Position After Liver Biopsy

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KEY TOPICS

  • Given the dependence of observing complete structures on the width of the biopsy and the total number of structures on the biopsy length 10, 11 it would be reasonable to follow the guidance of AASLD position paper on liver biopsy and obtain at least 3 cm of core using a 16 gauge needle 12.(More…)
  • A total of 71 patients with non-hilar RCN, without overlying bowel, liver, or spleen were recruited for this study and received office-based USPRB. The procedures were performed in the prone position with a Hitachi-Aloka alpha 7 ultrasound with biopsy probe.(More…)

POSSIBLY USEFUL

  • Shulman HM, Fisher LB, Schoch HG, Henne KW, McDonald GB. Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms.(More…)

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Position After Liver Biopsy
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description: Liver biopsy findings for HIV-infected patients with chronic …

KEY TOPICS

Given the dependence of observing complete structures on the width of the biopsy and the total number of structures on the biopsy length 10, 11 it would be reasonable to follow the guidance of AASLD position paper on liver biopsy and obtain at least 3 cm of core using a 16 gauge needle 12. [1] Suzuki A, Brunt EM, Kleiner DE, et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. [1] A liver biopsy is not required to evaluate a patient with suspected DILI. In the U.S. Drug-Induced Liver Injury Network (DILIN), only 50% of patients enrolled in the prospective protocol underwent liver biopsy during the course of their evaluation 1. [1] Evaluation of a liver biopsy in a suspected case of drug-induced liver injury (DILI) can be a daunting experience. [1]

Even in the absence of suspected DILI, a liver biopsy is often performed to confirm the clinical suspicion of AIH. Drug-induced AIH (DIAIH) has been reported in association with a number of drugs and also has been the subject of larger clinical studies 20, 63. [1] Unlike autoimmune hepatitis, in which the published algorithms incorporate liver biopsy as part of the diagnosis 2, 3, the most widely used clinical algorithm for DILI determination (the RUCAM) 4 does not have a place for including the findings of liver biopsies. [1] Table 3 lists some of the possible reasons to perform a liver biopsy in a case of suspected DILI. The situations of known underlying liver disease and autoimmune hepatitis deserve further consideration. [1] Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. [1] Schiano TD, Azeem S, Bodian CA, et al. Importance of specimen size in accurate needle liver biopsy evaluation of patients with chronic hepatitis C. Clin Gastroenterol Hepatol. 2005; 3 (9):930-935. [1] Suh N, Liapis H, Misdraji J, Brunt EM, Wang HL. Epstein-Barr virus hepatitis: diagnostic value of in situ hybridization, polymerase chain reaction, and immunohistochemistry on liver biopsy from immunocompetent patients. [1] Liver biopsy is reserved for patients in whom the diagnosis of VOD sinusoidal obstruction syndrome (SOS) is unclear and there is a need to exclude other diagnoses. [2] Rau R, Karger T, Herborn G, Frenzel H. Liver biopsy findings in patients with rheumatoid arthritis undergoing longterm treatment with methotrexate. [1] It is more likely that a point has been reached in the clinical evaluation where the findings need clarification and so a decision to perform a liver biopsy is made. [1] The determination that a drug is or is not involved in liver injury has real clinical consequences and a liver biopsy can provide a wealth of information on both the pattern of injury as well as its severity, guiding both determination of the etiology of the injury as well as subsequent clinical decision-making. [1] When a liver biopsy is performed in these circumstances, the pathologist should make full use of the opportunity this provides to demonstrate the power of careful histological analysis to illuminate difficult clinical problems. [1] An ultrasound-guided percutaneous liver biopsy was performed. [2] This may reflect the timing of the biopsy—if the liver biopsy is done because the injury is slow to resolve, there may be only a little residual injury left. [1] The nurse cares for the client scheduled for a liver biopsy. [3] Ratziu V, Charlotte F, Heurtier A, et al. Sampling variability of liver biopsy in nonalcoholic fatty liver disease. [1] Moreira RK, Chopp W, Washington MK. The concept of hepatic artery-bile duct parallelism in the diagnosis of ductopenia in liver biopsy samples. [1] And, subsequent liver biopsy confirmed the diagnosis of HVOD ( Fig. 3 ). [2] A liver biopsy is not like a simple laboratory test or even an imaging evaluation. [1] Crawford AR, Lin XZ, Crawford JM. The normal adult human liver biopsy: a quantitative reference standard. [1] Sometimes the changes in the liver biopsy are relatively unremarkable. [1]

