At high concentrations, free radicals and radical-derived, nonradical reactive species are hazardous for living organisms and damage all major cellular constituents. At moderate concentrations, how...

/pdf/free-radicals-in-the-physiological-control-of-cell-function-g3w3iyr0ph.pdf

Free Radicals in the Physiological Control of Cell Function

Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

Guideline for Prevention of Surgical Site Infection, 1999 ☆ ☆☆ ★ ★★

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

/pdf/guideline-for-prevention-of-surgical-site-infection-1999-2k3en33kqw.pdf

Guideline for Prevention of Surgical Site Infection, 1999

Introduction
Liver microcirculation disturbances are a cause of hepatic failure in sepsis. Increased leukocyte-endothelial interaction, platelet adherence and impaired microperfusion cause hepatocellular damage. The time course and reciprocal influences of ongoing microcirculatory events during endotoxemia have not been clarified.

/pdf/hepatic-platelet-and-leukocyte-adherence-during-endotoxemia-1mp8nc3vc8.pdf

Hepatic platelet and leukocyte adherence during endotoxemia

Much clinical and experimental evidence suggests that pancreatic ischaemia in the early phase of acute pancreatitis is important in the development of pancreatic necrosis. While depletion of intravascular volume has often been assumed to be the main circulatory defect, an additional disturbance of pancreatic microcirculation has been demonstrated experimentally. Possible contributory mechanisms include chemical-induced vasoconstriction, direct injury of vessel wall, intravascular coagulation and increased endothelial permeability resulting in pancreatic oedema, haemoconcentration and impaired venous drainage. Pancreatic ischaemia as a consequence of these local effects seems to be responsible for the transition of mild pancreatitis to parenchymal necrosis. In experimental models the beneficial effect of various drugs and of sympathetic blockade has been ascribed to an improvement in pancreatic perfusion. Although effective volume therapy is generally accepted as the mainstay of conservative treatment in acute pancreatitis, the efficacy of different fluid preparations is still controversial, and simple fluid resuscitation has not been shown to prevent the development of parenchymal necrosis. The specific impairment of pancreatic microcirculation cannot be prevented merely by replenishment of intravascular volume with crystalloids, albumin or plasma despite normalization of macrohaemodynamics. In contrast, partial replacement of blood by dextran preparations has been shown to increase pancreatic perfusion by improving blood fluidity. Isovolaemic haemodilution in conjunction with conventional fluid therapy may provide a new and effective means of protecting the pancreas from secondary injury due to the early ischaemic phase of acute pancreatitis.

Pancreatic ischaemia in experimental acute pancreatitis: Mechanism, significance and therapy

The majority of patients with colorectal cancer present at a stage when the primary cancer can be resected with curative intent. However, despite the high resectability rate, about 30-50% of these patients subsequently develop metastatic disease. In these patients, neoplastic cells were disseminated either before or during surgery of the primary cancer. Due to the lack of appropriate detection systems, the extent of pre- and intraoperative hematogenic tumor cell dissemination has not yet been determined. Using a reverse transcription-PCR assay to amplify cytokeratin 20 transcripts, we were able to detect 10 colorectal cancer cells in 10 ml of blood. Blood samples were taken from 65 patients undergoing resection of primary colorectal cancer or liver metastasis of colorectal cancer pre-, intra-, and postoperatively. Circulating tumor cells were detected in 24 of 58 patients with colorectal resections in correlation to the tumor stage and in 6 of 7 patients who underwent hemihepatectomy for liver metastasis. In 8 of 58 patients with colorectal resection and in 5 of 7 patients with hemihepatectomy, tumor cells could only be detected during or during and after surgery. These results demonstrate that hematogenic tumor cell dissemination is a frequent and early event in colorectal cancer. Surgery enhances the release of tumor cells into the circulation. The long-term follow-up of our patient cohort will provide data on the prognostic relevance of circulating tumor cells and might lead to new therapeutic concepts for perioperative prophylaxis of tumor cell implantation or postoperative adjuvant therapy regimens.

https://clincancerres.aacrjournals.org/content/clincanres/4/2/343.full.pdf

Dissemination of tumor cells in patients undergoing surgery for colorectal cancer.

Until 50 years ago, colorectal carcinoma appearing to infiltrate surrounding tissue was considered nonresectable. 1 Since then, extensive surgical procedures have been performed aimed at complete resection of locally advanced primary colorectal carcinoma. Results from several small series indicated that multivisceral en bloc resection of locally advanced tumors results in cure in many patients. 2,3 Undoubtedly such operations are demanding for both patient and surgeon, and the associated risks of complications and death must be weighed against a potential survival benefit.

The decision to perform a multivisceral resection for primary colorectal carcinoma is usually made at the time of surgery, because the need for multivisceral resection is rarely recognized before surgery. In this situation it is important to evaluate the accuracy with which curative or palliative outcome of the treatment can be predicted during surgery. It may also be speculated that surgical expertise has a major impact on the success of such complex procedures.

Few series have included sufficient patients to allow a meaningful analysis of prognostic factors, 4,5 and no attempt has yet been made to evaluate surgical experience as a potential prognostic factor in multivisceral resections. Therefore, we reviewed our experience with 201 multivisceral resections for primary colorectal cancer to determine the accuracy of intraoperative prediction of potential curability, to identify prognostic factors, and to examine the effect of surgical experience on immediate outcome and long-term results.

Multivisceral Resection for Locally Advanced Primary Colon and Rectal Cancer: An Analysis of Prognostic Factors in 201 Patients

Objective This study compares the results of liver transplantation (LTx) and liver resection (LR) for hepatocellular carcinoma (HCC) to test the widespread hypothesis that LTx is the preferable approach for small HCCs Summary Background Data With respect to scarcity of donor organs and poor results, LTxs for large HCCs are obsolete Small HCC transplantations have been reported to result in an excellent survival rate However, the data of comparative studies are controversial Methods Patients who were treated curatively by LTx (n = 50) or LR (n = 52) for HCC were included in this retrospective study Survival and freedom from recurrence were analyzed Patients were stratified according to prognostic factors (pT classification, tumor size, number of tumor nodules, vascular infiltration, and cirrhosis) Results Overall, after LTx and LR the 3-year survival rate and recurrence rate were not significantly different In the Cox analysis, tumor size (p = 002) and vascular infiltration (p = 004) were independent variables after LTx, whereas after LR, none of the tested prognostic parameters was significant With regards to recurrence, tumor size was the only independent factor, after both LTx and LR (p = 002, respectively) Directly comparing the two therapeutic approaches, a 3-year survival rate in pT 1/2, oligocentric (1-5 nodules), and oligocentric and small tumors proved to be superior after LTx The recurrence rate after LTx was superior to LR in pT 1/2 and oligocentric tumors Remarkably, for small (≤5 cm) tumors, LTx and LR resulted in a similar 3-year survival rate and freedom from recurrence Conclusions According to our analysis, the oncological advantage of LTx compared with LR is questionable This applies especially for small tumors Superior results of LTx in early stage HCC and particularly in oligocentric tumors may be attributed to incorrect preoperative diagnosis Nevertheless, LTx is a reasonable treatment for patients with early stage tumors if a LR is impossible because of tumor localization or poor functional hepatic capacity

Christian Herfarth

Papers

Hepatic platelet and leukocyte adherence during endotoxemia

Pancreatic ischaemia in experimental acute pancreatitis: Mechanism, significance and therapy

Dissemination of tumor cells in patients undergoing surgery for colorectal cancer.

Multivisceral Resection for Locally Advanced Primary Colon and Rectal Cancer: An Analysis of Prognostic Factors in 201 Patients

Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis.