Hepato Gastroenterol
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Hepato Gastroenterol · Oct 2007
Hyperbaric oxygen therapy for the treatment of postoperative paralytic ileus and adhesive intestinal obstruction associated with abdominal surgery: experience with 626 patients.
The results of hyperbaric oxygen (HBO) therapy for treatment of postoperative paralytic ileus and adhesive intestinal obstruction associated with abdominal surgery are unknown. ⋯ These results suggest that HBO therapy might deserve further assessment for use in management of postoperative paralytic ileus and adhesive intestinal obstruction as a new modality. HBO therapy is safe and non-invasive, and may be useful in the elderly patients, since mortality was relatively low in this series.
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Hepato Gastroenterol · Sep 2007
Case ReportsHepatectomy for hepatocellular carcinoma with indocyanine green excretory defect: a case report.
A 69-year-old female patient with an indocyanine green (ICG) excretory defect underwent hepatectomy for hepatocellular carcinoma (HCC). Abdominal computed tomography confirmed a mass lesion with central necrosis in the right anterior segment of the liver. Angiography revealed tumor stain pooling and a portal venous or arterial venous shunt. ⋯ The pathologic examination revealed moderately differentiated HCC. Her postoperative course was uneventful. ICG excretory defect did not seem to have effect on the short-term prognosis of hepatectomy.
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Acute appendicitis is the most common acute surgical infection seen in emergency department. The present study aims to evaluate the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of the serum D-lactate levels as a marker for the diagnosis of acute appendicitis. D-lactate is the stereoisomer of the mammalian L(+)-lactate, and is produced by indigenous bacteria (Escherichia coli, Klebsiella, Bacteroides, Lactobacillus) in the gastrointestinal tract. Once obstruction occurs, appendix is a good medium for bacterial proliferation, and ischemic injury leads to an increase in D-lactate levels. ⋯ We found positive correlations between serum D-lactate levels and acute appendicitis and serum D-lactate had the lowest false negative rate among the other parameters. Therefore, we conclude that D-lactate might be a simple and reliable diagnostic marker for appendicitis.
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Epidural analgesia improves postoperative outcome, and should benefit patients undergoing hepatectomy for cancer. However, the combination of underlying disease, surgery, and blood loss after hepatectomy may lead to hemostatic changes that, theoretically, increase the risk of epidural hematoma. To quantify these changes, we retrospectively reviewed the records of 229 patients at the Prince of Wales Hospital, Hong Kong. ⋯ We conclude that commonly measured hemostatic parameters are deranged after hepatectomy for cancer. Because of the complex cancer- and surgery-related hemostatic changes, whether these changes indeed indicate increased risk of neuraxial hematoma associated with neuraxial blocks is unclear. We also found that most Chinese patients were managed adequately with patient-controlled intravenous morphine. Clinicians contemplating neuraxial block on patients undergoing hepatectomy for cancer must weigh the potential risks and benefits.
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Hepato Gastroenterol · Jul 2007
Case ReportsPreservation of segment 4 inferior by distal middle hepatic vein reconstruction combined with extended right hepatectomy after portal vein embolization in a patient with a huge initially unresectable HCC.
An extended hepatectomy combined with preoperative portal venous embolization can offer curative resection in patients with initially unresectable hepatocellular carcinoma. However, hypertrophy of the future remnant liver is occasionally unsatisfactory after portal venous embolization in some patients to remove the initially unresectable tumor. In these patients, hepatic venous reconstruction to preserve hepatic parenchyma may contribute to the possibility of resection. ⋯ His postoperative course was almost uneventful. Postoperative abdominal computed tomography showed the satisfactorily preserved Segment 4 inferior. Distal hepatic venous reconstruction combined with an extended hepatectomy may further offer a chance of a curative resection for patients in whom enough hypertrophy of the future remnant liver is not obtained after portal venous embolization.