Two-stage laparoscopic liver resection for bilateral colorectal liver metastasis

Abstract Background Hepatectomy may prolong the survival of colorectal cancer patients with liver metastases. Two-stage liver surgery is a valid option for the treatment of bilobar colorectal liver metastasis. This video demonstrates technical aspects of a two-stage pure laparoscopic hepatectomy for bilateral liver metastasis. To the authors' knowledge, this is the first description of a two-stage laparoscopic liver resection in the English literature. Methods A 54-year-old man with right colon cancer and synchronous bilobar colorectal liver metastasis underwent laparoscopic right colon resection followed by oxaliplatinbased chemotherapy. The patient then was referred for surgical treatment of liver metastasis. Liver volumetry showed a small left liver remnant. Surgical planning was for a totally laparoscopic two-stage liver resection. The first stage involved laparoscopic resection of segment 3 and ligature of the right portal vein. The postoperative pathology showed high-grade liver steatosis. After 4 weeks, the left liver had regenerated, and volumetry of left liver was 43%. The second stage involved laparoscopic right hepatectomy using the intrahepatic Glissonian approach. Intrahepatic access to the main right Glissonian pedicle was achieved with two small incisions, and an endoscopic vascular stapling device was inserted between these incisions and fired. The line of liver transection was marked following the ischemic area. Liver transection was accomplished with the Harmonic scalpel and an endoscopic stapling device. The specimen was extracted through a suprapubic incision. The falciform ligament was fixed to maintain the left liver in its original anatomic position, avoiding hepatic vein kinking and outflow syndrome. Results The operative time was 90 min for stage 1 and 240 min for stage 2 of the procedure. The recoveries after the first and second operations were uneventful, and the patient was discharged on postoperative days 2 and 7, respectively. Conclusion Two-stage liver resections can be performed safely using laparoscopy. The intrahepatic Glissonian approach is a useful tool for pedicle control of the right liver, especially after previous dissection of the hilar plate

Low Temperature Magnetic Instabilities in Triply Charged Fulleride Polymers

The electronic properties of the C603- polymer in Na2Rb0.3Cs0.7C60 were studied by X-band and high field (109.056 GHz) ESR. They are characteristic of a strongly correlated quasi-one-dimensional metal down to 45 K. On further cooling, a pseudogap of magnetic origin opens at the Fermi level below 45 K with three-dimensional magnetic ordering occurring below TN≈15K, as confirmed by the observation of an antiferromagnetic resonance mode. The Na2Rb1-xCsxC60 family of polymers offers a unique way to chemically control the electronic properties, as the opening of the gap in this system of predominantly itinerant electrons is an extremely sensitive function of the interchain separation

Communication and electronic access: medical radiation science clinical centres' perspective

The last decade has seen a dramatic increase in the availability and use of electronic devices and information in day-to-day lives and in the workplace. The tertiary education sector has embraced the electronic age and has, in our cases, taken the lead with innovative use of information technology (IT). While the flexibility IT provides appeals to students and creates new opportunities, the IT infrastructure and staff development required to make full use of the new facilities requires significant investment. The aim of this study was to survey medical radiation science professional centres to assess the availability of IT resources, determine who has access to the IT resources and sample staff attitudes towards their preferred method of communication with the university. A questionnaire was mailed to each Chief Nuclear Medicine Scientist, Chief Radiation Therapist and Chief Radiographer for each clinical centre that participated in The University of Newcastle's clinical placement program (PPS). One hundred and thirty one questionnaires were returned, a response rate of 51 %. Twenty-seven responses from nuclear medicine centres (50%), twenty-four responses from radiation therapy centres (70%) and 80 responses from diagnostic radiography centres (48%). The majority (85%) of respondents reported they had between three and 30 computers where staff could access the internet, word processing and email. The preferred method of communication was email (52%) versus letter (30%) and telephone (17%). In the event that work load increased, email was a preferred method of communication where the preference for telephone and letters decreased