Local Venous Thrombotic Risk of an Expanding Haemostatic Agent Used During Liver Resection

Background

For patients undergoing liver resection that leaves an empty intraparenchymal cavity, traditional topical agents might be inadequate to achieve additional hemostasis. A new hemostatic expanding topical foam (BioFoam^®) has been designed to provide a mechanical seal. The objective of this study was to report our preliminary results regarding the safety and the efficacy using this foam.

Methods

Between 2009 and 2011, BioFoam^® was used to fill a three-dimensional defect following liver resection in 14 patients. The operative results and postoperative course of these patients were compared to those of 14 matched controls who underwent liver resection but did not receive BioFoam^®.

Results

The two groups were similar in terms of demographics, indications for liver resection, type of surgical procedure, and type and duration of clamping. BioFoam^® patients experienced significantly less operative blood loss (275 vs. 630 ml, p = 0.032) but similar operative transfusion rates (28.6 vs. 35.7 %, p = 0.686) compared to no-BioFoam^® patients. The postoperative mortality was nil and no patient developed postoperative hemorrhage. While the two groups shared similar overall (64.3 vs. 57.1 %, p = 0.599) and major (28.6 vs. 14.3 %, p = 0.357) complications rates, BioFoam^® patients experienced significantly higher major vascular thrombosis compared to no-BioFoam^® patients (29 vs. 0 %, p = 0.04). In the BioFoam^® group, major vascular thrombosis was associated with exposure of the vessel along the transection plane.

Conclusion

While the clinical benefit of BioFoam^® in high-risk liver resections leaving a deep parenchymal defect remains to be proven, the associated risk of vascular thrombosis should preclude its use in contact with major veins.     

An acute abdominal syndrome reveals a postoperative ilio-iliac arteriovenous fistula: about one case

Introduction

Postoperative ilio-iliac arteriovenous fistula is an unusual but known complication after lumbar surgery.

Case report

We report the case of a 74-year-old patient consulted at the emergency department for intense acute abdominal syndrome revealing a post-operative common ilio-iliac arteriovenous fistula 5 years after a lumbosacral arthrodesis L3–S1. The patient was treated with an endovascular arterial stent-graft with immediate vascular and clinical results.

Conclusion

Arteriovenous fistula is a possible etiology of acute abdominal syndrome in patients with lumbar or abdominopelvic surgery history.

     

Extended-release naltrexone/bupropion and liver health: Pooled,post hoc analysis from four randomized controlled trials

Sustained weight loss improves liver histology in non-alcoholic fatty liver disease. This post hoc analysis of four phase III, 56-week, randomized controlled trials investigated if extended-release naltrexone and bupropion (NB) affects alanine aminotransferase (ALT) and Fibrosis-4 (FIB-4) index in adults with overweight or obesity. Two thousand and seventy-three subjects (NB = 1310; placebo = 763; 79.0% female; 81.6% Caucasian) had baseline mean weight 101 kg, body mass index 36.2 kg/m², ALT 26.9 IU/L and FIB-4 0.79. At 56 weeks, NB-treated subjects experienced more weight loss than placebo (8.7 vs. 3.2 kg, respectively, P < .0001). Weight loss, independent of treatment, was associated with improved ALT and FIB-4 (P < .0001). There was a significant independent effect of NB on change from baseline for FIB-4 (P < .0001), but not for ALT (P = .54). Categorical ALT response (from above to within normal ranges: 10-40 IU/L for men; 7-35 IU/L for women) and achievement of 25% and 50% reduction in ALT were greater for NB versus placebo, and independently affected by weight loss (P < .0001), but not treatment. NB-associated weight loss may improve liver health by normalizing ALT values for those with high baseline levels.     

Co-Construction of an Intervention Model Using Sports in a Rehabilitation Setting: A Collaboration Between Researchers and Practitioners

The objective of this article is to develop an explanatory model of how a rehabilitation intervention functions within a sports context. Participants include three Coach-Educators (CEs) who organize and set up a rehabilitation intervention using ice hockey. In order to develop the model, two focus groups using the co-modeling methodology of Basque and Pudelko (2004) were conducted. Based on their experiences, the CEs illustrated and modeled the functioning of their intervention. A concept mapping software was projected on a screen to follow the co-modeling in real time. The first discussion group provided a first draft of the model which served as a starting point for the second. The data were analyzed in light of the Theory of change (Weiss, 1998). The CEs report that the objective of the intervention is social integration. This objective can be achieved either through the interaction of the activity components (i.e., youth, group, CEs, ice hockey, structured aspects), or by the CEs’ interventions involving four mechanisms: strengthening self-esteem, moving focus from oneself to others, destigmatization, and learning of prosocial behaviors. Many factors, such as gender, expertise and participants’ experiences were identified as having a positive or negative effect on achieving the objective of the program. Practical considerations and future research avenues are presented. For example, practitioners who use sport in the context of rehabilitation should be familiar with the characteristics and difficulties of the adolescents in Youth Centers and have a clinical rationale in relation to the problem underlying the intervention and its objective.     

Left atrial far-field sensing by left ventricular leads: a potential hazard in cardiac resynchronisation therapy.

BACKGROUND: Cardiac resynchronisation therapy (CRT) requires a lead advanced through the coronary sinus (CS) to pace the left ventricle (LV). Left atrial far-field signals (LAFFS) may be sensed by the LV lead at the time of implant or after lead dislodgement, and may inhibit ventricular pacing. OBJECTIVE: To assess the incidence of detection of LAFFS > 2 mV and its correlation with the CS lead position. METHODS: Data from the first 75 consecutive patients enrolled in the InSync III multicentre study were analysed. The position of the LV lead was recorded at implant. During follow-up, pacing was temporarily inhibited and the LV channel electrogram was recorded. The amplitude of LAFFS observed before discharge from the hospital and at 1 month of follow-up was retrospectively analysed. A LAFFS > 2 mV was considered clinically significant. RESULTS: CRT systems were successfully implanted in 71 of 75 patients. A LAFFS > 2 mV was recorded by the LV lead channel in six of 71 patients (8.5%). This phenomenon developed between hospital discharge and 1 month of follow-up in two of these patients and in one case disappeared within 1 month. It was observed in all CS tributaries except the anterior and mid-cardiac veins. CONCLUSIONS: Left atrial far-field signals sensed by the LV lead were not rare. Implanting physicians should be aware of this phenomenon in order to prevent potentially serious complications.     

Balance control interferes with the tracing performance of a pattern with mirror-reversed vision in older persons

GeroScience - When tracing a template with mirror-reversed vision (or distorted vision), the sensory information arising from the movement does not match the expected sensory consequences. In such...