Central bisectionectomy – a feasible alternative for centrally located liver tumors

Clinica de Chirurgie Generală şi Transplant Hepatic, I.C.Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Bisectionectomia centrală reprezintă rezecția hepatică a segmentelor 4a, 4b, 5 și 8, definite astfel de sistemul Brisbane. Denumită anterior în diferite feluri (mesohepatectomie, hepatectomie centrală, lobectomie centrală) bisectionectomia centrală este operația de elecție pentru tumorile hepatice situate în segmentele centrale, și este de preferat rezecțiilor hepatice extinse (trisectionectomia dreaptă/stângă) pentru că minimalizează riscul insuficienței hepatice postoperatorii. Prezentare de caz: Pacienta în vârstă de 54 de ani cu dureri în hipocondrul drept, scădere ponderală cca. 8 kg / 2 luni. Bioumoral: AFP, CA 19.9 și ACE – în limite normale / AgHbs, Ac Anti-HBc, Ac Anti-HCV – negative. EDS/EDI – de aspect normal, prezintă la examenul CT o formațiune tumorală hepatică situată central (segmentele 4a, 4b, 5 și 8) ce înglobează VHM, la distanță de bifurcația venei porte. Se practică o bisectionectomie centrală, cu ligaturarea pediculilor vasculari glissonieni drept anterior (seg. 5 și 8) și stâng medial (seg. 4a și 4b). Transecțiunea parenchimului hepatic se efectuează folosindu-se “SONOPET”. Cu evoluție postoperatorie bună, pacienta se externează la 9 zile postoperator. La 6 luni postoperator probele serice AFP – în limite normale, fără semne imagistice de recidivă. Bisectionectomia centrală poate fi realizată atunci când tumora nu invadează pediculii vasculari aferenți parenchimului restant (secțiunea dreaptă posterioara / secțiunea stângă laterală) și presupune doua planuri de secțiune. Concluzii: Bisectionectomia centrală este operația de elecție pentru tumorile hepatice centrale prin care se prezervă cantitatea maxima de parenchim hepatic, minimalizându-se riscul de IHA postoperatorie. Este posibilă în cazuri atent selecționate și necesită experiență în rezecțiile hepatice majore.Introduction: By Brisbane terminology central bisectionectomy is the resection of segments 4a, 4b, 5, and 8 of the liver. Formerly called in different ways (mesohepatectomy, central hepatectomy, central lobectomy) central bisectionectomy is the elective surgery for liver tumors located in central segments (4a, 4b, 5 and 8), with better results than extensive liver resections (right / left trisectionectmy) because it minimizes the risk of postoperative liver failure. Case report: A 54 years old female, presented for right upper quadrant pain, weight loss (8 kg / 2 months); Blood tests: normal AFP; negative Ag Hbs, Ab Anti-HBc, Ab Anti-HCV. UGE/LGE – with a normal aspect; CT scan revealed centrally located liver tumor (segments 4a, 4b, 5, and 8) that includes MHV, away from the portal vein bifurcation. We performed a regulated central bisectionectomy with ligation of vascular pedicles for right anterior section (seg. 5 and 8) and those for left medial section (seg 4a and 4b). With good postoperative course, the patient was discharged in the 9th postoperative day. Six months postoperatively, the patient is good, without tumor relapse signs. Central bisectionectomy can not be performed when the tumor invades the vascular pedicles afferent to remaining parenchyma and requires two planes of transection. Conclusions: Central bisectionectomy is the best choice surgery for centrally located liver tumors which preserves the maximum amount of liver parenchyma thus minimizing the risk of postoperative liver failure

15 years of Romanian national program of liver transplant – a retrospective analysis of 648 patients operated

