Multidisciplinary Delphi Consensus on Safety of Combining Transarterial Radioembolization with Yttrium-90 Microspheres with Systemic Anticancer Agents for the Treatment of Liver Malignancy.

Purpose: To provide guidance, via multidisciplinary consensus statements, on the safety interactions between systemic anticancer agents (such as radiosensitizing chemotherapy, immunotherapy, targeted therapy, and peptide receptor radionuclide therapy) and transarterial radioembolization (TARE) with yttrium-90 (Y)-labeled microspheres in the treatment of primary and metastatic liver malignancies.

Materials And Methods: A literature search identified 59 references that informed 26 statements on the safety of Y TARE combined with systemic therapies. Modified Delphi method was used to develop consensus on statements through online anonymous surveys of the 12 panel members representing the fields of interventional radiology, medical oncology, surgical oncology, hepatology, and pharmacy, focusing on hepatocellular carcinoma (HCC), metastatic colorectal cancer (mCRC), neuroendocrine tumors, metastatic breast cancer, and intrahepatic cholangiocarcinoma.

Sustained intraoperative allergic reaction to chlorhexidine: A case report.

Physicians should be prepared for the presentation and treatment of an anaphylactic reaction in a patient who has been exposed to chlorhexidine perioperatively and consider a sustained source of allergic exposure when faced with a refractory response to treatment.

No Drain, No Problem: Serum-Based Marker Prediction of Clinically Relevant Postoperative Pancreatic Fistula.

Background: Postoperative day (POD) 1 drain amylase concentration (DAC) is considered the most accurate predictor for the development of a clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Recent studies have associated drain placement with negative postoperative outcomes. This study aims to evaluate multiple biochemical markers and their associations with CR-POPF development in order to identify a reliable, non-drain dependent alternative to DAC.

SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm.

Background: Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver's two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies.

The impact of virtual interviews on the Fellowship Council application and main match process.

Background: The COVID-19 pandemic led the Fellowship Council (FC) to transition rapidly from in-person to virtual interviews. We investigated the impact of this transition on the FC application and main match process.

Methods: Five years (2018-2022) of deidentified FC applicant, program, and match rank data were used to assess differences between in-person (2018-2019) and virtual interview (2021-2022) cycles.

How Does the Sequence of the American Board of Surgery Examinations Impact Pass/Fail Outcomes?

Objective: Historically, the American Board of Surgery required surgeons to pass the qualifying examination (QE) before taking the certifying examination (CE). However, in the 2020-2021 academic year, with mitigating circumstances related to COVID-19, the ABS removed this sequencing requirement to facilitate the certification process for those candidates who were negatively impacted by a QE delivery failure. This decoupling of the traditional order of exam delivery has provided a natural comparator to the traditional route and an analysis of the impact of examination sequencing on candidate performance.

Novel Use of Hypoxia-Inducible Polymerizable Protein to Augment Chemotherapy for Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies and is the fourth leading cause of cancer-related deaths in the United States. Unfortunately, 80-85% of patients are diagnosed with unresectable, advanced stage tumors. These tumors are incurable and result in a median survival less than approximately six months and an overall 5-year survival rate of less than 7%.

Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.

Background: Secondary resection of initially unresectable colorectal cancer liver metastases (CRLM) can prolong survival. The added value of selective internal radiotherapy (SIRT) to downsize lesions for resection is not known. This study evaluated the change in technical resectability of CRLM with the addition of SIRT to FOLFOX-based chemotherapy.

Biologic Keyhole Mesh in Hiatal Hernia Repair.

Background And Objectives: Laparoscopic paraesophageal hernia repair (LPEHR) is the new standard, but the use of mesh is still debated. Biologic mesh has shown great promise, but only the U-shaped onlay has been extensively studied. Postoperative dysphagia has historically been a concern with the use of synthetic keyhole mesh and subsequently slowed its adoption.

