4 research outputs found

    Total regression of hepatocellular carcinoma bone metastases, after liver transplantation, with sorafenib-everolimus

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    Hepatocellular carcinoma (HCC) represents the 5th commonest malignancy worldwide. Liver transplantation consist a radical and most efficient treatment for HCC. Tumor recurrence or metastases after liver transplantation is not uncommon. Hereby is presented a case of a patient transplanted for alcoholic liver disease and HCC and presented with bone metastases a few months later. Treatment with sorafenib and everolimus showed full regression of the metastases. In conclusion, the point of this report is to advertise a single case of total regression of bone lesions due to HCC recurrence, with the combination of mammalian target of rapamycin and sorafenib, along with radiation

    Defining the bellwether procedures and processes for global trauma care: an international Delphi study

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    Background The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care.Methods A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale.Results A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: ‘Resuscitation & Stabilisation’—(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; ‘Diagnosis & Monitoring’—(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; ‘Optimisation & Intervention’—(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy.Conclusion The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve
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