bluuebunny/crossref_metadata_2025 huggingface dataset:
Juxtacaval Liver Resections with the Use of an Internal IVC Shunt Tube
Authors: Shimamura Yoshiyuki , Gunvén Peter , Ishii Masanori , Hasegawa Hiroshi
Published: September 2007

Almost one tenth of more than 370 hepatectomies, mostly for tumors, involved resection of major parts of
the caudate lobe, subsegment 1. Five of them were for tumors or hemangiomas here, compressing or
invading the vena cava; two were for metastases of colorectal cancer located very close to the junctions of the
right and middle hepatic veins with the vena cava. We would previously have deemed these tumors
unresectable. In these patients the vein was banded above and below the liver, an internal shunt tube placed
in preparation for shunting of blood, and the afferent liver blood flow controlled. Control of the vena cava
by tightening of the bands was needed in two cases. Tumor‐invaded parts of the vein wall were resected in
two other cases, in whom the presence of the tube facilitated the resection but the bands did not have to be
tightened. The procedure did not cause morbidity and we conclude that tumors close to the vena cava can
often be resected without complex vascular exclusion techniques, even when they invade the vein.
The Value of Routine Biochemical Tests in Discriminating Between Malignant and Benign Pancreatic Tumours
Authors: Athlin L. , Blind P-J , Eriksson S.
Published: September 2007

The probability that routine hematological laboratory tests of liver and pancreatic function can
discriminate between malignant and benign pancreatic tumours, incidentally detected during operation,
was investigated. The records of 53 patients with a verified diagnosis of pancreatic carcinoma and 19
patients with chronic pancreatitis were reviewed with regard to preoperative total bilirubin, direct
reacting bilirubin, alkaline phosphatase, glutamyltranspeptidase, aminotransferases, lactic dehydrogenase
and amylase. Multivariate and discriminant analysis were performed to calculate the predictive
value for cancer, using SYSTAT statistical package in a Macintosh II computer. Total and direct
reacting bilirubin and glutamyltranspeptidase were significantly higher in patients with pancreatic
carcinoma. However, only considerably increased levels of direct reating bilirubin were predictive of
pancreatic carcinoma.
Selective Variceal Decompression: Current Status
Authors: Jin Gongliang , Rikkers Layton F.
Published: September 2007

Since its introduction into clinical practice in 1967, selective variceal decompression by means of a distal
splenorenal shunt (DSRS) has become one of the more commonly performed portal‐systemic shunting
procedures in the treatment of variceal hemorrhage throughout the world. In addition to selective
decompression of gastroesophageal varices, the DSRS provides the advantages of preservation of portal
perfusion of the liver and maintenance of intestinal venous hypertension. Many large, uncontrolled
series and the majority of controlled randomized studies have demonstrated a lower incidence of
encephalopathy after the DSRS than after nonselective shunt procedures. A secondary advantage of the
DSRS is that the hepatic hilum is avoided, thus making subsequent liver transplantation a less
formidable procedure. None of the studies have shown an advantage to this shunt with respect to longterm
survival in patients with alcoholic cirrhosis. However, some of the large, uncontrolled series have
shown that survival is significantly improved in patients with non‐alcoholic cirrhosis compared to
nonselective shunt procedures in the same population. Controlled trials comparing the DSRS to
endoscopic sclerotherapy have shown that chronic endoscopic variceal sclerosis is an appropriate initial
therapy for most patients as long as shunt surgery is readily available if sclerotherapy fails.
Distribution and Effect of Galanin on Gallbladder and Sphincter of Oddi Motility in the Pig
Authors: Harling Henrik , Messell Tina , Jensen Steen Lindkaer , Poulsen Steen Seier
Published: September 2007

This study was designed to determine the occurrence and topographical distribution of galanin‐like immunoreactivity (GAL‐LI) in the porcine gallbladder and sphincter of Oddi and to investigate the pharmacologic effect of GAL on gallbladder and sphincter of Oddi motility. By radioimmunoassay the concentration of GAL‐LI in the gallbladder was 2.75 ± 0.23, 9.73 ± 1.33 in the common bile duct and 5.10 ± 0.37 in the sphincter of Oddi (pmol/g ± SE). By immunohistochemistry GAL‐LI was found exclusively in ganglionic cells and in nerve fibers among the smooth muscle bundles. Gallbladder and sphincter of Oddi pressures were recorded before and during 5‐minute local intraarterial infusion of 4, 8, 19, 39, 78 and 194 ng GAL‐Kg-1‐min-1 in 12 anaesthetized pigs. GAL in doses ≥ 39 ng.kg-1.min-1 significantly reduced sphincter of Oddi phasic wave frequency (4.8 ± 0.4 vs. 2.1 ± 0.5; p = 0.004) and sphincter of Oddi motility index (70.2 ± 6.02 vs. 27.7 ± 8.3; p = 0.002) but did not affect gallbladder pressure. We conclude that the distribution of GAL‐LI in the sphincter of Oddi and the effect that a pharmacologic dose of GAL has on sphincter of Oddi motor activity, suggests that GAL may be involved in the physiologic control of bile flow in the pig.
Pancreatic Stromal Tumor of Nerve Sheath Origin Treated by Pancreatoduodenectomy
Authors: Pereira-Lima L. , Kalil A. N. , Furian M. B.
Published: September 2007

