Liver resection by Ultrasonic Dissection and lntraoperative Ultrasonography

Ultrasonic dissetion (USD) and intraoperative ultrasonography (IOUS) have shown encouraging results in a retrospective analysis of 109 patients with benign or malignant liver disease. Of 109 patients assessed between 1980 and 1993, 84 were resected: 27 by finger fracture technique (FFT) and 57 by USD. Hospital mortality was 4.8% (4/84) and 30-day mortality was 6.0% (5/84). Overall morbidity was 48.8% (41/84) and liver related morbidity (hepatic bleeding, sepsis, and bile leak) was 34.5% (29/84); of the 29 patients, 5 required re-operation. Liver complications occurred in 12/27 (44.4%) in the FFT group as opposed to 17/57 (29.8%) in the USD group. The incidence of postoperative hepatic bleeding was significantly less by USD than by FFT(p=O.03). As well, intraoperative blood loss (p=O.01)number of intraoperative blood units used (p=0.002), and postoperative length of stay (p=O.O09) have been significantly reduced by USD. IOUS was used on 64 patients. Not only has it improved the sensitivity (99%) and specificity (98%) for detection of hepatic neoplasms, it has also helped increase the precision and accuracy of anatomical tumour localization. As a result, 11/64 patients (17.2%) had their preoperative plans changed: 8 were abandoned and 3 were revised. In summary, USD has significantly reduced intraoperative blood loss and hence reduced the number of intraoperative transfusions, incidence of postoperative complications and postoperative length of stay. IOUS should be routinely employed in patients undergoing liver resection since it provides critical information that could obviate oncologically useless resections

Electronic resonance enhanced coherent anti-Stokes Raman scattering technique for detection of combustion species and biological molecules

The application of electronic-resonance enhanced (ERE) coherent anti-Stokes Raman scattering (CARS) for the detection of nitric oxide (NO) and acetylene (C2H2) is experimentally demonstrated and the effects of various parameters on the ERE CARS signal investigated. In addition, the detection of dipicolinic acid (DPA) using âÂÂnormalâ CARS is demonstrated. For NO detection, the frequency difference between a visible Raman pump beam and Stokes beam is tuned to a vibrational Q-branch Raman resonance of the No molecule to create a Raman polarization in the medium. The second pump beam is tuned into resonance with the rotational transitions in the (1,0) band of the A2ã+-X2à electronic transition at 236 nm, and the CARS signal is thus resonant with transitions in the (0,0) band. A NO gas cell was used for the experiment to detect NO at various pressure levels. A significant resonant enhancement of the NO CARS signal was observed and good agreement between calculated and experimental data was obtained. For C2H2 detection, ERE CARS experiments were performed in a roomtemperature gas cell using mixtures of 5000 ppm C2H2 in N2. Visible pump and Stokes beams were used, with the frequency difference between the pump and Stokes tuned to the 1974 cm-1 ÃÂ2 Raman transition of C2H2. An ultraviolet probe beam with the wavelengths ranging from 232 nm to 242 nm is scattered from the induced Raman polarization to generate the ERE CARS signal. The effects of probe wavelength and pressure on signal generation are discussed. CARS was used to detect the 998 cm-1 vibrational Raman transition from a sample of polycrystalline DPA. The transition is the breathing ring vibration in the pyridine ring structure in the DPA molecule. The DPA 998 cm-1 transition is detected with excellent signal-to-noise ratio and the full-width-at-half-maximum is very narrow, approximately 4 cm-1

Classification of Liver Trauma

The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June 1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver injury. The number of units of blood transfused, the magnitude of the operative treatment required, the liver-related complications and the liver-related mortality correlated well with the OIS grade. The OIS grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be the universally accepted classification scheme in liver trauma

Blunt Liver Trauma at Sunnybrook Medical Centre: A 13 Year Experience

Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335), 99% being true positive

An Isolated Neurofibromal Polyp of the Colon

Solitary neurofibromal colonic polyps are a rare entity, particularly outside the setting of neurofibromatosis type 1. The clinical significance of such lesions has not yet been established. Though typically benign tumors, neurofibromas have been reported to undergo malignant transformation, with an increased risk of malignancy when associated with neurofibromatosis. In this case report, we present the rare case of a man found to have an isolated colonic neurofibroma without any personal/family history or clinical features of neurofibromatosis. A 59-year-old man with a history of dyslipidemia and degenerative joint disease presented for a routine screening colonoscopy. The colonoscopy revealed no abnormalities except a 3 mm transverse colon polyp and another 4 mm polyp in the descending colon. Biopsy results showed the descending colonic polyp to be a tubular adenoma; however, multiple levels of the 3 mm transverse colon polyp revealed interlacing bundles of spindle cells extending into the lamina propria with comma-shaped nuclei consistent with findings seen in neurofibroma. Isolated colonic neurofibromas are rare and understudied. While they are usually benign, they may undergo malignant transformation, especially when associated with neurofibromatosis. Thus, patients presenting with isolated neurofibromas should be followed for development of neurofibromatosis and malignancies

Does Weight Loss Through Means of Bariatric Surgery Reduce the Risk of Type 2 Diabetes in Obese Qatari Patients: A retrospective analysis

