Comparison of Tissue-Link combined with Cusa and Pringle in hepatectomy for primary hepatocellular carcinoma / 中国综合临床

Objective To evaluate the clinical effect of Tissue-Link combined with Cusa and Pringle in hepatectomy for primary hepatocellular carcinoma. Methods From January 2013 to January 2017,the clinical data of ninety-six primary hepatocellular carcinoma patients who had received hepatectomy were collected. 45 cases of hepatectomy (control group) were performed by Pringle. The other 51 cases (observation group) were treated with Tissue-Link combined with Cusa. The indexes and survival rates were compared between the two groups during and after operation. Results Compared with the control group, the operation time of the observation group was prolonged ((189. 2±45. 8) min vs. (151. 6±34. 7) min,t = -5. 101),the intraoperative blood loss ((273. 5±141. 6) ml vs. (371. 3±127. 2) ml,t = 7. 396),total bilirubin at seventh days after the operation (( 15. 7 ± 8. 9 ) μmol/ L vs. ( 26. 5 ± 10. 8 ) μmol/ L, t = 5. 320 ) and postoperative albumin supplementation((61. 0±9. 7) g vs. (84. 6±9. 3) g,t = 7. 698) of the observation group decreased. The tumor recurrence rate ( 0 vs. 8. 9% ( 4/ 45)), intrahepatic metastasis rate ( 7. 8% ( 4/ 51) vs. 20% ( 9/ 45)), extrahepatic metastasis rate (3. 9% (2/ 51) vs. 17. 8% (8/ 45)) (χ2 =. 031,6. 315,6. 746) decreased and the differences were statistically significant (P< 0. 05) . The 2 year and 3 year tumor free survival rate (88. 2%, 76. 5%) of the observation group was higher than those of the control group (64. 4%,44. 4%,χ2 = 5. 468, 8. 902),and the total survival rate of 3 year after operation (80. 4%) in the observation group was significantly, higher than that of the control group (51. 1%,χ2 = 4. 896),the difference was statistically significant (P<0. 05) . Conclusion Tissue-Link combined with Cusa is superior to Tissue-Link combined with Pringle in hepatectomy for primary hepatocellular carolnoma. It has less intraoperative blood loss, less damage to liver function and a lower relapse rate of ineisional margin,and the disease-free survival rate and overall survival rate are improved significantly.

A Case Report of Femoral Endarterectomy and Decalcification Using the Cavitron Ultrasonic Surgical Aspirator / 日本心臓血管外科学会雑誌

<p>A 69-year-old male complained of intermittent claudication of the right leg. Computed tomography revealed a right femoral artery stenosis with severe calcification and intimal thickening extending to the superficial and deep femoral arteries. Femoral endarterectomy and decalcification was carried out using the Cavitron Ultrasonic Surgical Aspirator (CUSA). All arteries were repaired by an ePTFE Y-shaped patch. Postoperative CT showed no stenosis and progressive calcification of the common, superficial and deep femoral arteries 2 years after surgery.</p>

A Case of Transvalvular Removal of Subvalvular Pannus beneath the Monocusp Tilting-Disk Mechanical Valve at the Aortic Position Using CUSA / 日本心臓血管外科学会雑誌

We describe our surgical treatment in a patient with subvalvular aortic stenosis due to pannus formation beneath a monocusp mechanical valve. In this case, transvalvular removal of subvalvular pannus using a CUSA (Cavitron ultrasonic surgical aspirator) was performed successfully. A 77-year-old woman underwent aortic valve replacement with a monocusp tilting-disk mechanical valve (Björk-Shiley, 23 mm) 30 years previously. Reoperation for severe aortic stenosis due to calcified subvalvular pannus formation was required. Intraoperative findings revealed no limitation of leaflet motion of the valve but presence of left ventricular outflow tract obstruction caused by subvalvular pannus formation under the major orifice of the prosthesis. Because of difficulty of exposure of the prosthetic valve due to severely calcified valsalva sinus wall, simple re-do aortic valve replacement seemed to be almost impossible. Therefore, we tried transvalvular removal of the pannus. A scalpel could not be applied due to severe calcification of the pannus. Then we used CUSA and removed the pannus successfully. Finally, subvalvular stenosis (LVOTO) was ameliorated and a decrease of trans-aortic valve velocity was recognized. She is doing well without recurrence 1.5 years after the surgery.

A força da palavra em Nicolau de Cusa / Power of the word and according to Nicholas of Cusa / La fuerza de la palabra en Nicolás de Cusa

A partir do momento em que se transpõe a dialética dos símbolos, rumo à experiência mística, é a força da palavra devidamente potencializada o que vai poder mover o ouvinte, uma vez que há uma força oculta por detrás de cada palavra. A força das palavras aparece, como uma contracção da força da mente, que se 'explica' nas múltiplas palavras que são, no mais fundo delas próprias, núcleos energéticos discursivos e que só podem ser entendidas nesse jogo dinâmico que se estabelece entre as coisas do mundo externo e seu referente interno, isto é, a mente. O discernimento é passado inicialmente, como propõe Nicolau de Cusa, por imagens sensíveis, continuando a proposta de Jesus, que falou inicialmente por figuras, mas disse também que chegaria a hora em que já não falaria por figuras, mas claramente, pois as palavras que de Deus recebeu, ele as deu aos homens cumprindo-se a profecia: no princípio era o Verbo (In principio erat verbum), no qual subjaz o poder criador da palavra. A proposta do Cusano é que nesta teoria do conhecimento se reconheçam as limitações da palavra e do discurso, inscrevendo-se a sua dialética no conhecimento intelectual da trindade, o qual, na unidade, ultrapassa tudo...

