Outcomes of liver-first strategy and classical strategy for synchronous colorectal liver metastases in Sweden

Background

Patients with synchronous colorectal liver metastases (sCRLM) are increasingly operated with liver resection before resection of the primary cancer. The aim of this study was to compare outcomes in patients following the liver-first strategy and the classical strategy (resection of the bowel first) using prospectively registered data from two nationwide registries.

Intraoperative liver steatosis characterization using diffuse reflectance spectroscopy

Background

Liver steatosis is associated with poor outcome after liver transplantation and liver resection. There is a need for an accurate and reliable intraoperative tool to identify and quantify steatosis. This study aimed to investigate whether surface diffuse reflectance spectroscopy (DRS) measurements could detect liver steatosis on humans during liver surgery.

Liver-first strategy for synchronous colorectal liver metastases – an intention-to-treat analysis

Background

The liver-first strategy signifies resection of liver metastases before the primary colorectal cancer. The aim of the present study was to compare failure to complete intended treatment and survival in liver-first and classical strategies.

Major intraoperative bleeding during pancreatoduodenectomy - preoperative biliary drainage is the only modifiable risk factor

Background

Pancreatoduodenectomy is associated with a high risk of complications. The aim was to identify preoperative risk factors for major intraoperative bleeding.

Postoperative pancreatic fistula-impact on outcome,hospital cost and effects of centralization

Background

One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs.

Intraductal papillary mucinous neoplasms of the pancreas – a cost-effectiveness analysis of management strategies for the branch-duct subtype

Background

Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) presents a clinical conundrum. Rigorous long-term surveillance or surgical resection is recommended. The economic consequences of the management have not been fully investigated.

First results from the Swedish National Pancreatic and Periampullary Cancer Registry

Background

Despite improvements in therapy regimens over the past decades, overall survival rates for pancreatic and periampullary cancer are poor. Specific cancer registries are set up in various nations to regional differences and to enable larger prospective trials. The aim of this study was to describe the Swedish register, including possibilities to improve diagnostic work-ups, treatment, and follow-up by means of the register.

Decreased removal of triglycerides from the blood — a mechanism for the hypertriglyceridemia in male patients with coronary artery disease

We determined serum apolipoprotein A I and A II concentrations and triglyceride and cholesterol concentrations in serum lipoprotein density classes in 28 male patients with severe ischaemic heart disease (IHD) and with angiographically verified coronary artery disease (CAD) and in age-matched controls. Both triglyceride and cholesterol concentrations in very low density lipoproteins and in low density lipoproteins were higher in IHD-patients than in the controls. The triglyceride but not the cholesterol concentration in serum was higher in IHD-patients than in the controls. The cholesterol in high density lipoproteins and the serum apolipoprotein A I concentration were lower in IHD-patients than in the controls. At least in part the higher triglyceride concentration in very low density lipoproteins could be attributed to a decreased removal of triglycerides from the blood since the fractional removal rate of an i.v. injected artificial triglyceride emulsion (Intralipid) was slower in IHD-patients than in the controls.     

Folic acid responsive postmenopausal homocysteinemia

Homocysteinemia is associated with juvenile arteriosclerosis, recurrent thromboembolic complications and osteoporosis. Plasma homocysteine, measured as homocysteine-cysteine mixed disulfide (MDS), has in other than homocysteinemics been reported to be higher in patients with coronary heart or cerebrovascular disease than in controls, and higher in men than in premenopausal women. Here, in groups of normal men and normal premenopausal and postmenopausal women, we measured plasma MDS in the fasting state and four hours after a methionine load (100 mg/kg body weight), before and after four weeks of folic acid therapy at 5 mg daily. In their fasting plasma, postmenopausal women (n = 5) had significantly (P less than 0.05) higher MDS concentrations than premenopausal women (n = 5) and younger men (n = 5). After the methionine load MDS concentrations in postmenopausal women rose markedly, reaching levels significantly higher than those in younger men (P less than 0.05), and with no overlap with values in premenopausal women (P less than 0.01), or in older men (n = 5, P less than 0.01). Folic acid therapy resulted in substantial reductions (n = 15, P less than 0.01) of MDS concentrations both before the methionine load (-31%) and after (-28%), though subjects had initially had normal concentrations of serum and erythrocyte folates. We speculate that moderate homocysteinemia might contribute to postmenopausal arteriosclerosis and osteoporosis. Should this prove to be the case, folic acid might be a useful prophylactic.     

Plasma lipoproteins and lipolytic enzyme activities during endurance training in sedentary men: Changes in high-density lipoprotein subfractions and composition

Eighteen healthy sedentary males took part in supervised bicycle training for 50 minutes three to five times a week. Twelve subjects (group A) trained for 6 weeks at heavy intensity, and six subjects (group B) trained for 12 weeks at moderate intensity. Maximal oxygen uptake increased by about 20% (P less than 0.01). Body weight and composition as well as diet remained unchanged. After 6 weeks plasma high-density lipoprotein (HDL) cholesterol concentrations had increased by 7% (P less than 0.05) in all subjects. The increase was most marked in group B at 14% (P less than 0.05) compared to 3% in group A (ns). Apolipoprotein AI (apo AI) increased by about 7% in both groups (P less than 0.01). After 12 weeks HDL cholesterol and apo AI levels had almost returned to initial values. Measurements of HDL components showed increases of 6% to 12% in free cholesterol, cholesteryl ester (P less than 0.05), and phospholipid (P less than 0.01); whereas, the minor triglyceride fraction decreased by 20% (P less than 0.01). Zonal ultracentrifugation in four subjects revealed a preferential rise of about 35% in the HDL2 subfraction, increasing the HDL2/HDL3 ratio by about 20%. In parallel, the composition of the lipoprotein classes changed. The protein moiety of all classes, except low-density lipoprotein (LDL), expanded at the expense of the core components cholesteryl ester and triglyceride. Hepatic lipase (HL) activity decreased by 6% (P less than 0.05), and lipoprotein lipase (LPL) activity in adipose tissue increased by about 50% (P less than 0.05) during the first 6 weeks of training, while LPL activity in postheparin plasma and skeletal muscle did not change. The transient rise in HDL cholesterol levels was correlated (P less than 0.05) to the elevation of adipose tissue LPL activity. The alterations in HDL concentration were also related to changes in body composition and diet, especially to an increase in fat intake.     