Centrul de Chirurgie Generală şi Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Transplantul hepatic (TH) a devenit metoda de elecție în tratamentul bolilor hepatice în stadiu terminal, cu peste 20.000 de proceduri anuale la nivel mondial. Scopul acestui studiu este de a analiza rezultatele programului de transplant hepatic românesc după 15 ani de activitate. Material și metode: Între aprilie 2000 și aprilie 2015, 648 de pacienți au fost transplantați cu ficat în România. Raportul pe sexe a fost 382 (m) / 266 (f), în timp ce raportul adulți/copii a fost de 588/60, cu o vârstă medie de 45 de ani. Indicațiile principale pentru TH au fost: ciroza de etiologie VHB (176 pct; 27,1%), HCC (128 pct; 19,7%), și ciroza de etiologie VHC (118 pct; 18,2%). Transplantul hepatic de la donator cadaveric a fost efectuat la 532 pacienți (82,1%): 512 pct cu ficat întreg, 16 pct – cu ficat split, 2 pct – cu ficat redus, transplant-domino – la 2 pct. Transplantul de ficat de la donator viu a fost efectuat la 116 pct (17,9%). Rezultate: Mortalitatea perioperatorie a fost de 7,9% (51 pct). Rata de retransplant a fost de 4,6% (30 pct). Supraviețuirea la 1, 3 și 5 ani pe termen lung a fost estimată la 88,8%, 82,5% și respectiv 79,2%. Timpul de așteptare pentru TH a scăzut semnificativ în timp. Mortalitatea pe un an pe lista de așteptare a scăzut semnificativ, de la 31,4% la 11,8%. Concluzii: Programul de transplant hepatic în România se adresează atât cauzelor de insuficiență hepatică acută și cronică, cât și tumorilor hepatice la adulți și copii, fiind folosite toate tehnicile chirurgicale. Amploarea programului a crescut constant în timp, ceea ce a adus la scurtarea timpului și a ratelor de mortalitate pe lista de așteptare.Background: Liver transplantation (LT) is the treatment of choice for end-stage liver diseases, with more than 20.000 procedures yearly worldwide. The aim of this study was to analyze the results of Romanian National Program of LT after 15 years of activity. Methods: Between April 2000 and April 2015, 648 patients received 678 LTs in Romania. Male/female ratio was 382/266, while adult/pediatric ratio was 588/60, with a mean age range 7 months – 68 yr. Main LT indications in the adult population were HBVrelated cirrhosis (176 pts; 27.1%), hepatocellular carcinoma (128 pts; 19.7%), and HCV-related cirrhosis (118 pts; 18.2%). DDLT (death donor liver transplant) was performed in 532 pts (82.1%): whole LT in 512 pts, split LT in 16 pts, reduced LT in 2 pts, and domino LT in 2 pts. LDLT (living donor liver transplant) was performed in 116 pts (17.9%). Results: Perioperative mortality was 7.9% (51 pts). Retransplantation rate was 4.6% (30 pts). Long-term overall 1-, 3-, and 5- year estimated survival rates were 88.8%, 82.5%, and 79.2%, respectively. Median waiting time for LT decreased significantly over time. One-year overall mortality on waiting list also decreased significantly over time from 31.4% to 11.8%. Conclusions: The liver transplantation program in Romania addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques. The program constantly increased over time, leading to less time and lower mortality rate on the waiting list with the results similar to those of other centers

