Intrahepatic Left to Right Portoportal Venous Collateral Vascular Formation in Patients Undergoing Right Portal Vein Ligation

Purpose

We investigated intrahepatic vascular changes in patients undergoing right portal vein ligation (PVL) or portal vein embolization (PVE) in conjunction with the ensuing hypertrophic response and function of the left liver lobe.

Methods

Between December 2008 and October 2011, 7 patients underwent right PVL and 14 patients PVE. Computed tomographic (CT) volumetry to assess future remnant liver (FRL) and functional hepatobiliary scintigraphy were performed in all patients before and 3 weeks after portal vein occlusion. In 18 patients an intraoperative portography was performed to assess perfusion through the occluded portal branches.

Results

In all patients after initially successful PVL, reperfused portal veins were observed on CT scan 3 weeks after portal occlusion. This was confirmed in all cases during intraoperative portography. Intrahepatic portoportal collaterals were identified in all patients in the PVL group and in one patient in the PVE group. In all other PVE patients, complete occlusion of the embolized portal branches was observed on CT scan and on intraoperative portography. The median increase of FRL volume after PVE was 41.6 % (range 10–305 %), and after PVL was only 8.1 % (range 0–102 %) (p = 0.179). There were no differences in FRL function between both groups.

Conclusion

Preoperative PVE and PVL are both methods to induce hypertrophy of the FRL in anticipation of major liver resection. Compared to PVE, PVL seems less efficient in inducing hypertrophy of the nonoccluded left lobe. This could be caused by the formation of intrahepatic portoportal neocollateral vessels, through which the ligated portal branches are reperfused within 3 weeks.     

Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature

We systematically reviewed the peer-reviewed literature to relate the survival of hybrid metal-on-metal hip resurfacing arthroplasty devices to a National Institute of Clinical Excellence (NICE) benchmark for choosing a primary total hip replacement, which is a survival rate of 90% at a follow-up of ten years. A total of 29 articles (10 621 resurfaced hips) met the inclusion criteria. The mean follow-up ranged from 0.6 to 10.5 years and the survival of the implant ranged from 84% to 100%. Of the 10 621 hips, 370 were revised (3.5%), with aseptic loosening as the most frequent mode of failure. None of the hip resurfacing arthroplasty implants used to date met the full ten-year NICE benchmark of survival. A total of 13 studies showed satisfactory survival compared with the three-year NICE benchmark.     

环氧合酶抑制剂与心血管事件的发生和预防

2004年,罗非昔布（万络）因致心血管疾病风险而撤市。市场上能增加心血管疾病风险的相关药物和环氧合酶（COX-2）抑制剂以及非选择性非甾体抗炎药（NSAID）也遭到质疑。本文论述是否新的证据能改进现有的临床实践和监管条例。过多的抑制COX-2会增加心血管疾病的发生风险,除非同时对血小板血栓素合成的抑制达95%以上,这可通过全血分析检测。最近研究证实,对乙酰氨基酚（扑热息痛）也是一种COX-2选择性抑制剂。流行病学调查指出,对乙酰氨基酚作为一种易得的非处方药物,也存在增加心血管事件的风险。目前尚无足够证据认为罗非昔布的替代药品是安全的。对NSAID的药品监管及处方应遵循“首要不伤害”的预警性原则,药品应强制性加注此类药物心血管风险的告示,以警示处方者和患者。     

Respiratory symptoms in the first 7 years of life and birth weight at term: the PIAMA Birth Cohort

RATIONALE: The relation between birth weight and respiratory symptoms and asthma in children remains unclear. Previous studies focused on a relation at separate ages. A longitudinal analysis may lead to a better understanding. OBJECTIVES: To estimate the effect of birth weight on the development and course of respiratory symptoms and asthma in the first 7 years of life. METHODS: In a prospective birth cohort study, 3,628 children with a gestational age 37 weeks or more were monitored for 7 years. Parental questionnaires were used to assess respiratory health yearly. Associations of birth weight with respiratory symptoms (wheezing, coughing, respiratory infections) and doctor's diagnosis of asthma were assessed in a repeated-event analysis. MEASUREMENTS AND MAIN RESULTS: Lower birth weight was associated with more respiratory symptoms (odds ratio [OR] per kg decrease in birth weight, 1.21; 95% confidence interval [CI], 1.09-1.34). The effect of birth weight increased from age 1 to 5, but decreased thereafter and was no longer significant at the age of 7. The effect of birth weight on respiratory symptoms was significantly greater among children exposed to tobacco smoke in their home than among nonexposed children (OR at 5 yr: 1.21 [95% CI, 1.02-1.44] and 1.52 [95% CI, 1.23-1.87], respectively). Birth weight and a doctor's diagnosis of asthma were not related (OR, 1.06; 95% CI, 0.82-1.37). CONCLUSIONS: A lower birth weight in children born at term is associated with a transiently increased risk of respiratory symptoms. This effect is enhanced by environmental tobacco smoke exposure.     

Quality of Life After Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection in Stage I/II Breast Cancer Patients: A Prospective Longitudinal Study

Background  Breast cancer patients’ quality of life (QoL) after surgery has been reported to improve significantly over time. Little is known about QoL recovery after sentinel lymph node biopsy (SLNB) in comparison to axillary lymph node dissection (ALND). Methods  175 of 195 stage I/II breast cancer patients completed the EORTC QLQ-C30: one day before surgery (T0) and after 6 (T1), 26 (T2), 52 (T3) and 104 (T4) weeks. Of these, 54 patients underwent SLNB, 56 SLNB+ALND and 65 ALND. General linear models and paired T-tests between T0–T4 and T1–T4 were computed. Complications, radiotherapy and systemic therapy were added to the model. Results  Significant time effects were found on physical, role and emotional functioning. Physical and role functioning decreased between T0 and T1. At T4, SLNB patients’ functioning had increased to their T0 level; ALND (+/– SLNB) patients’ functioning had increased, but had not improved to T0 level. Emotional functioning increased linearly between T0 and T4. At T4, emotional functioning was significantly higher in all groups as compared with T0. No significant group or interaction (time × group) effects were found. Complications and chemotherapy had a significant negative effect on role, emotional and cognitive functioning. Complications had a significant effect on social functioning also. Effect sizes varied between 0.00 and 0.06. Conclusion  Two years post surgery, breast cancer patients’ QoL is comparable to that shortly before surgery. Women rated their emotional functioning as even better. SLNB is not associated with a better QoL than ALND. However, undergoing systemic therapy and/or experiencing complications affects QoL negatively.