Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study

Background

Laparoscopic liver surgery has been difficult to popularize. High volume liver centres have identified left lateral sectionectomy (LLS) as a procedure with potential for transformation into a primarily laparoscopic procedure where surgeons can safely gain proficiency.

Methods

Forty-four patients underwent either laparoscopic (LLLS) or open (OLLS) left lateral sectionectomy (of segments II/III) for focal lesions at Southampton General Hospital.

Results

OLLS and LLLS groups were matched for age, sex and tumour types resected. Median operative time in the LLLS group was 180 (40–340) min and 155 (110–330) min in the OLLS group (p = 0.885) with median intra-operative blood loss in the LLLS group 80 (25–800) ml versus a larger 470 (100–3000) ml; p = 0.002 for patients receiving OLLS. Post-operative stay was also shorter in the LLLS group (3.5 (1–6) days) compared to the OLLS group (7 (3–12) days; p < 0.001). Resection margin was not different in the two groups (11 (1.5–30) mm (LLLS) versus 12 (4–40) mm (OLLS); p = 1) and neither was the complication rate (13% for LLLS versus 25% for OLLS; p = 0.541). There were no conversions to open in the LLLS group and no deaths in either group at 90 days. Between the first and second 12 LLLS the median operative time fell from 240 (70–340) min to 120 (40–120) min; p = 0.005 as well as median post-operative hospital stay from 4.5 (2–6) days to 2 (1–4) days, p = 0.001.

Conclusion

LLLS is a viable alternative to OLLS with potential improvements in intra-operative blood loss and shorter hospital stay without adversely affecting successful resection or complication rates. Larger prospective studies are required to explore this new avenue in laparoscopic liver surgery.     

New treatments for psoriasis: which biologic is best?

Psoriasis is a chronic, debilitating disease affecting not only the skin, but also having a significant impact on a patient's quality of life. The treatment of severe psoriasis is quite challenging due to the chronic, relapsing nature of the disease and the difficulties inherent in treatment planning. Though the biologics are perhaps the most promising of available psoriasis treatments, the decision to institute a given therapy may be fraught with complexity for the clinician. Patients now hear of these promising new treatments for psoriasis via print, television and radio advertising; they frequently come to their physician asking if they are eligible for any of these agents and, if so, 'which biologic is best?'. This paper attempts to determine the ideal biologic agent based upon several parameters: FDA- and EU-approved indications, therapeutic efficacy, impact on quality of life, cost-effectiveness, and safety profile. Certainly the physician is central to medical decision-making, though ultimately patient preference may play the largest role in determining the 'best' biologic agent. There is no single ideal biologic for all patients and a physician's job is to educate patients on the relative advantages and disadvantages of each agent. Through informed discussion, the clinician can help each individual patient decide which biologic agent is ideal for them.     

Policy and practice in teenage and young adult cancer care in England: Looking to the future

This paper outlines the current policy and service developments for the provision of cancer care for teenagers, young adults and their families in England. Key implications in terms of the settings and place of care, the centrality of the multidisciplinary team, the improvement of outcomes in TYA cancer care together with psychosocial issues are examined in more depth alongside the existing evidence base. In terms of the development of high quality, accessible specialist TYA cancer care and the development of a rigorous evidence base for the practice of TYA cancer care the next few years are crucial. The way forward is complex and challenging but the framework is in place in England to comprehensively improve the care and outcomes of teenagers and young adults with cancer.     

Does spirituality as a coping mechanism help or hinder coping with chronic pain?

Chronic pain is a complex experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Many chronic pain patients use religious/spiritual forms of coping, such as prayer and spiritual support, to cope with their pain. This article explores empirical research that illustrates how religion/spirituality may impact the experience of pain and may help or hinder the coping process. This article also provides practical suggestions for health care professionals to aid in the exploration of spiritual issues that may contribute to the pain experience.     

对氟苄胺合成工艺的改进

目的：获得成本低、工艺简单的合成方法。方法：以对硝基苯甲酸为原料经氟化、酰化和还原3步合成药物中间体对氟苄胺。结果：总收率达30．43％。结论：新的合成方法具原料易得、成本低廉、操作安全和工艺简单等特点。     

脑复清胶囊中阿魏酸的含量测定研究

目的：建立薄层扫描法测定脑复清胶囊中阿魏酸含量的方法。方法：采用碱水提取,酸化后以醋酸乙酯萃取脑复清胶囊中阿魏酸,薄层法测定含量。结果：本方法线性方程为y=127997.95x 1090.60,r=0.9996(n=5),线性范围为0.50-2.53ug,同板精密度试验：RSD＝4．40％（n=5)异板精密度试验。RSD＝4．65％（n=5),平均加样回收率98．28％,结论：薄层扫描法可作为脑复清胶囊中阿魏酸的含量测定8方法,本实验研究为该产品的质量控制提供了可靠依据。