Assessment of safety in hepatic resection for hepatocellular carcinoma focusing on indirect hyperbilirubinemia

Background/purpose

The indications for hepatic resection for hepatocellular carcinoma (HCC) patients with total bilirubin (T-Bil) equal to or higher than 1.2 mg/dl remain controversial. The aim of this study was to investigate the safety of hepatic resection for HCC patients who showed high T-Bil (≥1.2 mg/dl) with low direct bilirubin (D-Bil ≤ 0.5 mg/dl).

Methods

Thirty-four HCC patients showing high T-Bil with low D-Bil were treated with mono- to tri-segmentectomy between January 2000 and December 2010. The perioperative clinical parameters and prognosis of the high T-Bil/low D-Bil patients were compared with those of 253 HCC patients showing normal T-Bil. In addition, complication rates of the patients with high T-Bil/high D-Bil (n = 4) were analyzed.

Results

The prothrombin time activity, indocyanine green clearance test, asialo-scintigraphy, and platelet count were similar in the two groups. The mean serum albumin in high T-Bil/low D-Bil patients was significantly higher than that of normal T-Bil patients (4.2 ± 0.5 vs. 4.0 ± 0.4 g/dl, P = 0.004). There were no significant differences in operation time, intraoperative bleeding, red cell concentrate transfusion rate, postoperative complication rate, and disease-free and overall survivals between the two groups. Postoperative hyperbilirubinemia (T-Bil >5 mg/dl) with ascites was observed in one of four high T-Bil/high D-Bil patients (25 %).

Conclusions

Mono- to tri-segmentectomy can be performed in patients with low D-Bil (≤0.5 mg/dl) similarly to patients with low T-Bil (<1.2 mg/dl), even in HCC patients showing high T-Bil (≥1.2 mg/dl).     

The Private Practice of Prosthodontists: Current and Future Conditions of Practice in the United States (Part 2)

PURPOSE: Data are used to examine current and future conditions important to the private practice of prosthodontics. A concern is raised as to whether the future supply of prosthodontists is in sync with the dynamics of the US population and patient population. MATERIALS AND METHODS: Four trends are examined using data from various sources. The trends include: (1) growth in the number of private practicing prosthodontists, (2) projections of the future number of private practicing prosthodontists, (3) first year enrollment in dental schools, and (4) enrollments and graduates in residency programs. RESULTS: The number of private practicing prosthodontists has increased modestly over the past 21 years, growing 1.33% per year. The number of private practitioners is projected to reach 4,125 in 2025. A key variable in this projection is the growing number of elderly adults. While dental school enrollments have been increasing, concern is raised about the amount of exposure by students to an undergraduate curriculum in prosthodontics. There has been a general decline in enrollment in the nation's prosthodontics residency programs at the rate of -2.9% per year. An average of 181 program graduates are needed to achieve the 4125 projected number of private practitioners. CONCLUSION: Increasing demand for services from prosthodontists is supported by an increasing US population size and a growing population of elderly. Efforts to grow the number of private practicing prosthodontists will have to consider several concerns including residency program enrollments, undergraduate exposure to prosthodontics, and the overall economic returns expected from engaging in the private practice of prosthodontics. Choosing a career as a private practicing prosthodontist is a timely consideration and complimented by expected increases in demand for care and favorable financial returns to practice.