Vessel-Guided Mesohepatectomy for Liver Partition and Staged Major Parenchyma-Sparing Hepatectomies with Super-Selective Portal Vein Embolization or Enhanced ALPPS to Achieve R0 Resection for Colorectal Liver Metastases at the Hepatocaval Confluence.

Background. R0 minor parenchyma-sparing hepatectomy (PSH) is feasible for colorectal liver metastases (CRLM) in contact with hepatic veins (HV) at hepatocaval confluence since HV can be reconstructed, but in the case of contact with the first-order glissonean pedicle (GP), major hepatectomy is mandatory. To pursue an R0 parenchyma-sparing policy, we proposed vessel-guided mesohepatectomy for liver partition (MLP) and eventually combination with liver augmentation techniques for staged major PSH. Methods. We analyzed 15 consecutive vessel-guided MLPs for CRLM at the hepatocaval confluence. Patients had a median of 11 (range: 0-67) lesions with a median diameter of 3.5 cm (range: 0.0-8.0), bilateral in 73% of cases. Results. Grade IIIb or more complications occurred in 13%, median hospital stay was 14 (range: 6-62) days, 90-day mortality was 0%. After a median follow-up of 17.5 months, 1-year OS and RFS were 92% and 62%. In nine (64%) patients, MLP was combined with portal vein embolization (PVE) or ALPPS to perform staged R0 major PSH. Future liver remnant (FLR) volume increased from a median of 15% (range: 7-20%) up to 41% (range: 37-69%). Super-selective PVE was performed in three (33%) patients and enhanced ALPPS (e-ALPPS) in six (66%). In two e-ALPPS an intermediate stage of deportalized liver PSH was necessary to achieve adequate FLR volume. Conclusions. Vessel-guided MLP may transform the liver in a paired organ. In selected cases of multiple bilobar CRLM, to guarantee oncological radicality (R0), major PSH is feasible combining advanced surgical parenchyma sparing with liver augmentation techniques when FLR volume is insufficient.

[Delirium: a reappraisal of clinical characteristics and treatment perspectives after the transition from the DSM-IV to the DSM-5]. / Il delirium: una riconsiderazione delle caratteristiche cliniche e prospettive di trattamento con il passaggio dal DSM-IV al DSM-5.

The aim of this commentary is to discuss some clinical characteristics and treatment perspectives of delirium in the light of transition from the DSM-IV to the DSM-5. Such a transient dysfunction of cerebral metabolism, essentially reversible, presents an acute or subacute onset, and manifests itself clinically through a wide range of neuropsychiatric abnormalities. Delirium is a predictor of cognitive decline and is associated with a greater mortality. First line treatment of delirium is represented by haloperidol though atypical antipsychotics effectiveness and tolerability are increasingly evident.

Rapid reversal of severe lactic acidosis after thiamine administration in critically ill adults: a report of 3 cases.

BACKGROUND: Thiamine plays a critical role in energy metabolism. Critically ill patients may have thiamine deficiency and increased mortality due to potentially irreversible consequences. The aim of this study was to show the impact of thiamine deficiency in a series of patients and the rapid response to thiamine replacement, showing the changes in clinical and metabolic conditions over time. METHODS: We described 3 cases of hospitalized patients who had received parenteral nutrition (PN) without vitamin supplementation. All the patients were admitted to the ICU between 2010 and 2011 with a severe form of lactic acidosis, an unstable circulatory state, and a different neurological disorder (a lethargic state, a severe form of impaired near-coma consciousness, and Wernicke encephalopathy). RESULTS: Intravenous (IV) administration of thiamine was associated with a rapid and marked restoration of acid-base balance, hemodynamic stability and the disappearance of neurological disturbances, and normalization of the clinical and biochemical conditions of all the patients within the following hours. CONCLUSIONS: The 3 cases demonstrated the rapidity of the reversal of severe thiamine deficiency, achieved by appropriate replacement in different hospitalized patients. The regression of clinical and biochemical disorders requires a prompt diagnosis and treatment based on the IV administration of thiamine and magnesium sulfate. In hospitalized patients at risk, thiamine deficiency is prevented by the integration of thiamine supplementation into PN and other forms of nutrition support.

Abordagem interdisciplinar na disfunção temporomandibular - relato de caso / Interdisciplinary approach in temporomandibular disorders - case report

iomandibular. Este relato de caso tem como principal objetivo demonstrar os benefícios proporcionados pela intervenção da Fisioterapia, juntamente com a Odontologia em uma paciente do sexo feminino com 43 anos de idade, com diagnóstico de DTM. Os recursos utilizados para o tratamento foram técnicas de terapia manual e cadeias musculares associadas ao uso de uma placa de acrílico miorrelaxante. Os resultados obtidos foram uma melhora da postura global e a regressão da sintomatologia

Tratamento cirúrgico do hálux valgo pela técnica de osteotomia tipo adição: análise clínica e radiográfica / Surgical treatment of halux valgus by the technique of addition-type osteotomy: clinical and radiographic an / alysis

Neste estudo prospectivo foi avaliado o tratamento cirúrgico de 12 pacientes, 12 pés, portadores de hálux valgo de moderada e grave deformidade. Todos os pacientes fizeram reconstrução distal de partes moles pela mesma técnica cirúrgica, sendo empregado a osteotomia tipo adição para correção do varismo do primeiro metatarsal. A avaliação foi clínica e radiográfica. Concluindo-se que o índice de avaliação clínico e as medidas radiográficas, nos períodos pré e pós-operatório, melhoraram significantemente, à exceção da discrepância entre o primeiro e segundo metatarsais.