bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic Versus Open Cholecystectomy: A Prospective Matched‐Cohort Study
Authors: Porte Robert J. , De Vries Bas C.
Published: September 2007

To compare the results of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC)
for symptomatic cholelithiasis in elective surgery we performed a prospective matched‐cohort
study. Hundred consecutive patients who underwent LC in the period Sept. 1990‐June 1992,
and 100 patients who were age and sex matched and underwent an elective OC in the foregoing
two years (1989‐1990) were studied. The median operation time for LC (75, 40‐180 min) was
significantly longer than for OC (55, 20‐155 min; p < 0.001). Postoperative hospitalization was
significantly shorter after LC (3, 1‐16 days), compared with OC (7, 4‐22 days; p<0.001).
Conversion of LC to OC occurred in 12 (12%) patients initially scheduled to undergo LC.
Complications occurred in 5 patients (5%) after LC and in 5 patients (5%) after OC. The
calculated expenses (operation and postoperative hospitalization, 3rd class) were approximately
fl. 3740,‐ for LC (excl. investments for pieces of apparatus) and fl. 6725,‐ for OC. This
study demonstrates that LC can be performed safely with the number of complications
comparable to those for OC. Bile duct injury is a serious potential threat. The main advantages
ofLC are the minimal trauma, with more rapid recovery. Insurers seem to benefit from reduced
postoperative disability and earlier discharge.
Villous Adenocarcinoma of the Duodenum Invading the Ampulla of Vater: Case Report and Review of Literature
Authors: Catania Gaetano , Cardi Francesco , Migliore Marcello , Romeo Gaetano
Published: September 2007

We report a case of villous adenocarcinoma of duodenum arising from the ampulla of Vater with a review of the literature. Although preoperative endoscopic biopsies were performed, no malignancy was identified. Because of the pathological uncertainty we decided to perform a pylorus‐preserving pancreatoduodenectomy. Microscopic examination demonstrated glandular dysplasia with aspects of villous adenoma and well differentiated adenocarcinoma. We conclude that both in malignant cases and in cases with uncertain diagnosis a pylorus‐preserving pancreatoduodenectomy is the best surgical treatment because it results in better 5 year survival.
Treatment of Large Liver Cyst Evaluated with CA19‐9 in the Cystic Fluid
Authors: Ikeda Yasuharu , Kawasaki Katsumi , Ikeda Tetsuo , Uchida Hiroyuki , Morinaga Kazumasa
Published: September 2007

A middle‐aged woman was admitted with a diagnosis of liver cysts. The patient was symptomatic and was
treated by injecting absolute ethanol into the largest cyst every week, but the secretion from the cyst
persisted. The patient was then treated by absolute ethanol injection every day with good results.
CA 19‐9 was measured in the cystic fluid. The secretion was related to CA 19‐9 activity.

Thus, for patients with symptoms from a liver cyst, the injection of ethanol every day can be effective.
CA19‐9 level in the contents of the liver cyst was an important factor in assessing the effect of ethanol
injection on the liver cyst.
Results of Pancreatic Blood Shunting into the Systemic Blood Flow in Insulin‐Dependent Diabetics
Authors: Galperin E. I. , Diuzheva T. G. , Petrovsky P. F. , Chevokin A. Yu. , Dokuchayev K. V. , Rabinovich S. E. , Gitel E. P. , Kuzovlev N. F. , Platonov L. V.
Published: September 2007

A new surgical method of treating patients with unstable insulin‐dependent diabetes (IDD) has been
developed‐that of surgically shunting pancreatic blood into the systemic blood flow with the purpose of
creating a more optimal interaction of subcutaneously administered insulin and pancreas‐secreted
glucagon.

The long term results of the operation depend on the patency of a splenorenal anastomosis. This has
been studied by following up 137 patients over periods from half a year to three years. Anastomotic
patency was determined by renal and splenic venography and celiacy arteriography, which revealed a
patent anastomosis in 114 patients, and an obliterated one in 23.

Patients with patent anastomoses showed a lowering of glycosylated hemoglobin (HbAlc) from
13.3±0.03% to 9.3±0.6%, p<0.05, a decrease of the injected insulin dose from 0.97±0.04 to 0.72±0.03 U/ kg, p<0.05, disappearance or considerable abatement of pain in the lower extremities, and of hypoglycemia. Improvement of clinical status was accompanied by an increase of glucagon in the systemic blood stream from 60.8±10.1 to 91.5±9.4 pg/ml, p<0.05, a rise of tissue oxygen pressure, PO2, from 49.2±2.4 to 58.1±1.9 mm Hg, p<0.05. In patients with oblivious anastomoses postoperative HbAlc levels did not change from preoperative values: 12.9±0.4% and 12.8±0.7%, p<0.05, respectively; the insulin dose remained the same‐0.91 ±0.07 U/kg and 0.85±0.07 U/kg, p<0.05, no rise of the systemic blood glucagon content was noted, and former complaints continued.

