Efficacy of 5-Fluorouracil and High-Concentration Cisplatin Suspended in Lipiodol by Short-Term Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Background: Since advanced hepatocellular carcinoma (HCC) is potentially fatal, and patients’ quality of life (QOL) often deteriorates during their treatment, improving the prognosis and QOL of patients given chemotherapy is very important. In addition, cost-effective treatments are highly desirable when chemotherapy must be given repeatedly. The aim of this study was to evaluate the efficacy and usefulness of 5-fluorouracil (5-FU) and high-concentration cisplatin by short-term hepatic arterial infusion chemotherapy (3-day FPL) in advanced HCC patients. Methods: Thirty patients with unresectable advanced HCC were enrolled. The patients underwent hepatic arterial infusion chemotherapy via the implanted port system with 5-FU on days 1 - 3 and a fine-powder formulation of cisplatin in suspended pre-warmed lipiodol on day 2 every 4 to 10 weeks. Tumor response was assessed one month later with CT. Results: All patients had evidence of portal vein invasion (Vp2-4). Four patients achieved a complete response (CR), 8 patients achieved a partial response (PR), and 7 patients had stable disease (SD). The median progression-free survival (PFS) and overall survival (OS) were 198 days and 452 days, respectively. The OS was significantly longer in the successful disease control group (CR, PR, and SD) than in the progressive disease group (P < 0.005). Conclusions: Three-day FPL was effective and tolerable in advanced HCC patients due to its shorter time of administration than conventional FP therapy. Therefore, repetitive 3-day FPL appears useful and contributes to improving the prognosis and QOL of patients with advanced HCC. In addition, this protocol is a cost-effective treatment.

Multimodality treatment in hepatocellular carcinoma patients with tumor thrombi in portal vein

AIM: To compare the therapeutic effect and significances of multimodality treatment for hepatocellular carcinoma (HCC) with tumor thrombi in portal vein (PVTT). METHODS: HCC patients (n=147) with tumor thrombi in the main portal vein or the first branch of portal vein were divided into four groups by the several therapeutic methods. There were conservative treatment group in 18 out of patients (group A); and hepatic artery ligation(HAL) and/or hepatic artery infusion (HAI) group in 18 patients (group B), in whom postoperative chemoembolization was done periodically; group of removal of HCC with PVTT in 79 (group C) and group of transcatheter hepatic arterial chemoembolization (TACE) or HAI and/or portal vein infusion (PVI) after operation in 32 (group D). RESULTS: The median survival period was 12 months in our series and the 1-,3-, and 5-year survival rates were 44.3%, 24.5% and 15.2%, respectively. The median survival times were 2, 5, 12 and 16 months in group A, B, C and D, respectively. The 1-, 3- and 5-year survival rates were 5.6%, 0% and 0% in group A; 22.2%, 5.6% and 0% in group B; 53.9%, 26.9% and 16.6% in group C; 79.3%, 38.9% and 26.8% in group D, respectively. Significant difference appeared in the survival rates among the groups (P 【 0.05). CONCLUSION: Hepatic resection with removal of tumor thrombi and HCC should increase the curative effects and be encouraged for the prolongation of life span and quality of life for HCC patients with PVTT, whereas the best therapeutic method for HCC with PVTT is with regional hepatic chemotherapy or chemoembolization after hepatic resection with removal of tumor thrombi.

Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography

AIM: To investigate microvascular changes in eyes with central retinal vein occlusion(CRVO) complicated by macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes and best-corrected visual acuity(BCVA) and retinal thickness. METHODS: Twenty-eight eyes of 28 patients with macular edema caused by CRVO were included in this retrospective study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results of optical coherence tomography angiography(OCTA) automatic measurements of the vessel density in the superficial(SCP) and deep retinal capillary plexus(DCP), the foveal avascular zone(FAZ) area, the FAZ perimeter(PERIM), the vessel density within a 300-μm wide ring surrounding the FAZ(FD-300), the acircularity index(AI), the choriocapillaris flow area, and retinal thickness were recorded before and at one month after treatment and compared with the results observed in age-and sexmatched healthy subjects. RESULTS: The vessel density in the SCP and DCP, the FD-300, and the flow area of the choriocapillaris were allsignificantly lower in CRVO eyes than in healthy eyes, while the AI and retinal thickness were significantly higher(all P<0.05). After treatment, retinal thickness was significantly decreased, and the mean BCVA had markedly improved from 20/167 to 20/65(P=0.0092). The flow area of the choriocapillaris was also significantly improved, which may result from the reduction of shadowing effect caused by the attenuation of macular edema. However, there were no significant changes in SCP and DCP vessel density after treatment. The flow area of the choriocapillaris at baseline was negatively correlated with retinal thickness.CONCLUSION: OCTA enables the non-invasive, layerspecific and quantitative assessment of microvascular changes both before and after treatment, and can therefore be used as a valuable imaging tool for the evaluation of the follow-up in CRVO patients.

Nursing Care of Patients With Transcatheter Closure of Atrial Septal Defect via Femoral Vein

Objective:To explore the operative nursing coordination method for the treatment of congenital atrial septal defect(ASD)by transcatheter closure of atrial septal defect via femoral vein.It provides useful experience for the treatment of congenital heart disease.Methods a total of 12 patients undergoing minimally invasive atrial septal defect closure via femoral vein from January 2017 to November 2017 in our department of cardiac surgery were selected as the subjects.All patients received transesophageal ultrasound guided ASD occlusion by femoral vein.The operation and nursing contents include preoperative care,the cooperation of the itinerant nurses,the coordination of the instrument nurses and the postoperative nursing.Results the operation of 12 patients in this group was successful.The diameter of the occluder was 17.1+4.5 mm during the operation.The time of tracheal intubation was 2.4+0.7 h,from the femoral vein to the sheath tube time was 38.7+9.4 min,the occupancy of ICU was 12.5+2.6 h after the operation.The average time of hospitalization was 4.5+1.8 D.There were 2 cases of shunt 1mm immediately after operation.After 24h reexamination,the shunt disappeared,the heart murmur disappeared in the rest of the patients.No residual shunt and other complications occurred.

Treatment of hepatocellular carcinoma in patients with portal vein tumor thrombosis: Beyond the known frontiers

Hepatocellular carcinoma is one of the most frequent malignant tumors worldwide:Portal vein tumor thrombosis(PVTT)occurs in about 35%-50%of patients and represents a strong negative prognostic factor,due to the increased risk of tumor spread into the bloodstream,leading to a high recurrence risk.For this reason,it is a contraindication to liver transplantation and in several prognostic scores sorafenib represents its standard of care,due to its antiangiogenetic action,although it can grant only a poor prolongation of life expectancy.Recent scientific evidences lead to consider PVTT as a complex anatomical and clinical condition,including a wide range of patients with different prognosis and new treatment possibilities according to the degree of portal system involvement,tumor biological aggressiveness,complications caused by portal hypertension,patient’s clinical features and tolerance to antineoplastic treatments.The median survival has been reported to range between 2.7 and 4 mo in absence of therapy,but it can vary from 5 mo to 5 years,thus depicting an extremely variable scenario.For this reason,it is extremely important to focus on the most adequate strategy to be applied to each group of PVTT patients.

Linear endoscopic ultrasound evaluation of hepatic veins

Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound(EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.

Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review

AIM To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy(ALPPS), after failure of previous portal embolization. We also performed a literature review.METHODS Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization(PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps(ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened duringthe interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien Classification.RESULTS From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc(221-380), 450 cc(372-506), and 660 cc(575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4%(0.3-0.5), 0.6%(0.5-0.8), and 1%(0.8-1.2). Median volume growth of FLR was 69%(18-92) after PVE, and 45%(36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc(254-513), leading to an increase of +149%(68-199). After ALPPS-2, 4 patients had stage Ⅰ-Ⅱ complications. Three patients had more severe complications(one stage Ⅲ, one stage Ⅳ and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the ALPPS procedure.CONCLUSION Rescue ALPPS may be an alternative after unsuccessful PVE and could allow previously unresectable patients to reach surgery. Biliary drainage seems to reduce biliary complications.

maturity of associating liver partition and portal vein ligation for staged hepatectomy-derived liver regeneration in a rat model

AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.

