bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency Portasystemic Shunting in Cirrhotics With Bleeding Varices — A Comparison of Portacaval and Mesocaval Shunts
Authors: Soutter D. I. , Langer B. , Taylor B. R. , Greig P.
Published: September 2007

Despite the best conservative measures available for the control of major variceal hemorrhage, some
patients either continue to bleed, or rebleed early, and require emergency surgery. One hundred patients
with cirrhosis and uncontrolled bleeding were treated with emergency portasystemic shunts between 1968
and 1983. Fifty eight patients had end‐to‐side portacaval shunts and 42 had Dacron interposition mesocaval
shunts. Both groups were comparable with respect to age, sex and prevalence of alcoholism. There was an
increased severity of liver disease as assessed by Child′s class in the mesocaval group of patients.Overall in‐hospital mortality was 31% with no significant difference demonstrated between the
mesocaval group (28%) and the portacaval group (33%), nor between alcoholic cirrhotics (34%) and non‐alcoholic
cirrhotics (21%). Mortality rates based on severity of liver disease were: Child′s A (1/6) 17%,
Child′s B (9/48) 19%, and Child’s C (21/46) 46%. There was a statistically significant difference between
Child′s A & B and Child′s C (p < 0.01). Four patients were lost to follow‐up. No significant differences
were found in 5 year survival by life table analysis comparing portacaval (39%) vs. mesocaval (28%) groups
or alcoholic cirrhotics (36%) vs. non‐alcoholic cirrhotics (29%). Encephalopathy in survivors was absent in
46%, mild in 28% and severe in 26% of patients. There was no significant difference in encephalopathy
rates following portacaval or mesocaval shunting.Neither operation was clearly superior and choice of operation can be made on the basis of technical and
anatomical factors and surgeon experience. Emergency shunting remains a useful option for patients with
variceal bleeding refractory to other more conservative therapy, and is associated with acceptable early
mortality and long term survival rates.
Sphincteroplasty of the Sphincter of Oddi in the Treatment of Benign Distal Obstructions of the Bile Duct
Authors: Duca S.
Published: September 2007

Seventy patients in whom sphincteroplasty was performed by an original technique are presented. In
65 cases the indication was stenosis of the sphincter of oddi, associated or not with cholelithiasis or
hepatic hydatid disease. There were relative indications in another 5 patients. Sphincteroplasty was
achieved with the aid of an original probe, and average length of the incision of the ampullary area
was 28 mm.In the immediate postoperative period there was one case of acute postoperative pancreatitis, one
duodenal fistula and an upper digestive haemorrhage; also a residual stone was detected. All these
complications have responded favourably to conservative treatment. There was a single death in an old
patient with bronchopneumonia.The late results were very good or good with the exception of two cases: one which presented with
cholangitis episodes maintained by duodenal stasis, and one female patient, who after one year from
sphincteroplasty had to be reoperated on for an hepatic abscess.
Obstructive Jaundice in Chronic Pancreatitis
Authors: Hollands M. J. , Little J. M.
Published: September 2007

Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57
consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of
more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as
jaundice of unknown cause.

Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from
the onset of chronic pancreatitis. Jaundice was found to occur in the presence of more “destructive”
disease, and jaundiced patients had a higher incidence of pancreatic calcification, diabetes and
malabsorption at the time of presentation with jaundice.

Obstructive jaundice caused by chronic pancreatitis was found to carry a good prognosis for jaundice,
for pain and for life. Only one of the 11 patients died in hospital.

It is important to distinguish chronic pancreatitis from cancer in these patients. Pre‐operative and intraoperative
cytology have been helpful. Stent insertion is not an appropriate method of treatment for these
patients because of the benign nature of the disease and the possibility of exacerbating the pancreatitis. It is
important to be aware of another form of “malignant masquerade” causing obstructive jaundice.
A Study of The Local Toxicity of Agents Used for Variceal Injection Sclerotherapy
Authors: Robertson C. S. , Womack C. , Robson K. , Morris D. L.
Published: September 2007

Injection sclerotherapy is widely used in the treatment of oesophageal varices. However, few studies
have compared the local toxicity of sclerosant agents which may be important if serious local complications
are to be avoided.In this study the depth of injury caused by submucosal injection of increasing concentrations of
sodium tetradecyl sulphate, polidocanol, 5% ethanolamine oleate and 5% varicosid in rabbits stomach,
has been compared by histopathological examination.Macroscopic ulceration was seen in 14.6% of injection sites. Increasing concentrations of sodium
tetradecyl sulphate and polidocanol produced increasingly extensive microscopic inflammation. Five
percent varicosid caused more inflammation than 5% ethanolamine and only 3% polidocanol and 5%
varicosid caused full thickness inflammation. Only 5% ethanolamine produced inflammation consistently
confined to the mucosa and submucosa.On the basis of this study we feel that 5% ethanolamine is the most suitable agent for injection
sclerotherapy.
Cholesterol Microlithiasis: Bacteriology, Gallbladder Bile and Stone Composition
Authors: Sarli Leopoldo , Gafa′ Matteo , Longinotti Ernesto , Carreras Fabio , Pietra Nicola , Peracchia Anacleto , Dotti Claudio , Cavalier Simonetta
Published: September 2007

It is not known whether microcalculi possess structural differences compared with larger stones or
whether they represent simply an earlier stage in stone disease.

