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


[A Case of Superior Mesenteric Vein Thrombosis during Administration of Bevacizumab for Rectal Cancer].

Gan To Kagaku Ryoho 2019 Dec;46(13):2491-2493

Dept. of Surgery, Japan Community Healthcare Organization(JCHO)Osaka Hospital.

A colonoscopy to investigate fecal incontinence revealed a type 3 tumor in the rectum of a 67-year-old man. Histological findings demonstrated rectal adenocarcinoma. CT revealed multiple metastases in the liver, and the patient was diagnosed as having rectal cancer(Rb, Ant, type 3, T3, N3, M1a[H2], cStage Ⅳa). Read More

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December 2019

Perioperative anesthetic management for cesarean delivery of severe Wilson's disease with liver failure: a case report.

JA Clin Rep 2019 Nov 13;5(1):75. Epub 2019 Nov 13.

Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.

Background: Wilson's disease is a rare autosomal recessive disorder affecting copper metabolism, which presents liver and brain dysfunction caused by abnormal copper accumulation. We report a patient who showed exacerbation of liver failure during pregnancy.

Case Presentation: A 24-year-old woman with Wilson's disease was scheduled for emergency cesarean delivery at 30 weeks of gestation. Read More

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http://dx.doi.org/10.1186/s40981-019-0294-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966748PMC
November 2019

Anesthesia for the Patient with Severe Liver Failure.

Anesthesiol Clin 2020 Mar 3;38(1):35-50. Epub 2020 Jan 3.

Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. Electronic address:

The incidence of liver failure continues to increase, and it is associated with increased perioperative morbidity and mortality. Liver failure is associated with multiorgan dysfunction, including central nervous, cardiac, respiratory, gastrointestinal, renal, and hematological systems. Preoperative identification, optimization, and tailored anesthetic management are essential for optimum outcomes in patients with liver disease undergoing surgery. Read More

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http://dx.doi.org/10.1016/j.anclin.2019.10.002DOI Listing

Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association.

Circulation 2019 Jul 1:CIR0000000000000696. Epub 2019 Jul 1.

It has been 50 years since Francis Fontan pioneered the operation that today bears his name. Initially designed for patients with tricuspid atresia, this procedure is now offered for a vast array of congenital cardiac lesions when a circulation with 2 ventricles cannot be achieved. As a result of technical advances and improvements in patient selection and perioperative management, survival has steadily increased, and it is estimated that patients operated on today may hope for a 30-year survival of >80%. Read More

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http://dx.doi.org/10.1161/CIR.0000000000000696DOI Listing
July 2019
24 Reads

Dentistry and oral and maxillofacial surgery in the patient with liver disease: key messages for clinical practice.

Minerva Stomatol 2019 Aug 27;68(4):192-199. Epub 2019 May 27.

Unit of Gastroenterology, Molinette - San Giovanni Antica Sede Hospital, Turin, Italy -

The recent changes in terms of both epidemiology of chronic liver disease (CLD) and long-term survival of patients with CLD have had a great impact in the field of dentistry and oral and maxillofacial surgery. In this context, compared with the previous decades, today it is more probable to cure patients with CLD also at advanced stage (cirrhosis), that could remain asymptomatic for long, before the appearance of signs of decompensation. Hence, it is crucial to identify the patient with CLD and to define the stage of the latter. Read More

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http://dx.doi.org/10.23736/S0026-4970.19.04216-XDOI Listing
August 2019
14 Reads

Mixed neuroendocrine-non-neuroendocrine carcinoma of gallbladder: case report.

World J Surg Oncol 2019 Mar 22;17(1):55. Epub 2019 Mar 22.

Faculty of Medicine in Pilsen, Charles University, 301 00, Pilsen, Czech Republic.

