bluuebunny/crossref_metadata_2025 huggingface dataset:
Tuberculosis of the Common Bile Duct
Authors: Ratanarapee Samrerng , Pausawasdi Arun
Published: September 2007

The intrahepatic biliary tree can occasionally be infected by Mycobacteriurn tuberculosis, but tuberculosis of the common bile duct has not previously been reported. A 38‐year‐old man with obstructive jaundice, who was originally thought to have cholangiocarcinoma associated with opisthorchiasis (a common combination in Thailand), was finally proved to have tuberculosis of the common bile duct with adjacent tuberculous lymphadenitis. Following T‐tube drainage and antitubercular therapy, he made a complete recovery. The importance of a tissue diagnosis in all cases of obstructive jaundice is emphasized to avoid missing rare but curable diseases.
Hydatid Disease of the Liver. Diagnosis and Surgical Treatment
Authors: Xynos Evaghelos , Pechlivanides George , Tzortzinis Anastasios , Papageorgiou Antonis , Vassilakis John S.
Published: September 2007

A series of 155 cases of hepatic hydatid disease, occurring in 121 patients, were operated on at the Naval
and Veterans Hospital of Athens. Ultrasonography and computerized axial tomography provided the
preoperative diagnosis in 89 and 93 percent of the cases respectively in recent years. Thirty one percent
of the cases presented with complications, the commonest of these being infection of the cyst (10
percent) and rupture of the cyst into the bile ducts (17 percent). Total cystectomy was performed in
three cases and removal of the endocyst with its content in the remaining 152. The remaining cavity was
either externally drained (57 cases), or filled with omentum (omentoplasty — 95 cases). External fistula
and infection of the residual cavity occurred in 32 and 56 percent after simple drainage and in 4 and 2
percent respectively after omentoplasty. Differences are statistically significant (p < 0.001).
Hospitalization was also significantly longer after drainage than after omentoplasty (p < 0.01).
Obstructive jaundice after intrabiliary rupture of the cyst was more successfully managed after
additional choledochoduodenostomy than after simple drainage of the common bile duct.
Intrapericoneal recurrence of hydatid disease occurred in two cases. The conclusion of the present study
is, that ultrasonography and computerized axial tomography provide an acceptable rate in the diagnosis
and that omentoplasty offers a very low complication rate in the management of hydatid cystic disease of
the liver.
Factors Influencing the Concentrations of the Large Neutral Amino Acids in the Brain and in the CSF of Dogs After Portacaval Anastomosis
Authors: Jonung Torbjörn , Ramzy Adel , Herlin Per , Chance William T. , James J. Howard , Fischer Josef E.
Published: September 2007

Portal‐systemic shunting of blood is associated with hyperammonemia, an increased glutamine concentration
in brain, an altered plasma neutral amino acid pattern, and high levels of several of the large
neutral amino acids in brain. Since some of these amino acids are precursors for neurotransmitters and
for other potentially neuroactive substances, high CNS levels of these amino acids may contribute to the
development of encephalopathy. In order to determine the relative importance of changes in brain
glutamine levels and changes in competition among the neutral amino acids for blood‐brain transport,
we measured the concentrations of the large neutral amino acids in plasma, cisternal cerebrospinal fluid
and in brain tissue from various regions of dogs after end‐to‐side portacaval shunt. Although the
changes in CSF amino acid levels correlated partially with altered amino acid plasma competitor ratios,
better correlations were observed with the elevation of CSF glutamine. These results suggest a model of
blood‐brain amino acid transport in which a high level of glutamine in brain extracellular fluid competes
with other neutral amino acids for efflux from brain, thus raising brain amino acid levels after portalsystemic
shunting
Results of Hepatectomy for Hepatocellular Carcinoma at the National Cancer Center Hospital
Authors: Yamasaki Susumu , Makuuchi Masatoshi , Hasegawa Hiroshi
Published: September 2007

The number of hepatectomies has increased greatly in recent years. Surgery for hepatocellular carcinoma (HCC) in the normal liver has not increased. However, the increase in numbers of hepatectomies for HCC associated with liver cirrhosis is remarkable. More than 80% of our hepatectomy cases were cirrhotic and about 80% of these cirrhotic cases had HCCs 5cm or less in diameter. The operative mortality rate has improved in the latter half of this series, from 10.1% (9/89) to 1.5% (5/338), in spite of an increase in cases with poor liver function. This corresponds to a decrease in the mean value of the annual operative blood loss. The survival rates after hepatectomy for all cases (n = 378) were 40.6% ± 6.6 (% ± SE) for 5 year and 22.7% ± 5.3 for 10 year at the end of 1988. A difference of the 5‐year survival rate between the patients operated on before 1981 (n = 78, 25.6% ± 4.9) and after 1982 (n = 300, 46.1% ± 4.8) was observed (p<0.05). Because the cancer‐free survival rates of the patients operated on in the two periods, before 1981 and after 1982, were almost the same, the recent improvement of the survival rates seems to be due to a prolongation of survival time after recurrence.
Reoperation After Cholecystectomy. TheRole of the Cystic Duct Stump
Authors: Rogy M. A. , Függer R. , Herbst F. , Schulz F.
Published: September 2007

