Liver Venous Deprivation Versus Portal Vein Embolization Before Major Hepatectomy for Colorectal Liver Metastases: A Retrospective Comparison of Short- and Medium-Term Outcomes

BACKGROUND

Liver venous deprivation (LVD) is a recent radiological technique performed to induce hypertrophy of the future liver remnant. Medium-term results of major hepatectomy after LVD have never been compared with the actual standard of care, portal vein embolization (PVE).

METHODS

We retrospectively compared data from 33 consecutive patients who had undergone LVD (n = 17) or PVE (n = 16) prior to a right hemi-hepatectomy or right extended hepatectomy indicated for colorectal liver metastases (CRLM) between May 2015 and December 2019.

RESULTS

The 1-year and 3-year overall survival (OS) rates in the LVD group were 81.3% (95% confidence interval [CI]: 72-90) and 54.7% (95% CI: 46-63), respectively, against 85% (95% CI: 69-101) and 77.4% (95% CI: 54-100) in the PVE group; the differences were not statistically significant (p = 0.64). The median disease-free survival (DFS) rate was also comparable: 6 months (95% CI: 4-7) in the LVD group and 12 months (95% CI: 1.5-13) in the PVE group (p = 0.29). The overall intra-operative and post-operative complication rates were similar between the two groups. The mean daily kinetic growth rate (KGR) was found to be higher after LVD than after PVE (0.2% vs. 0.1%, p = 0.05; 10 cc/day vs. 4.8 cc/day, p = 0.03), as was the mean increase in future liver remnant volume (FLR-V) (49% vs. 27%, p = 0.01).

CONCLUSIONS

The LVD technique is well tolerated in patients undergoing right hemi-hepatectomy or right extended hepatectomy for CRLM. When compared with the PVE technique, the LVD technique has similar peri-operative and medium-term outcomes, but higher KGR and FLR-V increase.

Total pancreatectomy with intraportal islet autotransplantation for pancreatic malignancies: a literature overview

INTRODUCTION

'Brittle Diabetes' (BD) is a life-threatening metabolic complication after total pancreatectomy (TP). More than 500 Intraportal islet autotransplantation (IAT) have been performed to prevent this complication, with almost 70% insulin independence after 3 years. Even when insulin independence was not achieved, IAT successfully prevented severe hypoglycemia. Currently, preliminary results for oncologic situations are promising, but their oncological outcomes are still a matter of debate.

AREAS COVERED

We performed a bibliographic research of the last 25 years of data. Articles published in English in peer-reviewed journals were retained. In France, auto- and allo-islet transplantation was recently recognized as a valuable treatment for BD by the national health authority. While accepted for benign diseases, the risk of tumor spreading after IAT in oncologic situations is a source of concern.

EXPERT OPINION

Preliminary results of IAT in oncological situations are very encouraging. So far, there is no evidence of tumor dissemination. In our opinion, to overcome BD TP with IAT for resectable pancreatic malignancies in patients with a higher risk of postoperative pancreatic fistula and extended pancreatic cancers can be safely performed. Diagnosis of malignancy should not be considered as an exclusion criterion for IAT.

Management of recurrent implantation failure by gonadotropin-releasing hormone agonist and aromatase inhibitor suppression, in women without evidence of endometriosis

Endometriosis is common among those with infertility, although many cases go undiagnosed. This study was performed to determine whether empiric treatment with two months of depo-leuprolide 3.75 mg monthly (dep-GnRH-ag) and letrozole 5 mg daily improves pregnancy outcomes in patients with at least two unexplained failed embryo transfers (ETs) but without a previous diagnosis of endometriosis. A retrospective cohort study was performed with subjects who failed at least two good quality ET. The study excluded women with a known history of endometriosis or ovarian cysts (possible endometriomas). Subjects (N = 38) were treated with dep-GnRH-ag and letrozole pre-cycle. Matched women (N = 37) who did not receive either pretreatment served as a control group. Data were compared by non-paired T-tests and multivariate logistic regression to control for confounding effects. Demographic data, hormonal profiles, and ovarian reserve parameters were similar between the two groups. The treated group had failed more embryo transfers (3.5 ± 1.7 vs. 2.0 ± 1.3, p = .01) than the controls. When adjusting for the number of MII oocytes collected, number of blastocysts developed and number of blastocysts transferred, there were more pregnancies (24/38 vs. 11/37, p = .02) and ongoing pregnancies (18/38 vs. 9/37, p = .03) in the treated group. Patients with multiple unexplained failed ET may have undiagnosed endometriosis and may benefit from pretreatment with dep-GnRH-ag and letrozole. These results would benefit from being subjected to a randomized prospective study.

