Arterial Chemoembolization ◽  
Procollagen Iii

To explore the preventative effects of prostaglandin E1 (PGE1) on a rabbit model of CCl4-induced liver fibrosis after transcatheter arterial chemoembolization (TACE), we generated a rabbit model of CCl4-induced liver fibrosis by treatment with 40% CCl4 in iodized olive oil for 16 weeks. Body mass and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), albumin:globulin ratio (A:G), total bilirubin (TBIL), and direct bilirubin (DBIL) were measured. After TACE, the levels of hyaluronic acid (HA), procollagen III (PC III), laminin (LN), and collagen IV (IV-C) were measured, and the severity of liver fibrosis as well as the morphology of liver tissues were determined. Body mass in the model group was significantly decreased from 10 to 16 weeks, and the serum levels of ALT, AST, TP, TBIL, and DBIL levels were significantly increased while the model was being generated; the levels of ALB and A:G were significantly decreased. After TACE, serum levels of HA, PC III, and LN in the group injected with 1.0 mL iodized olive oil (Group B) were higher than in the group that were injected with 1.0 mL iodized olive oil + 0.2 mL PGE1 (Group C), whereas the serum levels of IV-C were lower. The severity of liver fibrosis was ameliorated in Group C. The combination of PGE1 and iodized olive oil prevented the development of liver fibrosis following TACE.

scholarly journals Evaluation of the “50-50 criteria” of post-hepatectomy liver failure as mortality predictor after resection of liver tumors

2019 ◽  
Vol 6 (3) ◽  
pp. 648
Author(s):  
Ashraf M. El-Badry ◽  
Ahmed E. Ahmed
Keyword(s):  
Liver Resection ◽  
Postoperative Complications ◽  
Liver Failure ◽  
Prothrombin Time ◽  
Total Bilirubin ◽  
Serum Total Bilirubin ◽  
Complication Rates ◽  
Group A ◽  
Cirrhotic Patients ◽  
Group B

Background: Post-hepatectomy liver failure (PHLF) represents a serious complication of liver resection. A standardized definition of PHLF based on serum total bilirubin (TB) level and prothrombin time (PT) reduction at the fifth postoperative day (POD-5) gained wide popularity.Methods: Medical records of consecutive adult patients who underwent elective liver resection for hepatic neoplasms from May 2015 to April 2018 were prospectively collected. PHLF was defined as serum total bilirubin (TB) level >50 mmol and prothrombin time (PT) reduction <50% on the fifth postoperative day (POD-5). Patients with PHLF were identified as group A and compared with group B (without PHLF) regarding postoperative complications and mortality.Results: Fifty-one patients were enrolled, forty-three with malignant (primary and secondary) neoplasms and eight with benign liver masses. Group A comprised eight patients who fulfilled the criteria of PHLF whereas 43 patients were included in group B. The mean age, gender ratio and mean number of resected liver segments were not significantly different between both groups. Patients in group A exhibited significantly increased complication rates compared with group B. Postoperative mortality occurred exclusively in group A where five among eight patients (62.5%) died postoperatively. The mortality rate was remarkably higher (100%) in cirrhotic patients who developed PHLF compared with 40% in non-cirrhotic with PHLF.Conclusions: PHLF is associated with increased severity of postoperative complications and mortality. Development of PHLF prompts intensive treatment protocol, particularly in cirrhotic patients.

scholarly journals Comparative Effectiveness of Enhanced Recovery After Surgery Program Combined With Single-Incision Laparoscopic Surgery in Colorectal Cancer Surgery: A Retrospective Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Changgang Wang ◽  
Haoran Feng ◽  
Xiaoning Zhu ◽  
Zijia Song ◽  
You Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Perioperative Management ◽  
Single Incision ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Single Incision Laparoscopic Surgery ◽  
Group A ◽  
Group B

