Przesuwanie granicy wieku i zmniejszanie liczby przeciwwskazań do resekcji wątroby u obciążonych onkologicznych chorych — opis przypadku

Liver resections are performed in increasing numbers due to oncological indications. Thus, the indications for surgical treatment of liver tumors are constantly expanding. Advanced age and other comorbidities often exclude this group of patients from treatment by liver resection. Patient C.S. (80 y.a., height 166 cm, weight 97 kg, ASA = 4) with risk factors was admitted for resection of metastatic lesions (adenocarcinoma) of the cecum to the liver. The patient was diagnosed with hypertension, atherosclerosis, stable coronary heart disease, type 2 diabetes, chronic renal failure (eGFR = 37), obesity, degenerative spinal lesions, sigmoid colon diverticulitis, dystonic tremor of the head. Previously operated upon and had amputation of the uterus with appendages (2005), cholecystectomy, right hemicolectomy (2012) complicated by respiratory failure with the need for ventilation seven days post-surgery. Prior to surgery, the patient had imaging tests such as ultrasound, CT and MRI scans of the abdomen, which confirmed a 55mm metastatic tumor in the seventh segment of the liver. The results were analyzed during a radiological and surgical consultation in order to prepare the safest available surgical access and the scope of the planned resection. A cardiac echocardiography was performed and the patient had a cardio-, neuro- and anesthetic consultation. The patient was fully informed about the high risk of complications and possible operational failure. During surgery a right hemihepatectomy was performed. The resected lobe weighed 712 g. Blood loss was < 500 ml, 2 units RBC and 2 units FFP were transfused. The surgery and the postoperative period proceeded without serious complications. The only problem was a short-lived biliary fistula, which healed spontaneously. Age and comorbid conditions are often a contraindication for surgery, but with proper medical support, the opportunity to interact with other professionals and thorough preparation of the patient and the team of surgeons, the risk of failure can be significantly minimized. A modern, personalized, multidisciplinary approach towards each patient can expand indications and reduce contraindications for hepatic resection.Resekcje wątroby ze wskazań onkologicznych są coraz częściej wykonywaną operacją. Wskazania do leczenia operacyjnego nowotworów wątroby stale są rozszerzane, wciąż jednak zaawansowany wiek pacjenta oraz inne towarzyszące choroby często wykluczają tę grupę chorych z leczenia resekcją wątroby. Chora C.S. (lat 80, wzrost 166 cm, masa ciała 97 kg, ASA = 4) obciążona internistycznie została zakwalifikowana do resekcji zmiany przerzutowej gruczolakoraka kątnicy do wątroby. W wywiadzie nadciśnienie tętnicze, uogólniona miażdżyca, stabilna choroba niedokrwienna serca, cukrzyca typu 2, przewlekła niewydolność nerek (eGFR = 37), otyłość, stany zwyrodnieniowe kręgosłupa, uchyłkowatość esicy, drżenie dystoniczne głowy. Stan po amputacji macicy z przydatkami (2005), po cholecystektomii, po hemikolektomii prawostronnej (2012) powikłanej niewydolnością oddechową z koniecznością wentylacji 7 dni od operacji. Wykonano USG, TK i MR jamy brzusznej, które potwierdzały guz przerzutowy o średnicy 55 mm w VII segmencie wątroby. Wyniki tych badań były dokładnie omówione na konsylium radiologiczno-chirurgicznym w celu zaplanowania najbezpieczniejszego dostępu i zakresu planowanej resekcji. Wykonano echokardiografię serca i konsultowano chorą kardiologicznie, neurologicznie oraz anestezjologicznie. Pacjentka była w pełni poinformowana o wysokim ryzyku powikłań i ewentualnego niepowodzenia operacji. Podczas operacji wykonano hemihepatektomię prawostronną. Resekowana część wątroby ważyła 712 g. Utrata krwi w czasie operacji < 500 ml, przetoczono 2 j. KKCz oraz 2 j. FFP. Chora zniosła zabieg operacyjny i okres pooperacyjny bez powikłań. Jedynym problemem była krótkotrwała przetoka żółciowa, która zagoiła się samoistnie. Wiek i choroby towarzyszące często stanowią przeciwwskazanie do leczenia operacyjnego, jednak przy odpowiednim zapleczu medycznym, możliwości współpracy z innymi specjalistami oraz dokładnym przygotowaniem chorego i zespołu przeprowadzającego operację ryzyko niepowodzenia znacznie spada. Zatem nowoczesne, indywidualne, wielospecjalistyczne podejście do chorego pozwala rozszerzać wskazania i zmniejszać przeciwwskazania do resekcji wątroby

