Location Of Lobe Research Articles

Efficacy and safety of radial probe endobronchial ultrasound-guided biopsy for peripheral lung lesions in chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease (COPD) is associated with frequent complications after transthoracic biopsy. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used to diagnose peripheral pulmonary lesions (PPLs). However, the efficacy and safety of this procedure for the diagnosis of PPLs in patients with COPD remain poorly understood. We investigated the usefulness of RP-EBUS-TBLB for diagnosing PPLs in patients with COPD. This retrospective observational study aimed to identify clinical outcomes of RP-EBUS-TBLB in patients with COPD. A total of 175 patients with COPD and 439 patients without COPD were included in this study. RP-EBUS-TBLB was performed without fluoroscopy using a guide sheath. The overall diagnostic accuracies in patients with COPD and without COPD were 80.6% (141/175) and 78.8% (346/439), respectively. There was no significant difference in the diagnostic yield based on the severity of airflow limitation (80.0%, 81.4%, and 79.2% for mild, moderate, and severe to very airflow limitations, respectively; P=0.97). In patients with COPD, diagnostic yields for malignant and benign lesions were 85.6% (95/111) and 71.9% (46/64). In multivariable analyses, larger lesion size [≥30 mm; odds ratio (OR), 2.86; 95% confidence interval (CI): 1.10-7.45; P=0.03] and within the lesion on EBUS image (OR 9.29; 95% CI: 3.79-22.79; P<0.001) were associated with diagnostic success in patients with COPD, whereas lesion location of upper lobe (OR, 0.36; 95% CI: 0.14-0.92; P=0.03) were associated with diagnostic failure. The overall complication rate in our study was 7.4% (13/175) in patients with COPD. Pneumothorax occurred in 4.6% (8/175), and chest tube insertion was needed in 1.7% (3/175) of the patients. RP-EBUS-TBLB can be used as an appropriate method to diagnose PPLs in patients with COPD. The size of the lesion (≥30 mm) and having the probe within the lesion were important for successful diagnosis. The location of the lesion in the upper lobe is associated with diagnostic failure. No difference was observed in the diagnostic yield based on the severity of airflow limitation. The complication rates were acceptable.

Sleeve Lobectomy After Neoadjuvant Chemoimmunotherapy Versus Chemotherapy for Squamous Cell Lung Cancer: A Multicenter, Retrospective Study

IntroductionTo analyze the feasibility and efficacy of sleeve lobectomy after neoadjuvant immunotherapy in multicenter patients with squamous cell lung cancer. MethodsWe retrospectively identified patients who received neoadjuvant immunotherapy (n = 14) or chemotherapy alone (n = 33) at five thoracic surgery centers between 2018 and 2020. The primary end point was 30-day major complications. The secondary end point was major pathologic response. Multivariate analysis was performed with a log-binomial regression model adjusting potential risk factors. ResultsAll patients received induction therapy and underwent sleeve lobectomy without 90-day postoperative deaths. The distribution of age, sex, nutrition status, pulmonary and cardiac function, tumor stage, surgical approach, and location of the pulmonary lobe was well balanced between the two cohorts. In the immunotherapy cohort, two patients (14.3%) experienced a pulmonary major complication, whereas nine pulmonary major complications and one cardiac major complication (30.3%) occurred in the chemotherapy cohort (p = 0.302). ConclusionsNeoadjuvant immunotherapy in addition to chemotherapy did not increase 30-day risk of postoperative complications, and immunotherapy is a favorable factor affecting pathologic downstage and response. Therefore, sleeve lobectomy after induction chemoimmunotherapy appears safe and feasible.

Endobronchial Valve Treatment of Tuberculous Cavities in Patients with Multidrug-Resistant Pulmonary Tuberculosis: A Randomized Clinical Study.

