Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
Richard S. Finn, MD, Anthony El-Khoueiry, MD, and Josep M. Llovet, MD, PhD, prepared useful practice aids pertaining to hepatocellular carcinoma for this CME activity titled "Breaking the Paradox: Expanding Options and New Questions in HCC Management: Mapping the Pathways to Better Patient Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HU6L5K. CME credit will be available until February 14, 2020.
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
Retrospective Analysis of Intra Operative Blood Loss in Pelvic Oncological Su...Premier Publishers
To study intraoperative blood loss and analyse average blood loss and number of transfusions in patients who underwent pelvic oncological surgeries in this oncology centre in South India from January 2012 – December 2018. A retrospective analysis of medical records of 257 patients who had undergone pelvic oncological surgeries in our institute from January 2012 and December 2018 was done and information regarding blood loss and transfusions was analysed with student’s T test. Out of 257 patients, 72 underwent pelvic exenteration of which 18 were operated for primary and 54 were operated for recurrences, 105 underwent Wertheim’s hysterectomy, 19 patients underwent APR, 8 underwent LAR, 5 underwent AR, 36 underwent surgical staging 8 underwent Cystectomy and 4 underwent sacrectomy. In our analysis we found that laparoscopic surgeries had less blood loss (average 354 ml) compared to open surgeries (average 811 ml) and upfront surgeries (531 ml) had less blood loss compared to surgeries done post chemoradiotherapy (668 ml) resulting in less number of transfusions, transfusion reactions, infections and early recovery in laparoscopic and upfront surgeries. Laparoscopic surgery in pelvic oncological surgeries has become a benefit to surgeons because of less intraoperative blood loss, reduced hospital stay and better outcomes. Though laparoscopic surgeries require a learning curve, extensive anatomical knowledge about the procedure during open surgeries made learning curve less steep. Blood loss in upfront cases is less than that of post chemoradiotherapy cases leading to less infection rates, better recovery and with increase in duration of surgery, blood loss is more.
Role of Radiotherapy in HCC. What do the guidelines say ? A comprehensive review of guidelines and other studies on role of radiotherapy in hepatocellular carcinoma.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
Ohio States 2016 ASH Review Blood and Marrow TransplantationOSUCCC - James
Ohio State’s 2016 ASH Review
Blood and Marrow Transplantation
Basem M. William, MD, MRCP(UK), FACP
Assistant Professor of Internal Medicine
Blood and Marrow Transplant Program
Detailed Information regarding MSKCC,IMDC score with evidence .
SSIGN Score, Fuhrman's grading described .
Prognostic significance of risk score explained
Retrospective Analysis of Intra Operative Blood Loss in Pelvic Oncological Su...Premier Publishers
To study intraoperative blood loss and analyse average blood loss and number of transfusions in patients who underwent pelvic oncological surgeries in this oncology centre in South India from January 2012 – December 2018. A retrospective analysis of medical records of 257 patients who had undergone pelvic oncological surgeries in our institute from January 2012 and December 2018 was done and information regarding blood loss and transfusions was analysed with student’s T test. Out of 257 patients, 72 underwent pelvic exenteration of which 18 were operated for primary and 54 were operated for recurrences, 105 underwent Wertheim’s hysterectomy, 19 patients underwent APR, 8 underwent LAR, 5 underwent AR, 36 underwent surgical staging 8 underwent Cystectomy and 4 underwent sacrectomy. In our analysis we found that laparoscopic surgeries had less blood loss (average 354 ml) compared to open surgeries (average 811 ml) and upfront surgeries (531 ml) had less blood loss compared to surgeries done post chemoradiotherapy (668 ml) resulting in less number of transfusions, transfusion reactions, infections and early recovery in laparoscopic and upfront surgeries. Laparoscopic surgery in pelvic oncological surgeries has become a benefit to surgeons because of less intraoperative blood loss, reduced hospital stay and better outcomes. Though laparoscopic surgeries require a learning curve, extensive anatomical knowledge about the procedure during open surgeries made learning curve less steep. Blood loss in upfront cases is less than that of post chemoradiotherapy cases leading to less infection rates, better recovery and with increase in duration of surgery, blood loss is more.