Utility of liver biopsy in bone marrow transplant patients. [4] The Buffalo, NY Veterans Affairs Medical Center is recruiting for a Chief Gastroenterologist (w/Academics) to provide EGD, Colonoscopy, Capsule Endoscopy, HALO-RFA of Barrett’s esophagus, ERCP, EUS, Liver Biopsy, High resolution, Esophageal manometry, Impedence/pH study and Double Balloon Enteroscopy care to our veteran patients. [5] Value of an individual liver biopsy in the preoperative evaluation of apparently healthy potential liver donors. [4] Utilization rates, complications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. [4]

A total of 71 patients with non-hilar RCN, without overlying bowel, liver, or spleen were recruited for this study and received office-based USPRB. The procedures were performed in the prone position with a Hitachi-Aloka alpha 7 ultrasound with biopsy probe. [6] The study will enroll 175 patients with liver biopsy proven NASH to receive seladelpar (10, 20 or 50mg/day) or placebo in a 2:2:2:1 randomization. [7] Secondary measures of note include histological improvement in NASH and fibrosis (using liver biopsy samples at baseline and 52 weeks). [7] To make a definitive diagnosis, the veterinarian will need to do a liver biopsy. [8]

POSSIBLY USEFUL

Shulman HM, Fisher LB, Schoch HG, Henne KW, McDonald GB. Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms. [1] Lia F, Moreno A, Matesanz R, et al. Veno-occlusive hepatic disease of the liver in renal transplantation: is azathioprine the cause? Nephron 1989;51:509-16. [2] Mcdonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. [2] Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation. [2] Carreras E. Veno-occlusive disease of the liver after hemopoietic cell transplantation. [2] Azar N, Valla D, Abdelsamad I, et al. Liver dysfunction in allogeneic bone marrow transplantation recipients. [2]

Tables of injury caused by particular drugs can found in DILI-specific chapters of the major textbooks of liver pathology as well as the pathology chapters of hepatotoxicity references. [1] The other changes in the liver observed in the liver with vascular injury vary from subtle in the case of hepatoportal sclerosis and nodular regenerative hyperplasia to dramatic, with extensive hemorrhage and necrosis in the case of VOD/SOS and Budd-Chiari. [1] It will also rise when there is liver damage and skeletal muscle injury. [9]

ERCP is a diagnostic procedure designed to examine diseases of the liver, bile ducts and pancreas. [10] The liver, bile ducts, gallbladder, pancreas and the papilla of Vater can be involved in numerous diseases, causing myriad of symptoms. [10] The patient had poor liver function preoperation with the Child-Turcotte-Pugh (CTP) rating of B. The donor was a China Category III (organ donation after brain death followed by cardiac death, DBCD) donor. [2] Reynolds WJ, Wanless IR. Nodular regenerative hyperplasia of the liver in a patient with rheumatoid vasculitis: a morphometric study suggesting a role for hepatic arteritis in the pathogenesis. [1] Dahl MG, Gregory MM, Scheuer PJ. Liver damage due to methotrexate in patients with psoriasis. [1] Outcomes: Now, this patient has been followed up for 6 months after discharge with normal liver graft function. [2]

The differential diagnosis of diffuse microvesicular steatosis is short, including only fatty liver of pregnancy. [1] Lichterfeld M, Fischer HP, Spengler U, Rockstroh JK. Fatty liver and increased serum lactate in a woman with HIV. Dtsch Med Wochenschr. 2003; 128 (3):81-84. [1]

Unlike the well-defined and commonly encountered patterns of chronic hepatitis and fatty liver disease, a biopsy in a case of DILI can show a wide variety of histological findings: inflammation, necrosis, cholestasis, fibrosis, nodular regeneration, vascular injury, and duct destruction among others. [1] There have been not been studies of biopsy adequacy in DILI, but some answers can be inferred from studies of biopsy adequacy in chronic viral hepatitis and fatty liver disease. [1]