Background: Multidrug-resistant pulmonary tuberculosis (MDR-PTB) has become a major cause of high morbidity and mortality related to TB. Conventional drug regimens are ineffective for the treatment of MDR-PTB patients with cavities. This study aimed to evaluate the clinical efficacy and safety of one-way endobronchial valves (EBVs) for the treatment of cavities in MDR-PTB patients. Methods: MDR-PTB patients with positive sputum cultures, sputum smears, and cavities were treated with EBVs in the drainage bronchus of the pulmonary cavity between November 2013 and March 2018. The participants comprised those who had failed previous anti-tuberculosis therapy, as determined by drug susceptibility testing. Results: Thirty-five MDR-PTB patients were included, three of whom were lost during follow-up. The size of the lung cavity was reduced in all of the patients after EBV implantation, including the three lost to follow-up. In the remaining 32 patients, the sputum culture conversion (SCC) rate reached 100%, and the cavity closure rate was 68.8%. There were no significant differences in the cavity closure rate between patients aged ≤40 and >40 years, between the upper and lower lobes, or between the use and non-use of linezolid groups (p > 0.05). Interestingly, the cavity closure rate was higher in women than in men (p = 0.005). Moreover, the cavity closure rate correlated with the time to SCC (correlation coefficient, 0.8933; p < 0.0001). There were no severe adverse events in the patients treated with EBV implantation. Conclusion: EBV installation is effective and safe for the treatment of cavities in MDR-PTB patients. The efficacy of EBV treatment may not be affected by age, disease course, or the location of the lung lobe in the cavity.

Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy.

OBJECTIVESWe compared the computed tomographic (CT) volumetric analysis and anatomical segment counting (ASC) for predicting postoperative forced expiratory volume in 1 s (FEV1) and diffusing capacity for carbon monoxide (DLCO) in patients who had segmentectomy for early-stage lung cancer.METHODSA total of 175 patients who had segmentectomy for lung cancer and had postoperative pulmonary function test were included. CT volumetric analysis was performed by software, which could measure total lung and target segment volume from CT images. ASC and CT volumetric analysis were used to determine predicted postoperative (PPO) values and the concordance and difference of these values were assessed. The relationship between PPO values and actual postoperative values was also investigated.RESULTSThe PPO-FEV1 and PPO-DLCO showed high concordance between 2 methods (concordance correlation coefficient = 0.96 for PPO-FEV1 and 0.95 for PPO-DLCO). There was no significant difference between PPO values as determined by 2 methods (P = 0.53 for PPO-FEV1, P = 0.25 for PPO-DLCO) and actual postoperative values [P = 0.77 (ASC versus actual) and P = 0.20 (CT versus actual) for FEV1; P = 0.41 (ASC versus actual) and P = 0.80 (CT versus actual) for DLCO]. We subdivided the patients according to poor pulmonary function test, the number of resected segments and the location of the resected lobe. All subgroup analyses revealed no significant difference between PPO values and actual postoperative values.CONCLUSIONSBoth CT volumetric analysis and ASC showed high predictability for actual postoperative FEV1 and DLCO in segmentectomy.

Features of diagnostics and treatment of thyrotoxicosis in patients with severe comorbid pathology: clinical case

Objective. To demonstrate the stages of diagnostics and successful treatment of thyrotoxicosis in a patient with severe comorbid pathology.&#x0D; Materials and methods. A clinical case report of a patient with toxic goiter is presented.&#x0D; Results. To specify the state of the thyroid gland, diagnostic and laboratory methods were applied: ultrasound examination (thyroid volume increased up to 182 cm2, isoechogenic nodule in the left lobe up to 1 cm, thyroid vascularization increased), spiral computed tomography (picture of diffuse nodular goiter with partial retrosternal location of the left thyroid lobe), hormone studies, the results of which revealed thyrotoxicosis. Thyroidectomy was subsequently carried out. Both thyroid lobes with isthmus were removed step-by-step with technical difficulties and high bleeding of tissues. The patient was discharged in 10 days in a satisfactory state.&#x0D; Conclusions. Thyrotoxicosis is certainly a complex surgical pathology, in which correct assessment of the diagnosis by instrumental, clinical and laboratory methods is required, as well as successful surgical intervention. Not only normalization of hormonal status of a patient has to be taken into account, but also the possibility of disease relapse, contraindications due to age, physiological status, and comorbid abnormalities.

Displacement of Gray Matter and Incidence of Seizures in Patients with Cerebral Cavernous Malformations.

