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| 1 | Ruptured hepatocellular carcinoma following chemoembolization:a western experience显示文摘BACKGROUND: Transcatheter arterial chemoembolization (TACE) is a recommended first line therapy for unresectable hepatocellular carcinoma (HCC). Serious complications such as neutropenic sepsis and hepatic decompensation are well known, but rupture of HCC following TACE is a rare and potentially fatal complication. The aim of this study was to identify the incidence of ruptured HCC following TACE and the associated risk factors. METHODS: A retrospective analysis was performed using our liver database with 'chemoembolization', 'ruptured HCC' covering the patients who received chemoembolization from January 1995 to December 2005. There were no exclusions. RESULTS: A total of 294 patients received chemoemboliza- tion in 530 sessions during the 10-year period. Of these, 2 ruptured following treatment (incidence 0.68%). The mean age was 65 years and the interval between the treatment and rupture was 2 and 24 days. The common factors were male sex, large tumor size (range 11-13 cm), and exophytic tumor growth. One patient died 2 days after rupture with hepatic decompensation while the second is alive after a 6-month follow up without tumor recurrence. CONCLUSIONS: Ruptured HCC following TACE is a rare but serious complication. Large tumor size, male sex, and exophytic growth of tumor may be predisposing factors for rupture. | Narendra Battula Parthi Srinivasan Mansoor Madanur Srinivas Prabhu Chava Oliver Priest Mohamed Rela Nigel Heaton | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，1： | 17 |
| 2 | 203例农村有偿献血感染HIV患者抑郁障碍及生活质量调查显示文摘目的:调查通过献血途径感染人类免疫缺陷病毒(HIV)的203例患者的情绪状况及生活质量。方法:采用贝克抑郁问卷、复合性国际诊断用检查提纲和SF-36对203例通过献血途径感染HIV的患者(HIV阳性组)及年龄、性别和受教育年限相匹配的198例HIV阴性献血者进行调查。结果:①HIV阳性组献血次数多于HIV阴性组(52.2±95.4/13.2±23.9,P<0.001),已婚者少于HIV阴性组(88.6%/ 95.5%,P=0.020),丧偶者多于HIV阴性组(10.9%/4.5%,P=0.020),失业率高于HIV阴性组(21.7%/4.0%,P<0.001),前一年全年工作时间少于HIV阴性组(5.0±3.5/7.5±3.0,P<0.001),家庭月收入低于HIV阴性组(476.3±412.7/709.9±513.7,P<0.001)。②HIV阳性组被诊断为获得性免疫缺陷综合征(AIDS)者占56.6%。HIV阳性组抑郁症的终生患病率为13.8%,HIV阴性组的终生患病率为5.1%。HIV阳性组的抑郁总分(11.3±11.3/6.6±9.6)、躯体(3.3±2.9/2.0±2.6)和非躯体因子分(8.0±8.8/4.6±7.4)均高于HIV阴性组(P<0.001)。HIV阳性组达轻度抑郁以上者占40.4%。HIV阳性组已制定自杀计划者高于HIV阴性组(8.4%/3.0%,P<0.05)。HIV阳性组总体生理健康(48.3±9.7/ 55.5±7.0)和心理健康(48.8±8.9/55.1±7.8)得分均低于HIV阴性组(P<0.001)。③HIV阳性组的贝克抑郁问卷总分与T细胞亚群CD4细胞计数无显著相关,与总体生理健康及心理健康呈显著负相关(r=- 0.46~0.68,P<0.001)。结论:HIV阳性患者生存状况较差。对HIV阳性感染者而言,抑郁给患者生活质量造成全面的影响,抑郁和自杀风险仍然是需要干预和处理的问题。 | 宁南义 石川 于欣 陈玉芳 吴尊友 Jin Hua Vigil O Cysique LA Franklin DR Grant I Heaton RK | 2008 | 中国心理卫生杂志2008，22，7： | 14 |
| 3 | Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis显示文摘BACKGROUND:Pancreatitis is associated with arterial complications in 4%-10%of patients,with untreated mortality approaching 90%.Timely intervention at a specialist center can reduce the mortality to 15%.We present a single institution experience of selective embolization as first line management of bleeding pseudoaneurysms in pancreatitis. METHODS:Sixteen patients with pancreatitis and visceral artery pseudoaneurysms were identified from searches of the records of interventional angiography from January 2000 to June 2007.True visceral artery aneurysms and pseudoaneurysms arising as a result of post-operative pancreatic or biliary leak were excluded from the study. RESULTS:In 50%of the patients,bleeding complicated the initial presentation of pancreatitis.Alcohol was the offending agent in 10 patients,gallstones in 3,trauma,drug-induced and idiopathic pancreatitis in one each.All 16 patients had a contrast CT scan and 15 underwent coeliac axis angiography. The pseudoaneurysms ranging from 0.9 to 9.0 cm affected the splenic artery in 7 patients:hepatic in 3,gastroduodenal and right gastric in 2 each,and left gastric and pancreatico-duodenal in 1 each.One patient developed spontaneous thrombosis of the pseudoaneurysm.Fourteen patients had effective coil embolization of the pseudoaneurysm.One patient needed surgical exclusion of the pseudoaneurysm following difficulty in accessing the coeliac axis radiologically.There were no episodes of re-bleeding and no in-hospital mortality. CONCLUSIONS:Pseudoaneurysms are unrelated to the severity of pancreatitis and major hemorrhage can occur irrespective of their size.Co-existent portal hypertension and sepsis increase the risk of surgery.Angiography and selective coil embolization is a safe and effective way to arrest the hemorrhage. | Harsheet Sethi Praveen Peddu Andreas Prachalias Pauline Kane John Karani Mohamed Rela Nigel Heaton | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，6： | 12 |
| 4 | 人类免疫缺陷病毒感染者抑郁障碍、自杀风险和日常生活能力的研究显示文摘目的研究人类免疫缺陷病毒(H IV)感染者抑郁症和自杀观念的流行情况及其与日常生活能力改变的关联。方法对28例H IV阳性者及23例H IV阴性者,用复合性国际诊断用检查提纲中文版调查抑郁症的总发生率和自杀史,用贝克抑郁问卷(BD I)评估当前抑郁障碍及自杀风险的严重程度,用日常生活能力问卷(ADL)评估H IV感染对日常生活能力的影响。结果(1)H IV阳性组和H IV阴性组中分别有22例(79%)和1例(4%)符合抑郁症的诊断标准(P<0.001);H IV阳性组BD I总分[(22.4±12.7)分]高于H IV阴性组[(6.6±7.8)分;P<0.001]。(2)H IV阳性组和H IV阴性组中分别有18例(64%)和2例(9%)有过自杀观念。(3)H IV阳性组ADL总分[(17.1±5.2)分]高于H IV阴性组[(14.0±0.0)分;P<0.001]。(4)BD I与H IV状况的交互作用是有显著贡献(F=23.95,P<0.001)的自变量,抑郁障碍与H IV状况的相互作用是有意义(F=13.29,P=0.001)的预测因子。结论H IV感染的人群中抑郁症的发生率及自杀风险均较高,抑郁的严重程度和日常生活能力受损有显著相关性。 | 于欣 石川 金华 J.Hampton Atkinson Robert Heaton Thomas Marcotte Corinna Young Joseph Sadek 吴尊友 Igor Grant | 2006 | 中华精神科杂志2006，39，2： | 8 |
| 5 | Pseudoaneurysm following laparoscopic cholecystectomy显示文摘BACKGROUND:Laparoscopic cholecystectomy(LC)is the operation of choice for removal of the gallbladder. Unrecognized bile duct injuries present with biliary peritonitis and systemic sepsis.Bile has been shown to cause damage to the vascular wall and therefore delay the healing of injured arteries leading to pseudoaneurysm formation.Failure to deal with bile leak and secondary infection may result in pseudoaneurysm formation. This study was to report the incidence and outcomes of pseudoaneurysm in patients with bile leak following LC referred to our hospital. METHODS:A retrospective analysis of our prospectively maintained liver database using pseudoaneurysm, bile leak and bile duct injury following laparoscopic cholecystectomy from January 2000 to December 2005 was performed. RESULTS:A total of 86 cases were referred with bile duct injury and bile leak following LC and of these,4 patients (4.5%)developed hepatic artery pseudoaneurysm(HAP) presenting with haemobilia in 3 and massive intra- abdominal bleed in 1.Selective visceral angiography confirmed pseudoaneurysm of the right hepatic artery in 2 cases,cystic artery stump in one and an intact but ectatic hepatic artery with surgical clips closely applied to the right hepatic artery at the origin of the cystic artery in the fourth case.Effective hemostasis was achieved in 3 patients with coil embolization and the fourth patient required emergency laparotomy for severe bleeding and hemodynamic instability due to a ruptured right hepatic artery.Of the 3 patients treated with coil embolization, 2 developed late strictures of the common hepatic duct. . (CHD)requiring hepatico-jejunostomy and one developed a stricture of left hepatic duct.All the 4 patients are alive at a median follow up of 17 months(range 1 to 65)with normal liver function tests. CONCLUSIONS:HAP is a rare and potentially life- threatening complication of LC.Biloma and subsequent infection are reported to be associated with pseudoaneurysm formation.Late duct stricture is common either due to unrecognized injury at LC or secondary to ischemia after embolization. | Mansoor Ahmed Madanur Narendra Battula Harsheet Sethi Rahul Deshpande Nigel Heaton Mohamed Rela | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，3： | 8 |
| 6 | Meta‐analysis: recurrence and survival following the use of sirolimus in liver transplantation for hepatocellular carcinoma显示文摘 | K. V. Menon A. R. Hakeem N. D. Heaton | 2012 | Aliment Pharmacol Ther2012，，4： | 8 |
