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    65 results match your criteria Perioperative Management of the Patient With Liver Disease

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    Anesthesia for the Patient with Concomitant Hepatic and Renal Impairment.
    Anesthesiol Clin 2016 Dec;34(4):645-658
    Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street-PH 5, New York, NY 10032, USA.
    Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Read More

    Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review.
    Paediatr Anaesth 2016 Oct 12;26(10):976-86. Epub 2016 Jul 12.
    Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA.
    Background: Combined heart and liver transplantation (CHLT) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (CHD) involving single ventricle physiology.

    Objective: The purpose of this study was to describe the perioperative management of pediatric patients undergoing CHLT at a single institution and to identify management strategies that may be used to optimize perioperative care.

    Methods: We did a retrospective database review of all patients receiving CHLT at a children's hospital between 2006 and 2014. Read More

    [Perioperative Airway Management in a Patient with Madelung's Disease: A Case Report].
    Masui 2016 Feb;65(2):168-71
    Madelung's disease is a rare disorder characterized by multiple, symmetric fatty tissues. The patient, 72-year-old man was admitted to our hospital for abdominal surgery for liver cancer. He had extreme fatty accumulations involving head and neck. Read More

    Anesthesia Management for Palliative Surgery of Massive Hepatic Metastatic Melanoma.
    A A Case Rep 2016 Apr;6(7):189-92
    From the *Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and †Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
    We report the perioperative management of a patient with melanoma. Surgical intervention was withheld at multiple institutions because of the presence of metastases; the patient was undergoing experimental immunotherapy and had responded everywhere except in the liver. She underwent hepatic right trisegmentectomy to improve her quality of life and to allow resumption of immunotherapy. Read More

    Pain Management With Bilateral Continuous Thoracic Paravertebral Block in a Patient With Fontan-Associated Hepatocellular Carcinoma Undergoing Hepatectomy.
    Reg Anesth Pain Med 2015 Nov-Dec;40(6):718-9
    From the Department of Anesthesiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
    Objective: We report a case of perioperative management of a single-ventricle patient with Fontan-associated liver disease undergoing hepatectomy.

    Case Report: A 12-year-old boy with Fontan circulation was scheduled for partial hepatectomy to remove a liver mass in segment 6. He received stent implantation to relieve conduit stenosis 6 months before the operation. Read More

    Historical Comparison of Overall Survival after Hepatic Resection for Patients With Large and/or Multinodular Hepatocellular Carcinoma.
    Medicine (Baltimore) 2015 Sep;94(35):e1426
    From the Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, PR China (J-HZ, X-MY, S-DL, Y-YW, B-DX, LM, F-XW, W-PY, L-QL); and Disease Classification Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, P.R. China (YC).
    The present study compared the efficacy of hepatic resection (HR) in patients with large hepatocellular carcinoma (HCC) and those with multinodular tumor and examined how that efficacy has changed over time in a large medical center.The intermediate stage of HCC comprises a highly heterogeneous patient population. Moreover, official guidelines have different views on the suitability of HR to treat such patients. Read More

    Current controversies in the management of metastatic colorectal cancer.
    Cancer Chemother Pharmacol 2015 Oct 26;76(4):659-77. Epub 2015 Jun 26.
    Medical Oncology Department, Biomedical Research Institute INIBIC, A Coruña University Hospital, A Coruña, Spain.
    The factors affecting the decisions for the treatment for patients with metastatic colorectal cancer (mCRC) are related to the patient, the tumor, and the treatment itself. Both cetuximab and panitumumab are anti-EGFR monoclonal antibody options for patients with RAS wild-type tumors. Several trials comparing these agents with bevacizumab are analyzed in this paper. Read More

    Abdominal wall hernia in cirrhotic patients: emergency surgery results in higher morbidity and mortality.
    BMC Surg 2015 May 21;15:65. Epub 2015 May 21.
    Starzl Unit of Abdominal Transplantation, University Hospital of Saint Luc, Université Catholique of Louvain, Brussels, Belgium.
    Background: Patients with cirrhosis have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical management strategy as well as timing of abdominal hernia repair remains controversial.

