Background: Bridging strategies are necessary for patients with HCC, who are on a liver transplant waiting list. Few centers have started using TARE as a bridging strategy and Yttrium 90 (Y90) has been approved for use in HCC, however, it is very expensive and not practical to use as standard of care in countries, where there is no universal insurance coverage. 188 Rhenium (188Re) radio labeled lipiodol for the treatment of HCC is an alternative isotope with very similar properties to Y90. Methods: We did a retrospective review of 3 patients who were treated with 188Re radio labeled lipiodol as a bridging modality and then later on underwent cadaveric orthotopic liver transplant (OLT). Radiological, histopathological (HPE), alpha-feto protein (AFP) levels, survival and recurrence outcomes were analyzed. Results: First patient had 2 tumors and was transplanted 1 month after TARE. He developed recurrence 8 months post transplant. Second patient had single HCC and had a complete radiological response post TARE. He underwent OLT, 2 months post TARE and HPE also showed complete tumor necrosis. Third patient had 3 lesions and underwent TARE and had a partial radiological response. He underwent OLT, 9 months post TARE. There was a partial response on HPE. Second and third patients are doing well 15 and 11 months post transplant respectively. Conclusion: 188Re radio labeled lipiodol is a very effective bridging strategy for maintaining or down staging HCC in appropriately selected liver transplant waiting list patients.
<b><i>Introduction:</i></b> We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. <b><i>Material and Methods:</i></b> A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. <b><i>Results:</i></b> Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). <b><i>Conclusions:</i></b> In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.
Background: Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development of a new program. Methods: We analyzed 53 simultaneous pancreas-kidney transplants performed over a period of seven years, from 2009 to 2016, with a median follow up of 39 months (range: 1-86 months). Results: Two patients have died, one patient because of a cardiac arrest immediately after surgery and another patient due to traffic accident complicated with a pneumonia. Among the 51 patients alive two grafts were lost, one due to chronic rejection four years after transplantation and the other one due to arterial thrombosis 20 days after transplantation, being this case the only requiring a transplantectomy. In ten patients one or more surgical reinterventions have been necessary due to the following diagnosis: graft pancreatitis (n=4), small intestinal occlusions (n=4), arterial thrombosis (n=1), abscess (n=1) and hemoperitoneum (n=1). Patient and graft overall survival rates at 1, 3 and 5 years were 98%, 95% and 95% and 96, 93 and 89%; respectively Conclusion: This study has shown that the Results of new pancreatic transplant program, which rely on previous experience of other groups, do not reflect a learning curve. Adequate personal education and learning, the use of standardized and adequate techniques, should assure optimal results
Background: Prevalence of hepatolithiasis is common in South-East Asia, which mainly presented as recurrent pyogenic cholangitis, acute cholangitis and accredited a risk factor for cholangiocarcinoma. Hepatectomy is an acknowledged therapeutic option for hepatolithiasis. Methods: From January 2005 to December 2014, 124 patients, whom received hepatectomy for hepatolithiasis at Kaohsiung Chang Gung Memorial Hospital, had been reviewed and analyzed. Results: The presentation included left sided stones in 69%, right sided stones in 18% and bilateral in 13% of patients. Immediate stone clearance after operation was 95.2%. Hospital mortality rate was 3.2%, including one patient with post-operative liver failure and 3 with severe sepsis. Stone recurrence rate was 15.3%. Only one patient developed cholangiocarcinoma during the seventh year of follow-up. In comparison with other series of non-operative management, hepatectomy had higher stone clearance and reduced recurrence of stone and cholangitis, and reduced the risk of cholangiocarcinoma. Our incidence of de-novo cholangiocarcinoma was lowest among other hepatectomy series, with comparable rate of stone clearance and recurrent cholangitis. Conclusion: Hepatectomy for hepatolithiasis has highest stone clearance and lowest recurrent cholangitis rates. Low 5-year risk of cholangiocarcinoma can be achieved by early hepatectomy, including complete resection of the bile duct segment from the bifurcation, complete stone clearance and resection of strictures.
Background: Hepatic alveococcosis is extremely aggressive disease. Methods: We examined 41 patients from 2008-2017,36 were operated:31 hepatic resections, 4 liver transplantation(OLT), 1 portosystemic shunting.Among all the cases of hepatic resections (n=1067) alveococcosis accounts for 3.28% Extrahepatic alveococcosis 2(lungs). The complications:9 obstructive jaundice, 4 portal hypertension, 1 viral hepatic cirrhosis. The size of a parasitic node in the liver varied 9.3-21.7cm. Results: 35 radical operated:31 R0-resections,4 OLT,1 portosystemic shunting. 6 were not operated:2 due to marked comorbidity;2 chronic infection+biliary fistulas;1 bile ducts stenting,1 suggested transplantation.Among the surgeries:4 right hepatectomy,16 right extensive hepatectomy,2 left extensive hepatectomy,1 left hepatectomy,1 hepatectomy with reverse autotransplantation of the left lateral segment,1 left hepatectomy "ex situ" with 1 and 8 segmentectomy,1 three-segmentectomy,3 bisegmentectomy,2 segmentectomy. 14 patients have IVC ingrowth:9 IVC prosthetic:4 one-stage left hepatic vein plastic,5eIVC resection.13 portal vein resection,7 resection of extrahepatic ducts,7 resection of diaphragm. 11 cases of bile leakage(ISGLS):grade Be4, Сe7. Postoperative complications-16(Clavien-Dindo):typeIIe4,IVbe1,IIIbe8,Ve3. The long-term results:1 recurrent case,2 fatal cases. Conclusion: Liver resection is a treatment of choice,characterized by large extent of resection,and accompanied by resection plastic operations on major vessels and bile ducts
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