This document discusses the impact of underlying liver disease on postoperative liver failure after surgery. It covers cirrhosis, chemotherapy-induced liver toxicity, and cholestasis.
For cirrhosis, it recommends patient selection based on Child-Pugh and MELD scores. It suggests limiting major resections to Child A patients without varices or thrombocytopenia. Portal vein embolization can help optimize liver remnant volume.
For chemotherapy-induced toxicity, it warns of increased morbidity from extensive preoperative chemo (>6 cycles) due to sinusoidal injuries. Optimization may include stopping bevacizumab.
For cholestasis, it recommends optimizing patients preoperatively with endoscopic
Laparoscopic Liver Resection : What to do and not do
Chirurgie laparoscopique du foie : indications et limites actuelles
Pr Daniel CHERQUI
Journées du Centre Hépato-Biliaire - JCHB 2019
Journées de Chirurgie
Liver transplantation current status, controversies and mythsAbhishek Yadav
Details the present status, indications, techniques about liver transplantation. Also dispels some common myths surrounding liver transplantation. #liver transplantation # living donor liver transplantation #liver cirrhosis #liver failure#transplantation#live donor#drabhishekyadav.com#liversurgeon#myths#livedonorlivertransplantation#organtransplantation#alcohololiverdisease
Laparoscopic Liver Resection : What to do and not do
Chirurgie laparoscopique du foie : indications et limites actuelles
Pr Daniel CHERQUI
Journées du Centre Hépato-Biliaire - JCHB 2019
Journées de Chirurgie
Liver transplantation current status, controversies and mythsAbhishek Yadav
Details the present status, indications, techniques about liver transplantation. Also dispels some common myths surrounding liver transplantation. #liver transplantation # living donor liver transplantation #liver cirrhosis #liver failure#transplantation#live donor#drabhishekyadav.com#liversurgeon#myths#livedonorlivertransplantation#organtransplantation#alcohololiverdisease
Métastases Hépatiques : Le Pr Christophe Penna, AP-HP Hôpital de Kremlin-Bicêtre nous donne son point vue de chirurgien colo-réctal sur le traitement à adapter en cas du cancer du colon
monarchE trial studied the benefit of adding abimaciclib to endocrine therapy (the standard of care for HR+/Her- early breast cancer) compared to endocrine therapy alone.
Liver transplantation; notes of DM/DNB/SpecialistsPratap Tiwari
Liver transplantation; extensive notes of DM/DNB/Specialists. This was my notes for my exam compiled from several sources, credit goes to original authors. This is just for quick revision
Métastases Hépatiques : Le Pr Christophe Penna, AP-HP Hôpital de Kremlin-Bicêtre nous donne son point vue de chirurgien colo-réctal sur le traitement à adapter en cas du cancer du colon
monarchE trial studied the benefit of adding abimaciclib to endocrine therapy (the standard of care for HR+/Her- early breast cancer) compared to endocrine therapy alone.
Liver transplantation; notes of DM/DNB/SpecialistsPratap Tiwari
Liver transplantation; extensive notes of DM/DNB/Specialists. This was my notes for my exam compiled from several sources, credit goes to original authors. This is just for quick revision
Gestion du petit foie restant: place et résultats des techniques pré-opératoires préventives de l'IHC :
Radiofréquence combinée à la résection - Dr Gabriella PITTAU / Pr Antonio SA CUNHA
Carcinome hépatocellulaire (CHC). Conférence du Dr Eric Vibert (Chirurgien, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie hépato-biliaire, Juin 2014, Paris.
Imagerie du cholangiocarcinome du hile. Conférence du le Pr Maïté Lewin (Radiologue, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie hépato-biliaire (Juin 2014, Paris).
Conférence du Dr. Maximiliano GELLI (Chirurgien hépatique, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire, juin 2014, Paris.
Chirurgie du cholangiocarcinome hilaire. Conférence du Dr Oriana Ciacio ( Chirurgienne, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire (juin 2014, Paris)
Traitement de la fistule biliaire après hépatectomie - Technique chirurgical et résultats. Conférence du Professeur Denis Castaing (Chirurgien Chef de service, AP-HP Hôpital Paul Brousse, Villejuif, France) aux Journées de Chirurgie Hépato-Biliaire, Juin 2014, Paris.