Seizures are the most common presentation in patients with cerebral cavernous malformations (CCMs). Based on the hypothesis that the volume or proportion of gray matter (GM) displaced by CCMs is associated with the risk of seizure, we developed an algorithm by which to quantify the volume and proportion of displaced GM and the risk of seizure. Image analysis was conducted on 111 patients with solitary CCMs (divided into seizure and nonseizure groups) from our gamma knife radiosurgery (GKRS) database from February 2005 and March 2020. The CCM algorithm proved effective in quantifying the GM and CCM using T1WI MRI images. In the seizure group, 11 of the 12 patients exhibited seizures at the initial presentation, and all CCMs in the seizure group were supratentorial. The location of the limbic lobe within the CCM was significantly associated with the risk of seizure (OR = 19.6, p = 0.02). The risk of seizure increased when the proportion of GM displaced by the CCM exceeded 31%. It was also strongly correlated with the volume of displaced GM. The volume and proportion of displaced GM were both positively correlated with the risk of seizure presentation/development and thus could be used to guide seizure prophylaxis in CCM patients.

Hepatic adrenal rest tumor in a patient with multifactorial liver cirrhosis: a case report with CT and MRI findings and pathologic correlation

BackgroundAdrenal rest tumor is an ectopic collection of adrenocortical cells in an extra-adrenal site, more frequently located around the kidney, retroperitoneum, spermatic cord, para-testicular region and broad ligament, but very rarely occurring also in the liver. Hepatic adrenal rest tumor poses a diagnostic challenge in differentiating it from hepatocellular carcinoma, particularly in a cirrhotic liver.Case presentationAn 83-years-old male was referred to our hospital by his family doctor for hepatological evaluation due to multifactorial liver cirrhosis. Ultrasound revealed a centimetric hypoechoic nodule in the VI hepatic segment in the context of a liver with signs of cirrhosis and steatosis. The patient first underwent MRI and then CT, which showed a fat containing focal liver lesion in the subcapsular location of the right lobe, strictly adjacent to the homolateral adrenal gland. The nodule was hypervascular in the arterial phase, washed out in the portal-venous and transitional phases, resulting hypointense in the hepato-biliary phase at MR imaging. In the suspicion of a hepatocellular carcinoma, the nodule was surgically removed, and the patient’s postoperative course was unremarkable. The final histopathological diagnosis was of adrenal rest tumor of the liver.ConclusionsHepatic adrenal rest tumor is an extremely rare hepatic tumor, often without any clinical manifestation, that can also occur in the cirrhotic liver as in our case. Although there are not specific imaging findings, the possible diagnosis of HART should be considered when we observe a well-defined lesion in the subcapsular location of the right lobe, with fat containing, hypervascularity after contrast medium injection and vascular supply from the right hepatic artery.

Single-center experience with endovascular treatment of cerebral arteriovenous malformations with intent to cure in pediatric patients.

This study aimed to report the incidence of technical complications and immediate complete angiographic occlusion, identify associated factors with failure of complete occlusion and identify predictors of technical complications in a single-center experience of pediatric arteriovenous malformations (AVM) treated with endovascular treatment with intent to cure. Patients between 1 and 18years of age undergoing endovascular embolization between 2011 and 2020 were included. A total of 120 embolizations were performed in 69 patients. The most frequent clinical presentation was intracerebral hemorrhage (76.8%). Immediate obliteration of the malformations was achieved in 40 (58%) cases. The technical complication rate was 15%. AVM nidus size between 3 and 6cm (OR: 3.91; 95% CI 1.1-13.85; p = 0.035) and the presence of multiple feeders (OR: 5.08; 95% CI 1.41-18.28; p = 0.074) were predictive of failure of immediate complete occlusion. The location of the temporal lobe (OR: 7.83; p = 0.048), deep venous drainage (OR: 4.67; p = 0.112), and the presence of an intranidal aneurysm (OR: 3.58; p = 0.134) were predictors of technical complications. Embolization of pediatric AVMs with intent to cure shows a high rate of technical complications and acceptable immediate occlusion rates. Nidus size and the presence of multiple feeders were predictive of failure of complete occlusion, while temporal lobe location, deep venous drainage, and the presence of an intranidal aneurysm were predictors of technical complications. Further studies are needed to determine the best therapeutic approach in the pediatric population.

Infrared clinical anatomy of mammary gland’s additional lobe in non-pregnant young woman

A method of infrared detection of mammary gland’s additional lobe has been developed due to changes in the local temperature of the anterior and lateral surfaces of the chest detected with a thermal imager that has an accuracy of 0.01 °C. It is shown that infrared thermography allows to diagnose, determine the location, shape and size of the additional lobe of the mammary gland in the last 3 days before menstruation.