The so‐called “Postcholecystectomy Syndrome” may be due to various pathological biliary causes. The
aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a
long (>1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy
in our patients. Three hundred and twenty two patients underwent a second operation on the bile
ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking finding was a long
cystic duct stump (>1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic
duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct
stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis
was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or
cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a
suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the
only pathological finding. Four years after reoperation this patient is still suffering from the same
intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for
recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of
postcholecystectomy symptoms.
Controversy in the Management of Cholangitis Secondary to Hydatid Daughter Cysts
Authors: Davidson Brian , Ezaki T. , Habib Nagy
Published: September 2007

A 36 year old Cypriot woman, resident in the U.K. since the age of three years, presented with pyrexia,
jaundice and upper abdominal pain. On ultrasound examination the biliary tree was dilated, contained
sludge and a cystic lesion was present in the liver. An endoscopic cholangiogram showed multiple filling
defects in the bile duct which were not felt to be removable endoscopically and a nasobiliary drain was
therefore inserted. On resolution of the cholangitis with drainage and antibiotics a laparotomy was
performed. The right lobe of the liver was largely replaced by a multiloculated cyst and the bile duct
contained multiple hydatid daughter cysts. A right hepatectomy was performed with t‐tube drainage of
the evacuated bile duct. She made an uneventful recovery and has had no problems on subsequent
follow up. Histology confirmed an intrabiliary rupture of a hydatid liver cyst.

Cholangitis secondary to daughter cysts is a rare but recognised complication of hydatid liver cysts.
Management of hydatid liver cysts by formal resection is controversial but may be preferable in this
situation.
“Adenomatous Polyps of the Gallbladder” Adenomas of the Gallbladder
Authors: Farinon Attilio Maria , Pacella Antonio , Cetta Francesco , Sianesi Mario
Published: September 2007

The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem.

Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow‐up examinations.
Pathogenesis of Cholesterol Gallstones
Authors: Strasberg Steven M. , Clavien Pierre-Alain , Harvey P. Robert C.
Published: September 2007

Cholesterol gallstone disease is extremely common. Three major stages are recognized for stone formation, namely bile that becomes supersaturated with cholesterol, cholesterol nucleation leading to crystal formation and finally retention of the crystals in the gallbladder resulting in stone formation. Supersaturation is common but nucleation into crystals probably requires protein nucleating factors. Impaired motility of the gallbladder causes crystal retention and is probably very important in stone formation.
Laparoscopic Cholecystectomy: Some Advantages or Just an Artifice of New Technology?
Authors: Penninckx F. , Aerts R. , Kerremans R. , Koninckx P. R.
Published: September 2007

Twelve selected patients undergoing cholecystectomy were operated in a prospective randomised study by laparoscopy (CO2 laser) or by classic surgery. Our preliminary results suggest that laparoscopic cholecystectomy is of clinical benefit as compared to classic cholecystectomy since it reduces the surgical trauma, limiting weight loss and shortening the hospital stay.
Measurement of Liver Blood Flow: A Review
Authors: Seifalian A. M. , Stansby G. P. , Hobbs K. E. F. , Hawkes D. J. , Colchester A. C. F.
Published: September 2007

The study of hepatic haemodynamics is of importance in understanding both hepatic physiology and
disease processes as well as assessing the effects of portosystemic shunting and liver transplantation. The
liver has the most complicated circulation of any organ and many physiological and pathological
processes can affect it1,2. This review surveys the methods available for assessing liver blood flow,
examines the different parameters being measured and outlines problems of applicability and interpretation
for each technique.

The classification of these techniques is to some extent arbitrary and several so called “different”
methods may share certain common principles. The methods reviewed have been classified into two
groups (Table 1): those primarily reflecting flow through discrete vessels or to the whole organ and those
used to assess local microcirculatory blood flow. All techniques have their advantages and disadvantages
and in some situations a combination may provide the most information. In addition, because of the
many factors affecting liver blood flow and sinusoidal perfusion, readings in a single subject may vary
depending on positioning, recent food intake, anxiety, anaesthesia and drug therapy. This must be
borne in mind if different studies are to be meaningfully compared.
Long‐Term Management After Variceal Bleed — The Current Role of Sclerotherapy
Authors: Bornman P. C. , Krige J. E. J. , Dunn J. P. , Terblanche J.
Published: September 2007

While injection sclerotherapy has been accepted as the treatment of choice for acute variceal bleeding,
its role as a definitive long‐term treatment modality has not yet been clearly defined. This paper will
critically analyse the current status of this technique, now widely used, and a comparison will be made
with conventional medical management. The review will be based on the 10 years′ Cape Town
experience and the published series on this subject. A long‐term management strategy will also be
discussed.
Primary “Brown Pigment” Bile Duct Stones
Authors: Vitetta Luis , Sali Avni , Little Peter , Nayman Jack , Elzarka Ayman
Published: September 2007

