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Purpose@#The tablet form of tacrolimus is more convenient for drug ingestion than the capsule form. We examined the efficacy and safety of tacrolimus tablets and a satisfaction survey after formula conversion in liver transplant (LT) recipients. @*Methods@#This study was an open-label, prospective clinical trial for tacrolimus formula 1:1 conversion from capsule to tablet in 41 adult LT recipients with tacrolimus maintenance therapy of more than 1 month. The primary endpoint was incidence of biopsy-proven acute rejection (BPAR) within 24 weeks. Surveys 1 week before and 4 weeks after formula conversion were conducted for total daily dose of medication, number, scale of discomfort and satisfaction. @*Results@#The overall incidence of BPAR was 0% and there was no graft loss or patient death. The incidence of adverse effects was 34.1% (n = 14) after formula conversion. The most common severe adverse effect was abnormal liver function test (n = 5): biliary complications (n = 4) and alcoholic recidivism (n = 1). Total daily dose and number of tacrolimus doses were significantly lower after formula conversion (P < 0.05) without changes in trough level. According to survey analysis, there was no significant difference in discomfort and satisfaction scales from capsule to tablet conversion (P < 0.05). @*Conclusion@#The present study suggests that the new tablet formula can be a useful treatment option to maintain a consistent level of tacrolimus with a lower total daily dose and number in adult LT recipients.
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Purpose@#Total necrosis of hepatocellular carcinoma (HCC) achieved via locoregional treatment (LRT) is considered to indicate a lack of tumor viability. Nonetheless, there is insufficient evidence of recurrence after liver transplantation (LT) in patients with such a status. The aim of this study was to investigate the prognosis of patients diagnosed with totally necrotic nodules upon explant hepatectomy after LT. @*Methods@#We conducted a retrospective study of patients diagnosed with totally necrotic nodules after LT for HCC. A total of 165 patients with HCC who underwent living- or deceased-donor LT from 2000 to 2020 in our hospital were included. @*Results@#A total of 5 patients (3.0%) exhibited HCC recurrence during a median follow-up of 84 months (range, 4–243 months) after LT. The 5-year overall and recurrence-free survival rates of these patients were 92.8% and 92.2%, respectively. Four patients in the HCC-recurrence group (80.0%) died even after further treatment, including transarterial chemoembolization, surgery, and systemic treatment. Both univariate and multivariate analyses of clinicopathological factors identified a maximum diameter of the totally necrotic nodules of >5 cm as the only factor associated with tumor recurrence following LT (P = 0.005 and P = 0.009, respectively). @*Conclusion@#Total necrosis of HCC via LRT yielded excellent survival outcomes for patients undergoing LT. Nevertheless, patients with large tumors should be considered at high risk of recurrence after LT, suggesting the need for their active surveillance during the follow-up period.
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Purpose@#The purpose of this study was to investigate the recurrence factors of choledocholithiasis after common bile duct (CBD) exploration. @*Methods@#From January 2000 to December 2018, we retrospectively reviewed 253 patients who underwent CBD exploration surgery. We excluded 100 cases who had residual stone, combined major surgery, or follow-up loss after surgery. Total of 153 patients were included, and we investigated the recurrence factors of choledocholithiasis. Various variables such as patients’ demographics, gallstones, preoperative endoscopic treatment, and laboratory data were analyzed to find factors related to recurrent choledocholithiasis. @*Results@#The median follow-up period was 20.6 months (range 4.7–219 months), and 27 patients (17.6%) had experienced recurrent choledocholithiasis. Univariate analysis showed that the following variables were associated with recurrence of choledocholithiasis; preoperative leukocytosis (white blood cell ≥ 11,000/µL), open procedure, T tube insertion, long hospital duration, and long operation time. Logistic regression multivariate analysis identified preoperative leukocytosis (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.21–9.73; p = 0.021), open procedure (OR, 5.54; 95% CI, 4.73–6.35; p = 0.037), and T-tube insertion (OR, 2.82; 95% CI, 1.04–7.65; p = 0.042) as independent predictors of recurrent choledocholithiasis. @*Conclusion@#Because of delayed recurrence of choledocholithiasis, it is recommended to continue follow-up of patients after CBD exploration surgery. Laparoscopic surgery was observed to be associated with a reduction in recurrence. The preoperative leukocytosis and clinical conditions in which open surgery is performed could be associated with recurrence of choledocholithiasis. However, further study is necessary to validate the result.
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A bezoar, a mixture of various undigested foreign substances in the gastrointestinal tract, causes intestinal obstruction at times. We report a case of non-surgical treatment in old age patient. An 89-year-old female presented with epigastric pain, general weakness, and intermittent melena for 1 month. There were episodic attacks of vomiting. An abdominal computed tomography scan showed a 5×4 cm, firm, atypically shaped mass at the stomach body and duodenal bulb with interspersed gas. Endoscopy showed a mass of fiber impacting the antrum pylorus, and the endoscopist failed to remove the bezoar at the first attempt. We subscribed olive oil for few days to make the bezoar small, and eventually, it was fragmented and removed without surgery. A phytobezoar is not uncommon disease required surgical removal if obstructive system developed.Ingestion of olive oil would be a helpful substitute for immediate operation in case of phytobezoar.
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A bezoar, a mixture of various undigested foreign substances in the gastrointestinal tract, causes intestinal obstruction at times. We report a case of non-surgical treatment in old age patient. An 89-year-old female presented with epigastric pain, general weakness, and intermittent melena for 1 month. There were episodic attacks of vomiting. An abdominal computed tomography scan showed a 5×4 cm, firm, atypically shaped mass at the stomach body and duodenal bulb with interspersed gas. Endoscopy showed a mass of fiber impacting the antrum pylorus, and the endoscopist failed to remove the bezoar at the first attempt. We subscribed olive oil for few days to make the bezoar small, and eventually, it was fragmented and removed without surgery. A phytobezoar is not uncommon disease required surgical removal if obstructive system developed.Ingestion of olive oil would be a helpful substitute for immediate operation in case of phytobezoar.
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PURPOSE: The purpose of this study was to investigate whether the indicators of nutritional risk screening tool are associated with postoperative complications following pancreaticoduodenectomy (PD). METHODS: We investigated whether nutritional risk is associated with postoperative complications based on the medical records of 128 patients who underwent PD from 2010. The tool was composed of 6 risk factors: albumin, total lymphocyte count, body mass index, weight loss, dietary intake loss, and nutritional symptoms. The patients were divided into 2 groups: a nutritional risk group and a nonrisk group. The rates of general complications and postoperative pancreatic fistula (POPF) were investigated according to this nutritional status. RESULTS: There were 65 patients who did not have any risk factors. However, 63 patients had one risk factor or more. In the nonrisk group, the overall complication rate and serious complication rate were 30.8% and 15.4%, respectively. If there were one or more risk factors, the overall and serious complication rates were 59.5% and 41.3%, respectively (P = 0.001 and P = 0.001, respectively). The rate of clinically relevant POPF (grade B or C) was 9.2% in the nonrisk group. However, this rate was 23.8% in the NRS risk group (P = 0.029). In multivariate analysis, the NRS risk group was a significant factor of clinically relevant POPF (odds ratio, 9.878; 95% confidence interval, 1.527–63.914; P = 0.016). CONCLUSION: There were statistically significant associations between complications and nutritional indicators. A comprehensive analysis of nutritional parameters will help predict postoperative complications.