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Cirrhosis, preoperative management

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https://www.readbyqxmd.com/read/27375806/axillobifemoral-bypass-for-aortitis-syndrome-in-a-living-donor-liver-transplant-patient
#1
Naoto Fukunaga, Kenji Uryuhara, Tadaaki Koyama
A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia...
2016: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/27207434/autoimmune-conditions-are-associated-with-perioperative-thrombotic-complications-in-liver-transplant-recipients-a-unos-database-analysis
#2
Dmitri Bezinover, Khaled Iskandarani, Vernon Chinchilli, Patrick McQuillan, Fuat Saner, Zakiyah Kadry, Thomas R Riley, Piotr K Janicki
BACKGROUND: End stage liver disease (ESLD) is associated with significant thrombotic complications. In this study, we attempted to determine if patients with ESLD, due to oncologic or autoimmune diseases, are susceptible to thrombosis to a greater extent than patients with ESLD due to other causes. METHODS: In this retrospective study, we analyzed the UNOS database to determine the incidence of thrombotic complications in orthotopic liver transplant (OLT) recipients with autoimmune and oncologic conditions...
2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/26973411/liver-surgery-in-cirrhosis-and-portal-hypertension
#3
REVIEW
Christina Hackl, Hans J Schlitt, Philipp Renner, Sven A Lang
The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome...
March 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/26973406/outcomes-of-abdominal-surgery-in-patients-with-liver-cirrhosis
#4
REVIEW
Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Antoni J Betbese, Joan A Roncal, Casimiro Javierre
Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes...
March 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/26901900/aortic-valve-replacement-in-patients-with-end-stage-liver-disease-a-modified-perfusion-concept-in-high-risk-patients
#5
Sven Peterss, Erik Beckmann, Rohan Bhandari, Johannes Hadem, Christian Hagl, Nawid Khaladj, Axel Haverich, Ingo Kutschka
BACKGROUND AND AIM OF THE STUDY: Cardiac surgery with the use of cardiopulmonary bypass in patients with end-stage liver disease is associated with a high risk of postoperative morbidity and mortality due to bleeding, and a high incidence of bacterial infection with associated secondary complications. Minimized extracorporeal perfusion circuits (MECCs) with a lower priming volume, reduced foreign surface area, and interdisciplinary preoperative and postoperative treatment may address these negative effects and improve patient outcomes...
May 2015: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/26789601/portal-venous-interventions-state-of-the-art
#6
REVIEW
David C Madoff, Ron C Gaba, Charles N Weber, Timothy W I Clark, Wael E Saad
In recent decades, there have been numerous advances in the management of liver cancer, cirrhosis, and diabetes mellitus. Although these diseases are wide ranging in their clinical manifestations, each can potentially be treated by exploiting the blood flow dynamics within the portal venous system, and in some cases, adding cellular therapies. To aid in the management of these disease states, minimally invasive transcatheter portal venous interventions have been developed to improve the safety of major hepatic resection, to reduce the untoward effects of sequelae from end-stage liver disease, and to minimize the requirement of exogenously administered insulin for patients with diabetes mellitus...
February 2016: Radiology
https://www.readbyqxmd.com/read/26607653/distinguished-prognosis-after-hepatectomy-of-hbv-related-hepatocellular-carcinoma-with-or-without-cirrhosis-a-long-term-follow-up-analysis
#7
Sheng-Li Yang, Li-Ping Liu, Yun-Fan Sun, Xing-Rong Yang, Jia Fan, Jian-Wei Ren, George G Chen, Paul B S Lai
BACKGROUND: Conflicting results have often been observed for the prognosis of hepatocellular carcinoma (HCC) patients, but few studies have attempted to explore the reasons for the conflicting results. We aimed to distinguish the prognosis of patients with HCC with cirrhosis (HCC-C) and that of patients with HCC without cirrhosis (HCC-NC). METHODS: Patients with hepatitis B virus (HBV)-associated HCC treated by curative liver resection at a single institution between 1995 and 2013 were retrospectively evaluated...
July 2016: Journal of Gastroenterology
https://www.readbyqxmd.com/read/26507533/the-prescription-of-medical-cannabis-by-a-transitional-pain-service-to-wean-a-patient-with-complex-pain-from-opioid-use-following-liver-transplantation-a-case-report
#8
Howard Meng, John G Hanlon, Rita Katznelson, Anand Ghanekar, Ian McGilvray, Hance Clarke
PURPOSE: The purpose of this case report is to describe a patient with a preoperative complex pain syndrome who underwent liver transplantation and was able to reduce his opioid consumption significantly following the initiation of treatment with medical cannabis. CLINICAL FEATURES: A 57-yr-old male with a history of hepatitis C cirrhosis underwent liver transplantation. Preoperatively, he was taking hydromorphone 2-8 mg⋅day(-1) for chronic abdominal pain. Postoperatively, he was given intravenous patient-controlled analgesia through which he received hydromorphone 30 mg⋅day(-1)...