Bile duct stones from 42 patients were morphologically and chemically analysed. The calculi from 27
patients had important primary bile duct stone (PBDS) features, consisting of a general ovoid shape and
fragile structure, with alternating light and dark brown pigmented layers on cross‐section. Chemically
these stones contained low levels of cholesterol, with high levels of bilirubin and calcium. Subsequent
infrared spectroscopy analysis showed that calcium bilirubinate and calcium palmitate were the only
calcium salts present. Calcium palmitate was prominent in the light brown layers. A morphological and
chemical comparison with gallbladder stones showed that bile duct “stasis stones” were similar in
morphological and chemical composition to the brown pigment gallbladder calculi. However, they were
distinct from most gallbladder stones, indicating that primary bile duct calculi have an aetiology that is
different to 90% of gallbladder calculi. Primary bile duct calculi were observed to occur with or without
the presence of a gallbladder, and more interestingly, in the bile duct of two patients with cholesterol
gallbladder stones. Bile duct bile of patients with primary choledocholithiasis were always moderately to
profusely infected and with abundant calcium bilirubinate precipitation. Moreover, this study has shown
that PBDS chemical analyses profiles were consistent and correlated well with their defined morphology.
Consequently, PBDS may be accurately identified at the time of operation by morphology. An
important aetiological factor would appear to be infection, which would seem to promote bile duct bile
stasis and eventual stone growth.
Percutaneous Aspiration, Lavage and Antibiotic Instillation. New Approach in the Management of Acute Calculous Cholecystitis
Authors: Salim Aws S.
Published: September 2007

Distension of the gallbladder and bacterial infection can perpetuate an attack of acute calculous cholecystitis and produce its local and systemic complications. This prospective randomized trial was conducted on patients with their first episode of acute calculous cholecystitis which was associated with pyrexia and tachycardia to examine whether ultrasound guided percutaneous aspiration and lavage of the gallbladder followed by intra‐lumenal instillation of 500 mg ampicillin (PALA) enhanced recovery from cholecystitis. Twenty patients were randomized to receive 500 mg of ampicillin every 6 hours for 5 days and another 20 patients were randomized to receive this treatment in addition to PALA within 12 hours of admission. Twenty four hours after admission to hospital, all the patients treated with PALA were apyrexial and had no residual right hypochondrial tenderness or guarding, a result superior (p < 0.001) to that of the group without PALA where at least 75% of patients were still showing these signs. Two days after admission the WBC count of the PALA group was significantly (p < 0.05) lower than that of the other group (6.32 ± 0.1 × 109/L vs 10.31 ± 0.4 × 109/L, mean ± SEM, n = 20). Four days after admission, all members of the PALA group were comfortably tolerating solid food for the previous 24 hours and were, therefore, discharged home whereas all members of the other group were still in hospital and 85% of them were discharged home after hospitalization for 6 to 7 days. Three members (15%) of this group deteriorated and underwent emergency surgery.

The results show that addition of PALA to the conventional non‐operative treatment of acute cholecystitis enhances recovery and avoids the complications necessitating emergency surgery.
Successful Surgical Treatment of Hepatocellular Carcinoma Invading Into Biliary Tree
Authors: Tanoue Kazuo , Kanematsu Takashi , Matsumata Takashi , Shirabe Ken , Sugimachi Keizo , Yasunaga Chikao
Published: September 2007

A 41‐year‐old woman was admitted to hospital with obstructive jaundice. Computed tomography
showed a large mass in the right hepatic lobe and marked dilatation of the biliary tree in the left lateral
segment of the liver. Angiography showed evidence of neovascularity. Percutaneous transhepatic
cholangiography revealed complete obstruction of the common bile duct just below the bifurcation. The
serum level of alpha‐fetoprotein on admission was 1,080,000 ng/ml. These findings suggested to us a
primary hepatocellular carcinoma invading the intrahepatic bile duct. Extended right lobectomy and
hepaticojejunostomy for bile drainage was carried out. The patient is doing well 3 years after surgery.

Hepatocellular carcinoma (HCC) invading to the portal vein is not so rare, but invasion into the bile
duct is much less common. In 1947, Mallory1 described a single case of HCC invading the gallbladder
and obstructing extrahepatic bile ducts. In 1975, Lin2 termed this HCC “Icteric type hepatoma”. The
incidence of such HCC in Japan was reported to be 1.9‐9%2,3.

Obstructive jaundice is a clinical manifestation of the terminal stage in HCC. We describe here our
treatment of a woman with HCC invading the common bile duct. Right extended lobectomy and
reconstruction of hepaticojejunostomy were effective.
Rectal Bleeding Associated With Chronic Pancreatitis
Authors: Seiler Ch. , Fielding G. , Blumgart L. H. , Triller J. , Schultheiss H. R.
Published: September 2007

Pseudocyst formation, with its attendant complications of compression, rupture, bleeding and fistula formation, is a well known complication of chronic pancreatitis. In 1966 Berne and Edmondson drew attention to the often fatal outcome of pancreatico‐colonic fistula complicated by hemorrhage. We present two cases of this rare complication of chronic pancreatitis as defined by the Marseille classification.
Blunt Liver Trauma at SunnybrookMedical Centre: A 13 Year Experience
Authors: Hanna Sherif S. , Pagliarello G. , Taylor G. , Miller H. , Scarth H. M. C. , Brenneman F.
Published: September 2007

Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in
Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being
due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335),
99% being true positive.

