scholarly journals A rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with liver cirrhosis

2021 ◽  
Vol 55 (2) ◽  
pp. 104-107
Author(s):  
S.D. Khimich ◽  
F.T. Muraviov
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Treatment ◽  
Negative Impact ◽  
Significant Proportion ◽  
Coagulation System ◽  
Rational Approach ◽  
Thromboembolic Complications ◽  
Acute Calculous Cholecystitis ◽  
Vein Thrombosis ◽  
Preoperative Prophylaxis

Background. It is known from scientific sources that a significant proportion of complications of liver cirrhosis is associated with negative impact of this pathology on the coagulation system. According to many scientists, liver cirrhosis in most cases poses a risk of developing both thrombotic and hemorrhagic complications. Objective: to identify a rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with cirrhosis. Materials and methods. We retrospectively analyzed the hospital records of 62 patients who were treated for complicated forms of cholelithiasis with verified liver cirrhosis for the period from 2005 to 2018. The distribution of patients by nosology was as follows: acute calculous cholecystitis — 48 patients, Mirizzi syndrome — 7, choledocholithiasis — 7. Results. Based on a comparative analysis of two groups, the risk of intraoperative bleeding in patients with preoperative prophylaxis was higher (3 cases — 8.1 %), with a blood loss of more than 400 ml. Hematomas of postoperative wounds were observed in 5 cases in group 1 and in one case in group 2. In the group of preoperative prophylaxis, portal vein thrombosis (n = 1), thrombosis of small branches of the pulmonary artery (n = 1), and deep vein thrombosis of the leg (n = 1) developed. No such complications were observed in the group with postoperative prophylaxis. Conclusions. The decision on the prevention of thromboembolic complications in this category of patients should be balanced and include an assessment of the risks of developing both hemorrhagic disorders and complications associated with thrombosis.

scholarly journals Serum ADAMTS-13 Levels as an Indicator of Portal Vein Thrombosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Tomasz Mikuła ◽  
Joanna Kozłowska ◽  
Wojciech Stańczak ◽  
Mariusz Sapuła ◽  
Aleksandra Różyk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Clinical Problem ◽  
Coagulation System ◽  
Decompensated Liver Cirrhosis ◽  
Vein Thrombosis ◽  
Bonferroni Test ◽  
The Mean

Background. Coagulation disorders in patients with liver cirrhosis are a common clinical problem. Cirrhosis should be considered a state of impaired blood clotting or an imbalance of the whole coagulation system. Cirrhosis-induced coagulopathy encompasses disturbances in both the procoagulant and anticoagulant systems. This mechanism may promote the development of thrombosis with portal vein thrombosis (PVT), which is considered an obstacle to orthotopic liver transplantation (OLT). We assessed serum ADAMTS-13 levels in patients with decompensated liver cirrhosis, with and without PVT. Material and Methods. Serum ADAMTS-13 levels, age, platelet count (PLT), and INR (international normalized ratio) were evaluated in (n=64) patients with liver cirrhosis either with PVT (group 1, n=31) or without PVT (group 2, n=33). The results were compared with those from healthy volunteers (group 3, n=37). Liver cirrhosis was based on Desmet’s classification of chronic hepatitis in liver biopsy stage ≥ 3 or liver elastography F-score ≥ 3. Serum ADAMTS-13 levels were measured with Quantikine® ELISA Human ADAMTS13 Immunoassay, R&D Systems Inc. We used Welch’s F-test, Games-Howell, one-way ANOVA, Bonferroni test, and logistic regression to determine whether ADAMTS-13 levels were a predictor that was independent of MELD and Child-Pugh scores. All results (P<0.05) were considered statistically significant. Results. The mean serum ADAMTS-13 level in patients with PVT was significantly lower than that in patients without PVT (P=0.001) and controls (P=0.001). The mean serum ADAMTS-13 level in patients without PVT was significantly lower than that in controls (P=0.001). ADAMTS-13 levels were significantly associated with PVT accounting for the Child-Pugh or MELD score in the logistic regression model. Conclusions. Low serum ADAMTS-13 levels can be a useful indicator of portal thrombosis in patients with decompensated liver cirrhosis irrespective of Child-Pugh or MELD scores. Further research is needed to determine whether ADAMTS-13 levels will find use in everyday clinical practice.

