Portal vein thrombosis in liver transplantation: radiologic evaluation, risk factors, and occult diagnosis

Aim:Portal vein thrombosis(PVT)in the liver transplant recipient poses many challenges.Unfortunately,the risk factors and effects on outcomes of PVT are not well-defined.Methods:This study analyzed the experience with PVT in liver transplant program from 2007 to 2013.This included the effectiveness of PVT diagnostics and its risk factors using logistical regression.The primary endpoints were Kaplan-Meir patient and graft survival.The secondary endpoints were the length of stay(LOS),transfusion rate,and overall morbidity.Independent predictors of survival were identified using a Cox’s proportional hazards model.Results:Two hundred and sixteen consecutive liver transplant recipients were examined,and 30(13.8%)had either a total or partial PVT.Two hundred and five patients had imaging within 1 year of liver transplantation with only 7(23.3%)of the 30 PVTs identified pre-operatively.Calculated sensitivity(4.8-50%)and negative predictive values(10.5-22.2%)were poor.Only,age significantly predicted PVT[P=0.037/hazard ratio(HR)=0.95].Ninety-day-patient and graft survival for PVT was similar at 6 months,although 1-year survival was significantly lower.“Occult”PVT was not associated with inferior survival.Model for end-stage liver disease score>25(P=0.001,HR=0.49/P=0.004,HR=0.52)and age>60 years(P=0.017,HR=0.64/P=0.013,HR=0.67)were significant predictors of patient and graft survival.Although the transfusion rate was significantly greater with PVT,LOS,and morbidity were not.Conclusion:Older recipients had a greater likelihood of PVT.Diagnostic studies were not effective at excluding PVT,and occult diagnosis did not affect the outcome.PVT was not an independent predictor of mortality or graft loss,but was associated with greater blood loss but not increased LOS or morbidity.

Targeting facial aging with nano and regenerative technologies and procedures

This study reviews information about the most novel ideas and modalities being incorporated into facial and neck cosmetic care.We seek to identify trends and developments within these areas as well as perceptions of plastic surgeons regarding their probable significance,and discussion on how these modalities may impact future practice patterns.It is hypothesized that nano and regenerative technologies are considered the most"hopeful".Emerging invasive and non-invasive modalities utilizing nano and regenerative concepts were reviewed.We intentionally sought to investigate approaches to beautification,including maintenance and reversal of signs of aging,utilizing methods lacking an established level of evidence.This included promising modalities which are currently at the investigational stage.Twelve board-certified plastic surgeons were surveyed regarding the clinical importance of twelve concepts and their expected impact on facial and neck rejuvenation.Scientific and technological creativity in aesthetics is rapidly changing,and the efficacy of innovations and safety margins are improving.Nano and regenerative medicine-based technologies and procedures were ranked most promising for the future of cosmetics.Their potential applications and research were reviewed in the context of surgical and non-surgical modalities in clinical practice.There has been an advent of new approaches to facial and neck aesthetic surgery and tissue care,which is well-beyond just skin care.With this new level of knowledge regarding variability in care responses and indications for procedures on an almost"molecular level",personalized and precise aesthetic surgery and medicine are quickly becoming a reality.

Effect of obesity on perioperative outcomes after laparoscopic hepatectomy

Aim:Laparoscopic hepatectomy is increasing in utilization,however the procedure has not been adequately examined in the obese patient.This study aims to analyze the effect of obesity on perioperative outcomes after laparoscopic hepatectomy.Methods:Retrospective analysis of 396 laparoscopic hepatectomies in normal[body mass index(BMI)<25],overweight(BMI≥25),obese(BMI≥30),and severely obese(BMI≥35)patients using multivariate regression models to determine the risk factors for post-operative complications.Results:Normal BMI(n=78;20%),overweight(n=209;52%),obese(n=86;22%),and severely obese(n=23;6%).Demographics were similar except for a higher American Society of Anesthesiologists(ASA)score in the obese group.Estimated blood loss and operating time were greatest in the overweight group,while length of stay and complications were statistically similar between groups.Univariate analysis identified that complications were associated with weight class,ASA score,blood loss,and resection;multivariate analysis revealed ASA and transfusion were best correlated with complications.Conclusion:Obese and overweight patients have similar complication profiles to normal BMI patients while severely obese patients have a higher incidence of complications that are primarily limited to Clavien-Dindo class I and II.