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( Wei Ying Jen ),( Margaret L Teng ),( Wee Chuan Hing ),( Valerie Ma ),( Shridhar Ganpathi Iyer ),( Chung Cheen Chai ),( Horng Ruey Chua ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Premixed hypotonic solutions of 0.33% saline + 5% dextrose + 10mmol/ L potassium-chloride (0.33S, tonicity 133mEq/L) and 0.9% saline ±dextrose (NS, tonicity 308mEq/L) are common peri-operative maintenance fiuids, but their effects on serum biochemistry are unclear. Methods: Using a single-centre, prospectively-maintained electronic database, we retrospectively examined post-operative biochemistry in adults maintained on exclusively 0.33S or NS peri-operatively, from March 2012 to September 2013. Outcomes included new-onset post-operative hyponatremia, hypokalaemia, hypoglycaemia, and acute kidney injury (AKI, =1.5x increase in serum creatinine); multivariate analyses were adjusted for demographics, comorbidities, surgery-types/duration, infusion time/ volumes, and hospital length-of-stay. Results: We studied 279 patients given 0.33S, and 279 NS controls matched for cumulative infusion volume. Mean age was 59(±18) years. More NS patients had diabetes mellitus, ischemic heart disease and chronic kidney disease (p<0.05). Surgery types included gastrointestinal/hepatobiliary (43%), orthopaedic (30%) and nephrectomy (3%). Mean fi uid volumes administered were 6.9(±3.3)L of 0.33S and 7.1(±5.6)L of NS (p=0.57), with 100% versus 52% of drips containing dextrose, respectively. More 0.33S patients (versus NS) developed hyponatremia (30% versus 17%, p<0.001); this difference was signifi cant for gastrointestinal/hepatobiliary (p=0.001) but not orthopaedic (p=0.74) surgeries. Less 0.33S patients (versus NS) had hypokalaemia (1% versus 10%, p<0.001), hypoglycaemia (1% versus 4%, p=0.01), and AKI (3% versus 8%, p=0.007). On multivariate analyses, 0.33S, gastrointestinal/hepatobiliary surgeries and nephrectomy were independently associated with hyponatremia; while NS, hypertension, longer infusion hours, and nephrectomy were independently associated with AKI (p<0.05). Conclusions: 0.33S infusion in post-surgical patients, especially post-gastrointestinal/ hepatobiliary surgeries, is strongly associated with hyponatremia, but with less hypokalaemia or hypoglycaemia, compared with NS. The association between NS administration and AKI is heavily confounded by baseline comorbidities and requires further prospective evaluation. Both fi uid types are not appropriate for isolated use, and more balanced maintenance fi uids are desired.
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Bridging therapies to liver transplantation for hepatocellular carcinoma: A bridge to nowhere?
Chun Han Nigel Tan,Yue Yu,Yan Rui Nicholas Tan,Boon Leng Kieron Lim,Shridhar Ganpathi Iyer,Krishnakumar Madhavan,Alfred Wei Chieh Kow 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.1
Backgrounds/Aims: Liver Transplantation (LT) is a recognized treatment for Hepatocellular Carcinoma (HCC). The role of Bridging Therapies (BT) remains controversial. Methods: From January 2001 to October 2012, 192 patients were referred to the National University Hospital, Singapore for consideration of LT for HCC. Sixty-five patients (33.8%) were found suitable for transplant and were placed on the waitlist. Analysis was performed in these patients. Results: The most common etiology of HCC was Hepatitis B (n=28, 43.1%). Thirty-six patients (55.4%) received BT. Seventeen patients (47.2%) received TACE only, while 10 patients (27.8%) received radiofrequency ablation (RFA) only. The remaining patients received a combination of transarterial chemoembolization (TACE) and RFA. Baseline tumor and patient characteristics were comparable between the two groups. The overall dropout rate was 44.4% and 31.0% in the BT and non-BT groups, respectively (p=0.269). The dropout rate due to disease progression beyond criteria was 6.9% (n=2) in the non-bridged group and 22.2% (n=8) in the bridged group (p=0.089). Thirty-nine patients (60%) underwent LT, of which all patients who underwent Living Donor LT did not receive BT (n=4, 21.1%, p=0.030). The median time to LT was 180 days (range, 20-558 days) in the non-BT group and 291 days (range, 17-844 days) in the BT group (p=0.214). There was no difference in survival or recurrence between the BT and non-BT groups (p=0.862). Conclusions: BT does not influence the dropout rate or survival after LT but it should be considered in patients who are on the waitlist for more than 6 months.
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