an-open-source-normothermic-perfusion-system-designed-for-research

An Open-Source Normothermic Perfusion System Designed for Research Scientists

The integration of ex vivo perfusion machines for human organs prior to transplantation has improved outcomes for recipients and increased organ ...

National Institutes of Health

Pediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases.

Qualities and characteristics of applicants associated with successful matriculation to pediatric surgery fellowship training.

Fibrolamellar hepatocellular carcinoma (FLC) is a rare variant of hepatocellular carcinoma (HCC), with most clinical data stemming from single-institution series. The variability in the literature lends support for analysis using a large national dataset. In doing so, we sought to (1) define the characteristics and outcomes of patients with FLC; (2) determine factors associated with survival in patients undergoing resection; and (3) compare the overall survival (OS) of patients with FLC with a matched group of patients with HCC.

Elevated Serum α-Fetoprotein is Associated with Abbreviated Survival for Patients with Fibrolamellar Hepatocellular Carcinoma Who Undergo a Curative Resection.

ASO Author Reflections: Fibrolamellar Hepatocellular Carcinoma and Alpha-Fetoprotein.

Postoperative hypotension frequently occurs after resection of pheochromocytoma and/or paraganglioma (PPGLs). Epidural anesthesia (EA) is often used for pain control in open resection of these tumors; one of its side effects is hypotension. Our aim is to determine if EA is associated with an increased risk of postoperative hypotension after open resection of PPGLs. We conducted a retrospective review of patients who underwent open resection of PPGLs at the National Institutes of Health from 2004 to 2019. Clinical and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension. Ninety-seven patients (46 female and 51 male; mean age, 38.5 years) underwent open resection of PPGLs and 69 (71.1%) received EA. Patients with EA had a higher rate beta-blocker use (79.7% vs 57.1%, P = 0.041), metastasis (69.6% vs 39.3%, P = 0.011), and were more frequently hypotensive after surgery (58.8% vs 25.0%, P = 0.003) compared to those without EA. Patients with postoperative hypotension had higher plasma normetanephrines than those without (7.3 fold vs 4.1 fold above the upper limit of normal, P = 0.018). Independent factors associated with postoperative hypotension include the use of beta-blockers (HR = 3.35 (95% CI: 1.16-9.67), P = 0.026) and EA (HR = 3.49 (95% CI: 1.25-9.76), P = 0.017). Data from this retrospective study suggest that, in patients with open resection of PPGLs, EA is an independent risk factor for early postoperative hypotension. Special caution is required in patients on beta-blockade. A prospective evaluation with standardized protocols for the use of EA and management of hemodynamic variability is necessary.

Epidural anesthesia and hypotension in pheochromocytoma and paraganglioma.

The risk of postoperative pancreatic exocrine insufficiency (PPEI) is unknown in patients with multiple endocrine neoplasia type I (MEN1) and von Hippel-Lindau (VHL) who require resection of pancreatic neuroendocrine tumors (PNETs).

Pancreatic insufficiency following pancreatectomy: Does underlying tumor syndrome confer a greater risk?

Small bowel neuroendocrine tumors (SB-NET) frequently metastasize to regional lymphatic or distant sites. Although most prognostication of SB-NET focuses on lymph node involvement, findings from studies of neuroendocrine tumors from other primary sites have suggested that preoperative serum chromogranin-A (CgA) levels may provide a more accurate metric.

Preoperative serum chromogranin-a is predictive of survival in locoregional jejuno-ileal small bowel neuroendocrine tumors.

Tumor-infiltrating lymphocytes are associated with improved survival in node-positive Merkel cell carcinoma: A national cohort analysis.

There are no approved locoregional therapies for peritoneal carcinomatosis from gastric adenocarcinoma (GA). Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) represents a potential treatment for advanced GA with isolated peritoneal metastasis.

Article	Year
Qualities and characteristics of applicants associated with successful matriculation to pediatric surgery fellowship training. Journal of pediatric surgery\| PubMed ID: 31761460	2020
Elevated Serum α-Fetoprotein is Associated with Abbreviated Survival for Patients with Fibrolamellar Hepatocellular Carcinoma Who Undergo a Curative Resection. Annals of surgical oncology\| PubMed ID: 31925595	2020
ASO Author Reflections: Fibrolamellar Hepatocellular Carcinoma and Alpha-Fetoprotein. Annals of surgical oncology\| PubMed ID: 32189170	2020
Epidural anesthesia and hypotension in pheochromocytoma and paraganglioma. Endocrine-related cancer\| PubMed ID: 32698142	2020
Pancreatic insufficiency following pancreatectomy: Does underlying tumor syndrome confer a greater risk? American journal of surgery\| PubMed ID: 32943182	2021
Preoperative serum chromogranin-a is predictive of survival in locoregional jejuno-ileal small bowel neuroendocrine tumors. Surgery\| PubMed ID: 33814188	2021
Tumor-infiltrating lymphocytes are associated with improved survival in node-positive Merkel cell carcinoma: A national cohort analysis. Journal of the American Academy of Dermatology\| PubMed ID: 33932537	2022
Cytoreduction and HIPEC for Gastric Carcinomatosis: Multi-institutional Analysis of Two Phase II Clinical Trials. Annals of surgical oncology\| PubMed ID: 36348206	2023

James McDonald

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