Role of Radiotherapy in HCC. What do the guidelines say ? A comprehensive review of guidelines and other studies on role of radiotherapy in hepatocellular carcinoma.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Nowadays the problem of surgical treatment of Colorectal
Cancer (CRC) is becoming very important due to the high speed of increasing morbidity and mortality, which is registered almost in all economically developed countries in the world [1,2]. In 2012, more than one million new cases of CRC were detected on our planet and about half a million people died from this disease [1]. On the territory of Russia, a primary diagnosis of colorectal cancer is annually established in 6000 people, with the highest incidence rates in the North-West region (St. Petersburg and Leningrad region), where in the general structure of oncopathology, colorectal cancer is in the second
Treatment and early outcome of 11 children with hepatoblastoma.Dr./ Ihab Samy
Fouad A. Fouad saleep MD., Ihab samy Fayek MD.
Department of Surgical Oncology – National Cancer Institute – Cairo University - Egypt.
Kasr el-aini medical journal Volume 18, No.4, October 2012.
Ghassan Abou-Alfa, MD, MBA, Robin K. (“Katie”) Kelley, MD, Professor Riccardo Lencioni, MD, FSIR, EBIR, and Amit Singal, MD, MS, prepared useful practice aids pertaining to HCC for this CME/MOC activity titled, "Composing Personalized HCC Treatment Strategies: Insights on Harmonizing Patient Care With a Multidisciplinary Ensemble." For the full presentation, monograph, complete CME/MOC information, and to apply for credit, please visit us at http://bit.ly/2kAyqO9. CME/MOC credit will be available until November 5, 2020.
Ohio States 2016 ASH Review Blood and Marrow TransplantationOSUCCC - James
Ohio State’s 2016 ASH Review
Blood and Marrow Transplantation
Basem M. William, MD, MRCP(UK), FACP
Assistant Professor of Internal Medicine
Blood and Marrow Transplant Program
Detailed Information regarding MSKCC,IMDC score with evidence .
SSIGN Score, Fuhrman's grading described .
Prognostic significance of risk score explained
Preoperative Factors Predict Perioperative Morbidity
and Mortality After PancreaticoduodenectomyDavid Yu Greenblatt, MD, MSPH, Kaitlyn J. Kelly, MD, Victoria Rajamanickam, MS, Yin Wan, MS,
Todd Hanson, BS, Robert Rettammel, MA, Emily R. Winslow, MD, Clifford S. Cho, MD, FACS,
and Sharon M. Weber, MD, FACS
Department of Surgery, University of Wisconsin, Madison, WI.
Original article:
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Introduction: Prediction of readmission as a result of either delayed presentation of infection, or worse an anastomotic leak is difficult. Efficient reduction in the length of stay and being able to predict problematic patients who may be readmitted or develop complications would be advantageous. To date,
other tests including CRP have proven to be insufficiently sensitive for this task.
Living Donor Liver Transplantation in Hepatocellular Carcinoma: How Far Can W...semualkaira
The expansion in Liver Transplantation (LT) selection criteria for
Hepatocellular Carcinoma (HCC) has shown acceptable results in
survival rate and tumor recurrence. Historical analysis of the results shows that the path taken so far is correct; however, there
are still doubts about the limit of this expansion. The acquisition
of new selection tools that measure the biological behavior of the
tumor, instead of the historic and simple preoperative morphological analysis, has been gaining strength in this expansion. In this
context, analyzing the ethical perspective in the use of grafts from
living donors is essential in order to seek a risk vs. benefit balance
for both donor and recipient.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
The article lays an emphasis on the laparoscopic surgical method used to treat colorectal cancer. It reviews the current status of the laparoscopic colorectal surgeries and recommendation of evidences for short- and long-term outcome. The early results were against laparoscopic approach. There was a need of properly designed study to validate or invalidate these findings. Seven large-scale trials compared laparoscopic and open colectomy for colon carcinoma and examined short-term and long-term outcomes. These trials included the Clinical Outcomes of Surgical Therapies (COST) trial funded by the National Cancer Institute in the United States, the Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in the United Kingdom, the Colon Cancer Laparoscopic or Open Resection (COLOR), a multicenter European trial.