SUN-067 Pituitary Dysfunction in Children with Ectopic Posterior Pituitary

Background: Imaging studies aid in the detection of structural abnormalities that may be associated with pituitary dysfunction, such as ectopic posterior pituitary (EPP). The location of the ectopic lobe can vary, but it is most commonly located along the median eminence in the floor of the third ventricle. An EPP could result from complete or partial defective neural migration during embryogenesis, which could explain the different loci of EPP. Affected individuals have either severe isolated growth hormone deficiency (IGHD) or combined pituitary hormone deficiencies (CPHD); diabetes insipidus is not a feature, indicating that the EPP is functioning normally. Aim: To detect the prevalence of IGHD or CPHD in children with EPP. In addition, to evaluate the association between the location of EPP and pituitary dysfunction. Methods: A retrospective chart review of MRI reports at St. Christopher’s Hospital for Children (SCHC) from 2006-2018 that were found to have EPP. Pituitary hormone function was evaluated in the majority of the patient population. Results: Of the 26 patients with EPP, [16 males (M) and 10 females (F)], mean chronologic age was 5.98+5.18 yrs, only 20 patients had an endocrine evaluation at SCHC. Of the 20 children, 14 had CPHD and 4 had IGHD.Patients were classified into 3 groups (upper, middle & lower) according to EPP location along the pituitary stalk. Of the 21 patients with upper EPP, 17 had pituitary dysfunction (14 with CPHD, 3 with IGHD). Of the 4 children with middle EPP, only 1 had pituitary dysfunction which was IGHD. One patient had lower EPP with hyperprolactinemia. Diabetes insipidus was not identified in any of the children. Conclusion: Our study supports previous reports that CPHD and IGHD are frequent in patients with EPP. Similarly, our data further demonstrate that no cases of diabetes insipidus have been reported in children with EPP.In our study, EPP is most commonly located along the upper third of pituitary stalk at the median eminence level, with a higher prevalence of CPHD and IGHD, a finding similar to prior studies. No CPHD was reported in middle/lower but IGHD was found in the middle EPP group.

Laparoscopic Isolated Caudate Lobectomy for Rectal Cancer Liver Metastasis

Summary: Metastatic tumor in the caudate lobe is difficult to manage and laparoscopic caudate lobectomy is regarded as a difficult procedure because of the deep location of the caudate lobe and its proximity to great vessels. Isolated caudate lobectomy is still rare and technically challenging. Therefore, we present a Case of a female patient who underwent laparoscopic isolated caudate lobectomy for liver metastasis of rectal cancer. A 58-year-old female was visited due to change in stool caliber. On the colonoscopy, mid rectal cancer was found. Surveillance computed tomography and magnetic resonance imaging showed 2cm metastatic liver mass in caudate lobe. We performed laparoscopic isolated caudate lobectomy for liver metastasis and laparoscopic low anterior resection for rectal cancer cooperatively. The caudate lobe was freed from the IVC and venous ligament. The short hepatic veins and the portal branches to the caudate lobe were ligated with clips. The procedure was completed totally laparoscopic technique. The operative time was 125 minutes. The intraoperative blood loss was minimal and the patient was safely discharged on the seventh postoperative day without perioperative complication. Pathology analysis showed a 2.4 × 2.1 × 2.1 cm metastatic adenocarcinoma with tumor-free resection margin. CT scan at 3 months after the operation showed complete removal of the caudate lobe with no evidence of recurrence. Our experience lobectomy demonstrated that laparoscopic caudate lobectomy is safe and feasible in patients with malignancy in caudate lobe.