Background: Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the gallbladder are extremely rare; indeed, the English expert literature reports a mere handful of case reports and case series on this topic. According to the WHO classification of 2010, MINEN are considered to be tumors consisting of two major components, neuroendocrine and non-neuroendocrine, each of which hosts at least 30% of the total cellular population. To date, the etiology and pathogenesis of MINEN have not been precisely determined and the non-specific symptoms generally result in late diagnosis (mainly in the terminal stages of the condition) and contribute to the generally poor prognosis. Read More

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http://dx.doi.org/10.1186/s12957-019-1598-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429764PMC
March 2019
12 Reads

[Preconditioning of the liver].

Chirurg 2019 Jul;90(7):542-547

Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie Tübingen, Hoppe-Seylerstraße 3, 72076, Tübingen, Deutschland.

Posthepatectomy liver failure (PHLF) still represents a severe complication after major liver resection associated with a high mortality. In addition to an insufficient residual liver volume various factors play an important role in the pathophysiology of PHLF. These include the quality of the parenchyma, liver function, perfusion, i. Read More

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http://dx.doi.org/10.1007/s00104-019-0926-0DOI Listing
July 2019
2 Reads

Persistent acidosis after reperfusion-A prognostic indicator of increased 30-day and in-hospital postoperative mortality in liver transplant recipients.

Clin Transplant 2019 03 24;33(3):e13473. Epub 2019 Jan 24.

Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

During liver transplantation, the patient is at risk of developing progressive lactic acidosis. Following reperfusion, correction of acidosis may occur. In some patients, acidosis will worsen, a phenomenon referred to as persistent acidosis after reperfusion (PAAR). Read More

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http://dx.doi.org/10.1111/ctr.13473DOI Listing
March 2019
4 Reads

Lusutrombopag (Mulpleta®) treatment in a patient with thrombocytopenia complicated by cirrhosis prior to continuous epidural anesthesia during renal artery embolization: a case report.

JA Clin Rep 2018 Nov 20;4(1):80. Epub 2018 Nov 20.

Pain Clinic and Palliative Care Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan.

Background: The oral thrombopoietin (TPO) receptor agonist lusutrombopag (Mulpleta®) was developed to improve thrombocytopenia in patients with chronic liver disease prior to elective invasive medical procedures. Mulpleta® was first approved for use in Japan in 2015 and in the USA in 2018. In the present report, we discuss a case in which pain management was performed during left renal artery embolization via continuous epidural anesthesia following oral administration of lusutrombopag. Read More

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http://dx.doi.org/10.1186/s40981-018-0217-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966968PMC
November 2018

Clinical outcome of 1,000 consecutive cases of liver transplantation: a single center experience.

Ann Surg Treat Res 2018 Nov 25;95(5):267-277. Epub 2018 Oct 25.

Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: The aim of this study was to analyze survival outcomes in 1,000 consecutive liver transplantations (LTs) performed at a single institution from 1993 to April 2017.

Methods: The study population was divided into 2 groups based on donor type: deceased donor LT (DDLT; n = 181, 18.1%) and living donor LT (LDLT; n = 819; 81. Read More

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https://synapse.koreamed.org/DOIx.php?id=10.4174/astr.2018.9
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http://dx.doi.org/10.4174/astr.2018.95.5.267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204322PMC
November 2018
17 Reads

Risk factors for hepatic insufficiency after major hepatectomy in non-cirrhotic patients.

Asian J Surg 2019 Jan 28;42(1):251-255. Epub 2018 Aug 28.

Department of Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.

Background: Although recent advances in surgical techniques and perioperative management have reduced the morbidity and mortality after hepatectomy, hepatic insufficiency after major hepatectomy remains an important concern. This study aimed to clarify the risk factors for post-hepatectomy liver insufficiency.

Methods: We enrolled 103 consecutive patients who underwent major hepatectomy which was defined as resection of four or more segments. Read More

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http://dx.doi.org/10.1016/j.asjsur.2018.03.002DOI Listing
January 2019
42 Reads

Half of Postoperative Deaths After Hepatectomy may be Preventable: A Root-cause Analysis of a Prospective Multicenter Cohort Study.

Ann Surg 2018 11;268(5):792-798

Department of Digestive Surgery, Amiens, France.

Objective: To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy.

Background: Mortality after liver resection has not decreased over the past decade.