We carried out a controlled study on 10 patients affected by gallbladder cholesterol microlithiasis (CM).
In all patients, samples from all parts of the stones were studied by X‐ray diffraction and by infrared
spectrophotometry. Bile analysis was carried out to determine cholesterol, phospholipid and total bile
acid content. The cholesterol saturation indices (C.S.I.) were calculated. In all samples, bacterial bile
culture was carried out. The results were compared with those of 10 patients who had undergone
cholecystectomy for large cholesterol stones, and for 10 patients who had undergone abdominal surgery
but without biliary pathology. Patients in these latter groups were matched with the first according to sex
and age.

Microcalculi proved to be layered (nucleus and external layer) in only 2 cases and larger stones in 9;
cholesterol was seen to be the principal crystalline component in all cases. Traces of bilirubin were found
in 7 CM and in the nuclei of 5 larger stones.

These results show that the structural composition of microcalculi is similar to that of the nucleus of
larger stones. No substantial differences exist, however, between the two groups of patients regarding the
other parameters taken into consideration.
A Pancreatic Tumour Presenting as a Ruptured Spleen
Authors: Chung S. , Park K. , Li A. K. C.
Published: September 2007

We report a case of spontaneous rupture of the spleen due to invasion from a pancreatic tumour. We are
unaware of any similar case having been reported in the literature.
CT‐Guided Pancreatic Percutaneous Fine‐Needle Biopsy in Differential Diagnosis between Pancreatic Cancer and Chronic Pancreatitis
Authors: Carlucci Michele , Zerbi Alessandro , Parolini Danilo , Sironi Sandro , Vanzulli Angelo , Staudacher Carlo , Faravelli Agostino , Garancini Paola , del Maschio Alessandro , di Carlo Valerio
Published: September 2007

Differential diagnosis between pancreatic cancer and chronic pancreatitis is still difficult to establish. In
63 patients with suspected pancreatic neoplasm we performed: serum CA 19‐9 assessment, abdominal
ultrasound, CT scan and CT‐guided pancreatic percutaneous fine‐needle biopsy. The conclusive diagnosis
was pancreatic cancer in 40 patients and chronic pancreatitis in 23 patients. With regard to the differential
diagnosis, sensitivity and specificity were respectively 80% and 78% for serum CA 19‐9, 75% and 65% for
abdominal US, 85% and 70% for CT scan, 00% and 87% for percutaneous fine‐needle biopsy. We
conclude that CT‐guided percutaneous fine‐needle biopsy is the most reliable method for differential
diagnosis between pancreatic cancer and chronic pancreatitis.
Papillotubular Adenoma of The Ampullary Region
Authors: Numata Minoru , Noguchi Toru
Published: September 2007

Papillotubular adenoma of the ampullary region in a rare tumor which has the potential for malignant
transformation. Although reported more frequently nowadays, ampullary tumors are difficult to diagnose
before operation unless they cause obstructive jaundice. Occasionally they are detected by
ultrasonography, computed tomography or ERCP in patients who complain of nonspecific upper
abdominal discomfort.We report a case of a periampullary papilotubular adenoma causing generalized pruritus and weight
loss but no jaundice. The tumor was extirpated by pancreaticoduodenectomy, and the patient has
remained healthy for over five years.
Pylorus Preserving Pancreatoduodenectomy Versus Whipple Procedurefor Adenocarcinoma of The Head of The Pancreas
Authors: Belli Lino , Riolo Franco , Romani Federico , Baticci Fabio , Rossetti Ornella , Puttini Maurizio
Published: September 2007

Thirty eight patients underwent pancreatoduodenectomy for histologically confirmed adenocarcinoma of
the head of the pancreas. Twenty one underwent a pylorus preserving pancreatoduodenectomy and
seventeen the classical Whipple procedure. We undertook this retrospective analysis to compare longterm
survival following the two different surgical procedures.Patients in the two groups were comparable for preoperative laboratory data, age and pathological
staging. Minor and major morbidity was not different between the two groups (33.3% and 35.2%
respectively). In the pylorus preservation group a delayed resumption of full oral diet and a consequent
prolonged hospital stay has been noted (;21.3 days vs 15.4 days, p<0.05). Mean survival was 21 months in
the pylorus preservation group and 17 in the Whipple group. No statistical difference was observed
between the two survival curves. According to these data the pylorus preserving pancreatoduodenectomy
represents a reasonable option for adenocarcinoma of the head of the pancreas.
Isolated Gallbladder Rupture Due to Blunt Abdominal Trauma
Authors: Schachter P. , Czerniak A. , Shemesh E. , Avigad I. , Lotan G. , Wolfstein I.
Published: September 2007

Traumatic injury to the extrahepatic biliary system is rare and usually diagnosed at laparotomy when it is
associated with other visceral injuries. Isolated gallbladder rupture due to blunt abdominal trauma is even
rarer. The clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and
treatment. Awareness to the possibilty of trauma to the extrahepatic biliary system enables early surgical
intervention and eliminates the high morbidity associated with delated diagnosis.

