Course Descriptions Jason Harle T
Download as PowerPoint Slide Figure 5. Intraoperative photo following right trisectorectomy and caudate lobectomy. Caudate lobectomy is an important part of the resection, as the ducts to the caudate often insert at the level of the confluence of the left and right hepatic ducts and are frequently involved Hum 111 week 9 powerpoint presentation the tumor.
This photograph indicates the inferior vena cava IVC clearly, as the caudate lobe has been removed. The portal vein branch to the left and the left hepatic artery are marked.
The open end of the bile duct draining segments 2 and 3 of the liver is indicated. The raw surface of the liver is as marked—only the liver to the left of the falciform ligament was retained. In contrast, two series from a U.
However, those reports did demonstrate a significant survival advantage for patients when a negative margin was achieved [ 5761 ].
Taken together, these data suggest that the addition of a partial hepatectomy is only useful when it allows microscopically negative resection margins to be achieved. To this end, several authors have reported the use of portal vein embolization PVE as an important presurgical treatment in patients who will likely need an extensive liver resection [ 58 ].
The main purpose of PVE is to induce compensatory hypertrophy of the future remnant liver and thus minimize postoperative liver dysfunction [ 62 ].
By allowing a larger volume resection to be carried out safely, PVE may allow negative resection margins to be obtained in patients who would otherwise be unresectable because of concerns of insufficient postoperative residual liver volume [ 6364 ]. The same principles of achieving a margin-negative resection apply with these tumors.
However, the cure rates in those patients may not actually be as high as these reports suggest, since not all series distinguished distal cholangiocarcinoma from carcinoma of the ampulla of Vater, a disease that has a significantly higher cure rate. Intrahepatic cholangiocarcinoma is usually treated by hepatic resection.
As with perihilar tumors, the preoperative and operative approach to these tumors should be aimed at insuring a margin-negative resection. Some groups are encouraging the use of selective ipsilateral PVE in these patients to allow a more aggressive hepatic resection and increase the number of patients who can undergo a curative resection [ 6267 ].
Liver Transplantation Liver transplantation for cholangiocarcinoma is controversial and, because of the high recurrence rate published by most authors, most centers have abandoned this as an indication for liver transplantation [ 68 — 70 ].
Given these data, the use of liver transplantation for the treatment of cholangiocarcinoma should be reserved for very select patients as a part of research protocols.
As more effective adjuvant and neoadjuvant protocols are developed, transplantation may be a more useful treatment for this disease. This is suggested by early results by De Vreede and colleagues in which highly selected patients with stage I and II hilar cholangiocarcinoma underwent neoadjuvant external beam radiation, systemic 5-fluorouracil FU therapy, and brachytherapy prior to liver transplantation [ 74 ].
Those studies demonstrate that early-stage cholangiocarcinoma may be an indication for liver transplantation done as part of a research protocol. Adjuvant Therapy Radiation Following complete surgical resection, the most common relapse pattern is local recurrence. Many authors have advocated postoperative radiation therapy alone or in combination with chemotherapy as a strategy for optimizing local control [ 45 ].
The most common approaches to radiotherapy include a combination of external beam irradiation and brachytherapy with iridium Ir. While this approach offers a theoretical benefit, the available literature on adjuvant radiotherapy following resection of cholangiocarcinoma is absent of prospective, randomized trials.
Small retrospective series have demonstrated significantly higher 5-year survival rates in patients with histological margin-positive resections That same group used a combination of intraoperative and postoperative radiotherapy, which resulted in a 5-year survival rate as high as However, other investigators have failed to demonstrate similar results using a combination of adjuvant external beam radiation and brachytherapy [ 78 ].
The role of adjuvant radiation following margin-negative resection is less clear. Pitt and colleagues published a nonrandomized trial of radiation therapy that failed to show benefit in these patients [ 39 ]. Chemotherapy Chemotherapy has not been shown to markedly improve survival in patients with either resected or unresected cholangiocarcinoma.
The routes of delivery vary in the literature and include systemic infusion, hepatic arterial infusion, and intraductal infusion. The majority of these reports are small, retrospective, single-center reviews and have recently been summarized by Todoroki [ 79 ].
A recent phase III, multi-institutional trial from Japan included patients with bile duct cancer [ 80 ].
PSY Week 5 Social Behavior Paper Or Presentation. Refer to the University of Phoenix Material: Social Behavior for detailed instructions and to select one option to complete your paper.. Format your assignment according to appropriate course-level APA guidelines.. Submit your assignment to the Assignment Files tab.. Social Behavior . Pharmaceutical Sector Country Profiles Experiences and Plans Dr Gilles Forte Dr Richard Laing Essential Medicines and Health Products Department. Fukuoka | Japan Fukuoka | Japan.
That study compared postoperative chemotherapy two courses of mitomycin C plus infusional 5-FU followed by prolonged oral administration of 5-FU until tumor progression with resection alone. It failed to show any benefit from chemotherapy [ 80 ]. Chemoradiation Treatment Given the potential radiosensitization effect of 5-FU, the combination of adjunctive radiation and chemotherapy should theoretically be more effective than either method alone.Pharmaceutical Sector Country Profiles Experiences and Plans Dr Gilles Forte Dr Richard Laing Essential Medicines and Health Products Department.
HUM/ Week 9 PPT Suppose you are a newspaper columnist asked to address the issue of global warming and energy in the next editorial blog of your newspaper’s website. Create a 6- to 8-slide Microsoft ® PowerPoint ® presentation that includes the following.
snaptutorial is a online tutorial store we provides HUM Week 9 Final Assignment Critical Thinking Presentation. Fall Quarter Class Schedule Updated 10/17/ AM. ACCOUNTING ACCT& PRINCIPLES OF ACCOUNTING I Covers fundamentals of accounting theory and practice, including a study of the accounting cycle, and the use of special journals.
Week 9 Education Critical Thinking Presentation University of Phoenix HUM - Summer %(1). Summary. This report compiles and summarizes all recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States.