Methods: The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between October 2012 and December 2014. Read More

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http://dx.doi.org/10.1097/SLA.0000000000002837DOI Listing
November 2018
39 Reads

Liver transplantation in hemophilia A and von Willebrand disease type 3: perioperative management and post-transplant outcome.

Rev Esp Enferm Dig 2018 Aug;110(8):522-526

Cirugía General y del Aparato Digestivo, H.C.U. Lozano Blesa.

Introduction: infection with the hepatitis C virus (HCV) causes significant morbidity and mortality in patients with hemophilia. Finally, patients are considered for a liver transplantation (LT) due to cirrhosis and/or hepatocellular carcinoma (HCC).

Case Report: we report the cases of congenital coagulopathy and HCV infection that underwent LT in our institution. Read More

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http://dx.doi.org/10.17235/reed.2018.5204/2017DOI Listing
August 2018
41 Reads

Desmopressin Reverses Overly Rapid Serum Sodium Correction in a Hyponatremic Patient Undergoing Living Donor Liver Transplantation: A Case Report.

A A Pract 2018 Aug;11(3):82-84

From the Department of Anesthesia and Perioperative Care, University of California, San Francisco, California.

Patients with end-stage liver disease are often hyponatremic due to multiple physiological processes associated with hepatic failure. For severely hyponatremic patients undergoing liver transplantation, intraoperative management of serum sodium concentration ([Na]s) is challenging. [Na]s tends to increase during transplantation by the administration of fluids with higher sodium concentration than the patient's [Na]s. Read More

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http://dx.doi.org/10.1213/XAA.0000000000000750DOI Listing
August 2018
21 Reads

Analgesic Effects of Oxycodone Relative to Those of Sufentanil, in the Presence of Midazolam, During Endoscopic Injection Sclerotherapy for Patients With Cirrhosis and Esophageal Varices.

Anesth Analg 2018 08;127(2):382-386

From the Department of Anesthesiology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Background: We evaluated the efficacy and gastroenterologist/patient satisfaction of midazolam combined with oxycodone, relative to that of midazolam combined with sufentanil, for anesthesia during endoscopic injection sclerotherapy (EIS) in patients with cirrhosis and esophageal varices.

Methods: Patients with cirrhosis (20-69 years of age), body mass index, 18-25 kg/m, American Society of Anesthesiology patient classification physical status I-II who underwent elective EIS were randomly assigned to 1 of 2 groups. In this prospective, double-blinded, randomized controlled trial, 1 group received midazolam and oxycodone (n = 64), and the other group received midazolam and sufentanil (n = 63). Read More

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http://dx.doi.org/10.1213/ANE.0000000000003305DOI Listing
August 2018
5 Reads

Perioperative management with phosphodiesterase type 5 inhibitor and prostaglandin E1 for moderate portopulmonary hypertension following adult-to-adult living-donor liver transplantation: a case report.

Surg Case Rep 2018 Feb 7;4(1):15. Epub 2018 Feb 7.

Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-0037, Japan.

Background: Portopulmonary hypertension (PPH) is a relatively rare but well-recognized complication of end-stage liver disease. Moderate or severe PPH (mean pulmonary artery pressure [mPAP] ≥ 35 mmHg) is usually a contraindication for liver transplantation due to high operation-related mortality. Here, we report on a patient with moderate PPH whose condition was successfully managed with a phosphodiesterase type 5 (PDE5) inhibitor (tadalafil) and prostaglandin E1, who experienced rapid improvement of PPH after living-donor liver transplantation (LDLT). Read More

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http://dx.doi.org/10.1186/s40792-018-0423-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803166PMC
February 2018
36 Reads

[Simultaneous Hepatorenal Transplantation from a Brain-Dead Donor for Graft Dysfunction and Renal Insufficiency in a Liver Transplant Recipient : A Case Report].

Hinyokika Kiyo 2017 Aug;63(8):313-318

The Department of Urology, Kyoto University Hospital.

