Fibrolamellar hepatocellular carcinoma (FL-HCC) is a malignant liver tumor which is thought to be a variant of conventional hepatocellular carcinoma (HCC). It accounts for a small proportion of HCC cases and occurs in a distinctly different group of patients which are young and usually not in the setting of chronic liver disease. The diagnosis of FL-HCC requires the integration of clinical information, imaging studies, and histology. In terms of the treatment options, the only potentially curative treatment option for patients who have resectable disease is surgery either liver resection (LR) or liver transplantation (LT). When performed in a context of aggressive therapy, long-term outcomes after surgery, particularly liver resection for FL-HCC, were favorable. The clinical outcome of patients with unresectable disease is suboptimal with median survival of less than 12 months. The aim of this review is to update the available evidence on diagnosis, treatment options, outcome predictors, and recent developments of patients with this rare disease and to provide a summarized overview of the available literature.

This thesis deal swith the specifics of nursing care for patiens with a resected tongue in the oral surgery department. The objectives of this work include focusing on the basics of care for patiens after a tongue resection and the most common problems nurses may encounter hen caring for these patients. The work consists of two parts: the theoretical and empirici parts. The theoretical part describes the field of dentistry and oral surgery, anatomy and physiology of the oral cavity. It also deals with orofacial surgery and the actual tongue resection procedure with a focus on nursing care for patiens after wards. In other chapters of the theoretical part we can read about the most common nursing problems in patiens after a tongue resection. In addition, the twelve patterns of health in Marjory Gordon's nursing model will be described for the empirical section. The empirical part is devoted to the research investigation. The thesis describes the metodology and organization of the research investigation. This was a qualitative research, the method of data collection was to create three case reports or case studies with follow discussion. Key words Carcinoma of the tongue, Tongue resection, Oral surgery, Dental care, Nursing care

Background: Transurethral resection leads to characteristic histological changes of tissue repair (’TUR cystitis‘), which also cause non-specific cytological changes. The aim of this study was to investigate the diagnostic sensitivity and specificity of conventional exfoliative urinary cytology in diagnosing residual urothelial carcinoma after differential transurethral resection. Patients and Methods: 417 urinary cytology specimens of all 374 patients undergoing primary (n = 326) or secondary (n = 91) transurethral resection of urothelial carcinoma of the bladder at our institution between June 1996 and December 1997 were examined. The cytology specimens were stained according to Papanicolaou’s method. The sensitivity and specificity of the cytologic diagnosis and of the tumour grading were compared with histological findings. Results: The overall sensitivity of urine cytology in tumour detection was 77.6% for primary lesions and 74.5% in the detection of residual carcinoma after transurethral resection. The diagnostic specificity was 77% and 84.3% respectively. The degree of sensitivity was dependent on tumour grade and was lower for well differentiated tumours. After transurethral resection, the sensitivity for grade 1 residual tumours was 11%, whereas it was 54% for grade 1 tumours before primary transurethral resection. Conclusions: The inflammatory changes following transurethral resection of primary bladder carcinoma cause reactive cytologic changes that make the diagnosis of well differentiated residual carcinoma more difficult. However, urinary cytology after transurethral resection has the same diagnostic accuracy for medium and poorly differentiated tumours as before primary resection and thus remains a very useful diagnostic tool. / Hintergrund: Transurethrale Resektionen von Blasentumoren führen zu histologischen Veränderungen («TUR Zystitis») im Sinne regenerativer Veränderungen, welche urinzytologisch zu diagnostischen Fehleinschätzungen führen können. Das Ziel unserer Untersuchung war der Vergleich der diagnostischen Sensitivität und Spezifität der Urinzytologie vor transurethraler Resektion mit der bei der Diagnose von Residualtumoren nach transurethraler Resektion. Patienten und Methoden: Untersucht wurden 417 urinzytologische Präparate von allen 374 Patienten, die in unserer Einrichtung zwischen Juni 1996 und Dezember 1997 einer primären (n = 326) oder sekundären (n = 91) transurethralen Resektion von Urothelkarzinomen der Harnblase unterzogen wurden. Die zytologischen Präparate wurden nach Papanicolaou gefärbt. Sensitivität und Spezifität der zytologischen Diagnostik und des Tumorgradings wurden mit den histologischen Befunden verglichen. Ergebnisse: Die Sensitivität der Urinzytologie in der primären Tumorerkennung lag bei 77,6% und die für die Diagnose von Residualtumoren nach transurethraler Resektion bei 74,5%. Die diagnostische Spezifität lag bei 77% bzw. 84,3%. Die Sensitivität war abhängig vom Differenzierungsgrad der Urothelkarzinome und war bei gut differenzierten Tumoren am niedrigsten. Nach transurethraler Resektion betrug die Sensitivität der zytologischen Diagnose für G1-Residualtumore lediglich 11%, während sie für G1-Primärtumore bei 54% lag. Schlußfolgerungen: Die entzündlichenVeränderungen nach transurethraler Resektion verursachen Veränderungen exfoliierter Urothelzellen, welche die zytologische Diagnose von residualen G1-Tumoren erschweren. Die Diagnose mäßig und schlecht differenzierter residualer Urothelkarzinome nach transurethraler Resektion hat dagegen die gleiche Sensitivität und Spezifität wie die bei primärer Untersuchung, so daß die Urinzytologie auch bei der Diagnose von Residualtumoren ein wertvolles diagnostisches Verfahren darstellt. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