For the validation of the argument that laparoscopy is safe, meta-analysis was performed. Certain conclusions of meta-analysis are also presented in this article. The individual merits and weaknesses of laparoscopic surgery as compared with open surgery as the primary treatment of colorectal cancer are being highlighted in this article.
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football athlete experienced acute posterior leg pain while pushing off on the line of scrimmage. Ultrasound (US) showed a midsubstance plantaris tendon rupture, an injury that, to our knowledge, has only been described once before in the medical literature [1]. US was also used to assist with rehab progression and return to previous level of activity, which was achieved three weeks after the injury. While there currently are no guidelines regarding return to sport after this injury, this case demonstrates that once pain is controlled and ROM restored, progression through rehabilitation and return to elite level sport is simply based on symptoms.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
Kratom is an herbal product that is derived from Southeast Asian Mitragyna speciose tree leaves [1-10]. This compound is used for many purposes such as stimulation, euphoria, or analgesia [1-10]. It has been recently identified as a drug of abuse by the United States Drug Enforcement Administration [2,8]. Side-effects from this compound have not been well documented. We describe a case of a 36-year-old female who develop nephrotoxicity after taking an herbal supplement. She took kratom as an adjunctive therapy for back pain management. She developed right upper quadrant pain and nausea. Laboratory tests showed elevated liver enzymes without evidence of bile duct obstruction. Liver enzymes normalized several weeks after Kratom discontinuation. We advise clinicians to be vigilant about Kratom’s hepatotoxic potential on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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2. Open Journal of Surgery
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ABSTRACT
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number
of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these
patients, including surveillance follow-up.
Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defined
based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.
Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least
a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of
largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of
ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological
parameters) were analysed.
Results: Sixty-seven early recurrences, including 26 intrahepatic recurrences, were observed. Risk factors for early liver recurrence were number of
metastases > 3 (P = 0.03), intra-operative blood loss > 200 ml (P = 0.02), deployment of ablation techniques (P = 0.008), hospital stay >10 days (P = 0.03),
and capsular invasion (P = 0.04).
Conclusion: Stratification of CRLM patients can help identifying the cohort of patients at high risk of early recurrence, thus helping clinicians counselling
patients appropriately. Accordingly; these high-risk patients might benefit from a more intensive follow-up, although further studies are required.
Keywords: Colorectal liver metastasis; Liver resection; Early recurrence
INTRODUCTION
The liver is the most common site for Colorectal Metastasis
(CRLM), and resection offers the best chance of cure in suitable
patients [1]. The purpose of liver resection is to remove all neoplastic
disease with a negative margin and leave adequately functioning liver
parenchyma [2]. Repeated hepatectomies to prolong survival and
benefits are not uncommon among patients [3]. Over the last decades’
new developments such as high-definition cross-sectional imaging,
better neoadjuvant chemotherapy, and improved peri-operative care,
have increased survival after liver resection [4]. However, about 60%
of patients who undergo resection for CRLM will still experience
recurrence of disease [5]. Resectability criteria have expanded, and
advances in liver surgery have increased the number of patients
eligible for resection. As such patients previously deemed inoperable
are now offered resectional surgery, with the potential consequence
of increase rate of recurrence. Only few studies have assessed the
factors leading to early recurrence in CRLM. Identifying these factors
will help stratify CRLM patients for targeted management [6] as well
as surveillance protocols. Intensive follow-up can result in earlier
detection of recurrences and an increased detection rate of isolated
local recurrences [5]. The definition of early recurrence varies in the
literature from one unit to another, and it can range from 6 to 24
months [4,6,7]. Recurrence is defined as recurrent disease in follow-
up imaging after surgery [8].
The aim of this study is to analyse pre-operative, operative and
post-operative parameters to identify factors that contribute to early
recurrence and to establish a scoring system that will enable patient
stratification according to the risk of early recurrence after resection.
METHODS
Study cohort
From January 2012 to December 2016, 133 patients with CRLM
underwent liver resection in our unit. All subjects involved in the
study consented via written consent when they come for their
intervention in line with the trust policy and clinical governance. Only
those who agreed their data to be used in research/publication were
involved. Throughout the data analysis the data set was anonymized
and no breach in confidentiality was reassured. We did not obtain
ethical approval as it is not necessary; as in this occasion we did not
do any clinical trial to the study population. This was an observational
study for those cohort of patients and data was obtained from the unit
prospectively collected database for analysis.
