Recurrent hepatic artery pseudoaneurysm repair with overlapping tapered stent-graft technique.

Hepatic artery pseudoaneurysms (HAPs) are rare but life-threatening complications associated with hepatic artery infusion pump (HAIP) therapy for unresectable liver metastases. Traditional management options include open surgery or stent placement, but these approaches have drawbacks. We present a unique case of a dislodged stent embedded in a HAP, resulting in delayed type-I endoleak. To address this, we employed a novel technique using multiple overlapping tapered stents to reconstruct the hepatic artery. This approach successfully excluded the pseudoaneurysm without endoleak. Stent-graft placement emerges as a safer and more effective option for managing HAP, preserving hepatic arterial flow, and reducing morbidity compared to other methods. However, further research is needed to evaluate this technique's long-term outcomes and potential complications.

A new approach to etching low-carbon microalloyed steels to reveal prior austenite grain boundaries and the dual-phase microstructure.

A modification to picric acid solutions has been undertaken to reveal the prior-austenite grain boundaries in microalloyed steels as a result of elemental segregation. It has been found the maximum addition of sodium dodecyl sulphate plus hydrochloric acid to fully reveal both the prior austenite grain boundaries and the final post-processed structures in these steels.

Single Center Retrospective Review of Post-laparotomy CT Abdomen and Pelvis Findings and Trends.

Purpose: To identify common findings visualized on CT following damage control laparotomy, including post-surgical changes and additional injuries, and to determine change in frequency of post-laparotomy CT at our institution over time. Methods: Single institution, IRB-Exempt, retrospective review of the University of Kentucky trauma registry from 1/2006 to 2/2019 for all trauma patients undergoing exploratory laparotomy initially and subsequently undergoing CT of the abdomen and pelvis within 24 hours. Operative findings from surgical operation notes and findings reported on post-laparotomy CT were recorded, including vascular and solid organ injuries, operative changes, free intraperitoneal fluid/air, and retroperitoneal findings. Next steps in management were also recorded. Results: In total 1,047 patients underwent exploratory laparotomy initially at our institution between 1/2006-2/2019. Of those, only 96 had a diagnostic CT of the abdomen and pelvis within 24 h after initial surgery, first occurring in 2010. Among these 96, there were 71 blunt and 25 penetrating injuries. Most common injuries recognized during exploratory laparotomy were bowel/mesentery (55), spleen (34), and liver (26). Regarding CT findings, all patients (96/96, 100%) had residual pneumoperitoneum, 84/96 (87.5%) had residual hemoperitoneum, 36/96 (37.5%) noted post-surgical changes or additional injuries to the spleen, 36/96 (37.5%) to the bowel/mesentery, and 32/96 (33.3%) to the liver, and 34/96 (35.4%) were noted to have pelvic fractures. After CT, 31/96 (32.3%) went back to the OR for relook laparotomy and additional surgical intervention and 7/96 (7.3%) went to IR for embolization. Most common procedures during relaparotomy involved the bowel (8) and solid organs (6). Conclusions: CT examination within 24 h post damage control laparotomy was exceedingly rare at our institution prior to 2012 but has steadily increased. Frequency now averages 20.5% yearly. Damage control laparotomy is an uncommon clinical scenario; however, knowledge of frequent injuries and common post-operative changes will aid in radiologist detection of additional injuries helping shape next step management and provide adequate therapy.

Association Between Sarcopenia and AFP Level in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma.

BACKGROUND: Sarcopenia is one of the most common complications of cirrhosis. Liver transplantation (LT) is the treatment of choice for patients with early-stage hepatocellular carcinoma (HCC) that are unsuitable for resection. METHODS: We performed a retrospective analysis of 163 patients transplanted at our institution with HCC from 1998 to 2016. Sarcopenia was diagnosed based on the skeletal muscle mass on computed tomography imaging using SliceOmatic 5.0 software at L3 level (≤52.4 cm2/m2 in males and ≤38.5 cm2/m2 in females). RESULTS: From the 163 patients who underwent LT for HCC, 119 had available computed tomography scan. From those, 61 were identified as sarcopenic by lumbar skeletal muscle index (LSMI), of which 53 patients were male (86.9%) with a median age of 59 y (56-64). The most common etiologies of cirrhosis were hepatitis C virus infection (55.7%) and alcohol liver disease (46.7%). A multivariable analysis was performed to find predictors of sarcopenia. Alpha-fetoprotein level >100 mg/dL (OR, 6.577; 95% CI: 1.370-51.464; P = 0.034) and gender (male) (OR, 5.878; 95% CI: 1.987-20.054; P = 0.002) were independently associated with the presence of sarcopenia in this cohort. Patients in the lowest quartile for LSMI had prolonged length of stay compared to the rest of the patients (P = 0.029). CONCLUSIONS: Alpha-fetoprotein level >100 mg/dL is associated with almost 6-fold increased risk of sarcopenia in patients with HCC undergoing LT. Patients in the lowest quartile of the LSMI are associated with 70% increased risk of prolonged length of stay in this cohort.

