Extended Right Hepatectomy following Clearance of the Left Liver Lobe and Portal Vein Embolization for Curatively Intended Treatment of Extensive Bilobar Colorectal Liver Metastases: A Single-Center Case Series.

BACKGROUND: Two-staged hepatectomy (TSH) including portal vein embolization (PVE) may offer surgical treatment for extensive bilobar colorectal liver metastases (CRLM). This study aimed to investigate the feasibility and outcomes of extended right hepatectomy (ERH) within TSH including PVE for patients with extended CRLM. METHODS: We retrospectively collected data of patients who underwent TSH for extended CRLM between 2015 and 2021 at our institution. Clearance of the left liver lobe (clear-up, CU) associated with PVE was followed by ERH. RESULTS: Minimally invasive (n = 12, 46%, MIH) or open hepatectomy (n = 14, 54%, OH) was performed. Postoperative major morbidity and 90-day mortality were 54% and 0%. Three-year overall survival was 95%. Baseline characteristics, postoperative and long-term outcomes were comparable between MIH and OH. However, hospital stay was significantly shorter after MIH (8 vs. 15 days, p = 0.008). Additionally, the need for intraoperative transfusions tended to be lower in the MIH group (17% vs. 50%, p = 0.110). CONCLUSIONS: ERH following CU and PVE for extended CRLM is feasible and safe in laparoscopic and open approaches. MIH for ERH may result in shorter postoperative hospital stays. Further high-volume, multicenter studies are required to evaluate the potential superiority of MIH.

Melamine and cyanuric acid-induced crystalluria, uroliths, and nephrotoxicity in dogs and cats.

This article discusses the 2007 recall of canned pet food because of concerns about adverse effects on kidney function of cats and dogs. The discovery of melamine and cyanuric acid in the foods is detailed. Case studies, including clinical, pathology, histology, and toxicology findings, are presented. An attempt is being made to identify the minerals in the uroliths and kidney tissues of affected animals.

Deconstruction of a complex tailored intervention to assess and treat discomfort of people with advanced dementia.

AIM: This paper describes the use of components of the Serial Trial Intervention (STI), which is designed to address problems of physical and affective discomfort in people with late-stage dementia. BACKGROUND: Nursing intervention studies frequently test the efficacy of tailored interventions that contain multidimensional assessment and diverse treatment components. Describing differences in the intervention as planned in the research design and as delivered under study conditions increases understanding of what really contributed to outcomes achievement, Type III error and improves the validity of conclusions regarding intervention effectiveness. METHOD: Data from 57 participants in the treatment arm of a randomized experiment testing the intervention are used to describe the assessments and treatments actually delivered, to evaluate the effectiveness of specific components, and to compare differences between those receiving and not receiving the intervention. DISCUSSION: While targeted treatment in response to positive physical assessment was effective for 86% of those receiving treatment, 70% of participants with a positive assessment finding did not receive treatment during this step of the STI. Trials of non-pharmacological treatments were effective for 62% and trials of analgesics were effective for 75% of participants. Those treated at the not-for-profit facilities received a higher dose of the intervention and had statistically significant less discomfort after treatment than those at for-profit facilities (effect size of 0.963). CONCLUSION: Components of the STI were effective for many participants and this supports the use of a multidimensional approach to resolve the unmet needs of people with dementia who no longer communicate their needs through spoken language. Treating the intervention as both a categorical and continuous variable in experimental studies allows the effect of group assignment as well as dosage delivered to be examined.