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B Presenter: b Emilio Alonso MD | Providence Portland Medical Center B Background: b Pancreatic ductal adenocarcinoma (PDAC) continues to be one of the leading causes of cancer death in the Unites States, with an increasing incidence over the past decades. We aimed to validate their IHC-subtyping and evaluate the gene expression HNF1A and KRT81 in an upfront-resected PDAC cohort. Gene expression analysis for KRT81/HNF1A were generated, from which gene expression ratio were calculated. [Extracted from the article]

B Presenter: b D. Rohan Jeyarajah MD | Methodist Richardson Medical Center B Background: b The role of Y90 in surgical algorithm for treatment of metastatic colorectal cancer (mCRC) to the liver is not well defined. B Methods: b A group of thought leaders from HPB, surgical oncology and transplant backgrounds were asked to participate in a delphi analysis framework to look at the data on Y90 in liver mCRC patients. [Extracted from the article]

Abstract: Municipal wastewaters are recognized as a major source of pharmaceutical and personal care products to the aquatic environment, thereby exposing biota to unknown chronic effects. This study sought to examine the immunotoxic effects of pharmaceutical and urban waste products on the freshwater mussel Elliptio complanata. Hemolymph samples were collected and treated in vitro with increasing concentrations of various drugs (bezafibrate, carbamazepine, fluoxetine, gemfibrozil, morphine, naproxen, novobiocin, oxytetracycline, sulfamethazole, sulfapyridine and trimethoprim) and urban waste related chemicals (coprostanol, caffeine, cotinine) for 24h at 15°C. In a parallel experiment, mussels were caged and placed in two final aeration lagoons for the treatment of domestic wastewaters. At the end of the exposure period, hemolymphs were tested for phagocytic activity, intracellular esterase activity, cell adherence and lipid peroxidation (LPO). The products that most increased phagocytosis were bezafibrate, gemfibrozil and trimethoprim, while novobiocin and morphine reduced its activity. Intracellular esterase activity was reduced most strongly with sulfamethazole, novobiocin, gemfibrozil, bezafibrate and carbamazepine. Cell adherence was decreased by oxytetracycline, novobiocin and naproxen, and increased by gemfibrozil, bezafibrate and sulfapyridine. Exposure to these products also modulated LPO in hemocytes. Coprostanol and naproxen were more potent to reduce LPO while novobiocin and sulfapyridine were the most potent to induce LPO. The potential to induce LPO was positively correlated with the number of functional groups on the molecule (i.e., its nucleophilicity). Mussels exposed to domestic wastewater treatment plant aeration lagoons had decreased intracellular esterase and phagocytic activity as well, suggesting immunosuppression. PPCPs (pharmaceuticals and personal care products) that are recognized to disrupt cytokine signalling network by the nitric oxide pathway and cell permeability were generally the most potent ones. The data suggest that PPCPs have the potential to cause adverse effects on the immune system of bivalves. [Copyright &y& Elsevier]

Background: Laparoscopic radiofrequency ablation (LRFA) and laparoscopic hepatic artery infusion pump (LHAIP) placement are new treatment options for patients with colorectal liver metastases. This study investigates the selection criteria, safety, efficacy, and preliminary outcomes of patients treated with LRFA and LHAIP placement. Methods: Forty five patients with colorectal metastases confined to the liver, 37 of whom had failed systemic chemotherapy, were treated with LRFA and/or LHAIP between September 1996 and December 2001. Treatment selection was individualized, based on each patient's general health, liver function, and tumor size, number, location, and distribution. Results: Twenty patients (44%) had LRFA alone, 10 (22%) had LHAIP placement alone, and 15 (33%) patients had combined LRFA and LHAIP therapy. The LRFA group had a significantly shorter mean operative time and blood loss (p <0.05), but hospital stays were similar when compared to patients receiving LRFA + LHAIP or LHAIP alone. Tumor characteristics were worse in both LHAIP groups, with a higher incidence of tumors ?4 cm, major vascular involvement, diffuse tumor pattern, bilobar distribution, and involvement of more than three segments. During a mean follow-up period of 11.5 ± 7.8 months (range, 1–38), the actuarial survival was 70%, 67%, and 50% for LRFA, LRFA + LHAIP, and LHAIP, respectively. LHAIP only patients had the shortest estimated mean survival time of the three groups by Kaplan-Meier survival curves (p = 0.001). Conclusion: LRFA and/or LHAIP placement are safe and feasible treatment options for the treatment of colorectal hepatic metastases. The choice of treatment for patients should be based primarily on tumor characteristics. Long-term studies, which will elucidate the role of these evolving treatments, are now under way. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic antireflux surgery is frequently denied to older patients with gastroesophageal reflux disease (GERD) because of a perceived higher operative complication rate, a decreased impact of the intervention on quality of life, and decreased cost effectiveness. This study compares disease severity, surgical outcomes, and impact on quality of life between elderly and young patients with GERD.Methods: Patients were selected from a prospectively maintained database of 1100 patients who underwent various laparoscopic esophageal procedures at our institution. Only patients having chronic intractable GERD and a minimum 6 months' follow-up were included in the study. Thirty elderly patients with a mean age of 71.2 years (SD +/- 5.6) were compared with a group of 30 younger patients (mean age, 43.9 +/- 12.8 years). Comparisons were made between subjective and objective outcomes, operative results, and health-related quality of life (HQRL) scores using SF-36 instruments.Results: The preoperative symptom assessment scores presenting frequency of symptoms on a 0-4 scale), and preoperative pH and manometry data were comparable in the two groups. Elderly patients had significantly higher ASA (American Society of Anesthesiologists) scores. Each group demonstrated a significant improvement in the postoperative symptom assessment scores and the esophageal functional studies (p<0.05). However, no significant differences were found in terms of postoperative complications, postoperative hospital stay, postoperative symptom scores, Demeester scores, or the HRQL data.Conclusion: Laparoscopic antireflux surgery in elderly patients improves acid reflux and appears to be safe and effective as measured by postoperative testing in elderly and young patients. [ABSTRACT FROM AUTHOR]

