DGHAL with the selective application of SHP/RAR is a safe and effective technique for advanced grade HR.

In conclusion, we have shown that, in septic patients with respiratory failure, LCT administration was associated with more significant changes of Qva/Qt, MPAP and PaO2/FIO2 compared to infusion of an LCT/MCT 1:1 emulsion. Clinically, these transient alterations might cause serious problems in patients with marginal arterial oxygenation and cardio-respiratory impairment.

Introduction: Serum lactate elevation has been used as a marker of tissue hypoxia in the setting of perioperative monitoring and critical care. It has also been correlated with perioperative morbidity and mortality. Cytoreductive surgery (CRS) & hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis is a major abdominal operation, requiring meticulous perioperative care. The aim of this study is to assess the clinical use of lactate measurements after CRS & HIPEC and its prognostic value in terms of immediate postoperative morbidity and mortality, as well as long term survival. Material & Methods: Of 140 patients diagnosed with peritoneal carcinomatosis who underwent cytoreductive surgery and HIPEC were prospectively studied. Serum lactate was measured by air blood gases analyser intraoperatively (just before the administration of HIPEC) and then daily till the fifth postoperative day. Postoperative complications were recorded and divided into two groups according to Clavien Dindo classification. Results: Intraoperative lactate measurements have not been associated with postoperative morbidity and mortality. On the other hand, lactate measurements on postoperative days 3 and 4 are of clinical significance. Specifically, an increase of 1 mmol/L of the average lactate value of days 3 and 4 raises the risk of a minor complication (Grades I to IIIa) by 1.9, the risk of a major complication (Grades IIIb to V) by 10.9 and the risk of mortality by 32.1%. Conclusions: The average of day 3 and 4 postoperative day lactate level is an independent predictor of morbidity and mortality in patients undergoing CRS and HIPEC.

Objective:The aim of the present study was to evaluate the role of age on different types of liver surgery. Methodology: Between 2002 and 2007, 50 patients underwent a variety of liver surgical procedures due to primary or metastatic tumours. Of these, 24 were 70 years old or older, and 26 patients were younger than 70 years old at the time of the operation. Results: Among the patients included in the study, 22 underwent radiofrequency ablation. Another 11 underwent non-anatomical liver resection. The remaining 17 patients underwent liver resection, with more than three segments resected. The type of procedure, duration of operation, estimated blood loss, and postoperative death and morbidity rates were not significantly different between the two groups. The mean survival of patients that underwent radiofrequency ablation or non-anatomical resection was not significantly different between the two groups. However, in the patients in which liver resection was performed, mean survival was significantly greater in the younger group. Conclusions: These results indicate that hepatic resection is a safe and feasible procedure in elderly patients. The postoperative outcome in this age group is comparable of that of younger patients.