Risk of Infectious Complications After Simultaneous Gastrointestinal and Liver Resections for Neuroendocrine Tumor Metastases.

BACKGROUND: Neuroendocrine tumors (NETs) are a relatively rare category of cancers that arise in the gastrointestinal (GI) tract and other organs. Extended hepatectomies including resection of multiple organs are often necessary to achieve negative margins. METHODS: We performed a review of patients undergoing liver resection for NET liver metastases from 2005 to 2015 using National Surgical Quality Improvement Program. We compared patients undergoing hepatectomy alone (HA) versus hepatectomy and a concomitant GI surgery procedure (colorectal, small bowel, and pancreatic) to evaluate postoperative infectious complications. RESULTS: During the study period, 354 patients underwent liver resection for metastatic NET. Hepatectomy alone was performed in 98 patients, and concomitant GI surgery was performed in 256 patients, including 83 colorectal resections (HCCR), 68 small bowel resections, 75 distal pancreatectomies, and 35 pancreaticoduodenectomies (HCPD). Infectious complications were more likely to occur in those undergoing HCPD (60%, P < 0.001), and HCCR (32.5%, P < 0.05) than in those undergoing HA (16.3%). Patients undergoing HCPD and HCCR had a 7.69-fold and 2.52-fold increased risk of infectious complication, respectively, compared with HA after adjustment for other infection risk factors. CONCLUSIONS: Neuroendocrine liver metastases requiring liver resection with concomitant colorectal resection or pancreaticoduodenectomy are at significantly increased risk of developing infectious complications.

Impact of super obesity on perioperative outcomes after hepatectomy: The weight of the risk.

BACKGROUND: We evaluated perioperative outcomes in super obese patients (body mass index >50 kg/m2) undergoing liver resection using the American College of Surgeons National Surgical Quality Improvement Program. METHODS: Patients undergoing hepatectomy recorded in the American College of Surgeons National Surgical Quality Improvement Program dataset from 2005 to 2015 were analyzed. Out of 21,228 hepatectomies in the National Surgical Quality Improvement Program dataset, 146 were performed on super obese patients. RESULTS: Seventy-two percent of the super obese patients were female with a median age of 50.6 years, and 10% were classified as American College of Surgeons Class ≥III. In this group, 69.2% were hypertensive, 38.4% were diabetics, and 17.8% had dyspnea. The median operation time was 248 minutes in the super obese group, greater than any other body mass index class. Twenty-two percent of these patients required perioperative transfusion, although 74% underwent partial hepatectomies. Body mass index >50 kg/m2 significantly increased morbidity in patients undergoing hepatectomies, almost 2-fold. Infectious complications increased by 86%, and the risk of developing critical care complications increased by 63%. CONCLUSION: Our data show that super obesity (body mass index >50 kg/m2) is the strongest independent predictor of perioperative morbidity. These patients also are at much greater risk of infectious complications and critical care complications. Future studies should be conducted using weight loss strategies in extreme obese patients to reduce their risk of life-threatening complications after hepatectomy.

Liver Transplantation for the Treatment of Complicated Iatrogenic Biliary Injuries: A National Review from the UNOS Data Set.