Clinical Application of Newborn Umbilical Vein Catheterization Combining with PICC

Purpose: Research on clinical application effect of combining very low birth weight newborn (VLBWN) umbilical vein catheterization (UVC) with peripherally inserted central catheter (PICC). Method: 60 cases of VLBWN checked in our hospital’s ICU are selected and divided into combination group (n = 30) and PICC group (n = 30) according to the random number table. Combination of UVC and PICC is applied on newborn of combination group while only PICC is applied on newborn of PICC group. These two groups’ newborn’s PICC catheterization operation time, PICC indwelling time, weight gain, hospital stays, hospital infection, planned extubation, successful single puncture, adverse events and other indexes are observed. Result: Newborns in combination group have less PICC catheterization operation time and less hospital stays than newborns in PICC group while newborns in combination group have longer PICC indwelling time and greater weight gain than newborns in PICC group. The difference here has statistical significance (p < 0.05). Combination group’s hospital infection ratio (3.33%) is lower than that of PICC group (23.33%). The difference here has statistical significance (p < 0.05). Newborns in combination group have a planned extubation rate of 93.33% and a successful single puncture rate of 93.33%, which are greater than those of newborn in PICC group (respectively 73.33% and 70.00%). The difference here has statistical significance (p < 0.05). Newborns in combination group have an adverse event occurrence rate of 43.33%, lower than that of PICC group (70.00%). The difference here has statistical significance (p < 0.05). Conclusion: Application of combination of UVC and PICC on VLBWN can greatly improve PICC catheterization efficiency and newborn patients’ nutriture and reduce rate of complications, thus, it is worthy of clinical application.

糖基化缺陷的血清IgA1与人脐静脉内皮细胞结合量的研究

目的:观察糖基化缺陷的血清IgA1是否可以与人脐静脉内皮细胞(HUVEC)结合,并比较正常血清IgA1及糖基化缺陷的血清IgA1与HUVEC结合量的异同,探讨血清IgA1尤其是糖基化缺陷的IgA1在IgA肾病血管损伤中的作用。方法:Jacalin亲和层析提取正常人血清IgA1,唾液酸酶和 /或半乳糖酶去除血清IgA1分子铰链区O 糖上连接的唾液酸和 /或半乳糖,形成糖基化缺陷的IgA1,分别形成去唾液酸IgA1 (DesIgA1),去唾液酸去半乳糖IgA1 (Des/DeGalIgA1)。分别用特异结合半乳糖或N 乙酰氨基半乳糖的花生凝集素 (PNA)和蚕豆凝集素 (VVL),以ELISA的方法检测酶切的充分性。流氏细胞技术检测并比较正常血清IgA1及糖基化缺陷的血清IgA1与HUVEC的结合量。结果:正常IgA1及DesIgA1,Des/DeGalIgA1均能与HUVEC结合。IgA1, DesIgA1,Des/DeGa lIgA1与HUVEC的结合量用免疫荧光强度的中位数表示分别为 2. 67±0. 35, 4. 62±1. 09, 4. 08±0. 41 (IgA1与DesIgA1相比,P=0. 015;IgA1与DesIgA1 /DeGalIgA1相比,P=0. 049;DesIgA1与DesIgA1 /DeGalIgA1相比,P>0. 05)。结论:IgA1分子可以与HUVEC相结合,唾液酸和 /或半乳糖缺失的IgA1与HUVEC的结合量显著高于正常IgA1分子,提示血清IgA1尤其是糖基化缺陷的IgA1在IgA肾病的血管损伤中可能起着一定的作用。

Portosplenomesenteric vein thrombosis in patients with early-stage severe acute pancreatitis

AIM To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis(PSMVT) in the early stage of severe acute pancreatitis(SAP).METHODS Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography(CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic(ROC) curve was generated for the qualifying independent risk factors.RESULTS Twenty-five of the one hundred and forty(17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis(AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index(CTSI) scores [odds ratio(OR): 2.742; 95% confidence interval(CI): 1.664-4.519; P = 0.000], hypoalbuminemia(serum albumin level < 25 g/L)(OR: 32.573; 95%CI: 2.711-391.353; P = 0.006) and gastrointestinal wall thickening(OR: 4.367, 95%CI: 1.218-15.658; P = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777(P = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.CONCLUSION High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.

