A comparison of volume clamp method-based continuous noninvasive cardiac output (CNCO) measurement versus intermittent pulmonary artery thermodilution in postoperative cardiothoracic surgery patients

The CNAP technology (CNSystems Medizintechnik AG, Graz, Austria) allows continuous noninvasive arterial pressure waveform recording based on the volume clamp method and estimation of cardiac output (CO) by pulse contour analysis. We compared CNAP-derived CO measurements (CNCO) with intermittent invasive CO measurements (pulmonary artery catheter; PAC-CO) in postoperative cardiothoracic surgery patients. In 51 intensive care unit patients after cardiothoracic surgery, we measured PAC-CO (criterion standard) and CNCO at three different time points. We conducted two separate comparative analyses: (1) CNCO auto-calibrated to biometric patient data (CNCO_bio) versus PAC-CO and (2) CNCO calibrated to the first simultaneously measured PAC-CO value (CNCO_cal) versus PAC-CO. The agreement between the two methods was statistically assessed by Bland–Altman analysis and the percentage error. In a subgroup of patients, a passive leg raising maneuver was performed for clinical indications and we present the changes in PAC-CO and CNCO in four-quadrant plots (exclusion zone 0.5 L/min) in order to evaluate the trending ability of CNCO. The mean difference between CNCO_bio and PAC-CO was +0.5 L/min (standard deviation?±?1.3 L/min; 95% limits of agreement ?1.9 to +3.0 L/min). The percentage error was 49%. The concordance rate was 100%. For CNCOcal, the mean difference was ?0.3 L/min (±0.5 L/min; ?1.2 to +0.7 L/min) with a percentage error of 19%. In this clinical study in cardiothoracic surgery patients, CNCO_cal showed good agreement when compared with PAC-CO. For CNCO_bio, we observed a higher percentage error and good trending ability (concordance rate 100%).     

Colorectal Cancer with Potentially Resectable Hepatic Metastases: Optimizing Treatment

Colorectal cancer is a common malignancy and often presents with synchronous or metachronous distant spread. For patients with hepatic metastases, resection is the principal curative option. Liberalization of the indications for hepatic resection has introduced a number of challenges related to the size, distribution, and number of metastases as well as the condition of the future liver remnant. Advances in systemic therapy have solidified its role as both an important adjunct to surgery and also for many patients as a mechanism to facilitate resection. In patients whose disease is marginally resectable as a consequence of the distribution of hepatic lesions that precludes complete resection or out of concern for the future liver remnant, a number of strategies have been advocated, including prehepatectomy systemic therapy, staged surgical approaches, ablative technologies, and preoperative portal vein embolization. It is the purpose of this review to discuss ways in which to optimize the treatment of patients with potentially resectable disease, specifically those who are judged to have “borderline” resectable situations.     

Ectopic thyroid gland in the porta hepatis and lingua.

A rare case of an ectopic thyroid gland in the porta hepatis and in the tongue in an asymptomatic euthyroid 24-year-old woman is reported. A solitary inhomogeneous, hypoechogenic and hyperechogenic mass in the porta hepatis was accidentally discovered by ultrasonography. Subsequent computed tomography demonstrated a heterogeneous, well-defined tumor with small calcifications without signs of environmental invasion. A hemangioma and focal nodular hyperplasia were excluded by blood pool and hepatobiliary scintigraphy. Surprisingly, fine-needle aspiration cytology revealed normal thyroid tissue. (123)I-scintigraphy confirmed the presence of ectopic dual thyroid tissue in the hepatic porta and lingua. At clinical inspection the lingual thyroid gland was palpable and visible, and appeared solid and spheroidal. The subhepatic, ectopic thyroid mass was resected. Postoperatively, thyroid hormone replacement was started to prevent an enlargement of the lingual thyroid. Today, 4 years after surgery, the patient remains euthyroid.