scholarly journals ANTIBIOTIC PROPHYLAXIS OF PURULENT AND SEPTICAL COMPLICATIONS DURING SURGICAL TREATMENT OF COMPLICATED GALLSTONE DISEASE ON BACKGROUND OF LIVER CIRRHOSIS

2019 ◽  
Vol 42 (3) ◽  
pp. 41-45
Author(s):  
Khimich S. D. ◽  
Muravyev F. T.
Keyword(s):  
Liver Cirrhosis ◽  
Surgical Treatment ◽  
Antimicrobial Prophylaxis ◽  
Gallstone Disease ◽  
Mirizzi Syndrome ◽  
Acute Calculous Cholecystitis ◽  
Escalation Therapy ◽  
Group 2 ◽  
Calculous Cholecystitis ◽  
Group 1

Purpose of the study. The goal of this investigation was to determine the main risk factors in development of purulent and septical complications during surgical treatment of complicated gallstone disease on background of liver cirrhosis. Materials and methods. We retrospectively reviewed medical records of 247 patients who undergone treatment in minimally invasive surgery centre of Zhytomyr regional clinical hospital during 2009–2018. All patients with complicated gallstone disease were divided in two groups: group 1 – patients with concomitant liver cirrhosis – 79(31,98%), and group 2 – patients without liver cirrhosis – 168 (68,02%). The inclusion criteria were presents of complicated gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice and Mirizzi syndrome), and verified liver cirrhosis. Patients with oncological history, immunodeficiency and morbid obesity were excluded. Liver cirrhosis was staged by Child-Тurcotte-Рugh system. In all cases patient’s condition was assessed by APACHE II scoring system and patients with cirrhotic lesion were additionally analyzed by MELD score. Acute calculous cholecystitis was diagnosed in 185 patients: group 1 – 68(Child A – 36, Child B – 31, Child C – 1), group 2 – 117 patients. The signs of cholodecholithiasis with obstructive jaundice were present in 49 cases: group 1 – 7 (Child A – 5, Child B – 1, Child C – 1), group 2 – 42. Mirizzi syndrome was verified in 9 cases: group 1 – 2 (Child A – 1, Child B – 1, group 2 – 7. Results and discussion. In all patients treatment was started in conservative way that included detoxic, antibacterial and hepatoprotective components. In group of control early operative tactic in cases with acute calculous cholecystitis was preferred. Antimicrobial prophylaxis was performed in cases of severe and moderate calculous cholecystitits with use of cephalosporines of 2 generation in moderate case, and protected cephalosporines of 3 generation in combination with metronidazol in severe. In main group providing of antimicrobial therapy was performed very carefully, because of higher risk of hepato-renal insufficiency. The early de-escalation therapy was mandatory performed. Purulent complications occurred in 13,2% of patient with liver cirrhosis in comparison with control group with 1,7% of complications. Conclusion. The treatment of complicated gallstone disease in patients with liver cirrhosis is very risky in case of postoperative purulent complications. In case of Child A stage of cirrhosis the treatment is safe, and the incidents of purulent complications is the same like in the absence of cirrhosis. Administration of antibiotics in cirrhotic should be very careful because of higher risk of hepato-renal insufficiency. The early de-escalation therapy should be mandatory performed. The «gold» standard of empirical antimicrobial therapy is the use of cephalosporines of 2 and 3 generation. Keywords: gallstone disease, cirrhosis, antimicrobial prophylaxis.