A pancreatic sarcoma of nerve sheath origin is reported in a 28‐year‐old female patient, who presented
with melaena. Preoperative imaging showed an 8.5 cm diameter mass in the head of pancreas. There
was bleeding from the papilla of Vater at endoscopy and a highly vascular lesion on arteriography. The
patient was submitted to proximal pancreatoduodenectomy and remains symptom‐free at 1 year follow‐up.
Clinical Evaluation of Tumour Marker Combinations in the Differential Diagnosis of Benign and Malignant Liver Disease
Authors: Lucarotti M. E. , Rothnie N. D. , Kelly S. B. , Hershman M. J. , Johanssen C. , Nilsson O. , Lindholm L. , Wood C. B. , Williamson R. C. N. , Habib N. A.
Published: September 2007

CEA, CA19‐9 and CA50 are tumour associated antigens defined by monoclonal antibodies which have
been raised against adenocarcinoma cell lines. The aim of this study was to determine whether their
combined use could improve diagnostic accuracy in patients with primary and secondary liver tumours.
An immunoradiometric assay was used for the detection of CEA and CA19‐9 and the Delfia system for
CA50. Serum was collected from 65 normal subjects, 40 with hepatobiliary carcinoma (26 primary, 14
secondary) and 17 with benign hepatobiliary disease. The cut‐off levels were calculated as the mean of
the control group plus 2 standard deviations. All three antibodies contributed to improving the correct
classification of secondary liver tumours (multivariant discriminant analysis p<0.05), but only CA19‐9
and CA50 contributed to the diagnosis of primary liver tumours (multivariant analysis p<0.05). The
diagnostic accuracy versus benign disease was 81% for primary carcinoma and 91% for secondary
carcinoma. Combined use of CEA, CA19‐9 and CA50 helps to differentiate benign from malignant
hepatobiliary disease.
Are Child′s Class C Patients With Acute Variceal Bleeding Worth Treating?
Authors: Johnston G. W. , Spencer E. F. A. , Mullan F. J.
Published: September 2007

In the ten year period January 1980 to December 1989, 102 patients with Child’s Class C liver disease
(Pugh′s Modification) were admitted with acute variceal bleeding to one surgical unit with a policy of
early sclerotherapy. There were 56 males and 46 females; the average age was 55 years (range 28–77).
Fifty‐three suffered from alcoholic cirrhosis. Four died before definitive treatment could be carried out,
three from liver failure and one from uncontrolled bleeding. Of the remaining 98 patients, eight had
urgent oesophageal transection with three deaths from hepatorenal failure; 90 had sclerotherapy with 19
hospital deaths, nine from recurrent bleeding, eight from liver failure often coupled with renal failure
and two from respiratory complications. Of the 76 who survived to leave hospital, 52 received chronic
injection sclerotherapy, 10 had elective oesophageal transection and 14 did not have further elective
intervention for various reasons. Surviving patients have been followed up at a special Liver Clinic with
minimum follow up of one year. Although no patient has yet survived ten years, the one, five and eight
year survivals of 50%, 21% and 13% suggest that salvage of thdse patients is worthwhile.
Pylorus‐Preserving Pancreatoduodenectomy. Experience in 20 Patients
Authors: Lerut J. , Luder P. J. , Krähenbiühl L. , Gertsch P. H. , Blumgart L. H.
Published: September 2007

Twenty patients underwent a pylorus‐preserving pancreatoduodenectomy for benign or malignant
periampullary and pancreatic disease. Eighteen patients had a partial and two patients a total
pancreatectomy. There were 19 elective and 1 emergency operations.

Post‐operative mortality was 4% (1/20 patients) and the median follow up was 31 months (range, 15–
75 months), during which period 8 patients with a malignant disease died.

Pylorus‐preserving pancreatoduodenectomy did not compromise survival in ampullary cancer.

One patient developed a marginal ulcer during the study period and one of twelve patients, examined
by technetium scintigraphy (done more than 3 months after the procedure), had delayed gastric
emptying. Two patients presented with a gastric retention as the first sign of recurrent pancreatic cancer.

The result of the operation was judged as excellent in 7 patients, good in 8 and as bad in only 2 of the
17 patients who survived more than 6 months . Body weight was studied in 15 patients surviving more
than one year after operation; five patients had gained weight, two had lost weight and in 8 there was no
difference.

Pylorus‐preserving pancreatoduodenectomy seems to be a valuable alternative in the treatment of
patients with benign and selected malignant pancreaticobiliary disease.
Hepatic Surgery Facilitated by a New Jet Dissector
Authors: Baer H. U. , Maddern G. J. , Blumgart L. H.
Published: September 2007

Increasing experience with major hepatic resections has stimulated the development of improved
resectional techniques and tools. A new high velocity water jet dissector is reported which offers
significant advances over previously developed ultrasonic and low pressure water jet machines. It has
been successfully used in 8 major hepatic resections with minimal blood loss, excellent visibility and
without complications. The dissector is also of value in the exposure of intrahepatic bile ducts for biliaryenteric
anastomosis.
Impact of the CUSA and Operative Ultrasound on Hepatic Resection
Authors: Little J. M. , Hollands M. J.
Published: September 2007