A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in
132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated
conservatively (n = 3) or died during resuscitation (n = 8).

Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although
overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or
hematoma accounting for 11 of 14 operations.

The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II
or III liver trauma according to Moore’s classification with a mortality of 12% (n = 32). The remaining
18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86
deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for
(1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and
sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of
335 patients (14% overall).

Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma
in our population of multiply injured patients from 12% (1976–1983) down to 7% (1985–1989); with a
gradual decline in overall mortality from 32% (1976–1983) to 19% (1985–1989), whereas the precentage
of deaths due to head injuries and liver injury have increased.
Surgical Treatment of Giant Cavernous Hemangioma Liver
Authors: Vishnevsky V. A. , Mohan V. S. , Pomelov V. S. , Todua F. I. , Guseinov E. K.
Published: September 2007

In the past five years, 16 adults (10 females, age 25–61 years, mean 48) with giant cavernous
hemangioma of the liver measuring 15–31 cm (mean‐19) underwent surgery in a single Institution.
Diagnosis was made with the help of multimodal investigations– ultrasound (US), computed tomography
(CT), hepatic angiography, hepatic scintigraphy and fine needle biopsy. Ultrasound and CT had
sensitivities of 69% and 82% respectively. Fourteen had preoperative selective hepatic artery embolization
to study its effect on operative blood loss. Indication for surgery in all cases was a large abdominal
mass with varying severity of pain. In addition, 5 had hemetological and/or coagulation abnormalities,
hemobilia in and pyrexia in 1. Seven left lobectomies, 3 left lateral segmentectomies, 2 right
lobectomies, 2 right trisegmentectomies and 4 non‐anatomical resections of to 3 segments were
performed. Postoperative complications developed in 25% with no operative mortality. Preoperative
selective hepatic artery embolization helped to decrease the operative hemorrhage in 13 (mean blood
loss– 1146 ml). In two cases severe bleeding required use of Cell‐saver and massive donor blood
transfusion. Our results suggest use of preoperative selective hepatic artery embolization and Cell‐saver
as an adjunct to the liver resection for these vascular tumors.
Etiology and Pathogenesis of Marked Elevation of Serum Transaminase in Patients With Acute Gallstone Disease
Authors: Isogai Masatoshi , Hachisuka Kitao , Yamaguchi Akihiro , Nakano Satoshi
Published: September 2007

From 1980 through 1988, biliary surgery was performed in 197 patients with acute gallstone disease and
concomitant elevation of serum glutamic oxalacetic transaminase (SGOT) or serum glutamic pyruvic
transaminase (SGPT) of over 300 Karmen units. In 137 patients, anatomic inspection and liver biopsy
were performed during the acute stage of the disease. Impacted and floating bile duct stones were found
in 69 (50%) and in 43 (32%) of the 137 patients, respectively. The main liver histology was necrosis of
liver cells. After surgery, high serum transaminase fell rapidly with immediate recovery in 99% of the
patients. In the remaining 60 patients, their signs and symptoms settled soon after initial conservative
treatment and surgery was performed after an average time of 21 days. At laparotomy, impacted bile
duct stones were found in 2 (3%) and liver histology revealed regeneration of liver cells.

These findings suggest that marked elevation of serum transaminase in patients with acute gallstone
disease might be due to an acute inflammatory liver cell injury caused by impacted bile duct stones or
migrating stones, which would be transient and reversible after early resolution of the bile duct
obstruction.
Collateral Formation After Repeated Transient Dearterialization of the RatLiver
Authors: Wang Li-Qing , Persson Bo G. , Bengmark Stig
Published: September 2007

Hepatic artery ligation is used for the palliation of patients with malignant liver tumours. Collaterals are
developed rapidly and could to some extent explain why the growth is affected for only a short period.
With intermittent dearterialization, collaterals seem to be avoided and possibly a more extended effect
should be expected. The most efficient period of dearterialization to avoid collaterals was studied in this
experiment. Five groups of rats were treated with daily repeated transient dearterializations for 0 (n
= 3), 60 (n = 6), 120 (n = 6), 180 (n = 6) and 240 minutes (n = 6) respectively for 5 days and compared
to another group (n = 3) that was permanently dearterialized. After treatment, celiac angiograms were
obtained. All hepatic arteries were reliably occluded and patent after 5 days of daily blockades in all but
two rats. There were no collaterals demonstrable on the angiograms in the first four groups after 5 days
of intermittent obstruction of the arterial blood flow to the liver. After 240 minutes of dearterialization
as well as after collaterals developed and were clearly demonstrated on the angiograms after six days.
Liver enzymes were normal even after 4 hours of dearterialization. Repeated occlusions of the hepatic
artery was reliably achieved with the implantable minioccluder. Repeated, transient dearterializations
for 1, 2 or 3 hours could be performed without development of collaterals and without damage to the
liver.
Multiple Biliary Papillomatosis
Authors: Tireli Mustafa , Uslu Adam
Published: September 2007

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary
papillomatosis treated surgically with a transhepatic stent.

Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is
regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis
with obstructive jaundice is presented.
The Effects on Toxicity of Circadian Patterning of Continuous Hepatic Artery Infusion
Authors: Kemeny M. Margaret , Alava Galo , Oliver Jorge M. , Smith Fred B.
Published: September 2007

Long term continuous hepatic artery infusion of FUDR was carried out in 34 rats. In the animals who
received a constant infusion schedule of 15mg/kg/day all died of toxicity with a mean survival of 9.3 days.
If the pattern of the continuous infusion was changed so that over 60% of the infusion was given during
the hours of 3pm to 9pm then all of the animals survived the 14 day infusion. If the maximum dose of
infusion was changed so that 60% of the infusion was given at night from 3am to 9am the infusion
became more toxic and all the animals died in a mean of 5.5 days. Pathologic sectioning of all the livers
reflected the above outcomes with the greatest amount of hepatic necrosis in the animals on the night
cycles. This study underscores the recent advances in chronobiology demonstrating that for continuous
hepatic arterial infusions the timing of delivery is crucial in determining the toxicity.
A Case of Primary Squamous Cell Carcinoma of the Liver Arising in a Solitary Cyst
Authors: Nieweg O. , Slooff M. J. H. , Grond J.
Published: September 2007

A case of primary squamous cell carcinoma in a pre‐existing hepatic cyst is presented. A review of the
literature suggests that this rare type of liver tumor tends to arise from solitary, nonparasitic cysts, lined
with squamous epithelium. Effective therapy is not available, the prognosis is grave.
Standard Surgical Approaches to Primary Choledocholithiasis — Definitive VersusTemporary Decompression
Authors: de Almeida António Castro Mendes , Aldeia Fernando José , dos Santos Noel Medina , Gracias Caetano Winston
Published: September 2007

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T‐tube
decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of
sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction,
due to dysmotility of the SO, lies behind most stone‐containing ducts. Thus it seems logical to us that a
permanent “fenestration” should be the management of most such ducts.

We prospectively followed‐up, for one to 10 years, two groups of patients submitted to primary
CBDE aiming to assess the short and long‐term results of two different surgical approaches to duct
lithiasis. In one (Group A) 162 CBDE′s were performed, out of 680 CHE′s (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE′s, out of 438 CHE′s (18%), with a “positivity” of 70%. In Group A a T‐tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T‐tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T‐tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long‐term results, though, were significantly worse among patients of Group A whose ducts were temporarily
decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent
stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for
bilio‐digestive anastomotic complications with cholangitis.

It is concluded that it is against the long‐term efficiency of the approach utilized in Group B that the
new laparoscopic techniques should be compared.
Diagnosis and Surgical Treatment of Hepatic Hydatid Disease
Authors: Bilge Ahmet , Sözüer Erdoğan M.
Published: September 2007

In this report two hundred and twenty six patients with hydatid disease were admitted to the Surgical
Department of Erciyes University (Kayseri) and Şişli Etfal Hospital (Istanbul) between 1978 and 1990
and reviewed retrospectively. One hundred and two patients (45.1%) were male and 124 (54.9%)
female. In the patients with hydatid cysts the most frequent symptom was right upper abdominal pain
(66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). One hundred
and sixty seven patients (73.9%) were examined with ultrasonography which has a diagnostic value of
94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic
shock (0.4%). All patients were operated on by using various surgical techniques; omentoplasty
(101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion
(10), pericystectomy (6), and hepatic resection (5).

The main postoperative complications were wound infection (12%) and biliary fistula (2.6%). The
total mortality rate was 1.8% in this series.
Fibronectin as a Prognostic Indicator in Portal Hypertension
Authors: Mckee Ruth F. , Maharaj D. P. , Garden O. J. , Carter D. C.
Published: September 2007

Plasma fibronectin levels were measured in 33 patients with portal hypertension and c6mpared with
modified Child’s grading and a previously described prognostic index. Outcome at one year from blood
sampling was recorded.
Mean plasma fibronectin level was 304.1 mg/ml (sem 24.3) and significantly lower levels were found in
patients who had had a variceal bleed within the previous seven days. Plasma fibronectin levels tended
to be lower in patients with poor liver function as assessed by modified Child’s grading but this did not
achieve statistical significance.
Plasma fibronectin alone was not an accurate predictor of one year survival in these patients but only
one of seven patients who had a plasma fibronectin level below 300mg/l in association with a poor
prognostic index survived for one year.
Cell Kinetics of Regenerating Liver After70% Hepatectomy in Rats ‐ 2‐Color FlowCytometric Analysis
Authors: Tamura Jun , Tanaka Junji , Fujita Ken-Ichi , Yoshida Masanori , Kasamatsu Takayuki , Arii Shigeki , Tobe Takayoshi
Published: September 2007

Two‐color flow cytometric (FCM) analysis using anti‐bromodeoxyuridine (BrdU) monoclonal antibody
(MoAb) was used to investigate the cell kinetics of regenerating liver after 70% partial hepatectomy in
rats. Three peaks were seen in DNA histograms of rat hepatocyte nuclei, corresponding to diploid(2c),
tetraploid(4c), and octaploid(8c). These proportions changed in the course of regeneration which were
clearly demonstrated by DNA histograms using flow cytometry. The proportion of diploid, tetraploid,
and octaploid nuclei in control liver were 49.3 ± 1.6%, 45.0 ± 7.4%, and 1.7 ± 0.7%, respectively. A significant change occurred at 24 hours after hepatectomy, as FCM revealed 25.9 ± 1.1% diploid, 54.5 ± 1.2% tetraploid, and 9.0 ± 0.9% octaploid. This shift to polyploid nuclei persisted until 72 hours, and then gradually returned to the pattern of control liver. The S‐phase nuclei which incorporated BrdU
increased rapidly at 24 hours to a peak of 11.3 ± 0.9%, and gradually decreased to 5.8 ± 0.8%,
5.3 ± 0.8%, 2.4 ± 0.6%, 2.9 ± 1.1%, and 1.2 ± 0.6%, at 48, 72, 96, 120, and 168 hours, respectively. This 2‐color FCM analysis made a detailed analysis of the cell kinetics in regenerating hepatocytes possible, and may be applied in investigations of various aspects of liver regeneration.
Radiation Stricture of the Biliary Ducts: An Emerging New Entity?
Authors: Halevy A. , Adam A. , Stamp G. , Benjamin I. S. , Blumgart L. H.
Published: September 2007

Two patients with stricture of the extrahepatic biliary tree are described. Both patients presented with a
clinical picture of obstructive jaundice one to two years following radiotherapy for a malignant
condition. As no recurrent tumour was detected in either of the patients the strictures were considered
to be the result of radiation therapy. Bilio-enteric decompression was performed in both patients who
are well at follow up one and ten years after the procedure.
Experimental and Clinical Evaluation of Capsular and Parenchymal Total LiverPerfusion
Authors: Kotzampassi Katerina , Eleftheriadis Efthimios , Aletras Homeros
Published: September 2007

Liver blood flow measurements obtained from both the liver surface and deep within the parenchyma,
were correlated in an effort to assess the usefulness of laser‐Doppler flowmetry for non‐invasive
monitoring of total liver blood flow, the probe being positioned on either the surface or within the liver
parenchyma.

In 23 Wistar rats and 10 biliary surgery patients, anaesthetized prior to gallbladder removal, liver
microcirculation was measured at 4 points on the capsular surface, and consequently at 4 points deep
within the parenchyma, using probes connected to a laser‐Doppler flowmeter. The findings revealed
that laser‐Doppler measurements on the liver surface and within the parenchyma were well correlated,
as no statistically significant differences were found either in rats or humans. It is concluded that laser‐
Doppler flowmetry for monitoring of total liver perfusion can be applied either on the capsular surface
or within the hepatic parenchyma.
Successful Treatment of Postoperative External Biliary Fistula by SelectiveNasobiliary Drainage
Authors: Vagianos C. , Polydorou A. , Karatzas T. , Vagenas C. , Stavropoulos M. , Androulakis J.
Published: September 2007

A 25‐year old man presented with a high output external biliary fistula after an operation for a giant
hydatid cyst of the liver. Endoscopic sphincterotomy was inadequate to close the fistula. A nasobiliary
tube was selectively inserted into the leaking hepatic duct and bile was continuously aspirated. The
fistula and the residual cavity healed completely. Details of the patients′ management using this
alternative technique, are discussed.
Pharmacokinetics of Mitomycin C Following Hepatic Arterial Chemoembolization With Gelfoam
Authors: Ding Jin Wen , de Wu Zai , Andersson Roland , Bengmark Stig
Published: September 2007

Twelve mongrel dogs were randomly allocated into two groups using matched paired‐design. Catheters
were inserted into the hepatic artery, hepatic vein and the femoral vein, respectively. In the first group,
gelfoam supplemented with mitomycin C (MMC) was injected into the hepatic artery, whereas the
second group received a hepatic arterial injection of MMC solution alone. Simultaneous blood sampling
from the hepatic and femoral veins at regular intervals was performed. MMC concentrations in plasma
was determined using high performance liquid chromatography (HPLC) and the pharmacokinetics of
MMC were determined.
MMC concentrations in hepatic and femoral veins did not differ and no significant difference in
pharmacokinetics was found when comparing MMC administration into the hepatic artery with or
without gelfoam supplementation. Thus, our results revealed that gelfoam could not delay the clearance
of MMC from the liver.
Hepatocellular Carcinoma and Sex Hormones
Authors: Nagasue Naofumi , Kohno Hitoshi
Published: September 2007

The liver is morphologically and functionally modulated by sex hormones. Long‐term use of oral
contraceptives and androgenic steroids can induce benign and malignant hepatocellular tumors.
Hepatocellular carcinoma (HCC) is more prevalent in men than in women. The role of sex hormones
and their receptors in the development of HCC was reviewed. Some HCCs may be androgen dependent
but others may be estrogen or even both dependent. Further studies are mandatory in order to utilize
such characteristics of HCC for an effective prophylaxis and therapy of this tumor.
Choledochoplasty by Vein Grafts in Iatrogenic Bile Duct Injuries
Authors: Salim Aws S.
Published: September 2007

The quality of immediate repair of common bile duct injuries with or without tissue loss occurring during
elective cholecystectomy is crucial and maybe the sole factor behind future stricture formation with its
considerable morbidity and mortality. Successful repair of iatrogenic common bile duct injuries has been
achieved by immediate saphenous vein grafts in two patients with cystic duct avulsion, in one patient
whose duct was split by a balloon catheter, and in one patient where a segment of the duct was resected.
Follow‐up for 5 years demonstrated that the grafting remained sound and produced no complications.
Consequently, the immediate repair of iatrogenic bile duct injuries using vein grafts deserves consideration.
A Comparison of Sms 201‐995 and Oesophageal Tamponade in the Control of Acute Variceal Haemorrhage
Authors: Mckee Ruth F. , Garden O. J. , Anderson J. R. , Carter D. C.
Published: September 2007

Forty endoscopically proven active variceal bleeds were entered in a prospective trial comparing
oesophageal tamponade with SMS 201‐995 infusion.

Oesophageal tamponade controlled 19 of 20 bleeds over the first four hours and 14 of 18 bleeds over
48 hours. SMS 201‐995 infusion controlled 18 of 20 bleeds over the first four hours and 10 of 20 bleeds
over 48 hours (p = 0.15). No significant differences between the groups were seen in time to control of
bleeding, amount of blood transfused or number of patients crossed over to the opposite treatment.
Complications in the oesophageal tamponade group were discomfort due to the tube (17 patients) and
chest infection (10 patients), while in the SMS 201‐995 group 7 chest infections and one episode of
hyperglycaemia occurred, with no symptomatic complaints. The patient survived the admission in 15 of
the oesophageal tamponade bleeds and all of the SMS 201‐995 bleeds (p = 0.047).

An intravenous infusion of SMS 201‐995 appears to have comparable efficacy to oesophageal
tamponade in variceal bleeding.
The Management of Persistent or Recurrent Variceal Bleeding After Injection Sclerotherapy by Somatostatin
Authors: Jenkins S. A. , Shields R. , Jaser N. , Ellenbogen S. , Naylor E. , Baxter J. N.
Published: September 2007

Sixteen patients with persistent (n = 11) or recurrent (n = 5) variceal bleeding after injection
sclerotherapy and balloon tamponade were treated with an intravenous infusion of somatostatin 250μg/
h. Somatostatin infusion successfully controlled the bleeding in 15 of the 16 patients but one rebled after
72 h of treatment. In one patient with poor liver function (Child’s C) bleeding was not controlled by
somatostatin, further injection sclerotherapy or balloon tamponade of the oesophagus. The results of
this study, although uncontrolled and with a small number of patients, suggest that somatostatin is a very
effective treatment for the control of post-injection sclerotherapy variceal bleeding.
Pulmonary Injury in Acute Experimental Pancreatitis Correlates With ElevatedLevels of Free Fatty Acids in Rats
Authors: Rosen H. R. , Tüchler H.
Published: September 2007

Since some authors have stated a certain role for so‐called “free fatty acids” (FFA) in the pathogenesis of AP and the subsequent systemic complications we tried to find possible correlations between FFA, pancreatitis and lung injury using a rat model. AP was induced by intraductal infusion of two different concentrations of glycodeoxycholic acid (GDOC 17 mmol and 34 mmol). An equal number of animals had only cannulation of the pancreatic duct without infusion and served as controls (GDOC‐control). In another experimental model iv.‐infusion of oleic acid (OA) was used to create severe lung injury comparable to human ARDS. In this model control animals received iv.‐infusion of saline solution only (SAL). At 2,6,12,24 and 48 hours the animals were sacrificed and blood was collected for determination of FFA, amylase and pO2. The pancreas and lungs were removed for histologic examination and the lungs were weighed. GDOC‐34 animals developed severe pancreatitis with hemorrhage and necrosis. Histology of the lungs showed edema, inflammatory infiltrates, hemorrhage and thickening of the alveolar membrane in GDOC‐34 rats as well as in OA‐animals. In contrast, there was only pancreatic edema until 24 hours in the GDOC 17 group and less severe histological changes in the lungs. Amylase, FFA, pO2 and lung weight were directly influenced by the different kinds of treatment. Furthermore, FFA correlated positively with the levels of amylase and lung weight and negatively with pO2. Infusion of OA alone also caused an increase in levels of amylase with pancreatic edema and focal necroses in some animals. These results show that it was possible to create different degrees of severity of AP which was in concordance with different degrees of morphologic changes and dysfunction in the lungs. FFA values correlated significantly with the clinical course as well as with increasing amylase, lung weight and decreasing pO2.
Intrahepatic Cholangiocarcinoma: Clinical Aspects, Pathology and Treatment
Authors: Schlinkert Richard T. , Nagorney David M. , van Heerden Jon A. , Adson Martin A.
Published: September 2007

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary tumor of the liver. To
further define its clinicopathology and surgical management, we reviewed our experience. Clinical
presentations of 32 patients with ICC was similar to that with hepatocellular carcinoma. Jaundice
occurred in only 27 percent. ICC was unresectable due to advanced disease stage in 81 percent. Six
patients had curative resections with two 5 year disease free survivors. Underlying liver disease was
associated with ICC in 34 percent of patients.
Pancreaticojejunostomy For Severe Symptomatic Chronic Pancreatitis
Authors: Denton G. W. L. , Brough W. A. , Tweedle D. E. F.
Published: September 2007

The role of operation, particularly pancreaticojejunostomy, in the treatment of abdominal pain from
chronic pancreatitis is controversial, but relief of pancreatic duct obstruction may decrease the rate of
pancreatic organ failure. Our results over 6 years in 13 carefully selected patients suggest that pancreatic
drainage does relieve pain but is less effective in preventing pancreatic exocrine failure. Pain was the
indication for operation in all patients.
Clinical Diversity in Biliary Pancreatitis — Classification of Two Types
Authors: Isogai Masatoshi , Hachisuksa Kitao , Yamaguchi Akihiro , Nakano Satoshi
Published: September 2007

One hundred and seven patients with biliary pancreatitis undergoing operation from 1976 to 1989 were
reviewed. To clarify the reason for failure to respond to conventional supportive therapy, 73 patients (68%) who underwent emergency surgery were retrospectively divided into two groups according to the severity of the pancreatitis evaluated at laparotomy and compared. Sixty‐two had minimal or mild pancreatitis (Group I), among whom 44 (71%) had life‐threatening acute biliary tract disease. All underwent biliary surgery and 4 (6%) subsequently died, 2 due to acute obstructive suppurative cholangitis. Eleven had hemorrhagic necrotizing pancreatitis (Group II), among whom 7 had complications of acute pancreatitis such as pancreatic ascites or abscess. These underwent pancreatic and/or
biliary surgery and 3 (27%) died of multi‐organ failure.

There appears to be two types of biliary pancreatitis refractory to conventional supportive therapy, which differ in the extent of surgery required and in mortality: (1) minimal or mild pancreatitis with persistent life‐threatening acute biliary tract disease (biliary type), and (2) more severe pancreatitis (pancreas type) early in the course of the disease.
Infected Peri‐Pancreatic Necrosis Causing Gallbladder Necrosis by Direct Extension
Authors: Schein Moshe , Assalia Ahmad , Schmulevski Pavel , Meislin Vladimir , Hashmonai Moshe
Published: September 2007

Acute acalculous cholecystitis may develop in patients suffering from necrotizing pancreatitis.
Conversely, acute pancreatitis may complicate acute gallbladder disease. We present a case that lends
support to the existence of another possibility: gallbladder necrosis caused by direct extension of the
necrotizing pancreatitic process.
The Outcome of Cholangitis After Percutaneous Biliary Drainage in Neoplastic Jaundice
Authors: Audisio Riccardo A. , Morosi Carlo , Bozzetti Federico , Cozzi Guido , Bellomi Massimo , Pisani Paola , Pestalozza Alessandra , Gennari Leandro , Severini Aldo
Published: September 2007

The purpose of this paper is to evaluate factors affecting the outcome of cholangitis after PTBD in jaundiced cancer patients. Twenty nine patients with neoplastic jaundice (male/female ratio 13/16, median age 55 years) with full clinical data, were treated by PTBD and developed cholangitis at a median of 9 days later. Four patients (14%) died of biliary sepsis a median of one month after PTBD while the other 25 survived a median of 6 months, with one week median duration of cholangitis. The probability of the cholangitis resolving was analyzed by time to resolution and it was found that 50% and 100% of the recoveries occurred 5 and 9 months respectively from the onset of the complication.

The series was analyzed to determine the role of several variables (disease/patient/treatment related)
in the resolution of cholangitis. Only a low stricture site, a large initial drainage catheter (10F) and a
temperature increase exceeding 39° C were correlated with a positive outcome. We conclude that
PTBD‐related cholangitis has, in our experience, a good chance of cure, low mortality rate and
satisfactory 6 months median survival.
Malignant Pancreatic Polypeptide Secreting Tumour of Islet Cells: A Case for Aggressive Surgical Palliation
Authors: Pullan R. D. , Scriven M. W. , O′dowd J. , Edwards A. T. , Lewis M. H.
Published: September 2007

A case of a malignant pancreatic polypeptide secreting tumour is reported. The tumour was metastatic
at presentation at which time it was excised. Pancreatic duct obstruction occurred 3 years after excision causing severe pain on eating. Major palliative surgery, in the form of a pancreatico‐jejunostomy, cured the severe symptoms. The patient survives, largely symptom free, over six years after original excision. This case illustrates the need for aggressive management of symptoms in tumours in which long term survival is possible despite locally advanced or metastatic disease.

ABBREVIATIONS: VIP — vasoactive intestinal peptide. CT — computed tomography. GI — gastrointestinal. HPP — human pancreatic polypeptide. APUD — amine precursor uptake and decarboxylation.