A 5 year old child with isolated gallbladder rupture caused by blunt abdominal trauma is presented.
A 10‐Year Prospective Evaluation of Balloon Tube Tamponade andEmergency Injection Sclerotherapy for Actively BleedingOesophageal Varices
Authors: Kahn D. , Bornman P. C. , Terblanche J.
Published: September 2007

During a 10 year study period 234 patients were admitted on 371 occasions with a total of 566 acute variceal
bleeding episodes. Of these, 173 patients had 343 variceal bleeds which required balloon tamponade to
achieve initial control of bleeding during 229 admissions and were then referred for emergency injection
sclerotherapy. Sixty‐eight percent of these patients had alcoholic cirrhosis and 42% were poor risk Grade
C patients. Injection sclerotherapy was performed initially using the rigid Negus oesophagoscope under
general anaesthesia and later using the fibreoptic endoscope under light sedation. Definitive control of
variceal bleeding was achieved with sclerotherapy during 197 hospital admissions (92%). Of the 17
failures of emergency sclerotherapy, 4 patients died from uncontrolled bleeding and 13 patients
underwent major surgical intervention. Definitive control of variceal bleeding was achieved with a single
injection treatment in 138 hospital admissions (70%). Complications were mostly of a minor nature and
occurred at a rate of 6% per injection treatment. The overall hospital admission mortality was 36%. The
majority of patients died due to liver failure. The mortality in patients who required 4 injection treatments
to control variceal bleeding was 71%. Injection sclerotherapy is proposed as the emergency treatment of
choice for patients whose variceal bleeding continues or recurs after initial conservative management.
Patients whose variceal bleeding is not controlled by 2 injection treatments require more major
emergency surgery.
Heterotopic Auxiliary Liver Transplantation with Portal Flow
Authors: Lorente Laureano , Arias Jaime , Aller Maria Angeles , Ispizua José Ignacio , Rodriguez José , Durán Hipólito
Published: September 2007

One of the causes of auxiliary liver transplantation failure is the inter‐liver competition between the host
liver and the graft for the hepatotrophic factors of the portal blood. We have developed an experimental
model of heterotopic partial (30%) liver isotransplant using Wistar rats so as to study this competition.

Splenoportography and dissection demonstrate the existence of collateral circulation. The collaterals
at 90 days post‐transplant (PT) consisted of veins from the portal vein to the host liver (PR),
paraesophageal veins (PE) and splenorenal veins (SR). At 60 days P.T., PR and SR veins but not PE
ones appeared, and at 30 days P.T., there were only PR veins. Graft atrophy at 90 days P.T. was
associated with a severe degree of bile duct proliferation.

The gradual development of portal hypertension causes porto‐systemic collateral circulation and the
graft loses the portal hepatotrophic factors. The late development of the portal hypertension and the
biliary proliferation could be caused by the hepatic arterial ischemia in this experimental model. Thus,
as has been described in the orthotopic liver tansplantation, the heterotopic one might require a double
vascularization, both portal and arterial.
Cystic Neoplasms of the ExocrinePancreas
Authors: Mosimann F. , Ribaux C. , Schnyder P.
Published: September 2007

Cystic neoplasms of the pancreas are rare and their diagnosis and treatment can be difficult. This report
details 7 patients who had histologically proven serous cystadenoma4, mucinous cystadenoma2 and
cystadeno carcinoma1. Computed tomography and sonography allowed excellent preoperative assessment
but to attempt a distinction between the histological variants may be hazardous. Two tumours
were only autopsy findings and 5 patients underwent laparotomy. It is confirmed that potentially
malignant mucinous cystadenomas and cytadenocarcinomas should be resected whenever possible;
serous cystadenomas are always benign and should therefore be resected only when the diagnosis is
doubtful or if they cause symptoms.
Percutaneous Management of PyogenicHepatic Abscesses
Authors: Andersson Roland , Forsberg Lillemor , Hederstrom Esbjörn , Hochbergs Peter , Bengmark Stig
Published: September 2007

Twelve patients (9 men, 3 women) with a mean age of 65 (54–78) years, with pyogenic hepatic abscesses
were managed by percutaneous drainage between 1979 and 1987. Biliary origin was most common (4
patients), followed by hepatic abscesses as a late postoperative complication (seen in 3 patients) and
hepatic abscesses occurring in association with acute appendicitis (2 patients). The origin was unknown
in 3 patients. Diagnosis was reached by computed tomography or ultrasonography with a diagnostic
delay of in mean 11 days. Seventeen abscesses were found among the 12 patients. The median abscess
size (maximal diameter) was 7 (1–12) cm. Nine patients were treated with percutaneous drainage with
an indwelling catheter within the abscess cavity for up to 3 weeks, while 3 patients were managed with
percutaneous puncture and aspiration alone. The most commonly isolated organism from the drained
hepatic abscess was E.coli. The course following percutaneous treatment was uneventful, without
mortality and recurrence of the hepatic abscess during follow‐up. One patient required surgical drainage
of an additional hepatic abscess.