Composite Replacement of Amalgam Restoration Versus Freshly Cut Dentin: An In Vitro Microleakage Comparison

OBJECTIVE

The aim of this study was to evaluate the microleakage of the composite restorations when bonded to tooth structure previously restored with amalgam material compared with that of freshly cut dentin.

METHODS AND MATERIALS

Thirty intact, extracted intact human molars were mounted in autopolymerizing acrylic resin. Class II box preparations were prepared on the occluso-proximal surfaces of each tooth (4-mm bucco-lingual width and 2-mm mesio-distal depth) with the gingival cavosurface margin 1 mm above the CEJ. Each cavity was then restored using high copper amalgam restoration (Disperalloy, Dentsply) and then thermocycled for 10,000 thermal cycles. Twenty-five of the amalgam restorations were then carefully removed and replaced with Filtek Supreme Ultra Universal (3M ESPE); the remaining five were used for scanning electron microscopy and energy dispersive x-ray spectroscopy analysis. A preparation of the same dimensions was performed on the opposite surface of the tooth and restored with composite resin and thermocycled for 5000 thermal cycles. Twenty samples were randomly selected for dye penetration testing using silver nitrate staining to detect the microleakage. The specimens were analyzed with a stereomicroscope at a magnification of 20×. All of the measurements were done in micrometers; two readings were taken for each cavity at the occlusal and proximal margins. Two measurements were taken using a 0-3 scale and the percentage measurements.

RESULTS

Corrosion products were not detected in either group (fresh cut dentin and teeth previously restored with amalgam). No statistically significant difference was found between the microleakage of the two groups using a 0-3 scale at the occlusal margins (McNemar test, p=0.727) or proximal margins (Wilcoxon signed-rank test, p=0.174). No significance difference was found between the two groups using the percentage measurements and a Wilcoxon signed-rank test at either the occlusal (p=0.675) or proximal (p=0.513) margins. However, marginal microleakage was statistically significant between the proximal and occlusal margins (p<0.001).

CONCLUSION

Within the limitations of this in vitro study, no significant difference was found between the microleakage of nondiscolored dentin in teeth that were previously restored with amalgam compared with freshly cut dentin. However, marginal microleakage in the proximal surface was higher than that in the occlusal surface.

Attitude of 100 Saudi Female Doctors towards their Health

Objective

To assess the overall health status, lifestyle behavior, and attitude towards menopause, hormonal replacement therapy (HRT) and human papilloma virus (HPV) vaccination among female Saudi doctors.

Materials and methods

This is a cross-sectional study that was conducted over a period of 2 months (November and December 2011). The study population was comprised of Saudi female physicians that are actively working. Ethics approval was obtained prior to conducting the study. A structured self-administered questionnaire was answered by the subjects. Inclusion criteria were any female physician who was willing to participate and was actively practicing at time of the study.

Results

One hundred responses were received. Forty-six subjects were <30 years and 31 subjects were >40 years of age. Obesity was defined as a body mass index (BMI) of >25 and morbid obesity as a BMI >30. Eight subjects had a normal BMI, 27 subjects were overweight, and 16 were morbidly obese. Six subjects were smokers and 13 had chronic illnesses such as diabetes. Only five of the subjects performed regular breast self-examination, and 40 subjects have a breast examination done by a physician. Pap smear was done at least once on only 17% of the subjects. Forty-eight subjects were willing to prescribe HRT to their patients. Sixty-five subjects were willing to administer the HPV vaccination to patients.

Conclusion

The overall health status, lifestyle, and attitude of Saudi female physicians towards their own health is suboptimal. This study shows that even physicians need to improve their lifestyle behavior and attitude towards their own health.