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| 1 | Complications of radiofrequency ablation of hepatic tumors:Frequency and risk factors显示文摘Radiofrequency ablation(RFA)has become an important option in the therapy of primary and secondary hepatic tumors.Surgical resection is still the best treatment option,but only a few of these patients are candidates for surgery:multilobar disease,insufficient liver reserve that will lead to liver failure after resection,extra-hepatic disease,proximity to major bile ducts and vessels,and co-morbidities.RFA has a low mortality and morbidity rate and is considered to be safe.Thus,complications occur and vary widely in the literature.Complications are caused by thermal damage,direct needle injury,infection and the patient’s co-morbidities.Tumor type,type of approach,number of lesions,tumor localization,underlying hepatic disease,the physician’s experience,associated hepatic resection and lesion size have been described as factors significantly associated with complications.The physician in charge should promptly recognize high-risk patients more susceptible to complications,perform a close post procedure follow-up and manage them early and adequately if they occur.We aim to describe complications from RFA of hepatic tumors and their risk factors,as well as a few techniques to avoid them.This way,others can decrease their morbidity rates with better outcomes. | Alexandre Zanchenko Fonseca Stephanie Santin Luiz Guilherme Lisboa Gomes Jaques Waisberg Marcelo Augusto Fontenelle Ribeiro Jr. | 2014 | World Journal of Hepatology2014，6，3： | 24 |
| 2 | Open abdomen in gastrointestinal surgery:Which technique is the best for temporary closure during damage control?显示文摘AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity. | Marcelo A F Ribeiro Junior Emily Alves Barros Sabrina Marques de Carvalho Vinicius Pereira Nascimento José Cruvinel Neto Alexandre Zanchenko Fonseca | 2016 | World Journal of Gastrointestinal Surgery2016，8，8： | 9 |
| 3 | Spleen preserving distal pancreatectomy in an isolated blunt pancreatic trauma显示文摘Blunt isolated pancreatic trauma is uncommon,accounting for 1%-4% of high impact abdominal injuries.In addition,its diagnosis can be difficult;physical signs may be poor and laboratory findings nonspecific,resulting in delayed treatment.Preserving the spleen during distal pancreatectomy (DP) is controversial.One of the spleen's functions regards immunity;complications following splenectomy include leukocytosis,thrombocytosis,overwhelming post splenectomy sepsis and some degree of immunodeficiency.This is why many authors favor its preservation.We describe a case of a young man with an isolated pancreatic trauma due to a blunt abdominal trauma with a delayed presentation who was treated with spleen-preserving DP and we discuss the value of this procedure with reference to the literature. | Alexandre Zanchenko Fonseca Marcelo Augusto Fontenelle Ribeiro Jr Orlando Contrucci Alexandre Pompeo Adriana Orsetti Herico Arsie Neto | 2011 | World Journal of Gastrointestinal Surgery2011，3，9： | 3 |
| 4 | Esophagectomy for a traumatic esophageal perforation with delayed diagnosis显示文摘Esophageal perforations are rare,and traumatic perforations are even more infrequent.Due to the rarity of this condition and its nonspecific presentation,the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients,which leads to a high mortality rate.An 18-year-old male patient was brought to the emergency room with a penetrating neck injury,caused by a gunshot wound.He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo-and pneumothorax.During the procedure,a 2 cm lesion was detected in the esophagus,and the patient underwent a primary repair.A contrast leakage into his right hemithorax was noticed on the 4th postoperative day;he was submitted to new surgery,and a subtotal esophagectomy and jejunostomy were performed.He was discharged from the hospital in good condition 20 d after the last procedure.The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment.In early diagnosed patients,more conservative therapeutics should be performed,such as primary repair,while in those with delayed diagnosis,the patient should be submitted to more aggressive and def initive treatment. | Alexandre Zanchenko Fonseca Marcelo Augusto Fontenelle Ribeiro Jr Mariana Frazo Maurício Campanelli Costas Lanes Spinelli Orlando Contrucci | 2009 | World Journal of Gastrointestinal Surgery2009，1，1： | 0 |
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