Preoperative Predictive Nomogram Based on Alanine Aminotransferase, Prothrombin Time Activity, and Remnant Liver Proportion (APART Score) to Predict Post-Hepatectomy Liver Failure after Major Hepatectomy

Introduction: Post-hepatectomy liver failure (PHLF) is a serious complication associated with major hepatectomies. An accurate prediction of PHLF is necessary to determine the feasibility of major hepatectomy. This study aimed to assess the association between PHLF and preoperative laboratory and computed tomography (CT) findings. Methods: Medical records of 65 patients who underwent major hepatectomy and preoperative CT were retrospectively reviewed. We evaluated future remnant liver volume evaluation models and remnant liver hemodynamics, which were assessed by arterial enhancement fraction (AEF) by using preoperative CT. Variables, including CT findings, were compared between patients with and without PHLF after major hepatectomy, and the preoperative PHLF-predicting nomogram was constructed using multivariate logistic regression. Results: The PHLF group included 21 patients (32.3%). The AEF was not significantly different between the two groups. In the future remnant liver volume evaluation models, future remnant liver proportion (fRLP) had the highest concordance index (C-index) in the receiver operating characteristic curve analysis (C-index, 0.755). Multivariate analysis of preoperative evaluable factors revealed that alanine aminotransferase levels (p = 0.034), prothrombin time activity (p = 0.021), and fRLP (p = 0.012) were independent predictive factors of PHLF. A nomogram (APART score) was constructed using these three factors, with a receiver operating curve showing a C-index of 0.894. According to the APART score, scores of 51-60 indicated moderate risk (40.0%), and scores over 60 indicated a high risk of PHLF (83.3%) (p < 0.001). Discussion: The APART score may help predict PHLF in patients indicated for major hepatectomies.journal articl

Anesthetic management of a patient with 15q tetrasomy for dental treatment

Background and objectives: 15q tetrasomy is a chromosomal abnormality that is a part of the heterogeneous group of extra structurally abnormal chromosomes. This syndrome is characterized by epilepsy, central hypotonia, developmental delay and intellectual disability, and autistic behavior. This is the first report of the anesthetic management of a patient with this syndrome. Case report: We administered general anesthesia for dental treatment in a patient with 15q tetrasomy. Conclusions: Appropriate planning for the prevention of complications such as seizures and hypotonia, and for delayed emergence from anesthesia, is required. Specifically, choosing short-acting drugs that do not induce seizures, together with suitable monitoring, resulted in successful anesthetic management of the patient with 15q tetrasomy

Manejo anestésico de paciente com tetrassomia 15q para tratamento odontológico

Justificativa e objetivos: Tetrassomia 15q e uma anomalia cromossomica que faz parte do grupo heterogeneo de cromossomos extras, estruturalmente anormais. Essa sindrome e caracterizada por epilepsia, hipotonia central, atraso no desenvolvimento e deficiencia intelectual e comportamento autista. Este e o primeiro relato do manejo anestesico de um paciente com essa sindrome. Relato de caso: Administramos anestesia geral para tratamento odontologico em um paciente com tetrassomia 15q. Conclusoes: Um planejamento adequado para prevenir complicac，oes como convulsoes e hipotonia e para emergencia tardia da anestesia e necessario. O manejo anestesico bem-sucedido do paciente com tetrassomia 15q foi o resultado especifico da escolha de farmacos de curta durac，ao que nao induzem convulsoes e monitorac，ao adequada

Carbon ion radiotherapy for inoperable pediatric osteosarcoma.

Background: Unresectable pediatric osteosarcoma has poor outcomes with conventional treatments.Results: Twenty-six patients aged 11-20 years (median 16) had inoperable osteosarcoma of the trunk (24 pelvic, 1 mediastinal and 1 paravertebral) without any other lesion at initial examination. There were 22 primary, 1 locally recurrent and 3 metastatic cases. Median CIRT dose was 70.4 Gy RBE (relative biological effectiveness) delivered in 16 fractions. Median follow-up was 32.7 months. Overall survival was 50.0% and 41.7% at 3 and 5 years, respectively. Ten patients survived for more than 5 years (range 5-20.7 years). Local control was 69.9% and 62.9% at 3 and 5 years, respectively and progression-free survival was 34.6% at 3 and 5 years. Only largest tumor diameter correlated with 5-year overall survival and local control. There were 4 grade 3-4 CIRT-related late toxicities, 1 case of bone fracture and no treatment-related mortalities. All patients (except 1) were able to ambulate after CIRT.Conclusions: CIRT was safe and efficacious in the treatment of inoperable pediatric osteosarcoma with improved local control and overall survival compared to conventional treatments.Methods: We retrospectively reviewed the records of pediatric and adolescent patients who received carbon ion radiotherapy (CIRT) for inoperable osteosarcoma between 1996 and 2014

A comparison of the hemodynamic responses between fentanyl and fentanyl-remifentanil in total intravenous anesthesia for orthognathic surgery

Background: The purpose of this retrospective study was to examine whether total intravenous anesthesia (TIVA) with fentanyl-remifentanil has potential hemodynamic advantages over that with fentanyl alone in orthognathic surgery. Methods: The subjects were 42 generally healthy patients who underwent orthognathic surgery under TIVA using propofol and opioids. Nineteen patients received fentanyl alone (F group), and 23 received fentanyl and remifentanil (FR group) as narcotic analgesics. The factors investigated included arterial blood pressure (ABP), heart rate, the lability index (L.I.) of ABP, number of case that required ephedrine and hypotensive anesthesia. The data between the two groups were compared using the Student’s t-test or Fisher’s exact test. Results: The ABP during anesthesia was significantly lower in the FR group than in the F group. The L.I of the ABP in the FR group was significantly lower than in the F group. The total dose of nitroglycerin for hypotensive anesthesia in the FR group was significantly smaller than that in the F group. The number of cases that required ephedrine was significantly higher in the F R group than in the F group, but hypotension that required administration of ephedrine easily improved, and no refractory hypotension was observed. Conclusion: Total intravenous anesthesia with fentanyl-remifentanil provides superior hemodynamic stability without unacceptable changes in the intraoperative AB