Psi4

Psi4 is an ab initio electronic structure program providing methods such as Hartree-Fock, density functional theory, configuration interaction, and coupled-cluster theory. The 1.1 release represents a major update meant to automate complex tasks, such as geometry optimization using complete-basis-set extrapolation or focal-point methods. Conversion of the top-level code to a Python module means that Psi4 can now be used in complex workflows alongside other Python tools. Several new features have been added with the aid of libraries providing easy access to techniques such as density fitting, Cholesky decomposition, and Laplace denominators. The build system has been completely rewritten to simplify interoperability with independent, reusable software components for quantum chemistry. Finally, a wide range of new theoretical methods and analyses have been added to the code base, including functional-group and open-shell symmetry adapted perturbation theory, density-fitted coupled cluster with frozen natural orbitals, orbital-optimized perturbation and coupled-cluster methods (e.g., OO-MP2 and OO-LCCD), density-fitted multiconfigurational self-consistent field, density cumulant functional theory, algebraic-diagrammatic construction excited states, improvements to the geometry optimizer, and the "X2C" approach to relativistic corrections, among many other improvements

Management of Giant Hepatic Hemangioma in Atypical Localization; Report of a Case and Literature Review

Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas. We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient’s life. After patient’s consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment

Improving “Silver-Standard” Benchmark Interaction Energies with Bond Functions

We investigate the effect of adding midbond basis functions on the performance of various conventional and explicitly correlated (F12) estimates of complete basis set limit coupled-cluster (CCSD­(T)/CBS) noncovalent interaction energies. In particular, we search for an improved “silver standard” of interaction energy calculations for systems where the CCSD­(T) computation is feasible in a double-ζ basis but not in a triple-ζ one. We follow a recent study (Sirianni J. Chem. Theory Comput. 2017, 13, 86) of different CCSD­(T)-F12 variants in midbondless bases over the A24 and S22 benchmark interaction energy databases, and extend Dunning’s correlation-consistent basis sets with three different midbond sets. The addition of bond functions is highly beneficial for conventional CCSD­(T) and most CCSD­(T)-F12 variants, improving both the CCSD part and the unscaled triples contribution. However, the commonly used scaling of triples by the ratio of the MP2-F12 and MP2 correlation energies usually overshoots: as a result, the scaled triples term gets worse upon the addition of bond functions. In contrast, a milder triples scaling by the ratio of the CCSD-F12b and CCSD correlation energies (Brauer , Phys. Chem. Chem. Phys. 2016, 18, 20905) leads to the most accurate estimates of this term as long as bond functions are included. The combination of the triples term scaled in this way with the CCSD-F12b interaction energy leads to the CCSD­(Tbb)-F12b approach that provides consistent high accuracy when a (3<i>s</i>3<i>p</i>2<i>d</i>2<i>f</i>) set of midbond functions is added to the aug-cc-pVDZ atom-centered basis set. The combination of midbond functions and the composite MP2/CBS+δ­(CCSD­(T)) treatment is able to make up for the deficiencies in the atom-centered part of the basis set, in particular, for a partial (or even complete) lack of diffuse functions. Considering both the A24 and S22 accuracy and the computational efficiency, we propose several new “silver standard” approaches improving upon the currently established midbondless levels of theory, ranging from the most consistent CCSD­(Tbb)-F12b/aug-cc-pVDZ+(3<i>s</i>3<i>p</i>2<i>d</i>2<i>f</i>) variant (with mean unsigned errors of 0.010 and 0.042 kcal/mol for the A24 and S22 databases, respectively) to the significantly cheaper MP2/CBS+δ­(CCSD­(T))/cc-pVDZ+(3<i>s</i>3<i>p</i>2<i>d</i>2<i>f</i>) approach (mean unsigned errors of 0.039 and 0.096 kcal/mol for A24 and S22, respectively)

