Day 2 :
- Hernia repair | Orthopaedic surgery | Surgical oncology | Surgical trauma critical care
Queen Mary Hospital, Hong Kong
Kenneth Chok has completed his Graduation from the University of Hong Kong, Honk Kong. He is currently the Deputy Director of Liver Transplant Center at Queen Mary Hospital, Honorary Consultant at the Queen Mary/Tung Wah Hospitals and Clinical Associate Professor at the University of Hong Kong. His research interests focus on the advances in the management of hepatocellular carcinoma, biliary complications and hepatorenal syndrome in living donor liver transplantation. He is one of the pioneers in advocating minimally invasive hepatobiliary surgery and associating liver partition and portal vein ligation for staged hepatectomy in the territory. He has published more than 160 peer-reviewed articles in high impact journals including Annals of Surgery, British Journal of Surgery and Liver Transplantation. Owing to his outstanding research and clinical performance, he was awarded Carlos Pellegrini traveling Fellowship in 2015 from the American College of Surgeons. Apart from his excellent clinical and research works, he is committed to promote organ donation in Hong Kong and is currently the Honorary Treasurer for Hong Kong Society of Transplantation and Council Member for Hong Kong Liver Foundation.
Colorectal cancer is a worldwide public health challenge. It is the most common cancer and the second leading cause of cancer mortality in Hong Kong. More than one third of patients present at an advanced stage of disease at diagnosis and the liver is the most common site of metastasis. Selection criteria for early diagnosis, chemotherapy and surgery have been recently extended. However, resectability remains poorly defined. The presence of metastasis is the most significant prognostic factor. For this reason, surgical resection of hepatic metastasis is the leading treatment. The most appropriate resection approach remains to be established. The primary cancer and the hepatic metastasis can be removed by simultaneous resection or two-step resection. These two approaches have comparable long-term survival outcomes. For patients with a limited future liver remnant, Portal Vein Embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy have been advocated. However, both have their pros and cons. Targeted biological chemotherapeutic agents and loco-regional therapies (chemoembolization, thermal ablation and arterial infusion chemotherapy) help to further improve favorable results. The recent debate about offering liver transplant to highly selected patients’ needs validated results from large clinical studies. Standardized evidence-based protocols are missing and hence optimal management of hepatic metastasis should be personalized and decided by a multidisciplinary team.
Suez Canal University, Egypt
Gouda El-Labban is currently the Professor of Surgery. He has completed his PhD from the University of Birmingham UK in Hepatobiliary Surgery. He previously served as Head of the Emergency medicine Department at Suez Canal University Hospital. He served as a member in a major international project funded by the European Commission in Medical Informatics. Throughout his career, he has published many research studies in international journals and conferences. Part of his professional service is reviewing manuscripts and proposals for international journals with high impact factors, in addition to coordinating many conferences of Surgery and Laparoscopy. His main research interests are Hepatobiliary and Laparoscopic Surgery. His work at the SCU Hospital involves teaching undergraduate and postgraduate students and training postgraduates on operative maneuvers.
Introduction & Aim: The appropriate time for Laparoscopic Cholecystectomy (LC) following Endoscopic Retrograde Cholangiopancreaticography (ERCP) in patients with obstructive choledocholithiasis is controversial. We aim to compare early versus delayed LC after ERCP in patients with calcular obstructive jaundice as regards conversion rate, postoperative morbidity and hospital stay.
Method: This study was conducted on 124 patients who underwent LC after ERCP due to calcular obstructive jaundice. Patients were randomly classified to two groups; in the first group (early group, n=62) LC was performed within 72 hours after ERCP, while in the second group (delayed group, n=62) LC was performed after 6 weeks.
Result: Conversion to open cholecystectomy was significantly more incident when LC was delayed for more than 6 weeks after ERCP (22.6% in delayed group versus 6.5% in early group). The duration of surgery and the postoperative hospital stay in the early group was significantly shorter than that of the delayed group (42.3±10.6 minutes versus 72.2±16.8 minutes and 1.1±1.9 day versus 3.5±1.2 days, respectively). No statistically significant difference was found between both groups as regarding the postoperative morbidity.
Conclusion: Performing LC as early as possible (within 72 hours after ERCP) lowers the conversion rate to open cholecystectomy thus decreasing the anticipated postoperative morbidity and prolonged hospital stay.