From the moment in which the dialectics of symbols is transposed, toward the mystical experience, it is the power of the word duly potentialized that will move the listener, once there is a hidden force behind each word. The power of the words appears as a contraction of the strength of the mind that "explains" itself in multiple words that are, in their deeper selves, discoursive energetic cores and that can only be understood in this dynamic game that is established between the things of the external world and its internal referent, that is, the mind. Discernment is passed initially, as Nicholas of Cusa proposed, by sensitive images, continuing Jesus' proposal that spoke at the beginning through images, however He also said that the time would come when He would no longer speak through images, but clearly, for the words He received from God He[[he gave them to men, thus fulfilling the prophecy: in the beginning was the Word (In principio erat verbum), in which lies the creative power of the word. Nicholas of Cusa's proposal is that in this theory of knowledge the limitations of the word and of the discourse are acknowledged, registering its dialectics in the intellectual knowledge of Trinity which, in the unity, exceeds all...

A partir del momento en que se transpone la dialéctica de los símbolos rumbo a la experiência mística, es la fuerza de la palabra debidamente potencializada, lo que hará hacer estremecer al oyente, una vez que hay una fuerza oculta detrás de cada palabra. La fuerza de las palabras aparece como una contracción de la fueza mental, que se 'explica' en las múltiples palabras que son en lo más fondo de las mismas, núcleos energéticos discursivos y que solo pueden ser compreendidas en ese juego dinámico, que se estabelece entre las cosas del mundo externo y su referente interno, esto es, la mente. El discernimiento es pasado inicialmente como lo propone Nicolás de Cusa, por imágenes sensibles, dándole continuidad a la propuesta de Jesús; que habla inicialmente por figuras, pero también disse que llegaría la hora en que no hablaría mas por médio de figuras, pero claramente, pues las palabras que de Dios recibió, él se las dio a los hombres cumpliendo la profecia: En el pincipio era el verbo (In principio erat verbum) en el cual subyace el poder crador de la palabra. La propuesta del Cusano es que en esta teoria de conocimiento sean reconocidas las de limitaciones de la palabra y del discurso, inscribiéndose en su propia dialéctica, en el conocimiento intelectual de la Trinidad, lo cual en la unidad lo ultra passa todo...

Successful Surgical Treatment of Extensive Mitral Annular Calcification Using CUSA and MIRA Valve / 日本心臓血管外科学会雑誌

We experienced a case of extensively calcified mitral annulus and severe mitral regurgitation. A 75-year-old woman underwent successful debridement of an annular calcification with a CUSA^® and replacement of mitral valve with a MIRA^TM valve in a supra-annular position. Use of CUSA^® allowed safe removal of the calcification and prevented the tearing of the A-V groove vessels. In our technique, calcification is left to a certain extent to keep annular strength. Also the MIRA^TM valve has soft and rich sewing cuff, which enhances coaptation in highly calcified annuli and accommodates even fragile tissue. This makes it possible to implant valves even in severely diseased annulus conditions.

The Incidence and Severity of Venous Air Embolism Determined by Transesophaseal Echocardiography in Hepatic Resection Using a Cavitron Ultrasonic Surgical Aspirator Dong / 대한마취과학회지

BACKGROUND: A new technique resecting the hepatic parenchyma without inflow occlusion using a Cavitron Ultrasonic Surgical Aspirator (CUSA(R) ) reduces intraoperative blood loss and perioperative morbidity. This study was designed to identify the incidence and severity of venous air embolism (VAE) using transesophaseal echocardiography (TEE) in hepatic resection using CUSA(R) . METHODS: Forty patients undergoing hepatic resection using CUSA(R) of ASA class 1 and 2 were selected. After insertion of an epidural catheter for postoperative analgesia, all patients were anesthetized with sevoflurane in 50% air/O2. After the induction of anesthesia, A TEE probe was inserted into the esophagus. Blood pressure, heart rate, central venous pressure, end tidal CO2, and arterial carbon dioxide tension were recorded after induction, and during and after hepatic resection. During hepatic resection, an anesthesiologist evaluated the degree of VAE by transesophageal echocardiography in the 4-chamber view. RESULTS: The mean time of using CUSA(R) was 65.3 +/- 24.4 minutes. Of 40 patients, 9 had VAE grade I, 14 grade II, 14 grade III, and 3 grade IV. However, no significant difference was observed in hemodynamics or PaCO2 after induction, or during or after hepatic resection. The mean amount of blood loss was 887.0 ml +/- 598.8 ml and the mean transfused amount was 123.1 +/- 351.3 ml. CONCLUSIONS: All patients showed air embolism during hepatic resection with CUSA(R) . Serious complications associated with air embolism would occur in patients with an undiagnosed intracardiac right to left shunt. Therefore, meticulous monitoring by transesophageal echocardiography might be recommended in hepatic resection with CUSA(R) .

Extirpated Intra- and Extracranial Metastasis of Hepatocellular Carcinoma: Case Report

A rare case of surgically extirpated intra- and extracranial metastasis of hepatocellular carcinoma is reported. This dumb-bell shaped tumor simulated malignant meningioma on computerized tomography brain scan and cerebral angiography. Removal of the mass was successfully achieved by external carotid ligation and CUSA dissection. We suggest that, when investigating patient with suspected cranial secondaries particulary if there is a bony involvement, serum alpha-fetoprotein and hepatic ultrasound should be carried out as screening procedures.