The suggested method is not an alternative for insulin therapy, but considerably enhances its potential.
Influence of the Gut Microflora and of Biliary Constituents on Morphological Changes in the Small Intestine in Obstructive Jaundice
Authors: Quraishy M. Saeed , Chescoe Dawn , Mullervy Jenny , Coates Marie , Hinton Richard H. , Bailey Michael E.
Published: September 2007

Increased amounts of intestinal endotoxin are absorbed in obstructive jaundice. The precise mechanism is not known but the increased absorption may arise from alterations in the luminal contents, in the intestinal flora, in the gut wall or in interactions between all three. To examine the effects of the intestinal flora we have compared the morphological changes in the small intestine in obstructive jaundice in germ free and conventional rats while the effects of bile constituents have been examined by addition of bile constituents to the diet of bile duct ligated rats. Changes in the intestine were examined, histologically, by enzyme histochemistry, and by transmission and scanning electron microscopy. The results showed no differences in response between germ free and conventional rats. Feeding of diets containing bile salts exacerbated the lesion. Feeding of diets containing cholesterol, however, reduced the degree of intestinal changes produced by cholestasis and completely antagonised the increase in damage caused by feeding of bile salts.
Hepatic Cryotherapy for Cancer: A Reviewand Critique
Authors: Morris D. L.
Published: September 2007

Background: Wedge or other nonanatomic hepatic resections, performed in an
attempt to spare functional parenchyma, often are not accomplished with clear resection
margins and may be complicated by hemorrhage from the depth of the resection.

Study Design: The current study describes a technique of cryoassisted hepatic
resection that allows for controlled resection with well‐defined margins. The early
experience in managing 16 tumors in 13 patients is reported.

Results: A cryoprobe is inserted into the tumor and freezing performed to a predetermined
resection margin using ultrasound control. The ice ball, so formed, is then
maintained and excised. The management of these 13 patients was associated with one
intraoperative and two postoperative complications, including a death of a patient with
cirrhosis who had infected ascites and died as a result of hepatic failure.

Conclusions: Cryoassisted hepatic resection seems to be safe and allows resection
with good tumor clearance and maximal preservation of functional parenchyma.
Acute Cholecystitis in Aged Patients
Authors: Prousalidis J. , Fahadidis E. , Apostolidis S. , Katsohis C. , Aletras H.
Published: September 2007

The aim ofthis study is the analysis ofthe results in 62 patients over 70 years ofage with acute cholecystitis treated in our Department from 1970 to 1990. The clinical picture in 47 patients was mild and in 15 severe. In 14 cases (10 calculous, 4 acalculous) the acute cholecystitis subsided with antibiotics (Group A). In 48
more cases (45 calculous, 3 acalculous) following 1‐3 days conservative treatment, operation was undertaken.
Besides acute cholystitis there was gangrene of gallbladder in 10, choledocholithiasis in 7 and
choloperitoneum without perforation in 7 cases. Cholecystostomy in 25, cholecystectomy in 15 and
cholecystectomy with exploration ofthe bill duct in 8 cases was performed (Group B). There was one death
in group A and 3 deaths .in group B. The hospital stay was 20 days. In conclusion the clinical findings in
acute cholecystitis in the aged are usually mild. In the case of failure of medical treatment, after 2‐3 days
emergency surgery should be performed.
Classification of Liver Trauma
Authors: Rizoli Sandro B. , Brenneman Frederick D. , Hanna Sherif S. , Kahnamoui Kamyar
Published: September 2007

The classification of liver injuries is important for clinical practice, clinical research and quality assurance activities. The Organ Injury Scaling (OIS) Committee of the American Association for the Surgery of
Trauma proposed the OIS for liver trauma in 1989. The purpose ofthe present study was to apply this scale
to a cohort ofliver trauma patients managed at a single Canadian trauma centre from January 1987 to June
1992.170 study patients were identified and reviewed. The mean age was 30, with 69% male and a mean ISS
of 33.90% had a blunt mechanism ofinjury. The 170 patients were categorized into the 60IS grades ofliver
injury. The number of units of blood transfused, the magnitude of the operative treatment required, the
liver‐related complications and the liver‐related mortality correlated well with the OIS grade. The OIS
grade was unable to predict the need for laparotomy or the length of stay in hospital. We conclude that the
OIS is a useful, practical and important tool for the categorization of liver injuries, and it may prove to be
the universally accepted classification scheme in liver trauma.
Changes in Hepatic Hemodynamics due to Primary Liver Tumours
Authors: Jakab F. , Ráth Z. , Schmal F. , Nagy P. , Faller J.
Published: September 2007

