Repeated hepatic resection for colorectal liver metastases: is this concept safe and feasible?

European Surgery - The beneficial outcomes of hepatectomy in patients with colorectal metastases have encouraged the attempts of repeated hepatectomy in patients with recurrent disease. Although...     

Fokus Neurochirurgische Intensivmedizin 2021/2022

Die Anaesthesiologie -     

Induction of Contralateral Hepatic Hypertrophy by Unilobar Yttrium-90 Transarterial Radioembolization versus Portal Vein Embolization: An Animal Study

PurposeTo compare hepatic hypertrophy in the contralateral lobe achieved by unilobar transarterial radioembolization (TARE) versus portal vein embolization (PVE) in a swine model.MethodsAfter an escalation study to determine the optimum dose to achieve hypertrophy after unilobar TARE in 4 animals, 16 pigs were treated by TARE (yttrium-90 resin microspheres) or PVE (lipiodol/n-butyl cyanoacrylate). Liver volume was calculated based on CT before treatment and during 6 months of follow-up. Independent t-test (P < .05) was used to compare hypertrophy. The relationship between hypertrophy after TARE and absorbed dose was calculated using the Pearson correlation.ResultsAt 2 and 4 weeks after treatment, a significantly higher degree of future liver remnant hypertrophy was observed in the PVE group versus the TARE group, with a median volume gain of 31% (interquartile range [IQR]: 16%–66%) for PVE versus 23% (IQR: 6%–36%) for TARE after 2 weeks and 51% (IQR: 47%–69%) for PVE versus 29% (IQR: 20%–50%) for TARE after 4 weeks. After 3 and 6 months, hypertrophy converged without a statistically significant difference, with a volume gain of 103% (IQR: 86%–119%) for PVE versus 82% (IQR: 70%–96%) for TARE after 3 months and 115% (IQR: 70%–46%) for PVE versus 86% (IQR: 58%–111%) for TARE after 6 months. A strong correlation was observed between radiation dose (median 162 Gy, IQR: 139–175) and hypertrophy.ConclusionsPVE resulted in rapid hypertrophy within 1 month of the procedure, followed by a plateau, whereas TARE resulted in comparable hypertrophy by 3–6 months. TARE-induced hypertrophy correlated with radiation absorbed dose.     

Der Telenotarzt als „Einsatzleiter“ zur Stabilisierung eines kritisch kranken Patienten

Notfall + Rettungsmedizin - Es wird über die präklinische Versorgung eines 82-jährigen Patienten im septischen Schock bei akuter Pankreatitis berichtet. Initial wurde nur ein...     

A new conditional performance score for the evaluation of adaptive group sequential designs with sample size recalculation

In standard clinical trial designs, the required sample size is fixed in the planning stage based on initial parameter assumptions. It is intuitive that the correct choice of the sample size is of major importance for an ethical justification of the trial. The required parameter assumptions should be based on previously published results from the literature. In clinical practice, however, historical data often do not exist or show highly variable results. Adaptive group sequential designs allow a sample size recalculation after a planned unblinded interim analysis in order to adjust the sample size during the ongoing trial. So far, there exist no unique standards to assess the performance of sample size recalculation rules. Single performance criteria commonly reported are given by the power and the average sample size; the variability of the recalculated sample size and the conditional power distribution are usually ignored. Therefore, the need for an adequate performance score combining these relevant performance criteria is evident. To judge the performance of an adaptive design, there exist two possible perspectives, which might also be combined: Either the global performance of the design can be addressed, which averages over all possible interim results, or the conditional performance is addressed, which focuses on the remaining performance conditional on a specific interim result. In this work, we give a compact overview of sample size recalculation rules and performance measures. Moreover, we propose a new conditional performance score and apply it to various standard recalculation rules by means of Monte-Carlo simulations.