Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection...Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months展开更多
Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of cura...Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of curative surgery,is associated with poor survival,requiring earlier detection and intervention.This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.Material and methods:A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training(n=150)and validation(n=52)sets.Baseline information and radiological,pathological,and laboratory findings were extracted from medical records.Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram,which was validated for discrimination,calibration,and clinical application.Results:Liver-metastases number,lymph-node suspicion,neurovascular invasion,colon/rectum location,albumin and post-operative carcinoembryonic antigen,and carbohydrate antigen 19–9 levels(CA19–9)were independent predictive factors and were used to construct the nomogramfor early recurrence after curative surgery.The area under the curve was 0.866 and 0.792 for internal and external validation,respectively.The model significantly outperformed the clinical risk score and Beppu’s model in our data set.In the lift curve,the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30%high-risk patients.Conclusion:Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.展开更多
The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inad...The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.展开更多
Colorectal Cancer is the second most common cancer in western countries and, currently, surgical resection is still the principal treatment for this pathology. However, the operation carries significant morbidity and ...Colorectal Cancer is the second most common cancer in western countries and, currently, surgical resection is still the principal treatment for this pathology. However, the operation carries significant morbidity and mortality, which is associated with an enormous use of healthcare resources. The aim of our study is to evaluate the incidence and the management of complications, and to understand how pre-exisiting comorbidities can influence the recovery of the patients. Between 2007 and 2012, a total of 534 patients underwent elective or emergency surgery for colorectal cancer in our department. Patients were identified for this study from a prospectively entered computerized database. Case notes of patients documented comorbidities, type of surgery performed, complication in the early postoperative period (30 days after surgery) and the management. Postoperative morbidity affected 89 patients (17%), of these 25 (27%) were anastomotic leakage (AL). 22 (24%) patients experienced intra-abdominal abscess. 16 patients (17%) had wound infections. 11 patients (13%) experienced post-operative bleeding and five of them had a re-operation within the I and the II day after surgery. 12 (13%) complained medical (cardiologic/respiratory) complications. We had 1 (1%) Small Bowel Obstruction, treated with a conservative therapy. Reoperation rate was 3% with 11 for AL, and 5 for bleeding. The mortality rate was 0.55% (3 patients). In our experience, we evidenced that surgery performed for advanced rectal cancer in the lower rectum, especially in urgency settings is associated with an increase of morbidity and mortality in the early post-operative period. Pre-existing comorbidities are involved in the morbidity of the patients, and a more accurate approach both in surgical technique and in the post-operative management can be proposed to the surgeon. Derivative stoma in high risk patients gave us the possibility of a conservative treatment of the Anastomotic Leak, the most common complication in our study, with antibiotics and CT展开更多
文摘Living donor liver transplantation (LDLT) is now performed with high rates of success due to judicious recipient and donor selection,careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The indications for LDLT for adult and pediatric recipients should be the same as for deceased donor liver transplantation. Early postoperative complications are often defined as complications occurring within the first 3 months
基金supported by the Key Technology Research and Development Program of Zhejiang Province [No.2017C03017]the National Natural Science Foundation of China [81672916,11932017,81802750]+2 种基金the Natural Science Foundation of Zhejiang Province [LQ20H180014 to Y.Y.]the China Postdoctoral Science Foundation [2019M652117 to Y.Y.]the Natural Science Foundation of Zhejiang Province [LBY20H160002].
文摘Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of curative surgery,is associated with poor survival,requiring earlier detection and intervention.This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.Material and methods:A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training(n=150)and validation(n=52)sets.Baseline information and radiological,pathological,and laboratory findings were extracted from medical records.Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram,which was validated for discrimination,calibration,and clinical application.Results:Liver-metastases number,lymph-node suspicion,neurovascular invasion,colon/rectum location,albumin and post-operative carcinoembryonic antigen,and carbohydrate antigen 19–9 levels(CA19–9)were independent predictive factors and were used to construct the nomogramfor early recurrence after curative surgery.The area under the curve was 0.866 and 0.792 for internal and external validation,respectively.The model significantly outperformed the clinical risk score and Beppu’s model in our data set.In the lift curve,the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30%high-risk patients.Conclusion:Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.
文摘The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.
文摘Colorectal Cancer is the second most common cancer in western countries and, currently, surgical resection is still the principal treatment for this pathology. However, the operation carries significant morbidity and mortality, which is associated with an enormous use of healthcare resources. The aim of our study is to evaluate the incidence and the management of complications, and to understand how pre-exisiting comorbidities can influence the recovery of the patients. Between 2007 and 2012, a total of 534 patients underwent elective or emergency surgery for colorectal cancer in our department. Patients were identified for this study from a prospectively entered computerized database. Case notes of patients documented comorbidities, type of surgery performed, complication in the early postoperative period (30 days after surgery) and the management. Postoperative morbidity affected 89 patients (17%), of these 25 (27%) were anastomotic leakage (AL). 22 (24%) patients experienced intra-abdominal abscess. 16 patients (17%) had wound infections. 11 patients (13%) experienced post-operative bleeding and five of them had a re-operation within the I and the II day after surgery. 12 (13%) complained medical (cardiologic/respiratory) complications. We had 1 (1%) Small Bowel Obstruction, treated with a conservative therapy. Reoperation rate was 3% with 11 for AL, and 5 for bleeding. The mortality rate was 0.55% (3 patients). In our experience, we evidenced that surgery performed for advanced rectal cancer in the lower rectum, especially in urgency settings is associated with an increase of morbidity and mortality in the early post-operative period. Pre-existing comorbidities are involved in the morbidity of the patients, and a more accurate approach both in surgical technique and in the post-operative management can be proposed to the surgeon. Derivative stoma in high risk patients gave us the possibility of a conservative treatment of the Anastomotic Leak, the most common complication in our study, with antibiotics and CT
