bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver Transplantation With Incidental Gallbladder Carcinoma in the Recipient Hepatectomy
Authors: Kennethwashburn W. , Davidlewis W. , Jenkins Roger L.
Published: September 2007

Gallbladder carcinoma(GBCA) is the most common malignancy of the biliary tract1 and is often
found seredipitiously after cholecystectomy. We report the first two cases of incidental GBCA in the
native gallbladder of two liver transplant recipients. Both patients are 2.5 years following uneventful
orthotopiic liver transplantation(OLTx) with no evidence of recurrent disease. Pathology of both
recipients was early and favorable. Neither patient received any further therapy. Given the incidence
of GBCA and the evolution of OLTx we would anticipate this finding to be more prevalent.
Selective Radionuclide Localisation in Primary Liver Tumours
Authors: Novell J. R. , Green A. J. , Hilson A. J. W. , Dusheiko G. , Dick R. , Hobbs K. E. F.
Published: September 2007

The therapeutic potential of 131I‐Lipiodol was investigated in 8 patients with cholangiocarcinoma (CCA)
and 15 patients with hepatocellullar carcinoma (HCC). Patients received one or two doses of
131I‐Lipiodol via hepatic arterial injection. The mean total administered activity was 668 (SD 325) MBq
in CCA and 953 (SD 477) MBq in HCC. One patient with CCA retained 131I‐Lipiodol. The cumulative
radiation dose was 9.6 Gy to tumour, 6.4 Gy to liver and 1.5 Gy to lung. The patient remained
asymptomatic with no evidence of tumour 30 months from the start of treatment, whereas the remaining
7 patients exhibited tumour progression. The mean survival in CCA was 11.6 (SD 14.5) months. All 15
patients with HCC retained 131I with tumour: liver ratios of up to 30:1. The mean cumulative radiation
dose was 34.7 (SD 32.4) Gy to tumour, 3.3 (SD 1.5) Gy to liver and 4.4 (SD 2.3) Gy to lung. The mean
dose per administered activity was 3.8 (SD 4.1) cGy/MBq. Partial response (reduction in tumour size >
50%) was observed in 6 patients (40%). The mean survival was 7.1 (SD 6.0) months.

131I‐Lipiodol can deliver highly selective internal irradiation to foci of HCC with evidence of objective
response and may be the treatment of choice for patients with cirrhosis and a small tumour.
Diagnosis and Surgical Treatment of Hepatic Hydatid Disease
Authors: Bilge Ahmet , Sözüer Erdoğan M.
Published: September 2007

In this report, 226 patients with hydatid disease admitted to the Surgical Department of Erciyes
University (Kayseri) and Şişli Etfal Hospital (Istanbul) in Turkey between 1978 and 1990 were
reviewed retrospectively. 102 patients (45.1%) were male and 124 (54.9%) female. The most
frequent symptom was right upper abdominal pain (66%). The most frequent signs were
hepatomegaly (43.8%) and palpable mass (39%). 167 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%). Patients were
operated on by various techniques; omentoplasty (101), external drainage of residual cavity (64),
marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection
(5). Main postoperative complications were wound infection (12%) and biliary fistula
(2.6%). Total mortality rate was 1.8% in this series.
Does Liver Transplantation in the Rat Cause a Regenerative Response
Authors: Engelbrecht G. H. C. , Mcleod Heather , Tyler Marilyn , Lotz Zoe , Jaskiewicz K. , Hickman Rosemary
Published: September 2007

This study was conducted to determine the pattern of early regenerative response to orthotopic intact
liver transplantation in the rat and to investigate whether the response differed in grafts with or without
revascularisation of the arterial bed.

Outbred male Long Evans (LE‐LE allogeneic, non rejector) rats weighing 300–350g were subjected
to orthotopic intact liver allograft using a “sleeve” anastomosis for the hepatic artery. Total warm
ischaemia ranged from 19 to 34 minutes and no storage was employed. Comparison was made with a
group of control rats which were subjected to 25 minutes total inflow occlusion and regeneration was
measured with tissue thymidine kinase (TK) and mitotic figures. Samples were taken at 1,2,4,7,10 and
20 days post‐operatively. Plasma aspartate aminotransferase (AAT) and light microscopy were used to
evaluate hepatocyte necrosis. There was a brief sharp increase in TK and AAT in the first 24 hours after
sham operation but no appearance of mitotic figures. A similar but more prolonged increase in TK
occurred in the arterialised transplant group with the highest levels recorded on day 4. The level
remained significantly elevated above pre‐operative until 10 days and declined within 20 days. Mitotic
figures appeared at 2 days, reached significance at 7 and 10 days and had disappeared by 20 days. The
pattern of changes was accentuated in animals in which the artery was not reanastomosed and the
increases in TK and AAT were still significant at 20 days. Whilst similar degrees of peri‐portal cellular
infiltrate occurred in both groups of rats, bile duct proliferation was most obvious in non‐arterialised
animals.

As compared with a previously prepared group of partially hepatectomised animals, the regenerative
response after liver transplant was delayed and prolonged especially in the non‐arterialised group.