    Methods: A cohort study of 67 cirrhotic patients who underwent hernia repair during the period of January 1998-December 2009 at the University Hospital of Sao Paulo were included. Read More

    A standardized anesthetic and surgical clinical pathway for esophageal resection: impact on length of stay and major outcomes.
    Reg Anesth Pain Med 2015 Mar-Apr;40(2):139-49
    From the *Department of Anesthesiology, Virginia Mason Medical Center; †Axio Research; and ‡Department of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA.
    Background And Objectives: Esophageal cancer is a leading cause of cancer death worldwide, and esophageal resection is associated with extremely high perioperative morbidity and mortality. A perioperative clinical pathway for esophagectomy patients in which anesthetic care is both integral and standardized has not been described previously.

    Methods: A continuously refined clinical pathway for perioperative care of the esophagectomy patient has been developed at the Virginia Mason Medical Center over the past 22 years. Read More

    Probable local anesthetic systemic toxicity in a postpartum patient with acute Fatty liver of pregnancy after a transversus abdominis plane block.
    A A Case Rep 2013 Dec;1(5):72-4
    From the *Department of Anesthesiology and Perioperative Care, Division of Pain Medicine, University of California-San Francisco, San Francisco, California; and †Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington.
    We present the case of a 25-year-old woman with acute fatty liver of pregnancy, a rare mitochondrial disorder that manifests during pregnancy and has a significant mortality rate. Postoperative pain management is challenging for myriad reasons. With the increasing application of transversus abdominis plane blocks for postcesarean delivery analgesia, we describe the real and potential complications of this method of regional analgesia in patients with this disease. Read More

    Acute Renal and Hepatic Failure in an Adolescent: An Unusual Presentation of Multiple Aortic Aneurysms.
    Pediatr Emerg Care 2015 Sep;31(9):649-51
    From the *Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; †Divisions of Critical Care Medicine and Anesthesiology and Perioperative Medicine, Children's National Medical Center, Washington, DC; and ‡Department of Anesthesiology and Critical Care Medicine & Pediatrics, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
    Aortic dissection secondary to thoracoabdominal aortic aneurysms is very uncommon in children, and this life-threatening diagnosis requires a high clinical index of suspicion. Unlike adults, in whom atherosclerosis, inflammation, and advanced age are typically contributing factors, aortic dissection in children is usually due to nonatherosclerotic causes.Aortic aneurysms can be asymptomatic when small but, when significantly enlarged, can compromise organ function and dissect, resulting in high mortality rates. Read More

    Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients.
    J Crit Care 2014 Oct 28;29(5):881.e7-13. Epub 2014 May 28.
    Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
    Purpose: Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients. Read More

    New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management. Australasian Society of Thrombosis and Haemostasis.
    Intern Med J 2014 Jun;44(6):525-36
    Haemostasis Thrombosis Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
    New oral anticoagulants (NOAC) are becoming available as alternatives to warfarin to prevent systemic embolism in patients with non-valvular atrial fibrillation and for the treatment and prevention of venous thromboembolism. An in-depth understanding of their pharmacology is invaluable for appropriate prescription and optimal management of patients receiving these drugs should unexpected complications (such as bleeding) occur, or the patient requires urgent surgery. The Australasian Society of Thrombosis and Haemostasis has set out to inform physicians on the use of the different NOAC based on current available evidence focusing on: (i) selection of the most suitable patient groups to receive NOAC, (ii) laboratory measurements of NOAC in appropriate circumstances and (iii) management of patients taking NOAC in the perioperative period, and strategies to manage bleeding complications or 'reverse' the anticoagulant effects for urgent invasive procedures. Read More