Living donor liver transplant in Romania – 116 cases experience

Centrul de Chirurgie Generală și Transplant Hepatic “Dan Setlacec”, Institutul Clinic Fundeni, Bucureşti, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Cererea pentru transplantul hepatic în Romania este în continuă creștere în timp ce penuria de donatori de organe persistă. Timpul lung de așteptare pentru un transplant de ficat şi disfuncţia hepatică progresivă aferentă așteptării a motivat multe familii să ia în considerare donarea de organe. Material și metode: În anul 2000 a fost realizat primul transplant hepatic ortotopic cu ficat întreg de către echipa I.Popescu et al. la Institutul Clinic Fundeni din Bucureşti, urmat de transplantul de ficat de la donator viu (LDLT) mai târziu în acelaşi an, ajungând în aprilie 2015 la un total de 116 de transplanturi cu ficat de la donator viu. LDLT a fost realizată cu hemificat drept la 78 pacienți, secțiune laterală stânga – la 26 pacienți, hemificat stâng – la 7 pacienți, hemificat stâng în bloc cu segmentul 1 – la 3 pacienți, şi dual graft – la 2 pacienți. Rezultate: Rata de morbidități majore a fost de 53,4% (62 pacienți), rata generală de retransplant a fost de 11,3% (13 pacienți). Rata de supraviețuire generală la 1-, 3-, şi 5 ani a fost de 88,8%, 82,5%, respectiv, 79,2%. Concluzii: Scopul nostru a fost de a reduce rata mortalității pe lista de așteptare prin scurtarea timpului de aşteptare pentru TH prin asigurarea grefelor necesare. Avantajele LDLT includ posibilitatea de a fi efectuate în regim programat şi cu un timp de aşteptare scurt pentru primitor, în timp ce indicaţiile de transplant pot fi extinse (ex: HCC în afara criteriilor Milano).Introduction: The request for Liver Transplant (LT) in Romania continues to increase while the donor pool size remains inadequate. The long waiting time for a liver transplant and the progressive liver dysfunction that occurs in this time has motivated many families to consider living donation. Material and methods: In 2000, the first successful LT (with whole graft) was carried out by I.Popescu et al. at Fundeni Clinical Institute in Bucharest, followed by the first living donor liver transplantation (LDLT) (successful) later the same year, reaching 116 living donors liver transplants by April 2015. LDLT was performed with right hemiliver in 78 pts, left lateral section in 26 pts, left hemiliver in 7 pts, left hemiliver with segment 1 in 3 pts, and dual graft LDLT in 2 pts: one received a right hemiliver and a left lateral section (17), and one received a left hemiliver and a left lateral section. Results: Major morbidity rates were 53.4% (62 pts) Overall retransplantation rate was 11.3% (13 pts). Long-term overall 1-, 3-, and 5- year estimated survival rates were 88.8%, 82.5%, and 79.2%, respective. Conclusions: Our main goal was to continuously reduce the drop-out rate on waiting list (due to mortality and morbidity) by shortening the waiting time for LT insured by providing the necessary grafts. Advantages of LDLT include the ability to be performed on an elective basis, with optimal timing and no waiting time for the recipient, while the indications for transplantation may be extended (i.e. HCC beyond Milan criteria)

Electron Neutrino and Antineutrino Appearance in the Full MINOS Data Sample

We report on v(e) and (v) over bar (e) appearance in v(mu) and (v) over bar (mu) beams using the full MINOS data sample. The comparison of these v(e) and (v) over bar (e) appearance data at a 735 km baseline with theta(13) measurements by reactor experiments probes delta, the theta(23) octant degeneracy, and the mass hierarchy. This analysis is the first use of this technique and includes the first accelerator long-baseline search for (v) over bar (mu) -\u3e (v) over bar (e). Our data disfavor 31% (5%) of the three-parameter space defined by delta, the octant of the theta(23), and the mass hierarchy at the 68% (90%) C.L. We measure a value of 2sin(2)(2 theta(13))sin(2)(theta(23)) that is consistent with reactor experiments. DOI: 10.1103/PhysRevLett.110.17180

Comparisons of annual modulations in MINOS with the event rate modulation in CoGeNT

The CoGeNT Collaboration has recently published results from a fifteen month data set which indicate an annual modulation in the event rate similar to what is expected from weakly interacting massive particle interactions. It has been suggested that the CoGeNT modulation may actually be caused by other annually modulating phenomena, specifically the flux of atmospheric muons underground or the radon level in the laboratory. We have compared the phase of the CoGeNT data modulation to that of the concurrent atmospheric muon and radon data collected by the MINOS experiment which occupies an adjacent experimental hall in the Soudan Underground Laboratory. The results presented are obtained by performing a shape-free chi(2) data-to-data comparison and from a simultaneous fit of the MINOS and CoGeNT data to phase-shifted sinusoidal functions. Both tests indicate that the phase of the CoGeNT modulation is inconsistent with the phases of the MINOS muon and radon modulations at the 3.0 sigma level. DOI: 10.1103/PhysRevD.87.03200

