scholarly journals Is There a Role for Perioperative Nutritional Support in Liver Resection?

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 177-179
Author(s):  
Albert Bothe ◽  
Glenn Steele
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Relative Risk ◽  
Confidence Interval ◽  
Chronic Active Hepatitis ◽  
Nutritional Support ◽  
Morbidity Rate ◽  
Control Group ◽  
Percent Confidence Interval ◽  
Septic Complications

Background: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma.Methods: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty-four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched chain amino acids, dextrose, and lipid emulsion (50 percent medium-chain trigylcerides) given intravenously for 14 days perioperatively).Results: There was a reduction in the overall postoperative morbidity rate in the perioperative-nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg; P=0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (–2.8 percent vs. –4.8 percent at 20 minutes, P=0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatechtomy. There were five deaths during hospitalization in the perioperativenutrition group, and nine in the control group (P not significant).Conclusions: Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.

scholarly journals Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

1998 ◽  
Vol 42 (6) ◽  
pp. 1336-1339 ◽  
Author(s):  
Ronen Loebstein ◽  
Antonio Addis ◽  
Elaine Ho ◽  
Roseann Andreou ◽  
Suzanne Sage ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Pregnancy Outcome ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
In Utero ◽  
Controlled Study ◽  
Control Group ◽  
Increased Risk ◽  
Clinically Significant

ABSTRACT Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

2004 ◽  
Vol 34 (8) ◽  
pp. 1431-1441 ◽  
Author(s):  
ULRIKA KREICBERGS ◽  
UNNUR VALDIMARSDÓTTIR ◽  
ERIK ONELÖV ◽  
JAN-INGE HENTER ◽  
GUNNAR STEINECK
Keyword(s):  
Psychological Distress ◽  
Relative Risk ◽  
Confidence Interval ◽  
Stressful Life Event ◽  
Population Based ◽  
Anxiety And Depression ◽  
Control Group ◽  
Bereaved Parents ◽  
Increased Risk ◽  
Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

scholarly journals Do low-dose corticosteroids improve survival or shock reversal from septic shock in adults? Meta-analysis with trial sequential analysis

2018 ◽  
Vol 46 (7) ◽  
pp. 2513-2524 ◽  
Author(s):  
Rui Xu ◽  
Qian Wang ◽  
Yan Huang ◽  
Ling Wu ◽  
Qi Liu ◽  
...  
Keyword(s):  
Septic Shock ◽  
Relative Risk ◽  
Confidence Interval ◽  
Sequential Analysis ◽  
Low Dose ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Control Group ◽  
Shock Reversal

Objective This meta-analysis with trial sequential analysis (TSA) was performed to determine whether low-dose corticosteroids (LDCs) can improve survival or shock reversal from septic shock in adults. Methods A literature search was performed using several databases (Medline, Cochrane Library, Embase, and Chinese Biological Medical Database) until 23 October 2017. The systematic review was registered in PROSPERO. Results Nine randomized controlled trials (RCTs) (n = 1182) were included. LDC intervention improved 7-day shock reversal compared with the control group (relative risk, 1.36; TSA-adjusted 95% confidence interval, 1.20–1.54). LDCs had no statistically significant effects on gastrointestinal bleeding or superinfection. LDCs did not reduce 28-day mortality from septic shock (relative risk, 0.96; TSA-adjusted 95% confidence interval, 0.74–1.24). The TSA indicated that RCTs of about 3000 patients would be needed to draw definitive conclusions; similar results were obtained in a subgroup analysis of nonresponders. Conclusions LDCs improve 7-day shock reversal. However, whether LDCs improve 28-day survival from septic shock in adults remains unclear. The results of well-designed larger RCTs are needed.

scholarly journals Quilting Sutures in Rhytidectomy: A Systematic Review of the Literature

2019 ◽  
Vol 40 (11) ◽  
pp. 1157-1164 ◽  
Author(s):  
Anthony Ballan ◽  
Samer Jabbour ◽  
Youssef El Rayess ◽  
Khalil Jabbour ◽  
Lena El Hachem ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Postoperative Complications ◽  
Confidence Interval ◽  
Meta Analysis ◽  
Control Group ◽  
Published Data ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Safety And Efficacy