| 7 | Cancer of the uncinate process of the pancreas:surgical anatomy and clinicopathological features显示文摘BACKGROUND:The clinicopathological features of uncinate process pancreatic cancer(UPPC) are poorly described.Furthermore the anatomy of the uncinate process and its division during surgery are central to pancreaticoduodenectomy for UPPC.We set out to describe the embryology and anatomy of the uncinate process and the clinicopathological features of UPPC.DATA SOURCES:All published case series of UPPC were reviewed and included in this review.RESULTS:The true incidence of UPPC is difficult to quantify,with the reported incidence ranging from 2.5% to 10.7% of pancreatic cancer.There are 5 published series of UPPC including 117 patients,72 males and 45 females,aged from 45-53 years to 61-84 years.The median survival was 5 or 5.5 months in 3 of the series,12.1 months in another based only on potentially resectable lesions and 17 months in another based only on resected cases.CONCLUSIONS:The number of reported series of UPPC is limited,with vague symptoms as the predominant presenting features of the disease.The prognosis is poor with synchronous venous resection demonstrating a survival advantage. | Adrian W. O'Sullivan Nigel Heaton Mohamed Rela | 2009 | Hepatobiliary & Pancreatic Diseases International2009，8，6： | 6 |
| 8 | Clinical features and treatment of sump syndrome following hepaticojejunostomy显示文摘BACKGROUND:Cholangitis after Roux-en-Y hepaticojejunostomy is usually caused by anastomotic stricture.A small number of cases present without evidence of obstruction and are ascribed to reflux of gastro-intestinal content into the biliary tree above the anastomosis (sump syndrome).Despite prophylactic rotating antibiotic therapy,the cholangitic episode may be severe and life-threatening.METHODS:From 2001 to 2006,six patients who had undergone an end-to-side hepaticojejunostomy presented to our institution with recurrent episodes of biliary sepsis.Anastomotic stricture was excluded by liver MRI/MRCP and percutaneous transhepatic cholangiogram (PTC).Barium meal showed reflux of contrast into the biliary tree in all patients.Three patients had a short jejunal Roux limb (less than 50 cm) on pre-operative imaging.RESULTS:Five patients underwent surgery and two of them had two operations.One patient had a Tsuchida antireflux valve and subsequently underwent lengthening of the Roux loop.Three patients had lengthening of the Roux loop;one underwent re-do hepaticojejunostomy and one had concomitant revision of the hepaticojejunostomy and lengthening of the Roux loop.The latter underwent further lengthening of the Roux loop.Three patients are cholangitis-free 6,36 and 60 months after surgery;two still experience mild episodes of cholangitis.CONCLUSIONS:An adequate length of the Roux loop is important to prevent reflux.However,Roux loop lengthening to 70 cm or more does not always resolve the problem and cholangitis,although generally less frequent and severe,may recur despite appropriate reconstructive or antireflux surgery.In these cases,life-long rotating antibiotics is the only available measure. | Gabriele Marangoni Amir Ali Walid Faraj Nigel Heaton Mohamed Rela | 2011 | Hepatobiliary & Pancreatic Diseases International2011，10，3： | 4 |
| 9 | Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease显示文摘 | Andrew D. Yeoman Rachel H. Westbrook Thawab Al‐Chalabi Ivana Carey Nigel D. Heaton Bernard C. Portmann Michael A. Heneghan | 2009 | Hepatology2009，，： | 3 |
| 10 | 兰索拉唑引起的致死性中毒性表皮坏死症 | Heaton N.R. Edmonds E.V.J. Francis N.D. 牛新武 | 2005 | 世界核心医学期刊文摘(皮肤病学分册)2005，0，6： | 3 |
| 11 | Novel en-bloc resection of locally advanced hilar cholangiocarcinoma: the Rex recess approach显示文摘Loco-regional recurrence after potentially curative resection remains a problem in hilar cholangiocarcinoma. Hilar dissection risks local spillage of tumor cells leading to suboptimal disease free survival. We have developed a new technique of radical resection for hilar cholangiocarcinoma based on the distinctive anatomy of the Rex recess of the liver, which has been assessed in two patients with locally advanced hilar cholangiocarcinoma. This technique included a right hepatectomy with en-bloc resection of the hepatoduodenal ligament and portal venous reconstruction to the left portal vein at the Rex recess. Both patients had R0 resection and have been disease-free for 26 and 38 months, respectively. | Mohamed Rela Rajesh Rajalingam Vivekanandan Shanmugam Adrian O' Sullivan Mettu S Reddy Nigel Heaton | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 3 |