    Liver-directed therapies: surgical approaches, alone and in combination with other interventions.
    Am Soc Clin Oncol Educ Book 2014 :101-10
    From the Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
    When feasible, surgical resection is typically the preferred therapeutic option in patients with both primary and secondary hepatic malignancies. Improved patient selection, preoperative management, and advances in perioperative care have had a considerable effect on short-term and long-term outcomes following hepatic resection. Parenchymal transection of the liver can be performed using many different techniques such as digitoclasia, clamp crushing, vessel sealing system, harmonic scalpel, water-jet, Cavitron Ultrasonic Surgical Aspirator, or radiofrequency dissecting sealer. Read More

    Urgent living donor liver transplantation for biliary atresia complicated by a strangulated internal hernia at Roux-en Y limb: a case report.
    Ann Transplant 2014 Mar 27;19:149-52. Epub 2014 Mar 27.
    Department of Transplantation, National Center for Child Health and Development, Tokyo, Japan.
    Background: When BA patients with end-stage liver dysfunction have bowel obstruction, especially strangulated internal hernia, selecting optimal surgical therapeutic options is crucial.

    Case Report: An 11-month-old female with end-stage biliary atresia (BA) was admitted for a strangulated internal hernia at the Roux-en Y limb and frequent episodes of gastrointestinal bleeding requiring blood transfusion. She was scheduled within a month to receive a portion of the liver from her blood-type identical mother. Read More

    Point of care perioperative coagulation management in liver transplantation and complete portal vein thrombosis.
    Case Rep Transplant 2014 6;2014:487364. Epub 2014 Feb 6.
    Department of Liver Surgery and Transplantation, Ospedali Riuniti, Via Conca 71, 60020 Ancona, Italy.
    Liver transplantation (LT) is a serious hemostatic challenge in patients with portal vein thrombosis (PVT). Advances in monitoring systems have improved surgery in this setting. We report the successful application of a point-of-care (POC) rotational viscoelastic thromboelastometry-guided (TEM) testing system (ROTEM) which allowed management of coagulation during LT in a 64-year-old cirrhotic patient with a model for end-stage liver disease (MELD) score of 16. Read More

    Liver resection for colorectal cancer metastases.
    Curr Oncol 2013 Jun;20(3):e255-65
    Hepatobiliary/Pancreatic Surgical Oncology, University Health Network, Mount Sinai Hospital, and University of Toronto, Toronto, ON.
    Questions: Should surgery be considered for colorectal cancer (crc) patients who have liver metastases plus (a) pulmonary metastases, (b) portal nodal disease, or (c) other extrahepatic metastases (ehms)?What is the role of chemotherapy in the surgical management of crc with liver metastases in (a) patients with resectable disease in the liver, or (b) patients with initially unresectable disease in the liver that is downsized with chemotherapy ("conversion")?What is the role of liver resection when one or more crc liver metastases have radiographic complete response (rcr) after chemotherapy?

    Perspectives: Advances in chemotherapy have improved survival in crc patients with liver metastases. The 5-year survival with chemotherapy alone is typically less than 1%, although two recent studies with folfox or folfoxiri (or both) reported rates of 5%-10%. However, liver resection is the treatment that is most effective in achieving long-term survival and offering the possibility of a cure in stage iv crc patients with liver metastases. Read More

    Hilar cholangiocarcinoma: preoperative liver optimization with multidisciplinary approach. Toward a better outcome.
    World J Surg 2013 Jun;37(6):1388-96
    Hepatobiliary Surgery Unit, General Surgery Department, Ospedale San Raffaele, Via Olgettina 60, Milano, Italy.
    Introduction: The diagnosis and treatment of hilar tumors requires a multidisciplinary approach based on the synergy of radiologists, surgeons, oncologists, and gastroenterologists. Klatskin tumor is a relatively rare disease with a poor prognosis. Currently, the only possible treatment is represented by the removal of the tumor associated with radical surgery, even though its results are still jeopardized by significant morbidity and mortality. Read More

