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https://www.readbyqxmd.com/read/28317045/fibrolamellar-variant-of-hepatocellular-carcinoma-presenting-during-pregnancy-management-dilemmas
#1
Nagalapuram Vishnu, Aditya V Kulkarni, Sreenivasan Vidhyalakshmi, Swaminathan Sambandam, Prerna Garg, Venkatakrishnan LeelaKrishnan, Krishnaveni Janarthan, Gursharan Singh, Maninder Kaur, T V Chitra, Biku Joseph John
The Fibrolamellar variant of Hepatocellular Carcinoma (FLHCC) is a rare form of liver cancer that presents in the 3(rd) decade of life, is rarely associated with cirrhosis or chronic Hepatitis B/C virus infection, and usually presents with normal serum alpha-fetoprotein (AFP) levels. FLHCC presenting during pregnancy is extremely rare, with only 4 cases reported. We present a case of FLHCC in pregnancy and discuss the dilemmas in management. A 26 year-old primigravida, 26 weeks of gestation presented with a month's history of obstructive jaundice secondary...
February 2017: Ann Hepatobiliary Pancreat Surg
https://www.readbyqxmd.com/read/28301974/folfox-and-intensified-split-course-chemoradiation-as-initial-treatment-for-rectal-cancer-with-synchronous-metastases
#2
T Bird, M Michael, M Bressel, J Chu, S Chander, P Cooray, J McKendrick, M Jefford, A Heriot, M Steel, T Leong, S Ngan
BACKGROUND: Optimal initial management of rectal carcinoma with synchronous metastases (RCSM) is controversial - both for patients being treated with curative and palliative intent. This study aims to evaluate the use of an upfront treatment strategy combining FOLFOX chemotherapy with split-course pelvic chemoradiation (FOLFOX + CRT) for patients with RCSM. MATERIAL AND METHODS: An analysis of all patients who commenced treatment with FOLFOX + CRT at our institutions between January 2009 and June 2014 was performed...
March 16, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28297813/-clinical-application-and-evaluation-of-an-early-non-sedation-protocol-for-critically-ill-respiratory-patients
#3
J B Huang, C Q Lan, H Y Li, L Chen, J G Pan, L L Chen, H Weng, Y M Zeng
Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared...
March 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28290970/severe-systemic-lead-toxicity-resulting-from-extra-articular-retained-shrapnel-presenting-as-jaundice-and-hepatitis-a-case-report-and-review-of-the-literature
#4
Ian A Grasso, Matthew R Blattner, Tyler Short, John W Downs
INTRODUCTION: Despite greater than 60,000 nonfatal firearm injuries per year in the United States, retained shrapnel is a relatively rare cause of systemic lead toxicity with less than 100 cases reported in the medical literature since 1867. While intra-articular retained shrapnel as a cause of lead toxicity is well-described, extra-articular fragments are less well known to cause symptomatic disease. CASE REPORT: A 31-year-old man initially presented with abdominal pain, constipation, jaundice, and elevated liver transaminases approximately 3 weeks after suffering a left lower extremity injury during athletic activity...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28282599/severe-fatal-protein-malnutrition-and-liver-failure-in-a-morbidly-obese-patient-after-mini-gastric-bypass-surgery-case-report
#5
Mohammad Ali Kalantar Motamedi, Maryam Barzin, Mohammadreza Ebrahimi, Reza Ebrahimi, Alireza Khalaj
INTRODUCTION: Mini-gastric bypass (MGB) is a bariatric surgical technique popular in many centers due to shorter duration, easier technique, and excellent weight loss results. However, it may be associated with postoperative malnutrition. This case describes the clinical course and unfortunate outcome of a morbidly obese patient who underwent MGB and developed malnutrition in the first postoperative year. PRESENTATION OF CASE: A 37 year-old female patient with a BMI of 44kg/m(2) successfully underwent MGB surgery in June 2015 and was discharged uneventfully...
