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

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.

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Factor II Related Antigen and Antithrombin III Levels as Indicators of Liver Failure in Consumption Coagulopathy

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657171 ◽

1982 ◽

Vol 47 (03) ◽

pp. 218-220 ◽

Cited By ~ 13

Author(s):

P Sié ◽

E Letrenne ◽

C Caranobe ◽

M Genestal ◽

B Cathala ◽

...

Keyword(s):

Liver Failure ◽

Antithrombin Iii ◽

Coagulation Factors ◽

Consumption Coagulopathy ◽

Blood Coagulation Factors ◽

Factor Ii ◽

At Iii ◽

Group A ◽

Group B

SummaryIn order to detect impaired synthesis of blood coagulation factors associated to consumption coagulopathy, a simultaneous evaluation of factor II-related antigen (II rAg) and of antithrombin III (AT III) was carried out in 16 patients affected with severe defibrination. An in vitro preliminary study on plasma and serum demonstrated that the levels of II rAg and of AT III, assessed by the Laurell technique with Behring antisera, were not reduced by the coagulation process. The patients were, a posteriori, classified into two groups according to the absence (group A) or the presence (group B) of factors predisposing to liver failure such as metastasis, cirrhosis, and prolonged shock. II rAg and AT III levels are significantly correlated; they are in the normal range in group A but reduced in group B. Thus II rAg or AT III level determinations are useful markers in the detection of liver failure associated to the consumption phenomenon. These results also suggest that part of the decreased AT III levels reported in severe cases of disseminated intravascular coagulation may be the consequence of an associated liver failure.

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Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia

Journal of Clinical Medicine ◽

10.3390/jcm9124132 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4132

Author(s):

Andrea Laufer ◽

Adrien Frommer ◽

Georg Gosheger ◽

Robert Roedl ◽

Frank Schiedel ◽

...

Keyword(s):

External Fixation ◽

Bone Transport ◽

Bone Union ◽

Complication Rates ◽

Union Rate ◽

Bone Fusion ◽

Group A ◽

Primary Bone ◽

Group B

Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.

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439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

British Journal of Surgery ◽

10.1093/bjs/znab134.280 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Durity ◽

G Elliott ◽

T Gana

Keyword(s):

Complicated Diverticulitis ◽

Complication Rates ◽

Long Term Outcomes ◽

Female Ratio ◽

Stoma Reversal ◽

Group A ◽

Grade 3 ◽

Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

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Comprehensive Nursing can Relieve the Negative Emotions of Patients undergoing Breast Cancer Resection and Reduce Postoperative

Tobacco Regulatory Science ◽

10.18001/trs.7.5.1.200 ◽

2021 ◽

Vol 7 (5) ◽

pp. 4234-4243

Author(s):

Xiaoxia Lv ◽

Lihua Wang ◽

Yan Zhai

Keyword(s):

Breast Cancer ◽

Postoperative Complications ◽

Quality Score ◽

Cancer Resection ◽

Upper Limb Function ◽

Sf 36 ◽

Group A ◽

Group B ◽

Nursing Quality

To explore the effect of comprehensive nursing on adverse emotions and postoperative complications of breast cancer patients undergoing mastectomy. Altogether 180 patients who received treatment in our hospital from May 2017 to May 2019 were selected as the research participants and divided into group A and group B. Among them, 100 cases in group A received comprehensive nursing, 80 cases in group B received routine nursing. The surgical indications, upper limb function, serum NGF, TK1 and CA15-3 expression level, VAS score, SAS, SDS score, quality of life SF-36 score were detected, and the incidence rate of postoperative complications and nursing quality score were compared. Compared with group B, group A had less postoperative bed time, intraoperative blood loss, length of hospital stay, better recovery of upper limb function, lower expression levels of serum NGF, TK1 and CA15-3, lower VAS score, SAS and SDS score, higher quality of life SF-36 score, lower incidence of postoperative complications and higher nursing quality score. Comprehensive nursing can relieve the negative emotions of patients undergoing breast cancer resection and reduce the incidence of postoperative complications.