BACKGROUND: Liver transplantation (LT) is rarely indicated in the management of iatrogenic bile duct injuries (IBDI), but occasionally, it becomes the only remaining therapy. The purpose of this study is to evaluate potential complications of IBDI and their impact on perioperative mortality, graft, and patient survival after LT. METHODS: The United Network for Organ Sharing database was queried for all LT performed in the United States between 1994 and 2014. Of the 101 238 liver transplants performed, 61 were related to IBDI. We performed a case matched analysis in a 5:1 ratio. RESULTS: The median age for patients with IBDI was 50.16 ± 11.7 years with a mean Model End-Stage Liver Disease score of 22.6 ± 9.8. Patients receiving LT for IBDI were more likely women (54.1%, P = 0.001), had lower incidence of hepatitis C virus infection (4.9%, P = 0.001) and longer cold ischemic time (P = 0.001). The mean body mass index was 25.5 ± 5.2 in patients transplanted for IBDI. IBDI was recognized as the strongest independent predictor associated with eightfold increased risk of early graft loss (P = 0.001; odds ratio, 8.4) and a 2.9-fold increased risk of 30-day mortality after LT in a case matched analysis (P = 0.03). CONCLUSIONS: IBDI is an uncommon but challenging indication for LT. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI.

Síndrome metabólico en conductores de servicio público en Armenia, Colombia / Metabolic syndrome in public service drivers in Armenia, Colombia

RESUMEN Objetivo Caracterizar y comparar la población de conductores de servicio público de una empresa de transporte en Armenia, Colombia. Materiales y Métodos Estudio analítico de corte transversal en el cual participaron conductores de taxi y colectivo en una empresa de servicio público de Armenia, Colombia. El análisis de las variables se realizó por medio de Statgraphics Centurion XVI. Se de criben las variables, se lleva a cabo una regresión múltiple y una regresión logística. Resultados Participaron 125 conductores, de los cuales, ocho se retiraron y finalmente quedaron 117 de sexo masculino como objeto de investigación. El 28,21 % ha conducido colectivo y 71,79 % taxi. Se observó un mayor consumo de alcohol respecto al de tabaco. El 60,69 % no realizaba ningún tipo de ejercicio físico. El promedio de IMC y perímetro abdominal fue de 28,03 kg/m2 y 100,09 cm, respectivamente. La media de triglicéridos y HDL-c en suero fue de 207,53 mg/dL y 33,12 mg/dL. Del total de conductores, el 49,57 % cumplía con los criterios diagnósticos de METS. Se encontraron diferencias estadísticamente significativas en los valores de IMC, perímetro abdominal, presión arterial sistólica, presión arterial diastólica, ejercicio semanal, triglicéridos y glicemia en ayunas entre individuos con Síndrome Metabólico y sin éste. Conclusiones Los conductores de servicio público presentan un perfil de riesgo aumentado para desarrollar Síndrome Metabólico. La obesidad, la hipertrigliceridemia y los bajos niveles de HDL-c fueron los principales parámetros de alarma para la presencia de Síndrome Metabólico.(AU)

ABSTRACT Objective To characterize and compare the population of public service drivers of a transport company in Armenia, Colombia. Materials and Methods Taxi and bus drivers from a transport company of Armenia, Colombia participated in an Analytical cross-sectional study. The analysis of the variables was made through Statgraphics Centurion XVI. The comparison of variables as well as multiple and logistic regression were carried out. Results 125 individuals participated, 8 were removed, and finally there were 117 male drivers as aim of research. The 28.21 % of individuals have driven small buses and the 71.79 % have driven cars. The increase in alcohol consumption was remarkable compared to tobacco. The 60.69 % of subjects did not get exercise. Besides, the BMI average and abdominal circumference was 28.03 kg/m2 and 100.09 cm respectively. The triglyceride average and serum HDL-C were 207.53 mg/dL to 33.12 mg/dL. 49.57 % of all drivers, fulfilled the Metabolic Syndrome diagnostic criteria. Statistically significant differences were found in the values of BMI, waist circumference, systolic blood pressure, diastolic blood pressure, weekly exercise, triglycerides and fasting glucose between individuals with and without Metabolic Syndrome. Conclusion Public service drivers have a profile risk for developing Metabolic Syndrome. Obesity, hypertriglyceridemia and low HDL-C were the main alarm parameters of the presence of Metabolic.(AU)Syndrome.

Sorafenib and FH535 in combination act synergistically on hepatocellular carcinoma by targeting cell bioenergetics and mitochondrial function.