    Successful management of complex open heart surgery in a patient with Child-Pugh class C liver cirrhosis: report of a case.
    Surg Today 2013 Mar 14;43(3):335-8. Epub 2012 Sep 14.
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 565-0871, 2-2 Yamadaoka, Suita, Osaka, Japan.
    Open heart surgery in patients with Child-Pugh class C liver cirrhosis has a high mortality rate and is generally considered to be contraindicated. A patient with liver cirrhosis (Child-Pugh class C) underwent mandatory complex open heart surgery due to severe heart failure. The perioperative management, including the prophylactic use of intraaortic balloon pumping to increase the hepatic blood flow and the early initiation of continuous veno-venous hemodialysis to avoid hepatic congestion, enabled the patient to survive. Read More

    Liver transplantation as an ultimate step in the management of iatrogenic bile duct injury complicated by secondary biliary cirrhosis.
    Ann Transplant 2012 Apr-Jun;17(2):38-44
    Division of Hepatobiliary Surgery and Liver Transplantation, M. Curie Hospital, Szczecin, Poland.
    Background: This report summarizes a single center's experience with liver transplantation (LT) performed for secondary biliary cirrhosis resulting from iatrogenic bile duct injury (BDI) sustained during cholecystectomy.

    Material/methods: Secondary biliary cirrhosis was the indication for LT in 5 (1.7%) out of 300 LTs performed in our center between Feb 2002 and April 2011. Read More

    Surgical risk in patients with cirrhosis.
    J Gastroenterol Hepatol 2012 Oct;27(10):1569-75
    Department of Gastroenterology and Hepatology, Royal Melbourne hospital, Parkville, Victoria, Australia.
    Surgery in the patient with cirrhosis is problematic, as encephalopathy, ascites, sepsis and bleeding are common in the postoperative period. Accurate preoperative assessment and planning, and careful postoperative management have the potential to reduce the frequency and severity of such complications, and reduce the length of hospital stay, but there is little literature evidence to prove this. Operative mortality and other risks correlate with the severity of the liver disease, co-morbidities and the type of surgery. Read More

    Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation.
    Transplant Proc 2012 Jun;44(5):1314-7
    Department of Anesthesiology, Pennsylvania State University College of Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA.
    Purpose: We present a retrospective study describing the perioperative use of continuous renal replacement therapy (CRRT) for orthotopic liver transplantation (OLT).

    Materials And Methods: We retrospectively reviewed the clinical course of patients who underwent OLT with the perioperative use of CRRT. The following variables were recorded: Gender, age, indication for transplantation, time when CRRT was initiated, postoperative need for CRRT, and the patient and organ (liver, kidneys) outcome up to 1 year after transplantation. Read More

    Surgical clearance for the patient with chronic liver disease.
    Clin Liver Dis 2012 May;16(2):421-33
    Division of Gastroenterology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
    Patients with chronic liver disease face greater risk of perioperative morbidity and mortality, with the greatest risk among patients with cirrhosis. Both the Child-Pugh score and the Model for End-Stage Liver Disease have been evaluated as predictors of postoperative mortality. Other comorbidities, age, and American Society of Anesthesiologists physical status classification are also important predictors of these outcomes. Read More

    Anesthetic considerations for the patient with liver disease.
    Curr Opin Anaesthesiol 2012 Jun;25(3):340-7
    Department of Anaesthesiology and Critical Care Medicine, University Medical Center Freiburg, Freiburg, Germany.
    Purpose Of Review: An increasing number of patients requiring surgery are presenting with chronic or end stage liver disease. The management of these patients demands anesthesiologists with in-depth knowledge of the consequences of hepatic dysfunction, the effects on other organs, the risk of surgery, and the impact of anesthesia.