New technologies have been developed for liver surgery, and, like all new technologies, they have a glamour which makes them seem desirable. There is an understanding abroad that they make liver surgery easier and open up the field to those without special training. But there is no proof that the new devices are in any way cost‐effective, and certainly no proof that liver surgery has become safer since their advent. Fifty consecutive elective liver resections have been studied, almost half performed with the aid of the ultrasonic dissector and aspirator and diagnostic intraoperative ultrasound. There was no mortality in the whole group, but a 24% morbidity. Operative diagnostic ultrasound was thought to allow more precise planning of surgery. Its use was not associated with any increase in operative time, nor was there any increase in postoperative morbidity. The ultrasonic dissector and aspirator improved technique, reflected in a lower blood loss for each case, in fewer transfusions required, in a shorter postoperative hospital stay and in an ability to achieve these benefits in older patients. Neither device could be said to offer an entree to instant liver surgery. The use of the two devices apparently offered savings measured by a fall in the median postoperative hospital stay of 4.5 days, by a saving of 700 mls in median blood requirement and by a fall in transfusion rate from 64% to 9%.
Primary Leiomyosarcoma of the Liver
Authors: Paraskevopoulos J. A. , Stephenson T. J. , Dennison A. R.
Published: September 2007

A case of primary leiomyosarcoma of the liver is described and the problems in diagnosis and
management are discussed together with a review of the available literature. These tumours have a
favourable prognosis when diagnosed preoperatively and the value of electron microscopic findings in
this situation are highlighted.
The Effect of Incomplete Bile Duct Obstruction on Diisopropanolnitrosamine—Induced Cholangiocarcinoma
Authors: Kinami Yoshio , Ashida Yoshinao , Seto Keitaro , Takashima Shigeki , Kita Ichiro
Published: September 2007

This study was carried out to clarify the influence of incomplete bile duct obstruction (IBDO) on the occurrence and proliferation of cholangiocarcinoma and to evaluate the effect of release of IBDO at an early stage, using 175 Syrian golden hamsters. These hamsters received 500mg/kg body weight of diisopropanolnitrosamine (DIPN) once weekly for 10 weeks, and then were divided into 3 groups, consisting of the simple laparotomy group (SL group), the IBDO group and 2 week IBDO group, in which IBDO was released after 2 weeks. The occurrence rates of cholangiocarcinoma at 20 weeks were 42% in the SL group, 76% in the IBDO group and 30% in the 2 week IBDO group. The mean numbers of tumors per hamster in the IBDO group were significantly greater than those in other groups (p < 0.05). Both occurrence rates and numbers of tumors in the 2 week IBDO group were similar to those in the SL group. The proliferation of bile ductules and isolation of bacteria from bile in the IBDO group had higher rates at 15, 20 weeks than those found in the other groups. These results suggest that IBDO has an influence, as promoter, on the occurrence of cholangiocarcinoma induced by DIPN, and the disappearance of its promoting effect is caused by release of the obstruction.
Chronic Rejection and Extrahepatic Biliary Tract Obstruction 8 Years After Orthotopic Liver Transplantation Using the Gallbladder‐Conduit Technique
Authors: Lerut J. , Zimmermann A. , Gertsch Ph. , Preisig R. , Blumgart L. H.
Published: September 2007

A case of delayed biliary obstruction and cholangitis, occurring in the setting of chronic allograft
rejection, 8 years after liver transplantation using the gallbladder‐conduit, is presented. Extrahepatic
biliary obstruction may be seen in the late follow‐up of liver grafting and rejection phenomena may play
a significant role in the development of such obstruction.
Short Intussusception Valves Prevent Reflux After Jejunal Interposition Bilioduodenal Anastomosis
Authors: Xunyang Liu , Shu Liu , Lirong Shen , Aiyin Pan , Jifang Wen , Shisui Zhang , Ming Han , Stiegmann G. V.
Published: September 2007

Short whole circumference and semi‐circumference intussusception valves were created in interposition
cholecysto‐jejunal‐duodenal conduits in pigs to determine which method best prevented gastrointestinal
reflux into the biliary tract. Following intravenous injection of 99 mTc‐HIDA the time interval for its
excretion from the liver and appearance in the duodenum was not different in either whole or semi‐circumference
valve animals or in controls without valves. After intragastric administration of 99 mTc‐DTPA the relative radioactivity of gallbladder contents (reflux) in the cohort without valves was
significantly higher than in both cohorts with valves. Animals with semi‐circumferential valves in turn
had significantly higher levels of nuclide than those with whole circumference valves. Reflux was
observed grossly in 100% of animals without valves, in 20% of those with semi‐circumference valves,
and in no animals with whole circumference valves. This study indicates that both Whole and semi‐circumference
intussusception valves placed in jejunal biliary conduits allow unimpeded flow of bile into
the gastrointestinal tract. Whole circumference valves are more effective for prevention of reflux than
semi‐circumferential valves.
Chronic Obstructive Pancreatitis as a Delayed Complication of Pancreatic Trauma
Authors: Bradley Edward L.
Published: September 2007

Increasing surgical experience with the immediate consequences of pancreatic injuries has resulted from
parallel growth in the volume of motor vehicle accidents and societal violence. However, few surgeons
are aware that complications may be considerably delayed following pancreatic trauma, occurring in
some cases months to years after apparent recovery from the original injury. In four patients with blunt
pancreatic trauma initially treated by non‐operative means, stricture of the main pancreatic duct
developed over a period of months as a result of progressive fibrosis at the site of ductal injury.
Pancreatic duct hypertension was demonstrated to be present in the obstructed duct, and secondary
changes of chronic pancreatitis developed in the obstructed segment of the gland (“upstream” chronic
pancreatitis). Seven similar patients with delayed onset of chronic obstructive pancreatitis after
pancreatic trauma were found in the literature. Symptoms related to these acquired ductal strictures are
most commonly those of abdominal pain and recurrent episodes of acute pancreatitis. Recognition of
post‐traumatic chronic obstructive pancreatitis principally involves awareness that injuries to the
pancreatic duct can produce remote complications. Pancreatoenteric drainage, or resection of the
obstructed segment of pancreas, provides prompt and effective relief.
Biliary Stricture Following Hepatic Resection
Authors: Matthews Jeffrey B. , Gertsch Philippe , Baer Hans U. , Schweizer Walter P. , Blumgart Leslie H.
Published: September 2007

Anatomic distortion and displacement of hilar structures due to liver lobe atrophy and hypertrophy occasionally complicates the surgical approach for biliary stricture repair. Benign biliary stricture following hepatic resection deserves special consideration in this regard because the inevitable hypertrophy of the residual liver causes marked rotation and displacement of the hepatic hilum that if not anticipated may render exposure for repair difficult and dangerous. Three patients with biliary stricture after hepatectomy illustrate the influence of hepatic regeneration on attempts at subsequent stricture repair. Following left hepatectomy, hypertrophy of the right and caudate lobes causes an anteromedial rotation and displacement of the portal structures. After right hepatectomy, the rotation is posterolateral, and a thoracoabdominal approach may be necessary for adequate exposure. Radiographs obtained in the standard anteroposterior projection may be deceptive, and lateral views are recommended to aid in operative planning.
The Possible Role of Sphincteroplasty and Surgical Sphincterotomy in the Pathogenesis of Recurrent Common Duct Brown Stones
Authors: Cetta Francesco
Published: September 2007

The hypothesis has been tested that postcholecystectomy common duct stones of the brown subtype are
a consequence of three factors: bile infection, old age and previous sphincterotomy. It was found that:
(i) 27 of 39 consecutive patients with recurrent common duct stones had brown stones. Nineteen of these
27 patients (70.3%) had previous sphincterotomy or sphincteroplasty: (ii) six of 15 patients with stone
and bile analysis both at the time of cholecystectomy and at the second operation and who had sterile
operative bile and non brown stones at the first operation, formed brown stones after T‐tube drainage
and after the onset of bile infection; (iii) patients with both intra and postoperative negative bile culture
(n = 39 out of 137) had a lower mean age (50.5 years) and less frequently had a sphincterotomy than did
individuals with a negative culture at operation, who subsequently had bile infection (n = 37; mean age
58.5 years; sphincterotomy in 88.8% of cases).

In addition, in a follow up study of 105 patients with sphincterotomy and with sphincteroplasty
(including ERCP or i.v. cholangiography in all cases), mean follow‐up interval 6.1 years, 11.3 % of
patients had brown recurrent common duct stones.

It is suggested that, since brown recurrent common duct stones are secondary to bile stasis and
infection and the duodenum is going to be colonized by bacteria with increasing age, sphincterotomy
(and subsequent stricture), facilitating bile contamination and bacterial overgrowth, could be one of the
major determinants of brown recurrent common duct stones (RCS) formation. In particular, more than
11% of the patients with a sphincterotomy are going to form in the future RCS of the brown subtype.
Primary Carcinoma of the Gallbladder
Authors: Paraskevopoulos John A. , Dennison Ashley R. , Johnson Alan G.
Published: September 2007

Carcinoma of the gallbladder is a relatively rare malignancy which is difficult to diagnose. The advent of
improved imaging methods and the expansion of interventional radiology however, combined with
advances in surgical technique, has produced a change in attitude towards this tumour. The available
world literature since 1960 has been reviewed and is presented in this article. However, whilst the
outlook for diagnosis and treatment is improving, clearly the association with cholelithiasis (between
45% and 100%), is a cause for concern particularly with the advent of treatments (lithotripsy,
percutaneous gallstone extraction) which leave gall bladder mucosa and residual fragments of stone in situ
.
Hepatic Dystychoma: A Five Year Experience
Authors: Little J. M. , Richardson Arthur , Tait Noel
Published: September 2007

In 5 years, 64 solid hepatic lesions have been referred for diagnosis and management which have been
found unexpectedly on organ imaging in well patients. We have called this lesion a “dystychoma”.

Patients have undergone a two phase investigation programme which allows a diagnosis without
admission to hospital in about 50% of cases. About three quarters of patients (47/64) have had nonneoplastic
lesions, and about half (33/64) have had haemangiomas. About one patient in four (17/64) has
had a neoplasm, and the neoplasm has been malignant in about one in six (11/64) of all patients.

We stress the need to pursue the diagnosis in these patients. There were no reliable clinical,
biochemical or imaging characteristics which individually distinguished benign from malignant lesions.
Age over 55 years, an enlarged liver or a palpable liver mass and a raised serum alkaline phosphatase
were all significantly more frequent with malignant tumours. The risk of malignancy rose with the
number of risk factors, and all patients with all three risk factors had malignant tumours.

Only 11 of the 64 patients were judged to have benefited by significant increase in quality or quantity
of life as a result of what was frequently inappropriate organ imaging. There is no strong argument for
replacing history taking and physical examination by CT scanning, ultrasound examination or other
organ imaging.
Infections Following Orthotopic Liver Transplantation
Authors: Arnow Paul M.
Published: September 2007

The epidemiology of infections associated with orthotopic liver transplantation is summarized herein, and approaches to prophylaxis are outlined. Infection is a major complication following orthotopic liver transplantation, and more than half of transplant recipients develop at least one infection. The risk of infection is highest in the first month after transplantation, and the most common pathogens are bacteria and cytomegalovirus (CMV). Bacterial infections usually occur in the first month, arise in the abdomen, and are caused by aerobes. The peak incidence of CMV infection is late in the first month and early in the second month after transplantationn. CMV syndromes include fever and neutropenia, hepatitis, pneumonitis, gut ulceration, and disseminated infection. Other significant problems are Candida intraabdominal infection, Herpes simplex mucocutaneous infection or hepatitis, adenovirus hepatitis, and Pneumocystis carinii pneumonia.

Prophylaxis of infection in liver transplant recipients has not been well‐studied. Several different regimens of parenteral, oral absorbable, and/or oral non‐absorbable antibiotics active against bacteria and yeast have been used at various centers, but no randomized controlled trials have been conducted. Selective bowel decontamination appears to be a promising approach to the prevention of bacterial and Candida infections, while oral acyclovir may be a relatively convenient and effective agent for CMV prophylaxis.
Duodeno‐Jejunal Varicosities Following Extrahepatic Portal Vein Thrombosis
Authors: Varsamidakis Nick , Davidson Brian R. , Hobbs Kenneth
Published: September 2007

A 31 year old man, under investigation for melena, was found at endoscopy to have varicosities at the
site of a duodeno‐jejunostomy which had been performed for duodenal atresia when he was three days
old. Angiography revealed an occluded portal vein with an extensive collateral circulation. At
laparotomy some of the collateral vessels were found to pass through the anastomotic site and directly
into the left lobe of the liver. The portal pressure was found to be minimally elevated. Resection of the
anastomotic segment was performed with reconstruction using a Roux en Y jejunal loop. Bleeding from
collateral vessels passing through an anastomosis site in a patient with extrahepatic portal vein
thrombosis has not previously been reported.
Hepatic Focal Nodular Hyperplasia: A Benign Incidentaloma or a Marker of Serious Hepatic Disease?
Authors: Muguti G. , Tait N. , Richardson A. , Little J. M.
Published: September 2007

Amongst 17 patients with hepatic focal nodular hyperplasia (FNH) encountered at Westmead Hospital
between 1981 and 1990, FNH was found in association with hepatocellular carcinoma (HCC) in three (3/
17), one male and two females, one of whom also had peliosis and an hepatic adenoma. FNH was also
found in association with other conditions which may affect hepatic function, structure or circulation,
including chronic obstructive airways disease (2), congestive cardiomyopathy (1), chronic active
hepatitis (1), granulomatous hepatitis (1), coeliac artery stenosis (1) and metastatic malignant melanoma
(1).
This report, derived from our experience with FNH over 10 years draws attention to a possible link
between FNH, hepatic malignancy and conditions which may disturb the hepatic circulation. We suggest
that patients with FNH should be investigated thoroughly and an aggressive management policy should
be adopted.
Erosive Gastritis and Portal Hypertension
Authors: Geraghty J. G. , Angerson W. J. , Carter D. C.
Published: September 2007

There is conflicting evidence concerning the effects of portal hypertension on the gastric mucosa. This
paper summarises the histological and haemodynamic alterations which are present in both human and
experimental portal hypertension. Despite the fact that histological studies suggests that the gastric
mucosa is an oedematous plethoric structure in portal hypertension, haemodynamic studies show that
gastric mucosal blood glow is at least maintained if not increased in portal hypertension. The term
“active” rather than “passive” congestion is a more appropriate description of the basic change present
in the gastric mucosa in portal hypertension.
Acute Calculous Cholecystitis: What is new in diagnosis and therapy?
Authors: Gouma Dirk J. , Obertop Huug
Published: September 2007

The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.
Arterioportal Fistulas (APF) in Liver Tumors: Prognosis in Relation to Treatment
Authors: Granov Anatoly M. , Tarazov Pavel G. , Ryzhkov Vladimir K.
Published: September 2007

Prognosis of 16 patients with hepatic tumors and angiographically proven arterioportal fistulas was
analysed in relation to treatment. Six patients received only conservative therapy; they all died of
variceal bleeding in the course of two months after angiography. Hepatic resection was performed in
four patients; three of them are still alive 13–52 months later including two free of both the tumor and
portal hypertension. Hepatic artery embolization was carried out in six patients. All of them died in 2–36 months after the procedure, but only two from gastroesophageal hemorrhage. It is concluded that prognosis of arterioportal fistulae in liver neoplasms is poor due to hyperkinetic
portal hypertension and following variceal bleeding. Hepatic resection of both the tumor and the fistula
is the treatment of choice. In unresectable cases hepatic artery embolization will decrease the risk of
variceal hemorrhage.
Partial Pancreaticoduodenectomy (Whipple Procedure) for Pancreatic Malignancy: Occlusion of a Non-Anastomosed Pancreatic Stump With Fibrin Sealant
Authors: Marczell Arthur P. , Stierer Michael
Published: September 2007

Following partial pancreaticoduodenectomy for periampullary and pancreatic cancer, the complication
and mortality rates are particularly high. Various approaches have aimed at improving the postoperative
result, with less than complete success. The discouraging results of others, and our own dissatisfaction,
led us to evaluate an atraumatic, sutureless method for management of the residual gland. Following
head resection, the remaining pancreas is occluded with a fibrin sealant (Tisseel c, Immuno AG,
Vienna) via injection into the pancreatic duct, which is then ligated and left free in the peritoneal cavity.
Among 44 patients treated with this method, there were no perioperative deaths. Three patients
developed local complications (2 fistulae, 1 pancreatitis) due to technical errors that presumably resulted
in incomplete occlusion. Evaluation of patients after two to three years indicates that the endocrine
function of the pancreas has been largely conserved despite ductal occlusion.
Tumours of Oddi: Diagnosis and Surgical Treatment
Authors: Nordlinger B. , Jeppsson B. , El-Khoury W. , Hannoun L. , Frileux P. , Huguet C. , Malafosse M. , Parc R.
Published: September 2007

A retrospective review of 56 patients operated upon for tumours of Oddi was performed in order to
determine optimal diagnostic and therapeutic procedures.
Common presenting symptoms were jaundice (86%) and anemia (21%). Mean size of the tumour was
2.3 cm. Five tumours were benign and 51 were malignant. According to the classification of Martin, five
were grade I: 10 grade II; 18 grade III; and 18 grade IV. Forty‐seven patients underwent resection of the
tumour: three local excisions for small benign tumors, six ampullectomies (followed in three by a
Whipples’ procedure for recurrence) and 41 Whipples’ procedures. The hospital mortality was 5.3%,
minor complications appeared in 21%.
The overall five years survival was 41%. It was 75% in grade I, 50% in grade II, 40% in grade III and
10% in grade IV. The patients who received ampullectomies were alive with a follow‐up of one, two and
three years. All patients operated upon for a benign tumour were alive except one who died of cardiac
failure. Ultrasonography and duodenoscopy are the most useful tests for the diagnosis of tumours of
Oddi. Prognosis depends on the degree of infiltration of the duodenal wall and the presence of positive
lymph nodes. Whipples’ procedure is best but ampullectomy can be used in elderly or poor risk patients.
Malignant tumours of the ampullary region are infrequent and reported to constitute betwee 0.02 and
five percent of all cancers of the digestive tract. With wider application of endoscopic techniques, there
has been an increasing interest in this group of tumours during recent years. In the literature tumours of
Oddi are usually reported in the group of periampullary tumours, including tumours of the ampulla
itself, duodenal wall surrounding the ampulla, the distal part of the common bile duct and head of the
pancreas. We have wanted to distinguish specifically the tumours of the ampulla of Vater and have
adopted the term tumour of Oddi introduced by Marchal and Hureau.The sphincter of Oddi exactly
delineates the junction between the bile duct, pancreatic duct and duodenum. We wanted to avoid using
the anatomic term ampulla of Vater, since this structure rarely appears as an ampulla. This then
excludes tumours in the head of pancreas, common bile duct above ths phincter of Oddi and tumours of
the duodenal wall adjacent to the papilla. These tumours seem to behave differently from other
pancreatic tumours, as they carry a different prognosis and need special attention. We have therefore
reviewed retrospectively 56 patients with tumours of Oddi with special reference to diagnosis,
histopathologic examination and surgical therapy.
Prospective Evaluation of Ultrasonic Surgical Dissectors in Hepatic Resection: A Cooperative Multicenter Study
Authors: Millat Bertrand , Hay Jean-Marie , Descottes Bernard , Fingerhut Abe , Fagniez Pierre-Louis
Published: September 2007

Blood loss is the major cause of postoperative mortality and morbidity associated with hepatic resection.
A prospective multicenter study was conducted to determine if ultrasonic dissectors (USD) were useful
in hepatic resection and could reduce this hemorrhagic risk. Forty‐seven hepatic resections were
performed in 42 consecutive patients during a two month period in 11 public, surgical centers.
Twenty‐one patients had primary or secondary malignancies, six had benign tumors, two had biliary
cysts, one had cholangiocarcinoma, one had Caroli’s disease, and 11 had hydatid cysts of the liver. Two
different USD devices were evaluated (CUSA System‐Lasersonics and NIIC‐DX 101 T). The hepatic
resections tested included a wide range of procedures. Each surgeon had the possibility of choosing
between the USD and his own usual technique for each operative step and according to local conditions.
The average volume of blood infused, irrespective of the underlying pathology or the procedure
performed, was 1.0 L (range 0‐4.8 L). Fourteen patients required no transfusions. No operative or
immediate postoperative deaths were recorded. Five major complications, all unrelated to the use of the
USD, developed in three patients. Access to intra and extraparenchymal arterial and venous tributaries
and particularly the control of the hepatic veins were facilitated by USD. While transection of hepatic
parenchyma was neither easier nor faster than with conventional techniques, it was found to be less
hemorrhagic. Overall appraisal was expressed on an analog scale; the USD was found to be helpful or
very helpful in 75 percent of all resections. With regard to the pathology being treated, total or partial
excision of hydatid cysts was greatly enhanced by the use of the USD while this benefit was not found for
wedge resections of other hepatic lesions. With regard to user friendliness and maintenance, the
NIIC‐DX 101 T device was preferred. We conclude that the USD facilitates formal hepatic resections.
Converging opinions emerging from various surgical centers reinforce this conclusion.
Cytomegalovirus‐Associated Pancreatitis in Acquired Immunodeficiency Syndrome
Authors: González-Reimers Emilio , Santolaria-Fernádez Francisco , Gómez-Sirvent Juan L. , Méndez-Medina Rafael , Martinez-Riera Antonio
Published: September 2007