| 12 | Developing a donation after cardiac death risk index for adult and pediatric liver transplantation显示文摘AIM To identify objective predictive factors for donor after cardiac death(DCD) graft loss and using those factors, develop a donor recipient stratification risk predictive model that could be used to calculate a DCD risk index(DCD-RI) to help in prospective decision making on organ use.METHODS The model included objective data from a single institute DCD database(2005-2013, n = 261). Univariate survival analysis was followed by adjusted Cox-regressional hazard model. Covariates selected via univariate regression were added to the model via forward selection, significance level P = 0.3. The warm ischemic threshold was clinically set at 30 min. Points were given to each predictor in proportion to their hazard ratio. Using this model, the DCD-RI was calculated. The cohort was stratified to predict graft loss risk and respective graft survival calculated.RESULTS DCD graft survival predictors were primary indication for transplant(P = 0.066), retransplantation(P = 0.176), MELD > 25(P = 0.05), cold ischemia > 10 h(P = 0.292) and donor hepatectomy time > 60 min(P = 0.028).According to the calculated DCD-RI score three risk classes could be defined of low(DCD-RI < 1), standard(DCD-RI 2-4) and high risk(DCD-RI > 5) with a 5 years graft survival of 86%, 78% and 34%, respectively.CONCLUSION The DCD-RI score independently predicted graft loss(P < 0.001) and the DCD-RI class predicted graft survival(P < 0.001). | Shirin Elizabeth Khorsandi Emmanouil Giorgakis Hector Vilca-Melendez John O'Grady Michael Heneghan Varuna Aluvihare Abid Suddle Kosh Agarwal Krishna Menon Andreas Prachalias Parthi Srinivasan Mohamed Rela Wayel Jassem Nigel Heaton | 2017 | World Journal of Transplantation2017，7，3： | 3 |
| 13 | Pancreatoblastoma:A rare indication for liver transplantation in children显示文摘Pancreatoblastoma(PB)is one of the exocrine pancreatic tumors and the most common malignant pancreatic tumor in young children.Patients can present with abdominal distension,pain,fatigue,vomiting and failure to thrive.Exocrine pancreatic tumors usually affect patients between 1 and 8 years,with a median age of 5 years.There is a slight preponderance in males and those of Asian descent[1].PB is considered to be embryonic in origin with moderately raised serum alpha-fetoprotein(AFP)levels[2].Axial imaging is necessary to assess other organ involvement,a common complication in adult patients,but diagnosis is confirmed on tissue histology[3].Complete surgical resection is the treatment of choice,if achievable.Indications for neoadjuvant systemic chemotherapy include large tumors that involve adjacent major blood vessels or other organs and metastatic disease[1].Herein we report a pediatric case of PB with liver metastases who underwent liver transplantation for metastatic liver disease. | Maria Mercadal-Hally Sucheta Vaidya Hector Vilca-Melendez Nigel Heaton Anil Dhawan Tassos Grammatikopoulos | 2020 | Hepatobiliary & Pancreatic Diseases International2020，19，5： | 2 |
| 14 | Spontaneous rupture of hepatocellular carcinoma: a Western experience显示文摘 | Narendra Battula Mansoor Madanur Oliver Priest Parthi Srinivasan John O’Grady Michael A. Heneghan Matthew Bowles Paolo Muiesan Nigel Heaton Mohamed Rela | 2009 | The American Journal of Surgery2009，，2： | 2 |
