scholarly journals Establishing a Porcine Model of Small for Size Syndrome following Liver Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Mohammad Golriz ◽  
Maryam Ashrafi ◽  
Elias Khajeh ◽  
Ali Majlesara ◽  
Christa Flechtenmacher ◽  
...  
Keyword(s):  
Liver Resection ◽  
Porcine Model ◽  
Clinical Laboratory ◽  
Liver Volume ◽  
International Normalized Ratio ◽  
Remnant Liver ◽  
Extended Liver Resection ◽  
Group A ◽  
Group B ◽  
Small For Size

Background. Small for size syndrome (SFSS) is responsible for a high proportion of mortalities and morbidities following extended liver resection. Aim. The aim of this study was to establish a porcine model of SFSS. Methods. Twenty-four Landrace pigs underwent liver resection with a remnant liver volume of 50% (group A, n=8), 25% (group B, n=8), and 15% (group C, n=8). After resection, the animals were followed up for 8 days and clinical, laboratory, and histopathological outcomes were evaluated. Results. The survival rate was significantly lower in group C compared with the other groups (p<0.001). The international normalized ratio, bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase levels increased shortly after surgery in groups B and C, but no change was observed in group A (p<0.05 for all analyses). The histopathological findings in group A were mainly mild mitoses, in group B severe mitoses and hepatocyte ballooning, moderate congestion, and hemorrhage, along with mild necrosis, and in group C extended tissue damage with severe necrosis, hemorrhage, and congestion. Conclusions. Combination of clinical, laboratory, and histopathological evaluations is needed to confirm the diagnosis of SFSS. 75% liver resection in porcine model results in SFSS. 85% liver resection causes irreversible liver failure.

scholarly journals Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

2017 ◽  
Vol 313 (4) ◽  
pp. G313-G319 ◽  
Author(s):  
Mohammad Golriz ◽  
Sepehr Abbasi ◽  
Parham Fathi ◽  
Ali Majlesara ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Liver Resection ◽  
Hepatic Artery ◽  
Base Excess ◽  
Jugular Vein ◽  
Liver Volume ◽  
Remnant Liver ◽  
Extended Hepatectomy ◽  
Acid Base ◽  
Jugular Veins ◽  
Small For Size

Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco2 values increased after 75% resection in the jugular vein. In contrast, arterial Po2 increased after every resection, whereas the venous Po2 decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco2 in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation. NEW & NOTEWORTHY This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.

scholarly journals Preoperative Chemotherapy on Functional Liver Regeneration for Colorectal Liver Metastases Assessed With 99mTc-GSA SPECT/CT Imaging

2018 ◽  
Vol 102 (9-10) ◽  
pp. 431-439 ◽  
Author(s):  
Toru Beppu ◽  
Hiromitsu Hayashi ◽  
Morikatsu Yoshida ◽  
Hidetoshi Nitta ◽  
Katsunori Imai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Liver Regeneration ◽  
Preoperative Chemotherapy ◽  
Colorectal Liver Metastases ◽  
Major Hepatectomy ◽  
Liver Volume ◽  
Control Group ◽  
Remnant Liver ◽  
Resection Rate

Objective: To investigate the functional liver regeneration after chemotherapy and liver resection for colorectal liver metastases (CRLM). Background/Purpose: Preoperative chemotherapy followed by liver resection for CRLM has been increasing; however, its negative impact on liver regeneration remains unknown. Methods: From January 2009 to December 2013, we enrolled 40 selected patients who underwent major hepatectomy without viral hepatitis and severe liver fibrosis. CRLM patients with preoperative chemotherapy (CT-CRLM group, n = 12) and patients without preoperative chemotherapy (control group, n = 28) were evaluated. Liver volume (LV) and functional liver volume (FLV) was assessed using Tc-99m–labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, single-photon emission computed tomography (SPECT), CT-fused images. Preoperative, future remnant liver, and post 1-month values were compared. Results: Median course of preoperative chemotherapy was 8 (range: 6–16). Preoperative background factors were almost identical including resection rate and functional resection rate. In the CT-CRLM group and in the control group, the percentage increases in LV were 39.3% ± 29.0% and 23.2% ± 23.5% (P = 0.037), and FLV were 79.4% ± 43.1% and 57.0% ± 33.4% (P = 0.417), respectively; absolute differences in LV were 216.2 ± 155.7 cm3 and 148.7 ± 134.7 cm3 (P = 0.086) and FLV were 19.4% ± 8.5%/m2 and 17.4% ± 7.9%/m2 (P = 0.235), respectively. We found no obvious tendency for negative influence on liver functional regeneration by the preoperative regimens for CRLM. Conclusions: Several courses of preoperative chemotherapy may not affect functional liver regeneration for CRLM patients after major hepatectomy.