Data regarding the afferent circulation of the liver in patients with primary hepatocellular carcinoma are
controversial, we have carried out measurement of hepatic arterial and portal venous flow
intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular
carcinoma the hepatic artery flow increased to 0.55±0.211 compared with the control value of 0.37±0.102
1/min. (p<0.01). The portal venous flow decreased from 0.61±0.212 l/min, to 0.47±l/min. p<0.01). Due to
the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly,
compared with controls.

The ratio of hepatic arterial flow to portal vein flow increased to 1.239±0.246 in patients with
hepatocellular carcinoma, which is double of the control value (0.66±0.259 l/min). After resection this
ratio did not change.

The resection did not alter hepatic artery or portal venous flow significantly, although the total hepatic
blood flow decreased significantly (p<0.01).

On the basis of our early results it is possible that the ratio of the two circulations may be to deel
measured with doppler ultrasound and provide diagnostic information.
Efficacy of Intra‐arterial Norcantharidin in Suppressing Tumour 14C‐labelled Glucose Oxidative Metabolism in rat Morris Hepatoma
Authors: Mack Peter , Ha Xiao-Fang , Cheng Li-Yao
Published: September 2007

Norcantharidin is the demethylated form of Cantharidin, which is the active ingredient of the blister beetle, Mylabris, a long used Chinese traditional medicine. Though not well publicised outside China, Norcantharidin is known to possess significant anti‐hepatoma activity, and is relatively free from side effects. In the present study, glucose oxidation in tumour and liver tissue slices harvested from hepatomabearing animals was quantified by measuring the radioactivity of 14C‐labelled CO released from 14C‐glucose in oxygen‐enriched incubation medium. Results were expressed asa tumour/liver ratio. For comparison, treatments with Norcantharidin, Adriamycin and with hepatic artery ligation were studied. The mean tumour/liver ratio was 4.2+2.2 in untreated controls, but dropped significantly to 2.3+0.5 (p<0.05) with intra‐arterial Norcantharidin (0.5 mg/kg) and to 2.3+0.7 (p<0.05) with intra‐arterial Adriamycin (2.4 mg/kg), and to 2.2+0.7 (p<0.05) with hepatic artery ligation. However, with intravenous Adriamycin at 2.4 mg/kg, the mean tumour/liver ratio was reduced to only 3.5+2.0 and was not significantly different from untreated controls. It is concluded that intra‐arterial Norcantharidin is as effective as intraarterial Adriamycin and hepatic artery ligation in suppressing tumour glucose oxidative metabolism. These results imply that Norcantharidin may have a role to play in the chemotherapy ofprimary livercancer.
Laparoscopic vs Open Ultrasound of the Liver: An in vitro Study
Authors: Cozzi P. J. , McCall J. L. , Jorgensen J. O. , Morris D. L.
Published: September 2007

Intra‐operative contact ultrasound is a sensitive method of detecting liver tumours. The aim of this study was to compare the sensitivity of open contact ultrasound (OUS) of the liver with laparoscopic contact ultrasound (LUS). Hypoechoic “lesions” were created in 5 fresh pig livers by inserting 28 grapes via small incisions in the inferior surface. The size (range 8–25 mm) and location of each grape was recorded. Scanning was undertaken in random order by two experienced independent observers with no knowledge of the size, number or position of the lesions, using an Aloka 650 series scanner and 7.5 MHz probes. The crude sensitivity with OUS was 96% and 100% respectively for the two observers, and 92% for each with LUS. One grape was interpreted as 2 seperate grapes on LUS by one observer. Absolute sensitivity (grapes identified in the correct location) was 86% and 93% respectively with OUS and 79% for each
observer with LUS.