Percutaneous drainage of hepatic abscesses, independent of origin, thus seems as a safe and reliable
method, which should be considered as the treatment of choice if facilities and knowledge of
percutaneous management are provided.
Spontaneous Bile Duct Rupture in Pregnancy
Authors: Piotrowski Joseph J. , Stiegmann Greg Van , Liechty R. Dale
Published: September 2007

Spontaneous bile duct rupture occurred in a 23‐year‐old who required emergency Cesarean section for
fetal distress. This condition has not been reported in association with pregnancy. Only forty cases of
spontaneous bile duct perforation in adults have been previously reported. Seventy percent of these
perforations were related to biliary calculi. Sites of perforation were evenly distributed between
common hepatic duct and common bile duct. Recommended treatment includes cholecystectomy,
common bile duct exploration, T‐tube placement, and Roux‐En‐Y ductal anastomosis if disruption is
extensive.
Pancreatic Resection for Carcinoma ofthe Pancreas and the PeriampullaryRegion. A Twenty‐Year Experience
Authors: Kairaluoma M. I. , Ståhlberg M. , Kiviniemi H.
Published: September 2007

410 patients were treated for pancreatic and periampullary carcinoma in 1968–1987 of whom 89 (21.5%)
underwent resection. Hospital mortality decreased from 33% in 1968–1972 to 0% in 1983–1987, but the
morbidity rate remained unchanged. The trends were similar in patients ≥ 70 and < 70 years of age. The
pylorus‐saving technique did not increase mortality, morbidity, operative blood loss or the incidence of
delayed gastric emptying, but it did reduce the operative time by one hour (p< 0.01). The real 5 year survival
for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5
years.

It is concluded that age as such is not a limiting factor for pancreatic resection. Resection can be
performed with acceptable mortality and survival rates even in patients over 70 years of age if enough
attention is paid to careful patient selection and proper preparation. The long‐term prognosis is nevertheless
related to tumour histology. The recent decline in operative mortality is mostly due to the resections
being performed by the same group of surgeons. The best biopsy, and also palliation, is radical removal of
the suspicious mass, provided that this can be performed with minimal risk.
The Need of Drainage After Cholecystectomy
Authors: Diez Julio A. , Pujato M. Raúl , Ferreres Alberto R.
Published: September 2007

In an attempt to rationalize the use of intraperitoneal drainage of the subhepatic space after simple, elective cholecystectomy, a prospective study was designed to compare the post‐operative course with and without drainage. There was a higher incidence of postoperative fever of unknown origin and wound infection in the drained group. In the group without drainage the hospital postoperative stay was shorter and there were no complications. The results suggest that routine surgical drainage after uncomplicated cholecystectomy is unnecessary and could be a source of postoperative fever and a higher incidence of wound infection.
Severe Juxtahepatic Venous Injury: Survival after Prolonged Hepatic Vascular Isolation Without Shunting
Authors: Krige J. E. J. , Worthley C. S. , Terblanche J.
Published: September 2007

Survival following major juxtahepatic venous injury is rare in blunt liver trauma despite the use of intracaval shunting. Prolonged liver arterial inflow control, total hepatic venous isolation and lobectomy without shunting was used in a patient to repair a combined vena caval and hepatic venous injury after blunt liver injury. An extended period of normothermic hepatic ischemia was tolerated. Early recognition of retrohepatic venous injury and temporary liver packing to control bleeding and correct hypovolemia are essential before caval occlusion. Hepatic vascular isolation without shunting is an effective simple alternative technique allowing major venous repair in complex liver trauma.
Bleeding Esophageal Varices and Portal Hypertension Caused by Arteriovenous Fistula of Splenic Artery
Authors: Shleapnik Moshe , Shpitz Baruch , Siegal Annette , Dinbar Alex
Published: September 2007

Splenic arteriovenous fistula is a rare but curable cause of portal hypertension. This report describes a patient with such a disorder, presenting with bleeding esophageal varices and ascites. It emphasises the importance of performing selective catheterization of the celiac and superior mesenteric artery in all patients with signs of portal hypertension without evidence of chronic liver disease. Etiopathology and management are discussed.
Subtotal Pancreatectomy for Cancer:Closure of the Pancreatic Remnant WithStaplers
Authors: Ahrén Bo , Tranberg Karl-G. , Andrén-Sandberg Åke , Bengmark Stig
Published: September 2007

This paper presents a 2‐year series of 26 consecutive pancreatectomies for periampullary cancer where the
pancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico‐digestive
anastomosis. The follow‐up period was 14 months or more. Seven patients developed operative complications.
Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after
2‐4 months, lntraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of these
patients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of
3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital median
stay was 27 days (range 10–83 days). Eighteeen patients have died after 4–30 months in recurrent disease and
seven patients are alive after a follow‐up period of 15–29 months. Pancreatic endocrine function seemed well
preserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotal
pancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality.
Although the conclusion should be tempered by the small number of patients, the results justify continued
evaluation of this technique with long‐term follow‐up.
Segmental Liver Transplantation From Living Donors Report of the Technique and Preliminary Results in Dogs
Authors: Cherqui Daniel , Emond Jean C. , Pietrabissa Andrea , Michel Mireille , Roncella Manuela , Brown Silas B. , Whitington Peter F. , Broelsch Christoph E.
Published: September 2007

A technique of orthotopic liver transplantation using a segmental graft from living donors was
developed in the dog. Male mongrel dogs weighing 25–30 kg were used as donors and 10–15 kg as
recipients. The donor operation consists of harvesting the left lobe of the liver (left medial and left
lateral segments) with the left branches of the portal vein, hepatic artery and bile duct, and the left
hepatic vein. The grafts are perfused in situ through the left portal branch to prevent warm ischemia.
The recipient operation consists of two phases: 1total hepatectomy with preservation of the inferior
vena cava using total vascular exclusion of the liver and veno‐venous bypass, 2implantation of the graft
in the orthotopic position with anastomosis of the left hepatic vein to the inferior vena cava and portal,
arterial and biliary reconstruction. Preliminary experiments consisted of four autologous left lobe
transplants and nine non survival allogenic left lobe transplants. Ten survival experiments were
conducted. There were no intraoperative deaths in the donors and none required transfusions. One
donor died of sepsis, but all the other donor dogs survived without complication. Among the 10 grafts
harvested, one was not used because of insufficient bile duct and artery. Two recipients died
intraoperatively of air embolus and cardiac arrest at the time of reperfusion. Three dogs survived, two
for 24 hours and one for 48 hours. They were awake and alert a few hours after surgery, but eventually
died of pulmonary edema in 2 cases and of an unknown reason in the other. Four dogs died 2–12 hours
postoperatively as a result of hemorrhage for the graft′s transected surface. An outflow block after
reperfusion was deemed to be the cause of hemorrhage in these cases. On histologic examination of the
grafts, there were no signs of ischemic necrosis or preservation damage.

