Hepatocellular carcinomas (HCCs) were resected in eight patients who had preoperative transcatheter arterial embolization (TAE) and in 25 patients without preoperative TAE. Three patients in the former group had ruptured HCCs before operation. Two of the former group and three of the latter group were found to have recurrences after a follow-up of 1 1/2 years. Although preoperative TAE resulted in significantly increased tumor necrosis, it increased the risk of gangrenous change of the gallbladder, induced adhesion of the hepatoduodenal ligament, and was not effective in reducing operative blood loss or operative time if the vessel selected for TAE was inadequate. Pathologic examination revealed tumor emboli still existing in the intrahepatic veins. Daughter nodules and capsular invasion by tumor cells were not affected by TAE. Transcatheter arterial embolization seems to be effective in controlling bleeding from ruptured HCC prior to staged resection of the tumor.
Abstract Background Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. Methods An international multicentric retrospective observational study was conducted over a 2‐year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. Results The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index ( CCI ) scores below and above 6 ( P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0–3 days after admission ( P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30‐day mortality in Grade I+ II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30‐day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. Conclusion Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
Abstract Background The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. Methods This is an international multi‐center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG 13 were statistically analyzed. Results A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30‐day all‐cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II , III severity, respectively ( P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. Conclusions This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C. *Correspondence to: Dr Tsann-Long Hwang, Department of Surgery, Chang Gung Memorial Hospital, 199, Tunghwa North Road, Taipei 105, Taiwan, R.O.C. E-mail: [email protected] Received: April 13, 2009; • Accepted: April 24, 2009.
Objective: To determine whether resveratrol provides vasculoprotection in trauma-hemorrhaged animals and whether the effects are mediated via estrogen receptor-dependent hemeoxygenase-1. Design: Prospective, multiexperimental, randomized, controlled studies. Setting: University research laboratory. Subjects: Male Sprague-Dawley rats weighing 300–350 g. Interventions: Male Sprague-Dawley rats underwent trauma hemorrhage (mean arterial pressure 40 mm Hg for 90 min, then resuscitation). Resveratrol (30 mg/kg) with or without an estrogen receptor antagonist (ICI 182,780), a hemeoxygenase enzyme inhibitor (chromium-mesoporphyrin), or vehicle was injected during resuscitation. At 24 hrs after trauma hemorrhage with resuscitation or sham operation, the animals were euthanized for further evaluation. Measurements and Main Results: Acetylcholine-induced endothelium-dependent relaxation decreased, whereas nicotinamide adenine dinucleotide-stimulated superoxide radical production in the aorta and aortic p22phox, p47phox, gp91phox, NOX1, and NOX4 mRNA concentrations increased in trauma-hemorrhaged rats vs. sham rats. All altered parameters were normalized in resveratrol-treated trauma-hemorrhaged rats. Furthermore, there was a significant increase in hemeoxygenase-1 after trauma hemorrhage, and resveratrol treatment further increased hemeoxygenase-1 expression in trauma-hemorrhaged rats. However, administration of ICI 182,780 or chromium-mesoporphyrin abolished the resveratrol-induced prevention of shock-induced oxidative stress and endothelial damage. In the resveratrol-treated rats subjected to trauma hemorrhage, there were significant improvements in plasma aspartate aminotransferase and alanine aminotransferase levels, and mortality rate, and there was lesser damage in histology. Conclusions: Resveratrol treatment prevented the overproduction of superoxide radical/NADPH oxidase expression and restored the trauma-hemorrhage-impaired endothelium-dependent relaxation via estrogen receptor-dependent stimulation of hemeoxygenase-1 expression.
<b><i>Purpose:</i></b> To evaluate the significance of plasma chromogranin A (CgA) levels in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) in terms of disease status and treatment responses. <b><i>Materials and Methods:</i></b> Forty-four GEP-NET patients comprising 15 disease-free patients and 29 patients with active disease, as well as 26 healthy participants were enrolled in this study between April 2010 and April 2011. Clinicopathological factors were collected and serial plasma CgA levels were measured. <b><i>Results:</i></b> Plasma CgA levels were significantly higher in GEP-NET patients with active disease than in disease-free patients (p = 0.011) or healthy participants (p = 0.001). No difference in CgA levels was observed in terms of primary tumor location, tumor grade, and functional status in patients with active disease. CgA values at 94 U/l distinguished healthy individuals or disease-free patients from patients with active disease. Sensitivity and specificity rates were 86 and 88%, respectively. CgA levels at 110 U/l differentiated patients without recurrence from those with recurrence, with a sensitivity rate of 100% and a specificity rate of 80%. Patients (5/5, 100%) with stable disease and who showed partial response after treatment had a more than 20% decrease in CgA levels compared with the baseline values. Patients (6/6, 100%) with progressive disease showed a less than 20% decrease or increase in CgA levels. <b><i>Conclusion:</i></b> The plasma CgA level is a reliable biomarker for GEP-NET. We conclude that changes in CgA levels are associated with disease status and treatment responses.
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