Journal of hepato-biliary-pancreatic sciences
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J Hepatobiliary Pancreat Sci · Jun 2015
ReviewJapanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015.
Japanese (JPN) guidelines for the management of acute pancreatitis were published in 2006. The severity assessment criteria for acute pancreatitis were later revised by the Japanese Ministry of Health, Labour and Welfare (MHLW) in 2008, leading to their publication as the JPN Guidelines 2010. Following the 2012 revision of the Atlanta Classifications of Acute Pancreatitis, in which the classifications of regional complications of pancreatitis were revised, the development of a minimally invasive method for local complications of pancreatitis spread, and emerging evidence was gathered and revised into the JPN Guidelines. ⋯ The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.
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J Hepatobiliary Pancreat Sci · Jun 2015
Preoperative intramuscular adipose tissue content is a novel prognostic predictor after hepatectomy for hepatocellular carcinoma.
Sarcopenia has been shown to be an independent predictor of lower disease-free and overall survival in various kinds of diseases. The quality of skeletal muscle has recently attracted much attention as a new parameter of sarcopenia. ⋯ Preoperative quality of skeletal muscle was closely correlated with postoperative mortality and HCC recurrence. IMAC could be incorporated into new selection criteria for hepatectomy for HCC.
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J Hepatobiliary Pancreat Sci · Jun 2015
Reverse Trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver.
Bleeding remains an important intraoperative complication in patients who undergo hepatectomy. It is generally believed that a reduction in central venous pressure will decrease bleeding from the hepatic venous system. To our knowledge, however, no study has compared the effectiveness of these techniques for controlling bleeding. So we compared the effectiveness of central venous pressure control techniques, such as infrahepatic inferior vena cava clamping, changes in surgical position of the patient, and hypoventilation anesthesia, for lowering central venous pressure. ⋯ Reverse Trendelenburg position decreased central venous pressure without significantly decreasing the systolic blood pressure, suggesting that it is possible to perform hepatectomy with reverse Trendelenburg position more safely than with inferior vena cava clamping.