A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases

OBJECTIVE: To assess outcome after a 2-stage hepatectomy procedure (TSHP) combined with portal vein embolization (PVE) in the treatment of patients with unresectable multiple and bilobar colorectal liver metastases (MBCLM). BACKGROUND: Patients with MBCLM are often considered for palliative chemotherapy only, due to too small future remnant liver (FRL). Recently, right hepatectomy with simultaneous left liver wedge resections after previous right PVE has been reported in a curative intent. However, the growth of metastatic nodules in FRL after PVE can be more rapid than that of the nontumoral remnant hepatic parenchyma. Therefore, metastases located in the FRL should be ideally resected before PVE. Then, a right (or extended right) hepatectomy can be safely performed during a second-stage hepatectomy. Therefore, we analyzed our experience with the use of TSHP combined with PVE in treatment of MBCLM. PATIENTS AND METHODS: Between December 1996 and April 2003, 33 patients with unresectable MBCLM were selected for a TSHP. A right or an extended right hepatectomy was planned after treatment of left FRL metastases to achieve a curative resection. The first-stage hepatectomy consisted in a clearance of the left hemiliver by resection or radiofrequency destruction of metastases of the left FRL. Subsequently, a right PVE was performed to induce atrophy of the right hemiliver and hypertrophy of the left hemiliver. Finally, a second-stage hepatectomy was planned to resect the right liver metastases. RESULTS: There was no operative mortality. Post-PVE morbidity was 18.1%; postoperative morbidity was 15.1% and 56.0% after first- and second-stage hepatectomy, respectively. TSHP could be achieved in 25 of 33 patients (75.7%). The 1- and 3-year survival rates were 70.0% and 54.4%, respectively, in the 25 patients in whom the TSHP was completed. CONCLUSIONS: In selected patients with initially unresectable MBCLM, a TSHP combined with PVE can be achieved safely with long-term survival similar to that observed in patients with initially resectable liver metastases.     

Successful treatment of a 9-year-old boy affected by acrodermatitis continua of Hallopeau with targeted ultraviolet B narrow-band phototherapy

Acrodermatitis continua of Hallopeau (ACH) consists of a relapsing pustular eruption of the distal portions of hands and feet. We described a case of a 9-year-old boy affected by ACH, successfully treated with targeted ultraviolet B 311 nm phototherapy, which seems to be an effective and safe therapy for this condition.     

Evaluation of plasma oxidative stress,with or without antioxidant supplementation,in superficial partial thickness burn patients: a pilot study

Background: Oxidative stress is one of the main causes of pathophysiological alterations observed during burn injury. The present pilot study aimed to determine whether a specific oral antioxidant supplementation could in any way influence free radical blood values in patients affected by superficial partial thickness burns.

Materials and methods: Plasma oxidants and plasma antioxidant capacity were analysed in 20 superficial partial thickness burn patients for a 2-week period; patients were randomly divided into two groups, one of which was supported with a specifically designed oral antioxidant formula (Squalene 100?mg, Vitamin C 30?mg, Coenzyme Q10 10?mg, Zinc 5?mg, Beta Carotene 3.6?mg, Bioflavonoids 30?mg, Selenium 55?mcg) administered daily, starting from the day of admission, for the whole study period.

Results: No significant differences were found in plasma oxidants and plasma antioxidant capacity between the two groups of patients.

Conclusions: These results did not reflect any significant benefits of an antioxidant oral supplementation at usual dosages when considering oxidative plasmatic values of superficial partial thickness burn patients.     

Validity and reliability of the SPORTS score

Purpose  

Successful outcomes for an athlete usually consist of returning to their sport. The Subjective Patient Outcome for Return to Sports (SPORTS) score has been recently proposed as an easy to use score for evaluating an athlete’s ability to return to their sport. The aim of this study was to test the reliability and validity of the SPORTS score in athletes 5–10 years after anterior cruciate ligament reconstruction.     

Psychological Features of Hypnotizability: A First Step Towards Its Empirical Definition

This study examined the relationship between the Hypnotic Induction Profile (HIP) and several psychological tests: Tellegen Absorption Scale (TAS), Spontaneity Assessment Inventory-Revised (SAI-R), Dissociative Experiences Scale (DES), Short-Form Boundary Questionnaire (SFBQ), Mini Locus of Control (MLOC), Testoni Death Representation Scale (TDRS), and the Interpersonal Reactivity Index (IRI). Two hundred and forty volunteers were administered the above tests; 78 of them were also administered the HIP, and its scores were compared to those on the other tests. A significant correlation was found among the TAS, DES, SFBQ, and IRI. The HIP was significantly correlated to the DES (r = .19 p_1tail = .045), and the IRI-ec subscale (r = .19 p_1tail = .044); 14 test items from DES, IRI, TAS, SAIR, and SFBQ were also significantly related to the HIP. The findings suggest that hypnotizability may relate to stronger perception of the inner world, decreased aptitude for managing memory processing, and increased sensitivity and empathy.