The Post-SIR-Spheres Surgery Study (P4S): Retrospective Analysis of Safety Following Hepatic Resection or Transplantation in Patients Previously Treated with Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres.

Background: Reports show that selective internal radiation therapy (SIRT) may downsize inoperable liver tumors to resection or transplantation, or enable a bridge-to-transplant. A small-cohort study found that long-term survival in patients undergoing resection following SIRT appears possible but no robust studies on postsurgical safety outcomes exist. The Post-SIR-Spheres Surgery Study was an international, multicenter, retrospective study to assess safety outcomes of liver resection or transplantation following SIRT with yttrium-90 (Y-90) resin microspheres (SIR-Spheres; Sirtex).

Isolated cryptococcal osteomyelitis in immunocompetent patient.

Cryptococcosis is a common opportunistic infection in AIDS patients. Almost all cases present with meningitis with or without fungaemia. Cryptococcal osteomyelitis occurs as part of a disseminated infection.

An unusual case of a coexistent serous cystadenoma and intraductal papillary mucinous neoplasm of pancreas. EUS to the rescue!

Context: Synchronous cystic neoplasms of pancreas are a highly rare occurrence.

Case Report: We report a very rare case of coexistent serous cystadenoma and multi-side branch intraductal papillary mucinous neoplasm (IPMN).

Conclusion: To our knowledge, there has been only one previous case report in the literature of a synchronous serous cystadenoma and a solitary IPMN lesion.

Covered stents for late postoperative arterial hemorrhage after pancreaticoduodenectomy.

The use of covered stents in treating delayed postoperative hepatic artery hemorrhage after pancreaticoduodenectomy may preserve hepatic arterial flow. The authors report two cases of massive hemorrhage after pancreaticoduodenectomy that were successfully treated with covered stents. Computed tomographic angiography demonstrated postprocedure patency of the hepatic arteries at 13 and 15 months, respectively.

The relationship between hepatic immunoglobulin production and CD154 expression in chronic liver diseases.

Background: CD40-CD154 is a receptor-ligand pair that provides key communication signals between cells of the adaptive immune system in states of inflammation and autoimmunity. The CD40 receptor is expressed constitutively on B lymphocytes, for which it provides important signals regulating clonal expansion and antibody production. CD154 is a member of the tumor necrosis factor superfamily, which is primarily expressed by activated T cells.

Guidelines for surgical procedures after liver transplantation.

Objective: The first purpose of this study is to identify the types and incidences of surgical procedures in patients who have previously undergone liver transplantation, with particular focus on the complication rates and the lengths of hospital stay. The second purpose is to present the management guidelines for patients with liver transplants at the preoperative, intraoperative, and postoperative stages of surgical procedure.

Summary Background Data: The surgical literature on this issue is scant, and with the growing liver transplant patient population it is not unlikey for any surgery specialist to have to operate on a patient who has undergone liver transplantation.

Autonomic function tests in non-insulin dependent diabetic patients and apparently healthy volunteers.

Traditionally accepted symptoms suggestive of autonomic neuropathy (ANP) were elicited in 65 non-insulin dependent diabetic patients attending a diabetic clinic and four autonomic function tests (AFTs) were performed in these diabetics and 60 non-diabetic healthy volunteers. Though 18 (27.6%) diabetics had symptoms of ANP, none of these symptoms were severe.

Russell's viper bite in Sri Lanka. A study of 22 cases.

Twenty-two patients who had been bitten by a Russell's viper were studied. Neurological manifestations and generalized myalgia were observed, respectively, in 86.4% and 72.

Tuberculous peritonitis: a review of thirty-five cases.

The clinical course of 35 patients with tuberculous peritonitis notified in Kandy (Sri Lanka) over a 6-year period has been reviewed. The maximum incidence occurred in the age group 21 to 40 years and the female/male ratio was 3:2. Clinical features were non-specific and the main presenting features were fever (68.