Robot-assisted laparoscopic partial hepatic caudate lobectomy

Background: Hepatic caudate lobectomy is considered to be a technically difficult surgery because of the unique anatomy and deep location of the hepatic caudate lobe. Here, we assessed the technical feasibility and safety of robotic partial caudate lobectomy using the da Vinci® Surgical System and compared it with traditional open/laparoscopic surgery.Material and methods: Six patients diagnosed with liver cancer (primary liver cancer, 5; metastasis of breast cancer, 1) who underwent caudate lobectomy were prospectively enrolled. Two patients underwent robotic surgery, one underwent laparoscopic surgery, and three underwent traditional/open surgery. Surgical procedure, recovery, and characteristics of robotic surgery were noted and compared with other approaches.Results: All surgeries were successfully completed, and no serious postsurgical complications were observed. In the robotic group, the time taken to complete the surgery and the estimated intraoperative bleeding were 150 and 90 min and 50 and 100 ml in patient 1 and patient 2, respectively. The patients were able to tolerate fluid diet on the following postsurgical day. These two patients had no postsurgical complications and were discharged from the hospital on days 5 and 6 after recovery, respectively. Pathologically, the margins of specimens obtained from these two patients were tumor-free (R0 resection). Tumor size in the traditional/open group was larger than that in the robotic and laparoscopic groups. Blood loss in the laparoscopic case was 50 ml and was less than that in the traditional/open surgery cases (300, 2100, and 1500 ml).Conclusions: Robot-assisted partial hepatic caudate lobectomy is a technically feasible surgery. Our study illustrated an advantage of robotic hepatic caudate lobectomy over laparoscopic or traditional/open surgery and suggested that da Vinci® minimally invasive hepatectomy is applicable in even more technically challenging anatomic locations.

Laparoscopic resection of caudate lobe. Technical strategies for a difficult liver segment

Background: Caudate lobe of the liver can be divided in three portions: Spiegel lobe, paracaval portion and caudate process. The particular anatomic location of the caudate lobe between the hilar plate and inferior vena cava represents an important obstacle for its laparoscopic removal and a difficult site even for conventional surgery. The aim of this video is to present a laparoscopic resection of the caudate lobe. The area to be removed includes the Spiegel lobe and the paracaval portion. Caudate process is preserved. Methods: A 57 year-old man with colorectal metastasis in segment 1 is referred for surgical treatment. Liver resection is advised and laparoscopic liver resection is proposed. Four trocars are used. The operation begins with complete mobilization of the left liver and ultrasound examination. Lesser sac is open and Arantius ligament is identified and divided. Spiegel lobe is fully mobilized and carefully detached from the inferior vena cava. The pedicle from caudate lobe is identified and controlled. Small veins to vena cava are identified and controlled with bipolar forceps or clips. Dissection progresses towards paracaval portion sparing caudate process (pedicle from right liver). Liver parenchyma is divided with bipolar forceps and resection is completed. Surgical specimen is retrieved through the umbilical incision. No drains are left in place. Results: Operative time was 120 minutes and there was minimal bleeding. Recovery was uneventful and patient was discharged on the third postoperative day. Final pathology showed colorectal metastasis with free margins. Conclusion: Isolate laparoscopic resection of caudate lobe is feasible and can be safely performed in specialized centers. An accurate knowledge of the intricate anatomy of the caudate lobe is essential for the success of this complex operation.

Analysis of pulmonary hydatid cysts underwent surgery

Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus. The liver and lungs are the most frequently involved organs. The treatment of lung hydatid disease is surgery. We aimed to discuss the results of surgically treated patients with pulmonary hydatid cysts in light of the related literature. Materials and Method: 85 patients were divided into two groups as complicated and non-complicated. Patients who had more than one cyst in the same lobe or patients with multiple lung cysts in different locations were excluded in the study. The significance of the results was assessed by Fisher's exact test. P values<0.05 were considered as significant. Findings: While the number of non-complicated patients was 58 (68%), it was 27 (32%) for complicated patients. In the statistical analysis, gender difference was not significant for both groups (p>0.05). Additionally, the disease was not significant in terms of right or left lung location (p>0.05). For both groups, the disease was not significant in terms of the location of lobe. Statistically, gender was found to be not significant on bronchus or pleural expanding (for male p>0.05, for female p>0.05). But, the right lung lesions were found to be significant in terms of the expansion in both bronchus and pleura (p<0.05). Centrally located lesions were found to be statistically significant in terms of bronchial expansion (p<0.05). Discussion: Hydatid disease is particularly common in places where farming is still widespread. We believe that the only treatment method is people's awareness and surgical procedures.