February 21, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28279659/intensive-early-rehabilitation-in-the-intensive-care-unit-for-liver-transplant-recipients-a-randomised-controlled-trial
#6
Pierre Maffei, Sandrine Wiramus, Laurent Bensoussan, Laurence Bienvenu, Eric Haddad, Sophie Morange, Mohamed Fathallah, Jean Hardwigsen, Jean-Michel Viton, Y Patrice Le Treut, Jacques Albanese, Emilie Gregoire
OBJECTIVE: To validate the feasibility and tolerance of an intensive rehabilitation protocol initiated during the postoperative period in Intensive Care Unit (ICU) in liver transplant recipients. DESIGN: Prospective randomized study SETTING: Intensive Care Unit Post Liver Transplantation PARTICIPANTS: and Interventions: This study compared two groups of liver transplant recipients over a period of one year: the control group (n=20) benefited from the usual treatment applied in the ICU (based on physician prescription for the physiotherapist and applied once a day), while the experimental group (n=20) followed a protocol of early and intensive rehabilitation (based on a written protocol validated by physicians and an evaluation by physiotherapist, with two sessions a day)...
March 6, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28271321/clinical-characteristics-and-predictors-of-mortality-in-cirrhotic-patients-with-candidemia-and-intra-abdominal-candidiasis-a-multicenter-study
#7
Matteo Bassetti, Maddalena Peghin, Alessia Carnelutti, Elda Righi, Maria Merelli, Filippo Ansaldi, Cecilia Trucchi, Cristiano Alicino, Assunta Sartor, Pierluigi Toniutto, Joost Wauters, Wim Laleman, Carlo Tascini, Francesco Menichetti, Roberto Luzzati, Pierluigi Brugnaro, Alessio Mesini, Stefania Raviolo, Francesco G De Rosa, Leonel Lagunes, Jordi Rello, George Dimopoulos, Arnaldo L Colombo, Marcio Nucci, Antonio Vena, Emilio Bouza, Patricia Muñoz, Mario Tumbarello, Raffaella Losito, Ignacio Martin-Loeches, Claudio Viscoli
PURPOSE: The aim of the study was to describe the characteristics of cirrhotic patients with candidemia and intra-abdominal candidiasis (IAC) and to evaluate the risk factors associated with 30-day mortality. METHODS: A multicenter multinational retrospective study including all consecutive episodes of candidemia and IAC in adult patients with liver cirrhosis in 14 European hospitals during the period 2011-2013 was performed. RESULTS: A total of 241 episodes (169 candidemia, 72 IAC) were included...
March 7, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28267779/defining-the-incidence-and-risk-factors-of-colistin-induced-acute-kidney-injury-by-kdigo-criteria
#8
Ryan K Shields, Rohit Anand, Lloyd G Clarke, Julie A Paronish, Matthew Weirich, Hanna Perone, Jake Kieserman, Henry Freedy, Christina Andrzejewski, Hector Bonilla
BACKGROUND: Acute kidney injury (AKI) remains a treatment-limiting toxicity of colistin. Recently developed clinical practice guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) group have harmonized definitions of AKI, but have not been widely applied to patients receiving colistin. METHODS: We retrospectively defined AKI by KDIGO definitions among adult patients receiving intravenous colistin for ≥ 3 days. Risk factors for AKI within 48 hours and 7 days of initiating colistin were determined by multivariable logistic regression...
2017: PloS One
https://www.readbyqxmd.com/read/28264703/life-threatening-emphysematous-liver-abscess-associated-with-poorly-controlled-diabetes-mellitus-a-case-report
#9
Yuichi Takano, Masafumi Hayashi, Fumitaka Niiya, Toru Nakanishi, Shotaro Hanamura, Kunio Asonuma, Eiichi Yamamura, Kuniyo Gomi, Yuichiro Kuroki, Naotaka Maruoka, Kazuaki Inoue, Masatsugu Nagahama
BACKGROUND: Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care. CASE PRESENTATION: The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe...
