Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review.

BACKGROUND: The physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. METHODS: A retrospective multicenter study of all patients who underwent LBDE during pregnancy from five centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. RESULTS: Five institutions reported performing LBDE during pregnancy in 8 patients. Median surgical time was 75 min (range: 60-140 min). The bile duct was cleared successfully in all patients, and the median hospital stay was 2 days (range: 1-3 days). The literature review identified a total of 7 patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal, or pregnancy-related complications in any of the total 15 patients included. The symptomatic common bile duct lithiasis with deranged liver function tests was the most frequent indication (n=7). CONCLUSION: LBDE during pregnancy appears to be safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.

The relationship between trial data in judicial sentences and self-reported aggression in men convicted of violence against women / Relación entre hechos probados en sentencias judiciales y agresión autoinformada en hombres condenados por violencia de género

Background: The Revised Conflict Tactics Scale (CTS-2) is widely used to assess intimate partner violence (IPV). Given the limitations preventing the collection of dyadic data, it is necessary to examine the relationship between the offender’s own self-reporting and the facts established in trial proceedings. This study assesses the relationship between aggression data self-reported by participants via CTS-2 and the data contained in convictions for partner abuse. Method: Two groups of men convicted of abuse against their female intimate partners or ex-partners (1,998 imprisoned offenders and 804 court-referred offenders), and 590 men from the community (general population) participated. The relationship was analyzed between the scores for self-reported CTS-2 items and violent behaviors described by proven facts. An ANCOVA with post-hoc comparisons (Bonferroni) was performed to assess the differences in CTS-2 scores between the three groups. Results: In the two groups of convicted participants, a significant relationship was found between CTS-2 items and the proven facts. Meanwhile, significant differences were found between the three groups in three CTS-2 subscales. Conclusions: The CTS-2 self-reported perpetrated aggression data provided by the convicted participants are related to the factual basis for convictions, and such data are therefore usable in forensic and psychological intervention contexts

Antecedentes: la Escala Táctica de Conflictos Revisada (CTS-2) es ampliamente utilizada para evaluar la violencia contra la pareja (VCP); dadas las limitaciones para obtener datos diádicos, es necesario examinar la relación entre el autoinforme de los maltratadores y las sentencias judiciales. Se evaluó la relación entre la agresión autoinformada mediante la CTS-2 y las condenas por maltrato de pareja. Método: participaron dos grupos de hombres condenados por maltrato contra su pareja o ex pareja femenina (1.998 internos en prisión y 804 derivados de la Justicia), y 590 hombres comunitarios (población general). Se analizó la relación entre las puntuaciones en los ítems de la CTS-2 y las conductas objetivadas por los hechos probados en las sentencias. Se realizó un ANCOVA con comparaciones post-hoc (Bonferroni) para evaluar las diferencias en la CTS-2 entre los tres grupos. Resultados: en los dos grupos de participantes condenados se encontró relación significativa entre algunos ítems de la CTS-2 y los hechos probados. Se encontraron diferencias significativas entre los tres grupos en tres subescalas de la CTS-2. Conclusiones: los datos de agresión autoinformada mediante la CTS-2 por los participantes condenados guardan relación con los hechos probados, y pueden ser útiles en contextos forenses y de intervención psicológica

Tourniquet-ALPPS is a promising treatment for very large hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

When very large hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinoma (IHCCs) with insufficient future liver remnants are treated using associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the outcome is often poor. We therefore tested the efficacy of a modified version of that technique, tourniquet-ALPPS. A review of the literature examining outcomes of HCC and IHCC patients treated with ALPPS revealed the incidences of morbidity ≥ III and postoperative mortality to be respectively 20.7% and 16.1% among HCC patients and 50% and 45.4% among IHCC patients. In the present case series, in which HCC and IHCC patients were treated with tourniquet-ALPPS, median tumor size was 100 mm (range: 70-200 mm). After surgical stage I, there was no morbidity, no mortality and the median future liver remnant had increased at day 7 by 76%. In surgical stage II, 100% of tumors were resectable (8 right trisectionectomies, 5 with inferior vena cava resection). Two patients experienced serious morbidity ≥ IIIB and 1 patient died (11%). One- and 3-year overall survival was 75% and 60%, respectively. Thus tourniquet-ALPPS appears to be an effective alternative to classical ALPPS for the treatment of patients with HCC or IHCC.

Clinical and pathological features of "small" GIST (≤2 cm). What is their prognostic value?

INTRODUCTION: Small GIST (<2 cm) are tumors whose biological behavior is benign and frequently involutes. Despite their increasing incidence, few studies have addressed the characteristics of these GIST. The aim of this work is to clarify the management of this entity. PATIENTS AND METHOD: The characteristics of ≤2 cm GIST were initially described, and then compared with those >2 cm. This series comprises 104 patients and they were divided according to tumor size in 4 groups: tumors which are ≤2 cm (group 1, G1), >2 and ≤ 5 cm (G2), >5 and ≤ 10 cm (G3) and >10 cm (G4). RESULTS AND DISCUSSION: Most of small GIST were asymptomatic and incidental, and were located in the stomach. There is an association between patients with associated tumors and asymptomatic GIST. A high overall mortality rate of up to 40% is observed being disease-specific mortality 4.5%. The disease-specific mortality increases proportionally with size. The overall survival (OS) at 5 years are lower for both <2 cm (61%) and >10 cm (53%) than the rest (85-91%). When analyzing the impact of tumor association on <2 cm GIST, we observed that the OS of patients with non-associated tumors was much higher than in the associated ones (90% vs 32% at 5 years, respectively), while no differences were observed in the disease specific survival. CONCLUSIONS: Small GIST are tumors that are very often incidentally discovered in the course of complementary examinations. Its prognosis is very good, but it depends on the associated tumor.

Role of 18F-FDG PET/CT vs CT-scan in patients with pulmonary metastases previously operated on for colorectal liver metastases.

OBJECTIVE: There is currently no conclusive scientific evidence available regarding the role of the 18F-FDG PET/CT for detecting pulmonary metastases from colorectal cancer (PMCRC) in patients operated on for colorectal liver metastases (CRLM). In the follow up of patients who underwent surgery for CRLM, we compare CT-scan and 18F-FDG PET/CT in patients with PMCRC. METHODS: We designed the study prospectively performing an 18F-FDG PET/CT on all patients operated on for CRLM where the CT-scan detected PMCRC during the follow up. We included patients who were operated on for PMCRC because the histological findings were taken as a control rather than biopsies. RESULTS: Of the 101 pulmonary nodules removed from 57 patients, the CT-scan identified a greater number (89 nodules) than the 18F-FDG PET/CT (75 nodules) (p < 0.001). Sensitivity was greater with the CT-scan (90 vs 76%, respectively) with a lower specificity (50 vs 75%, respectively) than with the 18F-FDG PET/CT. There were no differences between positive-predictive value and negative-predictive value. The 18F-FDG PET/CT detected more pulmonary nodules in four patients (one PMCRC in each of these patients) and more extrapulmonary disease in six patients (four mediastinal lymph nodes, one retroperitoneal lymph node and one liver metastases) that the CT-scan had not detected. CONCLUSION: Although CT-scans have a greater capacity to detect PMCRC, the 18F-FDG PET/CT could be useful in the detection of more pulmonary and extrapulmonary disease not identified by the CT-scan. Advances in knowledge: We tried to clarify the utility of 18F-FDG PET/CT in the management of this subpopulation of patients.