Surface dynamic of a protalus lobe in the temperate high mountain. Western Maladeta, Pyrenees

The Maladeta protalus lobe is located in the Maladetas massif (Central Pyrenees). A detailed geomorphologic map, RTK-GPS techniques, bottom temperature of the winter snowcover (BTS) technique and datalogger to monitor the ground thermal regime were used to reveal the present-day activity of the protalus lobe and its location in a mountain permafrost environment. Systematic monitoring using differential GPS at eight fixed points throughout the surface of the protalus lobe shows vertical and horizontal displacements during the field surveys of 2008, 2009, 2010, 2011, 2012 and 2013. The recorded dynamic defines a periglacial landform with low activity and rapid interannual variations in a thermal imbalance state. The location of protalus lobe in marginal periglacial environments of the temperate high mountain makes it an effective morphoclimatic geoindicator.

Automatic liver segmentation on Computed Tomography using random walkers for treatment planning.

Segmentation of the liver from Computed Tomography (CT) volumes plays an important role during the choice of treatment strategies for liver diseases. Despite lots of attention, liver segmentation remains a challenging task due to the lack of visible edges on most boundaries of the liver coupled with high variability of both intensity patterns and anatomical appearances with all these difficulties becoming more prominent in pathological livers. To achieve a more accurate segmentation, a random walker based framework is proposed that can segment contrast-enhanced livers CT images with great accuracy and speed. Based on the location of the right lung lobe, the liver dome is automatically detected thus eliminating the need for manual initialization. The computational requirements are further minimized utilizing rib-caged area segmentation, the liver is then extracted by utilizing random walker method. The proposed method was able to achieve one of the highest accuracies reported in the literature against a mixed healthy and pathological liver dataset compared to other segmentation methods with an overlap error of 4.47 % and dice similarity coefficient of 0.94 while it showed exceptional accuracy on segmenting the pathological livers with an overlap error of 5.95 % and dice similarity coefficient of 0.91.

Surgical Techniques for Totally Laparoscopic Caudate Lobectomy.

The purpose of this study is to identify the safety and feasibility of laparoscopic caudate lobectomy. Caudate lobectomy has been considered as technically difficult because of the deep location of the caudate lobe and its proximity to great vessels. Due to the technical difficulty, laparoscopic caudate lobectomy was not feasible in patients with malignancy in the caudate lobe. Six consecutive patients with caudate hepatic malignancy received laparoscopic caudate lobectomy at Samsung Medical Center from September 2007 to May 2014. Demographic data, intraoperative parameters, and postoperative outcomes were assessed. All procedures for these 6 patients with caudate malignancy were completed with totally laparoscopic technique. Only 1 patient who had hepatocellular carcinoma in the Spiegel lobe underwent partial caudate lobectomy, and others underwent complete caudate lobectomy. The mean tumor size was 2.65 cm (range 0.9-5.1 cm). The mean operative time was 382 minutes (range 168-615 minutes) and none required transfusion. The mean duration of hospital stay was 8 days (range 6-13 days). There was no perioperative complication and patient mortality in this series. The resected margins of the specimens were tumor free (R0 resections, range 0.1-1.2 cm). The mean follow-up period was 56 months (range 12.9-93.7 months). No patient died during the follow-up period. Our experience demonstrated that laparoscopic caudate lobectomy is safe and feasible in selected patients with malignancy in the caudate lobe.

Risk factors and consequences of perioperative reoperation in patients undergoing pulmonary resection surgery

Perioperative reoperation is generally agreed to be necessary for the management of particular, severe complications. Understanding the incidence and predictors of perioperative reoperation enables surgeons to improve surgery quality. The objective of this study is to investigate the incidence, risk factors, and consequences of perioperative reoperation after pulmonary resection. Data from patients who underwent perioperative reoperation after pulmonary resection surgery over the past 6years in our department were reviewed retrospectively. A propensity score-matched analysis was performed to identify the association between reoperation and clinical outcomes. Univariate and multivariate analysis were used to analyze independent risk factors for the occurrence of reoperation. Overall, 19,304 patients with various lung diseases who underwent pulmonary resection surgeries were analyzed retrospectively, in which 195 patients (1.01%) required reoperation for severe perioperative complications. The leading cause for reoperation was hemorrhage in 143 (73.33%) patients, followed by bronchopleural fistula in 22 patients (11.28%). Further indications for reoperation were chyle leak, bronchial esophageal fistula, empyema, pulmonary congestion, air leak, and femoral artery embolism. The mortality of reoperation was 5.13% (10/195), with the highest (33.33%) among bronchial esophageal fistula and empyema. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion (P<.05). Logistic regression indicated that patients with comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early reoperation that performed within 24hours (P<.05); however, operative approach showed no significance in terms of reoperation that happened beyond 24hours (P=.087). The incidence of perioperative reoperation after pulmonary resection surgery is low and is mainly related to technical issues from the initial operation. The most common complication is hemorrhage, and the mortality of reoperation in bronchial esophageal fistula and empyema is higher than in others. Patients undergoing reoperation had a higher mortality at hospital discharge, a longer duration of hospital stay, and a lesser incidence of postoperative transfusion. Preoperative comorbidity, operative approach of open thoracotomy, and location of upper lobe were independent risk factors for the occurrence of early perioperative reoperation that was performed within 24hours; approach of surgery was not significant in terms of reoperation that happened beyond 24hours.