scholarly journals A Prospective Randomized Trial to Assess the Antireflux Effect of Antireflux Mucosectomy in the Porcine Model

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Xuan Li ◽  
Weifeng Zhang ◽  
Meihong Chen ◽  
Shuchun Wei ◽  
Xiangyang Zhao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Porcine Model ◽  
Gastroesophageal Junction ◽  
Control Group ◽  
Potential Efficacy ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background. Both long-term proton pump inhibitor use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). Our aim was to investigate the potential efficacy of antireflux mucosectomy (ARMS) in porcine and determine the optimal circumference of resection in relation to gastroesophageal junction (GEJ). Methods. Nine pigs were allocated into the following 3 groups by computerized randomization: group A: control, group B: 1/3 circumference of the esophagus, and group C: 2/3 circumference of the esophagus. We performed mucosectomy with a crescentic mucosal resection at 3 cm above the GEJ and 1 cm below the GEJ. The animals were kept on a liquid diet for 24 h prior to endoscopy. At 6 weeks, animals underwent esophagoscopy, barium radiography, gastric yield pressure (GYP), and gastric yield volume (GYV) determination. Results. The weight of swines has no significant difference, and all pigs had maintained their weight after the procedure. We both found scar formation at the GEJ in group B and C. Compared with group A and B, group C produced significantly higher GYP (24.23±3.42 mmHg, p=0.004) and significantly smaller GYV (2200.0±238.96 mL, p=0.028) after 6 weeks. Barium radiography showed that the width of the cardia was narrower (13.73±1.19 mm, p=0.032) in group C after 6-week postprocedure. Conclusion. Our study demonstrated the potential antireflux effect of ARMS. We also recommend the 2/3 circumference resection of mucosa at 3 cm distance from the GEJ.

scholarly journals 1608. Use of Selective Reporting of Antimicrobial Susceptibilities and Its Impact on Antimicrobial Resistance Surveillance—National Healthcare Safety Network, 2017–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S586-S587
Author(s):  
Hsiu Wu ◽  
Liang Zhou ◽  
MINN M SOE ◽  
Jonathan R Edwards ◽  
Daniel Pollock
Keyword(s):  
Antimicrobial Resistance ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Performance Standards ◽  
Selective Reporting ◽  
National Healthcare ◽  
Group A ◽  
Group B ◽  
And Staphylococcus Aureus ◽  
Complete Reporting

Abstract Background Selective reporting (SR), recommended by the 2016 IDSA/SHEA antimicrobial stewardship guidelines, is a strategy to guide prescribing decisions by limiting the antimicrobial susceptibility testing (AST) results available to prescribers. Yet, SR carries risks that cumulative antibiograms reflect only partial AST results. The Clinical Laboratory Standards Institute (CLSI) M100 performance standards stipulate that AST results should be routinely reported for some antimicrobials (Group A agents) while SR is appropriate for other antimicrobials (Group B agents). We assessed the extent of SR use and its impact on national antimicrobial resistance (AR) surveillance. Methods We used Enterobacteriaceae (EB) and Staphylococcus aureus (SA) blood culture AST results that hospitals reported for group A and B agents to the CDC’s National Healthcare Safety Network’s AR option from 2017 through 2018. Routine reporting for an organism-agent combination was defined as results reported for ≥ 90% isolates for the hospital’s most frequently reported agents. SR was defined as a shortfall of > 20% in results reported for an agent compared with a routinely reported agent in a hospital that reported ≥ 30 isolates. We compared hospital antibiograms between SR and non-SR hospitals. We also identified isolate characteristics associated with AST reporting in SR hospitals. Results Among 242 and 185 hospitals reported ≥ 30 isolates, many showed patterns of SR (Figure 1). Of 437 and 425 hospitals reported ≥ 1 isolate, only 112 (26%) and 152 (36%) routinely reported AST results for all group A agents for EB and SA, respectively. For EB, 345 (79%) hospitals routinely reported AST results for ciprofloxacin or levofloxacin, although both are group B agents. For SA, 324 (76%) routinely reported vancomycin (Figure 2). Antibiograms for many agents differed between SR and non-SR hospitals (Figure 3, 4). In SR hospitals, non-susceptibility to narrower-spectrum drugs, patient location, age, and some species among EB were associated with AST reporting. Conclusion AST results reporting vary across hospitals and agents, and CLSI’s SR standards are used inconsistently. For AR surveillance, complete reporting calls for solutions that bypass SR. In the meantime, SR should be taken into account in national AR benchmarking. Disclosures All authors: No reported disclosures.

