Objective: Microwave ablation (MWA) of liver malignancies has gained much traction over the past 5 years. However, MWA carries relatively higher rates of residual disease compared to resection. Likelihood of MWA success is multifactorial and newer devices with more reliable ablation zones are being developed to overcome these drawbacks. This manuscript is a review of our first 100 liver ablations with the newer single antenna high powered MWA system. Materials and Methods: Retrospective chart review of patients that underwent MWA for either primary or secondary hepatic malignancies between March 2015 and July 2016 was conducted. The complete ablation rates, rate of new lesions, complications, and short-term survival were analyzed. Multiple statistical tests, including multivariate regression, were used to assess risk factors for local residual and recurrent disease. Results: Fifty-three patients (median age 61 ± 9 years, 39 males) underwent 100 MWAs. Of the 100 lesions ablated, 76 were hepatocellular cancers (HCCs) and 24 were metastases. Median lesion size was 16 ± 9 mm. Seventy- five of these patients had multifocal disease targeted in the same session. Seventy patients had cirrhosis (median model for end-stage liver disease score 9 ± 3; Child-Pugh B and C in 42%). An 83% complete lesion ablation rate was seen on follow-up imaging with liver protocol magnetic resonance imaging/computed tomography (median follow-up of 1 year). The minor complication rate was 9.4% with no major complications or 30-day mortality. Despite this, evidence of new foci of hepatic disease was found in 47% of patients, the majority (80%) of which were in HCC patients (P < 0.01) and most of these new lesions were in a different hepatic segment (64%). Degree of cirrhosis (P < 0.01), presence of non-alcoholic steatohepatitis (NASH) (P = 0.01) and lesion’s subcapsular location (P = 0.03) was significant predictors of residual disease. With the subset analysis of only HCC lesions larger than 1 cm, only the presence of NASH remained significant. Conclusion: The single probe high power MWA of malignant hepatic lesions is safe and effective with minimal morbidity. Degree of cirrhosis, NASH, and subcapsular location was associated with an increased rate of residual disease on short-term follow-up.

Objectives Acute pain management in opioid users can be challenging in the perioperative period. This study focuses on whether use of opioids increases sedation medication requirements in patients undergoing port placement under moderate sedation. Materials and Methods A retrospective review was performed on all patients undergoing port placement between June 1, 2017, and June 30, 2019. Exclusion criteria included receiving general anesthesia, no sedation, and errors in data entry. Data collection included demographics, use of opioids, benzodiazepines, antidepressants, tobacco, alcohol, and sedation data. Results Opioid, benzodiazepine, and selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) use was significantly associated with higher sedation drug dose requirements. Patients using opioids required 10.5% higher doses of midazolam compared with nonusers. Benzodiazepine users required 16.3% additional dosage of midazolam than nonusers. Finally, patients on SSRIs/SNRIs medications required 11.8% higher midazolam dosing when compared with nonusers. Conclusion Anticipating higher needs of sedation medications during procedures in patients with history of psychotropic agents use can allow for more effective sedation and patient satisfaction. More patient and provider awareness is needed on this topic, as health care policy is moving toward value-based healthcare, with patient satisfaction surveys being one of its indicators.

Purpose: Cholangiocarcinoma arising from biliary duct epithelial cells, is the second most common primary hepatic malignancy. Although surgical resection is the definite curative option for earlystage disease, only a minority of patients qualify for this procedure. Percutaneous microwave ablation is a minimally invasive procedure widely used for hepatocellular carcinoma and colorectal cancer metastasis to the liver. In this study, we aim to describe the safety and efficacy of percutaneous microwave ablation for the management of intrahepatic cholangiocarcinoma. Materials and Methods: A retrospective review of patients undergoing hepatic microwave ablation for cholangiocarcinoma at our center was performed. Eleven patients (66.5 ± 7.4 years, 55% males) with 30 tumors (20 ± 16 mm, max is 78 mm) were treated between 2014 and 2020. All procedures were performed under CTguidance using a high-power microwave ablation system. Patient's medical history, procedure technical information, outcomes, and follow-up data were reviewed. All statistical analyses were performed with SAS (v9.4). Results: Median imaging follow-up was 4 (2, 15) months. Tumor differentiation (9% well, 27% moderately, 9% poorly, and 55% unknown) and staging (45% T1a, 18% T1b, and 36% T2b), and receiving neoadjuvant/adjuvant chemotherapy (73% received). Two of eleven patients were initially treated with surgical resection. Complete ablation rate was 96.7% with local tumor control rate of 90%. All patients were discharged the next day without major complications. Conclusions: Percutaneous microwave ablation is safe and effective and may be a good second line alternative to surgery for treating early-stage intrahepatic cholangiocarcinoma of the liver with good short-term results despite a relatively complex cohort. Longer term follow-up is needed to validate survival benefit of this study.

of VTE in critically ill patients only. Most studies reported universal in-hospital (95.3%). The overall incidence of VTE was 16.8% and 12% despite prophylactic anticoagulation. Interestingly, subgroup analysis in critically ill patients demonstrated an incidence of VTE of 27.5% and 26.5% despite prophylactic anticoagulation. The overall incidence of DVT was 7.3% and 22.5% in critically ill patients admitted to ICU. PE with or without DVT occurred in 9.5% of patients, 5% in critically ill patients and 2.9% was detected despite anticoagulation. Conclusions: VTE was found at an alarming rate in hospitalized patients with COVID-19 in the United States and often presented as PE. Assessment of VTE risk is strongly recommended in patients with COVID-19. Given the observed higher than average pulmonary embolism incidence despite prophylactic anticoagulation, randomized trials are needed to determine whether there is any potential benefit of prophylactic IVC filter placement in patients with COVID-19, especially in the critical care setting.

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