The Survival Paradox of Elderly Patients After Major Liver Resections

The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age

Een goede buur? : LR46 en LR49: definitief archeologisch onderzoek naar een vicus, grafvelden, infrastructuur en een inheemse nederzetting in de omgeving van het Romeinse castellum in de Meern, deelgebied 'De Woerd' (gemeente Utrecht)

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Basisrapportage Archeologie 19

In 2004 is er door de gemeente Utrecht archeologisch onderzoek verricht in Leidsche Rijn deelplan De Woerd. Het onderzoek had hoofdzakelijk betrekking op het zuidelijk deel van de burgerlijke nederzetting (vicus) die hoorde bij het Romeinse castellum op de Hoge Woerd. In totaal is er 4,5 ha vlakdekkend onderzocht, waarvan het leeuwendeel van de sporen inderdaad Romeins bleek te zijn. Tijdens het onderzoek zijn onder meer twee Romeinse wegen gevonden. De eerste daarvan, die noordwest-zuidoost was georiënteerd, had een oppervlakte van ruim 8.000 m² en is grotendeels onderzocht. De tweede was noordoost-zuidwest georiënteerd en lag daarmee min of meer haaks op de eerste. Ook van de vicus zijn sporen teruggevonden. De aanleg van de vroegste fase kon in de (midden- of laat-) Flavische tijd worden gedateerd. Vanaf de tweede helft en met name in het laatste kwart van de tweede eeuw nam de menselijke activiteit sterk toe. Wat die activiteit op het onderzochte terrein precies inhield, is niet geheel duidelijk, maar op grond van het ecologisch vondstmateriaal kan worden aangenomen dat er paarden zijn gehouden. Mogelijk wijst dit op een voornamelijk agrarische functie van dit terreindeel. Aan het einde van de tweede eeuw veranderde het terrein in een erf met een gebouw en een waterput. In het tweede kwart van de derde eeuw werd het terrein waarschijnlijk verlaten. Tijdens het onderzoek zijn 64 crematies aangetroffen, die in vier verschillende clusters verspreid lagen over het terrein. Het onderzoek heeft nieuwe inzichten opgeleverd over de ontwikkeling van de vicus en de infrastructuur rondom het Romeinse castellum op de Hoge Woerd. Daarnaast zijn er aanknopingpunten voor verder onderzoek naar de sociale en politieke relaties tussen de bewoners van de inheemse nederzetting en de vertegenwoordigers van het Romeinse gezag in het castellum

Wegens wateroverlast : LR 39 De Balije II: wachttorens, rivierdynamiek en Romeinse infrastructuur in een rievierbocht van de Heldammer Stroom

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Computational Simulation of Authority-Responsibility Mismatches in Air-Ground Function Allocation

Authority-responsibility mismatches are created when one agent is authorized (has authority) to perform an activity, but a different agent is responsible for its outcome. An authority-responsibility mismatch demands monitoring by the responsible agent that itself requires additional information transfer and taskload. This paper demonstrates a computational simulation methodology that identifies when mismatches will occur in complex, multi-agent aviation operations, and their implications for information transfer between agents and task demands on each agent. A case study examines 25 authority and responsibility allocations in a NextGen/SESAR scenario in a terminal area where authority and responsibility for activities involving optimal profile descents, merging and spacing can be fluidly allocated to the aircraft (pilot/flight management system) or to the ground (air traffic controller/controller decision aids and automation)

Outcome and pattern of recurrence after curative resection for hepatocellular carcinoma in patients with a normal liver compared to patients with a diseased liver

Background/Aims: The purpose of this study was to investigate whether differences existed in demography and outcome after resection for hepatocellular carcinoma (HCC) in patients with a normal liver compared to patients with a diseased liver. Methodology: Twenty-seven Caucasian patients with HCC in a histologically proven normal liver (NL group) in the Netherlands and 141 Asian patients with HCC in a diseased liver (DL group) in Japan underwent a curative liver resection. Patient and tumor characteristics, post-resectional disease-free, overall survival rates and pattern of recurrence were investigated. Results: HCC's in the NL group were found to be larger, in a more advanced stage and needed more extended resections compared to HCC's in the DL group. Microvascular invasion was similar in both groups, while capsule formation was observed less in the NL group. Overall survival and disease-free survival after curative resection were not statistically different between both groups. Also even after stratification for T-stage, there was no difference in survival Although the rate of recurrence was similar in both groups, a significantly higher number of extrahepatic metastases was observed in the NL group. Conclusions: Distinct demographic differences existed between patients with HCC in the NL group compared to patients in the DL group. Extrahepatic recurrences were more frequent after curative resection for HCC in a normal liver. No difference in survival was demonstrated between both groups

The Clinical Relevance of the Anhepatic Phase During Liver Transplantation

This study assesses the relation between the anhepatic phase duration and the outcome after liver transplantation. Of 645 patients who underwent transplantation between 1994 and 2006, 194 were recipients of consecutive adult primary piggyback liver transplants using heart-beating donors. The anhepatic phase was defined as the time from the physical removal of the liver from the recipient to recirculation of the graft. Other noted study variables were the cold and warm ischemia times, donor and recipient age, donor and recipient body mass index, perioperative red blood cell (RBC) transfusion, indication for transplantation, and Model for End-Stage Liver Disease score. The primary outcome parameter was graft dysfunction, which was defined as either primary nonfunction or initial poor function according to the Ploeg-Maring criteria. The median anhepatic phase was 71 minutes (37-321 minutes). Graft dysfunction occurred in 27 patients (14%). Logistic regression analysis showed an anhepatic phase over 100 minutes [odds ratio (OR), 4.28], a recipient body mass index over 25 kg/m(2) (OR, 3.21), and perioperative RBC transfusion (OR, 3.04) to be independently significant predictive factors for graft dysfunction. One-year patient survival in patients with graft dysfunction was 67% versus 92% in patients without graft dysfunction (P <0.001). A direct relation between the anhepatic phase duration and patient survival could, however, not be established. In conclusion, this study shows that liver transplant patients with an anhepatic phase over 100 minutes have a higher incidence of graft dysfunction. Patients with graft dysfunction have significantly worse 1-year patient survival. Liver Transpl 15:1050-1055, 2009. (C) 2009 AASLD