Background: The rapid adoption of laparoscopic surgery since the late 1980s added tremendous complexity into the operating room (OR) environment. For each case, a plethora of additional equipment-including monitors, video equipment, wiring, tubing, and cords-had to be set up, prolonging OR turnover time and decreasing OR efficiency. In 1993, the concept of designated minimally invasive surgery (MIS) suites was introduced. MIS suites integrated monitors and video equipment into the OR on ceiling-mounted columns and moved the controls to a centralized nursing station. The overall effect of this innovation on OR efficiency has not been measured. Methods: Five RNs with varying degrees of MIS experience were instructed on video setup and put-away criteria and then timed while performing a set of standardized tasks. Each set of tasks was performed twice using a standardized surgery model. Differences in setup and put-away times between MIS suites and standard ORs were tested using the t-test for paired comparisons. Results: The mean ± standard deviation (SD) video setup times were 27.9 ± 5.3 sec (MIS) and 254.3 ± 54.0 sec (standard); the put-away times were 19.8 ± 2.7 sec (MIS) and 222.3 ± 26.0 sec (standard). The mean difference ± standard error (SE) in both the setup (226.4 ± 16.9 sec, p = 0.0001) and put-away times (202.5 ± 8.6, p = 0.0001) were large and statistically significant. Conclusion: Using a simulation model, we have demonstrated that the use of a MIS suite reduces video setup and put-away time significantly, with the potential for significant associated cost savings. This provides just one justification for the high cost of building such "ORs of the future." [ABSTRACT FROM AUTHOR]

Background: Recently there has been interest in performing laparoscopic herniorrhaphies without the use of staples or tacks to fix the mesh. Although mesh fixation has been linked to an increased incidence of nerve injury and involves increased operative costs, many surgeons feel that fixation is necessary to reduce the risk of hernia recurrence. This study evaluates the outcomes of laparoscopic herniorrhapies performed with and without mesh fixation at our institution. Methods: We retrospectively evaluated our last 172 laparoscopic herniorrhaphies, which span a period of conversion from staple fixation to nonfixation of total extraperitoneal herniorrhaphies using systematic chart review and follow-up self-administered questionnaires. The outcomes assessed were the incidences of postoperative neuralgia and hernia recurrence. Adjustment for important prognostic factors was achieved using Cox regression for estimating the risk of recurrence, and multiple logistic regression for estimating the risk of neuropathic complications. Results: Of 172 laparoscopic herniorrhaphies performed in 129 patients since July 1993, 105 were accomplished without mesh fixation, and 67 were performed with fixation of mesh to the abdominal wall. There were no significant differences in demographics between the two groups. A trend toward a higher incidence of neuropathic complications was observed in the mesh-fixation group (risk ratio [RR], 2.2; 95% CI, 0.5-10). A nonsignificant increased risk of hernia recurrence with fixation of mesh was observed (4.2 vs 1.6 per 100 hernia-years at risk; RR, 2.3; 95% CI, 0.4-13.10), but this finding may be associated with a selection bias with regard to giant hernia defects. Conclusions: Our data suggest that mesh fixation to the abdominal wall may be avoided in total extraperitoneal repairs without increasing the risk of hernia recurrence and neuropathic complications. The increased risk of recurrence observed with mesh fixation possibly results from selection bias. Large randomized controlled studies are needed to determine whether mesh fixation is truly related to neuropathic complications and the incidence of recurrence. [ABSTRACT FROM AUTHOR]