We report a case of lethal hepatorenal insufficiency in a 52-year-old man who received successful simultaneous hepatorenal transplantation from a deceased donor. The patient had undergone live-donor liver transplantation for type-C hepatitis and liver cirrhosis 11 years before he developed graft liver dysfunction due to recurrent viral hepatitis and cirrhosis. At that instance, he also developed end-stage renal dysfunction due to calcineurin inhibitor nephropathy and hepatorenal syndrome. Read More

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http://dx.doi.org/10.14989/ActaUrolJap_63_8_313DOI Listing
August 2017
69 Reads

Successful Blood Transfusion Management of a Living Donor Liver Transplant Recipient in the Presence of Anti-Jr: A Case Report.

Transplant Proc 2017 Sep;49(7):1604-1607

Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Aichi, Japan. Electronic address:

A 48-year-old Japanese woman was diagnosed with Budd-Chiari syndrome and transferred for possible living donor liver transplantation (LDLT). Examinations before LDLT revealed that the recipient had anti-Jr and preformed donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA). Rituximab was administrated at 16 days prior to the patient's scheduled LDLT for the prophylaxis of antibody-mediated rejection by DSA. Read More

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http://dx.doi.org/10.1016/j.transproceed.2017.06.009DOI Listing
September 2017
20 Reads

[Retrospective analysis of anesthetic and perioperative management in patients of acute fatty liver of pregnancy].

Zhonghua Yi Xue Za Zhi 2017 Jun;97(24):1878-1882

Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China.

To retrospectively analyze the clinical characteristics of patients with acute fatty liver of pregnancy (AFLP), and to discuss perioperative and anesthetic management. A retrospective review was conducted on the records of pregnant patients with a diagnosis of acute fatty liver of pregnancy in Peking University Third Hospital from January 2007 to December 2015. 12 cases were identified. Read More

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http://dx.doi.org/10.3760/cma.j.issn.0376-2491.2017.24.008DOI Listing
June 2017
20 Reads

Liver Transplantation in a Patient With Antiphospholipid Syndrome: A Case Report.

A A Case Rep 2017 Sep;9(5):148-150

From the Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California.

Antiphospholipid syndrome (APS) is an acquired thrombophilic disorder characterized by autoantibodies to cell membrane phospholipids. While altered coagulation can complicate end-stage liver disease, there are few reports describing the perioperative management for liver transplantation in recipients with a preexisting hypercoagulable disorder, such as APS. We present a patient with a history of APS, Budd-Chiari syndrome with cirrhosis, hepatopulmonary syndrome, and heparin-induced thrombocytopenia who underwent liver transplantation complicated by hepatic artery thrombosis. Read More

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http://dx.doi.org/10.1213/XAA.0000000000000551DOI Listing
September 2017
40 Reads

[Huge Hepatocellular Carcinoma with Portal Vein and Inferior Vena Cava Thrombi Treated with Curative Liver Resection and Perioperative Hepatic Arterial Infusion Chemotherapy - A Case Report].

Gan To Kagaku Ryoho 2016 Nov;43(12):1779-1781

Dept. of Surgery, Nara Medical University.

The prognosis of hepatocellular carcinoma(HCC)with main portal vein(MPV)and/or the inferior vena cava(IVC)tumor thrombi is dismal. The management of HCC with severe tumor thrombus is complicated. In this study, we report a case of HCC with tumor thrombi in the MPV and IVC that was successfullytreated via liver resection and perioperative hepatic arterial infusion chemotherapy(HAI). Read More

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November 2016
50 Reads

Strategies to Prevent Periprosthetic Joint Infection After Total Knee Arthroplasty and Lessen the Risk of Readmission for the Patient.

J Am Acad Orthop Surg 2017 Feb;25 Suppl 1:S13-S16

From the New York University Langone Medical Center, New York, New York.

