Liver resection for metastatic uveal melanoma: experience from a supra-regional centre and review of literature.

Management of liver metastases from uveal melanoma (LMUM) requires multimodal approach. This study describes evolution of liver resection for LMUM, reviewing current literature and institutional outcomes. Records of patients referred to the Melanoma Multi-Disciplinary Team between February 2005 and August 2018 were reviewed.

Chemosaturation with percutaneous hepatic perfusion of melphalan for metastatic uveal melanoma.

Uveal melanoma, the most common primary ocular malignancy in adults, carries a poor prognosis: 50% of patients develop the metastatic disease with a 10-25% 1-year survival and no established standard of care treatment. Prior studies of melphalan percutaneous hepatic perfusion (M-PHP) have shown promise in metastatic uveal melanoma (mUM) patients with liver predominant disease but are limited by small sample sizes. We contribute our findings on the safety and efficacy of the procedure in the largest sample population to date.

Attitudes to radiation safety and cholangiogram interpretation in endoscopic retrograde cholangiopancreatography (ERCP): a UK survey.

Background: Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) exposes staff and patients to potentially harmful ionizing radiation. We performed a UK survey to explore trainee and trainer attitudes to radiation protection and cholangiogram interpretation in ERCP.

Methods: An electronic 10-point survey was prospectively distributed to endoscopy unit leads, training programme directors between October and November 2019.

Percutaneous hepatic perfusion with melphalan in uveal melanoma: A safe and effective treatment modality in an orphan disease.

Background: Metastatic uveal melanoma (UM) carries a poor prognosis; liver is the most frequent and often solitary site of recurrence. Available systemic treatments have not improved outcomes. Melphalan percutaneous hepatic perfusion (M-PHP) allows selective intrahepatic delivery of high dose cytotoxic chemotherapy.

Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

Objectives: Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor.

Laparoscopic liver resection for lesions adjacent to major vasculature: feasibility, safety and oncological efficiency.

Background And Objectives: Laparoscopic liver resection for lesions adjacent to major vasculature can be challenging, and many would consider it a contraindication. Recently, however, laparoscopic liver surgeons have been pushing boundaries and approached some of these lesions laparoscopically. We assessed feasibility, safety and oncological efficiency of this laparoscopic approach for these lesions.

Vascular supply to the liver: a report of a rare arterial variant.

In the classic description of hepatic arterial supply, the common hepatic artery originates from the coeliac trunk. However, there are numerous variations to this classic pattern. We report a rare variant pattern of hepatic arterial supply and discuss the clinical significance of this variation.

Trans-jugular intrahepatic porto-systemic shunt placement for refractory ascites: a 'real-world' UK health economic evaluation.

Objective: To assess the benefit of trans-jugular intrahepatic porto-systemic shunt (TIPS) placement for refractory ascites.

Design: A retrospective observational study of all patients undergoing TIPS for refractory ascites in our hospital between 2003 and 2012.

Setting: Secondary care.

Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy.

Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively.

Arterialised hepatic nodules in the Fontan circulation: hepatico-cardiac interactions.

Hypervascular nodules occur commonly when there is hepatic venous outlet obstruction. Their nature and determinants in the Fontan circulation is poorly understood. We reviewed the records of 27 consecutive Fontan patients who had computerized tomography scan (CT) over a 4 year period for arterialised nodules and alterations in hepatic flow patterns during contrast enhanced CT scans and related these findings to cardiac characteristics.

Feasibility of laparoscopic distal spleno-pancreatectomy following previous necrosectomy. A case report.

Context: In recent years, laparoscopic approach to distal pancreatectomy has been increasingly favoured following several reports showing reductions in morbidity and hospital stay compared with open surgery. Previous major abdominal surgery is a relative contraindication for most laparoscopic procedures including distal pancreatectomy.

Case Report: We present a case of a young woman in whom we attempted and accomplished safely, a laparoscopic distal pancreatectomy despite having had major pancreatic necrosectomy and discuss the feasibility of this approach.

Management of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors.

Aims: In this article we present our experience with radiofrequency ablation (RFA) in the treatment of 105 renal tumors.

Materials And Methods: RFA was performed on 105 renal tumors in 97 patients, with a mean tumor size of 32 mm (11-68 mm). The mean patient age was 71.

Hepatic changes in the failing Fontan circulation.

Background: The failing Fontan circulation is associated with hepatic impairment. The nature of this liver injury is poorly defined.

Objective: To establish the gross and histological liver changes of patients with Fontan circulation relative to clinical, biochemical and haemodynamic findings.

Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver.

The increased use of high-contrast volume, arterial-phase studies of the liver has demonstrated the frequent occurrence of arterioportal shunts within both the cirrhotic and non-cirrhotic liver. This article sets out to explain the underlying microcirculatory mechanisms behind these commonly encountered altered perfusion states. Similarly, well-recognised portal perfusion defects occur around the perifalciform and perihilar liver and are largely caused by anomalous venous drainage via the paraumbilical and parabiliary venous systems.