March 6, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28260481/incidence-and-patient-outcomes-in-renal-replacement-therapy-after-orthotopic-liver-transplant
#10
Asude Ayhan, Zeynep Ersoy, Aydin Ulas, Pinar Zeyneloglu, Arash Pirat, Mehmet Haberal
OBJECTIVES: Our objective was to evaluate the incidence of renal replacement therapy after orthotopic liver transplant and to evaluate and analyze patient outcomes. MATERIALS AND METHODS: We performed a retrospective analysis of 177 consecutive patients at a tertiary care unit who underwent orthotopic liver transplant between January 2010 and June 2016. Patients who were admitted to the intensive care unit after orthotopic liver transplant and who required renal replacement therapy were included...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28260433/effect-of-graft-weight-to-recipient-body-weight-ratio-on-hemodynamic-and-metabolic-parameters-in-pediatric-liver-transplant-a-retrospective-analysis
#11
Zeynep Ersoy, Serife Kaplan, Aycan Ozdemirkan, Adnan Torgay, Gulnaz Arslan, Arash Pirat, Mehmet Haberal
OBJECTIVES: To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters. MATERIALS AND METHODS: We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28260430/anesthetic-and-perioperative-management-of-nontransplant-surgery-in-patients-after-liver-transplant
#12
Zeynep Ersoy, Asude Ayhan, Aycan Ozdemirkan, Gulsi Gulsah Polat, Pinar Zeyneloglu, Gulnaz Arslan, Mehmet Haberal
OBJECTIVES: We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures. MATERIALS AND METHODS: We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Başkent University Hospital. RESULTS: The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33)...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28257538/multidisciplinary-approach-to-complicated-pregnancy
#13
Josip Andelo Borovac, Josko Bozic, Tina Ticinovic Kurir, Nikola Zaja, Kresimir Kolic, Vedran Hrboka
A nulliparous pregnant woman in her mid-20s and in the 32nd week of gestation presented to the emergency department with severe headache and vomiting. She had an uneventful medical history; however, the physical examination upon hospital admission revealed a hypertensive emergency, papilledema, and 2+ dipstick proteinuria. Upon establishing the diagnosis of preeclampsia, aggressive therapy with corticosteroids, antihypertensive medication, and seizure prophylaxis was initiated. Hemodynamic stability was achieved within 24 hours and the patient remained in the observation unit located within the gynecology clinic...
March 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28245861/liver-radiofrequency-ablation-as-emergency-treatment-for-a-ruptured-hepatocellular-carcinoma-a-case-report
#14
Alessandra Bertacco, Francesco D'Amico, Maurizio Romano, Michele Finotti, Alessandro Vitale, Umberto Cillo
BACKGROUND: Hemoperitoneum is a possible complication of hepatocellular carcinoma that may require emergency surgery as an alternative to radiological locoregional therapies. CASE PRESENTATION: We present a case report of a 78-year-old white man with alcoholic-related cirrhosis and a multifocal hepatocellular carcinoma. An abdominal computed tomography scan showed multiple and bilateral foci of bleeding from broken liver cancer. He was urgently transferred from our radiology unit to our operating room for massive hemoperitoneum...
March 1, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28241780/thromboelastometry-versus-standard-coagulation-tests-versus-restrictive-protocol-to-guide-blood-transfusion-prior-to-central-venous-catheterization-in-cirrhosis-study-protocol-for-a-randomized-controlled-trial
#15
Leonardo Lima Rocha, Camila Menezes Souza Pessoa, Ary Serpa Neto, Rogerio Ruscitto do Prado, Eliezer Silva, Marcio Dias de Almeida, Thiago Domingos Correa
BACKGROUND: Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far. The aim of this study is to compare three transfusion strategies (routine coagulation test-guided - ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis...