March 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/26487632/association-between-dementia-and-postoperative-complications-after-hip-fracture-surgery-in-the-elderly-analysis-of-87-654-patients-using-a-national-administrative-database
#9
Yusuke Tsuda, Hideo Yasunaga, Hiromasa Horiguchi, Sumito Ogawa, Hirotaka Kawano, Sakae Tanaka
INTRODUCTION: Mortality following hip fracture surgery is higher in patients with dementia than those without; however, few large-scale studies have investigated postoperative in-hospital complications in such patients. The aim of this study was to elucidate the complications that occur after hip fracture surgery in patients with and without dementia using a large national database. MATERIALS AND METHODS: We retrospectively identified patients aged ≥70 years who underwent hemiarthroplasty, osteosynthesis for femoral neck fracture or osteosynthesis for intertrochanteric fracture, and compared the occurrence of postoperative complications between patients with and without dementia...
November 2015: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/26468314/limits-of-surgical-resection-for-bile-duct-cancer
#10
REVIEW
Fabian Bartsch, Stefan Heinrich, Hauke Lang
INTRODUCTION: Perihilar cholangiocarcinoma is the most frequent cholangiocarcinoma and poses difficulties in preoperative evaluation. For its therapy, often major hepatic resections as well as resection and reconstruction of the hepatic artery or the portal vein are necessary. In the last decades, great advances were made in both the surgical procedures and the perioperative anesthetic management. In this article, we describe from our point of view which facts represent the limits for curative (R0) resection in perihilar cholangiocarcinoma...
June 2015: Viszeralmedizin
https://www.readbyqxmd.com/read/26155227/peribiliary-cysts-developed-in-normal-underlying-liver-report-of-a-case
#11
Hee Joon Kim, Choong Young Kim, Young Hoe Hur, Jung Chul Kim, Chol Kyoon Cho, Hyun Jong Kim
Peribiliary cysts, known as cystic dilatation, of the extramural peribiliary glands of the bile duct are rare, and are usually detectable under conditions of pre-existing hepatobiliary diseases such as liver cirrhosis. Preoperative diagnosis is often difficult, because they are usually asymptomatic. Distinction of peribiliary cysts from premalignant or malignant cystic lesions is mandatory. Herein, we report a case of peribiliary cyst, which was preoperatively assumed as unilobar Caroli's diseases in healthy young patients and briefly discuss the management of the condition...
August 2013: Korean Journal of Hepato-biliary-pancreatic Surgery
https://www.readbyqxmd.com/read/26144511/-management-of-patients-with-tips
#12
Édith Dailleau, Sophie Dos Santos, Adrien Garçon, Cécile Russeil, Stéphanie Brajon
The Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure is now performed in almost twenty hospitals in France, including Tours university hospital. The aim is to reduce portal hypertension (PHT) by diverting the portal system to the caval system within the liver. The main cause of PHT is cirrhosis, which may be of alcoholic, viral, dysmetabolic or autoimmune origin.
January 2015: Revue de L'infirmière
https://www.readbyqxmd.com/read/25780312/successful-surgical-management-of-ruptured-umbilical-hernias-in-cirrhotic-patients
#13
Nikolaos A Chatzizacharias, J Andrew Bradley, Simon Harper, Andrew Butler, Asif Jah, Emmanuel Huguet, Raaj K Praseedom, Michael Allison, Paul Gibbs
Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre's experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites...
March 14, 2015: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/25558343/ventricular-arrhythmia-in-patients-with-prolonged-qt-interval-during-liver-transplantation-two-cases-report
#14
Min-Soo Kim, Na Young Kim, Ji Eun Park, Soon Ho Nam
QT interval prolongation is associated with an increased risk of ventricular arrhythmia in various conditions. Cardiac electrophysiologic abnormalities including QT interval prolongation are well documented in patients with advanced liver cirrhosis. We report two cases of patients with QT interval prolongation on preoperative electrocardiography who exhibited repetitive ventricular arrhythmias with significant hemodynamic deterioration during liver transplantation. For the treatment and prevention of ventricular arrhythmias during the intraoperative period, we performed intravenous administration of lidocaine and isoproterenol, corrected imbalances of electrolytes including potassium and magnesium, and prepared a defibrillator...