Current status of associating liver partition with portal vein ligation for staged hepatectomy: Comparison with two-stage hepatectomy and strategies for better outcomes

Since its introduction in 2012,associating liver partition with portal vein ligation for staged hepatectomy(ALPPS)has significantly expanded the pool of candidates for liver resection.It offers patients with insufficient liver function a chance of a cure.ALPPS is most controversial when its high morbidity and mortality is concerned.Operative mortality is usually a result of posthepatectomy liver failure and can be minimized with careful patient selection.Elderly patients have limited reserve for tolerating the demanding operation.Patients with colorectal liver metastasis have normal liver and are ideal candidates.ALPPS for cholangiocarcinoma is technically challenging and associated with fair outcomes.Patients with hepatocellular carcinoma have chronic liver disease and limited parenchymal hypertrophy.However,in selected patients with limited hepatic fibrosis satisfactory outcomes have been produced.During the inter-stage period,serum bilirubin and creatinine level and presence of surgical complication predict mortality after stage II.Kinetic growth rate and hepatobiliary scintigraphy also guide the decision whether to postpone or omit stage II surgery.The outcomes of ALPPS have been improved by a combination of technical modifications.In patients with challenging anatomy,partial ALPPS potentially reduces morbidity,but remnant hypertrophy may compare unfavorably to a complete split.When compared to conventional two-stage hepatectomy with portal vein embolization or portal vein ligation,ALPPS offers a higher resection rate for colorectal liver metastasis without increased morbidity or mortality.While ALPPS has obvious theoretical oncological advantages over two-stage hepatectomy,the long-term outcomes are yet to be determined.

牛颈静脉经不同方法交联改性后的免疫原性

目的:研究牛颈静脉带瓣管道经不同方法交联后免疫原性的变化。方法:将牛颈静脉随机分为4组(n=10):多聚环氧化合物(PC)交联组、染料介导光氧化(DMP)交联组、戊二醛(GA)交联组及新鲜牛颈静脉对照组。制备牛颈静脉匀浆,与完全福氏佐剂混合制成复合乳剂抗原,免疫新西兰大白兔。采用双向免疫扩散法测定兔血清抗体滴度。取新鲜牛颈静脉免疫的兔血清,采用免疫印迹法(Westernblotting)体外检测交联后的牛颈静脉组织匀浆的抗原组分。结果:免疫印迹显示新鲜牛颈静脉组织有特异性重复出现的阳性条带,经PC,DMP交联处理的牛颈静脉均未出现明显阳性条带,经GA交联处理的牛颈静脉中1例出现阳性条带,但无特异性重复出现的条带,各交联处理组间免疫原性无明显差异。结论: PC,DMP及GA交联处理的牛颈静脉可有效地灭活其免疫原性,适合临床应用要求。

