The principles of liver resection Vagg, Daniel; Toogood, Giles
Surgery (Oxford),
August 2020, 2020-08-00, Letnik:
38, Številka:
8
Journal Article
Recenzirano
Liver resection offers the only potential for curative treatment for many primary and secondary hepatic malignancies. With ongoing advances in both surgical technique and postoperative management, ...the indications for surgery continue to expand; however, perioperative risk remains significant as increasingly complex cases are considered. The fundamental principle is to achieve complete resection of disease with preservation of an adequate functional liver remnant. Successful outcomes rely on detailed knowledge of both intra- and extrahepatic anatomy and demand meticulous attention to patient selection, surgical technique and perioperative care. This article reviews the essential considerations in contemporary hepatobiliary surgery.
Abstract Background Acute pancreatitis is a common acute surgical presentation in Western Society. The causes and pattern of pancreatitis has not been previously documented for Western Sydney. As ...Western Sydney contains many areas of low socio-economic status with an expected high level of alcohol abuse, it was hypothesised that alcoholic pancreatitis would be more prevalent in this population. The aims of this study were to determine the epidemiology, aetiology and outcomes of acute pancreatitis. Methods A retrospective analysis of patients presenting with acute pancreatitis to four tertiary hospitals over a four-year period was undertaken. Results 932 patients presented with acute pancreatitis with a median age of 50 years (range 16–95); 470 (50.4%) were female. Almost half had gallstones (40%), 25.6% idiopathic, 22% alcohol induced and 3.9% post ERCP. 69 (7.4%) of patients were admitted to ICU/HDU, with a median length of stay in ICU was 6 days (range 1–106). 85 (11.1%) patients had severe pancreatitis (score ≥ 3). Mortality in this study was 1% (9). Conclusion The majority of patients with acute pancreatitis in Western Sydney present with mild disease and have a low risk of morbidity or mortality. The ratio of gallstone to alcohol aetiology was 2:1. Idiopathic pancreatitis is responsible for more cases than expected.
Study of the early management of acute pancreatitis Nesvaderani, Maryam; Eslick, Guy D.; Faraj, Shadi ...
ANZ journal of surgery,
October 2017, 2017-Oct, 2017-10-00, 20171001, Letnik:
87, Številka:
10
Journal Article
Recenzirano
Background
Acute pancreatitis (AP) is a common acute surgical presentation with evidence‐based guidelines for early management. The aim of this study was to assess the compliance to the published ...guidelines in patients presenting with AP in Western Sydney.
Methods
A retrospective case note audit was conducted for all patients with a confirmed diagnosis of AP from 2008 to 2011 in Western Sydney.
Results
There were 932 patients. The mortality was low for mild (0.7%) and severe (1.2%) AP. There was an under‐utilization of ultrasound (U/S) with 239 (25.6%) patients not having a U/S. There was an over‐utilization of early (within 72 h) computed tomography scanning for diagnosis (31.1%), assessment of severity (16.1%) and assessment for the presence of complications (7.3%). Inappropriate prophylactic antibiotic usage occurred in 15.3% patients. Of 373 cases of gallstone pancreatitis, only 231 (69.1%) had a cholecystectomy within 4 weeks of presentation. There was an under‐utilization of early endoscopic retrograde cholangiopancreatography for associated cholangitis (12.5%). Only 16 (18.8%) patients with severe pancreatitis received enteric feeding. In patients with pancreatic necrosis, 50% had invasive intervention delayed beyond 4 weeks and 69% had minimally invasive procedures performed prior to necrosectomy. Patients having a minimally invasive procedure initially showed an improvement in mortality compared with those who had primary necrosectomy (0 versus 40%, P = 0.025).
Conclusions
Although morbidity and mortality were acceptable, there was a failure to comply with evidence‐based guidelines for the early management of pancreatitis. The results support for the development and auditing of protocols for the early assessment and treatment of AP in all hospitals.
Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is ...sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions.
Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases.
Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001).
This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients’ postoperative course negatively.
Gaia is a major European Space Agency (ESA) astrophysics mission designed to map and analyse 10\(^9\) stars, ultimately generating more than 1 PetaByte of data products. As Gaia data becomes publicly ...available and reaches a wider audience, there is an increasing need to facilitate the further use of Gaia products without needing to download large datasets. The Gaia Added Value Interface Platform (GAVIP) is designed to address this challenge by providing an innovative platform within which scientists can submit and deploy code, packaged as "Added Value Interfaces" (AVIs), which will be executed close to the data. Deployed AVIs and associated outputs may also be made available to other GAVIP platform users, thus providing a mechanism for scientific experiment reproducibility. This paper describes the capabilities and features of GAVIP.
This chapter explores the urgent relevance of posthumanist theory and practice for democratizing creative educational experiences in 21st-century schools, universities, and informal learning ...environments. Posthumanism challenges the
myopic centering of the human in creative education in an age of climate change, artificial intelligence, and zoonotic disease, where nonhuman agencies are intricately imbricated in human cultures and lives. Using a cartographic
methodology, the chapter critically maps key theories and debates in posthumanist creativity studies across four substantive fields of inquiry: (a) process philosophy, (b) affect studies, (c) place-based education, and (d) creative
ecology. Drawing links between theoretical concepts and practical examples of creative experience across formal and informal education contexts, the chapter scopes an alternative agenda for critical studies of creativity in light of the
posthuman turn. Author abstract
Alfred Rolfe was arguably the most prolific silent era Australian director. He was responsible for more than 25 feature films, encompassing the bushranger genres, early Australian war cinema and ...various melodramas. Many of his films were both critical and commercial successes. The only surviving footage is scenes from two of his 1915 war films. This important director has been overshadowed by his contemporaries, particularly Raymond Longford. This paper argues that Rolfe's contribution to early Australian cinema was significant, not just in volume, but also in artistic terms, in subject matter, and in popular appeal. The centenary of Anzac is also the centenary of Australia's first Gallipoli movie, Rolfe's The Hero of the Dardanelles (1915), which was one of the most successful films at the box office for its time.
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