Perioperative acute phase response and outcome of hepatic resection, an experimental study

Identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This experimental study evaluated the correlation between peri-operative acute phase response and outcome of hepatic resection. The study was conducted on sixty healthy golden hamsters, which underwent partial hepatectomy. They were arranged in 3 groups [20 per each]. One day prior to resection, fracture of the left hind leg was done in group I [GI] and wound infection had been created in group II [GII]; while nothing done in group III [GIII] that acted as a control. Blood samples to estimate SGPT and serum albumin [as basic investigations for hamsters liver function] and serum IL-6 and CRP [as acute phase reactants] were taken preoperatively, immediately after resection and for the consecutive 3 days post operatively. The mean serum level of both acute phase reactants increased in GI and GII preoperatively and continues to rise immediately after resection. Post-operatively; among the three groups, the mean serum level of both reactants was higher in GI than in GII that was in turn higher than in GIII except when the postoperative complications were more severe than the other group, then this relation changed

Limb-salvage angioplasty in poor surgical chronic liver disease and diabetic patients

Critical limb ischemia [CLI] in high surgical risk patients with chronic liver diseases has a grave prognosis with a one-year mortality rate of 20% and a one- year amputation rate of 25% after the initial diagnosis. According to Trans-Atlantic Inter-Society Consensus [TASC]-II Guidelines, revascularization [surgical and endovascular] is the treatment of choice for patients with critical limb ischemia [CLI]. The primary goal of revascularization is to relieve ischemic rest pain, heal ulcers, prevent amputation, improve patient's quality of life [limb salvage] and secondary goal was the periprocedural complications. Endovascular techniques include balloon angioplasty, stents, stent-grafts, and plaque debulking procedures. Surgical options, identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This study evaluated the treatment out comes after limb salvage angioplasty for patients who otherwise would be candidates for primary amputation due to poor co-morbid conditions as chronic liver disease and diabetes. The clinical evaluation, laboratory investigations and abdominal ultrasonography were performed to all patients to evaluate their liver status. Patients were classified according to Child-pugh classification into child A, B and C. All patients were subjected to either detailed arterial duplex or C.T. angiography to assess their arterial lesions from January 2008- January 2010. 95 patients with critical limb ischemia [Rutherford categories 4, 5, 6] were treated by primary percutaneous transluminal angioplasty [PTA]. No patient was excluded on the basis of the extent of arterial occlusive disease. The primary end points were immediate technical success, clinical improvement and limb salvages rates. Secondary end points were periprocedural complications and mortality. Most of the patients were male [54.7%] with mean age 62 [48-70 years]. Underlying cirrhosis due to HCV was [82.2%], HBV [5.4%], while mixed viral infections was [12.4%]. 54% were categorized as Child B, 32% as child A and 14% as child C. Associated diabetes mellitus was present in 96% of the cases, hypertension in 64.2%, ischemic heart disease in 74% and hyperlipedemia in 32%. Rest pain, tissue loss, or both, were the presenting symptoms in 83% while infection and ulcer were present in the other 17% of patients. The total numbers of interventions were 154; the treated lesions were 89 in the tibial arteries, 12 in the popliteal artery, 44 in the superficial femoral artery, 3 in the common femoral artery and 6 in the iliac arteries with initial technical success rate of 93.6% and periprocedural complications of 12.6%. All patients were in Rutherford clinical category 4, 5, 6 none of these patients had a previous bypass operation. Mean follow-up was 15 months. The limb-salvage rate was 87.4%. Eighty patients [84.2%] of toe amputation sites healed primarily, three patients with rest pain had resolution of their symptoms after angioplasty. All technical failures were due to inability to cross the lesions. Of the 6 technical failures, 4 required amputation, and 2 refused any further therapy