| 1. |
- Ansari, Daniel, et al.
(författare)
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Neoadjuvant/Downstaging Radiochemotherapy in Marginally Resectable Pancreatic Cancer
- 2014
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 61:136, s. 2387-2390
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Tidskriftsartikel (refereegranskat)abstract
- Pancreatic cancer is a challenging disease due to the low resection rate at the time of initial diagnosis. A relatively new classification of marginally resectable pancreatic cancer has emerged and there is some evidence that this subgroup of patients may benefit from neoadjuvant radiochemotherapy. The first major definition of marginally resectable pancreatic cancer was made at M. D. Anderson Cancer Center and published in 2006. This definition was purely anatomical and CT-based and only handles the relationship of the pancreatic tumor to its surrounding major vessels. Later on, two other subtypes have been added to this definition: suspicion or known metastasis in regional lymph nodes (N1 disease), or severe pre-existing medical comorbidities requiring prolonged evaluation or recovery and precluding immediate surgery. Other definitions (anatomical and CT-based) for marginally resectable pancreatic cancer have also been established. For systematic research on neoadjuvant therapy in marginally resectable pancreatic cancer, however, the lack of uniform definitions and randomized trials have been troublesome. Nevertheless, several small cohort studies have demonstrated that 40-80% of the marginally resectable patients could proceed to resection after neoadjuvant treatment and also reporting some promising effects on microscopic resection margins, lymph node status and survival.
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| 2. |
- Blind, Per-Jonas, et al.
(författare)
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Fast-Track Program for Liver Resection - Factors Prolonging Length of Stay
- 2014
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 61:136, s. 2340-2344
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Fast-track programs involving multi-modal measures to enhance recovery after surgery, reduce morbidity and decrease hospital length of stay (LOS) are used for different major surgical procedures. For liver resections, factors influencing LOS within a fast-track program have been studied only to a limited extent, which was the aim of the present study. Methodology: The present study comprises the first 64 patients included in a fast-track program for liver resections introduced in March 2012. Patient outcomes were compared to a historical cohort of patients (n=62) operated in 2009. Factors prolonging LOS was analyzed by uni- and multivariate analysis. Results: Median LOS was 6 days (range 3-42 days) within the fast-track program as compared with 8 days (range 5-47 days) in the historical cohort (P=0.004). On multivariate analysis, factors increasing LOS in the fast-track group were found to be the presence of complication (P=0.018), extent of resection (major as compared to minor) (P=0.001) and inability to drink > 1250 ml on the day after surgery (P=0.002). Conclusion: Patients who can only drink limited amounts of fluid the day after-liver resection represent a subset of patients that should be given special attention within a fast-track program.
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| 5. |
- Eriksson, Anders, 1957, et al.
(författare)
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Elevation of cytokines in peritoneal fluid and blood in patients with liver cirrhosis
- 2004
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 51:56, s. 505-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Liver cirrhosis, described as the endstage of a necroinflammatory process, is often accompanied by ascites formation. The rationale for this study was the hypothesis that patients with liver cirrhosis have a low-grade chronic inflammatory response, which leads to an increased amount of proinflammatory cytokines accumulated in ascites. Twenty-five patients with liver cirrhosis complicated by ascites and twelve healthy volunteers were prospectively included in the study. METHODOLOGY: Ascites and blood samples from the patients were obtained for analysis of inflammatory cytokines using enzyme-linked immunosorbent assay methodology. Blood samples were taken from the healthy volunteers to obtain reference values. RESULTS: Plasma and ascites concentrations of interleukin-1alpha, interleukin-6, and tumor necrosis factor-alpha were significantly elevated in the patients compared with plasma levels in the group of healthy controls. Significant elevation of interleukin-10 concentrations was found in ascites but not in plasma in the patients. There was no significant difference in interleukin-10 levels between patient and control plasma. CONCLUSIONS: The findings suggest that elevated cytokine concentrations in ascites and serum could perpetuate an inflammatory reaction that may be a source of preservation of an ongoing systemic inflammatory reaction. This may contribute to the maintenance, and even progress, of the liver dysfunction, leading to exaggerated ascites development.
