bluuebunny/crossref_metadata_2025 huggingface dataset:
Common Bile Duct Obstruction by Free Floating Tumor
Authors: Prinz Richard A. , Ko Tien C. , Maltz Sheldon B. , Reynes Carlos J. , Marsan Richard E. , Freeark Robert J.
Published: September 2007

Tumors usually spread by local invasion or by vascular or lymphatic metastases. We report six patients
in whom tumor cells were shed into the common bile duct with resulting obstruction. The three men and three women had jaundice and upper abdominal discomfort. Jaundice was intermittent in four patients.
Preoperative total serum bilirubin ranged from 2.5 to 16.1 mg/dl; alkaline phosphatase ranged from 221 to 605 IU/1. Ultrsasound showed a dilated gallbladder [GB] in five patients with dilated intrahepatic ducts in three and stones in only one. ERCP showed a single filling defect in two of three patients and multiple defects in one. PTC showed multiple defects in one patient. At operation a thick gelatinous tissue fragment or clot was seen in the common bile duct of each patient. Frozen section identified tumor tissue in all. The source was GB carcinoma [2], GB adenomyoma [1], hepatic metastases of colon cancer [2] and common bile duct cancer [1]. Treatment consisted of pancreaticoduodenectomy [2], including one for GB cancer, left hepatic lobectomy [1], choledochoduodenostomy [1], common duct exploration with T‐tube insertion and cholecystectomy [1]. One patient with metastatic colon cancer and another with gallbladder cancer died within one year of operation. The other four are alive from 2 to 4 years later. Conclusion: Benign or malignant tumors within the hepatobiliary tree can shed tissue into the common bile duct which can cause biliary obstruction. Any tissue fragment found in the common bile duct should be evaluated by frozen section. Recognition of this mode of tumor spread is needed for appropriate therapy of the underlying benign or malignant tumor.
Maxon is an Optimal Suture for Bile Duct Anastomoses in Pigs
Authors: Jeans Phil , Hall Pauline , Liu Yong-Feng , Baker Robert A. , Holt Andrew , Saccone Gino T. P. , Harvey John R. , Scicchitano Jan , Toouli James
Published: September 2007

Background. Three commonly used sutures were tested in a pig model of bile duct anastomosis to assess
their relative contributions to inflammation and scarring.

Methods. Thirty pigs were randomised to bile duct division and anastomosis with either polyglyconate
(Maxon), polyglactin 910 (Vicryl) or polypropylene (Prolene). Half the animals were sacrificed at two
weeks and the remainder at 23 weeks. Anastomoses were assessed by cholangiography, scanning
electron microscopy and light microscopy.

Results. There was less short term histological reaction with the two monofilament materials, Prolene
and Maxon, compared to the braided suture Vicryl. Maxon was associated with less long term
inflammation than Prolene, was found to handle better, and has an advantage over Prolene by being
absorbable.

Conclusion. Maxon is an optimal suture for bile duct anastomoses. Its long term absorption
characteristics make it suitable for situations where bile duct healing may be delayed.
Ultrasonic Mucosectomy of the Gallbladder: A Histological Analysis
Authors: Gagner Michel , Blanco Ramon , Rossi Ricardo L.
Published: September 2007

The Cavitron Ultrasonic Surgical Aspirator (CUSA) may be used to remove mucosa of organs of the
gastro‐intestinal tract. A histological analysis was performed on gallbladders treated with a
CUSA‐mucosectomy to assess the extent and degree of mucosectomy and to evaluate parietal damage.
The histological studies performed on three specimens of chronic cholecystitis revealed a complete
mucosectomy except in areas where Rokitansky‐Aschof sinuses were present. There was no evidence of
parietal damage. The CUSA may be used to remove the mucosa of gallbladders without injury to other
layers, and may have a potential application in procedures such as mucosal cholecystectomy.
Gallbladder Volvulus
Authors: Gonzalez-Fisher Ricardo F. , Vargas-Ramirez Lourdes , Rescala-Baca Elias , Dergal-Badue Elias
Published: September 2007

A case of torsion of the gallbladder is presented. This is a rare condition that occurs more frequently in
elderly females, it is associated with anatomical variants related to abnormal fixation of the gallbladder
to the liver bed. It is usually diagnosed at laparotomy and treatment consists of cholecystectomy. This
condition should be suspected in elderly females with acute cholecystitis or acute abdominal pain of
unknown origin.
“Clip‐Stone” Filiation Within the Biliary Tract
Authors: Mansvelt B. , Harb J. , Farkas B. , Mourou M. , Huguet C.
Published: September 2007

A case of cholangitis due to the migration of a metal clip used for surgical cholecystectomy 4 years
earlier, is reported. The diagnostic approach and therapeutic options, either endoscopic or surgical are
discussed. The use of resorbable clips during the performance of laparoscopic cholecystectomy should
avoid this type of complication.
Needle Track Seeding of Primary and Secondary Liver Carcinoma After Percutaneous Liver Biopsy
Authors: John Timothy G. , Garden O. James
Published: September 2007

Seeding of tumour in the needle track following percutaneous needle biopsy of liver neoplasms is rarely
reported. We describe two such cases following the needle biopsy of an hepatocellular carcinoma and
secondary colorectal carcinoma respectively. The risk of needle track recurrence of liver tumours should
not be regarded as insignificant. The diagnosis of liver neoplasms may be achieved by non‐invasive
modalities, and their needle biopsy should be reserved for cases not amenable to surgical resection.
Monocyte Secretion of β‐Hexosaminidase in Patients With Obstructive Jaundice
Authors: Jiang W. G. , Puntis M. C. A.
Published: September 2007

Monocyte hydrolases are harmful when secreted inappropriately. In this study we have investigated the
levels of one of the hydrolases, β‐hexosaminidase in patients with obstructive jaundice. These patients
showed markedly elevated plasma levels, and their monocytes show increased spontaneous secretion
and total enzyme content. The plasma enzyme levels correlate with monocyte enzyme content as well as
bile salt, and bilirubin levels, the high levels may also reflect Kupffer cell damage, as these cells clear the
enzyme. Compared with controls monocytes from jaundiced patients show reduced enzyme secretion
after PMA stimulation, in vitro, and unchanged secretion after zymozan stimulation. There is a
difference between plasma enzyme levels in benign and malignant patients but this does not provide a
clear distinction between the two groups. We conclude that patients with obstructive jaundice have
increased blood level of β‐hexosaminidase, and that activated monocytes partly contribute to this
change.
Pilot Study on Alcohol‐Induced Chemonecrosis of Hepatic Metastases From Colonic Cancer
Authors: Salim Aws S.
Published: September 2007

Administration of 98% ethanol destroys tissues by coagulative necrosis. In the rat bearing 1,2‐dimethylhydrazine‐induced colonic carcinoma which has spread to the liver, direct injection of 0.1–0.2
ml ethanol into each of the hepatic metastases at the time of total colectomy afforded a significant
survival advantage relative to colectomy alone (20.1 ± 0.2 vs 12.8 ± 0.2 months of age, mean ± SEM,
n = 20, p < 0.01 by the Mann‐Whitney U test). A pilot study was, therefore, carried out (2 women and 4 men, age range 43 to 71 years—mean 56) to examine the clinical significance of these observations in
patients with multiple hepatic metastases from carcinoma of the sigmoid colon. The tumour was
resected then all palpable hepatic secondaries were injected with 1–1.5 ml of 98% ethanol. Two weeks
post‐operatively and thereafter once every two months any hepatic lesions detected ultrasonically were
similarly treated percutaneously. All the patients tolerated this treatment without any observed distress
or adverse effects. Their mean survival measured from the time of tumour resection until death from any
cause was 20 months (range 17 to 26 months). The survival gain afforded by chemonecrosis in addition
to its simplicity and safety deserves further consideration to assess the exact role of this method in the
treatment of liver metastases from colonic cancer.
Cholangitis and Budd Chiari Syndrome as Complications of Simple Cystic Liver Disease
Authors: Johnstone A. J. , Turnbull L. W. , Allan P. L. , Garden O. J.
Published: September 2007

We report the case of a 63 year old woman who developed the complications of cholangitis and Budd
Chiari syndrome secondary to polycystic disease of the liver. The two complications were not present
simultaneously, and both resolved after decompression of the liver cysts.
Large Foreign Body as a Nidus for a Common Duct Stone in a Patient Without Spontaneous Biliary Enteric Fistula or Previous Abdominal Surgery
Authors: Cetta Francesco , Lombardo Francesco , Rossi Stelio
Published: September 2007

We report a case of a brown pigment gallstone, which formed around a phytobezoar in the common bile
duct, in a patient without spontaneous biliary enteric fistula or previous abdominal surgery. A brief comment on the possible origin of the phytobezoar in this case and on the pattern of deposition of brown material over a pre‐existent nidus is also presented.
Biliary Surgery Via Minilaparotomy — A Limited Procedure for Biliary Lithiasis
Authors: Nagakawa Takukazu
Published: September 2007

Cholelithiasis until now has been treated using solvents, lithotripsy via a biliary endoscope, laser or shock wave lithotripsy, and laparoscopic cholecystectomy. have developed a new surgical treatment for cholelithiasis in which a cholecystectomy is performed through a minilaparotomy. This paper presents this new technique and discusses the principles of surgery for cholelithiasis using this technique. This procedure is performed by a 2 to 3 cm subcostal skin incision in the right hypochondrium. More than 400 patients were treated by this technique. This procedure is not different in terms of blood loss .or operation time from conventional methods, and no significant complications have occurred. Intraoperative X‐ray examination is performed routinely because of easy insertion of a tube from the cystic duct into the bile duct. Reduction of the length of the incision greatly facilitates postoperative recovery, shortening the hospital length‐of‐stay to within 3 days. The surgical manipulation of only a limited area of the upper abdomen is unlikely to induce postoperative syndromes, such as adhesions or ileus. Following this experience, a biliary drainage procedure based on cholangionmanomery and primary closure of the choledochotomy was introduced. This approach allowed even patients with choledocholithiasis to undergo a minilaparotomy and be discharged within one week.
Annular Pancreatitis and Gastric Cancer
Authors: Kelly S. B. , Williamson R. C. N.
Published: September 2007

Annular pancreas can present in adult life, usually when inflammation of the pancreatic ring causes
duodenal stenosis. Although peptic ulcer is often associated with annular pancreas, an association with
gastric carcinoma has not been previously described. Here we report a patient with annular pancreas,
chronic alcoholic pancreatitis and gastric carcinoma, who was successfully treated by radical proximal
pancreatoduodenectomy.
Adenocarcinoma in Caroli′s Disease Treated by Liver Transplantation
Authors: Balsells J. , Margarit C. , Murio E. , Lazaro J. L. , Charco R. , Vidal M. T. , Bonnin J.
Published: September 2007

Caroli′s disease is characterized by congenital cystic dilatation of the intrahepatic bile ducts. In 7% of
casea a malignant tumor develops complicating the course of the disease.

We report the case of a 25 year‐old woman in whom Caroli′s disease was diagnosed at the age of 11.
From that time on, she had several episodes of cholangitis. In 1989, the abdominal ultrasound and CT
scan showed dilatation of the intrahepatic bile ducts, intracystic lithiasis and a solid mass. FNA cytology
showed a papillary adenocarcinoma. At laparotomy a tumor was found occupying both hepatic lobes,
and intraoperative US showed another two nodules in the left lobe. The tumor was considered
unresectable. Examination of the hilar lymph nodes was tumor‐negative. Two weeks later, the patient
underwent an ortothopic liver transplantation (OLT). The pathological examination confirmed Caroli′s
disease with adenocarcinoma. Two years after OLT, the patient is alive with normal liver function and
no evidence of disease.

To our knowledge this is the first case report of adenocarcinoma in Caroli′s disease treated by OLT.
Biliary Duct Granular Cell Tumor: A Rare But Surgically Curable Benign Tumor
Authors: Lewis W. David , Buell Joseph F. , Jenkins Roger L. , Burke Peter A.
Published: September 2007

Granulosa cell tumors are rare benign tumors which may be found throughout the body. Rare cases are
isolated within the biliary tree. If completely resected, surgical excision is curative.

A case of biliary duct granulosa cell tumor is presented with review of the world’s literature on this
topic.
Unresectable Malignant Biliary Obstruction: Treatment by Self‐Expandable Biliary Endoprostheses
Authors: Glättli Andreas , Stain Steven C. , Baer Hans U. , Schweizer Walter , Triller Jürgen , Blumgart Leslie H.
Published: September 2007

The primary goal in the treatment of malignant obstruction is the relief of jaundice. Although operative
biliary bypass is a reliable method of palliation, nonoperative palliation may be desirable in selected patients.

We report our experience with forty‐eight self expandable metallic biliary endoprostheses (Wallstent)
percutaneously placed in 35 patients with irresectable malignant biliary obstruction. In twelve patients more than one stent was necessary to bridge the entire length of the biliary stenosis. The obstruction was due to primary tumors in 14 and to lymph node metastases in 12. In nine patients transanastomotic stents were placed after previous bilioenteric anastomosis because of malignant obstruction. Complications occurred in 11 patients (31.4%), and five patients died within 30 days of stent placement (14.3%). The mean stent patency to date of patients discharged is 6.1 months, and the mean survival 7.2 months. Follow up data is available for 29 patients, and excellent palliation was achieved for more than 75% of the survival time in 22 (76%). Seven patients have had documented stent occlusion requiring
further intervention (24%).

In this selected group of patients, the results of percutaneous self‐expandable stents are encouraging.
However, our data does not support the initial reports of self‐expandable endoprostheses that suggest an
improved result compared to conventional plastic stents. A randomized study using either expandable
stents as compared to operative biliary enteric bypass is necessary.
Gastrointestinal Hemorrhage Due to Splenic Artery Aneurysm Pancreatic DuctFistula in Chronic Pancreatitis
Authors: Seiler Christian , Blumgart Leslie H.
Published: September 2007

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis
is rare. It is, however, important to diagnose this condition particularly in patients having chronic
pancreatitis, since it may result in a life‐threatening situation. The diagnosis is usually difficult to
establish and it may take repeated admissions for intermittent gastrointestinal bleeding until the real
source is recognized. Clinical attacks of epigastric pain followed by GI‐bleeding 30–40 minutes later are
characteristic. Occasionally these attacks are followed by transient jaundice. The present case report
describes this rare complication and reviews the current literature.
Histopathological Determinants of Survival in Resected Cases of Pancreas Cancer
Authors: Brower S. T. , Newman R. M. , Pertsemlidis D. , Kreel I. , Aufses A. H.
Published: September 2007

We have examined the histopathological factors affecting the degree of local spread, regional lymph
node (RLN) metastases, and overall survival (O.S.) in a group of 39 cases of resected carcinoma of the
exocrine pancreas. Although the mean O.S. for the group was 14.3 months, resected patients without
RLN involvement had a mean survival of 24 months. In contrast the mean O.S. rate was 8 months for
patients with RLNs involved. Size, tumor location, and histological grade were compared to RLN
involvement and O.S. The mean size of primary tumor did not differ significantly between patients with
or without RLN′s (r.1 versus 4.6cms). However, 7 or 8 T1 tumors were <4cm and 35% of tumors <4cm
were T1 lesions. In contrast, only of 17 tumors (6%) >4cm was T1. Histological grade was correlated with nodal status and O.S. There was a significant difference between histological grade and the
presence of metastatic lymph nodes (G1, 37% positive, G2‐4.50% positive). Patients with well
differentiated tumors had a mean survival of 21 months compared to a mean survival of 10 months for
less differentiated tumors (p<0.05). This difference was even more significant when stratified for nodal
status. The patients with well differentiated tumors and no RLN involvement had a mean survival of
32.5 months compared to 8.6 months for well differentiated tumors with RLN involvement. In
summary, we have shown that size, histological grade, and local spread predict for nodal status.
However, specific patient subsets (G1, node negative) may exhibit an excellent survival when curative
pancreas resection is successful.
Flushable Exo‐Endodrainage: A Modified Palliative Approach to Non‐Resectable Malignant BiliaryObstruction
Authors: Stierer M. , Wasl H. , Rosen H. R. , Marczell A. P. , Spoula H.
Published: September 2007

The introduction of new imaging techniques has markedly improved the diagnosis of hepatobiliary
disorders. Due to their anatomic situation, a substantial percentage of malignancies located near the
hilus is not suitable for surgical management. We discuss an effective palliative intervention to relieve
jaundice. In many instances drainage is a superior choice when biliodigestive anastomoses are not
technically feasible and palliative resection carries a high complication rate.

We present an irrigatable exo‐endodrainage method employing a modified port‐a‐cath system as a
new alternative. In four patients, all older than 75 years, this system was implanted because of jaundice
due to unresectable malignant stenosis of the extrahepatic bile duct. One patient (80 years old) died of
pre‐existing acute necrotizing pancreatitis, although hyperbilirubinemia was found to decrease on the
7th postoperative day. The other three patients showed complete normalization of their bilirubin levels
and their port‐a‐cath systems remained open until their death (at 3 weeks, 6 months and 7 months
respectively).
Extrahepatic Biliary Papillomatosis Occurring After Removal of a Dysplastic Gall Bladder
Authors: Sagar P. M. , Omar M. , Macrie J.
Published: September 2007

A case is presented of a woman who developed obstructive jaundice secondary to dysplastic mucinous
papillomatosis two years after she had undergone cholecystectomy and exploration of the common bile
duct. The gall bladder was dysplastic. It is suggested that the dysplastic glands removed from the
common bile duct at the second operation either represented seedlings from dysplastic areas of the gall
bladder or were a manifestation of dysplastic field change.
Factors Relating to Coagulation, Fibrinolysis and Hepatic Damage After Liver Resection
Authors: Oguro Atsushi , Taniguchi Hiroki , Daidoh Takeshi , Itoh Akiyoshi , Tsukuda Nobuhiro , Takahashi Toshio
Published: September 2007

A survey of the blood of twenty‐two patients who had undergone hepatic resection was performed.
Serum levels of α‐2 plasmin inhibitor‐plasmin complex initially decreased from 1.58 ± 0.31 μg/ml on the preoperative day (PREOP), to 0.92 ± 0.14 μ/ml on the first postoperative day (POD 1), and then increased to 3.13 ± 0.92 μg/ml on the seventh postoperative day (POD 7) (mean ± SE)). Thrombin‐anti‐thrombin III complex (14.2 ± 4.3 ng/ml on PREOP and 26.0 ± 4.1 ng/ml on POD 7
(mean ± SE)) and D‐dimer (335 ± 96 ng/ml on PREOP and 1859 ± 258 ng/ml on POD 7 (mean ±
SE)) increased in the early postoperative stage. The level of 6‐keto‐prostaglandin F1α increased after
the operations (from 13.2 ± 1.8 pg/ml on PREOP to 37.8 ± 12.8 pg/ml on POD 7 (mean ± SE)). The
level of thromboxane B‐2 decreased at first, and then gradually increased and returned to its
preoperative level on POD 7 (144.7 ± 43.8 pg/ml on PREOP, 57.6 ± 27.5 pg/ml on POD1 and 152.5
± 58.4 pg/ml on POD 7 (mean ± SE)). Superoxide dismutase activity increased at first, and then
gradually decreased, postoperatively (2.8 ± 0.5 NU/ml on PREOP, 4.8 ± 0.8 NU/ml on POD1 and 2.6
± 0.3 NU/ml on POD 7 (mean ± SE)). That is, biodefensive reactions which protect patients against
the shift to disseminated intravascular coagulation (DIC) were inferred with by the increase in antiplatelet
aggregation, despite the activation of coagulation and fibrinolytic mechanisms after hepatic
resection.
Acute Fulminant Pancreatitis: Debridement or Formal Resection of the Pancreas
Authors: Kiviniemi Heikki , MäKelä Jyrki , Kairaluoma Matti I.
Published: September 2007

During the ten year period from 1980 to 1989, 51 patients were treated at Oulu University Central
Hospital for fulminant acute pancreatitis. Five were in a moribund state on admission and died shortly
afterwards, 6 were treated conservatively and survived, and 40 were operated on, 17 by primary
pancreatic resection and 23 by debridement of the peripancreatic area. Mortality rates were 53 per cent
for the resection group and for the debridement group 22 per cent.

Reoperations were performed in 24 per cent of patients in the pancreatic resection group and in 60 per cent of those in the debridement group.

The high mortality rate associated with primary pancreatic resection has caused us to adopt a more
conservative strategy, and surgical treatment is directed towards later complications of this severe
disease.
Percutaneous Alcohol Sclerotherapy of Simple Hepatic Cysts. Results From a Multicentre Survey in Italy
Authors: Montorsi Marco , Torzilli Guido , Fumagalli Uberto , Bona Stefano , Rosati Riccardo , de Simone Matilde , Rovati Vittorio , Mosca Franco , Filice Carlo
Published: September 2007

The increased use of Ultrasonography (US) has led to increased detection of simple hepatic cysts. For symptomatic cysts treatment is necessary. Until some years ago surgery was the only therapy. We have treated a large number of patients with Percutaneous Alcohol Sclerotherapy (PAS) and evaluated retrospectively the efficacy of this approach.

Data on 21 patients with symptomatic simple hepatic cysts were reviewed retrospectively. Cysts had a mean diameter of 9 cm (range: 7–15 cm). PAS was always performed under local anesthesia and US guidance. 25% of the volume was replaced with 95% ethanol and then completely aspirated after 20–30 minutes.

No complications or deaths occurred. In all patients symptoms disappeared after treatment. In 15 out of 21 cases there was no evidence of residual cyst on US, computed tomography (CT) or magnetic resonance (MRI). In 6 patients with shorter follow‐up, cysts showed a mean reduction in diameter of 50%. The mean follow‐up was 18 months (range 6–60 months).

We conclude that PAS is easy with low risk for the patients and with good long‐term results; it should therefore become the procedure of choice for simple hepatic cysts.
Traumatic Duodenal Rupture and Avulsion of the Ampulla of Vater
Authors: Cox M. R. , Eastman M. C.
Published: September 2007

Duodenal injury following blunt abdominal trauma is uncommon. The severity of injury can vary from
an intramural haematoma to a duodenal rupture with associated transection of the pancreatic duct. A
case of duodenal rupture with avulsion of the ampulla of Vater is presented and discussed.
Intra‐Abdominal Venous Pressure During Laparoscopic Cholecystectomy
Authors: Iwase Kazuhiro , Takao Tetsuto , Watanabe Hirotoshi , Tanaka Yasuhiro , Kido Tetsuo , Ogawa Noritusugu , Ono Norio , Yoshitake Hiroshi
Published: September 2007

Superior vena cava (SVC) and inferior vena cava (IVC) pressures were measured serially during
laparoscopic cholecystectomy in which the intra‐abdominal pressure was maintained at
12mmHg. The influences of alteration of position from 15 degrees head‐down to 15 degrees
head‐up and of the operative procedure of holding the gallbladder up to the right subphrenic
space on SVC and IVC pressures were mild. IVC pressure was maintained almost equal to the
intra‐abdominal pressure during prolonged continuous pneumoperitoneum lasting longer than
60min, while SVC pressure did not change significantly during operation. The discrepancy
between SVC and IVC pressures underwent no change during continuous pneumoperitoneum.
Non‐Operative Management of a Common Bile Duct Injury Sustained During Cholecystectomy in a Morbidly Obese Patient. (Non‐Operative Repair of CBD Injury)
Authors: Ashdown Boyd C. , Suhocki Paul V. , Jowell Paul S. , Meyers William C.
Published: September 2007

A 29 year old morbidly obese patient suffered injury to his common bile duct during cholecystectomy.
Subsequent access to the biliary tree was obtained by using a long heavy gauge needle after
first opacifying the system with contrast injection through a nasobiliary tube. It is now twenty six
months after initial percutaneous biliary drainage placement and eighteen months after removal
of all biliary access. The patient is asymptomatic and has normal liver function tests. This
technique can be useful in morbidly obese patients who are at increased risk from surgical repair
of biliary duct injuries.
The Effect of Communication Between the Right and Left Liver on the Outcome of Surgical Drainage for Jaundice due to Malignant Obstruction at the Hilus of the Liver
Authors: Baer H. U. , Rhyner M. , Stain S. C. , Glauser P. W. , Dennison A. R. , Maddern G. J. , Blumgart L. H.
Published: September 2007

Debate continues regarding the optimal management of irresectable malignant proximal biliary
obstruction. Controversy exists concerning the ability of unilateral drainage to provide adequate
biliary decompression with tumors that have occluded the communication between the right and
left hepatic ductal systems.

Between October 1986 and October 1989, 18 patients with malignant proximal biliary
obstruction were treated by an intrahepatic biliary enteric bypass. Patients were divided into two
groups based on the presence or absence of a communication between the right and left biliary
systems. In Group I (n = 9), there was free communication; and in Group II (n = 9) there was no
communication. There were two perioperative deaths (11%) one due to persistent cholangitis
and the other to myocardial insufficiency both with one death in each group. The median
survival (excluding perioperative deaths) was 5.6 months. Comparison of pre‐ and postoperative
serum levels of bilirubin and alkaline phosphatase showed a significant decrease in each group,
but no difference between the groups in the size of the reduction. Sixteen patients survived at least
three months and the palliation was judged as excellent in eight, fair in five, and unchanged
in three.

These results demonstrate the effectiveness of biliary enteric bypass regardless of communication
between the left and right biliary ductal systems.
Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis
Authors: Stipa Francesco , Gavelli Adolfo , Huguet Claude
Published: September 2007

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial.
Surgical treatment with pancreatic resection or trancystic arterial ligation is not always
satisfactory since postoperative mortality rate is high, especially for lesions located in the
pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms
(one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic
head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in
all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up
of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be
a useful approach, which should be compared to arterial embolization in the future.
Pancreatic Exocrine Enzymes and Intrapancreatic Protein Synthesis in Acute Oedematous Pancreatitis
Authors: Kinami Yoshio , Kita Ichiro , Kojima Yasuhiko , Takashima Shigeki
Published: September 2007

Changes in serum and intrapancreatic enzyme content and protein synthesis in pancreas were
studied in acute oedematous pancreatitis (AOP). Male Wistar rats (n = 111) were divided into
2 groups, controls with a sham operation and those with AOP. Serum amylase levels rose
immediately after the procedure causing AOP and then fell gradually, while serum lipase and
ribonuclease levels remained higher than control values over 48h. (p < 0.05, 0.01). Serum
deoxyribonuclease (DNase) II levels were unchanged. Intrapancreatic enzyme levels were
scarcely affected by AOP. 3H‐leucine uptake into pancreatic tissue of rats with AOP was
decreased throughout the study (p < 0.001), but some protein synthesis continued. Intrapancreatic
enzyme contents are maintained despite diffusion into the blood because the pancreas
retain its ability to synthesize enzymes.
Hepatic Angiomyolipoma
Authors: Bakhotmah Mohamad Abid , Yamasaki Susumo
Published: September 2007

Hepatic angiomyolipomas are rare benign tumours. First reported by Ishak in 1976. Since then, the
world literature showed only 32 cases including 8 autopsy findings. In this paper a retrospective analysis
of the published data will be presented and the first report ofthe preoperative colour doppler and
intraoperative sonography appearances will also be described.
The Effects of Long‐Term Graft Preservation on Intraoperative Hemostatic Changes in Liver Transplantation
Authors: Bakker C. Minke , Blankensteijn Jan D. , Schlejen Peter , Porte Robert J. , Gomes Maria J. , Lampe Harald I. H. , Stibbe Jeanne , Terpstra Onno T.
Published: September 2007

We compared hemostatic changes during OLT and HLT after various periods of graft storage, to
investigate whether the host liver in HLT protects the recipient from hemostatic deterioration induced
by severe graft storage damage. In particular, the mechanism of fibrinolytic deterioration was
investigated. The effect of prostaglandin E1 (PGE1) on these parameters was also studied.

Material and Methods: 69 pigs underwent either OLT (N = 32) or HLT (N = 37) with a graft stored for
2 hr (N = 31), 24 hr (N = 16), 48 hr (N = 7), or 72 hr (N = 15). PGE1 was given intravenously to both
donor and recipient animals and was added to the preservation and flushing solutions. Fibrinolysis
(euglobulin clot lysis time, t‐PA activity and α2‐antiplasmin) and coagulation parameters (activated partial thromboplasmin time, prothrombin time, fibrinogen and platelet count) were measured at
several intervals during transplantation.

Statistics: Univariate non‐parametric tests were used for analysis of coagulation and fibrinolysis
parameters. For the three main variables‐ i.e., the type of transplantation, the use of PGE1, and the
preservation time, multiple regression analysis was performed.

Results: Fibrinolytic activity increased during the anhepatic period of OLT. Graft reperfusion was
followed by a rise in t‐PA in both OLT and HLT. In HLT, t‐PA quickly returned to normal, whereas a
continuous increase was found in OLT. The coagulation parameters, in turn, remained unchanged
during the anhepatic period and deteriorated in OLT compared to HLT. The duration of graft storage
was directly related to the severity of the hemostatic changes, although this effect was more apparent in
OLT than in HLT.

Conclusions: Changes in hemostasis are more pronounced in OLT than in HLT. This suggests that the
host liver protects the recipient from the effects of graft storage damage, even after long preservation
times. Early postreperfusion fibrinolytic activity was presumably due to t‐PA release from the graft both
in OLT and HLT. The further rise t‐PA in OLT might be caused by the release of cytokines from the
graft, that subsequently evoke endothelial t‐PA release. In HLT, t‐PA and cytokines may be cleared by
the native liver. No positive or negative effect of PGE1 on coagulation or fibrinolysis parameters was
noticed.
Solitary Metastasis From Cutaneous Melanoma to the Liver: Resection byExtended Left Hepatectomy (Trisegmentectomy) With Clearance of Tumor From the Portal Vein
Authors: Vauthey Jean-Nicolas , Winter Matthias W. , Blumgart Leslie H.
Published: September 2007

A 61‐year‐old woman presented with low grade fever and an epigastric mass eight years
following resection of a stage Clark IV infraclavicular cutaneous melanoma followed by axillary
node dissection. Investigations revealed a tumor in segment II, III, IV and V of the liver and
a thrombus involving the main portal vein. Liver resection with extended left hepatectomy (left
trisegmentectomy) and portal vein thrombectomy is reported.
Abdominal Wall Haematoma Complicating Laparoscopic Cholecystectomy
Authors: Bhattacharya S. , Tate J. J. T. , Davidson B. R. , Hobbs K. E. F.
Published: September 2007

Of 61 consecutive patients undergoing laparoscopic cholecystectomy, 4 (6.25%) developed abdominal wall
haematomas. This complication of laparoscopic cholecystectomy may occur more commonly than existing
literature suggests, and manifests in the post‐operative period (days 2 to 6) by visible bruising, excessive pain
or an asymptomatic drop in haematocrit. It is readily confirmed by ultrasonography. While no specific
treatment is necessary apart from replacement of significant blood loss, the patient requires reassurance that
this apparently alarming complication will rapidly resolve.
Amebic Liver Abscess With Intra‐Biliary Rupture
Authors: Ibrarullah Md. , Agarwal Deepak K. , Baijal Sanjay S. , Mittal Bhagwant R. , Kapoor Vinay K.
Published: September 2007

The case of a large amebic liver abscess with an atypical presentation is reported. High output bile
drainage persisted after ultrasound guided percutaneous catheter drainage because of a preexisting
communication of the abscess with the right hepatic ductal system. The abscess was managed
successfully by surgical evacuation and internal drainage into a defunctioned jejunal loop.
Cholecystobronchocolic Fistula: A Late Complication of Biliary Sepsis
Authors: Collie D. A. , Redhead D. N. , Garden O. J.
Published: September 2007

A case of a 48 year old woman presenting with bilioptysis due to a cholecystobronchocolic fistula is
reported. Bilioptysis is a rare complication of biliary fistulae, with a high mortality due to chemical
pneumonitis. Bronchospasm and rapid respiratory failure may ensue if aggressive management is not
adopted. The site of fistulation is established by cholangiography, preferably by the percutaneous
transhepatic route. Continued biliary drainage can lead to closure of these fistulae, or allow sufficient
improvement in clinical condition to allow definitive surgery to be performed electively.
Management of Isolated Gastric Varices by Devascularization and Proximal Gastrectomy in Cirrhotic Patients
Authors: Hsieh Jan-Sing , Huang Che-Jen , Huang Tsung-Jen
Published: September 2007

Twenty patients with liver cirrhosis were treated by surgery for bleeding from isolated gastric varices.
The presence of tortuous and engorged gastric veins connecting with a large splenorenal shunt was
demonstrated by transhepatic portography in all patients. The surgical procedures consisted of
splenectomy, proximal gastrectomy, paragastric devascularization, and ligation of the splenorenal
shunt. Sixteen patients survived the surgery. Four deaths were caused by emergency operation for
uncontrollable hemorrhage in extremely poor risk patients. Of the 16 survivors, 15 had been followed
wth endoscopy and portography for a mean period of 42 months. The other one died of hepatocellular
carcinoma three years after surgery. There was no bleeding episode during the period of follow‐up in
these patients. Recurrent esophageal varices of mild degree were documented by endoscopy and
portography in three patients. Portography demonstrated that several newly formed retroperitoneal
veins arising from the junction of the portal and superior mesenteric veins joined to form recurrent
varices in these three patients. There was no significant change of the mean portal venous pressure
before and after surgery. Our data reveals that elective surgery may provide satisfactory results in
patients with isolated gastric varices. Transhepatic portography is the method of choice in radiologic
investigation for prominent gastric varices.
Splanchnic Haemodynamics and Vasoactive Agents in Experimental Cirrhosis
Authors: Geraghty J. G. , Angerson W. J. , Carter D. C.
Published: September 2007

It is well known that portal hypertension is associated with a hyperdynamic systemic circulatory
state. This study measures systemic and splanchnic haemodynamics in an experimental rat
model of hepatic cirrhosis. It also investigates the association between haemodynamic changes in
cirrhotic animals and circulating levels of the vasoactive hormones glucagon and vasoactive
intestinal polypeptide (VIP). Splanchnic blood flow was significantly increased in the cirrhotic
group (13.2 ± 1.3 vs. 9.2 ± 1.6 ml/min, P < 0.05). Circulating levels of glucagon and VIP were two
and five fold increased respectively in cirrhotic animals compared to controls. There was a strong
correlation between portal pressure and glucagon levels in the cirrhotic group (r = 0.85). Raised
splanchnic blood flow is partly responsible for elevated portal pressure in this model and this rise
may be humorally mediated.
“SPLIT” Pancreaticojejunostomy in theSurgical Treatment of Chronic Pancreatitis
Authors: Mulder W. , de Jong E. , van Gulik T. M. , de Wit L. Th. , van Leeuwen D. J. , Verbeek P. C. M. , van der Heyde M. N.
Published: September 2007

“Split” pancreaticojejunostomy is a procedure consisting of vertical transection of the pancreas
and anastomosis of both sides of the cut pancreatic duct with an interposed, Roux‐en‐Y jejunal
loop. In this paper we report the long term results of this procedure in the treatment of eight
patients with chronic pancreatitis (CP).
Duodenal Web and Pancreas Divisum Causing Pancreatitis in an Adult
Authors: Kollias J. , Toouli J.
Published: September 2007

Duodenal malformations are the third commonest cause of intestinal obstruction in infants1. A
spectrum of intrinsic obstructive lesions within the duodenum ranges from atresia to congenital bands2.
Rarely, duodenal malformations may first present in adulthood. Less than 70 cases of duodenal web
presenting in an adult have been reported in the literature. In 10 patients the presentation was associated
with pancreatitis. We report a case of congenital duodenal web associated with pancreas divisum which
first presented in an adult with the clinical characteristics of recurrent acute pancreatitis.
Treatment Strategies for Hepatic Metastases From Pancreatic Cancer in Patients Previously Treated With Radical Resection Combined With Intraoperative Radiation Therapy
Authors: Takamori Hiroshi , Hiraoka Takehisa , Kanemitsu Keiichirou , Tsuji Tatsuya , Saito Naoyuki , Nishida Hidefumi , Sakaguchi Hisashi , Miyauchi Yoshimasa
Published: September 2007

Since 1984, we have performed extended radical resection combined with extended intraoperative
radiation therapy (IORT) for pancreatic cancer. This approach has provided
a dramatic improvement in long‐term survival and control of local recurrence. Hepatic metastases,
however, remain an unsolved problem. Among patients with this combined therapy, we
found hepatic metastases in 8 of 22 patients postoperatively. Four of these 8 were considered
candidates for further therapy and underwent treatment for their hepatic metastases, the other
4 had too extensive disease. Two patients with multiple hepatic metastases underwent percutaneous
ethanol injection therapy and chemotherapy, but they died within a year. Two
patients with a solitary hepatic metastases underwent hepatic resection. One patient died two
years and six months after the first operation because of multiple metastases in the liver and both
lungs, while the other patient is still alive over six years after the first operation with an excellent
performance status. When a patient has no local recurrence and a solitary metastasis in the liver,
surgical resection of the liver metastasis should be performed.
Intrahepatic Biliary Cystadenoma With Intracystic Gallstone Formation
Authors: Lei Shize , Domenico Don R. , Howard John M.
Published: September 2007

Biliary cystadenoma is a rare tumor of the liver. We describe a biliary cystadenoma of the left lobe of the
liver with intracystic gallstone formation. This is the first report of stone formation in biliary
cystadenoma of the liver.
Solitary Hepatic Lymphangioma
Authors: Stavropoulos M. , Vagianos C. , Scopa C. D. , Dragotis C. , Androulakis J.
Published: September 2007

Hepatic lymphangiomas are extremely rare; moreover cystic lymphangiomas usually arise in
areas such as the neck and axilla, where loose connective tissue allows the expansion of lymphatic
channels. The case of a 65‐year old male is described, who presented with a solitary lymphangioma
in the liver. The lesion was discovered incidentally and due to diagnostic uncertainty was
removed surgically. A short review of histology, clinical presentation and preoperative diagnostic
difficulties of hepatic lymphangiomas is given.
Attitudes Towards Detection and Management of Hepatic Metastases of Colorectal Origin: A Second Look
Authors: Bruinvels David J. , de Brauw L. Maurits , Kievit Job , Habbema J. Dik F. , van de Velde Cornelis J. H.
Published: September 2007

In the present study we undertook an international postal survey to assess the current attitudes
towards the detection and management of hepatic metastases in colorectal cancer patients, who
have been operated on with curative intent. Results of this survey were compared to results of an
earlier survey, held in 1985. Both surveys indicate that there is no consensus on the follow‐up of
patients at risk of hepatic metastases. Especially the interpretation of unexplained rises in
carcinoembryonic antigen (CEA) levels leads to much controversy. Only 37% of the hospitals
performing liver surgery were willing to perform second‐look laparotomies based on CEA only.
Also there is no agreement on the maximum number of liver metastases that will justify partial
liver resection for cure. Clearly, there is a need for prospective randomized trials on which a more
rational policy regarding hepatic metastases in colorectal cancer patients can be based.
Acute Phase Response in Patients With Uncomplicated and Complicated Endoscopic Retrogradic Cholangiopancreaticography
Authors: Kiviniemi Heikki , Juvonen Tatu , Mäkelä Jyrki
Published: September 2007

Acute phase response after endoscopic retrogradic cholangiopancreaticography (ERCP) was studied
in 42 patients with suspected pancreatic or biliary diseases. In uncomplicated cases acute phase
response determined by serum C‐reactive protein levels was rare and did not parallel the serum
amylase or lipase levels. In three of the these 42 patients, post‐ERCP pancreatitis developed and CRP
levels elevated sharply and paralleled the degree of pancreatitis. Six additional patients outside of this
prospective study with post‐ERCP‐pancreatitis and daily CRP determinations were used to determine
the CRP‐response curve in post‐ERCP pancreatitis.
Outpatient Laparoscopic Cholecystectomy
Authors: Smith R. , Kolyn D. , Pace R.
Published: September 2007

Outpatient Laparoscopic Cholecystectomy was attempted in 98 patients selected from 266 patients
presenting for elective cholecystectomy (37%). Two patients required admission following conversion to
“open” Cholecystectomy, one patient was admitted for observation because of a technically difficult
Laparoscopic Cholecystectomy and 16 patients were admitted because of refractory nausea and
vomiting in the early post‐operative period. Seventy‐nine patients (81%) were able to be discharged
home within 4 to 6 hours of surgery, with only one patient requiring readmission to hospital because of
the onset of nausea and vomiting. There were no post‐operative complications attributable to the
outpatient experience. We believe this approach to elective gallbladder pathology can be safely
accomplished in selected patients and will be increasingly utilized in the future.
Duodenal Leiomyosarcoma Mimicking a Pancreatic Pseudocyst
Authors: Sperti C. , Pasquali C. , Di Prima F. , Baffa R. , Pedrazzoli S.
Published: September 2007

A case of duodenal leiomyosarcoma presenting as a cystic mass is reported. Amylase, tumour
markers levels in the cyst fluid and radiological findings suggested an inflammatory pancreatic
pseudocyst. Exploratory laparotomy and frozen section examination showed a smooth muscle
tumour of the duodenum. Pancreatoduodenectomy with pylorus‐preser vation was performed
and the patient remained symptom‐free at 8 months follow‐up.
An Analysis of Infectious Failures in Acute Cholangitis
Authors: Thompson Jesse , Bennion Robert S. , Pitt Henry A.
Published: September 2007

To determine the factors responsible for therapeutic failures in acute cholangitis, a series of 127
patients was analyzed. There were 64 females and 63 males whose mean age was 57.2 years. Ninetyfour
(74.0%) of these patients were clinically cured with initial measures, whereas 33 patients (26%)
failed initial therapy for an infectious reason. No differences were observed between the two groups in
regard to age and gender. However, more patients in the group that failed had a malignant cause for
their bile duct obstruction (72.7% vs. 42.6%, p < 0.01) and had a pretreatment positive blood culture
(45.5% vs. 13.8%, p < 0.01). Patients who failed had a higher mean total bilirubin level (9.7 mg/dl vs.
5.5 mg/dl, p < 0.005) and more of them had a level greater than 2.2 mg/dl (97% vs. 69.9%, p < 0.001).
Also, more bile cultures were initially positive (93.9% vs. 76.6%, p < 0.05) and more organisms were
isolated per culture (3.88 vs. 2.86, p < 0.03) in the patients who failed. In addition, more patients failed
who had two or more organisms in the bile (33% vs. 8.3%, p < 0.02). Patients in whom Candida, or any
panresistant organism was isolated also tended to fail. Multivariant analysis showed that malignancy,
bacteremia, bilirubin ≥ 2.2 mg/dl, ≥ 2 organisms in the bile and a panresistant organism were the best
predictors of treatment failure with a serum bilirubin level ≥ 2.2 mg/dl being the variable that increases
a patient′s log‐odds ratio of failure the greatest. In conclusion, patients with acute cholangitis who
have an increased chance to fail initial therapy can be identified, and treatment altered accordingly.
Neutrophil Priming by Cytokines in Patients With Obstructive Jaundice
Authors: Jiang W. G. , Puntis M. C. A. , Hallett M. B.
Published: September 2007

Patients with obstructive jaundice frequently suffer postoperative complications. We have investigated
the relationship of obstructive jaundice to the neutrophil oxidase response and the “priming” of the
response by the cytokines TNFα, interleukin‐1 (IL‐1), IL‐6, and IL‐8. On stimulation with f‐met‐leuphe
(fmlp), the respiratory burst in neutrophils from jaundiced patients was greatly increased compared
with controls (p < 0.01), jaundiced patients having the highest respiratory burst levels were those with
the poorest prognosis. Neutrophils from controls were primed by all the cytokines tested, whereas
“jaundiced” cells were primed only by IL‐1, and not by TNFα, IL‐6, or IL‐8, which in fact produced
slight inhibition. We conclude that neutrophils from obstructive jaundiced patients have raised oxidative
responses which may be due to “pre‐priming” in vivo by cytokines, such as IL‐6, IL‐8, or TNFα. This exaggeration of the oxidative response in circulating neutrophils may contribute to the peri‐operate
complications of patients with obstructive jaundice.