This study demonstrates the technical feasibility of living hepatic allograft donation. It shows that it is
possible, in the dog, to safely harvest non ischemic segmental grafts with adequate pedicles without
altering the vascularization and the biliary drainage of the remaining liver. We propose that this
technique is applicable to human anatomy.
Primary Leiomyosarcoma of theGallbladder
Authors: Fotiadis Costas , Gugulakis Alexandros , Nakopoulou Lydia , Sechas Michael
Published: September 2007

The case of a 64 year old female who was known to have gallstones is presented. She was admitted to
the Hospital following an attack of acute cholecystitis. Ten days after vigorous conservative treatment
cholecystectomy was performed. The histological examination showed the presence of the gallbladder
leiomyosarcoma. Primary sarcomas of the gallbladder are rare, leiomyosarcoma being the most infrequent
type, their preoperative diagnosis almost impossible and their prognosis poor.
Primary Hepatocellular Carcinoma: Hospital Based Epidemiologic Study
Authors: Sedlack Jeffrey D. , Nauta Russell J.
Published: September 2007

From 1968‐1985 a series of thirty‐seven patients with primary hepatocellular carcinoma was collected from the tumor registry of the Fairfax County Hospital, in the metropolitan Washington, D.C. area. These patients were found to have a mean age at diagnosis of sixty‐two (males) to sixty‐six (females). Thirty per cent of patients were previously cirrhotic and nineteen per cent had a history of viral hepatitis. There were no patients with documented birth control pill or steroid use. The most common presenting symptoms were anorexia and right upper quadrant pain. Liver‐spleen scan was the most commonly used diagnostic study, but by the 1980′s CT scanning was usually diagnostic. Both alkaline phosphatase and serum glutamyloxalotransferase were reliably elevated in twenty‐six of twenty‐eight and twenty‐one of twenty‐four patients respectively. Forty‐eight per cent of patients with tumor histology reprted had multicentric tumors, thirty‐eight per cent had nodular tumors, and fourteen per cent had diffuse disease.

Survival was as dismal in this as in other studies with a mean of seventy‐nine days. No significant difference was noted between cirrhotic and non‐cirrhotic patients. Chemotherapy and radiation therapy did not significantly impact upon survival.

Finally, a cohort analysis was done and a possibly significant peak in incidence of primary hepatocellular carcinoma was seen in men born from about 1911 through 1920. The authors noted that these males were in the group of draft eligible persons for World War II and questioned a link between veteran status and later development of HCC.
The Role of CEA and Liver Function Tests in the Detection of Hepatic Metastases From Colo‐Rectal Cancer
Authors: Bonfanti G. , Bombelli Luigia , Bozzetti F. , Doci R. , Gennari L. , Koukouras D.
Published: September 2007

Carcinoembryonic antigen and some liver function tests (alkaline phosphatase, gamma‐glutamyl‐transpeptidase, lactic dehydrogenase and cholinesterase) were evaluated in patients with primary colorectal cancer in order to define their role in the pre‐operative detection of liver metastases.

The records of 278 consecutive patients admitted to the Istituto Nazionale Tumori of Milan between January 1982 and December 1983 who were suffering from primary invasive colo‐rectal cancer and who underwent laparotomy were retrospectively analyzed.

At laparotomy, liver metastases were found in 38 pts (13.7%). Considering single tests, CEA was the most sensitive (71%); no single test was found to be reliably predictive, when the result was abnormal. On the contrary, the normal value of each test was associated with a good prediction.

When we considered all the five tests together in the single patient their predictive value, when abnormal, proved to be quite good only if four or five results were abnormal. On the other hand, liver metastases in the presence of all normal tests were found only in two patients, so giving a negative predictive value of about 97%.

So we conclude that, in the lack of an infallable imaging technique for liver evaluation, in the presence of all normal tests any other investigation on the liver could be avoided. However, when liver tests are pathologic, some other imaging technique should be performed in order to supply the surgeon with information about the extent and the spread of the metastases.
Serum and Urine α — Amylase Isoenzymes levels After Operative Cholangiogram
Authors: Xynos Evaghelos , Neonakis Evaghelos , Pechlivanidis George , Vassilakis John S.
Published: September 2007

Serum and urine total α‐amylase isoenzymes values were estimated in two groups of patients, who underwent either elective cholecystectomy and operative cholangiogram (group A — 59 patients) or cholecystectomy without operative cholangiogram (group B — 68 patients). Serum and urine total α‐amylase and pancreatic isoamylase (p‐type) values were statistically significantly increased within the first 24 postoperative hours as compared to the preoperative levels only in group A (p < 0.05). No clinical signs of pancreatitis were observed. Serum lipase alterations did not reach any statistically significant difference in either group. It is concluded that transient hyperamylasaemia after peroperative cholangiogram may be due to a reversible chemical pancreatitis caused by the infused opacifying agent into the common bile duct.
Preeminence of Lesser Splanchnic BloodFlow in Selected Patients WithGeneralized Portal Hypertension
Authors: Witte Charles L. , Witte Marlys H. , Pond Gerald D.
Published: September 2007