Factors limiting exercise performance in progressive systemic sclerosis

In order to evaluate to which extent various organs limit physical performance in PSS, maximal working capacity was studied in 22 patients. Special attention was given to cardiac and pulmonary function, joint mobility, and muscular strength. A model for scoring these parameters is given. Working capacity was on the average 51% of the predicted normal value. Ventilation at maximal workload was high despite normal arterial blood gases and presumably normal physiologic dead space. This can be explained by an increased demand on ventilation from an increased muscle metabolism. This may be due to impeded mobility of respiratory and locomotive organs.The maximal heart rate was low and patients with low physical capacity had only a small decrease in base excess. One third of the patients developed arrhythmia during exercise, which contributed to a low performance. Other myocardial involvement was common, seen in the Q-waves, low voltage, left axis deviation, and increased heart volume. In PSS, these ECG changes probably reflect myocardial fibrosis that has developed without clinically manifest infarction. Special attention must be given to arrhythmias at work, which are overlooked in a resting ECG. Ventricular tachycardia plays an important role in sudden death, which, when it occurs, almost always does so within the first years after the onset of PSS.There was no close linkage between cardiac dysfunction and pulmonary fibrosis or joint-muscle impairment. The scoring system showed an equal distribution in reduction of working capacity as to circulation, pulmonary function, and locomotive function. Irrespective of the degree of work reduction, at least two organ systems were impaired in almost all of the patients. This emphasizes the complexity of the disease which is already in its early stage.     

Implication of primary tumor location for the indication of preoperative chemotherapy in patients with colorectal liver metastases

Background

The benefit of preoperative chemotherapy for colorectal liver metastases (CRLM) remains uncertain. The aim was to clarify the effect of preoperative chemotherapy on CRLM according to the primary tumor location.

Erythrocyte heat production in human obesity: microcalorimetric investigation of sodium-potassium pump and cell metabolism

Changes in overall cellular metabolism, induced by specific inhibition of the Na-K-pump, were determined in erythrocytes from 33 normal and 25 obese subjects. Cellular metabolism was determined by measurement of heat production rates in erythrocytes suspended in plasma with and without the cardioactive glycoside, ouabain. Specific inhibition with ouabain induced the same decrease of the heat production rate in the two groups (14 +/- 5 mW/L for normal subjects and 13 +/- 5 mW/L for obese subjects). In neither group was there a correlation between the ouabain-inhibitable rate of metabolism and body weight. The present study results do not give support to the suggestion that a defect in the Na-K-pump activity would exist in the erythrocyte of human obese subjects and could not therefore be of importance in the pathogenesis of the disease.     

Heat production by adipocytes from obese subjects before and after weight reduction

Microcalorimetry has been employed to measure the heart production by adipocytes obtained by percutaneous biopsy from lean subjects and from obese subjects before and after weight reduction. Cellular heat production was significantly lower in obese than in lean subjects. After weight reduction cellular heat production increased in fat cells from the obese subjects but was still significantly lower than in cells from control subjects. A number of variables reflecting uptake and mobilization of depot fat have measured and correlated to the heat production values in the obese subjects. The findings are consistent with the view that a decreased total metabolic activity might contribute to the development or perpetuation of obesity.     

Congenital obstruction of the pulmonary veins at their atrial junctions. Review of the literature and a case report

A survey of the reports of congenital stenosis and/or atresias of the pulmonary veins is presented and a new case added. The correct diagnosis has not been made in vivo. “Recurrent respiratory tract infections” and hemoptysis are the most common symptoms. Pulmonary venous stasis seen at the chest examination, difference in the pressure of the left atrium and the PCW pressure in either or both lungs, and slow passage of the contrast medium through the obstructed vein may suggest the diagnosis. Angiocardiography can also exclude other conditions which may cause the same symptoms.     

Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment.

Thirty-four patients suspected of being magnesium deficient were given intravenous infusions of potassium and magnesium. The muscle contents of sodium, potassium, magnesium, and chloride were determined by atomic absorption spectrophotometry on skeletal muscle samples obtained by percutaneous biopsies. The frequency of ventricular etopic beats (VEBs) was assessed from a 3-hour ECG tape recording before the infusions and after the completion of each infusion. The potassium infusions did not result in any changes in the cellular potassium content, nor in the frequency of VEBs. After the magnesium infusions, however, a significant increase was noted in the cellular potassium content and likewise a significant decrease in the frequency of VEBs. This emphasizes the importance of magnesium in potassium metabolism.     

Prospective comparison of gadoxetic acid-enhanced liver MRI and contrast-enhanced CT with histopathological correlation for preoperative detection of colorectal liver metastases following chemotherapy and potential impact on surgical plan

Objective

To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan.

Impact of chemotherapy-associated liver injury on tumour regression grade and survival in patients with colorectal liver metastases

Background

An inverse relation between chemotherapy-associated liver injury (CALI) and tumour response to chemotherapy has been reported. The aim was to validate these findings, and further investigate the impact of CALI on survival in patients who underwent partial hepatectomy for colorectal liver metastases (CRLM).