Inclusion criteria were patients who underwent liver resection
for CRLM, who were followed-up for at least one year. We identified
115 patients who were eligible for the study. Early recurrence was
defined as evidence of recurrent disease on CT or Liver MRI within a
year from liver surgery.
Pre-operative, intra-operative, post-operative and follow-up data
were collected from the prospectively maintained Unit database.
Pre-operative and post-operative investigations/analysis
There is a well-maintained unit database for CRLM cases where all
patients’ information and pre-operative/ post-operative parameters
were collected. Those cases were discussed in multidisciplinary team
meetingsometimemorethanonce.Theyhadfullassessmentincluding
fitness for resection; clinically and via cardiopulmonary exercise tests.
Patients who received pre-operative neoadjuvant chemotherapy had
surgery, on average, 6 weeks later. Intra-operative ultrasound was
used when the tumour was not obvious or to clarify the anatomy and
relation to vascular structures. Accompanying ablation techniques
were performed in some patients. All operations performed either by
two consultants or a consultant and senior fellow.
Clinico-pathological parameters
The parameters analysed included pre-operative variables
(sex, age, BMI, comorbidities, CEA and LFTs, lesion number,
size of largest liver lesion, neoadjuvant chemotherapy), operative
variables (anatomical vs non-anatomical, major vs minor, redo liver
surgery, concomitant use of ablation techniques, blood loss, blood
transfusions, Pringle’s manoeuvre), and post-operative variables
(complications, length of hospital stay, histology parameters). This
work has been reported in line with the STROCSS criteria [9].
Statistical analysis
Statistical analysis was performed using IBM SPSS version 22, and
the significance level was set at p < 0.05. Descriptive statistics were
reported, and summary statistics were constructed for the baseline
3. Open Journal of Surgery
SCIRES Literature - Volume 3 Issue 1- www.scireslit.com Page - 021
variables, using frequencies and proportions for categorical data and
medians and ranges for continuous variables. Categorical outcomes
were analysed using the chi‐squared test, and continuous variables
were compared using Student’s t-test and the Mann–Whitney U test
accordingly.
Univariate and multivariate analyses were performed to identify
risk factors contributing to early recurrence. A multiple regression
model was also performed to detect simultaneous significant variables
in predicting recurrence within one year.
RESULTS
133 patients were included in the study, of which 81 (60.9%) were
male. The median age was 66 (SD +/- 10.81), with an age range of 25
to 84. Mean ASA grade was 2.23 and mean WHO performance status
was 0.7. Mean BMI was 27.16 (range 16-42).
Mean liver function test results pre-operatively, on day one and
on day five post-operatively are shown in table 1.
The mean Pringle manoeuvre duration of 10.85 minutes and the
mean length of stay in hospital was 7.5 days (SD = 3.8).
There were 67 (58.2%) early recurrences, of which 26 (22.6%)
were intrahepatic. Descriptive statistics are displayed as the mean ±
SD and median for various variables.
Analyses of the pre-operative, operative and post-operative
factors were performed to determine which factors could predict
CRLM recurrence within one year (Table 2). Risk factors for early
liver recurrence were number of metastases > 3 (OR 0.103; p =
0.03), intra-operative blood loss > 200 ml (OR 0.244 p = 0.02), use of
ablation techniques (OR 0.292 p = 0.008), hospital stay > 10 days (OR
0.295 p = 0.03) and capsular invasion (OR 0.434 p = 0.04).
A multiple regression model was generated (Table 3), and it
showed that these simultaneous significant variables were significant
in predicting recurrence within one year:
• Anatomical resection
• Ablation
• Microvascular infiltration
• Longer length of hospital stay
• Post-op packed Red Blood Cell (RBC) transfusions
DISCUSSION
This study demonstrated that the factors influencing early
recurrence in CRLM are major hepatectomies, presence of more
than three hepatic lesions, use of ablation, microvascular invasion,
prolonged hospital stay and post-operative blood transfusions. Early
hepatic recurrence was 22%, comparable to published studies that
quote figures between 20% and 56.7% [10,11]. Several studies have
been carried out to investigate risks of recurrence.