Abstract Background Different technical variations exist for the utilization of quilting sutures (QS) in rhytidectomy. No systematic review or meta-analysis of the studies describing the use of QS in facelifts has been published to date to the authors’ knowledge. Objectives The objective of this study was to summarize all the published data regarding the utilization of QS in rhytidectomy, compare QS techniques, and evaluate their effect on postoperative complications. Methods On April 1, 2019, a systematic search of the Medline, Embase, and Cochrane databases was conducted. All the studies describing the usage of QS in facelifts were included in this review. Studies reporting hematoma rate in a QS group and a control group were included in the meta-analysis part of this study. Results The initial search of the databases yielded 93 results. Four trials were included in the systematic review and 2 were included in the meta-analysis. The total number of included patients with QS was 527. Two studies employed internal QS and the remaining studies utilized external QS. The meta-analysis found a lower rate of hematoma in the QS group (relative risk, 0.02; 95% confidence interval = 0.00-0.13; P < 0.0001). Conclusions QS can be applied either internally or externally and are very effective in reducing hematomas after facelifts. QS could be a great asset in facelifts but should be utilized with caution because additional work is needed to confirm their safety and efficacy. Level of Evidence: 2

scholarly journals DNA Methylation and Micro-RNAs: The Most Recent and Relevant Biomarkers in the Early Diagnosis of Hepatocellular Carcinoma

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 607 ◽  
Author(s):  
Angela Cozma ◽  
Adriana Fodor ◽  
Romana Vulturar ◽  
Adela-Viviana Sitar-Tăut ◽  
Olga Hilda Orăşan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Early Diagnosis ◽  
Human Subjects ◽  
Control Group ◽  
Cancer Type ◽  
Dna Hypomethylation ◽  
Dna Hypermethylation ◽  
Aberrant Expression ◽  
Micro Rnas

Hepatocellular carcinoma (HCC) is a frequently encountered cancer type, and its alarming incidence is explained by genetic and epigenetic alterations. Epigenetic changes may represent diagnostic and prognostic biomarkers of HCC. In this review we discussed deoxyribonucleic acid (DNA) hypomethylation, DNA hypermethylation, and aberrant expression of small non-coding ribonucleic acid (RNA), which could be useful new biomarkers in the early diagnosis of HCC. We selected the articles on human subjects published in English over the past two years involving diagnostic markers detected in body fluids, cancer diagnosis made on histopathological exam, and a control group of those with benign liver disease or without liver disease. These biomarkers need further investigation in clinical trials to develop clinical applications for early diagnosis and management of HCC.

TALE OF THREE CITIES

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. A42-A42
Author(s):  
Student
Keyword(s):  
Health Care ◽  
Relative Risk ◽  
Child Health ◽  
Confidence Interval ◽  
Child Health Care ◽  
Percent Confidence Interval ◽  
New Haven ◽  
Diagnostic Categories ◽  
Medical Diagnostic ◽  
The Cost

Hospitalization accounts for a large proportion of the expenditures for child health care, and differences in the rate of hospitalization may produce important variations in the cost of that care. We studied the rates of hospitalization in Boston, Rochester (N.Y.), and New Haven (Conn.) in 1982. We assigned the risk of hospitalization in Rochester a score of 1.00. Boston children were hospitalized at more than twice the rate of Rochester children for most medical diagnostic categories (relative risk, 2.65; 95 percent confidence interval, 2.53 to 2.78), and the rate for the New Haven group was intermediate (relative risk, 1.80;95 percent confidence interval, 1.68 to 1.93).

Non-alcoholic fatty liver disease and relative risk of incident steatohepatitis, cirrhosis and hepatocellular carcinoma events in four European primary care databases

2018 ◽  
Vol 68 ◽  
pp. S57-S58
Author(s):  
M. Alexander ◽  
K. Loomis ◽  
N. Dhalwani ◽  
J. van der Lei ◽  
T. Duarte-Salles ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Primary Care ◽  
Liver Disease ◽  
Relative Risk ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

scholarly journals Efficacy of parecoxib sodium on postoperative shivering: meta-analysis of clinical trials

2017 ◽  
Vol 46 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Yu Zhu ◽  
Chengmao Zhou ◽  
Yuting Yang ◽  
Yijian Chen
Keyword(s):  
Clinical Trials ◽  
Relative Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Control Group ◽  
Effective Strategy

Objective To evaluate the effect of parecoxib on preventing postoperative shivering. Methods Main outcomes were the relative risk (odds ratio, OR) and 95% confidence interval (CI) relative to the incidence of shivering. Results Fourteen trials with 1,175 patients were analyzed. The pooled evidence suggested that parecoxib sodium, given before anesthesia or postoperatively (only 4 cases), had the potential to prevent postoperative shivering (OR = 0.21, 95% CI, 0.16, 0.29). Compared with the placebo, parecoxib sodium significantly lowered the incidence of postoperative shivering as follows: mild shivering [OR = 0.51, 95% CI (0.35, 0.74)]; moderate shivering [OR = 0.28, 95% CI (0.18, 0.45)]; severe shivering [OR = 0.18, 95% CI (0.10, 0.33)]. Compared with placebo, there was no significant association of parecoxib sodium with restlessness [OR = 0.95, 95% CI (0.59, 1.52)] or nausea/vomiting [OR = 0.24, 95% CI (0.09, 0.66)]. In addition, pethidine rescue was used significantly more often in the control group than in the parecoxib sodium group [OR = 0.22, 95% CI (0.09, 0.53)]. Conclusions Parecoxib sodium may be an effective strategy for preventing postoperative shivering.

