Survival and recurrence after hepatic resection in cirrhotic patients

Although hepatic resection is one of the most effective treatments for hepatocellular carcinoma [HCC], the long term results of hepatic resection of this malignancy are far from satisfactory. The potential benefits of hepatectomy for patients with HCC have not been fully delineated. This study aimed to identify surgical outcomes of 18 consecutive cirrhotic patients with HCC undergoing hepatic resection. 18 patients with cirrhotic liver underwent hepatic resection between March 2002 and January 2007. We had 14 men and 4 women. The mean age was 55 years with a range between 42 and 67 years. The 30-day [operative] mortality rate was one case [5.5%] and there was one additional late death [5.5%]. Ten patients [62.5%] had recurrence after curative resection. Major hepatectomy was performed in 14 patients [77%] and the other 4 [22%] had minor hepatectomy In our study, the overall survival of patients after 3 years was 43.75% while the disease-free survival was 37.5%. The survival rate after operation remains unsatisfactory mainly because of the high recurrence rate. The improved care of cirrhotic patients, early detection and effective treatment of recurrent HCC may play an important role in achieving better prognosis and survival after operation

Role of percutaneous radiological intervention for treatment of dysfunctional hemodialysis vascular access

Early detection and percutaneous treatment of stenosis and thrombosis of hemodialysis access either native fistula [AVF] or graft can prolong the use of these shunts. The study is designed to investigate the role of interventional radiological procedures in treatment of failed hemodialysis access. Between year 2003 and 2006, 19 patients with upper limb shunts were subjected for multiple diagnostic angiographic procedures for their failing hemodialysis access. Detection of thrombosis or stenosis was followed by interval complex treatment. For all patients; 11 thrombolytic therapies, 29 dilations and 5 stent placements were done. These were performed in 13 native fistulas [9 forearms. 4 upper arm] and 6 prosthetic grafts. Restenosis and rethrombosis were treated by consecutive redilation and further declotting. The dysfunction was related to the venous side of hemodialysis access in 90% of patients while it was on the arterial side in only 10%. The initial interventional success rate was 88% in the forearm. 100% in upper arm and 83% in grafts. The complications were mild and transient including 4 hematomas at puncture sites, 4 consequent access infection and 2 arrhythmic episodes; all were managed conservatively. The mean primary patency rates at 1 year period were ranging from 62.5% to 25% [62.5% for forearm AVFs, 25% for upper arm AVFs, and 40% for grafts] [P<0.05]. The secondary patency rates at 1 year were ranging from 88% to 75% [88%forforearm AVFs 75% for upper arm AVFs and 80% for grafts]. Mean period necessary for reintervention was 14 months in the forearm 5 months in the upper arm and 6.5 months in grafts [P<0.05]. All patients are maintained on Aspirin and Coumarin. The percutaneous treatment of stenosis and thrombosis in hemodialysis access was effective in 90% of cases and yielded a mean 40% primary and 80% secondary patency rates at one year period. The overall results were more encouraging in native forearm AVFs compared to upper arm AVFs and grafts where maintenance of the two latters need more interventions

True measurment of inferior vena cava diameter before filter placement is crucial: correlation between three methods commonly used

Accurate determination of inferior vena cava [IVC] size before filter placement is of outmost importance in order to avoid filter migration especially at a diameter of 28 mm [megacava]. High quality inferior vena cavaography is mandatory to accomplish this. The purposes of this study were to [a] determine if significant differences exist between IVC measurements obtained using a gold standard technique and two other widely accepted methods, and [b] if differences exist, how often do these differences cause incorrect IVC sizing around a diameter of 28 mm. Twelve inferior vena cavograms were retrospectively evaluated. The transverse diameter of the infrarenal IVC was determined by using a calibrated intravascular catheter [method 1], subtraction of 20% from the measured transverse IVC diameter on a cut-film radiograph [method 2], and a radiopaque ruler placed immediately posterior to the patient [method 3]. The concordance correlation of methods 2 and 3 versus method 1 were 90.9% and 81.8% respectively to determine agreement at art IVC diameter of 28 mm. In conclusion, inferior vena cavegraphy prior to IVC filter placement should he performed with a calibrated intravascular catheter, as the two other formerly accepted methods of determining IVC diameter, that is, the 20% maqnification rule, and use of an external measuring device are unreliable and result in high incidence of technically false results