Ezrin在肝癌中的表达及其与肿瘤黏附、侵袭和门静脉癌栓的关系

目的 探讨细胞骨架连接蛋白 (ezrin)在肝癌组织和细胞系中的表达及其与肿瘤黏附、侵袭和门静脉癌栓的关系。方法 4 1例肝细胞肝癌及其癌旁肝组织标本按肿瘤大小、有无播散灶及远处转移、包膜、门静脉癌栓等分为高侵袭和低侵袭 2组并与同期 9例良性肝病肝组织作比较 ,分别采用RT PCR和免疫组化技术检测ezrin表达。另选MHCC97L、MHCC97H和LM 33株肝癌细胞系并检测ezrin表达 ;同时运用脂质体转染反义寡核苷酸抑制MHCC97H细胞ezrin表达 ,比较转染前后细胞黏附、侵袭能力的改变。结果 高侵袭肝癌ezrin表达显著高于低侵袭肝癌 (P <0 .0 5 ) ,癌栓组织ezrin表达强度更高 (P <0 .0 5 )。MHCC97L、MHCC97H和LM33株细胞系均表达ezrin ,其强度随侵袭性增加依次增强。脂质体转染反义寡核苷酸能显著抑制MHCC97H的ezrin表达以及黏附、侵袭能力。结论 Ezrin在肝癌、门静脉癌栓和MHCC97L、MHCC97H、LM3细胞系中均表达 ,其表达强度随侵袭性增强而增加 ;Ezrin可能主要通过影响肿瘤黏附、侵袭能力 ,从而在肿瘤侵袭及门静脉癌栓形成中起重要作用。

True left-sided gallbladder with variations of bile duct and cholecystic vein

A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder polyp.Computed tomography(CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion.CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein.CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct.Laparoscopic cholecystectomy was performed for a gallbladder polyp,and the intraoperative finding showed that the cholecystic veins joined the round ligament.A true left-sided gallbladder is closely associated with several anomalies; therefore,surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.

Portal vein thrombosis with protein C-S deficiency in a noncirrhotic patient

There are several conditions that can lead to portal vein thrombosis(PVT), including including infection, malignancies, and coagulation disorders. Anew condition of interest is protein C and S deficiencies, associated with hypercoagulation and recurrent venous thromboembolism. We report the case of a non-cirrhotic 63-year-old male diagnosed with acute superior mesenteric vein thrombosis and PVT and combined deficiencies in proteins C and S, recanalized by short-term low molecular heparin plus oral warfarin therapy.

Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus

AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.

Associating liver partition and portal vein ligation for staged hepatectomy: From technical evolution to oncological benefit

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel approach in liver surgery that allows for extensive resection of liver parenchyma by inducing a rapid hypertrophy of the future remnant liver. However,recent reports indicate that not all patients eligible for ALPPS will benefit from this procedure. Therefore,careful patient selection will be necessary to fully exploit possible benefits of ALPPS. Here,we provide a comprehensive overview of the technical evolution of ALPPS with a special emphasis on safety and oncologic efficacy. Furthermore,we review the contemporary literature regarding indication and benefits,but also limitations of ALPPS.

Towards a Classification of Left Common Iliac Vein Compression Based on Triplanar Phlebography

Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a classification of left common iliac vein compression based on the end point of triplanar pelvic phlebogrpahy. Methods: Based on 61 consecutive patients found to have left common iliac vein compression on triplanar phlebography in the course of treatment of venous disease, clinical presentation and symptomatology were retrospectively used to create a classification of left common iliac vein compression. Treatment of left common iliac vein compression was also retrospectively correlated with staging. Results: The following classification was arrived at: Stage 0, no compression and no intraluminal fibrous bands;Stage 1, evidence of compression by surrounding anatomical structures with or without the presence of fibrous bands;Stage 2: evidence of compression with or without fibrous bands as evidenced by cross-pelvic collaterals;Stage 3: compression of the left common iliac vein. Fibrous bands replaced by localised occlusion, with collateralisation and no involvement of adjacent venous segments;Stage 4a: as for Stage 3 but with the addition of thrombotic involvement of adjacent venous segments;Stage 4b: as for Stage 4a but with involvement of distal venous segments, femoral and popliteal. Stages 3, 4a or 4b correlated well with clinical presentations of DVT, PE, venous ulceration, vulval or cross-pelvic collaterals, ipsilateral limb swelling and claudication. The presence of varicose veins or recurrent varicose veins was a common finding amongst all groups. Conclusion: Acceptance of this classification system would provide a common terminology to allow more transparent assessment of modalities of treatment for this condition.

Significance of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Portal Vein System of Pancreatic Cancer Patients

Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.