Studies of biopsy size in fatty liver disease have shown similar findings 8. [1] The hepatic pathologist may be asked to disentangle contributions to injury from multiple etiologies—a difficult task requiring experience in the biopsy changes over a wide range of liver diseases. [1] Rocken C, Meier H, Klauck S, Wolff S, Malfertheiner P, Roessner A. Large-needle biopsy versus thin-needle biopsy in diagnostic pathology of liver diseases. [1]

The latter drug appears to cause VBDS as its primary pattern, although it is possible that there is bias towards biopsy of only severe prolonged injury in cancer patients. [1] Once the biopsy has been thoroughly reviewed for the pattern and severity of injury as described the pathologist must consider the histological changes in light of the patient’s history ( Figure 1 ). [1] The biopsy may be approached systematically, first by careful identification of histological lesions and then by identification of the overall pattern of injury. [1] The differential diagnosis for cholestatic hepatitis and acute cholestasis depends heavily on the other histological features in the biopsy, particularly the inflammatory pattern. [1] The pathological findings, the histological differential diagnosis and expert interpretation are part of a complete biopsy assessment and provide information that is of greatest value in patient management. [1]

In biopsies performed to evaluate a broad clinical differential diagnosis, these biopsy size estimates should be considered as lower estimates. [1] It should be remembered that these studies were performed to identify size limitations with respect to specific biopsy features or for making a specific diagnosis (steatohepatitis). [1] A child who has leukemia is to have a bone marrow biopsy performed. [9] RATIONALE: The iliac crest is the site usually used for a bone marrow biopsy. [9] RATIONALE: A biopsy specimen cannot be obtained during a cardiac catheterization. [9]

Prior biopsies can be very helpful in defining a pre-existing level of disease severity that can be compared to the current biopsy. [1] Most of these studies have focused on the effects of biopsy size on the staging and grading of chronic hepatitis C. Sampling error is increased with shorter biopsies as well as with those taken with a narrow gauge needle with a significant underestimation of both grade and stage in biopsies less than 1.5 cm in length or 10 portal areas 5 – 7. [1] Biopsies obtained using a transvenous approach using narrower gauge needles may require additional length of biopsy. [1]

Once the clinical decision to perform a biopsy has been made, it is important that a plan for biopsy evaluation be made prior to the procedure. [1] Clearly the more clinical questions that need to be addressed, the more critical it is to have an adequate biopsy to work with, both for the separate specialized testing outlined above and for routine histological assessment. [1] True blinded review, in which the biopsy is evaluated in the absence of any clinical information, has the greatest chance to identify subtle unexpected findings but is difficult to achieve in a typical practice setting. [1] Additional clinical testing may be required to exclude non-DILI etiologies that are suggested by the biopsy. [1]

Because of the inherent complexity of the pathology, the pathologist must approach the biopsy with a systematic evaluation plan. [1] The bleeding is likely secondary to a biopsy that had been performed. [11]

The pathology results of donor can also exclude the possibilities of HVOD in the donor liver before the operation. [2] The liver function of the donor was stable with detection indicators of alanine aminotransferase (ALT) 46 U/L, aspartate aminotransferase (AST) 74 U/L, and total bilirubin (TBil) 18.4 ?mol/L. The cold ischemic time and anhepatic phase were 325 and 56 minutes, respectively. [2]

RATIONALE: AST (SGOT) and ALT (SGPT) are liver function tests. [9] Bat-Erdene et al demonstrated that graft liver infection and IVC stenosis can lead to the most important cause of HVOD. [2] The level of CYP in zone 3 of the liver acinus is the highest, while zone 3 is also the most affected by HVOD. [2]

Antoniades CG, Quaglia A, Taams LS, et al. Source and characterization of hepatic macrophages in acetaminophen-induced acute liver failure in humans. [1] Danan G, Benichou C. Causality assessment of adverse reactions to drugs–I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries. [1] Al-Mukhaizeem KA, Rosenberg A, Sherker AH. Nodular regenerative hyperplasia of the liver: an under-recognized cause of portal hypertension in hematological disorders. [1] True arteritis is rare in the liver, but has been reported as part of a syndrome drug induced systemic vasculitis 57, 58. [1]

