Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorec...Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after surgery.Improvements in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.展开更多
Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicil...Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.展开更多
The management of hepatocellular carcinoma(HCC)is challenging because most patients have underlying cirrhosis,and the treatment provides,historically,a limited impact on the natural history of patients with advanced-s...The management of hepatocellular carcinoma(HCC)is challenging because most patients have underlying cirrhosis,and the treatment provides,historically,a limited impact on the natural history of patients with advanced-stage disease.Additionally,recurrence rates are high for those patients who receive local and locoregional modalities,such as surgical(resection and transplantation)or imageguided(ablation and intra-arterial)therapies.Translational research has led to new concepts that are reshaping the current clinical practice.Substantial advancements were achieved in the understanding of the hallmarks that drive hepatocarcinogenesis.This has primed a successful incorporation of novel agents with different targets,such as anti-angiogenic drugs,targeted-therapies,and immune-checkpoint inhibitors.Although clinical trials have proven efficacy of systemic agents in advanced stage disease,there is no conclusive evidence to support their use in combination with loco-regional therapy.While novel local modalities are being incorporated(e.g.,radioembolization,microwave ablation,and irreversible electroporation),emerging data indicate that locoregional treatments may induce tumor microenvironment changes,such as hyperexpression of growth factors,release of tumor antigens,infiltration of cytotoxic lymphocytes,and modulation of adaptative and innate immune response.Past trials that evaluated the use of antiangiogenic drugs in the adjuvant setting after ablation or chemoembolization fail to demonstrate a substantial improvement.Current efforts are directed to investigate the role of immunotherapy-based regimens in this context.The present review aims to describe the current landscape of systemic and locoregional treatments for HCC,present evidence to support combination approaches,and address future perspectives.展开更多
文摘Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after surgery.Improvements in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.
文摘Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used,especially for the treatment of respiratory and cutaneous infections.In general,it is a well-tolerated oral antibiotic.However,amoxicillin/clavulanate can cause adverse effects,mainly cutaneous,gastrointestinal,hepatic and hematologic,in some cases.Presented here is a case report of a 63-yearold male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate.After 6 wk of prolonged use of the drug,he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia(total bilirubin>300 mg/L).Diagnostic investigation was conducted by ultrasonography of the upper abdomen,serum tests for infection history,laboratory screening of autoimmune diseases,nuclear magnetic resonance(NMR)of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound.The duration of disease was approximately 4 mo,with complete resolution of symptoms and laboratory changes at the end of that time period.Specific treatment was not instituted,only a combination of anti-emetic(metoclopramide)and cholestyramine for pruritus.
文摘The management of hepatocellular carcinoma(HCC)is challenging because most patients have underlying cirrhosis,and the treatment provides,historically,a limited impact on the natural history of patients with advanced-stage disease.Additionally,recurrence rates are high for those patients who receive local and locoregional modalities,such as surgical(resection and transplantation)or imageguided(ablation and intra-arterial)therapies.Translational research has led to new concepts that are reshaping the current clinical practice.Substantial advancements were achieved in the understanding of the hallmarks that drive hepatocarcinogenesis.This has primed a successful incorporation of novel agents with different targets,such as anti-angiogenic drugs,targeted-therapies,and immune-checkpoint inhibitors.Although clinical trials have proven efficacy of systemic agents in advanced stage disease,there is no conclusive evidence to support their use in combination with loco-regional therapy.While novel local modalities are being incorporated(e.g.,radioembolization,microwave ablation,and irreversible electroporation),emerging data indicate that locoregional treatments may induce tumor microenvironment changes,such as hyperexpression of growth factors,release of tumor antigens,infiltration of cytotoxic lymphocytes,and modulation of adaptative and innate immune response.Past trials that evaluated the use of antiangiogenic drugs in the adjuvant setting after ablation or chemoembolization fail to demonstrate a substantial improvement.Current efforts are directed to investigate the role of immunotherapy-based regimens in this context.The present review aims to describe the current landscape of systemic and locoregional treatments for HCC,present evidence to support combination approaches,and address future perspectives.
