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Deliberate external pancreatic fistula after pancreaticoduodenectomy performed in the setting of acute pancreatitis, and its internalization through fistula-jejunostomy

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 94-96页

作者： Sorin t Alexandrescu Andrei C Zlate razvan t grigorie Mihnea Ionescu Irinel Popescu Fundeni Clinical Institute Dan Setlacec Centre of General Surgery and Liver TransplantationSos.Fundeni nr.258sector 2BucharestRomania Carol Davila University of Medicine and Pharmacy BucharestRomania titu Maiorescu University Faculty of MedicineBucharestRomania

to the Editor:Many patients with tumors of the pancreatic head or of the ampulla of Vater require endoscopic manipulation of the duodenal papilla in order to achieve tumor biopsy or for common bile duct *** interventional endoscopy approaches may lead to acute *** iatrogenic acute pancreatitis will influence the surgical strategy in patients scheduled for pancreaticoduodenectomy(PD).Due to the small number of cases,the surgical strategy in patients who require PD in the context of acute pancreatitis has not been standardized.

关键词： pancreatitis acute Vater

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Aggressive surgical approach in patients with adrenal-only metastases from hepatocellular carcinoma enables higher survival rates than standard systemic therapy

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 28-33页

作者： Sorin t Alexandrescu Adina E Croitoru razvan t grigorie Dana R tomescu Gabriela Droc Mugur C Grasu Irinel Popescu Dan Setlacec Centre of General Surgery and Liver transplantation Fundeni Clinical InstituteBucharest 022328Romania Carol Davila University of Medicine and Pharmacy Bucharest 020021Romania Department of Oncology Fundeni Clinical InstituteBucharest 022328Romania Faculty of Medicine Titu Maiorescu UniversityBucharest 031593Romania Dan tulbure Centre of Anesteziology and Intensive Care Fundeni Clinical InstituteBucharest 022328Romania Department of Radiology Fundeni Clinical InstituteBucharest 022328Romania

Background:Although guidelines recommend systemic therapy even in patients with limited extrahepatic metastases from hepatocellular carcinoma(HCC),a few recent studies suggested a potential benefit for resection of extrahepatic ***,the benefit of adrenal resection(AR)for adrenal-only metastases(AOM)from HCC was not proved *** is the first study to compare long-term outcomes of AR to those of sorafenib in patients with AOM from ***:the patients with adrenal metastases(AM)from HCC were identified from the electronic records of the institution between January 2002 and December *** who presented AM and other sites of extrahepatic disease were ***,the patients with AOM who received other therapies than AR or sorafenib were ***:A total of 34 patients with AM from HCC were *** of these,22 patients had AOM,6 receiving other treatment than AR or ***,8 patients with AOM underwent AR(AR group),while 8 patients were treated with sorafenib(SOR group).the baseline characteristics of the two groups were not significantly different in terms of age,sex,number and size of the primary tumor,timing of AM diagnosis,Child-Pugh and ECOG *** a median follow-up of 15.5 months,in the AR group,the 1-,3-,and 5-year overall survival rates(85.7%,42.9%,and 0%,respectively)were significantly higher than those achieved in the SOR group(62.5%,0%and 0%at 1-,3-and 5-year,respectively)(P=0.009).the median progression-free survival after AR(14 months)was significantly longer than that after sorafenib therapy(6 months,P=0.002).Conclusions:In patients with AOM from HCC,AR was associated with significantly higher overall and progression-free survival rates than systemic therapy with *** results could represent a starting-point for future phase II/III clinical trials.

关键词： Adrenal metastases Hepatocellular carcinoma Adrenal resection Sorafenib Survival

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Influence of hepatitis viruses on clinico-pathological profiles and long-term outcome in patients undergoing surgery for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 162-172页

作者： Anna-Maria tanase traian Dumitrascu Simona Dima razvan grigorie Agnes Marchio Pascal Pineau Irinel Popescu Center of General Surgery and Liver transplant Fundeni Clinical Institute Unité "Organisation nucléaire et oncogenèse" INSERM U993Institut