December 2014: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/25392842/small-for-size-liver-remnant-following-resection-prevention-and-management
#15
REVIEW
Rony Eshkenazy, Yael Dreznik, Eylon Lahat, Barak Bar Zakai, Alex Zendel, Arie Ariche
In the latest decades an important change was registered in liver surgery, however the management of liver cirrhosis or small size hepatic remnant still remains a challenge. Currently post-hepatectomy liver failure (PLF) is the major cause of death after liver resection often associated with sepsis and ischemia-reperfusion injury (IRI). ''Small-for-size'' syndrome (SFSS) and PFL have similar mechanism presenting reduction of liver mass and portal hyper flow beyond a certain threshold. Few methods are described to prevent both syndromes, in the preoperative, perioperative and postoperative stages...
October 2014: Hepatobiliary Surgery and Nutrition
https://www.readbyqxmd.com/read/25376591/partial-hepatectomy-for-liver-metastases-from-nasopharyngeal-carcinoma-a-comparative-study-and-review-of-the-literature
#16
REVIEW
Jun Huang, Qijiong Li, Yun Zheng, Jingxian Shen, Binkui Li, Ruhai Zou, Jianping Wang, Yunfei Yuan
BACKGROUND: The management of liver metastases from nasopharyngeal carcinoma (NPC) has not been extensively investigated. This study aimed to compare the long-term outcome of patients with liver metastases from NPC who were treated by a partial hepatectomy or transcatheter hepatic artery chemoembolization (TACE). METHODS: Between January 1993 and December 2010, 830 patients were diagnosed with liver metastases from NPC and exhibited a complete response to the primary cancer of the nasopharynx and regional lymph nodes...
2014: BMC Cancer
https://www.readbyqxmd.com/read/25238440/cirrhosis-patients-have-increased-risk-of-complications-after-hip-or-knee-arthroplasty
#17
Thomas Deleuran, Hendrik Vilstrup, Søren Overgaard, Peter Jepsen
BACKGROUND AND PURPOSE: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). PATIENTS AND METHODS: Using Danish healthcare registries, we identified all Danish residents who underwent a THA or TKA for primary osteoarthritis in the period 1995-2011. We compared the risk of complications in patients with or without cirrhosis. RESULTS: The surgical technique was similar in the 363 cirrhosis patients and in 109,159 reference patients, but cirrhosis patients were more likely to have been under general anesthesia (34% vs...
February 2015: Acta Orthopaedica
https://www.readbyqxmd.com/read/25148949/-pulmonary-hypertension-in-liver-diseases
#18
REVIEW
Laurent Savale, Caroline Sattler, Olivier Sitbon
Portopulmonary hypertension (PoPH) is defined by the combination of portal hypertension and precapillary pulmonary hypertension (mPAP ≥ 25 mmHg, PCWP < 15 mmHg and PVR > 3 Wood units). PoPH is characterised by pathobiological mechanisms that are similar to other forms of pulmonary arterial hypertension. Prevalence of PoPH is estimated at 0.5-5% among patients with portal hypertension with or without cirrhosis. Treatment strategies most commonly employed for PoPH patients are based on recommendations for idiopathic PAH management...
September 2014: La Presse Médicale
https://www.readbyqxmd.com/read/25045572/abo-incompatible-living-donor-liver-transplantation-from-hepatitis-b-core-antibody-positive-donor-to-hepatitis-c-liver-cirrhosis-recipient-a-case-report
#19
Akira Umemura, Hiroyuki Nitta, Akira Sasaki, Takeshi Takahara, Yasushi Hasegawa, Go Wakabayashi
Herein, we describe an extremely rare experience of a patient with liver cirrhosis from hepatitis C virus (LC-HCV) who underwent an ABO-incompatible living donor liver transplantation (ABO-I-LDLT) using a hepatitis B core antibody (HBc-Ab) positive donor's liver graft. A 47-year-old Japanese woman with end stage LC-HCV, as a recipient, was preoperatively administered rituximab, mycophenolate mofetil, and steroids without plasma exchange. A routine ABO-I-LDLT procedure was applied using her daughter's HBc-Ab positive liver graft...
2014: Case Reports in Transplantation
https://www.readbyqxmd.com/read/24976715/role-of-endoscopy-in-the-bariatric-surgery-of-patients
#20
REVIEW
Giovanni D De Palma, Pietro Forestieri
Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett's esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases...
June 28, 2014: World Journal of Gastroenterology: WJG
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