It is concluded that a regenerative response occurred in liver allografts in rats soon after operation,
which was slightly prolonged if the hepatic artery was not anastomosed and that the response seemed to
be related to hepatocyte damage which occurred as part of the procedure. The relevance of these
findings to clinical liver transplantation is discussed.
Strategies for Reducing Blood Transfusions in Hepatic Resection
Authors: Matsumata T. , Itasaka H. , Shirabe K. , Shimada M. , Yanaga K. , Sugimachi K.
Published: September 2007

A comparison of 60 blood transfused and 71 nonblood transfused hepatic resection patients was
done to evaluate strategies for reducing blood transfusions during hepatic surgery. There were no
significant differences between the two groups with regard to preoperative laboratory data,
except for prothrombin time and hematocrit value. The mean operative blood loss was 1990 ml
and 760 ml in the blood transfused and nonblood transfused groups, respectively. A multivariate
analysis suggested that the patient’s body weight, preoperative prothrombin time, and operative
blood loss independently predicted the need for intraoperative blood transfusion. Major
postoperative complications developed more frequently in the blood transfused group than in
the nonblood transfused group (31.7 vs. 11.3%, p<0.005). These results suggest that the
difference in operative blood loss between the two groups was related to the prolonged
prothrombin time and a susceptibility for blood transfusion was found to exist particularly in
patients with a lower hematocrit value as well as a lower body weight. Thus, the improvement of
these preoperative laboratory data combined with avoiding the use of the hematocrit value as
a determining factor for intraoperative transfusion could correspond to a reduction in operative
blood loss, while curtailing the demands on blood bank facilities, and lowering the risk of
postoperative complications.
Gall Bladder Tumour, Choledochal Cyst and an Anomalous Pancreatico‐Biliary Junction
Authors: Khan T. F. Toufeeq , Sherazi Zaheer A. , Tan Yan Yew
Published: September 2007

This report highlights the association of a tumour in an acalculous gall bladder with an anomalous
pancreatico‐biliary junction (PBJ) and a type IVa choledochal cyst. Cholecystectomy and Rouxen‐
Y hepatico‐jejunostomy (RHJ) was performed after division of the common bile duct (CBD)
and excision of the dilated segment. The details of the case are presented and the role of an abnormal
PBJ in gall bladder carcinogenesis is discussed.
Hepatoblastoma in an Adult with Biliary Obstruction and Associated Portal Venous Thrombosis
Authors: Kacker Lav K. , Khan E. M. , Gupta Rohit , Kapoor V. K. , Pandey Rakesh , Gupta R. K. , Saraswat V. A.
Published: September 2007

We present a case of adult hepatoblastoma. This young female presented with severe acute
cholangitis. Preoperative diagnosis was common bile duct (CBD) obstruction with portal vein
thrombosis. On exploration she had a tumor mass in the CBD. The unusual features of this case
are discussed in this report.
The Role of Leucoyte‐Derived Free Oxygen Radicals in the Pathogenesis of Experimental Acute Pancreatitis
Authors: Akpinar E. , Özden I. , Savci N. , Emre A.
Published: September 2007

The role of free oxygen radicals in experimental acute pancreatitis induced by common bile duct
ligation was investigated by measuring malondialdehyde levels in the rat pancreas. Also, the
potential role of leucocytes as the source of free oxygen radicals was tested by inducing
leukopenia with methotrexate. The malondialdehyde levels in the control, pancreatitis and
pancreatitis + methotrexate groups were 9.6 ± 2.0, 44.8 ± 11.4, and 25.6 ± 5.0 nmol malondialdehyde/
g pancreas tissue respectively. The corresponding histopathological severity scores were
0.5 ± 0.7, 8.1 ± 1.2 and 3.7 ± 1.1. The results suggest that the leucocyte may be an important
source of free oxygen radicals in this experimental model.
Improvement of Rat Survival and Liver Mitochondrial Function in Biliary Obstruction After Treatment With Sodium Thiosulfate
Authors: Myslovaty B. , Kyzer S. , Levinsky H. , Chaimoff C.
Published: September 2007

The exact cause of liver failure occurring after long standing biliary obstruction is not known.
Impairment of hepatic mitochondrial respiration was postulated in some studies. Sodium
thiosulphate (STS) is known to have a protective effect on liver function during administration of
hepatotoxic chemotherapy. In the present experimental study the effect of treatment with STS in
the presence of obstructive jaundice was studied by determination of the survival rate of rats
subjected to biliary obstruction and by polarographic determination of the hepatic mitochondrial
function. Treatment with STS was found to result in a significant improvement in rats′
survival rate (p < 0.05). Polarography demonstrated significant preservation of mitochondrial
respiratory capacity after treatment with STS. The results of the present study show that the
deterioration in liver function in the presence of biliary obstruction is probably caused by
impairment of mitochondrial respiration. This may be preserved by treatment with STS. The
exact explanation of its effect is not yet clear.
Hepatocellular Carcinoma Arising in Non‐Cirrhotic Haemochromatosis
Authors: Thompson N. P. , Stansby G. , Jarmulowicz M. , Hobbs K. E. , McIntyre N.
Published: September 2007