CT-Guided Percutaneous Step-by-Step Radiofrequency Ablation for the Treatment of Carcinoma in the Caudate Lobe.

The location of the caudate lobe and its complex anatomy make caudate lobectomy and radiofrequency ablation (RFA) under ultrasound guidance technically challenging. The objective of the exploratory study was to introduce a novel modality of treatment of lesions in caudate lobe and discuss all details with our experiences to make this novel treatment modality repeatable and educational.The study enrolled 39 patients with liver caudate lobe tumor first diagnosed by computerized tomography (CT) or magnetic resonance imaging (MRI). After consultation of multi-disciplinary team, 7 patients with hepatic caudate lobe lesions were enrolled and accepted CT-guided percutaneous step-by-step RFA treatment.A total of 8 caudate lobe lesions of the 7 patients were treated by RFA in 6 cases and RFA combined with percutaneous ethanol injection (PEI) in 1 case. Median tumor diameter was 29 mm (range, 18–69 mm). A right approach was selected for 6 patients and a dorsal approach for 1 patient. Median operative time was 64 min (range, 59–102 min). Median blood loss was 10 mL (range, 8-16 mL) and mainly due to puncture injury. Median hospitalization time was 4 days (range, 2–5 days). All lesions were completely ablated (8/8; 100%) and no recurrence at the site of previous RFA was observed during median 8 months follow-up (range 3–11 months). No major or life-threatening complications or deaths occurred.In conclusion, percutaneous step-by-step RFA under CT guidance is a novel and effective minimally invasive therapy for hepatic caudate lobe lesions with well repeatability.

Diagnostic value of acoustic radiation force impulse imaging for evaluating the degree of liver fibrosis in chronic hepatitis B

Objective To investigate the clinical value of the acoustic radiation force impulse imaging (ARFI) in the quantitative evaluation of fibrosis staging in chronic hepatitis B. Methods A total of 373 patients with chronic hepatitis B were grouped in accordance with the depth of the right anterior lobe and posterior lobe of the liver and underwent ARFI to measure ARFI values. Liver biopsy was performed in all patients to investigate the relationship between liver fibrosis stages and ARFI values in different groups. Results The ARFI values in different pathological grades with the same depth of the right anterior and right posterior lobe of the liver were statistically significant (P<0.001); the ARFI values between the middle and deep parts of the right anterior lobe and the same location of the right posterior lobe were statistically significant (P<0.01); for the right anterior lobe, the ARFI value of the shallow part showed statistical significance from that of the middle and the deep part (P<0.05). Receiver operating characteristic (ROC) curve analysis for different sampling locations showed that the largest area under the ROC curve, which was 0.818, existed in the middle part of the right anterior lobe, indicating that it could be the optimal sampling location for the measurement of ARFI values. Liver stiffness at ARFI imaging was significantly correlated with liver fibrosis stage in chronic hepatitis B and spearman coefficient of correlation was 0.530 (P<0.001). The areas under the ROC curves for the chronic hepatitis B patients with severe liver fibrosis (≥S3) and early cirrhosis (=S4) were 0.818 and 0.860, respectively. Conclusions ARFI imaging was promising for clinical application and could be utilized as a noninvasive method for the quantitative evaluation of fibrosis staging in chronic hepatitis B. Key words: Ultrasonography; Hepatitis B, chronic; Liver cirrhosis; Acoustic radiation force impulse