Toward an Accurate Description of Methane Physisorption on Carbon Nanotubes

We present a high-level ab initio investigation of the effects of model size and curvature on the exterior and interior binding energy of methane on single-walled carbon nanotubes. The interaction energies of methane with curved coronene were computed using complete basis set MP2 with a CCSD­(T) correction. A variety of novel dispersion-including density functional approaches were then compared to the benchmark data. The top-performing functionals were used to calculate binding energies between methane and larger nanotube fragments all the way through infinite nanotubes. The methane binding energy of a narrow (9,0) carbon nanotube, compared to a flat graphene surface, is decreased by 32% on the exterior but increased by 185% on the interior

Toward an Accurate Description of Methane Physisorption on Carbon Nanotubes

We present a high-level ab initio investigation of the effects of model size and curvature on the exterior and interior binding energy of methane on single-walled carbon nanotubes. The interaction energies of methane with curved coronene were computed using complete basis set MP2 with a CCSD­(T) correction. A variety of novel dispersion-including density functional approaches were then compared to the benchmark data. The top-performing functionals were used to calculate binding energies between methane and larger nanotube fragments all the way through infinite nanotubes. The methane binding energy of a narrow (9,0) carbon nanotube, compared to a flat graphene surface, is decreased by 32% on the exterior but increased by 185% on the interior

Toward an Accurate Description of Methane Physisorption on Carbon Nanotubes

We present a high-level ab initio investigation of the effects of model size and curvature on the exterior and interior binding energy of methane on single-walled carbon nanotubes. The interaction energies of methane with curved coronene were computed using complete basis set MP2 with a CCSD­(T) correction. A variety of novel dispersion-including density functional approaches were then compared to the benchmark data. The top-performing functionals were used to calculate binding energies between methane and larger nanotube fragments all the way through infinite nanotubes. The methane binding energy of a narrow (9,0) carbon nanotube, compared to a flat graphene surface, is decreased by 32% on the exterior but increased by 185% on the interior

Benchmarking the CO₂ Adsorption Energy on Carbon Nanotubes

We present benchmark interaction energy calculations of carbon dioxide physisorbed onto flat and curved polycyclic aromatic hydrocarbons as models of carbon nanotubes. The accuracy of the complete-basis-set second-order Møller–Plesset perturbation theory combined with a CCSD­(T) coupled-cluster correction in a moderate basis set is first assessed for a series of CO₂–(benzene, naphthalene, and pyrene) complexes to establish the basis set requirements. The same composite approach is then used to compute accurate interaction energies for 195 CO₂–curved coronene geometries representing different intermolecular distances, orientations, and nanotube diameters. The CO₂–curved coronene benchmark data set is then used to assess the performance of a wide variety of dispersion-including DFT functionals. Among them, only the nonlocal VV10 and double-hybrid B2PLYP-D3­(BJ) functionals exhibit relative errors below 10%. Interestingly, all DFT variants deviate strongly from the benchmark at short-range because of overdamping. We show that these short-range deficiencies can be corrected by refitting the damping parameters of Grimme’s -D3 dispersion approach on the newly constructed data set and that the refitted parameters are also suitable for the complexes of CO₂ with larger polycyclic aromatic hydrocarbons but not for the smaller CO₂–benzene and CO₂–naphthalene systems