Arterialisation of the Portal Vein With an Aortoportal Jump Graft for Portal Vein Thrombosis Following Liver Resection for Malignancy

Fibrolamellar hepatocellular carcinoma (FHCC) is a variant of hepatocellular carcinoma, which mainly affects a young age group and carries a relatively good prognosis. It is widely accepted that aggressive curative resection is still the best option for FHCC. We report here a case of successful arterialisation of the portal vein with an aortoportal jump graft for portal vein thrombosis, which developed postoperatively in an already comprised portal vein with tumour invasion following an extensive liver resection for FHCC

Controversy in the Management of Cholangitis Secondary to Hydatid Daughter Cysts

A 36 year old Cypriot woman, resident in the U.K. since the age of three years, presented with pyrexia, jaundice and upper abdominal pain. On ultrasound examination the biliary tree was dilated, contained sludge and a cystic lesion was present in the liver. An endoscopic cholangiogram showed multiple filling defects in the bile duct which were not felt to be removable endoscopically and a nasobiliary drain was therefore inserted. On resolution of the cholangitis with drainage and antibiotics a laparotomy was performed. The right lobe of the liver was largely replaced by a multiloculated cyst and the bile duct contained multiple hydatid daughter cysts. A right hepatectomy was performed with t-tube drainage of the evacuated bile duct. She made an uneventful recovery and has had no problems on subsequent follow up. Histology confirmed an intrabiliary rupture of a hydatid liver cyst

Nonlinear Dynamic and Kinematic Model of a Spar-Buoy: Parametric Resonance and Yaw Numerical Instability

Mathematical models are essential for the design and control of offshore systems, to simulate the fluid–structure interactions and predict the motions and the structural loads. In the development and derivation of the models, simplifying assumptions are normally required, usually implying linear kinematics and hydrodynamics. However, while the assumption of linear, small amplitude motion fits traditional offshore problems, in normal operational conditions (it is desirable to stabilize ships, boats, and offshore platforms), large motion and potential dynamic instability may arise (e.g., harsh sea conditions). Furthermore, such nonlinearities are particularly evident in wave energy converters, as large motions are expected (and desired) to enhance power extraction. The inadequacy of linear models has led to an increasing number of publications and codes implementing nonlinear hydrodynamics. However, nonlinear kinematics has received very little attention, as few models yet consider six degrees of freedom and large rotati ons. This paper implements a nonlinear hydrodynamic and kinematic model for an archetypal floating structure, commonplace in offshore applications: an axisymmetric spar-buoy. The influence of nonlinear dynamics and kinematics causing coupling between modes of motion are demonstrated. The nonlinear dynamics are shown to cause parametric resonance in the roll and pitch degrees of freedom, while the nonlinear kinematics are shown to potentially cause numerical instability in the yaw degree of freedom. A case study example is presented to highlight the nonlinear dynamic and kinematic effects, and the importance of including a nominal restoring term in the yaw DoF presented

Immunological basis of genesis of hepatocellular carcinoma : unique challenges and potential opportunities through immunomodulation

A majority of hepatocellular carcinoma (HCC) develops in the setting of persistent chronic inflammation as immunological mechanisms have been shown to play a vital role in the initiation, growth and progression of tumours. The index review has been intended to highlight ongoing immunological changes in the hepatic parenchyma responsible for the genesis and progression of HCC. The in-situ vaccine effect of radiofrequency (RF) is through generation tumour-associated antigens (TAAs), following necrosis and apoptosis of tumour cells, which not only re-activates the antitumour immune response but can also act in synergism with checkpoint inhibitors to generate a superlative effect with intent to treat primary cancer and distant metastasis. An improved understanding of oncogenic responses of immune cells and their integration into signaling pathways of the tumour microenvironment will help in modulating the antitumour immune response. Finally, we analyzed contemporary literature and summarised the recent advances made in the field of targeted immunotherapy involving checkpoint inhibitors along with RF application with the intent to reinstate antitumour immunity and outline future directives in very early and early stages of HCC

Colorectal cancer liver metastases: laparoscopic and open radiofrequency-assisted surgery

Introduction: The liver is the most common site of colorectal metastases (colorectal liver metastases – CLM). Surgical treatment in combination with oncological therapy is the only potentially curative method. Unfortunately, only 10–25% of patients are suitable for surgery. Traditionally, open liver resection (OLR) is usually performed. However, laparoscopic liver resection (LLR) has become popular worldwide in the last two decades. Aim: To evaluate the effectiveness and benefits of radiofrequency minor LLR of CLM in comparison with OLR. Material and methods: The indication for surgery was CLM and the possibility to perform minor laparoscopic or OLR not exceeding two hepatic segments according to Couinaud’s classification. Results: Sixty-six minor liver resections for CLM were performed. Twenty-five (37.9%) patients underwent a laparoscopic approach and 41 (62.1%) patients underwent OLR. The mean operative time was 166.4 min for LLR and 166.8 min for OLR. Average blood loss was 132.3 ±218.0 ml during LLR and 149.5 ±277.5 ml during OLR. Length of hospital stay was 8.4 ±2.0 days for LLR and 10.5 ±5.8 days for OLR. All resections were R0. There was no case of mortality. Postoperative complications were recognized in 9 (13.6%) patients: 8 in the group of OLR patients and 1 in the LLR group. The median survival time for LLR was 70.5 months and for OLR 61.9 months. The 5-year overall survival rate was higher for LLR vs. OLR – 82.1% vs. 69.8%. The average length of disease-free interval after LLR was greater (52.2 months) in comparison with OLR (49.4%). The 5-year disease-free interval was 63.2% for LLR and 58% for OLR. Conclusions: Outcomes and oncological radicality of minor laparoscopic liver resections of CLM are comparable to outcomes of OLR.Web of Science10221220