LUS was almost as sensitive as OUS in this model of hepatic metastases.
Gallbladder Bilharziasis
Authors: Bakhotmah Mohamad Abid
Published: September 2007

A 30 years old man presented with symptoms of Bilharziasis. Ultrasound showed gallstones in the
gallbladder which was removed laproscopically, heavy bilharzial infection was detected in the gallbladder
tissue. The first case in Saudi Arabia is reported. A Review of the world literatures since 1966 about the
subject is presented and different aspects of the gallbladder schistosomiasis are discussed.
The Potential Role of Intraoperative Ultrasonography in the Surgical Treatment of Hilar Cholangiocarci noma
Authors: Watanapa P. , Hargrove N. S. , Sirivatanauksorn Y.
Published: September 2007

The role of intraoperative ultrasonography (IOU) in the surgical treatment of hilar cholangiocarcinoma
was explored in twenty‐two patients, 17 males and 5 females. The mean age was
55 years (range 36‐78 years). Preoperative imaging studies included abdominal ultra‐sonography
and/or CT scan, and visceral angiography. Operations performed were segment III
bypass in 18 patients, local resection of tumour in 2 and resection of tumour en bloc with left
hepatectomy in 2. Interpretation of IOU in terms of vascular involvement by the tumour (as
compared to angiography or operative findings) was correct in 21 patients; no vascular invasion
in 20 and portal vein invasion in the remainder. One false negative result occurred in a patient
whose IOU failed to show right hepatic artery encasement by the tumour. When compared to
postoperative cholangiography or surgical specimen, IOU correctly demon‐strated location and
extent of the tumours in all but one patient who had incomplete tumour resection. IOU was also
helpful in locating segment III duct for biliary bypass. The mean time used for IOU was 15.1 min
(range 10‐20 min.), and there was no procedure‐related com‐plication. When supplemented with
operative exploration, IOU seems to be very useful in the assessment of the resectability of hilar
cholangiocarcinoma.
Obstructive Jaundice Associated with Polcystic Liver Disease
Authors: Dmitrewski J. , Olliff S. , Buckels J. A. C.
Published: September 2007

A 65 year old patient with polycystic liver disease presented with obstructive jaundice thought to be a cholangiocarcinoma. Subsequent investigations demonstrated a large cyst compressing the confluence of the hepatic ducts. Percutaneous decompression of the biliary tree led to a complication necessitating surgery. Treatment options for symptomatic polycystic liver disease are reviewed.
The Role of Endotoxaemia in the development of Renal Disorders Experimental Obstructive Jaundice in Rats
Authors: Dawiskiba Janusz
Published: September 2007

In rats with 2‐week obstructive jaundice the sensitivity to endotoxin was studied and the effect of a single dose of endotoxin on histological development in the kidney, liver and spleen was also investigated. We were tested the effect on accumulation and distribution within organs, of fibrinogen labelled with radioactive iodine 125. We showed an increased sensitivity to endotoxin in obstructive jaundice. The cause of death in most rats was acute circulatory failure during the course of endotoxic shock, without clinical features of disseminated intravascular coagulation. In the isotope study, after endotoxin administration there was a specific dynamic increase of fibrinogen accumulation in the kidneys of rats with obstructive jaundice. We proposed, that the cause of the kidney changes during the course of obstructive jaundice could be the local activation of intrarenal coagulation.
Isolated Resection of Segment I (Caudate Lobe): Is it Justified?
Authors: Blumgart Leslie H.
Published: September 2007

Background: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed.

Methods: Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularised by Pringle′s maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava.

Results: Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction.

Conclusions: This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.
Development of Collaterals in Intermittent and Permanent Ischemia of the Liver
Authors: Ok Engin , Yilmaz Zeki , Akgün Erhan , Sözüer Erdoğan M. , Yeşilkaya Yaşar , Öztürk Figen
Published: September 2007

The ischemia caused by hepatic dearterialization as therapy for hepatic malignancies is transient because of the rapid formation of collaterals. In order to prevent this transient repeated ischemia has been suggested.

An experimental study was planned to compare the collateral occurrence in persistent ischemia and transient repeated ischeamia of the liver. Fourteen dogs (seven persistent ischemia, seven transient repeated ischemia) were used in this study. Hepatic dearterialization were performed in both groups. In the first group (persistent ischemia), the hepatic artery was ligated proximal to the gastroduodenal artery. In the second group (transient repeated ischemia), the hepatic artery was occluded externally in the same region as the first group by means of a device modified from 8 guage Foley catheter and after occlusion for one hour it was reopened. Occlusions were repeated twice in a day. Five dogs in the first group and six dogs in the second group completed a three weeks ischemia period and angiography were then performed in all. The dogs were sacrificed after the angiography and examined for possible abscess formation, arterial thrombosis, peritoneal adhesions and liver necrosis. After angiography, the two groups were also examined for collateral occurrence. Only one collateral occurred in the transient repeated ischemia group, but in the persistent ischemia group, collaterals occurred in all dogs. This difference between two groups is statistically significant (Fischer Absolute Chi Square Test, p=0.013).