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Ablating Aspiration Needle Tract Prior to Microwave Ablation Can Improve Therapeutic Outcomes for Predominantly Cystic Thyroid Nodules

Frontiers in Endocrinology ◽

10.3389/fendo.2021.752822 ◽

2021 ◽

Vol 12 ◽

Author(s):

Haizhen Yang ◽

Yanwei Chen ◽

Baoding Chen ◽

Shuangshuang Zhao ◽

Zheng Zhang ◽

...

Keyword(s):

Postoperative Complications ◽

Microwave Ablation ◽

Thyroid Nodules ◽

Cyst Fluid ◽

Cystic Fluid ◽

Needle Tract ◽

Intracystic Hemorrhage ◽

Group A ◽

Hospital Stays ◽

Group B

PurposeTo investigate whether ablating the aspiration needle tract could improve the safety and efficacy of ultrasound-guided microwave ablation (MWA) for predominantly cystic thyroid nodules.Materials and MethodsThis retrospective study evaluated 41 predominantly cystic thyroid nodules that underwent MWA between June 2017 and August 2019. The nodules were stratified by different procedures into two groups: the aspiration needle tract was ablated before cyst fluid aspiration and MWA when treating 26 nodules in Group A, while the other 15 nodules in Group B underwent MWA directly after cyst fluid aspiration. Baseline characteristics, intervention time, hospital stays, nodules with intraoperative intracystic hemorrhage, and postoperative complications were compared between the two groups. Volume, volume reduction rate (VRR), compressive score (CS), and aesthetic score (AS) were evaluated during follow-up.ResultsBoth groups achieved decreases in volume, CS, and AS, as well as an increase in VRR. The volumes and VRRs in Group A at 1, 3, 6, and 12 months were significantly smaller and greater than those in Group B (p < 0.001). The incidence of intraoperative intracystic hemorrhage in Group A was significantly lower than that in Group B (p=0.035). Compared to Group B, hospital stays were much shorter in Group A (p=0.040). There were no significant differences in intervention time, cystic fluid volume or postoperative complications.ConclusionAspiration needle tract ablation dramatically reduces the incidence of intraoperative intracystic hemorrhage and markedly improves the efficacy of MWA for predominantly cystic thyroid nodules.

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Surgical treatment of multiple brain metastases

Journal of Neurosurgery ◽

10.3171/jns.1993.79.2.0210 ◽

1993 ◽

Vol 79 (2) ◽

pp. 210-216 ◽

Cited By ~ 354

Author(s):

Rajesh K. Bindal ◽

Raymond Sawaya ◽

Milam E. Leavens ◽

J. Jack Lee

Keyword(s):

Brain Metastases ◽

Survival Time ◽

Prognostic Indicators ◽

Survival Duration ◽

Surgical Removal ◽

Complication Rates ◽

Multiple Brain Metastases ◽

Significant Difference ◽

Group A ◽

Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

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Review of Operative Treatment of Delayed Presentation of Acute Cholecystitis

The American Surgeon ◽

10.1177/000313481908500140 ◽

2019 ◽

Vol 85 (1) ◽

pp. 98-102

Author(s):

Ryan D. Eubanks ◽

Kenneth R. Hassler ◽

Grant Huish ◽

Tammy Kopelman ◽

Ross F. Goldberg

Keyword(s):