There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care. Read More

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http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:land
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http://dx.doi.org/10.5435/JAAOS-D-16-00635DOI Listing
February 2017
62 Reads

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

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http://dx.doi.org/10.1016/j.anclin.2016.06.002DOI Listing
December 2016
33 Reads

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

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http://dx.doi.org/10.1111/pan.12950DOI Listing
October 2016
39 Reads

[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

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February 2016
41 Reads

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

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http://dx.doi.org/10.1213/XAA.0000000000000220DOI Listing
April 2016
26 Reads

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

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http://pdfs.journals.lww.com/rapm/2015/11000/Pain_Management
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http://dx.doi.org/10.1097/AAP.0000000000000316DOI Listing
September 2016
50 Reads

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

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http://dx.doi.org/10.1097/MD.0000000000001426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616519PMC
September 2015
139 Reads
5.723 Impact Factor

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

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http://dx.doi.org/10.1007/s00280-015-2808-6DOI Listing
October 2015
30 Reads

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

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http://dx.doi.org/10.1186/s12893-015-0052-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443633PMC
May 2015
44 Reads

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

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http://pdfs.journals.lww.com/rapm/2015/03000/A_Standardized_
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http://dx.doi.org/10.1097/AAP.0000000000000197DOI Listing
November 2015
43 Reads

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

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http://dx.doi.org/10.1097/ACC.0b013e3182973a2fDOI Listing
December 2013
34 Reads

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

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http://pdfs.journals.lww.com/pec-online/2015/09000/Acute_Ren
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http://dx.doi.org/10.1097/PEC.0000000000000256DOI Listing
September 2015
55 Reads

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

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https://linkinghub.elsevier.com/retrieve/pii/S08839441140021
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http://dx.doi.org/10.1016/j.jcrc.2014.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682627PMC
October 2014
48 Reads

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

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http://www.asth.org.au/downloads/NOAC_imj_12448.pdf
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http://doi.wiley.com/10.1111/imj.12448
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http://dx.doi.org/10.1111/imj.12448DOI Listing
June 2014
33 Reads

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

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http://dx.doi.org/10.14694/EdBook_AM.2014.34.101DOI Listing
November 2015
29 Reads

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

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http://dx.doi.org/10.12659/AOT.890213DOI Listing
March 2014
37 Reads

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

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http://dx.doi.org/10.1155/2014/487364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933299PMC
March 2014
35 Reads

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

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http://dx.doi.org/10.3747/co.20.1341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671032PMC
June 2013
56 Reads

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

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http://link.springer.com/content/pdf/10.1007/s00268-013-1980
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http://link.springer.com/10.1007/s00268-013-1980-2
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http://dx.doi.org/10.1007/s00268-013-1980-2DOI Listing
June 2013
48 Reads

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

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http://dx.doi.org/10.1007/s00595-012-0325-3DOI Listing
March 2013
21 Reads

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

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http://dx.doi.org/10.12659/aot.883221DOI Listing
November 2012
32 Reads

Surgical risk in patients with cirrhosis.

Authors:
Amanda Nicoll

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

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http://dx.doi.org/10.1111/j.1440-1746.2012.07205.xDOI Listing
October 2012
61 Reads

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

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http://dx.doi.org/10.1016/j.transproceed.2012.01.142DOI Listing
June 2012
77 Reads

Surgical clearance for the patient with chronic liver disease.

Authors:
Andrew J Muir

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

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http://dx.doi.org/10.1016/j.cld.2012.03.008DOI Listing
May 2012
30 Reads

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

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http://dx.doi.org/10.1097/ACO.0b013e3283532b02DOI Listing
June 2012
76 Reads

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

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http://dx.doi.org/10.4254/wjh.v3.i3.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074087PMC
March 2011
21 Reads

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

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http://dx.doi.org/10.1016/j.transproceed.2010.09.073DOI Listing
December 2010
30 Reads

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

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http://link.springer.com/content/pdf/10.1007/s12282-010-0241
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http://link.springer.com/10.1007/s12282-010-0241-6
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http://dx.doi.org/10.1007/s12282-010-0241-6DOI Listing
January 2012
45 Reads

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

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http://dx.doi.org/10.1038/nrurol.2010.161DOI Listing
November 2010
21 Reads