    Recent Findings: Chronic or end stage liver disease is associated with an increased risk of perioperative morbidity and mortality. Read More

    Intensive care management of liver transplanted patients.
    World J Hepatol 2011 Mar;3(3):61-71
    Paolo Feltracco, Stefania Barbieri, Helmut Galligioni, Elisa Michieletto, Cristiana Carollo, Carlo Ori, Department of Pharmacology and Anesthesiology, University Hospital of Padova, Padova 35100, Italy.
    Advances in pre-transplant treatment of cirrhosis-related organ dysfunction, intraoperative patient management, and improvements in the treatment of rejection and infections have made human liver transplantation an effective and valuable option for patients with end stage liver disease. However, many important factors, related both to an increasing "marginality" of the implanted graft and unexpected perioperative complications still make immediate post-operative care challenging and the early outcome unpredictable. In recent years sicker patients with multiple comorbidities and organ dysfunction have been undergoing Liver transplantation; appropriate critical care management is required to support prompt graft recovery and prevent systemic complications. Read More

    Japanese-style intensive medical care improves prognosis for acute liver failure and the perioperative management of liver transplantation.
    Transplant Proc 2010 Dec;42(10):4109-12
    Division of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
    The Japanese style of intensive medical care for acute liver failure has yielded high survival rates. The care system comprises artificial liver support (ALS) together with treatment for the underlying disease. Plasma exchange in combination with high-volume hemodiafiltration using an high performance membrane has become the standard ALS system. Read More

    Successful perioperative management for a breast cancer patient with Bernard-Soulier syndrome.
    Breast Cancer 2012 Jan 23;19(1):88-92. Epub 2010 Nov 23.
    Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima, Japan.
    We herein report the first case of a Bernard-Soulier syndrome (BSS) patient undergoing a surgical procedure for breast cancer. BSS is a rare hereditary thrombocytopathy associated with defects of the platelet glycoprotein complex glycoprotein Ib/V/IX and characterized by large platelets, thrombocytopenia, and severe bleeding symptoms. Because of the rarity of BSS, there are as yet no defined protocols for the perioperative management, which can be very complex and challenging in patients with coagulopathies, in particular BSS. Read More

    Progression of intramedullary metastasis during perioperative cessation of sunitinib.
    Nat Rev Urol 2010 Nov 12;7(11):634-7. Epub 2010 Oct 12.
    Department of Oncology, Azienda Ospedaliera Treviglio-Caravaggio, Piazzale Ospedale 1, 12-24047 Treviglio, Bergamo, Italy.
    Background: A 57-year-old woman presented with metastatic renal cell carcinoma (RCC). She was enrolled in a clinical study, in which she received two cycles of neoadjuvant sunitinib therapy followed by cytoreductive nephrectomy. Her primary tumor and rib metastasis showed a good response to neoadjuvant therapy; however, after surgery, the patient developed neurologic symptoms, including flaccid paraparesis with paresthesia and hypoesthesia. Read More

    Successful left hemihepatectomy and perioperative management of a patient with biliary cystadenocarcinoma, complicated with MELAS syndrome: report of a case.
    Surg Today 2010 Sep 26;40(9):878-82. Epub 2010 Aug 26.
    Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
    Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like syndrome (MELAS) is a rare, fetal disease caused by a mutation in mitochondrial DNA that leads to impaired oxidative metabolism in skeletal muscle, the central nervous system, and liver function. This report presents the case of a 50-year-old woman with biliary cystadenocarcinoma complicated by MELAS who underwent a successful left hemihepatectomy. In this case, the diagnostic key for the malignant tumor was an (18)F-fluorodeoxyglucose positron emission tomography study, which was useful even in a patient with MELAS, which causes abnormal glucose metabolism. Read More

    Liver transplant quality and safety plan in anesthesia and intensive care medicine.
    Transplant Proc 2010 Jul-Aug;42(6):2229-32
    Clinic of Anesthesia and Intensive Care Medicine, Department of Surgical Science, Medical School, University of Udine, Udine, Italy.
    Patients scheduled for orthotopic liver transplantation (OLT) may have coexisting diseases and more likely receive grafts of poorer quality than in the past. Perioperative mortality and morbidity are usually due to a combination of factors related to the patient, graft, surgery, anesthesia, and intensive care management. Anesthesia and intensive care are the areas with the highest frequency and severity of errors. Read More

    Perioperative considerations in patients with cirrhotic cardiomyopathy.
    Curr Opin Anaesthesiol 2010 Apr;23(2):128-32
    Anestesia e Rianimazione SSN, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
    Purpose Of Review: This review aims to identify specific criteria for cirrhotic cardiomyopathy, examine the correlation with perioperative adverse outcomes and explore options for hemodynamic monitoring.