Although restricted transhepatic portal flow is necessary for development of generalized portal
hypertension (GPH), increased splanchnic arterial inflow also contributes to GPH and its clinical
sequelae. In this context, we describe 7 male and 6 female patients (mean age 48 years) in whom the
lesser splanchnic (gastrosplenic) system played a key role in the signs and symptoms of GPH. These 13
patients (9 with hepatic cirrhosis, 3 with primary myeloproliferative disorder, and 1 with extrahepatic
portal block) shared common features of massive splenomegaly, huge splenofundic gastric varices, often
with a prominent natural shunt to the left renal vein. Total or near total splenectomy alone or combined
where appropriate with coronary vein ligation was effective in controlling varix hemorrhage (10
patients), ascites (3), or complications of an enlarged spleen‐anorexia and abdominal pain (3),
hemolytic anemia (1) and profound thrombocytopenia with severe epistaxis (1). Intraoperative jejunal
portal venography was crucial in operative management in order to establish definitively the presence or
absence of coronary venous collaterals, and when present, to verify their operative ligation.

These distinctive patients illustrate: 1) GPH is a heterogeneous syndrome of divergent splanchnic
circulatory patterns, a feature which should be taken into account in selecting operative treatment; 2)
one well‐defined subgroup displays prominent hyperdynamic lesser splanchnic and specifically, splenic
blood flow as a major contributor to clinical complications; and 3) within this subgroup, splenectomy
combined with documented absence or surgical interruption of coronary venous collaterals as corroborated
by intraoperative portography is effective alternative treatment.
Gallstone Decalcification and Dissolution Using Chenodeoxycholate and Citrate
Authors: Sali Avni , Vitetta Luis
Published: September 2007

Gallstone dissolution may be possible only in selected patients. Patients with calcified or large gallstones are not suitable for dissolution. Citrate is normally present in bile and an oral citrate load can increase biliary citrate.

A combination of chenodeoxycholic acid (C.D.C.A.) and citrate has been shown to dissolve calcified cholesterol gallstones in vitro. Patients with calcified or large gallstones were treated with a combination of C.D.C.A. and citrate. Partial decalcification was achieved in seven out of twenty patients with calcified stones (35%) and complete decalcification in four patients (20%). One of the patients with large stones had complete dissolution.

Five patients who were suitable for C.D.C.A. treatment but did not respond were also treated with C.D.C.A. and citrate. One of the patients in this latter group had complete dissolution. Oral citrate can decalcify some calcified gallstones.
Implantable Drainage After MajorAbdominal Surgery in CompromisedPatients
Authors: Andersson Roland , Jeppsson Bengt , Holmberg Anna , Bengmark Stig
Published: September 2007

The risk of superinfection following routine abdominal drainage after major surgery is debated.
Especially in patients with malignant diseases and a compromised host defense, this might be a factor
increasing morbidity and mortality. During a 3‐year period (1986–1988) 41 patients operated on for
malignant abdominal conditions received a peritoneal catheter connected to a subcutaneous portal
inserted in order to participate in a trial on postoperative intraperitoneal chemotherapy using 5‐
Fluorouracil. No abdominal drains were inserted. In 15 patients, the subcutaneous portal was used for
evacuation of postoperative fluid accumulation within the abdomen. The mean age was 53 (range 41–70)
years. Inserted catheters were used for drainage up to 14 days postoperatively. The daily amount of fluid
drained varied from 20 to 2 000 ml with a mean of 610 ml/patient and day. One patient required removal
of the catheter due to infection around the subcutaneous chamber. Otherwise, the catheter system was
not associated with any other complications or complaints. One patient developed a postoperative left
subphrenic abscess drained percutaneously by the guidance of ultrasonography, a complication that
could not be attributed to the catheter system but merely to the major operation per se. An implantable
device for peritoneal access thus also seem useful for drainage of postoperative fluid collection, as
evaluated in this preliminary report.
Euro‐Collins Solution Versus Uw‐Solution for Long‐Term Liver Preservation in the Isolated Rat‐Liver Perfusion Model
Authors: Toom René Den , De Jong Marion , Krenning Eric P. , Hoek Hans J. Van Der , Kate Fiebo J. W. Ten , Hennemann Georg , Terpstra Onno T.
Published: September 2007

To compare UW‐solution (UW) and Euro‐Collins (EC) for long‐term liver preservation we investigated
the morphology and metabolic capacity of rat liver after 18 and 42‐hours cold‐storage in either UW or
EC.

After harvesting the rat liver was transferred to a perfusion chamber where it was perfused for 10 min
with UW or EC at 4°C. Thereafter livers were stored at 4°C in UW or EC for 18 hours (both groups
n = 6) or for 42 hours (both groups n = 8). After 18‐hr or 42‐hr cold‐storage a 2‐hr warm perfusion
(37°C) was started with Krebs‐Ringer solution with carbogen to which 125Iodine‐triiodothyronine
(T3)
was added. Control livers (n = 8) were immediately perfused with Krebs‐Ringer without cold‐storage.
The following parameters were assessed: ASAT‐levels in the perfusate, T3‐metabolites in the bile and
the perfusate, the perfusion pressure, the volume of bile secreted and light‐microscopical morphology at
the end of the warm perfusion period.