Despite the propagation of biliopancreatic operations, there have been few pancreaticoduodenctomies in complete situs inversus patients reported in the literature. Here we report a pylorus preserving pancreaticoduodenectomy in a complete situs inversus patient for a distal cholangiocarcinoma. B Conclusion: b In Conclusion, a pancreaticoduodenectomy could be safely performed on a complete situs-inversus patient with minimal adjustments by an experienced surgeon in a high volume center for panceaticobiliary surgery. [Extracted from the article]

B Presenter: b Jon Gerry MD | Providence Portland Medical Center B Background: b Recent changes to MELD exception rules decrease availability of organs to HCC patients with low biological MELD. B Results: b Among 2433 patients who underwent liver resection for HCC, 314 patients (13%) had a bilirubin greater than 1.0 mg/dL, and 975 (40%) had cirrhotic liver texture. B Conclusion: b In the setting of cirrhosis, PHLF and in-hospital mortality after partial hepatectomy are worse in patients with an elevated bilirubin greater than 1 mg/dL, but the rates are similar to non-cirrhotic patients undergoing major hepatectomy. [Extracted from the article]

Introduction: Basic fibroblast growth factor (bFGF) and hepatocyte growth factor (HGF) are important positive regulators of tumor growth and angiogenesis. This study was designed to assess the effect of bFGF and HGF infusion on tumor growth and metastases in a syngeneic, rat colon adenocarcinoma tumor model. Methods: Liver tumors were established in each of 21 BD9 rats via surgical, subcapsular implantation of a 1.0 mm3 piece of a subcutaneously grown DHD/K12/TRb tumor. Test groups were infused systemically with 5 μg/day/rat bFGF or 0.5 μg/day/rat HGF via osmotic pump; and controls received saline. At 28 days all animals were killed and examined. Tumor volume was calculated as π[a2 × b]/6, where a is shorter length and b the longer length. Liver and lung specimens were fixed in zinc formalin and embedded in paraffin for H&E staining and immunohistochemical study. Results: On histologic examination, tumor cells were seen to grow along blood vessel branches after infusion bFGF and HGF. Both VEGF and Flk-1 expression was strong cytoplasmic staining in cancer cells from hepatic, peritoneal and lung metastases. Conclusion: While both bFGF and HGF appear to induce an increase in tumor growth in this model, the effect of bFGF was marked. Similarly, HGF appeared to stimulate the development of distant metastases, though not reaching significance, while bFGF produced local and distant metastases with statistically significant increase in lung metastases. This rat colon adenocarcinoma cell line expressed VEGF and its receptor Flk-1. Further studies are required to evaluate the mechanism of tumor growth and metastasis stimulation. TABLE—ABSTRACT P8Control (n = 7)bFGF (n = 7)HGF (n = 6&ast;)P valueTumor volume (mm3)48.8 ± 17.685.1 ± 25.0†59.3 ± 26.9†<.05Intrahepatic mets03/7‡0‡=.19Peritoneal mets03/7‡1/6‡=.19Lung mets&ast;&ast;05/7‡1/6‡=.02&ast;One rat in this group died at postoperative two weeks.†,‡bFGF group vs control group by Kruskal Wallis test. [Copyright &y& Elsevier]

Abstract: Environmental pollutants with hormonal activity including bisphenol, diallyl phtalate and tetrabromodiphenyl ether, have the potential to alter gonadal development and reproduction in aquatic wildlife. Little is known about the biological impact of environmentally relevant concentrations in mussels. To investigate some aspects of their potential estrogenic action, mussels were continuously exposed during 3 weeks. Gonadal development and vitellogenin like protein levels were examined. Bisphenol (50μg/l) induced the expression of phospho-proteins in females and spawning in both sexes. Diallyl phthalate and tetrabromodiphenyl ether decreased phospho-protein levels in both sexes and induced spawning in males. Moreover, severe damaging effects on ovarian follicles and ovocytes were observed in both bisphenol A- and tetrabromodiphenyl ether-exposed female mussels. [Copyright &y& Elsevier]

Presents a corrected reprint of the article "Laparoscopic radiofrequency ablation and hepatic artery infusion pump placement in the evolving treatment of colorectal hepatic metastases,' by J. Cheng, R. E. Glasgow, R. W. O’Rourke, L. L. Swanstrom, P. D. Hansen, published in the Volume 17, 2003 issue of the "Surgical Endoscopy" journal.