    Recent Findings: Cirrhotic cardiomyopathy is characterized by an increase in cardiac output, blunted systolic contractile response to stress, diastolic dysfunction and electrophysiological abnormalities. Adverse events due to cirrhotic cardiomyopathy are not as well characterized, but evidence suggests that some cardiovascular complications during surgery and in the postoperative period are caused by an impaired response to physiological stress. Read More

    Anesthetic concerns and perioperative complications in repair of myelomeningocele: a retrospective review of 135 cases.
    J Neurosurg Anesthesiol 2010 Jan;22(1):11-5
    Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
    Myelomeningocele (MMC) a complex congenital spinal anomaly, results from neural tube defect during first 4 weeks of gestation. Medical records of 135 children who underwent excision and repair of MMC from January 2003 to December 2006 were analyzed, retrospectively. Data on associated illnesses, anesthetic management, perioperative complications, and outcome were recorded. Read More

    Surgery in the patient with liver disease.
    Med Clin North Am 2009 Sep;93(5):1065-81
    Department of Surgery, University of California-Davis, Sacramento, CA 95817, USA.
    Liver dysfunction is a prominent entity in Western medicine that has historically affected patients suffering from chronic viral or alcoholic hepatitis. The incidence of these conditions has not changed dramatically in recent years but the overall number of patients with liver dysfunction has increased considerably with the emergence of the obesity epidemic. Nonalcoholic fatty liver disease (NAFLD) has become increasingly recognized as the most common cause of chronic liver disease in the United States. Read More

    [Preoperative management of patients with liver disease].
    Ther Umsch 2009 Jul;66(7):537-43
    Institut für Anästhesiologie, Universitätsspital Zürich.
    Patients undergoing liver surgery due to benign or malignant liver tumors are evaluated in a multidisciplinary way: surgeons, gastroenterologists, anesthesiologists, intensive care physicians, radiologists, oncologists and pathologists are involved in the perioperative evaluation. Surgical know-how, combined with a broad spectrum of diagnostic and therapeutic options stand for a high degree of safety and effectiveness of perioperative treatment. The general physical status of the patient, the type and extend of liver disease, as well as the complexity of liver resection have significant impact on perioperative morbidity and mortality. Read More

    Surgery in the patient with liver disease.
    Clin Liver Dis 2009 May;13(2):211-31
    Division of Hepatology, Department of Internal Medicine, Baylor University Medical Center, 4th Floor Roberts, 3500 Gaston Avenue, Dallas, TX 75246, USA.
    The advent of liver transplantation has greatly improved the long-term survival of patients with decompensated cirrhosis, and surgery is now performed more frequently in patients with advanced liver disease. The estimation of perioperative mortality is limited by the retrospective nature of and biased patient selection in the available clinical studies. The overall experience is that, in patients with cirrhosis, use of the Child classification and Model for End-Stage Liver Disease (MELD) score provides a reasonably precise estimation of perioperative mortality. Read More

    [A case report of perioperative management for liver transplantation in a patient with multiple old myocardial infarction].
    Beijing Da Xue Xue Bao 2009 Apr;41(2):239-41
    Department of Anaesthesia, Peking University People's Hospital, Beijing 100044, China.
    A 60-years-old (85 kg, 178 cm) coronary arterial disease patient having had acute myocardial infarction for several times received liver transplantation successfully. He had a previous episode of acute myocardial infarction associated with entire obstruction of right coronary 6 years ago, and was inserted a bracket then. One year ago the patient got chest pain again, and was diagnosed as inferior wall myocardial infarction. Read More