After cold storage in UW‐solution the ASAT‐levels in the perfusate were lower than after storage in
EC as well as the perfusion pressures. These livers demonstrated a better T3‐metabolism and secreted
more bile than EC‐stored livers. Histological examination showed more tissue damage in the EC‐stored
livers than in the UW stored livers.

We conclude that cold‐storage of rat liver in UW‐solution resulted in a better morphology and
metabolic capacity as compared with EC‐solution.
Splanchnic and Systemic Hemodynamics in Cirrhotic Patients With Refractory Ascites. Effect of Peritoneovenous Shunting
Authors: Vons Corinne , Hadengue Antoine , Lee Samuel S. , Smadja Claude , Franco Dominique , Lebrec Didier
Published: September 2007

The splanchnic and systemic hemodynamics of 14 patients with refractory ascites were studied and were compared to those of 15 patients with ascites responding to medical treatment. Among the 14 patients, 10 were grade B and 4 C, according to the Pugh classification. Of the 15 patients, 5 were Pugh B and 10 C. In patients with refractory ascites, free hepatic venous pressure was significantly higher and hepatic venous pressure gradient was significantly lower than in patients with responsive ascites. Hepatic and azygos blood flows were not significantly different between the two groups. Cardiac output was lower in patients with refractory ascites (p < 0.05) than in those with responsive ascites. In patients with refractory ascites, six months after peritoneovenous shunting, there was a significant reduction of wedged and free hepatic venous pressures and azygos blood flow. Cardiac output increased by 20% (p < 0.02). This study shows that hemodynamic alterations in patients with refractory ascites is the consequence of increased intraabdominal pressure due to chronic ascites. Six months after peritoneovenous shunting splanchnic and systemic hemodynamics became similar to those observed in patients without ascites.
Morphological and Functional Discrepancies in Endocrine Pancreas After Partial Hepatectomy in Dogs
Authors: Hirano Tetsuya , Manabe Tadao , Tobe Takayoshi
Published: September 2007

To clarify the changes in pancreatic hormones and their role in the regeneration of the liver after partial hepatectomy, we measured the portal levels of insulin and pancreatic glucagon and their responses to a glucose load after about 40% hepatectomy in dogs. The changes in the A and B cells of the islets of Langerhans were examined histologically. In the early stages after hepatectomy portal insulin levels decreased significantly, and the response of portal insulin to a glucose load was lower than in the control sham‐operated dogs. Both islet size and the number of B cells increased significantly after hepatectomy. Portal pancreatic glucagon levels increased significantly after hepatectomy, and the response of pancreatic glucagon to a glucose load was not suppressed. The number of A cells also increased significantly.

Thus, there were differencies between insulin and pancreatic glucagon in their morphological and functional effects after hepatectomy. Although this difference is not clearly understood, there is a possibility that insulin consumption is accelerated in the remnant liver after hepatectomy. Insulin and pancreatic glucagon appear to play important but different roles in the regenerating liver from the morphological point of view.
Hepatolithiasis Associated With Anomalous Biliary Anatomy and a Vascular Compression Hepatolithiasis and Anomalous Anatomy
Authors: Cullingford Graham , Davidson Brian , Dooley James , Habib Nagy
Published: September 2007

Biliary tract abnormalities occur in about one of every three people, usually being minor and of no clinical significance.Major abnormalities, however, may present in an unusual manner and provide a major hazard to the unsuspecting surgeon.

A patient presenting with cholangitis without jaundice or abnormal liver function tests is reported. Endoscopic retrograde cholangiography failed to demonstrate any bile ducts in the right postero‐lateral segments of the liver, the “naked segment sign”. A percutaneous transhepatic cholangiogram demonstrated a stricture obstructing the right posterior segmental hepatic duct with hepatolithiasis above the stricture. At operation an anomalous vessel was found at the site of the stricture.

This case highlights the unusual way in which biliary tract anomalies may present and the importance of adequate pre‐operative investigation.
An Unusual Case of Hepatic Tumor
Authors: Frena Antonio , Mazziotti Alighieri , Zanetti Gianfranco , Gozzetti Giuseppe
Published: September 2007

A case is reported of a large hepatic tumor in a patient aged 71. Preoperative diagnostic techniques, including echography, CT and angiography, did not provide sufficient criteria for a precise diagnosis. The mass was removed with an extended right hepatectomy with no particular physiopathological consequences. Histological analysis revealed that this was a metastasis from a melonoma of the choroid, operated on 17 years previously.
Metabolic Alterations in Obstructive Jaundice: Effect of Duration of Jaundice and Bile‐Duct Decompression
Authors: Younes R. N. , Vydelingum N. A. , Derooij P. , Scognamiglio F. , Andrade L. , Posner M. C. , Brennan M. F.
Published: September 2007

We examined the effect of prolonged bile duct obstruction, and subsequent biliary decompression, on
biochemical and metabolic parameters, using a reversible jaundice model in male Fischer 344 rats. The
animals were studied after biliary obstruction for varying periods (4 days, one week, and two weeks) and
following decompression. They were sacrificed one or two weeks following decompression. All the rats
were compared to sham operated, pair‐fed, controls. Obstructive jaundice rapidly increased bilirubin,
liver enzymes, serum free fatty acid, and triglyceride levels. Glucose levels were significantly decreased
in the jaundice rats compared to their pair‐fed controls. Only after two weeks of jaundice was significant
hypoalbuminemia observed. Following decompression, all biochemical and metabolic values gradually
returned to normal levels, except for albumin. Hypoalbuminemia was not reversed within the two‐week
post‐decompression period. The rats jaundiced for two weeks had significantly higher mortality,
compared to the other groups. We conclude that prolonged jaundice adversely affects the metabolic
capacity of the rats, with albumin concentration being markedly decreased, and that biliary decompression
could not reverse completely all the alterations seen with cholestasis, especially following two
weeks of bile duct obstruction.
Liver Atrophy Associated With Monolobar Caroli′s Disease
Authors: Mohan L. N. , Thomas P. G. , Kilpadi A. B. , D′Cunha S.
Published: September 2007

The association of the atrophy‐hypertrophy complex in monolobar Caroli’s disease (Type I) is reported
in a 30 year old male who presented with recurrent cholangitis. Ultrasound and CT scan showed
localised, right sided, saccular biliary dilatation in a normal sized liver. Severe right lobar atrophy was
detected at operation and the resected right lobe weighed only 140 gms. Distortion of the hilar vascular
anatomy and posterior displacement of the right hepatic duct orifice were problems encountered at
surgery.
Long Term Variceal Sclerotherapy: Is Endoscopic Sclerosis a Unique Therapeutic Approach and a True Alternative to Surgery?
Authors: Paquet K-J. , Lazar A. , Rambach W.
Published: September 2007

Endoscopic sclerotherapy has been used to control acute variceal haemorrhage which persists despite
conservative therapy, prevent recurrent variceal haemorrhage in patients with a history of oesophageal
haemorrhage, and to prevent a haemorrhage in patients with oesophageal varices who never bled.

In this short paper I will cover our personal experience with more than 2000 patients receiving
particularly paravariceal endoscopic sclerotherapy of bleeding esophageal varices, and especially
present the results of our prospective and controlled randomized trials (Table 1) and underline
the thesis that endoscopic sclerotherapy and surgical procedures for patients with portal
hypertension are complementary supporting measures or options.
Selective Regional Chemotherapy of Unresectable Hepatic Tumours Using Lipiodol
Authors: Novell J. R. , Dusheiko G. , Markham N. I. , Reddy K. , Dick R. , Hobbs K. E. F.
Published: September 2007

Over a 30 month period from 1987 to 1990, selective hepatic cannulation under fluoroscopic control was
performed in 57 consecutive patients with primary and secondary malignancies of the liver. Fifty‐three
patients were subsequently treated using intra‐arterial Lipiodol emulsified with epirubicin. The tumours
treated were hepatocellular carcinoma (n = 35), metastatic adenocarcinoma (n = 14), intrahepatic
cholangiocarcinoma (n = 3) and leiomyosarcoma (n = 1). For hepatocellular carcinoma the cumulative
survival was 38% at one year; the median survival was 12.2 months for Stage I, 6.3 months for Stage II
and 0.9 months for Stage III tumours.

In metastatic disease the cumulative survival was 63% at one year.

These data suggest that targeted intra‐arterial chemotherapy with Lipiodol‐epirubicin is a useful
palliative therapy for patients with Stage and II HCC, and that a controlled trial of this treatment
should be undertaken.
Devascularization and Transection Procedures
Authors: Idezuki Yasuo
Published: September 2007

Transection and devascularization procedures have been by far the most popular operations for the
treatment of oesophagogastric varices in Japan during the last two decades1-5 and although since the new
development of endoscopic sclerotherapy during the last ten years the number of patients treated by
operation has decreased considerably, these procedures still remain the treatment of choice in many of
the surgical institutions in Japan, especially in good‐risk patients with oesophagogastric varices.
Choledochal Cyst and Chronic Pancreatitis — Treated by Proximal Pancreatectomy
Authors: Jalleh R. P. , Williamson R. C. N.
Published: September 2007

A 32‐year‐old woman with a choledochal cyst (Todani type I) developed recurrent acute pancreatitis
leading to calcific chronic pancreatitis. She had previously been treated with two cyst drainage
procedures and subtotal cyst excision. This association between choledochal cyst and chronic pancreatitis
has not been previously reported. Severe continuing symptoms led to pylorus‐preserving proximal
pancreatoduodenectomy, which was undertaken to prevent future carcinoma in the cyst remnant and
progression of the chronic pancreatitis
Retroperitoneal Biloma Secondary to Operative Common Bile Duct Injury
Authors: Čólović Radoje , Perišić-Savić Mirjana
Published: September 2007

Encapsulated collections of bile (“biloma”) may be a sequela of liver trauma, operative injury or disease. Such collections may be intrahepatic or extrahepatic and usually in the supramesocolic compartment of the abdomen. This is a report of a retroperitoneal biloma, an entity that has been reported only twice to date but this is the first secondary to an operative common bile duct lesion.

Evacuation of the biloma and reconstruction of the associated biliary stricture were successfully carried out. The patient remains sympton free with normal clinical and laboratory data more than 14 months after surgery.

Operative common bile duct (CBD) injury may be followed by a number of complications. To our knowledge retroperitoneal biloma secondary to a CBD lesion has not been previously reported.