scholarly journals Pathological and microbiological impact of a gentamicin-loaded biocomposite following limited or extensive debridement in a porcine model of osteomyelitis

2020 ◽  
Vol 9 (7) ◽  
pp. 394-401
Author(s):  
Sophie A. Blirup-Plum ◽  
Thomas Bjarnsholt ◽  
Henrik E. Jensen ◽  
Kasper N. Kragh ◽  
Bent Aalbæk ◽  
...  
Keyword(s):  
Bone Tissue ◽  
Porcine Model ◽  
Drill Hole ◽  
Post Mortem ◽  
Tissue Samples ◽  
Group A ◽  
Extensive Debridement ◽  
Group B ◽  
The Right ◽  
Surrounding Bone

Aims CERAMENT|G is an absorbable gentamicin-loaded biocomposite used as an on-site vehicle of antimicrobials for the treatment of chronic osteomyelitis. The purpose of the present study was to investigate the sole effect of CERAMENT|G, i.e. without additional systemic antimicrobial therapy, in relation to a limited or extensive debridement of osteomyelitis lesions in a porcine model. Methods Osteomyelitis was induced in nine pigs by inoculation of 104 colony-forming units (CFUs) of Staphylococcus aureus into a drill hole in the right tibia. After one week, the pigs were allocated into three groups. Group A (n = 3) received no treatment during the study period (19 days). Groups B (n = 3) and C (n = 3) received limited or extensive debridement seven days postinoculation, respectively, followed by injection of CERAMENT|G into the bone voids. The pigs were euthanized ten (Group C) and 12 (Group B) days after the intervention. Results All animals presented confirmatory signs of bone infection post-mortem. The estimated amount of inflammation was substantially greater in Groups A and B compared to Group C. In both Groups B and C, peptide nucleic acid fluorescence in situ hybridization (PNA FISH) of CERAMENT|G and surrounding bone tissue revealed bacteria embedded in an opaque matrix, i.e. within biofilm. In addition, in Group C, the maximal measured post-mortem gentamicin concentrations in CERAMENT|G and surrounding bone tissue samples were 16.6 μg/ml and 6.2 μg/ml, respectively. Conclusion The present study demonstrates that CERAMENT|G cannot be used as a standalone alternative to extensive debridement or be used without the addition of systemic antimicrobials. Cite this article: Bone Joint Res 2020;9(7):394–401.

Triggered Liver Regeneration: From Experimental Model to Clinical Implications

2015 ◽  
Vol 54 (3-4) ◽  
pp. 148-161 ◽  
Author(s):  
Attila Szijártó ◽  
András Fülöp
Keyword(s):  
Liver Resection ◽  
Surgical Technique ◽  
Liver Regeneration ◽  
Molecular Mechanisms ◽  
Liver Tumors ◽  
Therapeutic Option ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Comprehensive Overview

Background: Major liver resection is the only therapeutic option for patients with malignant liver tumors. However, extended hepatectomy often leads to postoperative liver failure, mainly due to insufficient amounts of the remnant liver. Recently, selective portal vein occlusion (PVO) has been introduced to increase the remnant liver volume. This novel surgical technique initiated a progressive development in liver surgery, resulting in a significant increment in potential candidates for curative liver resection. Summary: The theoretical basis for this great advancement is formed by an understanding of the mechanisms of PVO-induced liver regeneration, mainly obtained from animal studies. The aim of this review is to give a comprehensive overview of the relevant animal models of PVO and to discuss the main characteristics of triggered liver regeneration, including the induced hemodynamic, morphological and functional alterations as well as the underlying molecular mechanisms, which might be of interest in both the laboratory and the clinic. Key Messages: Although basic research revealed the main characteristics of PVO-triggered liver regeneration within the last decades, several important issues regarding the regenerative process remain uncertain. To answer these open questions, additional well-designed animal experiments are needed in the future, which allow further refinement of this surgical technique.