    Perioperative management of the patient with liver disease and management of the chronic alcoholic.
    Oral Maxillofac Surg Clin North Am 2006 May;18(2):213-25, vi-vii
    Oral & Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.
    Each year millions of Americans undergo surgical procedures requiring local, general, or spinal epidural anesthesia. A disproportionate number of the patients are older than age 65, and up to 10% of the patients have end-stage liver disease. Most patients do not suffer complications as a result of the surgical procedure or the anesthetic. Read More

    Hepatic and splenic hydatidosis managed with percutaneous aspiration, injection, and reaspiration (PAIR) of the hepatic cyst and laparoscopic splenectomy.
    J Gastrointest Surg 2008 Sep 27;12(9):1615-7. Epub 2007 Nov 27.
    Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
    The treatment of hydatidosis traditionally consisted of surgery with a perioperative course of anthelmintic medications. However, percutaneous aspiration, injection, and reaspiration (PAIR) combined with oral albendazole has been recently shown to be as effective as surgery in the treatment of liver hydatidosis. We report a 20-year-old female immigrant from Western Europe who presented with discomfort in her upper abdomen. Read More

    Surgical treatment for superficial esophageal cancer with liver cirrhosis and esophageal varices: report of a case.
    Anticancer Res 2007 Sep-Oct;27(5B):3507-11
    Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
    Surgical treatment of esophageal cancer is substantially invasive and often entails some postoperative complications. Perioperative management for patients with liver cirrhosis involves great difficulties. Recently, we conducted an esophagectomy for the treatment of superficial esophageal cancer in a 52-year-old male patient with liver cirrhosis and esophageal varices, with gratifying results. Read More

    Perioperative outcome after laparoscopic radiofrequency ablation of liver tumors: an analysis of 521 cases.
    Surg Endosc 2007 Apr 8;21(4):613-8. Epub 2007 Feb 8.
    Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
    Background: Radiofrequency thermal ablation (RFA) is gaining increased acceptance for the treatment of unresectable primary and metastatic liver tumors. Understanding the morbidity and laboratory changes after RFA is important for operative indications and perioperative management.

    Methods: The authors prospectively analyzed the 30-day morbidity and mortality rates of patients undergoing laparoscopic RFA for liver tumors in a 10-year period. Read More

    Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction.
    BMC Surg 2006 May 19;6. Epub 2006 May 19.
    Department of G,I, Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
    Background: The clinico-surgical implication and successful management of a rare case of factor five (V) deficiency with portal hypertension and hypersplenism due to idiopathic extra-hepatic portal venous obstruction is presented.

    Case Presentation: A 16-year old boy had gastro-esophageal variceal bleeding, splenomegaly and hypersplenism. During preoperative workup prolonged prothrombin time and activated partial thromboplastin time were detected, which on further evaluation turned out to be due to factor V deficiency. Read More

    Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis.
    Arch Surg 2006 Apr;141(4):385-8; discussion 388
    Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, Mass.
    Hypothesis: Distal splenorenal shunt (DSRS) is a safe and effective treatment for patients with Child-Pugh class A and B cirrhosis with recurrent variceal hemorrhage after failed transjugular intrahepatic portosystemic shunt.

    Design: Retrospective case review.

    Setting: Hepatobiliary surgery and liver transplantation department in a tertiary referral medical center. Read More

    Cardiac surgery in children with end-stage liver disease awaiting liver transplantation.
    Ann Thorac Surg 2006 Feb;81(2):697-700
    Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California-Los Angeles, California 90095-1741, USA.
    Background: Cardiac repair for congenital heart disease in children awaiting liver transplantation presents unique therapeutic challenges and dilemmas. We tested the hypothesis that operations in these children requiring cardiopulmonary bypass (CPB) were not associated with prohibitive morbidity and mortality.