Transient repeated ischemia is superior to persistent ischemia because of fewer collaterals, but in practise, total dearterialization of the liver is impossible.
Resection Margins for Colorectal Metastases to The Liver: Do They Make A Difference?
Authors: Adams Reid B. , Langer Bernard
Published: September 2007

Objective: The authors determined an appropriate surgical treatment for liver metastases from
colorectal cancers. Clinicopathologic featuresof metastatic lesions of colorectal cancers
were studied.

Summary Background Data: Major hepatic resection is the usual procedure for treatment of hepatic metastases from colorectal cancers.

Methods: Forty consecutive patients who underwent hepatic resections were prospectively studied,
for a total of 89 metastatic liver tumors.

Results: Metastatic tumor often extended along Glisson’s capsule, including invasion to the portal
vein (9 cases), the hepatic vein (3 cases), the bile duct (16 cases), and the nerve (6 cases).
The main tumor had small satellite nodules in only one patient, and there were no
microscopic deposits in the parenchyma, even within 10 mm from the metastatic tumors.
Fibrous pseudocapsule formation was observed in 28 patients.

Discussion: The rarity of intrahepatic metastasis from metastatic tumor supports nonanatomic
limited hepatic resection as the procedure of choice for metastatic colorectal cancer in the
liver. The spread via Glisson′s capsule should be taken into consideration for complete
tumor clearance.
Treatment of a Giant Haemangioma of the Liver With Kasabach‐Merritt Syndrome by Orthotopic Liver Transplant
Authors: Longeville J-H. , Hall P. De La M. , Dolan P. , Holt A. W. , Lillie P. E. , Williams J. A. R. , Padbury R. T. A.
Published: September 2007

We describe a case of giant cavernous haemangioma of the liver with disseminated intravascular coagulopathy (Kasabach‐Merritt syndrome) which was cured by orthotopic liver transplant.

A 47 year old man presented with bleeding and tender massive hepatomegaly after tooth extraction. Investigations showed disseminated intravascular coagulopathy and a giant hepatic haemangioma involving both lobes of the liver. Initial treatment failed to resolve the coagulopathy and liver resection was attempted. At laparotomy the turnout was unresectable and the only option for cure was to offer a liver transplantation. The orthotopic liver transplant was performed 20 days after initial laparotomy. Subsequently, all coagulation parameters returned to normal and the patient remains well after 12 months. Orthotopic liver transplant can be considered for giant hepatic haemangioma with Kasabach‐Merritt syndrome when resection is necessary and a partial hepatectomy is not technically feasible.
Clinical Observation: Congenital Absence of the Left Portal Vein in a Patient Undergoing Hepatic Resection
Authors: Charny C. K. , Ling P. , Botet J. , Blumgart L. H.
Published: September 2007

Congenital absence of the left portal vein is a rare vascular anomaly with a reported prevalence varying from one in 62 to one in 507 cases. A patient admitted for recurrent cholangitis secondary to extensive dilation of the left biliary ductal system associated with Caroli′s Disease was determined by preoperative dynamic CT to have an excessively large right portal vein and no left portal vein. The surgeon must be aware of any variations in portal vascular anatomy in patients undergoing hepatic resection in order to prevent potentially fatal postoperative complications.
Portacaval Shunt for Portal Hypertensive Gastropathy
Authors: Collins John Craig , Sarfeh I. James
Published: September 2007

Portal hypertensive gastropathy is a vascular disorder of the gastric mucosa distinguished by ectasia of the mucosal capillaries and submucosal veins without inflammation. During 1988 to 1993, 12 patients with biopsyproven cirrhosis (10 alcoholic, 2 posthepatitic) were evaluated and treated prospectively by portacaval shunt for active bleeding from severe portal hypertensive gastropathy. Eleven patients had been hospitalized for bleeding three to nine times previously, and one was bleeding uncontrollably for the first time. Requirement for blood transfusions ranged from 11 to 39 units cumulatively, of which 8 to 30 units were required specifically to replace blood lost from portal hypertensive gastropathy. Admission findings were ascites in 9 patients, jaundice in 8, severe muscle wasting in 10, hyperdynamic state in 9. Child′s risk class was C in 7, B in 4, A in 1. Ten of the 12 patients had previously received repetitive endoscopic sclerotherapy for esophageal varices, which has been reported to precipitate portal hypertensive gastropathy. Eight patients had failed propranolol therapy for bleeding. Portacaval shunt was performed emergently in 11 patients and electively in 1, and permanently stopped bleeding in all by reducing the mean portal vein‐inferior vena cava pressure gradient from 251 to 16 mm saline. There were no operative deaths, and two unrelated late deaths after 13 and 24 months. During 1 to 6.75 years of followup, all shunts remained patent by ultrasonography, the gastric mucosa reverted to normal On serial endoscopy, and there was no gastrointestinal bleeding. Recurrent portal‐systemic encephalopathy developed in only 8% of patients. Quality of life was generally good. It is concluded that portacaval shunt provides definitive treatment of bleeding portal hypertensive gastropathy by eliminating the underlying cause, and makes possible prolonged survival with an acceptable quality of life.
Is there a Role for Preoperative Infusion or Intraoperative Cholangiography?
Authors: Lau W. Y. , Li Arthur K. C.
Published: September 2007

Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined.

Study design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC. The patients in the PIC and IOC groups were similar with regard to age, history of biliopancreatic complications, and laboratory findings. The cost of PIC in Sweden is nearly five times greater than the cost of IOC.

Results: Satisfactory opacification of the biliary system was obtained in 90.1 and 96.8 percent of patients who underwent PIC and IOC, respectively. Preoperative infusion cholangiography required support by IOC in 19.5 percent of patients. There were no statistically significant differences between the PIC and IOC groups with regard to the incidence (7 percent in both groups) of or positive predictive value (68 and 80 percent, respectively) for bile duct stones, rate of retained stones (6 and 20 percent, respectively), intraoperative (5.6 and 6.3 percent, respectively) or postoperative (13.3 and 15.9 percent, respectively) morbidity, or incidence of bile duct anomalies (0.9 and 0.3 percent, respectively). Median operative time was longer in .patients with (95 minutes) compared to those without (75 minutes) IOC (p<0.001). More postoperative complications occurred after bile duct exploration (26 of 75 patients) compared to cholecystectomy alone (114 of 917 patients, p<0.001). The 30‐day mortality was zero. Minor bile duct injuries occurred in two patients (0.2 percent) at cholecystectomy, (one with and one without bile duct exploration). In no patient was the cholangiographic finding of a biliary anomaly crucial for the safe execution of cholecystectomy.

Conclusions: In our study, PIC and IOC were comparable, but routine use of either method did not promote the safety of cholecystectomy and thus their routine use is not warranted. The shorter operative time and preoperative identification of common bile duct (CBD) stones provided by PIC might favor this examination when applied selectively in patients with increased risk of having CBD stones. However, this potential advantage is offset by the need for PIC to be supported by IOC in approximately 20 percent of patients. Also, the cost of PIC is greater than the cost of IOC.
Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Choledochal Cysts
Authors: Akkiz Hikmet , Çolakoğlu Salih O. , Ergün Yilmaz , Demiryürek Haluk , Akinoğlu Alper , Tuncer Ïlhan , Özgür Gürsel , Hafta Ali
Published: September 2007

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionaly, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.
Pre‐Liver Transplant: Tips Versus Distal Splenorenal Shunt
Authors: Faust Thomas W. , Sorrell Michael F.
Published: September 2007

Recurrent variceal bleeding in liver transplant candidates with end‐stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT). Endoscopic sclero‐therapy and medical therapy are considered as first‐line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS) has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS). In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients) or DSRS (17 patients) for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child‐Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014) but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001). Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1). We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.
Perspectives in Pancreatic Pain
Authors: Salim A. S.
Published: September 2007

This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.
Collision Tumour of the Ampulla of Vater: Carcinoid and Adenocarcinoma
Authors: Williams I. M. , Williams N. W. , Stock D. , Foster M. E.
Published: September 2007

Obstructive jaundice is most commonly due to luminal stones or lesions of the head of the pancreas and more rarely ampullary and primary common bile duct lesions. Obstruction due to lesions of the ampulla of Vater may be due to adenocarcinoma which has a significantly better long term prognosis than carcinomas located in the head of the pancreas. A case is presented where two tumours were identified at the ampulla of Vater of the resected specimen one an adenocarcinoma and the other a carcinoid tumour representing a collision tumour.
Nonabsorbable Antibiotics Reduce Bacterial and Endotoxin Translocation in Hepatectomised Rats
Authors: Kakkos S. K. , Kirkilesis J. , Scopa C. D. , Arvaniti A. , Alexandrides T. , Vagianos C. E.
Published: September 2007