The pathologist should be alert to overlapping patterns of injury, particularly if the patient has a known underlying liver disease, such as viral hepatitis or NASH. Once competing causes of injury have been thoroughly evaluated, consideration can turn to the patient’s list of medications, including any over-the-counter drug and herbal or nutritional supplements. [1] Given the prevalence of chronic viral hepatitis and fatty liver disease (both alcoholic and non-alcoholic), it is not unusual for patients with a possible drug injury to have a known (or suspected) underlying liver disease. [1] This is particularly true of the common patterns of injury, chronic hepatitis and fatty liver disease, as well as cases in which the injury is relatively mild and etiologically non-specific. [1] It does not cause fatty liver disease of any sort and has not been associated with vascular injury patterns or cirrhosis. [1] The pattern of microvesicular steatosis should be distinguished from other forms of fatty liver disease because of its clinical and prognostic significance. [1] Drug induced fatty liver disease is well-reported but because the non-drug etiologies of fatty liver disease are very common, caution should be taken before ascribing steatosis to DILI. There are three basic patterns of fatty liver disease caused by drug and other agents: Macrovesicular steatosis (with or without inflammation and fibrosis), steatohepatitis and microvesicular steatosis. [1] In drug induced macrovesicular steatosis and steatohepatitis, the changes may be very similar to the changes of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). [1] These are changes to the stomach mucosa caused by advanced liver disease. [11]

While cholestasis is clearly out of place in most early stage chronic liver diseases there may be other findings, such as obvious duct injury or loss, granulomas, vascular injury or microvesicular steatosis that might suggest a superimposed injury. [1] Kleiner DE, Chalasani NP, Lee WM, et al. Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations. [1] Chalasani N, Fontana RJ, Bonkovsky HL, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. [1]

Grant LM, Kleiner DE, Conjeevaram HS, Vuppalanchi R, Lee WM. Clinical and histological features of idiosyncratic acute liver injury caused by temozolomide. [1] Orman ES, Conjeevaram HS, Vuppalanchi R, et al. Clinical and histopathologic features of fluoroquinolone-induced liver injury. [1]

Chronic cholestatic injury ( Figure 7 ) is less common than cholestatic hepatitis, accounting for only about 10% of cases 15, but it is clinically important as it is the most common pattern of injury in patients with evidence of chronic liver injury due to drugs 39. [1] A more recent analysis of biopsies from 249 cases of suspected drug and herbal-induced liver injury by the U.S. DILIN found that over half of the biopsies could be classified into one of six necroinflammatory and cholestatic injury patterns. [1] In Hans Popper’s landmark paper on drug and toxin induced liver injury, acute viral hepatitis-like injury and cholestastic hepatitis accounted for 39% and 32% of the cases, respectively 19. [1] Bjornsson ES, Hoofnagle JH. Categorization of drugs implicated in causing liver injury: Critical assessment based on published case reports. [1] The evaluation of liver biopsies performed in cases of suspected drug induced liver injury (DILI) can be complex. [1] Figure 1 outlines a general approach to the evaluation of liver biopsies in DILI. The initial review should be as objective as possible, without regard to clinical information. [1]

Stift J, Baba HA, Huber E, et al. Consensus on the histopathological evaluation of liver biopsies from patients following allogeneic hematopoietic cell transplantation. [1]

Lessons: The use of tacrolimus in patients after liver transplantation may cause HVOD. [2] Rationale: Hepatic vein occlusive disease ( HVOD ) is a rare complication after liver transplantation, which is characterized by nonthrombotic, fibrous obliteration of the small centrilobular hepatic veins by connective tissue and centrilobular necrosis in zone 3 of the acini. [2] Hepatic vein occlusive disease ( HVOD ) is a rare complication after liver transplantation, with complicated pathogenesis and poor prognosis. [2] Abbreviations: ACR acute cell rejection, ALT alanine aminotransferase, AMR antibody-mediated rejection, AST aspartate aminotransferase, CT computed tomography, CTP rating Child-Turcotte-Pugh rating, CYP cytochrome P450, DBCD organ donation after brain death followed by cardiac death, HCT hematopoietic stem cell transplantation, HVOD hepatic vein occlusive disease, IVC inferior vena cava, LT liver transplantation, POD postoperation day, TBil total bilirubin. [2]

