When Diarrhea Is More Serious Than You Think
Hepatobiliary Clinic
Dr. Derek DuBay with a inpatient recovering from a partial hepatectomy for a 21cm hepatocellular carcinoma. Program Highlights
The University of Alabama at Birmingham (UAB) Liver Transplant faculty have busy elective hepatobiliary practices. Over 150 major liver resections or extrahepatic biliary tree procedures are performed annually. The clinic has a large patient volume of hepatocellular carcinoma, cholangiocarcinoma, benign biliary disorders, and focal hepatic lesions in addition to metastatic disease. All patients with malignancies are discussed at an Interdisciplinary Liver Tumor Board consisting of physicians with clinical expertise in hepatobiliary malignancies including hepatobiliary surgeons, hepatologists, medical oncologists, radiation oncologists, interventional radiologists and liver pathologists. The Interdisciplinary Liver Tumor Board functions in a collaborative effort to best diagnose and treat patients with focal hepatic lesions, hepatocellular carcinoma, hepatic colorectal metastases, and cholangiocarcinoma.
Outcomes
A host of tertiary care treatment options are provided including surgical, interventional, chemotherapy, and radiation approaches. In many cases, multiple treatment modalities are utilized in concert to eradicate hepatic malignancies. The advanced surgical approaches include techniques to facilitate aggressive liver resections when close margins or residual liver function is a concern, such as portal vein embolization, sequential liver resection, and vascular resection/ reconstruction. Liver transplantation is also offered for tumors that meet certain requirements. Approximately 30% of the 100+ liver transplants performed annually are for hepatic malignancies. There is expertise in tumor ablation techniques, transarterial chemoembolization (TACE), and Ytrium90 intra-arterial spheres with approximately 100 patients treated with these interventions annually. UAB also offers novel methods of focal liver tumor irradiation. There are several clinical trials for developing chemotherapy regimens, and chemotherapy-radiation combination protocols. In many cases, chemotherapy and radiation protocols are initiated at UAB and continued locally for patient convenience.
Patient Centered Approach
Patients are contacted directly by the hepatobiliary physician extenders and offered a clinic appointment within a week of referral. We strive to provide excellent communication with referring physicians and compassionate patient care. Every patient is presented at the Interdisciplinary Liver Tumor Board. Health care professionals with interest and expertise in hepatic malignancies including surgeons, hepatologists, medical and radiation oncologists, liver pathologists, and diagnostic and interventional radiologists attend this weekly meeting. All radiographic studies and pathological information is reviewed before a comprehensive treatment plan is recommended. The treatment plan will be clearly communicated to both the patient and the referring physician.
Facilities
Outpatient clinics are located in the Kirklin Clinic, in close proximity to laboratory and radiology services. Liver operations are performed in the new, state-of-the-art operating complex at UAB, and interventional radiology procedures are performed in the Heart and Vascular Institute. Patients are initially cared for in the surgical intensive care unit when appropriate and then transferred to a dedicated liver surgery general ward that is staffed by a dedicated transplant and liver surgery nursing team.
Unraveling The Pathogenesis And Etiology Of Biliary Atresia
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An Introduction To The Boxelder Tree
Boxelder trees, also known as ash-leaved maples, are one of the most common and adaptable urban trees in North America—though they also may be the "messiest" from a visual perspective. The boxelder is very commonly seen in treeless plains and flanking the streets west of the Mississippi River.
It seems that the tree takes on positive characteristics not seen in the eastern half of North America in its western habitat. California interior boxelders take on yellow and red colors in autumn that rival eastern maple. Its drought tolerance makes the tree great for dry country landscapes and very easy on limited water resources. The best thing about it is that it's comfortable on poor sites where more desirable trees cannot maintain adequate health for a long life.
Learn more about the ubiquitous boxelder, including how to identify it, how to grow and maintain it, and problems that could come up.
About the Boxelder undefined undefined / Getty Images The boxelder (Acer negundo) also goes by ashleaf maple, Manitoba maple, and poison ivy tree. It's a member of the plant family Aceraceae. Although considered a "maple outcast" by many, it is indeed in the maple family and the only native maple with more than one blade or leaflet on a single leaf stalk. Boxelder is native to North America and grows in USDA Plant Hardiness Zones 3 through 8. It's very common throughout the western U.S. The tree is crafted into bonsai specimens and used as a screen or windbreak and for land reclamation. Boxelders often have multiple furrowed trunks or very squat single trunks. It grows rapidly and large (25 to 50 feet). One of the tallest ever measured had a recorded height of 110 feet. The tree's crown spread is 25 to 45 feet, and the crown is typically broad and ragged or disheveled. For this reason—and its proneness to breakage—it's not recommended to plant one in your yard. Flowers are without petals, dioecious, and yellowish-green, and the female tassels are very conspicuous. The very maple-looking seeds, called samaras, hang in long, profuse clusters and stay on the tree throughout winter. Nearly every seed is viable and will cover up a disturbed area with seedlings. The boxelder is a very prolific seeder. Boxelder Leaf Botanics Leaf arrangement: Opposite/subopposite Leaf type: Odd pinnately compound Leaflet margin: Lobed; serrate Leaflet shape: Lanceolate; ovate Leaflet venation: Pinnate; reticulate Leaf type and persistence: Deciduous Leaflet blade length: 2 to 4 inches Leaf color: Green Fall color: Orange; yellow Fall characteristic: Showy Boxelder Cultivars Nahhan / Getty Images There are several attractive cultivars of boxelder including "Aureo-Variegata," "Flamingo," and "Auratum." The cultivar Acer negundo, "Aureo-Variegata," is noted for its leaves bordered in gold. Acer negundo, "Flamingo," has variegated leaves with pink margins and is somewhat available at local nurseries. Acer negundo, "Auratum," has abundant gold leaves but is a little harder to find. Even though these cultivars are ornamental, they still share the original boxelder tree's undesirable characteristics, including unattractive female fruit and breakage. The chances of the tree's early removal are still high because of its quick growth. Problems With Boxelder Robert_schafer_photography / Getty Images Boxelder is a rather unattractive tree when limbs break and create a landscape maintenance nightmare. The fruit droops in clusters, which some describe as looking like "dirty brown socks." And the boxelder bug makes things even worse. The Boxelder Bug The boxelder bug (Leptocoris trivittatus) loves the boxelder tree. This half-inch red-striped insect is a true pest during winter. Adults even multiply and invade homes near where boxelder trees grow, making it one of the most common household pests in the U.S. The bug emits a foul odor, stains fabric, and can cause asthmatic reactions. Despite the havoc it could wreak in your home, it does not harm its host tree. Pruning Boxelder Nahhan / Getty Images You will have to prune this tree regularly. Boxelder branches droop as the tree grows and will require pruning if you have consistent walking and vehicular traffic under the canopy. The tree form is not particularly showy and should be grown with one single trunk to maturity. The tree is susceptible to breakage that can occur either at the crotch due to poor collar formation or where the wood itself is weak. Boxelder Trees The boxelder, also known as ash-leaved maple, is a common urban tree in North America known for its adaptability, drought tolerance, and vibrant autumn colors in the western half of the continent. Despite its quick growth and drought resistance, boxelder is often considered undesirable due to its messy appearance, prolific seeding, and susceptibility to breakage. Boxelder trees attract boxelder bugs, which can become household pests during winter but don't harm the tree itself.
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