Shin et al. (2012) used Fong’s clinical risk score to predict
recurrence, employed to predict survival, and found that patients
with a higher clinical risk score were indeed more likely to develop
recurrence. [12] However, most studies focused on overall tumour-
free survival rather than early recurrence [13].
Some studies identify the number of liver lesions as a predictive
factor of overall recurrence and early recurrence [12-14]. However,
timelines used to define early recurrence range between 6 and 18
months due to lack of a standardised definition [7,11,15,16], making
it difficult to predict exactly what constitutes early recurrence.
Imai et al (2017) found that concurrent radiofrequency ablation
with hepatectomies did not increase recurrence rate. However, our
data suggested that radiofrequency ablation is both an independent
predictor of early recurrence as well as a predictor when combined
with other factors [17]. This agrees with results from other published
work in the literature [10,16,18]. Ablation patients might have
increased recurrence rates because it is likely that they have more
advanced disease that cannot be cleared by surgery alone.
Furthermore, we found that postoperative blood transfusion was
predictive of earlier recurrence, as also reported by Postlewait et al.
(2016). In this study, the authors showed that more than 3 units of
blood transfusion was significantly related to early recurrences [19].
The relationship between transfusion and recurrence of cancer can
be explained by the immunosuppressive effect of blood transfusion;
where there is persistent post-operative inflammatory response which
contribute to both growth in cancer cells and reduced cell-mediated
immunity collectively leading to increase chances of recurrence of
CRLM [20]. From our data, it also appears that more than 200mls
of blood loss intraoperatively was associated with earlier recurrence.
The number of chemotherapy cycles has been shown to be of
value when it comes to predicting early recurrence [7]. However,
in our study we could not demonstrate the effect of neoadjuvant
chemotherapy in reducing recurrence rates. Although statistically
not significant the overall number of cycles of chemotherapy before
surgery shows some association with increased early recurrence
which can be justified by disease aggressiveness.
Other tumour characteristics associated with early recurrence
in some studies include bilobar metastases and larger tumour size
[11,12], as well as a timeframe of less than 30 months between
colorectal tumour and initial liver metastases [13]. Our data did not
reveal these factors to be significant [10].
We found that a hospital stay of more than 10 days increases
the risk of early recurrence, and this has also been suggested by
previous studies [21]. Those patients who needed to stay longer had
either a more complex resection due to disease extent or increased
complication rates with consequent negative effect on the immune
system.
While our study found no significant earlier recurrence
with smaller resection margins, several studies states differently.
Intrahepatic recurrence may be associated with microsatellite
metastases around the main tumour [22], and a positive surgical
margin influences surgical site recurrence [14]. We did find that
capsular and microvascular infiltration may be an indication for early
recurrence.
Thus, we can conclude that patients with certain characteristics,
namely higher number of tumours, intraoperative blood loss,
concurrent intraoperative ablation and with longer hospital stay are
Table 1: Liver function test pre-and post-operative
ALT Bilirubin INR
Pre-op 23.6 8.3 0.97
Post-op day 1 373.24 19.4 1.2
Post-op day 5 138.65 12.3 0.85
4. Open Journal of Surgery
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Table 2: Analysis of variables
Variables OR (P-value) Analysis
Gender M vs F 1.5 (0.321)
No effect of Gender on recurrence. More females are affected but not
significantly
Age > 65yrs old or < 65yrs old 0.98 (0.96) No effect of Age on recurrence
Body mass index (BMI) 0.91 (0.069)
No effect of BMI on recurrence. Less recurrence for lower BMI but not
significantly
Diabetes mellitus (NIDDM/IDDM)
1.833 (0.662) IDDM to NIDDM
1.96 (0.397) N to NIDDM
No effect of NIDDM/IDDM on recurrence. Less recurrence for NIDDM but
not significantly.
Pre-op ALT (< 20, 20-40, > 40)
1.89 (0.44) < 20 to > 40
1.18 (0.844) 2-40 to > 40
No effect of PreOp ALT on recurrence. Less recurrence for more than 40
but not significantly.
Pre-op Bilirubin 0.968 (0.496)
No effect of Bilirubin on recurrence. Less recurrence for higher bilirubin but
not significantly.