Izaki T, Inomata Y, Asonuma K, et al. Early graft failure due to a veno-occlusive disease after a pediatric living donor liver transplantation. [2] Yamada N, Urahashi T, Ihara Y, et al. Veno-occlusive disease/sinusoidal obstruction syndrome associated with potential antibody-mediated rejection after pediatric living donor liver transplantation : a case report. [2] In this article, we report 1 case of HVOD after liver transplantation, which may be induced by tacrolimus. [2] HVOD after liver transplantations was first reported as complications of azathioprine hepatotoxicity by Sterneck et al in 1991. [2]

Sebagh M, Debette M, Samuel D, et al. Silent” presentation of veno-occlusive disease after liver transplantation as part of the process of cellular rejection with endothelial predilection. [2] Sebagh M, Azoulay D, Roche B, et al. Significance of isolated hepatic veno-occlusive disease/sinusoidal obstruction syndrome after liver transplantation. [2] Kitajima K, Vaillant JC, Charlotte F, et al. Intractable ascites without mechanical vascular obstruction after orthotopic liver transplantation : etiology and clinical outcome of sinusoidal obstruction syndrome. [2] Takamura H, Nakanuma S, Hayashi H, et al. Severe veno-occlusive disease/sinusoidal obstruction syndrome after deceased-donor and living-donor liver transplantation. [2] Shen T, Feng XW, Geng L, et al. Reversible sinusoidal obstruction syndrome associated with tacrolimus following liver transplantation. [2]

Patient concerns: A 59-year-old male patient with alcoholic liver cirrhosis underwent liver transplantation in our center. [2] Sterneck M, Wiesner R, Ascher N, et al. Azathioprine hepatotoxicity after liver transplantation. [2] Our present case reported a 59-year-old male with alcoholic liver cirrhosis underwent liver transplantation in our center. [2] In cases in which the etiology of liver injury is unclear or potentially multifactorial, the evaluation begins with examination of multiple levels stained with hematoxylin and eosin and includes routine special stains ( Table 1 ). [1] While drugs and herbals have been associated with all types of liver injury, any individual agent has a limited range of injury patterns 15. [1] These histological lesions can be arranged in combinations that can be difficult to classify into recognizable patterns of liver injury. [1] Confluent necrosis centered around the central vein (zone 3) that mimics hypoxic-ischemic liver injury is the characteristic injury pattern of acetaminophen. [1]

Drug induced liver injury is always a diagnosis of exclusion, so the emphasis should be on identification of potential competing causes of injury. [1] From Kleiner DE. Liver histology in the diagnosis and prognosis of drug-induced liver injury. [1] Biopsies of suspected drug-induced liver injury pose a particular challenge to the pathologist that requires a careful and systematic approach. [1] Russo MW, Hoofnagle JH, Gu J, et al. Spectrum of statin hepatotoxicity: experience of the drug-induced liver injury network. [1] De Bus L, Depuydt P, Libbrecht L, et al. Severe drug-induced liver injury associated with prolonged use of linezolid. [1]

Hepatic pathology in drug induced liver injury is complex, but may be approached systematically. [1] Shulman HM, Gooley T, Dudley MD, et al. Utility of transvenous liver biopsies and wedged hepatic venous pressure measurements in sixty marrow transplant recipients. [2] Liver biopsies performed to diagnose graft versus host disease (GVHD) offer similar difficulties. [1] Often dubbed the “silent disease” because it frequently goes undiagnosed, non-alcoholic steatohepatitis or NASH is one of the fastest growing diseases in the developed world and is expected to become the leading cause of liver transplants by 2020. [12] In future liver transplant patients, we should pay close attention to the use of tacrolimus. [2]

After an objective review of the histological findings the pathologist must decide whether there are histological features present that are not consistent with the underlying liver disease. [1] One possible outcome is that no histological features can be identified that are not explained by the known underlying liver disease. [1]

Clinical Liver Disease 2014;4(1):12–6; with permission. [1] Potential DILI must be separated from concomitant non-DILI liver disease. [1]

HVOD is relatively a rare complication of liver transplantation with the incidence of approximately 2%. [2] Batsaikhan BE, Sergelen O, Erdene S, et al. Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation. [2]