RAD18 is an E3 ubiquitin ligase that prevents the replication forks from collapsing caused by damaged DNA. As an important factor controlling replication, its dysregulation was shown to be associated with some human tumours. However, the clinical relevance of this finding is unknown. The aim of the thesis was evaluation of selected RAD18 variants that had been identified in breast and ovarian cancer patients. This work revealed functional defects of RAD18 variants not only in replication fork protection but also in repair of DNA double-strand breaks. This unconventional role of RAD18 is known to be dependent on upstream ubiquitination events, however, its contribution to the repair per se is not understood. This work aimed to elucidate the function of RAD18 in DNA double-strand break repair by homologous recombination focusing especially on its relationship with 53BP1. Data presented here show that RAD18 effectively disrupts 53BP1 accumulation in the repair foci by competition for the same binding partner and thus promotes resection of DNA ends. This antagonistic function of RAD18 is restricted both spatially (to the vicinity of the repair centre) and temporarily (to S phase). Moreover, it seems to be regulated by existence of RAD18 in two distinct complexes. Potential models for this regulation...

Background: Chronic pancreatitis (CP) often leads to recurrent pain as well as exocrine and/or endocrine pancreatic insufficiency. This study aimed to investigate the effect of pancreatic head resections on glucose metabolism in patients with CP. Methods: Patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD), Whipple procedure (cPD), or duodenum-preserving pancreatic head resection (DPPHR) for CP between January 2011 and December 2020 were retrospectively analyzed with regard to markers of pancreatic endocrine function including steady-state beta cell function (%B), insulin resistance (IR), and insulin sensitivity (%S) according to the updated Homeostasis Model Assessment (HOMA2). Results: Out of 141 pancreatic resections for CP, 43 cases including 31 PPPD, 2 cPD and 10 DPPHR, met the inclusion criteria. Preoperatively, six patients (14%) were normoglycemic (NG), 10 patients (23.2%) had impaired glucose tolerance (IGT) and 27 patients (62.8%) had diabetes mellitus (DM). In each subgroup, no significant changes were observed for HOMA2-%B (NG: p = 0.57; IGT: p = 0.38; DM: p = 0.1), HOMA2-IR (NG: p = 0.41; IGT: p = 0.61; DM: p = 0.18) or HOMA2-%S (NG: p = 0.44; IGT: p = 0.52; DM: p = 0.51) 3 and 12 months after surgery, respectively. Conclusion: Pancreatic head resections for CP, including DPPHR and pancreatoduodenectomies, do not significantly affect glucose metabolism within a follow-up period of 12 months.

Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia

Simple Summary Good oxygenation of both bowel ends is an important prerequisite to promote anastomotic healing after colorectal resections. Bowel oxygenation is usually assessed clinically. Hyperspectral imaging is a contactless and contrast-free tool that allows quantifying tissue oxygen intraoperatively. In this study, the results of 105 colorectal resections with hyperspectral imaging are reported. Abstract Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.

Esophagectomy often presents anastomotic leaks (AL), due to tenuous perfusion of gastric conduit fundus (GCF). Hybrid (endovascular/surgical) ischemic gastric preconditioning (IGP), might improve GCF perfusion. Sixteen pigs undergoing IGP were randomized: (1) Max-IGP (n = 6): embolization of left gastric artery (LGA), right gastric artery (RGA), left gastroepiploic artery (LGEA), and laparoscopic division (LapD) of short gastric arteries (SGA); (2) Min-IGP (n = 5): LGA-embolization, SGA-LapD; (3) Sham (n = 5): angiography, laparoscopy. At day 21 gastric tubulation occurred and GCF perfusion was assessed as: (A) Serosal-tissue-oxygenation (StO2) by hyperspectral-imaging; (B) Serosal time-to-peak (TTP) by fluorescence-imaging; (C) Mucosal functional-capillary-density-area (FCD-A) index by confocal-laser-endomicroscopy. Local capillary lactates (LCL) were sampled. Neovascularization was assessed (histology/immunohistochemistry). Sham presented lower StO2 and FCD-A index (41 ± 10.6%; 0.03 ± 0.03 respectively) than min-IGP (66.2 ± 10.2%, p-value = 0.004; 0.22 ± 0.02, p-value < 0.0001 respectively) and max-IGP (63.8 ± 9.4%, p-value = 0.006; 0.2 ± 0.02, p-value < 0.0001 respectively). Sham had higher LCL (9.6 ± 4.8 mL/mol) than min-IGP (4 ± 3.1, p-value = 0.04) and max-IGP (3.4 ± 1.5, p-value = 0.02). For StO2, FCD-A, LCL, max- and min-IGP did not differ. Sham had higher TTP (24.4 ± 4.9 s) than max-IGP (10 ± 1.5 s, p-value = 0.0008) and min-IGP (14 ± 1.7 s, non-significant). Max- and min-IGP did not differ. Neovascularization was confirmed in both IGP groups. Hybrid IGP improves GCF perfusion, potentially reducing post-esophagectomy AL.

Purpose Extended resections in hepatopancreatobiliary (HPB) surgery frequently require vascular resection to obtain tumor clearance. The use of alloplastic grafts may increase postoperative morbidity due to septic or thrombotic complications. The use of suitable autologous venous interponates (internal jugular vein, great saphenous vein) is frequently associated with additional incisions. The aim of this study was to report on our experience with venous reconstruction using the introperative easily available parietal peritoneum, focusing on key technical aspects. Methods All patients who underwent HPB resections with venous reconstruction using peritoneal patches at our department between January 2017 and November 2021 were included in this retrospective analysis with median follow-up of 2 months (IQR: 1–8 months). We focused on technical aspects of the procedure and evaluated vascular patency and perioperative morbidity. Results Parietal peritoneum patches (PPPs) were applied for reconstruction of the inferior vena cava (IVC) (13 patients) and portal vein (PV) (4 patients) during major hepatic (n = 14) or pancreatic (n = 2) resections. There were no cases of postoperative bleeding due to anastomotic leakage. Following PV reconstruction, two patients showed postoperative vascular stenosis after severe pancreatitis with postoperative pancreatic fistula and bile leakage, respectively. In patients with reconstruction of the IVC, no relevant perioperative vascular complications occurred. Conclusions The use of a peritoneal patch for reconstruction of the IVC in HPB surgery is a feasible, effective, and low-cost alternative to alloplastic, xenogenous, or venous grafts. The graft can be easily harvested and tailored to the required size. More evidence is still needed to confirm the safety of this procedure for the portal vein regarding long-term results.

No description available.