Measurement of Neutrino and Antineutrino Oscillations Using Beam and Atmospheric Data in MINOS

We report measurements of oscillation parameters from v(mu) and (v) over bar (mu) disappearance using beam and atmospheric data from MINOS. The data comprise exposures of 10.71 X 10(20) protons on target in the v(mu)-dominated beam, 3.36 X 10(20) protons on target in the (v) over bar (mu)-enhanced beam, and 37.88 kton yr of atmospheric neutrinos. Assuming identical v and (v) over bar oscillation parameters, we measure vertical bar Delta m(2)vertical bar = (2.41(-0.10)(+0.09)) X 10(-3) eV(2) and sin(2)(2 theta) = 0.950(-0.036)(+0.035). Allowing independent v and (v) over bar oscillations, we measure antineutrino parameters of vertical bar(m) over bar (2)vertical bar = (2.50(-0.250)(+0.23)) X 10(-3) eV(2) and sin(2)(2 (theta) over bar) = 0.97(-0.08)(+0.03), with minimal change to the neutrino parameters

Observation of muon intensity variations by season with the MINOS near detector

A sample of 1.53 x 10(9) cosmic-ray-induced single muon events has been recorded at 225 m water equivalent using the MINOS near detector. The underground muon rate is observed to be highly correlated with the effective atmospheric temperature. The coefficient alpha(T), relating the change in the muon rate to the change in the vertical effective temperature, is determined to be 0.428 +/- 0.003(stat.) +/- 0.059(syst.). An alternative description is provided by the weighted effective temperature, introduced to account for the differences in the temperature profile and muon flux as a function of zenith angle. Using the latter estimation of temperature, the coefficient is determined to be 0.352 +/- 0.003(stat.) +/- 0.046(syst.)

Precision measurement of the speed of propagation of neutrinos using the MINOS detectors

We report a two-detector measurement of the propagation speed of neutrinos over a baseline of 734 km. The measurement was made with the NuMI beam at Fermilab between the near and far MINOS detectors. The fractional difference between the neutrino speed and the speed of light is determined to be (v/c - 1) = (1.0 +/- 1.1) x 10(-6), consistent with relativistic neutrinos

Measurement of the multiple-muon charge ratio in the MINOS Far Detector

The charge ratio, R-mu = N mu + / N mu-, for cosmogenic multiple-muon events observed at an underground depth of 2070 mwe has been measured using the magnetized MINOS Far Detector. The multiple-muon events, recorded nearly continuously from August 2003 until April 2012, comprise two independent data sets imaged with opposite magnetic field polarities, the comparison of which allows the systematic uncertainties of the measurement to be minimized. The multiple-muon charge ratio is determined to be R mu = 1.104 + / - 0.006(stat)(-0.010)( + 0.009) (syst). This measurement complements previous determinations of single-muon and multiple-muon charge ratios at underground sites and serves to constrain models of cosmic-ray interactions at TeV energies

Observation of seasonal variation of atmospheric multiple-muon events in the MINOS Near and Far Detectors

We report the first observation of seasonal modulations in the rates of cosmic ray multiple-muon events at two underground sites, the MINOS Near Detector with an overburden of 225 mwe, and the MINOS Far Detector site at 2100 mwe. At the deeper site, multiple-muon events with muons separated by more than 8 m exhibit a seasonal rate that peaks during the summer, similar to that of single-muon events. In contrast and unexpectedly, the rate of multiple-muon events with muons separated by less than 5-8 m, and the rate of multiple-muon events in the smaller, shallower Near Detector, exhibit a seasonal rate modulation that peaks in the winter