RATIONALE: The bed sheets should not be drawn tightly over the feet because this action might cause foot drop–especially with the client in the supine position. [9] RATIONALE: The client should lie in bed in a recumbent position on top of a pressure dressing that has been applied to the site. [9] RATIONALE: Bed rest will reduce metabolic needs in this client who has pneumonia and is having difficulty meeting oxygenation needs. Semi upright position, not bed rest, will promote thoracic expansion. [9]

A semi-reclining position allows for moderate thoracic expansion (not as much as semi-Fowler’s), but that is not the reason for using a semi-reclining position in a client who had a craniotomy. [9] A semi-reclining position will help a little in preventing circulatory overload (not as much as semi-sitting), but that is not the reason for using semi-reclining in a client who has had a craniotomy. [9]

The bed should be placed in the highest position before turning the client to protect the backs of the personnel. [9] The position of the client should be changed every two hours. [9] The semi-sitting position would make the client worse by increasing venous return. [9] The prone position, lying on the abdomen, does not decrease venous return, which is what this client desperately needs. [9] The client should be in a semi-sitting position during suctioning. [9] The NAP positions the client side lying and applies lotion to the back. 2. [3] Any client with severe dyspnea, orthopnea, and bubbling respirations needs to be in an upright position. [9] That is not the major reason for placing the client in the semire clining position, however. [9]

When the patient is in a semi-conscious state, they can still follow instructions such as changing the body position on the X-ray table. [10] RATIONALE: This position will help to stop bleeding without causing aspiration of any blood dripping down the back of the throat. [9] RATIONALE: The recumbent position aggravates pancreatic pain. [9] RATIONALE: The semi-sitting position is the position of choice following abdominal surgery. [9] RATIONALE: The semi-reclining position will promote drainage from the operative area and prevent cerebral edema without putting undue pressure on the cerebral structures. [9]

The nurse positions the arm in an extended position before checking the triceps reflex. 2. [3] After the procedure, the nurse should position him on his right side with a pillow under his rib cage. [9]

“You will change positions several times during the procedure.” 3. [3]

Because of how sick he was, Noah’s position on the organ waiting list was moved up to the highest urgency, meaning he would get the first liver available. [13] From this report, we know that with at least this eagle, she had fidelity to her nesting territory (Mills County) and returned there after release. (Liver biopsy showed lead poisoning as cause of death. [14] The assumed synchronous movement of the tumor target and the internal tracking reference may explain why there was no difference in targeting errors for different offset distances, as long as the reference sensor remained within the liver ( Fig 7 ). [15] This suggests that the margin of acceptable offset distances between the reference sensor and the tumor target may be relatively wide (up to 6 cm in our series), as long as the reference sensor can be positioned within the liver. [15] When analyzing all offset measurements performed with the EM reference positioned within the liver at different offset distances relative to the artificial tumor (range: 20.6 mm to 61.0 mm), mean TPE was 3.2 1.6 mm (n 365). [15] No significant correlation between the TPE and different intrahepatic offset distances (range 21 to 61 mm, n 365) was shown as long as the EM reference was placed within the liver. [15] No significant correlation was observed between targeting accuracy and the magnitude of the offset distance, as long as the EM reference remained within the liver (r 0.03, p 0.62). [15] Accordingly, the rate of targeting measurements that resulted in a TPE of ? 3 mm was 52% when the EM reference was positioned within the liver versus 16% when the EM reference was located externally on the skin ( Fig 7 ). [15] The animal was positioned on the table such that its upper body and liver were covered by the EM field ( Fig 1 ). [15] A displacement of the artificial tumor relative to the surrounding liver tissue and thus to the EM sensor was noticed during the insertion of the ablation probe. [15] A right subcostal laparotomy was performed to insert the pre-formed artificial tumors, which were fixed between the liver lobes using organic glue. [15] Sindram D, Simo KA, Swan RZ, Razzaque S, Niemeyer DJ, Seshadri RM, et al. Laparoscopic microwave ablation of human liver tumours using a novel three-dimensional magnetic guidance system. [15] These include factors affecting the local distribution of thermal energy such as properties of the tumor and underlying liver tissue, vessel proximity, and the applied ablation modality, energy and duration. [15] “Once the tumor in the liver gets large enough, they can treat that by ablation,” he said. [13] If the tumor has metastasized to your liver or the lining of your abdomen, these areas may also be visible. [16]