BackgroundRecently, enhanced recovery after surgery (ERAS) has been widely used in the perioperative management of colorectal cancer (CRC). This study aimed to evaluate the safety and feasibility of ERAS combined with single-incision laparoscopic surgery (SILS) in CRC surgery.MethodsThis was a retrospective study of patients with CRC who underwent surgery between April 2018 and April 2020 in Ruijin Hospital(North), Shanghai Jiaotong University School of Medicine. The patients were divided into three groups: group A (n=138), patients who underwent traditional multiport laparoscopic colectomy with conventional perioperative management; group B (n=63), patients who underwent SILS; and group C (n=51), patients who underwent SILS with ERAS.ResultsOverall, 252 participants were included in the retrospective study. The median operation time (min) in group B and group C was shorter than that in group A (group A 134.0 ± 42.5; group B 117 ± 38.9; group C 111.7 ± 35.4, p=0.004). The estimated surgical blood loss (ml) was lower in groups B and C than in group A (group A 165.1 ± 142.2; group B 122.0 ± 79.4; group C 105.2 ± 55.8, p=0.011). The length of surgical incision (cm) was shorter in groups B and C than in group A (group A 7.34 ± 1.05; group B 5.60 ± 0.80; group C 5.28 ± 0.52, p&lt;0.001). The time before first flatus (hours) in group C was shorter than in groups A and B (group A 61.85 ± 21.14; group B 58.30 ± 20.08; group C 42.06 ± 23.72; p&lt;0.001). The days prior to the administration of free oral fluids in group C was shorter than in groups A and B (group A 4.79 ± 1.28; group B 4.67 ± 1.11; group C 2.62 ± 0.64; p&lt;0.001). The days of prior solid diet was less in group C than in groups A and B (group A 7.22 ± 3.87; group B 7.08 ± 3.18; group C 5.75 ± 1.70; p=0.027). The postoperative length of stay (LOS) was less in group C compared with that in groups A and B (group A 9.46 ± 4.84 days; group B 9.52 ± 7.45 days; group C 7.20 ± 2.37 days; p=0.023). The visual analog scale (VAS) scores on day 0, 1, and 2 in groups B and C were lower than those in group A (day 0, p&lt;0.001; day 1, p&lt;0.001; day 2, p=0.002), while the VAS score on day 3 showed no differences in the three groups (group A 1.29 ± 1.38; group B 0.98 ± 1.24; group C 0.75 ± 0.64, p=0.018).ConclusionThe findings suggest that SILS combined with ERAS may be a feasible and safe procedure for CRC surgery because it provides favorable cosmetic results, early dietary resumption, shorter hospital stays, and appropriate control of postoperative pain without increases in complications or readmission rates compared to conventional perioperative care with SILS or conventional laparoscopic surgery(CLS) of CRC. Further prospective randomized controlled studies are needed to enhance evidence-based medical evidence.

scholarly journals COMPARISON OF HEMODYNAMIC STATUS AND COMPLICATIONS BETWEEN TWO DIFFERENT DOSES OF INTRAMYOMETRIAL VASOPRESSIN DURING LAPAROSCOPIC MYOMECTOMY: A RETROSPECTIVE STUDY, THE LESSER THE BETTER

2021 ◽  
pp. 111-113
Author(s):  
NUPUR MODA ◽  
SUSHREE DAS ◽  
MADHUSMITA PATRO ◽  
PRERNA BISWAL
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Blood Loss ◽  
Normal Saline ◽  
Airway Pressure ◽  
Laparoscopic Myomectomy ◽  
Hemodynamic Status ◽  
Group A ◽  
Group B ◽  
Different Doses

Objective: Our aim is comparison of hemodynamic status and complications between two different doses of intramyometrial vasopressin during laparoscopic myomectomy. Methods: We did a retrospective analysis of hemodynamic status and its anesthetic concerns in patients who received two different doses of intramyometrial vasopressin. Eighty patients undergoing laparoscopic myomectomy under general anesthesia were divided into two groups of 40 patients in each group. In Group A (n=40), 10 units of intramyometrial vasopressin in 200 ml of normal saline were given and, in Group B, 20 units of intramyometrial vasopressin in 200 ml of NS were given intraoperatively by surgeon. Results: 20 units intramyometrial vasopressin used dogmatically by surgeons drops blood loss but it is connected with cardiovascular impediments. Hence, 10 units of intramyometrial vasopressin as compared to 20 units which are used by some surgeons are associated with similar blood loss and lesser side effects such as bradycardia, pulmonary edema, hypotension, blood loss, and increased airway pressure. Conclusion: Hence, anesthesiologists and gynecologists must take the precautions to escape and minimize the frequency of impediments with intramyometrial vasopressin by selecting the appropriate dosage of vasopressin.

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