Background and objectives: The use of bariatric surgeries such as Gastric Bypass and Sleeve Gastrectomy in managing obesity and associated diseases such as type 2 diabetes mellitus (T2DM) has been induced in clinical practice. Weight reduction through means of bariatric surgery has metabolic benefits and may improve the management of T2DM. The aim of this study was to investigate if weight loss through bariatric surgery can reduce the risk of T2DM in patients without the onset of T2DM. Study design: A retrospective analysis was conducted on post-bariatric patients at the department of bariatric and metabolic surgery at Hamad General Hospital. Methods: Tow hundred and two eligible pre-diabetic Qatari patients who have undergone bariatric surgery in 2016 and satisfied the inclusion and exclusion criteria of the study were analyzed. Data on Glucose, Insulin and C-peptides levels at baseline and follow-up were extracted in order to compare the change of these variables at baseline, 6 and 10 months follow up before and after 10 months from the date of surgery. Results: Seventy one males with mean age of 32.73 ± 10.37 and one hundred and thirty one females with mean age of 33.90 ± 9.88 were included in the analysis. Change in weight was strongly and positively associated with change in insulin level (0.701, 95% CI: 0.027, 1.347, p= 0.042) also, as weight changes fasting glucose changes (1.993, 95% CI: 0.359, 3.627, p= 0.017). Follow-up period greater than 6 months was not found to be significantly associated with weight loss (2.049, 95% CI: -2.249, 6.349, p= 0.313). Conclusion: Our study confirms results from international studies that weight loss through bariatric surgery can reduce the risk of developing Type 2 Diabetes in Qatari obese patients. The results of the study also suggest that post-surgery periods can be detrimental to the fate of fasting glucose and insulin levels and therefore compliance maybe of great importance to ensure success and sustainability of weight loss and diabetes prevention. Larger samples size and longer follow-up period is required to confirm these findings.Qatar University and Hamad Medical Corporatio

The Role of Serum Periostin Level in Different Pediatric Allergic Diseases: A Case-Control Study

Background: Allergic diseases represent one of the most common types of diseases globally and affect a large sector of population especially children. The main purpose of this study is to evaluate the relation between serum periostin and different allergic diseases and to compare them with children of non-allergic diseases as a control group. Methods: 80 children were included in the study; 40 had allergic diseases and 40 children had no allergic diseases as controls. All participants completed the history and clinical examination, complete blood count, total serum immunoglobulin IgE (UI/ml), and serum periostin level. Results: Among the patients with allergic diseases, bronchial asthma was the most common diagnosed disease 29/40 (72.50%). Patients with allergic diseases had significantly higher mean (±SD) serum periostin when compared to infants with no allergic diseases (271.9±263.27 ng/ml and 115.33±191.42 ng/ml, P-value 0.0001). However, highly elevated serum periostin >150 ng/ml were found exclusively in patients with allergic diseases 22/40 (55.00%) and only in 4/40 (10.0%) of the controls (p-value<0.0001). Furthermore, there were a statistically significant difference between the patients with different degrees of allergic diseases severity and serum periostin level as it was 1080±251.73 ng/ml in severe allergic diseases compared to 244.5±263.57 ng/ml in mild allergic diseases (P- value 0.01). Conclusion: The most common type of allergic diseases in our study was bronchial asthma. Higher serum periostin levels were observed in allergic patients in comparison to the controls; and they were found to have a significant relationship with disease severity

Is EGFR expression altered following postoperative chemotherapy for colorectal adenocarcinoma?

BACKGROUND: There is immunohistochemical evidence to suggest that expression of epidermal growth factor receptor (EGFR) in primary colorectal adenocarcinoma predicts its expression in recurrent disease. This study investigates whether postoperative chemotherapy affects the degree of concordance between EGFR statuses of the two tumors. METHODS: Thirty-three patients were identified from the files of Sunnybrook Health Sciences Center from July 1994 to June 2005. All patients had resection of their primary tumors and their distant recurrences. Eighteen patients received postoperative chemotherapy, 3 of which also received postoperative radiation therapy. Representative primary and recurrent tumor sections were stained using mouse anti-EGFR antibodies and only membranous staining of malignant cells was recorded. Results were reported as negative (no staining), 1+ (positivity in <50% of cells) or 2+ (positivity in >50% of cells). RESULTS: EGFR immunostaining in the 15 patients, who received no postoperative chemotherapy, was decreased in 3 recurrences, remained the same in 10 and increased in 2. In the group of 18 patients who received postoperative chemotherapy, EGFR immunostaining was decreased in 6 recurrences, remained the same in 9 and increased in 3 (p = 0.6598). In patients who received postoperative chemotherapy, the odds ratio for a recurrence to show lower levels of EGFR immunostaining compared to its originally resected primary was 4.75 (CI = 0.94 – 26.73). CONCLUSION: These preliminary data suggest that recurrences following postoperative chemotherapy are likely to have lower levels of EGFR expression compared to cases who receive no chemotherapy. Although the difference of immunostaining profiles between the two groups was not statistically significant, this observation might impact the management of these patients by targeted biologic therapies and its practical implications need further validation in larger series

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior