bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver and Pancreatic Resection in the Elderly
Authors: Garden O. J.
Published: September 2007

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.

Methods: Five hundred seventy‐seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.

Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5‐year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long‐term survival was poorer for the elderly patients, with a 5‐year survival rate of 21% compared with 29% for the younger cohort (p=0.03).

Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long‐term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.
Chronic Pancreatitis and Neoplasia: Correlation or Coincidence
Authors: Zografos G. N. , Bean A. G. , Bowles M. , Williamson R. C. N.
Published: September 2007

Any link between pancreatic carcinoma and chronic pancreatitis could reflect the malignant potential of a chronic inflammatory process. Four patients with ductal adenocarcinomas had a long history of pancreatic pain (median duration 5 years) and showed clearcut evidence of chronic pancreatitis “downstream” of the tumour. Four were alcoholics and two heavy smokers. These four cases arose within a surgical series of approximately 250 patients with chronic pancreatitis, giving an incidence of 1.6 per cent. The incidence and anatomical distribution of carcinoma and chronic pancreatitis could possibly be consistent with a casual relationship.
Endoscopic Management of Perforation of Right Hepatic Duct Following Non‐Surgical Abdominal Trauma
Authors: Sharma B. C. , Maini A. , Saraswat V. A.
Published: September 2007

Isolated bile duct injuries after blunt abdominal trauma are rare. Surgery is the usual mode of treatment. We report a patient with a right hepatic duct injury following blunt abdominal trauma who was managed successfully by endoscopic papillotomy.
The Internal Biliary Fistula – Reappraisal of Incidence, Type, Diagnosis and Management of 33 Consecutive Cases
Authors: Yamashita Hiroyuki , Chijiiwa Kazuo , Ogawa Yoshiaki , Kuroki Syoji , Tanaka Masao
Published: September 2007

To reevaluate the current features of spontaneous internal biliary fistulas, we reviewed 1,929 consecutive patients who had been treated for biliary tract diseases during the recent 12‐year period. Thirty‐three patients had internal biliary fistulas and the incidence was 1.9%. Of 33 patients, 20 were women and 13 were men with the average age 63 years, and their mean duration of illness was 4 years. A total of 37 fistulas were found and the most common type was choledochoduodenal (62%), followed by cholecystoduodenal (19%), cholecystocholedochal (11%) and cholecystocolonic (8%) fistulas. Internal biliary fistulas of thirty‐one patients were caused by biliary stones and those of two patients by malignant tumors. All of the 17 bile samples examined were bacteria positive and the majority of calculi were brown pigment stones. All of the choledochoduodenal fistulas were correctly diagnosed by endoscopic retrograde cholangiography. In 14 patients with cholecystoenteric or cholecystocholedochal fistulas, direct evidence of the internal fistula was obtained only in 7 patients (50%) preoperatively. Pneumobilia, a small atrophic gallbladder adherent to the neighboring organs and a history of spontaneous disappearance of jaundice in elderly patients may indicate the presence of a cholecystoentric fistula. Since the preoperative diagnostic rate for internal biliary fistula involving the gallbladder is still low, care is necessary before and at the time of surgery especially during laparoscopic cholecystectomy for elderly patients with cholelithiasis.
Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage
Authors: Gallagher P. J. , Mclauchlin G. , Bornman P. C. , Krige J. E. J. , Thomson J. , Marks I. N. , Terblanche J.
Published: September 2007

Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34 – 62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2 – 40) blood, transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1 – 9), was diagnostic in only one. Side‐viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy
is preferred for splenic artery lesions.
Delayed Presentation of Porta Hepatis Injury Following Blunt Abdominal Trauma
Authors: Lau L. L. , Diamond T.
Published: September 2007

A 73 year old lady developed abdominal pain, anaemia and obstructive jaundice 18 days after a road traffic accident. The jaundice was due to compression of the biliary confluence by a haematoma which was caused by a laceration of the left portal vein. The portal vein was repaired (lateral venorrhaphy) and post‐operative recovery was uncomplicated. Porta hepatis injuries are difficult to diagnose and delayed presentation is not uncommon. Significant morbidity and mortality may ensue if aggressive management is not adopted.
Resection of Hilar Cholangiocarcinoma
Authors: Strasberg Steven M.
Published: September 2007

Objective: Morbidity and mortality involved in the resection of hilar cholangiocarcinoma were reviewed retrospectively. The clinicopathologic and laboratory parameters that might influence the patient′s survival also were re‐evaluated.

Summary Background Data: Although much progress has been made in the diagnosis and management of hilar cholangiocarcinoma, long‐term outlook for most patients remains poor. Surgical resection is usually prohibited because of its local invasiveness, and most patients can only be managed by palliative drainage. Recently, many surgeons have adopted a more aggressive resection with varying degrees of success. Several prognostic factors in bile duct carcinoma have been proposed; however, no reports have specifically focused on resected hilar cholangiocarcinoma and its prognostic survival factors using multivariate analysis.

Methods: The clinical records and pathologic slides of 49 cases with resected hilar cholangiocarcinoma were reviewed retrospectively. Twenty clinical and laboratory parameters were evaluated for their correlation with postoperative morbidity and mortality, whereas 31 variables were evaluated for their significance with postoperative survival. Variables showing statistical significance in the first univariate analysis were included in the following multivariate analysis using stepwise logistic regression test for factors affecting morbidity and mortality and Cox stepwise proportional hazard model for factors influencing survival.

Results: There were 5 in‐hospital deaths, and the cumulative 5‐year survival rate in 44 patients who survived was 14.9%, with a median survival of 14.0 months. Multivariate analysis disclosed that coexistent hepatolithiasis and lower serum asparate aminotransferase levels (90 U/L) had a significant low incidence of postoperative morbidity, whereas a serum albumin of less than 3 g/dL was the only significant factor affecting mortality. Regarding survival, univariate analysis identified eight significant factors: 1) total bilirubin 10 mg/dL, 2) curative resection, 3) histologic type, 4) perineural invasion, 5) liver invasion, 6) depth of cancer invasion, 7) positive proximal resected margin, and 8) positive surgical margin. However, multivariate analysis disclosed total bilirubin ≥ 10 mg/dL, curative resection, and histologic type as the three most significant independent variables.

Conclusions: Surgical resection provides the best survival for bilar cholangiocarcinoma. An adequate nutritional support to increase serum albumin over 3g/dL is the most important factor to decrease postoperative mortality. Moreover, preoperative biliary drainage to decrease jaundice and a curative resection with adequate surgical margin are recommended if longer survival is anticipated. Patients with well differentiated adenocarcinoma seem to survive longer compared to those with moderately or poorly differentiated tumors.
Complex Cystic Duct is Associated With Cholelithiasis
Authors: Deenitchin Georgi P. , Yoshida Junichi , Chijiiwa Kazuo , Tanaka Masao
Published: September 2007

The relationship between complex cystic ducts and
cholelithiasis has seldom been investigated quantitatively.
Thus we attempted a retrospective survey
on two case series with and without cholelithiasis in
a university hospital. A total of 500 patients who
underwent endoscopic retrograde cholangiography
were reviewed, 250 of whom had cholelithiasis and
another 250 no gallstones. They were sampled at
random during the period from 1979 through 1993.
Parameters including the length, inner diameter and
configuration of the cystic duct, and the angle
formed by the cystic duct, and the axis of the
gallbladder were compared between the groups
with or without cholelithiasis. The patients with
gallstones has significantly (p<0.001) longer and
narrower cystic ducts (a mean of 48mm and 4mm in
length and diameter, respectively) than did those
without stones (a mean of 28mm and 7mm,
respectively). Moreover, patients with gallstones
showed a significantly (p<0.001) more acute angle
between the gallbladder and the cystic duct than
those without (a mean angle of 84° and 119°
respectively). The overall frequency of the disfigurements
of the cystic duct was significantly higher
in the group with gallstones (99%) than in the
group without (29%). The results therefore suggested
that complex cystic ducts are associated with
cholelithiasis.
Serous Adenoma of the PancreasWith Multiple Microcysts CommunicatingWith the Pancreatic Duct
Authors: Samel S. , Horst F. , Becker H. , Brinck U. , Schwörer H. , Ramadori G. , Oestmann J.-W.
Published: September 2007

The rare neoplastic cystic adenomas of the pancreas
form two groups of tumors: macrocystic mucinous
and microcystic serous adenomas. Both entities
show specific radiologic and histologic features.
Several recent case reports, however, suggest some
diversity within the group of microcystic serous
adenomas. We present the case of a young man
operated because of epigastric pain for 12 months
and a palpable microcystic tumor of the pancreatic
head. Multiple cysts communicating with branches
of the pancreatic duct in an alveolar‐like pattern
were demonstrated on endoscopic retrograde cholangiopancreatography.
Histologic examination of
the specimen confirmed the diagnosis of a serous
adenoma of the pancreas. The tumor morphology in
this case may suggest a ductal origin of microcystic
serous adenomas.
Extraorganic Hepatic Artery Aneurysm:Failure of Transcatheter Embolization
Authors: Tarazov Pavel G. , Ryzhkov Vladimir K. , Polysalov Vladimir N. , Prozorovskij Kyrill V. , Polykarpov Alexej A.
Published: September 2007

Hepatic artery aneurysm (HAA) was diagnosed in a
62‐year‐old man who was a poor candidate for
surgery because of severe liver cirrhosis and diabetes
mellitus. Two attempts to occlude the HAA by
transcatheter embolization failed because of recanalization
of the aneurysm. Moreover, aneurysmal
dilatation of the superior mesenteric artery and the
left renal artery developed and progressed. Both the
literature and the present case show that an
individual approach to treatment of extraorganic
HAA should be chosen in dependantan location and
anatomy of the lesion.
The Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Abdominal Surgery
Authors: Diez J. , Delbene R. , Ferreres A.
Published: September 2007

