Modern concepts of hepatic insufficiency, their advantages and faults: views of a general surgeon and transplantologist

Modern concepts of hepatic insufficiency, their advantages and faults: views of a general surgeon and transplantologist

Safe standard remnant liver volume after hepatectomy in HCC patients in different stages of hepatic fibrosis

Background To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. Methods Data for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage. Results Logistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001). Conclusions Right hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.

Relationship between Pre-Eclampsia, Renal Impairment and Hepatic Insufficiency among Pregnant Women in Al-Jouf Area -

Background: Pre-eclampsia is a pregnancy-specific syndrome. It affects 3-5% of pregnant women and is characterized by oedema, high blood pressure, and proteinuria. Moreover, in women with pre-eclampsia dysfunction of many organs, such as kidney and liver, is diagnosed, while in the case of foetus growth restriction is observed. Pre-eclampsia, when left untreated, can lead to a high mortality rate. In low-income countries, this disorder is one of the main causes of maternal and child mortality. Pre-eclampsia predisposes women in later life to cardiovascular diseases. So far, in acute cases of pre-eclampsia stabilization of the mother and fotus, and finally, termination of pregnancy at a time optimal for both sides can only be considered.Methods: The present work is designed to investigate the relationship between pre-eclampsia, renal and hepatic insufficiency in the Al-Jouf area through collecting information from the electronic database of maternity hospital for 100 pregnant women who suffered from pre-eclampsia compared with normal pregnancies.Results: The prevalence of pre-eclampsia is more prone in eldest women (older than 35 years old) almost 45% than younger women (20-25 years old), PC to MPV ratio value showed a significant suppression in pre-eclamptic pregnancies in comparison with normal pregnant women while HbA1c % value indicated a significant increase in the pre-eclamptic cases than the healthy pregnant women. Renal indices, serum creatinine, urea, and albumin were significantly higher in the pre-eclamptic women than in women with normal pregnancies.Conclusion: There is a tight relationship between hypertensive disorders during pregnancies, chronic renal disorders and hepatic insufficiency.