Treatment of advanced hepatocellular carcinoma (HCC) remains a challenge due to the high tumor heterogeneity. In the present study, we aim to evaluate the impact of the ß-catenin inhibitor, FH535, alone or in combination with the Ras/Raf/MAPK inhibitor Sorafenib, on the bioenergetics profiles of the HCC cell lines Huh7 and PLC/PRF/5. Single low-dose treatments with FH535 or Sorafenib promoted different effects on mitochondrial respiration and glycolysis in a cell type specific manner. However, the combination of these drugs significantly reduced both mitochondrial respiration and glycolytic rates regardless of the HCC cells. The significant changes in mitochondrial respiration observed in cells treated with the Sorafenib-FH535 combination may correspond to differential targeting of ETC complexes and changes in substrate utilization mediated by each drug. Moreover, the bioenergetics changes and the loss of mitochondrial membrane potential that were evidenced by treatment of HCC cells with the combination of FH535 and Sorafenib, preceded the induction of cell apoptosis. Overall, our results demonstrated that Sorafenib-FH535 drug combination induce the disruption of the bioenergetics of HCC by the simultaneous targeting of mitochondrial respiration and glycolytic flux that leads the synergistic effect on inhibition of cell proliferation. These findings support the therapeutic potential of combinatory FH535-Sorafenib treatment of the HCC heterogeneity by the simultaneous targeting of different molecular pathways.

[Metabolic syndrome in public service drivers in Armenia, Colombia]. / Síndrome metabólico en conductores de servicio público en Armenia, Colombia.

OBJECTIVE: To characterize and compare the population of public service drivers of a transport company in Armenia, Colombia. MATERIALS AND METHODS: Taxi and bus drivers from a transport company of Armenia, Colombia participated in an Analytical cross-sectional study. The analysis of the variables was made through Statgraphics Centurion XVI. The comparison of variables as well as multiple and logistic regression were carried out. RESULTS: 125 individuals participated, 8 were removed, and finally there were 117 male drivers as aim of research. The 28.21 % of individuals have driven small buses and the 71.79 % have driven cars. The increase in alcohol consumption was remarkable compared to tobacco. The 60.69 % of subjects did not get exercise. Besides, the BMI average and abdominal circumference was 28.03 kg/m2 and 100.09 cm respectively. The triglyceride average and serum HDL-C were 207.53 mg/dL to 33.12 mg/dL. 49.57 % of all drivers, fulfilled the Metabolic Syndrome diagnostic criteria. Statistically significant differences were found in the values of BMI, waist circumference, systolic blood pressure, diastolic blood pressure, weekly exercise, triglycerides and fasting glucose between individuals with and without Metabolic Syndrome. CONCLUSION: Public service drivers have a profile risk for developing Metabolic Syndrome. Obesity, hypertriglyceridemia and low HDL-C were the main alarm parameters of the presence of Metabolic Syndrome.

OBJETIVO: Caracterizar y comparar la población de conductores de servicio público de una empresa de transporte en Armenia, Colombia. MATERIALES Y MÉTODOS: Estudio analítico de corte transversal en el cual participaron conductores de taxi y colectivo en una empresa de servicio público de Armenia, Colombia. El análisis de las variables se realizó por medio de Statgraphics Centurion XVI. Se de criben las variables, se lleva a cabo una regresión múltiple y una regresión logística. RESULTADOS: Participaron 125 conductores, de los cuales, ocho se retiraron y finalmente quedaron 117 de sexo masculino como objeto de investigación. El 28,21 % ha conducido colectivo y 71,79 % taxi. Se observó un mayor consumo de alcohol respecto al de tabaco. El 60,69 % no realizaba ningún tipo de ejercicio físico. El promedio de IMC y perímetro abdominal fue de 28,03 kg/m2 y 100,09 cm, respectivamente. La media de triglicéridos y HDL-c en suero fue de 207,53 mg/dL y 33,12 mg/dL. Del total de conductores, el 49,57 % cumplía con los criterios diagnósticos de METS. Se encontraron diferencias estadísticamente significativas en los valores de IMC, perímetro abdominal, presión arterial sistólica, presión arterial diastólica, ejercicio semanal, triglicéridos y glicemia en ayunas entre individuos con Síndrome Metabólico y sin éste. CONCLUSIONES: Los conductores de servicio público presentan un perfil de riesgo aumentado para desarrollar Síndrome Metabólico. La obesidad, la hipertrigliceridemia y los bajos niveles de HDL-c fueron los principales parámetros de alarma para la presencia de Síndrome Metabólico.