BACKGROUND: the global risk of hepatocellular carcinoma(HCC) is largely due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In recent years, however, an increased prevalence of non-viral HCC has been noted. the clinical impact of the presence/absence of viral infections in HCC remains controversial. the present study aimed to assess the effect of hepatitis viruses on demographics, clinical and pathological features and long-term outcome in a large cohort of Romanian patients who underwent surgery for HCC. MEtHODS: the study included 404 patients with HCC who had undergone resection, transplantation or radiofrequency ablation at a single institution between 2001 and 2010. the patients were divided into four groups: 85 patients with hepatitis B virus infection (HBV group), 164 patients with hepatitis C virus infection (HCV group), 39 patients with hepatitis B and C virus co-infection (HBCV group), and 116 patients without viral infection (non-BC group). RESULtS: the patients of both HBV (56.0±11.3 years) and HBCV groups (56.0±9.9 years) were significantly younger than those of the HCV (61.0±8.5 years, P=0.001) and non-BC groups(61.0±13.0 years, P=0.002). Interestingly, the prevalence of liver cirrhosis was significantly lower in the non-BC group (47%)than in any other subsets (72%-90%, P<0.002). Furthermore, the non-BC patients were more advanced according to the Barcelona Clinic Liver Cancer stages than the patients of the HCV or HBCV groups (P<0.020); accordingly, they were more frequently assessed beyond the Milan criteria than any other groups (P=0.001). No significant differences in the disease-free or overall survival rates were observed among these groups. CONCLUSIONS: Patients with non-viral HCC are diagnosed at advanced ages and stages, a situation plausibly due to the poor effectiveness of cancer surveillance in community practice. the presence of viral infections does not appear to impair the longterm prognosis after surgical treatm

关键词： hepatitis B virus hepatitis Cvirus hepatocellular carcinoma recurrence prognosis

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Role of ammonia in predicting the outcome of patients with acuteon- chronic liver failure

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World Journal of Clinical Cases 2021年第3期9卷 552-564页

作者： Stefan Chiriac Carol Stanciu Camelia Cojocariu Ana-Maria Singeap Catalin Sfarti tudor Cuciureanu Irina Girleanu razvan Alexandru Igna Anca trifan Department of Gastroenterology “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology "St.Spiridon"Emergency HospitalIasi 700111Romania Intensive Care “Grigore T.Popa”University of Medicine and PharmacyIasi 700115Romania

BACKGROUND High venous ammonia(VA)values have been proven to be a part of the mechanism of hepatic encephalopathy in patients with liver cirrhosis(LC)as well as acute ***,VA has been associated with poor prognosis and high mortality in these clinical ***,the role of ammonia in acuteon-chronic liver failure(ACLF)has not yet been clearly *** to assess the role of VA in predicting the outcome of cirrhotic patients with ACLF in a tertiary care *** We performed a retrospective observational study including consecutive patients with LC hospitalized for acute non-elective indications such as ascites,hepatic encephalopathy(HE),upper gastrointestinal bleeding,or bacterial infections that fulfilled the Asian Pacific Association for the Study of the Liver(APASL)criteria for *** study was conducted in“***”University Hospital,Iasi,Romania,a tertiary care center,between January 2017 and January *** APASL ACLF Research Consortium(AARC)score was calculated and ACLF grade was established ***-haven classification was used for *** analysis was performed using IBM SPSS version *** Four hundred and forty-six patients were included,aged 59(50-65)years,57.4%***-Pugh,model for end-stage liver disease(MELD)and AARC scores were 11(10-12),19.13±6.79,and 7(6-8),respectively.66.4%had ACLF grade I,31.2%ACLF grade II,and 2.5%ACLF grade *** was diagnosed in 83.9%,34%grade I,37.2%grade II,23.5%grade III,and 5.3%grade *** mortality was 7.8%.VA was 103(78-148)μmol/*** operating characteristic analysis showed good accuracy for the prediction of in-hospital mortality for the AARC score[Area under the curve(AUC)=0.886],MELD score(AUC=0.816),VA(AUC=0.812)and a fair accuracy for the Child-Pugh score(AUC=0.799).Subsequently,a cut-off value for the prediction of mortality was identified for VA(152.5μmol/L,sensitivity=0.706,1-specificity=0.190).Univariate analysis found acute kidney in

关键词： Venous ammonia Hepatic encephalopathy Acute-on-chronic liver failure Asian Pacific Association for the Study of the Liver Acute-on-chronic Liver Failure Research Consortium score Cirrhosis Mortality

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