Feasibility and potential of three-dimensional printing in laryngotracheal stenosis.

BACKGROUND: The use of three-dimensional printing has been rapidly expanding over the last several decades. Virtual surgical three-dimensional simulation and planning has been shown to increase efficiency and accuracy in various clinical scenarios. OBJECTIVES: To report the feasibility of three-dimensional printing in paediatric laryngotracheal stenosis and discuss potential applications of three-dimensional printed models in airway surgery. METHOD: Retrospective case series in a tertiary care aerodigestive centre. RESULTS: Three-dimensional printing was undertaken in two cases of paediatric laryngotracheal stenosis. One patient with grade 4 subglottic stenosis with posterior glottic involvement underwent an extended partial cricotracheal reconstruction. Another patient with grade 4 tracheal stenosis underwent tracheal resection and end-to-end anastomosis. Models of both tracheas were printed using PolyJet technology from a Stratasys Connex2 printer. CONCLUSION: It is feasible to demonstrate stenosis in three-dimensional printed models, allowing for patient-specific pre-operative surgical simulation. The models serve as an educational tool for patients' understanding of the surgery, and for teaching residents and fellows.

Use of pericholedochal plexus for portal flow reconstruction in diffuse portal vein thrombosis: case report.

Portal vein thrombosis (PVT) remains a challenging issue for liver transplantation surgeons. Most patients who have PVT undergo eversion thrombectomy. When thrombectomy is not successful due to diffuse PVT, other modalities are adapted, such as the use of a venous jump graft or portal tributaries. Here, we report our successful experience with reconstruction of portal flow using collateral plexus for a patient with grade 4 PVT. Thrombectomy did not restore portal flow. A pericholedochal plexus was found on the lateral wall of common bile duct. Direct end-to-end anastomosis was performed between the donor's portal vein and patient's choledochal plexus. Postoperative color Doppler ultrasound revealed normal portal flow.

Hepatotoxicity of anti-tuberculosis chemotherapy in patients with liver cirrhosis.

OBJECTIVE: To determine whether liver cirrhosis patients are at higher risk for drug-induced hepatotoxicity (DIH) than control subjects during treatment for tuberculosis (TB) with standard short-course regimens containing isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and/or pyrazinamide (PZA). METHODS: Fifty liver cirrhosis patients with newly diagnosed active TB treated with INH, RMP, EMB and/or PZA were included in the study, along with 147 patients without liver disease selected as control subjects. DIH was defined as alanine aminotransferase (ALT) > 120 IU/l with hepatitis symptoms or ALT > 200 IU/l. RESULTS: The aetiology of the liver cirrhosis patients consisted of alcoholic liver cirrhosis (n = 37, 74%), hepatitis B (n = 10, 20%) and hepatitis C (n = 3, 6%). The mean Child-Pugh score of all liver cirrhosis patients was 7.0 ± 1.2. DIH was more frequently found in liver cirrhosis patients, but the difference was not statistically significant (8.0% vs. 2.7%, P = 0.115). INH and RMP were successfully rechallenged and maintained until the end of treatment in three of four liver cirrhosis patients with DIH. CONCLUSION: Although DIH developed more frequently in TB patients with liver cirrhosis, the apparent difference in the incidence of DIH did not achieve statistical significance. Most of the patients with DIH were successfully treated with a standard short-course regimen including INH and RMP.

Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions.

BACKGROUND: Tumour recurrence is common after hepatic resection of hepatocellular carcinomas (HCCs) greater than 10 cm in diameter. This study evaluated the outcome of patients with huge HCC after primary resection and treatment of recurrent lesions. METHODS: A retrospective review was undertaken of clinical data for 100 patients with huge HCC who underwent liver resection. RESULTS: Mean(s.d.) tumour diameter was 13.3(3.0) cm; 80 per cent were single lesions. Systematic and non-systematic resections were performed in 80 and 20 per cent of patients respectively, with R0 resection achieved in 86 per cent. Overall 1-, 3- and 5-year disease-free survival rates were 43, 26 and 20 per cent respectively. Risk factors for HCC recurrence were resection margin less than 1 cm and macrovascular invasion. Extensive tumour necrosis of 90 per cent or more after preoperative transarterial chemoembolization was not a prognostic factor. Some 85 per cent of patients with recurrence received various treatments, and these patients had a longer post-recurrence survival than those who were not treated. Overall 1-, 3- and 5-year survival rates were 66, 44 and 31 per cent respectively. CONCLUSION: In patients with huge HCC, hepatic resection combined with active treatment for recurrence resulted in longer-term survival. Frequent protocol-based follow-up appears to be beneficial for the early detection and timely treatment of recurrence.