scholarly journals Hepatocyte Growth Factor in Patients with Three Different Stages of Chronic Liver Disease including Hepatocellular Carcinoma, Cirrhosis and Chronic Hepatitis: An Immunohistochemical Study

2001 ◽  
Vol 15 (3) ◽  
pp. 159-165 ◽  
Author(s):  
Banu Bilezikçi ◽  
Asuman Nihan Haberal ◽  
Beyhan Demirhan
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Liver Disease ◽  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Hepatoma Cells ◽  
Control Group ◽  
Positive Staining ◽  
Ito Cells ◽  
Hepatocyte Growth

BACKGROUND AND AIMS: The specific role of hepatocyte growth factor in liver disease is unknown. The presence and density of this factor in patients with three different stages of liver disease were investigated, with the aim of assessing its prognostic significance.PATIENTS AND METHODS: Liver specimens from patients with chronic hepatitis (n=20), cirrhosis (n=20), hepatocellular carcinoma (n=30) and normal livers (n=20) were immunohistochemically stained to determine the presence and density of hepatocyte growth factor.RESULTS: There were significantly more hepatocyte growth factor-positive Kupffer and Ito cells in all three diseased groups than in the control group. Also, there was significantly more positive staining in chronic hepatitis specimens than in specimens from the cirrhosis, hepatocellular carcinoma and control groups (P<0.05). The hepatoma cells in 10 of the hepatocellular carcinoma cases stained positive, but none of the hepatocytes in the chronic hepatitis, cirrhosis and normal liver specimens stained. It was only possible to assess nonmalignant hepatocytes adjacent to the hepatocellular carcinoma in the four resection specimens, and no staining for hepatocyte growth factor was observed in these areas. There was no statistical association between density of hepatocyte growth factor and histological activity index in chronic hepatitis, or between density of hepatocyte growth factor and grade of hepatocellular carcinoma.CONCLUSIONS: Similar to some previous reports, this study revealed that hepatoma cells can also express this growth factor. Immunohistochemical detection of hepatocyte growth factor may prove to be a useful method of diagnosing hepatocellular carcinoma in challenging cases.

Effect of Antimicrobial Prophylaxis on the Incidence of Infections in Clean Surgical Wounds in Hospitals Undergoing Renovation

2006 ◽  
Vol 27 (12) ◽  
pp. 1372-1376 ◽  
Author(s):  
Osvaldo Iribarren ◽  
Miguel Araujo
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Surgical Site Infection ◽  
Antimicrobial Prophylaxis ◽  
Control Group ◽  
Site Infection ◽  
Double Blind ◽  
Prophylaxis Group ◽  
Surgical Wounds ◽  
American Society

Objective. To measure the effect of cephazolin prophylaxis on the rate of surgical site infection among patients with clean surgical wounds, categorized by risk group, in a hospital undergoing renovation. Design. Randomized, double-blind clinical trial. Setting. Saint Paul General Hospital, Coquimbo, Chile, during a period when it was undergoing significant interior remodeling. Patients. General surgery patients who received antibiotic prophylaxis before clean wound surgery between March 2003 and May 2004 and a matched control group of patients who did not receive such prophylaxis. Results. A total of 303 patients participated in the study. The rate of infection among patients with an American Society of Anesthesiologists (ASA) classification of 1 in the prophylaxis group was 7.3%, whereas among ASA 1 patients in a no-prophylaxis control group it was 10.3% (P = .40). In the prophylaxis group, the ASA 2 and ASA 3 patients combined had an infection rate of 10.5%, whereas in the no-prophylaxis group these patients had a rate of 30.0% (relative risk, 0.33 [95% confidence interval, 0.58-0.96]; P = .03). Both the ASA 2 and ASA 3 patients were protected from infection by prophylaxis; these patients had 1.7 and 2.2 times, respectively, more risk of developing a surgical site infection than did ASA 1 patients after a clean surgical procedure, but the ASA 2 and ASA 3 patients who did not receive prophylaxis had 4.3 and 4.8 times, respectively, greater risk of infection (relative risk, 0.91 [95% confidence interval, 0.83-0.99]; P = .02). Prophylaxis significantly reduced the rate of infection in the ASA 2 and ASA 3 groups. Conclusions. We recommend the use of antimicrobial prophylaxis with cephalosporins in ASA 2 and ASA 3 patients undergoing clean wound surgery during a period when significant renovations are being performed in the hospital.

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