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Cirrhosis, preoperative management

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https://www.readbyqxmd.com/read/29198689/utility-of-tolvaptan-in-the-perioperative-management-of-severe-hyponatremia-during-liver-transplantation-a-case-report
#1
A Parekh, P Rajaram, G Patel, R M Subramanian
Severe hyponatremia can complicate the pretransplantation management of patients with decompensated cirrhosis while they await liver transplantation. Before the liver transplant, it is critical to correct severe hyponatremia to an appropriate level to reduce the risks of perioperative complications such as central pontine myelinolysis, cerebral edema, and seizures. Vasopressin receptor antagonists, and in particular tolvaptan, offer a therapeutic modality that can correct severe refractory hyponatremia in a timely and predictable manner before liver transplantation...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29025385/the-impact-of-preoperative-variables-on-intraoperative-blood-loss-and-transfusion-requirements-during-orthotopic-liver-transplant
#2
Mohammad Hossein Eghbal, Kazem Samadi, Mohammad Bagher Khosravi, Mohammad Ali Sahmeddini, Sina Ghaffaripoor, Mohammad Ghorbani, Sakineh Shokrizadeh
OBJECTIVES: Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively...
October 12, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28841541/use-of-the-liver-maximum-function-capacity-test-limax-for-the-management-of-liver-resection-in-cirrhosis-a-case-of-hypopharyngeal-cancer-liver-metastasis
#3
S Cammann, F Oldhafer, K I Ringe, W Ramackers, K Timrott, M Kleine, J Klempnauer, F Lehner, H Bektas, F W R Vondran
INTRODUCTION: The presence of liver cirrhosis goes along with a higher chance for the need of liver resection. As established laboratory parameters often underestimate the degree of cirrhosis this is associated with an increased risk for postoperative liver failure due to the preoperatively impaired liver function. Known liver function tests are unlikely to be performed in daily use because of high cost or expenditure of time. Liver maximum function capacity test (LiMAx) provides a novel tool for measurement of liver function and references for the safety of liver resection...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28834223/liver-and-systemic-hemodynamics-in-cirrhotic-children-impact-on-the-surgical-management-in-pediatric-living-donor-liver-transplantation
#4
Catherine de Magnée, Francis Veyckemans, Thierry Pirotte, Renaud Menten, Dana Dumitriu, Philippe Clapuyt, Karlien Carbonez, Catherine Barrea, Thierry Sluysmans, Christine Sempoux, Isabelle Leclercq, Francis Zech, Xavier Stephenne, Raymond Reding
BACKGROUND AND AIMS: Cirrhosis in adults is associated with modifications of systemic and liver hemodynamics, whereas little is known about the pediatric population. The aim of this work was to investigate whether alterations of hepatic and systemic hemodynamics were correlated with cirrhosis severity in children. The impact of hemodynamic findings on surgical management in pediatric living donor liver transplantation was evaluated. METHODS: Liver and systemic hemodynamics were studied prospectively in 52 children (median age= 1 year; 33 biliary atresia)...
August 17, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28732141/intraoperative-ultrasound-for-prediction-of-hepatocellular-carcinoma-biological-behavior-prospective-comparison-with-pathology
#5
Roberto Santambrogio, Claudia Cigala, Matteo Barabino, Marco Maggioni, Giovanna Scifo, Savino Bruno, Emanuela Bertolini, Enrico Opocher, Gaetano Bulfamante
BACKGROUND AND AIMS: Preoperative prediction of both microinvasive hepatocellular carcinoma and histological grade of hepatocellular carcinoma is pivotal to treatment planning and prognostication. Aim of the study was to evaluate whether some intraoperative ultrasound features correlate with both the presence of same histological patterns and differentiation grade of hepatocellular carcinoma on the histologic features of the primary resected tumor. METHODS: All patients with single, small hepatocellular carcinoma that underwent hepatic resection were included in this prospective double-blind study: the intraoperative ultrasound patterns of nodule were registered and compared with similar histological features...
July 21, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28469455/perioperative-care-of-patients-with-liver-cirrhosis-a-review
#6
REVIEW
Naeem Abbas, Jasbir Makker, Hafsa Abbas, Bhavna Balar
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28426586/predictive-modeling-of-massive-transfusion-requirements-during-liver-transplantation-and-its-potential-to-reduce-utilization-of-blood-bank-resources
#7
Aliaksei Pustavoitau, Maggie Lesley, Promise Ariyo, Asad Latif, April J Villamayor, Steven M Frank, Nicole Rizkalla, William Merritt, Andrew Cameron, Nabil Dagher, Benjamin Philosophe, Ahmet Gurakar, Allan Gottschalk
BACKGROUND: Patients undergoing liver transplantation frequently but inconsistently require massive blood transfusion. The ability to predict massive transfusion (MT) could reduce the impact on blood bank resources through customization of the blood order schedule. Current predictive models of MT for blood product utilization during liver transplantation are not generally applicable to individual institutions owing to variability in patient population, intraoperative management, and definitions of MT...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28407283/acoustic-radiation-force-impulse-imaging-for-assessing-liver-fibrosis-preoperatively-in-infants-with-biliary-atresia-comparison-with-liver-fibrosis-biopsy-pathology
#8
Fen Gao, Ya-Qing Chen, Jing Fang, Sheng-Li Gu, Luan Li, Xiao-Ying Wang
OBJECTIVES: The purpose of this study was to investigate the diagnostic performance of acoustic radiation force impulse (ARFI) in assessing liver fibrosis preoperatively in infants with biliary atresia (BA). METHODS: A total of 50 consecutive infants with BA and 50 healthy infants who underwent ARFI examination were recruited. Siemens Acuson S2000 in Virtual Touch Quantification mode (Siemens Medical Solutions, Mountain View, CA) was used to measure shear wave speeds (SWSs)...
August 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28306680/anaesthesia-in-patients-with-liver-disease
#9
Malgorzata H Starczewska, Wint Mon, Peter Shirley
PURPOSE OF REVIEW: The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery...
June 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28127714/short-and-long-term-outcomes-of-laparoscopic-organ-sparing-resection-in-pancreatic-neuroendocrine-tumors-a-single-center-experience
#10
Javier A Cienfuegos, Joseba Salguero, Jorge M Núñez-Córdoba, Miguel Ruiz-Canela, Alberto Benito, Sira Ocaña, Gabriel Zozaya, Pablo Martí-Cruchaga, Fernando Pardo, José Luis Hernández-Lizoáin, Fernando Rotellar
BACKGROUND: Laparoscopic organ-sparing pancreatectomy (LOSP) is an ideal therapeutic option in selected cases of pancreatic neuroendocrine tumors (PNETs). Nevertheless, given the low frequency of PNETs, there is scarce evidence regarding short and particularly long-term outcomes of LOSP in this clinical setting. METHODS: All patients with PNETs who underwent surgery (under a LOSP policy) were retrospectively reviewed from a prospective database maintained at our center...
October 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/27375806/axillobifemoral-bypass-for-aortitis-syndrome-in-a-living-donor-liver-transplant-patient
#11
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
#12
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...
May 21, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/26973411/liver-surgery-in-cirrhosis-and-portal-hypertension
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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