It can be the beginning of other complications and diseases of the liver, including cancer, with which Howell was later diagnosed. [13] When his cancer came back for the third time, Howell was put on the waiting list for a liver. [13] It’s October, and that means it’s Liver Cancer Awareness Month! For the fourth year in a row, the American Liver. [17] “I was just extraordinarily lucky to keep my cancer with only liver involvement,” he said. [13] If primary CNS lymphoma spreads to the liver, the cancer cells in the liver are actually lymphoma cells. [18]

Banovac F, Tang J, Xu S, Lindisch D, Chung HY, Levy EB, et al. Precision targeting of liver lesions using a novel electromagnetic navigation device in physiologic phantom and swine. [15] Srimathveeravalli G, Leger J, Ezell P, Maybody M, Gutta N, Solomon SB. A study of porcine liver motion during respiration for improving targeting in image-guided needle placements. [15] To date, various navigation systems are commercially available for percutaneous image-guided targeting of liver lesions. [15]

Most patients, he said, get a pediatric surgery called a Kasai procedure that attempts to create drainage of the liver. [13] Lu DSK, Yu NC, Raman SS, Limanond P, Lassman C, Murray K, et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. [15] Patterson EJ, Scudamore CH, Owen DA, Nagy AG, Buczkowski AK. Radiofrequency ablation of porcine liver in vivo: effects of blood flow and treatment time on lesion size. [15] Widmann G, Schullian P, Haidu M, Bale R. Stereotactic radiofrequency ablation (SRFA) of liver lesions: technique effectiveness, safety, and interoperator performance. [15] Maier-Hein L, Tekbas A, Seitel A, Pianka F, Mler SA, Satzl S, et al. In vivo accuracy assessment of a needle-based navigation system for CT-guided radiofrequency ablation of the liver. [15]

Clark Andrew Bonham, MD, associate professor of surgery, performed the removal of Noah’s liver, and Esquivel did the transplant. [13] Peterhans M, Oliveira T, Banz V, Candinas D, Weber S. Computer-assisted liver surgery: clinical applications and technological trends. [15] A donor match was available — only it was not a pediatric liver, but one from an older teenager. [13] Show your support by joining the American Liver Foundation monthly donor program and pay respect to a loved one who has lost the fight or who is struggling against liver disease by giving in his or her honor. [17] This is most often due to the extent of tumor burden or the severity of the underlying liver disease. [15] More than a race, it’s moments that will challenge, inspire and change you! Attain fitness goals while fundraising to create a better future for 30 million Americans with liver disease. [17]

Less than 30% of patients with HCC qualify for standard curative treatments such as complete surgical resection, liver transplantation or local ablation. [15] The international normalized ratio to prioritize patients for liver transplantation: problems and possible solutions. [4]

The potential benefits of using stereotactic navigation systems for targeting and ablation of liver tumors as compared to traditional ultrasound (US) or computed tomography (CT)-guidance include a more accurate and efficient targeting, with a reduction of radiation doses in some settings. [15] Many other factors contribute to a successful local ablation of liver tumors aside from accurate tumor targeting. [15] Radiation doses applied for navigated targeting of liver tumors are reduced to an absolute minimum with the proposed technique, requiring 2 single perpendicular fluoroscopic images for measurement and calculation of the offset distance between the tumor and the EM reference. [15] Schwalbe M, Williamson T, Paolucci I, Fuss T, Baumgartner I, Candinas D, et al. A concept for electromagnetic navigated targeting of liver tumors using an angiographic approach. [15]

Percutaneous navigated positioning of ablation probes was performed by a surgeon experienced with stereotactic ablation of liver tumors. [15] The proposed technique allows precise and efficient navigated positioning of ablation probes into liver tumors in the animal model. [15]