Pre-op Carcinoembryonic Antigen
(CEA)
1.000 (0.958) No effect of CEA on recurrence.
ASA status
000 (.999) 1 to 3
0.906 (0.824) 2 to 3
No effect of ASA on recurrence. Not enough data for status 1
Number of liver lesions (1-3, 3 lesions,
> 3 lesions)
0.328 (0.012) 1-2 to > 3
0.103 (0.037) 3 to > 3
Lower risk for 1-3 as compare to > 3 lesions.
Lower risk for 3 as compare to > 3 lesions.
3 lesions has the lowest risk
Size of largest lesion 1.048 (0.624) No effect of Size of largest lesion on recurrence.
Segments involved (Segments 1,2,3,4
or Segments 5,6,7,8)
.625 (,424) 1-4 to both
.614 (.270) 5-8 to both
No effect
Neoadjuvant chemotherapy 0.565 (0.175)
No effect of Neoadjuvant chemotherapy on recurrence. Lower risk with No
but not significantly
Number of cycles of chemotherapy ( <
6,6, 8, > 8)
1.13 (.055) More risk is associated with more cycle
Liver surgery (anatomical, non-
anatomical)
2.14 (.102) A to NA
2.54 (.083) A + NA to NA
No effect
Surgical approach (laparoscopic or
open)
0.422 (0.273)
No effect of Surgical approach on recurrence. Lower risk with laparoscopic
but not significantly
Major hepatectomy (yes or no) 0.44 (0.053) Major hepatectomies has a higher risk of recurrence
Redo hepatectomy (yes or no) 0.813 (0.697)
No effect of Redo hepatectomy on recurrence. Lower risk with No but not
significantly
IOUS (yes or no) .938 (,89) No effect
Ablation techniques (yes or no) 0.292 (0.008) Use of ablation techniques increase risk of recurrence
Blood loss (< 200ml, 20-500ml, >
500ml)
0.244 (0.021); 200 to > 500
0.28 (.046) 200-500 to > 500
Less blood loss is significantly associated to lower recurrence risk
Post-op blood transfusion (RBC
transfusion)
2.44 (0.11) No effect, more blood transfusion more risk but not significantly
Pringle’s time (nil, < 15 minutes, 15-30
minutes, 30-45minutes, > 45 minutes)
.880 (.85) 0 to > 30
.875 (.87) 0-15 to > 30
.375 (.37) 15 -30 to > 30
No effect
POD1 ALT 1.00 (0.569) No effect
POD1 Bilirubin 1.002 (0.807) No effect
POD 1 INR 0.912 (.836) No effect
POD5 ALT 1.001 (.225) No effect
POD5 Bilirubin 1.01 (.501) No effect
POD 5 INR 2.37 (.738) No effect
Complication (bile leak, intra-
abdominal collection)
1.56 (.379) No effect
Length of stay (5 days, 6-10 days, >
10 days)
.55 (.33) 5 comp. to > 10
.295 (.037) 6-10 com. to > 10
6 to10 days has significantly less risk compare to > 10 days
Distance from resection margin (mm)
(Positive margin = 0, 1-5mm, 6-10 mm,
> 10mm)
1.650 (.433) 0 to > 10
1.000 (1.000) 1-5 to > 10
.529 (.433) 6-10 > 10
No effect
Histology grading Not enough data No Effect
Microvascular infiltration .347 (0.12) No has significantly lower risk
Capsular invasion .434 (.045) No has significantly lower risk
Hepatic Steatosis (yes or no) No effect
5. Open Journal of Surgery
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at a higher risk for early recurrence and will need a more intensive
follow up postoperatively.
Further studies might help to further delineate the risk factors for
early colorectal liver metastases recurrence.
ACKNOWLEDGEMENT
The assistance of Mr. William Turner and his team from All Stats
for their contribution in the data analysis.
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Table 3: Multiple regression analysis of factors related to early recurrence of CRLM.
Variables associated with early recurrence Standard error Odds ratio P-value
Anatomical resection 0.796 6.06 0.024
Ablation 0.768 1.62 0.018
Presence of microvascular infiltration 0.606 1.69 0.003
Longer length of stay 0.953 1.16 0.024
Post-op blood transfusions 1.429 37.39 0.011