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 The Application of Selective Hepatic Inflow Vascular Occlusion with Anterior Approach in Liver Resection: Effectiveness in Managing Major Complications and Long-Term Survival

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Khai Viet Ninh ◽  
Nghia Quang Nguyen ◽  
Son Hong Trinh ◽  
Anh Gia Pham ◽  
Thi-Ngoc-Ha Doan
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Anterior Approach ◽  
Liver Volume ◽  
Operation Time ◽  
Vascular Occlusion ◽  
Remnant Liver ◽  
Term Survival ◽  
Average Hospital ◽  
Hepatic Pedicle

Background. Hepatectomy is always a challenge to surgeons and requires an appropriate approach for specific tumors to achieve effective complication management. Selective hepatic pedicle clamping is more considerable strategy when comparing with total hepatic pedicle clamping in the balance between reducing blood loss and transfusion with causing the hepatic parenchyma damages (two main complications affecting liver resection result). Objectives. In this study, we aim to describe the application of selective hepatic inflow vascular occlusion (SHIVO) and anatomical anterior approach in liver resection and evaluate the results, focusing on intraoperative and postoperative complications. Methods. We enrolled 72 patients who underwent liver resection with SHIVO at Viet Duc University Hospital in 4-year period (2011-2014) and then followed up all of them until June 2020 (in 52.6 ± 33 months; range, 2-105 months) or up to the time of death. All the patients were diagnosed with primary or secondary liver cancer, and their future remnant liver volume measured on 64-slice CT scan (dm3) to body   weight   kg > 0.8 % (for right hepatectomy). Perioperative parameters were collected and analyzed. Results. The average operation time was 196.2 ± 62.2 minutes, and blood loss was 261.4 ± 202.9  ml; total blood transfusion proportion during and after surgery was 16.7%. Complications accounted for 44.5% of patients in which pleural effusion was the most common one (41.7%). There were no liver failure and biliary fistula after surgery. No deaths were recorded during 30 days postoperatively. Average hospital stay was 11.4 ± 3.7 days. Blood transfusions during the operation and major liver resection were the factors significantly affecting the percentage of complications after liver surgery in our study. In the last follow-up evaluation, 44 patients were dead and 28 patients were alive, in which 7 with recurrence and 21 without recurrence. The overall survival rate was 38.9%. Conclusion. SHIVO in anatomical liver resection is a safe and feasible approach to help resect precisely targeted tumors and manage several complications in liver resection.

scholarly journals Clinical Characteristics, Dynamic Profile of Radiology and Laboratory Findings in Coronavirus Disease 2019

2020 ◽  
Author(s):  
ailing liu ◽  
Jing Zhang ◽  
Wei Qiao ◽  
Wei Zang ◽  
Yingying Zhang ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Oxygenation Index ◽  
Laboratory Findings ◽  
Single Centre Study ◽  
History Of ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Dynamic Profile

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, more and more data from different area and different stages of disease have been needed.Methods In this retrospective, single-centre study, we included all 38 confirmed cases of Covid-19 in Weihai from Jan 24 to Feb 24, 2020. Patients were divided into group A by normal Oxygenation Index (OI), group B by abnormal OI (less than 400 mmHg).The dynamic changes in clinical laboratory parameters were tracked from day 1 to day 32 after the onset of the disease at 4-day intervals. Cases were analyzed for clinical, radiological features and laboratory data. Outcomes were followed up until Feb 24, 2020.Results 38 patients with Covid-19 were included in this study, 68.42% patients were family clustered, and 97.37% patients had a history of exposure. The mean days between exposure and onset were about 5 days. Most patients were men, mean age was 43 years, 52.6% patients had chronic diseases. Most patients had fever or cough, about a third of patients had expectoration or fatigue, and 5 (13.16%) patients had shortness of breath.

Sign in / Sign up

Export Citation Format

Share Document