| 15 | Liver transplantation for acute intermittent porphyria:a viable treatment?显示文摘BACKGROUND:Acute intermittent porphyria (AIP) is the most common hepatic porphyria.Its clinical presentation includes severe disabling and life-threatening neurovisceral symptoms and acute psychiatric symptoms.These symptoms result from the overproduction and accumulation of porphyrin precursors,5-aminoleuvulinic acid (ALA) and porphobilinogen (PBG).The effect of medical treatment is transient and is not effective once irreversible neurological damage has occurred.Liver transplantation (LT) replaces hepatic enzymes and can restore normal excretion of ALA and PBG and prevent acute attacks.METHOD:Two cases of LT for AIP were identified retrospectively from a prospectively maintained LT database.RESULT:LT was successful with resolution of AIP in two patients who suffered from repeated acute attacks.CONCLUSION:LT can correct the underlying metabolic abnormality in AIP and improves quality of life significantly. | Faisal S Dar Koji Asai Ali Raza Haque Thomas Cherian Mohamed Rela Nigel Heaton | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 2 |
| 16 | Biliary Complications After Liver Transplantation Using Grafts from Donors After Cardiac Death: Results from a Matched Control Study in a Single Large Volume Center显示文摘 | Michelle L. DeOliveira Wayel Jassem Roberto Valente Shirin Elizabeth Khorsandi Gregorio Santori Andreas Prachalias Parthi Srinivasan Mohamed Rela Nigel Heaton | 2011 | Annals of Surgery2011，，5： | 2 |
| 17 | Thrombolysis of stroke mimics via telestroke显示文摘Background The rate of intravenous tissue plasminogen activator(IVtPA)administered to stroke mimics(SM)occurs in 24%-44%of telestroke series.Methods We reviewed 270 suspected acute ischaemic stroke(AIS)patients who were evaluated by telestroke and received IVtPA from 1 July 2016 to 30 September 2017 at our academic comprehensive stroke centre.Results Among 270 AIS patients who received IVtPA via telestroke,64(23.7%)were diagnosed with SM.Compared with patients who had a stroke,the SM group was younger(mean age 56.4 vs 68.2,p<0.0001),more likely to be female(60.9%vs 45.6%,p=0.0324)and had longer door-to needle times(85.3 vs 69.9,p=0.0008).The most common SM diagnoses were migraine 26(40.6%),conversion disorder 12(18.8%),encephalopathy 7(10.9%)and unmasking(9.4%).Among the SM,migraine and conversion disorder were younger compared with the other subgroups(p<0.001).Functional exam elements were noted more frequently in conversion disorder(66.7%)and migraine(34.6%),but rare in other diagnoses(p=0.006).Among the SM,23(35.9%)had a history of a prior similar episodes,and 15(23.4%)had a history of more than 5 spells.Conclusions In our telestroke programme,23.7%of those administered thrombolysis had a final diagnosis of SM. | Vivien H Lee Ravyn Howell Randheer Yadav Sharon Heaton Karen L Wiles Sushil Lakhani | 2022 | Stroke & Vascular Neurology2022，7，3： | 2 |
| 18 | Lessons from look-back in acute liver failure? A single centre experience of 3300 patients显示文摘 | William Bernal Anna Hyyrylainen Amit Gera Vinod K. Audimoolam Mark J.W. McPhail Georg Auzinger Mohammed Rela Nigel Heaton John G. O’Grady Julia Wendon Roger Williams | 2013 | Journal of Hepatology2013，，1： | 2 |
| 19 | 策略将在肝移植以后减少丙肝病毒复发显示文摘 Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graftoutcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients. | Ruben Ciria María Pleguezuelo Shirin Elizabeth Khorsandi Diego Davila Abid Suddle Hector Vilca-Melendez Sebastian Rufian Manuel de la Mata Javier Briceo Pedro López Cillero Nigel Heaton | 2013 | World Journal of Hepatology2013，5，5： | 2 |
| 20 | Minimizing the risk of small-for-size syndrome after liver surgery显示文摘Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant(FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-forsize syndrome(SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specifc modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Results: Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusions: With those techniques the indications of radical treatment for patients with liver tumors have signifcantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modifcation of interventions and the right timing of surgery. | Michail Papamichail Michail Pizanias NigelD Heaton | 2022 | Hepatobiliary & Pancreatic Diseases International2022，21，2： | 2 |
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