A middle‐aged woman suffering from CMV pancreatitis and HIV positive was treated
Tuberculous Pancreatic Abscess: A Rare Condition Mimicking Carcinoma
Authors: Watanapa P. , Vathanopas V.
Published: September 2007

We report a rare case of obstructive jaundice caused by a tuberculous abscess in the head of pancreas,
mimicking carcinoma. The case was successfully treated by pylorus‐preserving proximal pancreatoduodenectomy
and antituberculous drugs.
Primary Bile Duct Stones and Bacterial Activity
Authors: Vitetta Luis , Sali Avni
Published: September 2007

The results of this study suggest that infection with beta‐glucuronidase active bacteria is the initial event
in the nucleation of primary bile duct stones (PBDS).

PBDS from five patients were morphologically fragile and “earthy” with alternating light and dark
brown pigment layers with no evidence of a distinct central nucleus that may have been reminiscent of a
different structure. Chemically, calcium bilirubinate and calcium palmitate were prominent throughout
their structure. All bile duct biles had a positive culture and were always associated with at least one
bacterial species which was beta‐glucuronidase active. Moreover, fragments of PBDS nuclear areas had
positive cultures that were comparable with those present in their individual bile duct bile. Microscopic
examination of bile showed abundant precipitation of calcium bilirubinate granules in all samples.

Thus, bile duct bile infection with beta‐glucuronidase active bacteria (e.g. E. coli, C. perfringens)
appears to be a key factor in PBDS pathogenesis, having a precursor role, rather than being a
consequence. Bile stasis is likely to be a co‐factor which must have a supportive role in subsequent stone
growth.
Left‐Sided Hepatectomy With a Linear Stapling Device: An Experimental Study on Pigs
Authors: Zilling Thomas , Walther Bruno S. , Holmin Torsten
Published: September 2007

Thirteen pigs underwent resection of the left liver lobe. By random selection, the animals were resected
either with the aid of an RLG 90R linear stapling device or by the conventional finger‐fracture technique.
There was one postoperative death due to anaesthetic complications. The median operative time using
the stapler was 27 min (range 19–40 min) which was significantly shorter (p = 0.0065) than that required for resection by the finger‐fracture technique (42.5 min; range 37–55 min).

The median blood loss, estimated by counting the number of gauze swabs used, was 425 ml and 275 ml
for the finger‐fracture resected and stapler resected groups, respectively (ranges 275–550 ml versus 175–
300 ml; p = 0.015).

The animals were sacrificed and examined one week after the operative procedure. Except for a small
bile pseudo‐cyst in one pig operated upon with conventional resection, no sign of bleeding or biliary
leakage was revealed.

This study demonstrates the feasibility of stapling the liver to facilitate resection.
A Review of Pancreatico‐Pleural Fistula in Pancreatitis and Its Management
Authors: Burgess N. A. , Moore H. E. , Williams J. O. , Lewis M. H.
Published: September 2007

Pancreatico‐pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural
cavity, most commonly from an enlarging pseudocyst.
We review the literature on the causes, investigations and treatment of pancreatico‐pleural fistulae
and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico‐pleural
fistula associated with pancreatic duct obstruction.
The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient
was managed conservatively. However, deterioration in the patients′ condition led to an urgent but not
emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic
duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The
patient subsequently completely recovered.
Is Aggressive Surgical Palliation of Proximal Bile Duct Cancer With Involvement of Both Main Hepatic Ducts
Worthwhile?
Authors: Wilker Dietmar K. , Izbicki Jakob R. , Rohloff Ralf , Knoefel Wolfram-T. , Mandelkow Hans , Schweiberer Leonhard
Published: September 2007

The only curative treatment for proximal bile duct cancer with involvement of both main hepatic ducts is
liver transplantation. Most patients do not fulfill the requirements for liver transplantation. Our
treatment strategy in appropriate cases is palliative tumor resection and reconstruction of the biliary
passage by sutureless bilioenteric anastomosis. We have treated 12 patients, 5 in combination with
intraluminal and percutaneous radiotherapy. Our results indicate that this strategy leads to effective
palliation in some cases provided that only microscopic residual tumor is left in-situ. Our survival times
compare favourably with survival after liver transplantation.
Primary Solitary Tuberculosis of the Liver
Authors: Emre Ali , Akpinar Edip , Acarli Koray , Alper Aydin , Çevikbaş Uǧur , Arioǧul Orhan
Published: September 2007

Primary solitary tuberculous involvement of the liver is a rare condition. We present the case of a patient
who was operated on with a preoperative diagnosis of hepatocellular carcinoma. Liver resection was
performed and antituberculous therapy was started. It is difficult to make the correct diagnosis preoperatively
except when a successful needle biopsy can be performed. Despite the rarity of the condition
primary solitary tuberculosis should be considered among the space occupying lesions of the liver.
Pancreaticogastrostomy After Pancreatoduodenectomy
Authors: Sauvanet A. , Belghiti J. , Panis Y. , Gayet B. , Camara E. , Urrejola G. , Fékété F.
Published: September 2007