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| 6. |
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| 7. |
- Hammarström, L-E, et al.
(författare)
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Endoscopic sphincterotomy for bile duct calculi: factors influencing the success rate. Hepato-Gastroenterol 1996; 43: 127-133.
- 1996
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Ingår i: Hepato-Gastroenterology. - 0172-6390. ; 43:7, s. 127-133
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Endoscopic sphincterotomy is an established treatment of retained or recurrent common bile duct calculi after cholecystectomy and in the majority of patients with an intact gallbladder. In order to identify patients ultimately requiring additional endoscopic procedures or surgery, factors predictive of decreased endoscopic bile duct clearance were sought. MATERIAL AND METHODS: Between 1981 and 1992 endoscopic sphincterotomy was performed in 393 consecutive patients with either intact gallbladders (n = 246), recurrent (n = 92) or retained (n = 55) calculi. RESULTS: There was a 9.4% overall early complication rate for the procedure and a 30-day mortality rate of 0.5% (two patients, non-procedure related). Complete removal of all bile duct calculi failed in 35/393 patients (8.9%). In patients with intact gallbladder the clearance rate at first attempt was higher (p = 0.002; Chi-square test) in the presence of solitary as compared to multiple stones. The same was found in patients with recurrent stones as well (p < 0.001). In non-cholecystectomized patients with single or multiple stones smaller than 10 mm, the clearance rate was higher at first (p = 0.02) as well as at final (p < 0.002) attempt as compared to patients with larger stones. Single small ( < 10 mm) compared to single large stones in patients with intact gallbladder had a higher clearance rate at final (p = 0.002) but not at first (p = 0.18) attempt. Patients with intact gallbladder and pancreatitis had higher clearance rate at first attempt compared to patients with jaundice (p = 0.001) or patients without concomitant pancreatobiliary disease (p = 0.002). Clearance rate was the same in patients with and without endoscopic sphincterotomy complications, except for patients with basket impaction, in whom the clearance rate was decreased (p = 0.02). CONCLUSIONS: Thus, in patients with intact gallbladder surgery should be considered after failed complete bile duct clearance at first attempt.
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| 9. |
- Kaczynski, Jerzy, 1951, et al.
(författare)
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Clinical features in hepatocellular carcinoma and the impact of autopsy on diagnosis. A study of 530 cases from a low-endemicity area
- 2005
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Ingår i: Hepatogastroenterology. - 0172-6390. ; 52:66, s. 1798-802
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) had been one of the malignancies with the highest reported increase of incidence in Sweden, but during the late 20-year period the incidence has been decreasing. The aims of our study were to state the impact of autopsy on diagnosis and to identify clinical characteristics in HCC. METHODOLOGY: This retrospective study was performed in Goteborg, Sweden and included all cases with a diagnosis of liver cancer from a period with a high autopsy frequency (1958-1979). The cases were reevaluated histopathologically and the autopsy records as well as the case files were scrutinized. RESULTS: The majority (63%) of the 530 biopsy verified cases of HCC were diagnosed unexpectedly at autopsy. Cirrhosis of the liver could be established in 71% of the cases, but was diagnosed or at least clinically suspected before the diagnosis of the tumor only in a minority (19%) of all HCC patients. At presentation, malaise (85%), weight loss (78%), anorexia (67%) and hepatomegaly (84%) were common. The median survival time from diagnosis was one month. In most cases (92%) the cause of death was either directly or indirectly related to HCC and/or underlying liver disease such as advanced tumor disease, hepatic failure and gastrointestinal bleeding. Spontaneous rupture of HCC was the cause of death in 17 cases (3%) CONCLUSIONS: In an unselected population in a low incidence area of HCC, most patients have clinically unknown cirrhosis of the liver and present with vague general paramalignant symptoms. HCC has an extremely poor prognosis. Since HCC, in a majority of cases, remains undiagnosed before death, the autopsy has great impact on the diagnosis. This should be considered in interpretation of results from epidemiological studies.
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