Acute Cholecystitis ◽

Symptom Onset ◽

Postoperative Bleeding ◽

Index Admission ◽

Complication Rates ◽

Delayed Presentation ◽

Estimated Blood Loss ◽

Before And After ◽

Group A ◽

Group B

Treatment of patients with delayed acute cholecystitis (AC) includes antibiotics and interval cholecystectomy based on proposed change at 72 hours from symptom onset to a chronic fibrotic phase with concern for increased complication rates. The purpose of our study was to compare the outcomes of patients undergoing laparoscopic cholecystectomy (LC) for AC before and after this golden 72-hour window. After institutional review board approval, a retrospective study was performed of patients presenting over two years with AC, who underwent LC during the index admission. A chart review was performed, and patients were divided into symptoms <72 hours (group A) and symptoms >72 hours (group B). Complications were defined as postoperative bleeding, return to operating room, and bile leaks. One hundred and eighty-four patients met the study criteria. Group A included 96 patients managed 5 to 71 hours after symptom onset, whereas Group B encompassed 88 patients with symptoms 72 to 336 hours. Both groups had similar baseline demographics and disease severity. No statistically significant differences were noted between the groups regarding overall complications or 30-day morbidity; however, Group B had an increased hospital stay length (P < 0.0001) and estimated blood loss (P = 0.028). LC seems safe despite duration of symptomatology and should be considered during the index admission in all AC patients.

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Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25413 ◽

2019 ◽

Vol 11 (1) ◽

pp. 24-28

Author(s):

Ben Limbu ◽

Hannah S Lyons ◽

Mohan Krishna Shrestha ◽

Geoffrey C Tabin ◽

Rohit Saiju

Keyword(s):

Success Rate ◽

Financial Burden ◽

Controlled Trial ◽

Nasolacrimal Duct ◽

Complication Rates ◽

Tube Removal ◽

Significant Difference ◽

Silicone Stent ◽

Group A ◽

Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

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Pull-Type Radiologically Inserted Gastrostomy: An Improvised Technique Using a Frugal Innovation

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-1681124 ◽

2019 ◽

Vol 03 (01) ◽

pp. 007-011

Author(s):

Anurag Chahal ◽

Sundeep Malla ◽

Chinmaya Dash ◽

Deepak Gupta ◽

Shivanand Gamanagatti

Keyword(s):

Radiation Dose ◽

Safety Profile ◽

Conventional Technique ◽

New Technique ◽

Fluoroscopy Time ◽

P Value ◽

Complication Rates ◽

Nasogastric Feeding ◽

Group A ◽

Group B

Abstract Purpose To describe a new technique for “pull type” radiologically inserted gastrostomy (RIG) and prospectively compare it with conventional (described) technique in terms of technical ease (fluoroscopy time, radiation dose) and safety profile. Materials and Methods Adult patients with head injury with Glasgow coma scale (GCS) (M score) < 5, one week after decompression or those requiring nutritional support for > 4 weeks, or patients with recurrent aspiration pneumonitis on nasogastric feeding were included. Hemodynamically unstable patients or those with uncorrectable coagulopathy were excluded. Patients underwent pull-type RIG with alternate patient getting allocated to groups A (conventional technique) and B (new technique). The authors compared the technical success, complication rate, fluoroscopy time, radiation dose, and cost of hardware in these two groups. Results The average fluoroscopy time for group A (9 patients) was 498.7 ± 145.3 seconds, whereas for group B (16 patients), it was 302.8 ± 54.1 seconds with p-value = 0.06. The mean radiation dose of group A was 74.7 ± 15.7 mGy, whereas for group B, it was 56.7 ± 14.1 mGy (p-value = 0.004). The minor complication rates were 11.1% in both the groups. Conclusion The authors’ innovative technique using a customized snare has the potential to increase the technical ease of pull-type RIG with reduced fluoroscopy time, radiation dose, and cost with a similar safety profile.

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Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up

The American Surgeon ◽

10.1177/000313481808401239 ◽

2018 ◽

Vol 84 (12) ◽

pp. 1927-1931

Author(s):

Zhenbo Dai ◽

Qinghua He ◽

Boyu Pan ◽

Liren Liu ◽

Dejun Zhou

Keyword(s):

Postoperative Complications ◽

Hypopharyngeal Cancer ◽

Reconstruction Method ◽

Observation Study ◽

Reconstruction Procedure ◽

Intrathoracic Stomach ◽

Group A ◽

Group B ◽

Medical University ◽

Gastric Pull Up

Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups ( P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.

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