Anticoagulation dilemma in a high-risk patient with On-X valves.

Thromboembolism continues to be a major concern in patients with mechanical heart valves, especially in those with unsatisfactory anticoagulation levels. The new On-X valve (On-X Life Technologies, Austin, TX, USA) has been reported as having unique structural characteristics that offer lower thrombogenicity to the valve. We report a case where the patient received no or minimal systemic anticoagulation after placement of On-X mitral and aortic valves due to development of severe mucosal arterio-venous malformations yet did not show any evidence of thromboembolism.

Intraoperative ultrasound and tissue elastography measurements do not predict the size of hepatic microwave ablations.

Rationale And Objectives: Image-guided thermal ablation is used to treat primary and secondary liver cancers. Evaluating completeness of ablation is difficult with standard intraoperative B-mode ultrasound. This study evaluates the ability of B-mode ultrasound (US) and tissue elastography to adequately measure the extent of ablation compared to pathologic assessment.

Timing of elective surgery as a perioperative outcome variable: analysis of pancreaticoduodenectomy.

Objectives: The timing of major elective operations is a potentially important but rarely examined outcome variable. This study examined elective pancreaticoduodenectomy (PD) timing as a perioperative outcome variable.

Methods: Consecutive patients submitted to PD were identified.

Management of hepatocellular adenoma: comparison of resection, embolization and observation.

Introduction: Hepatocellular adenoma (HA) is an uncommon benign hepatic tumour with the potential for malignant change or spontaneous haemorrhage. Resection has been the recommended treatment, but outcomes with other approaches are ill defined.

Methods: Demographic and outcomes data were retrospectively collected on patients diagnosed with HA at a tertiary hepatobiliary centre from 1992-2011 whom underwent resection, bland embolization or observation.

Ablation of perivascular hepatic malignant tumors with irreversible electroporation.

Background: Ablation is increasingly used to treat primary and secondary liver cancer. Ablation near portal pedicles and hepatic veins is challenging. Irreversible electroporation (IRE) is a new ablation technique that does not rely on heat and, in animals, appears to be safe and effective when applied near hepatic veins and portal pedicles.

Operative procedures for unresectable pancreatic cancer: does operative bypass decrease requirements for postoperative procedures and in-hospital days?

Background: The optimal surgical management of patients found to have unresectable pancreatic cancer at open exploration remains unknown.

Methods: Records of patients who underwent non-therapeutic laparotomy for pancreatic cancer during 2000-2009 and were followed until death at Memorial Sloan-Kettering Cancer Center, New York, were reviewed.

Results: Over the 10-year study period, 157 patients underwent non-therapeutic laparotomy.

Multi-institutional review of repeat irradiation of chest wall and breast for recurrent breast cancer.

Purpose: To review the toxicity and clinical outcomes for patients who underwent repeat chest wall or breast irradiation (RT) after local recurrence.

Methods And Materials: Between 1993 and 2005, 81 patients underwent repeat RT of the breast or chest wall for locally recurrent breast cancer at eight institutions. The median dose of the first course of RT was 60 Gy and was 48 Gy for the second course.