THE VALUE OF SKELETAL MUSCLE MASS IN PREDICTING SHORT-TERM OUTCOMES OF SURGICAL TREATMENT FOR KLATSKIN TUMOR

2018 ◽  
Vol 64 (5) ◽  
pp. 564-569
Author(s):  
Yuriy Zharikov ◽  
Tatyana Zharikova ◽  
Vladimir Nikolenko
Keyword(s):  
Skeletal Muscle ◽  
Surgical Treatment ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Negative Impact ◽  
Treatment Algorithm ◽  
Preoperative Treatment ◽  
Klatskin Tumor ◽  
Short Term ◽  
Oncological Patients

The objective of this review study was to analyze the relationship between skeletal muscle mass and postoperative short-term outcomes morbidity in patients with Klatskin tumor who underwent surgical treatment. Low index skeletal muscle mass had a negative impact factor on postoperative morbidity following resection of Klatskin tumor and should therefore be considered as preoperative risk assessment. The further study of body composition in oncological patients allowed revealing the group of patients with high probability of postoperative complications and this factor needed to be added to future models predictive scale of short-term outcomes with the aim of making the most rational preoperative treatment algorithm.

scholarly journals Rotational thrombelastometry (ROTEM) improves hemostasis assessment compared to conventional coagulation test in ACLF and Non-ACLF patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jessica Seeßle ◽  
Jan Löhr ◽  
Marietta Kirchner ◽  
Josefin Michaelis ◽  
Uta Merle
Keyword(s):  
Liver Cirrhosis ◽  
Test Performance ◽  
Coagulation System ◽  
Bleeding Events ◽  
Coagulation Parameters ◽  
Normal Limits ◽  
Coagulation Tests ◽  
Prospective Assessment ◽  
Patient Groups ◽  
Coagulation Assay

Abstract Background Patients with liver cirrhosis typically exhibit abnormal coagulation parameters in conventional coagulation tests (CCTs). Rotational thromboelastometry (ROTEM) is a holistic blood coagulation assay. This method provides an insight into the global hemostatic capabilities and has been suggested to provide a better overview of the coagulation system in liver cirrhosis. Methods The goal of this study was to examine hemostasis in patients with stable liver cirrhosis (Non-ACLF) and in acute-on-chronic liver failure (ACLF) by CCT and ROTEM including agreement of both tests and the prospective assessment of test performance based on clinical outcomes in ACLF patients. Therefore, ACLF patients were additionally subgrouped by bleeding events. Fifty-five Non-ACLF patients and twenty-two patients with ACLF were analysed in this prospective cohort study. Results Coagulation parameters analysed by CCT were outside the normal range in Non-ACLF and ACLF patients, but were significantly more aberrant in ACLF patients. Non-ACLF patients analysed by ROTEM revealed parameters largely within the normal limits, while significantly more ROTEM parameters in ACLF patients were affected. Maximum clot firmness (MCF) was significantly divergent between both patient groups and correlated well with levels of fibrinogen and platelet count. Using Cohen’s Kappa coefficient κ, the strength of agreement between CCT and ROTEM analyses was determined to be fair for Non-ACLF patients and moderate for ACLF patients. Bleeding events occurred significantly more often in ACLF group with significantly reduced A10 and MCF. Conclusions For assessing hemostasis in Non-ACLF and ACLF patients the underlying dataset shows advantages of ROTEM over CCT. A10 and MCF represent suitable prognostic parameters in predicting bleeding events in ACLF group.

Antiphospholipid Antibodies and Antiphospholipid Syndrome: Role in Portal Vein Thrombosis in Patients With and Without Liver Cirrhosis

2010 ◽  
Vol 17 (4) ◽  
pp. 367-370 ◽  
Author(s):  
Lucio Amitrano ◽  
Paul R. J. Ames ◽  
Maria Anna Guardascione ◽  
Luis R. Lopez ◽  
Antonella Menchise ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Vein Thrombosis

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

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