There is increasing evidence that septic complications, occurring after major hepatectomies, may be caused by gram negative bacteria, translocating from the gut. We investigated in rats, the effect of extended hepatectomy on the structure and morphology of the intestinal mucosa as well as on the translocation of intestinal bacteria and endotoxins. We also examined the effect of nonabsorbable antibiotics on reducing the intestinal flora and consequently the phenomenon of translocation by administering neomycin sulphate and cefazoline. Hepatectomy was found to increase translocation, while administration of nonabsorbable antibiotics decreased it significantly. In addition, hepatectomy increased the aerobic cecal bacterial population, which normalised in the group receiving antibiotics. Among the histological parameters evaluated, villus height demonstrated a significant reduction after hepatectomy, while the number of villi per cm and the number of mitoses per crypt, remained unchanged. Our results indicate that administration of nonabsorbable antibiotics presents a positive effect on bacterial and endotoxin translocation after extended hepatectomy, and this may be related to reduction of colonic bacterial load as an intraluminal effect of antibiotics.
Symptomatic Giant Cavernous Haemangioma of the Liver: Is Enucleation a Safe Method?
Authors: Demiryürek H. , Alabaz Ö. , Ağdemir D. , Sungur I. , Erkoçak E. U. , Akinoğlu A. , Alparslan A. , Źorludemir S.
Published: September 2007

Twenty‐three patients with symptomatic giant hemangioma of the liver were treated by surgery between 1979 and 1996 at the department of General Surgery, Faculty of Medicine, University of Çukurova. Twenty‐three enucleations were performed in 21 patients, left lateral segmentectomy in one patient and enucleation plus left lobectomy in one patient. The tumors were enucleated along the interface between the hemangioma and normal liver tissue. The diameters of the tumors ranged from 5×5 to 25×15 cm. The mean blood loss for enucleations was 525 ml (range 500–1000 ml). There was no mortality and no postoperative bleeding. Three patients had postoperative complications. Enucleation is the best surgical technique for symptomatic giant hemangioma of the liver. It may be performed with no mortality, low morbidity and the preservation of all normal liver parenchyma.
Solid and Cystic Tumor (SCT) of the Pancreas in an Adult Man
Authors: Ohiwa K. , Igarashi M. , Nagasue N. , Nagasaki M. , Harada T.
Published: September 2007

Solid and cystic tumor (SCT) of the pancreas predominantly Occurs in women, and the occurrence in men is extremely rare. We experienced a male case of SCT. A 38‐year‐old man was admitted with the complaint of upper abdominal pain. CT scan showed the presence of a mass in the head of the pancreas. The mass was composed of high density areas and low density areas. Ultrasonograms revealed the mass being composed of high echoic areas and low echoic areas. The mass .was hypovascular on angiography. SCT was suspected and pancreaticoduodenectomy was performed. The cut surface of the tumor showed mainly cystic degenerative areas containing dark red hemorrhagic materials. Microscopically, there were solid areas in the periphery and pseudopapillary areas in the center. No metastasis was found in the removed lymph nodes. The tumor cells were not stained by Grimelius′ silver stain. The tumor cells were positive for alpha‐l‐antitrypsin (AAT) and neuron‐specific enolase (NSE). Pancreatic hormones such as insulin, glucagon, and somatostatin were all negative. Electron micrograph showed that tumor cells were rich in mitochondria. Zymogen granules and neurosecretory granules were not detected. Estrogen receptor (ER) and progesterone receptor (PR) were both negative.
Is There a Role for Perioperative Nutritional Support in Liver Resection?
Authors: Bothe Albert , Steele Glenn
Published: September 2007

Background: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma.

Methods: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty‐four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched chain amino acids, dextrose, and lipid emulsion (50 percent medium‐chain trigylcerides) given intravenously for 14 days perioperatively).

Results: There was a reduction in the overall postoperative morbidity rate in the perioperative‐nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg; P=0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (–2.8 percent vs. –4.8 percent at 20 minutes, P=0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatechtomy. There were five deaths during hospitalization in the perioperativenutrition group, and nine in the control group (P not significant).

Conclusions: Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.
Haemoperitoneurn Secondary to Rupture of Retroperitoneal Variceal
Authors: Molina-Perez M. , Rodriguez-Moreno F. , Gonzalez-Reimers E. , Perez-Palma J. , Santolaria-Fernandez F. , Essardas-Daryanani H. , Martinez-Riera A.
Published: September 2007

A 45‐year‐old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl), and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.
ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection
Authors: Kitano Seigo , Kim Yang-II
Published: September 2007

Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.

Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child′s A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.

Setting: A tertiary referral center.

Patients: The preoperative, intraoperative, and post‐operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.

Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.

Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.

Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.
The Role of Laparoscopy and Ultrasonography in Pancreatic Head Carcinoma
Authors: Beger Hans G. , Schoenberg Michael H.
Published: September 2007

Objective: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with
carcinomas of the pancreatic head and periampullary region.

Summary Background Data: Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy.

Methods: A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region).

Results: “Occult” metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively).

Conclusions: Staging laparoscopy is indispensable in the detection of “occult” intraabdominal metastases. Laparoscopic ultrasonography improves the accuracy of laparoscopic staging in patients with potentially resectable pancreatic and periampullary carcinomas.
Can Small Hepatocellular Carcinoma be Cured by Percutaneous Acetic Acid Injection Therapy?
Authors: Fan S.-T.
Published: September 2007

To assess the efficacy of ultrasound (US)‐guided percutaneous acetic acid (in concentrations of 15%, 20%, 30%, 40%, and 50%) injection for small hepatocellular carcinomas (HCCs) for long‐term prognosis, percutaneous acetic acid injection using 15% to 50% acetic acid was performed in 91 patients with one to four HCCs smaller than 3 cm during the past 6.5 years. During the series of treatment sessions for each patient, the same concentration of acetic acid was used. All tumors could be treated successfully with percutaneous acetic acid injection despite the differences in acetic acid concentration used. The number of treatment sessions to treat similar size of tumor was less when the higher concentration of acetic acid was used. No serious complications occurred as a direct sequela to percutaneous acetic acid injection. None of the tumor treated regrew. The 1‐, 2‐, 3‐, 4‐, and 5‐year survival rates for 91 patients were 95%, 87%, 80%, 63%, and 49%, respectively. The 1‐, 2‐, 3‐, 4‐, and 5‐year cancer‐free survival rates of these patients were 83%, 54%, 50%, 37%, and 29%, respectively. Both liver function and size of tumor affected both survival rate and cancer‐free survival rate significantly, but the number of tumors did not. The concentration of acetic acid did not affect the survival rate. Percutaneous acetic acid using 15% to 50% acetic acid will be effective therapy for small HCCs for long‐term prognosis.
Nesidioblastosis in the Adult Surgical Management
Authors: Garcia J. Palla , França Teresa , Pedroso Consiglieri , Cardoso Carlos , Cid M′Olímpia
Published: September 2007

Nesidioblastosis is an exceedingly rare occurrence in the adult and, when it appears, it is usually part of a MEA1 syndrome.

We present a case of nesidioblastosis in a young woman, with no concurrent endocrine pathology, while we discuss in detail the diagnostic and therapeutic problems posed by this condition.

The selected treatment was sub‐total pancreatectomy (70–80%) and the histopathologic and immunohistochemical tests of the surgical specimen showed: “Diffuse Nesidioblastosis”.

The histopathologic and immuno‐histochemical features of the resected pancreas are analysed in detail.
Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients
Authors: Rohde Luiz , da Costa Mário Sérgio Borges , Wendt Luis Roberto , Corleta Oly , Ferreira Marcelo
Published: September 2007

The authors report their experience with surgical treatment of 39 patients with biliary strictures of iatrogenic origin. Patients were grouped according to the level of obstruction as described by Bismuth, and the type of repair was based on this classification. A total of 45 operations were performed, including those for recurrent strictures: 22 hepaticojejunostomies, 10 Hepp and Couinad′s operations, 6 choledochojejunostomies, 3 separate right and left hepaticojejunostomies, 1 hepaticojejunostomy with mucosal graft (Smith′s technique), 1 intrahepatic cholangiojejunostomy (Longmire′s technique), 1 choledochoduodenostomy and 1 choledochoplasty. Results were considered good if the patient was free of symptoms, jaundice or episodes of cholangitis, with serum alkaline phosphatase less than two‐times the normal value. Minimum follow‐up period of two years (obtained in 35 patients) was required to evaluate the results. Good results were obtained in 26 of those 30 patients (87%) who underwent only one biliary reconstruction, and in 3 of those 5 (60%) with more than one repair. Overall, 29 patients (83% of those 35) presented good results. The complexity of the surgical treatment of biliary strictures imposes the adoption of measures to prevent lesions to the bile duct. Factors related to the prognosis that must be emphasized are surgeonsa′ individual experience and skills, location of the stricture and diameter of the anastomosis.