Mean time for navigated positioning of ablation probes (from skin incision to final position of EM tracked ablation probe) was 13.4 8.3 seconds (n 505). [15] Hypothetically, the sequence would include the positioning of the microcatheter into a suitable position for TACE under fluoroscopic guidance, followed by introduction of the EM tracked wire and percutaneous navigated positioning of the ablation probe. [15] In 6 animals, 124 targeting measurements were performed with an offset distance < 30 mm (clinically most feasible position), resulting in a mean TPE of 2.9 1.6 mm. [15] To assess the position of the tumor center (target point t) relative to the EM reference (r), the distances between the two points were measured in the x, y, and z axes in two perpendicular fluoroscopic images (1024 x 1024 px, pixel spacing 0.25 mm/px) before each targeting series. [15] As primary endpoint, TPE was assessed when the EM reference was placed in direct vicinity (? 30 mm Euclidean distance) relative to the intrahepatic tumor, corresponding to the clinically most relevant position when the EM reference is placed into tumor supplying arteries of HCC lesions (n 20 in each animal). [15] To position an EM reference in the vicinity of an intrahepatic tumor in a clinically feasible environment, a prototype of an angiographic wire with integrated EM reference sensor was developed, with corresponding dimensions in order to fit through a 2.7 French microcatheter (inner diameter: 0.65 mm). [15]

The unpaired student’s t test was used for between-group analyses of intra- versus extrahepatic position of the EM reference and for different breathing modalities with respect to targeting accuracy. [15] Position of tracked ablation probe after completion of navigated targeting. [15] Both the EM tracked wire and the EM tracked ablation probe were calibrated to their tip by pivoting, a calibration method which estimates the position of the tip as the center of a rotation. [15] Adding electromagnetic (EM) navigation technology as the tracking modality for target referencing allows a dynamic scenario, in which the reference position is continuously updated while avoiding inaccuracies associated with an explicit registration process. [15] A computer combines the X-rays into detailed, cross-sectional images of your abdominal organs, showing the size and position of the tumor. [16] Most navigation techniques rely on image-to-patient registration, the alignment of perioperative image data with the intraoperative patient and organ position. [15]

Krker J, Xu S, Glossop N, Viswanathan A, Borgert J, Schulz H, et al. Electromagnetic tracking for thermal ablation and biopsy guidance: clinical evaluation of spatial accuracy. [15] Krker J, Xu S, Venkatesan A, Locklin JK, Amalou H, Glossop N, et al. Clinical utility of real-time fusion guidance for biopsy and ablation. [15]

In the context of image-based hepatic ablation and biopsy, various EM navigation approaches based on registration of different intraoperative imaging modalities with pre-procedural image data have been proposed. [15]

Stereotactic biopsy : A biopsy procedure that uses a computer and a 3-dimensional (3-D) scanning device to find a tumor site and guide the removal of tissue so it can be viewed under a microscope to check for signs of cancer. [18] Appelbaum L, Solbiati L, Sosna J, Nissenbaum Y, Greenbaum N, Goldberg SN. Evaluation of an electromagnetic image-fusion navigation system for biopsy of small lesions: assessment of accuracy in an in vivo swine model. [15] Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. [18]

Esquivel, who also holds the Arnold and Barbara Silverman Professorship in Pediatric Transplantation, was among the first surgeons to do liver transplants in children — especially tiny babies — and has been doing them for nearly three decades. [13] An angiographic wire with integrated EM reference sensor at its tip was inserted via a transarterial femoral access and positioned in the vicinity of artificial liver tumors. [15] In our experimental model this might also be influenced by a tumor displacement due to a less solid fixation of artificial tumors in the surrounding liver parenchyma than in real liver tumors. [15]

RANKED SELECTED SOURCES(18 source documents arranged by frequency of occurrence in the above report)

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5. (9) Single liver donor benefits two patients — one young, one old | News Center | Stanford Medicine

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7. (4) Liver biopsy. – Semantic Scholar

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10. (3) Primary CNS Lymphoma Treatment (PDQ)–Patient Version – National Cancer Institute

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12. (2) Gastrointestinal stromal tumor (GIST) – Overview – Mayo Clinic

13. (2) Reader Inquiry: What’s The Updated Outlook For CymaBay Therapeutics? – CymaBay Therapeutics (NASDAQ:CBAY) | Seeking Alpha

14. (1) Madrigal Pharma more than doubles after liver drug study success | Reuters

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16. (1) USAJOBS – Job Announcement

17. (1) AUA 2018: Office-Based Ultrasound-Guided Percutaneous Renal Mass Biopsy

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