    Methods: Over the last 10 years (1994-2004), five infants were identified in our database with end-stage liver disease and awaiting liver transplantation that required cardiac surgery. Read More

    [A case report of rapid inhalation induction with sevoflurane in a patient with porphyria].
    Masui 2005 Nov;54(11):1292-4
    Department of Dentistry and Oral and Maxillofacial Surgery, Hamamatsu University School of Medicine, Hamamatsu 431 3192.
    We experienced anesthetic management for a patient with acute intermittent porphyria. A 52-year-old woman underwent a partial right mastectomy. She was anesthetized with continuous thoracic epidural blockade combined with general anesthesia using nitrous oxide, oxygen and sevoflurane. Read More

    Sudden onset of paraplegia after total hip replacement surgery in a patient with hepatocellular carcinoma--a case report.
    Acta Anaesthesiol Taiwan 2004 Sep;42(3):165-9
    Department of Anesthesiology, Chang Gung Memorial Hospital, Niao Shung Hsiang, Kaohsiung, Taiwan, ROC.
    Postoperative paraplegia is a major complication, of which the pathogenesis is usually multifactorial. This report is to discuss the case of a 36-year-old male patient who, after total hip replacement (THR), right, sustained a sudden-onset postoperative paraplegia. On subsequent examination, it was discovered that the patient had multiple vertebral metastases from hepatocellular carcinoma (HCC) resulting in thecal sac compression at L1 and S1 levels. Read More

    [Living-related liver transplantation in a patient with hepatopulmonary syndrome].
    Masui 2004 Jun;53(6):668-71
    Department of Anesthesiology and Resuscitology, School of Medicine, Okayama University, Okayama 700-8558.
    We experienced the perioperative management of the living related liver transplantation (LRLT) in a patient with hepatopulmonary syndrome (HPS). HPS is seen in 15% of patients of the endstage liver failure, and it accompanies the various types of hypoxia. The diagnostic standards of HPS are chronic liver disease usually complicated by portal hypertension with or without cirrhosis, arterial hypoxemia (PaO2 < 70 mmHg or A-aDO2 gradient > 20 mmHg), and intrapulmonary vascular dilation. Read More

    [Risk factors of morbidity and mortality following surgical resection for hepatocellular carcinoma].
    Korean J Hepatol 2004 Mar;10(1):51-61
    Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
    Background/aims: Recently, mortality following surgical resection for hepatocellular carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Read More

    [Desflurane in acute intermittent porphyria].
    Anaesthesist 2004 Mar;53(3):244-8
    Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg.
    Despite the low incidence of the acute porphyrias, a profound knowledge of the disease is essential for anaesthesiologists, as a variety of perioperatively administered drugs are potential triggers of an acute attack. There is an ongoing discussion about the use of volatile anaesthetics in porphyrias, but halothane and isoflurane seem to be safe. There is no clinical data or case report about the use of desflurane in this specific patient group, but its fast and relatively unchanged elimination and the minimal induction of the cytochrome P 450 system seem to be favorable in this setting. Read More

    Psychiatric considerations in the patient receiving organ transplantation: a clinical case conference.
    Gen Hosp Psychiatry 2003 Nov-Dec;25(6):484-91
    Massachusetts General Hospital, Boston, MA, USA.
    Psychiatric consultations to evaluate a patient's suitability to receive organ transplantation can require the integration of multiple types and sources of information. A patient's social support network, history of treatment compliance, ongoing Axis I and Axis II disorders, and understanding of the procedure and follow-up required must all be evaluated during such a consultation. This article presents the case of a woman with borderline personality disorder who developed hepatic failure following a drug overdose, and discusses her evaluation for liver transplantation. Read More

    Laparoscopic surgery for cancer: are we ready?
    Acta Gastroenterol Belg 2003 Jul-Sep;66(3):227-30
    IRCAD/EITS, European Institute of Telesurgery, University of Louis Pasteur, Strasbourg, France.
    Following feasibility studies more and more large prospective reports even randomised trials document the treatment of digestive cancer using a laparoscopic approach. While the spectre of port-site recurrences, once so alarming has faded, it has become a challenge for laparoscopic surgeons to provide long-term follow-up. There is good class II and III evidence that staging laparoscopy (SL) has a value for oesophageal, gastric, pancreatic and hepatobiliary cancer as well as for intra-abdominal lymphomas since it adds to primary staging and often alters the clinical stage of the disease and hence the management of the individual patient. Read More

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