Population-based study からみた神経予後不良因子の検討

Nanoparticle-liver interactions: Cellular uptake and hepatobiliary elimination

Multiplexed immunohistochemistry, imaging, and quantitation: A review, with an assessment of Tyramide signal amplification, multispectral imaging and multiplex analysis

Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresho...

Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review.

1993年，30位医学期刊编辑和临床试验专家在加拿大开会制定了一套建议——CONSORT声明。CONSORT即Consolidated Standards of Reporting Trials（临床试验报告统一标准），是CONSORT小组拟定的一系列建议标准，用以改善RCT报告款项参差不齐产生的问题，指导作者提高其临床试验报告质量，读者、审稿人和编辑可以利用CONSORT声明来帮助评估和解释RCT报告。

Consort

OBJECTIVE: To review the literature on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery.
BACKGROUND: Postoperative liver failure is the major cause of mortality and morbidity after partial liver resection and develops as a result of insufficient remnant liver function. Therefore, accurate preoperative assessment of the future remnant liver function is mandatory in the selection of candidates for safe partial liver resection.
METHODS: A MEDLINE search was performed using the key words "liver function tests," "functional studies in the liver," "compromised liver," "physiological basis," and "mechanistic background," with and without Boolean operators.
RESULTS: Passive liver function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after liver surgery. Dynamic quantitative liver function tests, such as the indocyanine green test and galactose elimination capacity, are more accurate as they measure the elimination process of a substance that is cleared and/or metabolized almost exclusively by the liver. However, these tests only measure global liver function. Nuclear imaging techniques ((99m)Tc-galactosyl serum albumin scintigraphy and (99m)Tc-mebrofenin hepatobiliary scintigraphy) can measure both total and future remnant liver function and potentially identify patients at risk for postresectional liver failure.
CONCLUSIONS: Because of the complexity of liver function, one single test does not represent overall liver function. In addition to computed tomography volumetry, quantitative liver function tests should be used to determine whether a safe resection can be performed. Presently, (99m)Tc-mebrofenin hepatobiliary scintigraphy seems to be the most valuable quantitative liver function test, as it can measure multiple aspects of liver function in, specifically, the future remnant liver.

https://www.zora.uzh.ch/id/eprint/77125/1/Hoekstra_stieger_review_2013.pdf

Physiological and biochemical basis of clinical liver function tests: a review

Objective:To evaluate tumor growth in a series of patients undergoing liver resection after portal vein embolization (PVE).Background:The regenerative response after PVE leading to compensatory hypertrophy of the nonembolized liver segments potentially enhances tumor growth.Methods:Portal vein embol

/pdf/tumor-progression-after-preoperative-portal-vein-1rm6a1zrui.pdf

Tumor progression after preoperative portal vein embolization.

Liver hemangiomas are the most common benign liver tumors and are usually incidental findings. Liver hemangiomas are readily demonstrated by abdominal ultrasonography, computed tomography or magnetic resonance imaging. Giant liver hemangiomas are defined by a diameter larger than 5 cm. In patients with a giant liver hemangioma, observation is justified in the absence of symptoms. Surgical resection is indicated in patients with abdominal (mechanical) complaints or complications, or when diagnosis remains inconclusive. Enucleation is the preferred surgical method, according to existing literature and our own experience. Spontaneous or traumatic rupture of a giant hepatic hemangioma is rare, however, the mortality rate is high (36-39%). An uncommon complication of a giant hemangioma is disseminated intravascular coagulation (Kasabach-Merritt syndrome); intervention is then required. Herein, the authors provide a literature update of the current evidence concerning the management of giant hepatic hemangiomas. In addition, the authors assessed treatment strategies and outcomes in a series of patients with giant liver hemangiomas managed in our department.

Management of giant liver hemangiomas: an update

Background
There is an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating hypertrophic pyloric stenosis (HPS). The aim of this study was to compare the results of both surgical strategies by means of a systematic review and meta-analysis of the available literature.

/pdf/open-versus-laparoscopic-pyloromyotomy-for-hypertrophic-urcuft6h8n.pdf

Open Versus Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis: A Systematic Review and Meta-Analysis Focusing on Major Complications

Background: Biliary leakage after liver resection continues to be reported. Management of bile leakage has changed in recent years, with nowadays non-surgical procedures as the preferred treatment. Methods: Biliary leakage and management were assessed in 381 patients who underwent liver resection between January 2005 and April 2011. Results: The overall rate of biliary leakage after liver resection was 5.0%, with a higher incidence in patients who had undergone concomitant hepaticojejunostomy (HJ; 13.6 vs. 3.2%). Hospital stay (p = 0.047), major resections (p = 0.018), operation time (p = 0.011), and relaparotomy (p = 0.002) were risk factors for postoperative bile leakage. Multivariate analysis identified relaparotomy as an independent factor (OR 4.216, p = 0.034). Bile leakage in patients without HJ (n = 10) was managed in 6 patients by percutaneous transhepatic biliary drainage (PTD), and in 3 patients by endoscopic drainage. One patient was treated surgically. All patients with an HJ and postoperative bile leakage (n = 9) underwent PTD. Conclusion: The incidence of posthepatectomy biliary leakage has decreased over time, while PTD and endoscopic stenting are effective treatment modalities. PTD is the treatment of choice in bile leakage after resection combined with HJ.

/pdf/posthepatectomy-bile-leakage-how-to-manage-4g7s5etka5.pdf

Lisette T. Hoekstra

Papers

Physiological and biochemical basis of clinical liver function tests: a review

Tumor progression after preoperative portal vein embolization.

Management of giant liver hemangiomas: an update

Open Versus Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis: A Systematic Review and Meta-Analysis Focusing on Major Complications

Posthepatectomy bile leakage: how to manage.