The aim of this study was to evaluate the place of pancreaticogastrostomy (PG) in reducing pancreatic
fistula after pancreatoduodenectomy. From January 1988 to June 1991, 32 consecutive patients (mean
age, 57 years) were operated on, 25 for malignant disease (78%). The pancreatic remnant was normal in
17 patients (53%) and sclerotic in the others. There was one operative death (3.1%) unrelated to PG.
Post‐operative complications occurred in five patients (16%). Only two complications were related to
PG: 1 patient had anastomotic intra‐gastric bleeding and was reoperated on, 1 patient with a normal
pancreatic remnant developed a pancreatic fistula (3.1%) treated conservatively.

Reported series of PG, as well as our results, demonstrates that PG is associated with a dramatic
decrease of both pancreatic fistula and mortality rates. The risk of anastomotic haemorrhage can be
reduced by preventative ligation of submucosal gastric vessels.

In conclusion, PG appears as a simple and reliable method of management of the pancreatic remnant
after pancreatoduodenectomy.
Lost Stone During Laparoscopic Cholecystectomy: Retrieval Using a Condom
Authors: Chung S. C. S. , Li M. K. W. , Li A. K. C.
Published: September 2007

Laparoscopic cholecystectomy is becoming increasingly popular for the treatment of gall stone disease.
In this technique, the gall bladder is dissected free under laparoscopic vision and then extracted. We
report an interesting complication that occurred during extraction of a gall bladder containing a large
stone and a novel method of overcoming the problem.
Reticuloendothelial System Function Following Acute Liver Failure Induced by 90% Hepatectomy in the Rat
Authors: Wang Xiangdong , Andersson Roland , Ding Jinwen , Norgren Lars , Bengmark Stig
Published: September 2007

Sepsis and bacterial infections are frequent complications of acute liver failure and following major liver
resection. The mechanisms underlying this phenomenon are unclear. In this study, RES function and blood clearance of radiolabelled E. coli was immediately impaired following 90% hepatectomy, although the reduction in liver volume resulted in an increase in splenic (temporary) and pulmonary (persisting) uptake. A significant correlation between liver function and host RES function was observed. The uptake capacity of the RES in the liver remnant and spleen did not correlate with subserosal blood flow. The uptake in the brain gradually increased with time, paralleling an increased
leakage across the blood‐brain barrier. Thus, a significantly impaired RES function resulted from
experimental 90% hepatectomy‐induced acute liver failure, which might explain the high incidence of
septic events in the clinical situation.
Massive Necrotizing Pancreatitis in an Immunosuppressed Renal Transplant Recipient (Successful Therapy)
Authors: Slaton Joel W. , Howard John M. , Selman Steven H.
Published: September 2007

Severe pancreatitis may be associated with massive necrosis of the pancreas and/or retroperitoneal
adipose tissue. Toxicity results from the dead tissue and secondary infection. A 45 year old patient,
while fully immunosuppressed, developed this complication following cadaveric renal transplantation.
He survived continued immunosuppression, 16 operative debridements of the retroperitoneum, and
maintained a functioning renal transplant.

In view of the previously reported high mortality rates from mild pancreatitis after transplantation,
the current experience warrants further evaluation of the open method of treatment.
Papillo‐Choledochectomy in the Operative Management of Mucosal Neoplasms of the Periampullary Region
Authors: Kasahara Kogoro , Saito Ken , Kondo Yasuo , Yasuda Toshihiko , Yasuda Yoshikazu , Nakada Masatoshi , Nagai Hideo , Kanazawa Kyotaro
Published: September 2007

Two patients with mucosal cancer of the periampullary region were treated with papillocholedochectomy,
which entails removal of the papilla of Vater and the whole length of the common bile duct. The neoplasm is dissected out through the plane between the duodenal circular and longitudinal muscles, deep to the sphincter of Oddi and the fibromuscular layer of the bile duct. Pathological examination showed that cancer was confined to the mucosal layer without stromal invasion, and that the operation achieved radical cure. For mucosal cancer, papillo‐choledochectomy is
an alternative to pancreatoduodenectomy, provided that repeated frozen‐section studies confirm the
completeness of excision.
Partial Cholecystectomy Safe and Effective
Authors: Ibrarullah Md. , Kacker L. K. , Sikora S. S. , Saxena R. , Kapoor V. K. , Kaushik S. P.
Published: September 2007

Patients undergoing surgical treatment for calculous disease were considered to have had a partial
cholecystectomy performed when a part of the gall bladder wall was retained for technical reasons.
Forty patients underwent partial cholecystectomy: for chronic cholecystitis (20), acute cholecystitis (4),
Mirizzi′s syndrome (14), portal hypertension or partially accesible gall bladder (one patient each). Four
patients (10%) developed infective complications and two patients had retained common bile duct
stones. In a mean follow up period of 13 months (range 1–36 mths), only 3 patients have ongoing mild
dyspeptic symptoms while the rest have remained asymptomatic. Partial cholecystectomy has been
found to be a safe and effective procedure in difficult cholecystectomy situations, since it combines the
merits of cholecystectomy and cholecystostomy.