February 27, 2017: Trials
https://www.readbyqxmd.com/read/28223040/red-blood-cell-exchange-as-an-approach-for-treating-a-case-of-severe-tacrolimus-overexposure
#16
Valentina Spallanzani, Lucia Bindi, Irene Bianco, Arianna Precisi, Paolo DeSimone, Alessandro Mazzoni, Gianni Biancofiore
Immunosuppressive medication dosing errors are not unfrequent and may present a number of challenges to transplant clinicians. Tacrolimus (TAC) is a widely used immunosuppressant with a narrow therapeutic index and potential severe side effects, including neurotoxicity and kidney injury. We herein report a case of 60-year-old woman who underwent deceased-donor liver transplantation at our center and due to inadvertent TAC overexposure was admitted to the Intensive Care Unit because of severe neurologic impairment, kidney injury and arterial hypotension...
February 2, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28222805/use-of-activity-tracking-in-major-visceral-surgery-the-enhanced-perioperative-mobilization-epm-trial-study-protocol-for-a-randomized-controlled-trial
#17
Steffen Wolk, Theresa Meißner, Sebastian Linke, Benjamin Müssle, Ann Wierick, Andreas Bogner, Dorothée Sturm, Nuh N Rahbari, Marius Distler, Jürgen Weitz, Thilo Welsch
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are aimed at minimizing postoperative stress and accelerating postoperative recovery by implementing multiple perioperative principles. "Early mobilization" is one such principle, but the quality of assessment and monitoring is poor, and evidence of improved outcome is lacking. Activity trackers allow precise monitoring and automatic feedback to the patients to enhance their motivation for early mobilization. The aim of the study is to monitor and increase the postoperative mobilization of patients by giving them continuous automatic feedback in the form of a step count using activity-tracking wristbands...
February 21, 2017: Trials
https://www.readbyqxmd.com/read/28220780/bacterial-infections-change-natural-history-of-cirrhosis-irrespective-of-liver-disease-severity
#18
Elena Dionigi, Matteo Garcovich, Mauro Borzio, Gioacchino Leandro, Avik Majumdar, Aikaterini Tsami, Vasiliki Arvaniti, Davide Roccarina, Massimo Pinzani, Andrew K Burroughs, James O'Beirne, Emmanuel A Tsochatzis
OBJECTIVES: We assessed the prognostic significance of infections in relation to current prognostic scores and explored if infection could be considered per se a distinct clinical stage in the natural history of cirrhosis. METHODS: We included consecutive patients with cirrhosis admitted to a tertiary referral liver unit for at least 48 h over a 2-year period. Diagnosis of infection was based on positive cultures or strict established criteria. We used competing risk analysis and propensity score matching for data analysis...
February 21, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28217513/clinical-and-epidemiological-study-of-stress-hyperglycemia-among-medical-intensive-care-unit-patients-in-central-india
#19
Jitendra Sharma, Sachin Chittawar, Ram Singh Maniram, T N Dubey, Ambrish Singh
BACKGROUND: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. AIMS AND OBJECTIVE: To study and determine the prevalence and factors associated with stress hyperglycemia. MATERIALS AND METHODS: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015...
January 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28213828/screening-for-non-alcoholic-fatty-liver-disease-in-children-and-adolescents-with-type-1-diabetes-mellitus-a-cross-sectional-analysis
#20
Sebastian Kummer, Dirk Klee, Gerald Kircheis, Michael Friedt, Joerg Schaper, Dieter Häussinger, Ertan Mayatepek, Thomas Meissner
The liver is intensely involved in glucose metabolism and is thereby closely related to diabetes pathophysiology. Adult patients with type 1 diabetes mellitus (DM) are at an increased risk for non-alcoholic fatty liver disease (NAFLD). Here, we studied the prevalence of NAFLD in a cohort of children and adolescents with type 1 DM in a tertiary care paediatric diabetes centre in Germany. We screened 93 children and adolescents with type 1 DM using ultrasound, laboratory investigations, and liver stiffness measurements (Fibroscan® [FS] and acoustic radiation force imaging [ARFI])...
February 17, 2017: European Journal of Pediatrics
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