Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience.

BACKGROUND AND STUDY AIMS: In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department. PATIENTS AND METHODS: From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications. RESULTS: The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR. CONCLUSION: We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.

Physical Properties, Film Thickness, and Bond Strengths of Resin-Modified Glass Ionomer Cements According to Their Delivery Method.

PURPOSE: To determine the effect of changing the dispensing or mixing method of resin-modified glass ionomer (RMGI) cements on their water sorption, solubility, film thickness, and shear bond strength. MATERIALS AND METHODS: Disc-shaped specimens of RMGI cements (RelyX: Luting [handmix], Luting Plus [clicker-handmix], Luting Plus [automix], GC: Fuji PLUS [capsule-automix], FujiCEM 2 [automix], [n = 10]) were prepared according to ISO standard 4049 for water sorption and solubility tests. Furthermore, the percentage of mass change, percentage of solubility, and percentage of water absorbed was also determined. Film thickness was measured according to ISO standard 9917-2; the mean of 5 measurements for each cement was calculated. Shear bond strength for each cement was determined according to ISO standard 29022 before and after thermocycling at 20,000 cycles, temperatures 5 to 55°C with a 15-second dwell time (n = 10/subgroup). Two- and one-way ANOVA were used to analyze data for statistical significance (p < 0.05). RESULTS: Water sorptions of the RMGI cements were in close range (214-250 µg/mm3 ) with no statistical differences between counterparts (p > 0.05). RelyX Luting Plus (clicker-handmix) displayed lower solubility than its handmix and automix counterparts (p < 0.05). Film thickness of RelyX cements was significantly different (p < 0.05). RelyX Luting Plus (automix) had the lowest film thickness (19 µm) compared to its handmix (48 µm) and clicker-handmix (117 µm) counterparts (p < 0.05). GC Fuji PLUS (capsule-automix, 22 µm) was significantly lower than the automix version (GC FujiCEM 2, 127 µm) (p < 0.05). Shear bond strength of RelyX Luting Plus (automix) was significantly lower than its handmix and clicker-handmix versions (p < 0.05). GC Fuji PLUS (capsule-automix) was significantly higher than GC FujiCEM 2 (automix) (p < 0.05). The binary interaction of the two independent variables (dispensing/mixing method and thermocycling) was significant for the shear bond strengths of the GC cements only (p < 0.05). CONCLUSIONS: Change in the dispensing/mixing method of RMGI cement from the same brand may have an effect on its physical properties, in addition to its film thickness and shear bond strength. Newer, easier, and faster cement delivery systems are not necessarily better. Clinical outcomes of these differences are yet to be confirmed.

Mechanical properties of resin-based cements with different dispensing and mixing methods.

STATEMENT OF PROBLEM: Resin-based cements are frequently used in clinical practice. To reduce time and technique sensitivity, manufacturers have introduced the same brand of cement with different dispensing methods. The effect of this change on properties of the cement is unknown. PURPOSE: The purpose of this in vitro study was to evaluate the mechanical properties of resin-based cements with different dispensing systems. MATERIAL AND METHODS: Specimens of resin-based cements (n=14) PANAVIA SA Cement Plus Handmix, PANAVIA SA Cement Plus Automix, RelyX Unicem Handmix, RelyX Unicem 2 Automix, G-CEM Capsule Automix, G-CEM LinkAce Automix, Variolink II Handmix, and Variolink Esthetic Automix were prepared for each mechanical test. They were examined after thermocycling (n=7/subgroup) for 20000 cycles as to fracture toughness (FT) (ISO standard 6872; single-edge V-notched beam method), compressive strength (CS) (ISO 9917-1), and diametral tensile strength (DTS). The specimens were mounted and loaded at a crosshead rate of 1 mm/min (0.5 mm/min for FT) with a universal testing machine until failure occurred. The 2-and 1-way ANOVA followed by the Tukey HSD post hoc test were used to analyze data for statistical significance (α=05). RESULTS: Thermocycling had a significant effect in reducing the FT property of all resin-based cements except RelyX Unicem 2 and G-CEM LinkAce (P<.05). Variolink II and G-CEM LinkAce showed better FT properties than their automixed counterparts (P<.05). The overall CS of all automixed resin-based cements was better than that of their hand-mixed counterpart, except for Variolink II. PANAVIA SA Automixed and G-CEM LinkAce had higher DTS than their hand-mixed counterparts (P<.05). CONCLUSIONS: Changing the dispensing method alters the mechanical properties of resin-based cements. The clinical significance of these results is yet to be determined.