Tomasz Kameczura is Interventional cardiologist experienced in invasive cardiology, currently dealing with ACS's and elective PCI's and is the founder of NewTechMed LLC/NY/USA.
Background: The reduction of heart damage and improvement of patient outcome are the main goals in the treatment of myocardial infarction. For both crucial are the shortening of time to reperfusion and use of appropriate pharmacological treatment. Two commonly recognized milestones in this area are the techniques of mechanical reperfusion and new generations of antiplatelet drugs. Restrain of myocardial metabolic activity seems to be possible third way, which may have an impact on myocardial damage especially during the critical ischemia. The use of direct heart hypothermia to reduce myocardial metabolic activity is very promising tool for reducing left ventricle damage and improve patient’s prognosis.
Method: The study is conducted using an animal model. We compare 20 domestic swine (Polish Landrace Pig), 10 in the Study Group (SG) and 10 in the Control Group (CG). The animals in both groups were randomly paired by age, sex and body mass. Animals in the CG are sequentially given analgesia, sedation and respiratory therapy. After that we get an arterial access (femoral artery), perform coronary-angiography and by using balloon catheter (BC) perform inflation in proximal part of LAD (POBA) (target prox/mid LAD with a diameter of 2.5-4.0 mm behind ostium DG1). After 45 minutes the BC is removed from the LAD. The animal is observed, monitored (if necessary appropriate medication is given). Past 48-hours since POBA the EF assessment (Ejection Fraction) of LV is performed. Then the subject is euthanized and staining of heart tissue is performed with quantitative assessment of Infarct Area (IA) and Area at Risk (AAR). Similarly, in SG the coronary angiography is performed with POBA LAD. After removal of BC from the LAD, a dry puncture of pericardium (pericardial catheter inserted to the pericardial sac) is performed, with subsequent 12 hours procedure of direct hypothermia of heart (saline 30 °C). 48 hours since POBA, there the evaluation of EF is made, subject is euthanized, then same staining procedures as in control group performed with quantitative assessment OD AI and AAR.
Result: Comparison of baseline EF and MVO in CG1 and SG1 showed no significant differences (all p>0.05). MVO was significantly reduced at SG2 and EF was significantly greater in SG2 comparison to the CG2. Similarly, for the EF and MVO significant difference was observed between the SG2 and CG2 (p<0.001).
Conclusion: Direct Heart Hypothermia (DHH) method by METcooler in acute experimental heart ischemia is a viable and safe method in an animal model. Dry pericardial puncture and lowering the temperature in the pericardial sac by applying a closed refrigerant circuit are relatively simple procedures that can be performed if necessary in a regular cath-lab/cardiology department. Preliminary results demonstrate that the DHH may be considered in the future as an additional method to reduce cardiac damage in the course of myocardial infarction.
Sawai Man Singh Medical College, India
Deepesh Kalra is the senior Surgeon/Consultant at the Sawai Man Singh Medical College, India and Professor of Plastic Surgery. He has completed his Graduation in Medical from the prestigious King Georges Medical College Lucknow India and his Post-graduation (MS) in General Surgery from King Georges Medical College Lucknow. He was trained in the field of Craniofacial Surgery by Prof. Ian T. Jackson of the Mayo clinic USA. Further He was trained in the field of Microvascular Surgery by Dr. Robert Acland of USA. He has successfully performed more than 15 thousand operation. He has delivered several lectures at national and international seminars and presented more than 100 research papers. He has published several new techniques and published more than 20 research paper in national and international Journals.
Meta-plastic breast carcinoma is very rare neoplasm. We report a case of meta-plastic breast carcinoma containing characteristic features of infiltrating ductal carcinoma and chondrosarcoma. A 62 year-old female presented with complaint of a lump in the right breast for the last 2 years. FNAC was suggestive of mucinous tumor. Tru-cut biopsy had been performed outside our institution, which was suggestive of a ductal carcinoma with mucinous component. Modified radical mastectomy of the right breast was performed and histopathology was suggestive of infiltrating ductal carcinoma and chondosarcoma of the right breast. All resected lymph nodes were free of metastasis. Immunohistochemistry was suggestive of a meta-plastic carcinoma with components of ductal carcinoma and chondrosarcoma with moderately positive ER, negative PR, positive pan-cytokeratin in ductal carcinoma component, positive S-100 and KI-67.