Hepatocellular carcinoma—role of interventional radiologist Dr. Muhammad Bin ...Dr. Muhammad Bin Zulfiqar
In these presentation we will discuss the merits, demrits and outcomes of various interventional radiology modalities for the treatment of hepatocellular carcinoma
Presentation on New Advances in the Treatment of Liver Tumors (Laparoscopic Resections) by Dr. Kimberly Moore Dalal, Surgical Oncology & General Surgery, Peninsula Medical Center.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
- 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
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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.
13. Makuuchi, Semin Surg Oncol 1993
Ascites
None or controlled Not controlled
ICGR15 Limited resection Enucleation Not indicated for hepatectomy
Trisectorectomy
bisectorectomy
Left-sided
hepatectomy
Right-sided
sectoriectomy
Segmentectomy Limited resection Enucleation
Normal 1.1 – 1.5 mg/dL 1.6 – 1.9 mg/dL > 2.0 mg/dL
Total bilirubin level
Normal 10% - 19% 30% - 39% > 40%20% - 29%
Vert d’Indocyanine
14. Major impact of pre-operative platelet rate < 150.000 / mL
22%
6%
Liver Failure: 11%
Mortality : 9%
2011
Maithel, JACS 2011
15. Only hepatic venous pressure gradient > 10 mmHg was significant in
multivariate analysis for decompensated cirrhosis after hepatectomy
Risk factor in univariate analysis
Bilirubin rate
Urea rate
Rate of platelet
ICG Clearence
Hepatic venous pressure gradiant,
Décompensation de la cirrhose : Persistance d’une ascite à 3 mois Bruix, Gastro 1996
23. Truant, JACS 2007
• RLV-BWR was more relevant than RLV-TLV in predicting postoperative course after
right trisectionectomy
• Patients with an anticipated RLV < 0,5% of the body weight were at risk of hepatic
dysfunction
• No deaths in the group of patients with RLV/BWR >0,5%
26. Agrawal, HPB 2011
Pre-operative liver biopsy to detect NASH in order to:
• Limit the extent of hepatic resection
• Use the PVE to optimize the post-operative outcome
• Aggressively treat the cardiovascular associated
disease
27. Wakai, JGIS 2011
• 225 patients
• 3 groups NAFLD – HCV – HBV
• Morbidity 59% vs 31/28% p= 0,043
• Mortality 12% vs 0,7%/3,3% p= 0,016
42. Rubbia-Brandt, Ann Oncol 2004
• 51% of patients who received pre-operative
chemotherapy had sinusoidal dilatation
• 25% perisinusoidal and venocclusive fibrosis
• Developement correlated to the use of Oxaliplatine
50. De Graaf, J Nucl Med 2010
Cut-off 2,5%/min/m2 can predict the incidence of liver failure
3% vs 56%
51. Chimiothérapie - Conclusions
• Attention aux lésions induites par la chimiothérapie
(> 6 cycles)
• Augmentation de la morbidité post-opératoire
• Une augmentation des cycles n’augmente pas la
réponse pathologique
• Bevacizumab a un effet protecteur sur le
développent de SOS
54. Kawasaki, Ann Surg 2003
Morbidity related to biliary drainage 2,5%
No post-operative liver failure
55. Seyama, Ann Surg 2003
Cholangitis 30% (initial period)
1 Tumor seeding (percuteneous)
No post-operative liver failure
56. Grandadam, Ann Surg Oncol 2010
Mortality 10,5% in the group without optimization
57. Sugawara Surgery 2013
• 21% of cholangitis in patients with biliary
drainage
• 75% of positive bile cultures at the operation
• No difference in postoperative morbidity and
mortality in patients with and without biliary
drainage
59. Hirano, JHBP Sc 2014
P=0,004
• Tumor seeding on the of
percutaneous drainage
• Peritoneal recurrence in the
percutaneous group
• Better survival for endoscopic
drainage
63. Farges BJS 2013
• Biliary drainage does not affect mortality
• Decrease the mortality rate after right sided
hepatectomy
• Increase mortality after left sided
hepatectomy
• Preoperative bilirubine > 50 mmol increases
mortality
65. Cholestase - Conclusions
• Optimisation du patient avant chirurgie
• Drainage biliaire du foie restant par voie
endoscopique
• Traiter de façon systématique les patients avec
prothèses biliaires avec antibiotiques à large
spectre