Hybrid-ALPPS followed by Ante Situm with Cardiopulmonary Bypass: Rapid Liver Augmentation and Complex Surgery.

BACKGROUND: Tumors invading the inferior vena cava (IVC) and hepatic veins pose a challenge for surgeons. Hannoun et al.1 were able to show that the resection of these tumors can be done under hypothermia in the Ante-Situm position. Additionally, not only the localization of the tumor but the remaining volume of the remnant liver (FLR) needs to be considered. Schnitzbauer et al.2 were able to induce massive liver hypertrophy in a short period, combining an in-situ split with a portal vein ligation (ALPPS). As this controversial technique has evolved, a safe ALPPS can be performed nowadays.3 To our knowledge, this is the first case that combines a laparoscopic partial ALPPS with an extended resection requiring cardiopulmonary bypass (CPB). METHODS: A 58-year-old female presented with a known chronic hepatitis C suffered from a pulmonary embolism, caused by a large, central hepatocellular carcinoma (HCC) with invasion of the suprahepatic IVC and continuous growth into the right atrium (RA). Due to the small FLR, we performed a laparoscopic hybrid-partial-ALPPS with an embolization of the right portal vein. We were able to remove the mass with an Ante-Situm position and resection of the RA under CPB. RESULTS: The postoperative course was complicated by posthepatic liver failure and bleeding. However, after 28 days the patient was discharged in a good medical condition. CONCLUSIONS: Although tumors invading the suprahepatic IVC and RA pose a surgical challenge, patients can be treated adequately with multidisciplinary management. Advanced HCCs have high recurrence rates; however, a R0 resection might improve overall survival. Wakayma et al. showed in their retrospective study with 13 patients a median survival of 30.8 months when a complete resection was performed.4 Our patient had a disease-free survival of 11 months and is still alive after 24 months. Taking the complexity of the operation and the oncological prospect with a probable recurrence into account, indication for surgery needs to be considered on an individual basis.

[Navigated liver surgery : Current state and importance in the future]. / Navigierte Leberchirurgie : Aktueller Stand und Bedeutung in der Zukunft.

The preoperative computer-assisted resection planning is the basis for every navigation. Thanks to modern algorithms, the prerequisites have been created to carry out a virtual resection planning and a risk analysis. Thus, individual segment resections can be precisely planned in any conceivable combination. The transfer of planning information and resection suggestions to the operating theater is still problematic. The so-called stereotactic liver navigation supports the exact intraoperative implementation of the planned resection strategy and provides the surgeon with real-time three-dimensional information on resection margins and critical structures during the resection. This is made possible by a surgical navigation system that measures the position of surgical instruments and then presents them together with the preoperative surgical planning data. Although surgical navigation systems have been indispensable in neurosurgery and spinal surgery for many years, these procedures have not yet become established as standard in liver surgery. This is mainly due to the technical challenge of navigating a moving organ. As the liver is constantly moving and deforming during surgery due to respiration and surgical manipulation, the surgical navigation system must be able to measure these alterations in order to adapt the preoperative navigation data to the current situation. Despite these advances, further developments are required until navigated liver resection enters clinical routine; however, it is already clear that laparoscopic liver surgery and robotic surgery will benefit most from navigation technology.

Engaging men and women as allies: a workplace curriculum module to challenge gender norms about domestic violence, male bullying and workplace violence and encourage ally behavior.

This post-hoc analysis discusses a replicable workplace behavior change module called Men and Women As Allies, that was designed and implemented by a team of labor, management and community anti-violence educators at a private sector telecommunications employer. A job site-specific educational seminar linked issues of domestic violence to male bullying and workplace violence. It challenged social stereotypes about gender, taught skills to engage ally peer behavior and provided information on how to seek assistance from union, workplace and external community resources.

Effects of bulk wave radiation on IDT admittance on 42 degrees YX-LiTaO3.

This paper investigates the effects of bulk acoustic wave (BAW) radiation on the admittance of interdigital transducers (IDTs) with significant internal reflections of shear horizontal (SH) type leaky surface acoustic waves (SAWs) on 42 degrees YX-LiTaO3 (42-LT). Theoretical analysis is made by using the discrete Green function theory, and synchronous one-port resonators are analyzed. It is shown that the BAW radiation significantly affects the IDT characteristics even for resonators; under certain circumstances, BAWs launched from an IDT are converted into SH-type SAWs by the strong internal reflections, and they interact with the BAWs radiated by the IDT. Then, the net amount of the radiated BAW power is highly dependent upon the number of IDT finger pairs. For the precise simulation of devices based on the SH-type SAWs with strong internal reflections, the BAW radiation should carefully be taken into consideration. If the BAW radiation is ignored, the radiated power of the SH-type SAWs may seem to be negative above the BAW cut-off frequency.

SAW devices for consumer communication applications.

An overview of surface acoustic wave (SAW) filter techniques available for different applications is given. Techniques for TV IF applications are outlined, and typical structures are presented. This is followed by a discussion of applications for SAW resonators. Low-loss devices for mobile communication systems and pager applications are examined. Tapped delay lines (matched filters) and convolvers for code-division multiaccess (CDMA) systems are also covered. Although simulation procedures are not considered, for many devices the theoretical frequency response is presented along with the measurement curve.