A retrospective study was carried in 1500 patients submitted to elective laparoscopic cholecystectomy to ascertain its feasibility in patients with previous abdominal surgery. In 411 patients (27.4%) previous infraumbilical intraperitoneal surgery had been performed, and 106 of them (7.06%) had 2 or more operations. Twenty five patients (1.66%) had previous supraumbilical intraperitoneal operations (colonic resection, hydatid liver cysts, gastrectomies, etc.) One of them had been operated 3 times. In this group of 25 patients the first trocar and pneumoperitoneum were performed by open laparoscopy. In 2 patients a Marlex mesh was present from previous surgery for supraumbilical hernias. Previous infraumbilical intraperitoneal surgery did not interfere with laparoscopic cholecystectomy, even in patients with several operations. There was no morbidity from Verres needle or trocars. In the 25 patients with supraumbilical intraperitoneal operations, laparoscopic cholecystectomy was completed in 22. In 3, adhesions prevented the visualization of the gallbladder and these patients were converted to an open procedure. In the 2 patients Marlex mesh prevented laparoscopic cholecystectomy because of adhesions to abdominal organs. We conclude that in most instances previous abdominal operations are no contraindication to laparoscopic cholecystectomy.
External Biliary Fistula
Authors: Dadoukis J. , Prousalidis J. , Botsios D. , Tzartinoglou E. , Apostolidis S. , Papadopoulos V. , Aletras H.
Published: September 2007

We report 210 cases of external biliary fistula treated in our clinics between 1970–1992. In 7 cases, fistulas were formed after iatrogenic bile duct injury, in 4 cases after exploration of common bile duct, in 4 cases due to disruption of biliary‐intestinal anastomosis, and in 2 cases due to liver trauma. In 85 cases bile leak was observed after cholecystomy, in 103 cases after hydatid disease surgery, and in 4 cases after the passage of P.T.C. catheter. In one patient the appearance of the fistula was due to spontaneous discharge of a gallbladder empyema. 173 cases were managed conservatively, and 37 cases surgically.
The Thermal Activity of Normal and Malignant Tissues
Authors: Mack Peter , Cheng Li-Yao
Published: September 2007

The usefulness of metabolic heat measurements in
quantifying the response of a solid tumour to anticancer
treatment was evaluated. The heat production
characteristic of malignant tissues, as measured from
human stomach, breast and liver cancer samples,
was observed to be inconsistent, and its value could
be higher or lower than that of its normal tissue of
origin. The various thermal activity responses of an
experimental rat hepatoma to hepatic artery ligation,
cryotherapy, intra‐arterial (i.a) Adriamycin (2.4 mg/
kg), i.a. Norcantharidin (0.5 mg/kg) were next
studied. The tumour/liver (T/L) ratio of untreated
tumour‐bearing rats was 0.83 but this fell to a
minimum at 24 h in both the hepatic artery ligation
and the cryosurgery groups. In these two groups
marked fluctuations in the heat production of
normal liver occurred with poor recovery of the T/
L ratio even at 2‐‐3 weeks. In the Adriamycin group,
the T/L ratio dropped to a minimum at 5 days, and in
the Norcantharidin group, at 3 days. Minimal
disturbances in the thermal activity of liver tissue
occured in these two chemotherapy groups and the
T/L ratio recovered by 3 weeks. Norcantharidin
appeared as efficacious as Adriamycin in the
treatment of hepatoma when evaluated in terms of
thermal activity.
The Role of Oxygen Free Radicals in Acute Renal Failure Complicating Obstructive Jaundice: An Experimental Study
Authors: Yüceyar Serdar , Gümüştaş Koray , Ertürk Süphan , Hamzaoğlu Ismail H. , Uygun Nesrin , Ayaz Meltem , Cengiz Ali , Kafadar Yilmaz
Published: September 2007

Oxydant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxydant defense mechanism. This study is designed to investigate the possible role of oxydant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control(C) (N=7); Renal ischemia (RI) (N=7); Obstructive jaundice+renal ischemia (OJ+RI) (N=7); Obstructive jaundice (OJ) (N=7). All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD), Superoxide Dismutase (SOD) and Catalase in renal cortex and Glutathione Peroxidase (GSH‐Px), in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p <0.05). When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 ±0.01 U/g (tissue) and 0.362±0.03 U/g (tissue) respectively] (p <0.05). SOD and GSH‐Px activities of each ischemic group at 3rd day were decreased compared to non‐ischemic groups. This fall was significant (p <0.05). But there was no statistical difference between jaundiced and non‐jaundiced groups. Alterations in catalase activities also had no statistical significance.

These findings may suggest that the injury induced by oxygen free radicals at re‐oxygenation of tissue after ischemia may also play a role in the pathogenesis of acute renal failure developed in obstructive jaundice.
Inferior Vena Caval ThrombosisAfter Traumatic Liver Injury
Authors: Kimoto Takeo , Kohno Hitoshi , Uchida Masaaki , Yamanoi Akira , Yamamoto Akitaka , Nagasue Naofumi , Ando Seiichi , Suemitsu Kouya , Ohtani Mitsuru
Published: September 2007

We report here the case of a 35‐year‐old man who
presented with inferior vena cava thrombosis
(IVCT) after blunt hepatic trauma. The IVCT was
incidentally detected by computed tomography (CT)
35 days after deep parenchymal suturing and suture
approximation for liver lacerations. The patient
denied any symptoms of thrombophlebitis. However,
he had presented with significantly elevated
values of FDP‐D‐dimer and a modest increase in
plasminogen concentration, which indicated that he
had been in a hypercoagulable and hypofibrinolytic
state after the operation. He had not undergone any
prophylactic anticoagulant therapy because of his
concomitant subarachnoid hemorrhage and huge
hepatic hematoma. The patient was treated with an
emercy thrombectomy. Posttraumatic IVCT is extremely
rare phenomenon. We should consider IVCT
in patients with a severe hepatic injury, particularly
if their coagulation system change into hypercoagulable
and hypofibrinolytic state. Additionally, this
case made us reflect on the treatment of traumatic
liver injury.
Lymphoepithelial Cyst of the Pancreas: SerumMarkers do not Help
Authors: Chan S. P. , Hatton C. W. , Falk G. L.
Published: September 2007

We report a case of lymphoepithelial cyst of the
pancreas with non‐specific elevation of CA 19.9 and
CEA. Pre‐operative diagnosis by conventional means
proved elusive, and only surgical resection and
histopathology revealed the diagnosis. The origin
and diagnosis are discussed by literature review.
Is Chemoembolisation of Value in Inoperable Primary Hepatocellular Carcinoma
Authors: Raoul Jean-Luc
Published: September 2007

primary treatment for unresectable hepatocellular carcinoma (HCC). In this unit, 185 patients with a new diagnosis of HCC not amenable to surgery were seen between 1988 and 1991. Intended therapy for these patients was chemoembolisation with doxorubicin (60 mg/m2) and lipiodol, repeated at six week intervals until it was technically no longer possible o.r until complete tumour response had been obtained. Chemoembolisation was possible in 67 of the 185 (37%). Reasons for exclusion were portal vein occlusion (n=36), decompensated cirrhosis (n 44), distant metastases (n=5), diffuse tumour or unsuitable anatomy (tumour or vasculature) (n=11), patient refusal (n=11), and other (n=11). Patients excluded from treatment survived for a median of 10 weeks (range 3 days‐19 months). In patients treated, 18 had small HCC (4cm) and 49 had large or multifocal HCC. Chemoembolisation was carried out a median of two sessions for small and three sessions for large tumours. Ten of 18 patients with small HCC showed a 50% or greater reduction in tumour size. Five of 49 patients with large or multifocal tumours showed a response to treatment. Median overall survival for treated patients was 36 weeks (range 3 days–4 years). One patient has subsequently undergone liver transplantation with no recurrence and minimal residual disease at transplantation. Two other patients are alive three years after chemoembolisation, one with no evidence of recurrent disease. No patient was thought suitable for surgery after their response to chemoembolisation. Chemotherapy related complications were seen in 22%. Complications were significantly more common in patients with larger tumours and poor liver reserve. Five patients died as a result of chemotherapy related complications. In conclusion, only one third of UK patients with unresectable HCC are treatable by chemoembolisation. Results with small tumours are encouraging, with a high response rate and the possibility of surgical intervention in previously inoperable disease. Large tumours, however, show a poor response and significant incidence of side effects, suggesting that this treatment offers little benefit in advanced disease.
Carcinoma of the Ampulla of Vater:Determinants of Long‐term Survivalin 94 Resected Patients
Authors: Klempnauer Jürgen , Ridder Gerd Jürgen , Maschek Hansjörg , Pichlmayr Rudolf
Published: September 2007

This retrospective study details 94 patients after
surgical resection of carcinoma of the ampulla of
Vater to determine prognostic factors. The tumour
was limited to the ampulla of Vater in 32%, invaded
the duodenal wall in 34%, infiltrated 2cm or less
into the pancreas in 22%, and invaded more than
2cm into the pancreas and/or other adjacent structures
in 11%. Curative resection was accomplished
in 97% of cases. After exclusion of perioperative
deaths the 1‐, 5‐ and 10‐year survival rates were
79.6%, 38.2%, and 31.6%, respectively with a median
survival of 3.68 years. 26 patients survived more than
five and 15 patients more than ten years. In an
univariate analysis advanced tumour size, poor
tumour grading, lymph node metastases and advanced
UICC stage significantly decreased survival.
Comparison of short and long survivors confirmed
tumour size, lymph node status and UICC stage as
significant prognostic factors. In a multivariate
analysis (Cox model), only tumour size was a
statistically independent predictor of prognosis.
The survival probability increased with each year a
patient survived after resection. When a patient had
already survived five years after resection, the
probability to survive another five years was 83%.
Careful clinicopathologic staging is important for
the prognosis after resection.
Changing Therapy for Gastrinoma
Authors: Bornman P. C. , Radebold K.
Published: September 2007

Objective: The author analyzed potential survival determinants in gastrinoma to characterize a possible uniform staging system and to determine whether complete surgical resection improves expected survival.

Summary and Background Data: Gastrinoma is an indolent yet malignant neuroendocrine tumor. The associated gastric acid hypersecretion can be controlled medically. Staging of gastrinoma is inconsistent and the role Of surgical resection controversial.

Methods: Seventy‐four patients with gastrinoma with a minimum 5‐year follow‐up were assessed. Cox′s proportional hazards regression model was used to examine the association of risk factors with survival.

Results: The following factors had no effect on survival: age at diagnosis, sex, presence of lymph node metastases, associated multiple endocrine neoplasia, and method of ulcer treatment. The three unique determinants of survival were primary tumor size (relative risk 1.534; p<0.0005), liver metastases (relative risk, 2.947; p<0.0209), and complete surgical resection (relative risk 0.163; p<0.0076). On the basis of these risk factors, a uniform staging system is proposed and predictive survival curves developed.

Conclusions: The primary determinants of survival in gastrinoma are the size of the primary tumor and liver metastases. Complete surgical resection reduces mortality, regardless of other factors.
Small‐Diameter PTFE Portosystemic Shunts: Portocaval vs Mesocaval
Authors: Shields Robert
Published: September 2007

Fifty‐seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty‐one patients had Child‐Pugh gradeA disease and 26 grade B; all had a liver volume of 1000– 2500 ml. Follow‐up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child‐Pugh grade A 88 per cent and for grade B 67 per cent. Small‐lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.
Isolated Hepatic Splenosis: First Reported Case
Authors: D′Angelica Michael , Fong Yuman , Blumgart Leslie H.
Published: September 2007

Splenosis is the autotransplantation of splenic
tissue, most commonly seen after traumatic splenic
rupture and splenectomy. Post‐traumatic splenosis
is often considered a rare entity, but is probably
underreported because of its asymptomatic nature.
We describe the first reported case of splenosis
presenting as a liver mass, indistinguishable from a
liver tumor by standard preoperative evaluation.
The pathophysiology, evaluation and management
of splenosis is discussed as well as the decision to
resect a benign appearing liver mass.
Cholangitis Due to Candidiasis of the Extra‐Hepatic Biliary Tract
Authors: Wig J. D. , Singh Kartar , Chawla Y. K. , Vaiphei K.
Published: September 2007

A case of isolated candidal fungal balls in the
common bile duct causing obstructive jaundice and
cholangitis is described. There were no predisposing
factors. The fungal balls were removed from the
common bile duct and a transduodenal sphincteroplasty
was performed. Microscopic analysis yielded
colonies of candida. Postoperative period was uneventful.
At follow‐up no evidence of candida
infection was evident. He is now 3 years post-surgery
and is well.
Scolicidal Agents in Hydatid Cyst Surgery
Authors: Besim H. , Karayalçin K. , Hamamci O. , Güngör Ç. , Korkmaz A.
Published: September 2007

Injecting scolicidal solutions into the hydatid cyst and packing the operative field with sponges soaked in scolicidal agents have been used to avoid dissemination of the parasite during surgery. In the first part of this invitro study, we tried to determine the scolicidal property of various agents in different concentrations and exposure times. In the second part, we tested whether sponges soaked in different type and concentrations of scolicidal agents have any role beyond being a mechanical barrier. 20% saline, 3% hydrogen peroxide, 1.5% cetrimide‐0.15% chlorhexidine (10% Savlon®), 95% ethyl alcohol, 10% polyvinylpirrolidone‐iodine (Betadine®) and their further dilutions were used in this study. Protoscoleces were obtained from the cyst containing livers of the sheep and viability was determined with dye‐uptake (0.1% Eosin) and flame cell activity. Savlon® was found to be the least concentration dependent scolicidal agent among those studied. Scoleces sprayed on sponges soaked in 20% saline, 95% ethyl alcohol, Betadine® and 3% hydrogen peroxide were killed after 15 minutes. 3% and 10% saline and normal saline were ineffective. Sponges work not only as a mechanical barrier but also as a chemical one if the agent is chosen correctly. In purely cystic hydatid liver disease, the risk of dissemination of the cyst contents can be avoided by injection of a potent scolicidal agent such as Savlon®.
An Alternative Technique in the Treatment of Celiac Axis Stenosis Diagnosed During Pancreaticoduodenectomy
Authors: Machado Marcel C. C. , Penteado Sonia , Montagnini André L. , Machado Marcel A. C.
Published: September 2007

Celiac compression is usually a benign condition, but when surgery necessitates division of collaterals from the superior mesenteric artery, it may cause life‐threatening celiac organ ischemia. Celiac axis obstruction is found in 12.5% to 49.7% of patients during abdominal angiography. In such patients, the arterial blood supply to the stomach, spleen, and liver is sustained through extraordinarily welldeveloped pathways in the pancreas.

Though collateral pathways may be sacrificed during pancreaticoduodenectomy, only a small proportion of patients develop hepatic, gastric and splenic ischemia during the procedure. If the appropriate angiographic studies have not been obtained before pancreatic resection, a test occlusion of the gastroduodenal artery, as recommended by Bull et al. [2], should precede its ligation. The hepatic arteries are palpated before and after the test occlusion. In the occasional patient in whom the pulse diminishes during occlusion or if there is evidence of upper abdominal visceral ischemia, revascularization of the celiac circulation may be required. Reestablishment of the celiac circulation may be accomplished by the use of a vein graft between the aorta and the celiac tributaries. This article describes an alternative technique for revascularization of the celiac circulation without the use of a venous graft.
Evacuation of the Pleural Cavity With an InfantFeeding Catheter Following en Bloc Resectionof Hepatocellular Carcinoma and InvolvedDiaphragm–an Institutional Experience
Authors: Chung C. C. , Lau W. Y. , Leow C. K. , Leung K. L. , Lai P. B. S.
Published: September 2007

En bloc resection of hepatocellular carcinoma and
the involved diaphragm will, towards the end of
operation, require evacuation of the pleural cavity,
usually with a chest drain. We describe our method
and experience of evacuating the pleural cavity, at
the time of diaphragmatic repair, with an infant
feeding catheter without the need of a chest drain.
We have found the method safe and efficacious.
Complete Caudate Lobectomy:Its Definition, Indications, and Surgical Approaches
Authors: Sasada Akinori , Ataka Keiji , Tsuchiya Kazuhiko , Yamagishi Hiroyuki , Maeda Hiromi , Okada Masayoshi
Published: September 2007

There are three ways to approach and resect the
caudate lobe of the liver, that is; and isolated caudate
lobectomy, a combined resection of the liver overlying
the caudate lobe, and a transhepatic anterior
approach by splitting parenchyma of the liver.

We had two patients with neoplasms originating
in the caudate lobe who underwent a complete
caudate lobectomy. Both patients have been doing
well without liver dysfunction. Although after the
transhepatic anterior approach we anticipated an
adverse effect from splitting the parenchyma of the
liver, the postoperative course was uneventful and
similar to that of the right side approach.
Surgical Treatment for Biliary Carcinoma Arising After Pancreatoduodenectomy
Authors: Seki Hitoshi , Miyagawa Shinichi , Kobayashi Akira , Kawasaki Seiji
Published: September 2007

The clinicopathological features and surgical treatment of biliary carcinoma around the major hepatic duct confluence arising after pancreatoduodenectomy (PD) due to initial bile duct carcinoma are described in three patients. Occurrence of biliary carcinoma more than 12 years after initial surgery and a histological finding of cholangiocellular carcinoma mixed with hepatocellular carcinoma suggested metachronous incidence of biliary carcinoma after PD. Extended right hemihepatectomy with complete removal of the residual extrahepatic bile duct and segmental, resection of the jejunal loop were carried out safely without operative death or severe postoperative complications. Two patients died of tumor recurrence 6 months after surgery, and the remaining patient is currently living a normal life without evidence of recurrence 17 months after surgery. These surgical procedures are a therapeutic option in patients with biliary carcinoma around the major hepatic duct confluence arising after PD.
The Need to Handicap the Recipient′s Native Liverin the Rat Model of Heterotopic Auxiliary LiverTransplantation
Authors: Fan Ye-Dong , Praet Marleen , De Hemptinne Bernard
Published: September 2007

In the rat model of heterotopic auxiliary liver transplantation
(HALTx), the opinion varies on whether
and how the recipient′s native liver should be
handicapped. To avoid atrophy of the transplanted
organ, in this study, two different handicaps were
evaluated and their effects on post‐operative animal survival
and liver biology are described. With a sole
portacaval shunt (group 1) all rats survived longer
than 3 months. An additional handicap of the liver
with either a 68% partial hepatectomy (68% PH)
(group 2), or both a 68% PH and a common bile duct
ligation (CBDL) (group 3) led to a 100% mortality
within 2 days after surgery. When an auxiliary liver
was transplanted to the rats handicapped with a 68%
PH (group 4), serum Bilirubin and ALAT values
were significantly lower than those handicapped
with both a 68% PH and a CBDL (group 5). Autopsy
and histology of the long‐term survivors revealed
the atrophy of the engrafted livers and the regeneration
of the native livers in group 4, whereas it
showed the opposite in group 5. Thus the various
manipulations of the native liver do influence
differently the post‐transplant animal survival,
serum liver biochemistry and the outcome of the
engrafted liver in this rat model of HALTx.
Surgical Management of CalcifiedHydatid Cysts of the Liver
Authors: Prousalidis J. , Tzardinoglou E. , Kosmidis Ch. , Katsohis K. , Aletras O.
Published: September 2007

Hydatid disease of the liver is still a major cause of
morbidity in Greece. Beside the common complications
of rupture and suppuration, calcification of the
hepatic cysts represent a not well studied, less frequent
and sometimes difficult surgical problem. In
the present study 75 cases with calcified symptomatic
liver echinococcosis were operated on in the
1st Propedeutic Surgical Clinic between 1964 to
1996. Twenty‐eight patients were male and 47 female
with ages from 23 to 78 years. The diagnosis was
based mainly on the clinical picture and radiological
studies. In 5 cases the operative method was
cystopericystectomy. We performed evacuation of
the cystic cavity and partial pericystectomy and
primary closure of the residual cavity in 6 cases,
omentoplasty or filling of the residual cavity with a
piece of muscle of the diaphragm in 4 cases and
external drainage by closed tube, in 60 cases. In 12 of
those with drainage, after a period of time, a second
operation with easy, removal of most of the calcareous
wall plaques was performed. The mortality rate
was 2%.

Our results could be considered satisfactory. In
the calcified parasitic cysts of the liver the proposed
technique is cystopericystectomy. An alternative
procedure is pericystectomy and drainage with
a “planned” reoperation with a bloodless, due
to intervening inflammation, chiseling of the
calcification.
Arterialisation of the Portal Vein With an AortoportalJump Graft for Portal Vein Thrombosis Following LiverResection for Malignancy
Authors: Jiao Long R. , Habib Nagy
Published: September 2007

Fibrolamellar hepatocellular carcinoma (FHCC) is a
variant of hepatocellular carcinoma, which mainly affects
a young age group and carries a relatively good
prognosis. It is widely accepted that aggressive curative
resection is still the best option for FHCC. We
report here a case of successful arterialisation of the
portal vein with an aortoportal jump graft for portal
vein thrombosis, which developed postoperatively in
an already comprised portal vein with tumour invasion
following an extensive liver resection for FHCC.
Results of Surgical Treatment(Modified Sugiura‐Futagawa Operation) of PortalHypertension Associated to CompleteSplenomesoportal Thrombosis and Cirrhosis
Authors: Mercado Miguel Angel , Chan Carlos , Zenteno-Guichard Gustavo , Vásques Moisés , Hernández Jorge , Orozco Héctor
Published: September 2007

Background Hemorrhagic portal hypertension, secondary
to both intrahepatic and extrahepatic portal
hypertension, is an uncommon entity. In this condition,
the extrahepatic and the intrahepatic obstruction
of the portal vein, due to chronic liver disease,
produce a more severe form of hemorrhagic portal
hypertension that is more difficult to control. The
results of surgical treatment (modified Sugiura‐
Futagawa operation) in this subset of patients is
analyzed.

Methods Among 714 patients with a history of
hemorrhagic portal hypertension, 14 cases were
found with histologically proven liver cirrhosis
and complete splenomesoportal thrombosis demonstrated
by means of preoperative angiography.
Patients with incomplete (partial) splenomesoportal
thrombosis were excluded. There were nine males
and 5 females with a mean age of 51 years. Alcoholic
cirrhosis was demonstrated in 50% of the cases, post
hepatitic cirrhosis in 28%, primary biliary cirrhosis
in 7%, and cryptogenic cirrhosis in 14%. There were
nine Child‐Pugh A and 5 B cases. All cases were
treated by means of our modified Sugiura‐Futagawa
procedure.

Results Bleeding recurrence from esophagogastric
varices was shown in one case, colonic varices in one
case and hypertensive gastropathy in another of the
survivors. Post operative encephalopathy was
shown in 3 of the cases. The thirty‐six month
survival rate was 30% (Kaplan‐Meier).

Conclusions The combination of intrahepatic plus
extrahepatic portal hypertension has a worse prognosis.
Treatment options are limited (sclerotherapy
and/or devascularization), because shunt surgery,
TIPS and liver transplantation have a very restricted
role and postoperative outcome is poor.
Choledochal Cyst Associated With PolycysticKidney Disease: Report of a Case
Authors: Hasegawa T. , Kim M. , Kitayama Y. , Kitamura K. , Hiranaka T.
Published: September 2007

We report a very rare case of type I choledochal cyst
associated with a polycystic kidney disease. A 48‐
year‐old female had been dependent on hemodialysis
for chronic renal failure due to polycystic
kidney disease and was incidentally diagnosed to
have a dilated common bile duct by an ultrasonography.
An endoscopic retrograde cholangiopancreatography
showed a spindle‐shaped, dilated
common bile duct (type I choledochal cyst) without
visualization of the pancreatic duct. She underwent
a resection of the choledochal cyst. Intraoperative
cholangiography showed no reflux of contrast
medium into the pancreatic duct. Amylase level of
the aspirated bile from the bile duct was not
elevated. In the case of choledochal cyst combined
with renal fibropolycystic disease, pancreaticobiliary
maljunction may not contribute to the etiology
of choledochal cyst. In such cases, management of
choledochal cyst is still controversial and requires
further discussion.
What Causes Cancer Gallbladder?: A Review
Authors: Chaurasia P. , Thakur M. K. , Shukla H. S.
Published: September 2007

Gallbladder cancer is a common malignancy of the
biliary tract. It is the fifth common malignancy of the
gastrointestinal tract in United States [1] and third in
Northern India [2]. Despite such high prevalence,
there is scanty published literature about this disease
in indexed journals. Therefore, this article is intended
to provide a brief overview of gallbladder cancer risk
factors, based mainly on published evidence from
analytical epidemiology and recent research findings
of biologists and practising oncologists. Furthermore,
an attempt has been made to establish an association
between different causative factors and the occurrence
of the disease.
Results of a Modified Sugiura′s Devascularisation in theManagement of “Unshuntable” Portal Hypertension
Authors: Shah S. R. , Nagral S. S. , Mathur S. K.
Published: September 2007

The results of a modified Sugiura devascularisation
procedure were assessed in 14 patients with thrombosis
of the portal and splenic vein requiring surgery
for variceal hemorrhage, with no vein suitable
for orthodox shunt surgery. The venous anatomy
was determined by ultrasonography with Doppler
studies and portovenography. Liver biochemistry as
well as liver architecture on histopathology was
normal in all. The surgery was elective in 9 cases for
documented bleed from diffuse fundal gastric
varices (FGV) and emergency in 5 cases, 3 having
bleeding FGV and 2 for failure of emergency
esophageal variceal sclerotherapy. All were subjected
to a transabdominal extensive devascularisation
of the upper two third of the stomach and lower
7–10cm of the esophagus. Stapled esophageal
transection (n=11) or esophageal variceal under‐running
(n=1) was performed in all with esophageal
varices. FGV were underrun. Follow up endoscopies
were done six monthly. There were 9 males and 5
females with a mean age of 17.2 years (SD 12.8).
There was no operative mortality. Acute variceal
bleeding was controlled in all patients. Over a mean
follow up of 38 months, all but one remain free of
recurrent bleeding. We conclude that a modified
Sugiura devascularisation procedure is effective in
the immediate and medium term control of variceal
bleeding in patients with “unshuntable” portal
hypertension.
The Real Incidence of Extracapsular (Satellite)Cysts of Liver Echinococcus
Authors: Voros Dionysios , Kalovidouris Angelos , Gouliamos Athanasios , Vlachos Lambros , Danias Nickolaos , Papadimitriou John
Published: September 2007

Background: The presence of extracapsular (Satellite)
cysts in liver echinococcus granulosus is known
for many years. In one of our previous studies of
radiological (CT) material they were found to be
present in 16% of cases.

Methods: In the present study the operative findings,
in cases of total capsectomy (cystopericystectomy)
or partial lobectomy are presented.

Results: The real incidence of these cysts in
operative specimens was as high as 29,5%. They
were present in 15 out of 51 totally excised cysts.

Conclusions: We conclude that satellite cysts are
present more often than they are radiologically
detected. As they can be incriminated as a cause of
recurrence of the disease they must be excised en
block with the main parasitic cysts, by means of
more radical procedures such as cystopericystectomy
or partial hepatectomy, whenever it is feasible.
Liver Resections for Metastases from IntraabdominalLeiomyosarcoma
Authors: Kalil Antonio Nocchi , Pereira Bianca De Lourdes , Brenner Marcia Cristina Lima , Pereira-Lima Luiz
Published: September 2007

This paper discusses liver resection for intraabdominal
leiomyosarcoma metastases as a therapy for
carefully selected patients. Of the 83 hepatectomies
performed from 1992 to 1996, five were resections for
liver metastases due to intraabdominal leiomyosarcoma,
in 3 patients. The surgical indication was single
liver metastases, without any evidence of extrahepatic
disease. No mortality occurred during surgery and the
longest survival was 38 months. We concluded that
liver resection for leiomyosarcoma metastases can be
performed, allowing a long term survival in an
occasional patient.
Monolobar Caroli′s Disease and Cholangiocarcinoma
Authors: Abdalla Eddie K. , Forsmark Christopher E. , Lauwers Gregory Y. , Vauthey J. Nicolas
Published: September 2007

Caroli′s Disease (CD) is a rare congenital disorder
characterized by cystic dilatation of the intrahepatic
bile ducts. This report describes a patient with cholangiocarcinoma
arising in the setting of monolobar
CD. In spite of detailed investigations including
biliary enteric bypass and endoscopic retrograde
cholangiography, the diagnosis of mucinous cholangiocarcinoma
(CCA) was not made for almost one
year. The presentation, diagnosis and treatment of
monolobar CD and the association between monolobar
CD and biliary tract cancer are discussed.
Hepatic resection is the treatment of choice for
monolobar CD.
Mucin Hypersecreting Intraductal PapillaryNeoplasm of the Pancreas
Authors: Kim Anthony W. , Ryan Anna , Millikan Keith W. , Doolas Alexander
Published: September 2007

Mucin Hypersecreting Intraductal Papillary Neoplasm
is a rare neoplasm that arises from ductal
epithelial cells. This entity is distinct from the more
commonly known Mucinous Cystadenoma or Mucinous
Cystadenocarcinoma. Despite this distinction,
it has been erroneously categorized with these
more common cystic neoplasms. Characteristic clinical
presentation, radiographic, and endoscopic
findings help distinguish this neoplasm from the
cystadenomas and cystadenocarcinomas. Histopathologic
identification is not crucial to the
preoperative diagnosis. This neoplasm is considered
to represent a premalignant condition and, therefore,
surgical resection is warranted. Prognosis,
following resection, is felt to be curative for the
majority of patients.

We present two cases of Mucin Hypersecreting
Intraductal Papillary Neoplasm and discuss their
diagnosis and surgical therapy.
Tuberculosis of the Gallbladder
Authors: Kumar K. , Ayub M. , Kumar Mohan , Keswani N. K. , Shukla H. S.
Published: September 2007

Analysis of 5 patients with gallbladder tuberculosis
who had open cholecystectomy and review of
literature have shown that, although still rare it presents
as a part of systemic miliary tuberculosis,
abdominal tuberculosis, isolated gallbladder tuberculosis
and as acalculus cholecystitis in anergic
patients. There are no pathognomonic signs, the
diagnosis depends on suspicion of tuberculosis, peroperative
findings and histological examination.