Current State of Liver Transplantation for Cholangiocarcinoma: A Comprehensive Literature Review.

Cholangiocarcinoma is the second most common primary hepatic neoplasm, accounting for 10% to 20% of primary liver tumors and 3% of all gastrointestinal neoplasms. The 3 anatomic types (intrahepatic, perihilar, and distal) have distinct epidemiologies, etiopathogenesis, and clinical outcomes. Surgical resection remains the current standard of treatment, but outcomes remain poor. With the continued expansion of liver transplant programs, use of liver transplant for malignant indications has also increased, with reports of encouraging outcomes. However, given the scarcity of livers fortransplant and accompanying possible complications, liver transplant for treatment of patients with cholangiocarcinomas remains experimental in most of the world. We reviewed the existing literature on treatment modalities for cholangiocarcinoma with emphasis on the pros and cons of surgical resection and indications, protocols, and outcomes of liver transplant as a treatment modality for patients with cholangiocarcinoma.

Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial.

AIMS: Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design. METHODS: Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2 (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up. RESULTS: At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001). CONCLUSION: Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025-1032.

Clinical evaluation of improvised gauze-based negative pressure wound therapy in military wounds.

The use of negative pressure wound therapy (NPWT) in civilian and military wounds is found effective in promoting granulation tissue, decreasing exudate and improving patient comfort. The Use of gauze-based NPWT is increasing in civilian trauma cases with availability of proprietary systems using gauze as filler material rather than the traditionally used reticulated open-cell foam. Military trauma wounds differ from civilian trauma wounds in energy of impact, degree and nature of contamination as well as the hostile environments. The Use of gauze as filler material for NPWT in military trauma wounds is less well studied. This study is a retrospective analysis of use of improvised gauze-based NPWT in military trauma wounds. The whole assembly was constructed from commonly available operation theatre supplies and no proprietary system was used. Results were very encouraging and the use of this improvised method can be useful and cheap alternative to costly proprietary systems.

The Budd Chiari syndrome: a 22 year male treated successfully with mesocaval shunt.

Budd Chiari syndrome (BCS) is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atrio cava junction. BCS could have serious consequences if not treated promptly. Comprehensive angiographic studies, computerised tomography, liver ultrasonography, histology and pathologic analyses are essential for establishing the disease severity, stratifying risk factors, choosing the appropriate therapy and objectively assessing the response. The main objective of therapy is to alleviate portal and IVC hypertension. Here we present a report of a young man with BCS who underwent mesocaval shunt. The eight months follow up showed that patient was free of symptoms and duplex scans confirmed the patency of the shunt.

Primary pancreatic tuberculosis: a rare and elusive diagnosis.

Primary pancreatic tuberculosis is an extremely rare entity, even in tuberculosis endemic areas. A 22-year-old male presented with features of obstructive jaundice. Ultrasonography and computed tomography scan showed mass in the pancreatic head for which he underwent a pancreatoduodenectomy. Histological examination of the specimen showed caseating granulomas. Antituberculous medicines were started and he remained well 18 months after surgery. Pancreatic tuberculosis is rare and is frequently confused with pancreatic cancer on clinical presentation as well as on imaging studies. A high index of suspicion is vital to avoid surgeries in this medically treatable, often misdiagnosed condition.

Knowledge, attitude and practices of healthcare providers towards deep vein thrombosis prophylaxis in five teaching hospitals of Rawalpindi.

BACKGROUND: Prophylaxis of deep vein thrombosis (DVT) is underutilised in Pakistan. This cross-sectional survey was designed to evaluate knowledge, attitude and practices of healthcare providers towards DVT prophylaxis in teaching hospitals in and around Rawalpindi. METHODS: Knowledge, attitude and practices was assessed by a 12-item questionnaire filled-in by healthcare providers in five teaching hospitals. Eleven out of 12 questions were multiple-choice type and one was open ended. RESULTS: One hundred-sixty-nine, out of 200 questionnaires were returned and were analysed. Total 43.2% of the respondents were house-officers. Although 98.8% agreed that DVT prophylaxis is clinically important, but 39.4% actually prescribed it themselves. Out of these, only 10.3% respondents did it routinely. Low molecular weight heparin (LMWH) was the preferred prophylaxis used (36.7%). Most of the respondents underestimated the prevalence and consequences of DVT in hospitalised patients. CONCLUSION: Knowledge and practices of healthcare providers about DVT prophylaxis in hospitalised patients is less than ideal. Hospitals need to develop their own guidelines for DVT prophylaxis.

Mid aortic syndrome: a rare vascular disorder.

Coarctation of abdominal aorta, Middle aortic syndrome (MAS) is a rare disease with only 200 reported cases. MAS may present clinically as uncontrolled hypertension, abdominal claudication or lower limb claudication. Surgical treatment is effective in controlling symptoms and improves life expectancy. We present another case of this rare entity, diagnosed and treated at Armed Forced Institute of Cardiology and Combined Military Hospital, Rawalpindi. This is the second reported case of MAS diagnosed and treated in Pakistan.