Asunto(s)
Angiomiolipoma , Hiperplasia Nodular Focal , Neoplasias Hepáticas , Humanos , Angiomiolipoma/patología , Angiomiolipoma/complicaciones , Angiomiolipoma/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/diagnóstico , Hiperplasia Nodular Focal/patología , Hiperplasia Nodular Focal/diagnóstico , Hiperplasia Nodular Focal/complicaciones , Femenino , Adulto , Hígado/patología , Hígado/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
BACKGROUND: Laparoscopic liver surgery is gaining increasing acceptance worldwide, but its frontiers are constantly challenged. Laparoendoscopic single-site surgery (LESS) has been performed for various organs, but the feasibility of LESS hepatectomies has yet to be explored fully. METHODS: From May 2010 to March 2011, seven patients underwent LESS minor hepatectomies. Patient demographic, operative, and clinical data were reviewed. RESULTS: Five left lateral sectionectomies, one segment 3, and one segment 5 resection were performed. The median operative time was 142 min (range, 104-171 min), and the median blood loss was 200 ml (range, 100-450 ml). The median hospital stay was 3 days (range, 1-11 days). For all the patients, the indications for surgery were suspected malignant tumors, and the surgical resection margins were clear for every patient. CONCLUSIONS: Laparoendoscopic single-site minor hepatectomy is a novel modification to traditional laparoscopic surgery. The method is safe and feasible without any compromise to oncologic safety for selected patients with hepatocellular carcinoma (HCC) and colorectal liver metastases that are peripheral and smaller than 5 cm in size.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Endoscopía del Sistema Digestivo/métodos , Hepatectomía/métodos , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Anciano , Pérdida de Sangre Quirúrgica , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadRESUMEN
We describe the development of a simple and highly sensitive electrochemical (amperometric) sensing of bilirubin based on bilirubin oxidase (BOx) incorporated into the gold nanoparticles (AuNPs). This nanoelectrode platform with self-assembled enzyme is highly sensitive toward the electrochemical oxidation of bilirubin and increased the bilirubin concentration linearly from 1 to 5000 µM with a correlation coefficient of 0.9960, and an apparent Michaelis constant (K(M,app)) of 44 ± 0.4 µM. Using an amperometric method, the detection limit for bilirubin at the enzyme-modified electrode was 1.4 nM (signal-to-noise ratio=3). The modified electrode retained a stable response for 2 days while losing only ca. 3.4% of its initial sensitivity during a 10 days storage period in 0.2M phosphate buffer solution (pH=8.4) at ≤ 4°C. The practical application of the modified electrode was demonstrated by measuring the concentration of bilirubin in blood serum sample.
Asunto(s)
Bilirrubina/análisis , Técnicas Biosensibles , Técnicas Electroquímicas/métodos , Oro/química , Nanopartículas del Metal/químicaRESUMEN
INTRODUCTION: A higher rate of conversion to open surgery is a well-known problem in patients with acute cholecystitis undergoing laparoscopic cholecystectomy. The aim of this study is to analyze factors which may impact on conversion rates, and to analyze our outcomes following implementation of a departmental strategy in reducing conversion rates. MATERIALS AND METHODS: 122 patients with acute cholecystitis were considered for laparoscopic cholecystectomy from July 2003 to July 2007. An audit of the results of laparoscopic cholecystectomy was done in July 2005 and a departmental strategy aimed at reducing the conversion rates was introduced. The strategies included early laparoscopic cholecystectomy (within 72 hours of admission), performed or supervised by specialist hepatobiliary surgeons, and modifications of operative techniques. This study compares the conversion rates before and after that audit. Forty-eight patients (group A) were from the preaudit period and the remaining 74 (group B) were from the postaudit period. A multivariate analysis was performed to identify risk factors for conversion to open surgery and whether the strategies implemented resulted in decrease in conversion rates. RESULTS: In the group A patients, there was a conversion rate of 29.2%. Gallbladder wall thickness of greater than 5 mm was found to be a statistically significant (p = 0.028) risk factor for conversion to open surgery. In group B patients, the conversion rates were significantly lower at 6.75% (p = 0.001). Analyzing both groups of patients, using multivariate analysis, gallbladder wall thickness, increasing age, and preaudit operative period were found to be independently associated with conversion to open surgery. CONCLUSIONS: This study demonstrated that, with specific strategies to decrease conversion and with technical improvements, the conversion rates can be decreased with no demonstrable difference in postoperative complications. Gallbladder wall thickness and increasing age are risk factors for conversion to open surgery.