Hepatocellular carcinoma arising in a patient with genetic haemachromatosis, without cirrhosis, has
only been described once previously. We present a patient with a 15 year history of genetic
haemachromatosis who underwent resection of a hepatocellular carcinoma in a liver with normal
architecture.
Combined Interventional Radiological and Endoscopical Approach for the Treatment of a Postoperative Biliary Stricture and Fistula
Authors: Triller Jürgen , Schmassmann Adrian , Schweizer Walter , Czerniak Abraham
Published: September 2007

A 43‐year old woman was admitted 11 days after open cholecystectomy with a iatrogenic bile
duct injury. On admission the patient showed an uncontrolled biliary fistula through an external
drain placed at an emergency laparotomy for biliary peritonitis with fever and jaundice. PTC
showed a biliary stricture type II (Bismuth). A percutaneous drainage was performed to
decompress the biliary system. Three weeks later, percutaneous balloon dilatation of the
stricture was performed. However, bile leakage persisted. In a combined transhepatic/
endoscopic procedure, the percutaneous biliary drainage was replaced by a nasobiliary tube.
One week later, no stricture was found and the biliary leak was sealed. The patient could be
discharged without symptoms or signs of cholestasis. The multidisciplinary management of
post‐operative biliary fistula is presented, comparing the role of interventional radiology,
endoscopy and surgery.
Definitive Surgical Treatment for Cholelithiasis in Selected Patients with Liver Cirrhosis
Authors: Wu Cheng-Chung , Hwang Chi-Jou , Fang June-Hei , Liu Tse-Jia
Published: September 2007

To determine whether definitive surgery such as cholecysectomy or extraction of bile duct
stones is appropriate in cirrhotic patients the results of definitive surgery have been reviewed
retrospectively in a group of 112 cirrhotic patients with cholelithiasis. Eighty‐seven of these
patients underwent definitive surgery for gallstones and the remaining 25 were treated
conservatively.

Child′s criteria were applied to each patient. Patients with Child′s grade A disease had fewer emergency procedures, operative blood loss and transfusion were less and they had a shorter
hospital stay compared with patients with grades B and C. There were 4 deaths after definitive
surgery for emergency conditions and these were all in Child′s grade C. Of the 83 survivors
after definitive procedures .78 patients (93.9%) were still alive 52.8 months later without any
biliary tract symptoms. Of the 25 patients undergoing conservative treatment 2 were Child′s B
and 23 were Child′s C grade.

We suggest that definitive surgery can be carried out safely, in Child′s A and B cirrhotic patients, either electively or as an emergency. However, a more conservative approach is advisable in Child C patients with acute conditions and definitive surgery is recommended as
an elective procedure after the liver function has improved.
Fibrolamellar Hepatocellular Carsinoma “It is not a Ordinary Case for Mediterranean Countries”
Authors: Arslan Ismail , Öner Köksal , Kiliffturgay Sadik , Agar Nihat , Alpaslan Fahrettin
Published: September 2007

The fibrolamellar variant of hepatocellular carcinoma (HCC) is an uncommon tumour with
distinctive clinical and histological features. Although the first case of fibrolamellar hepatocellular
carcinoma (FI‐HCC) was described by Edmondson in 1956, and later confirmed in five
patients by Peters, the majority of reports followed those of Berman et al. and Craig et al. 1,2.

A case of FI‐HCC, which is rarely diagnosed in Mediterranean countries including Turkey,
is presented in the following report.
Can We Do Away With PTBD?
Authors: Bapat R. D. , Rege N. N. , Koti R. S. , Desai N. K. , Dahanukar S. A.
Published: September 2007

Percutaneous Transhepatic Biliary Drainage (PTBD) is performed in surgical jaundice to
decompress the biliary tree and improve hepatic functions. However, the risk of sepsis is high
in these patients due to immunosuppression and surgical outcome remains poor. This raises a
question—can we do away with PTBD? To answer this query a study was carried out in 4
groups of patients bearing in mind the high incidence of sepsis and our earlier studies, which
have demonstrated immunotherapeutic potential of Tinospora cordifolia (TC): (A) those
undergoing surgery without PTBD (n = 14), (B) those undergoing surgery after PTBD
(n = 13). The mortality was 57.14% in Group A as compared to 61.54% in Group B. Serial
estimations of bilirubin levels carried out during the course of drainage (3 Wks) revealed a
gradual and significant decrease from 12.52 ± 8.3 mg% to 5.85 ± 3.0 mg%. Antipyrine half‐life
did not change significantly (18.35 ± 4.2 hrs compared to basal values 21.96 ± 3.78 hrs). The
phagocytic and intracellular killing (ICK) capacities of PMN remained suppressed (Basal:
22.13 ± 3.68% phago, and 19.1 ± 4.49% ICK; Post drainage: 20 ± 8.48% Phago and 11.15 ± 3.05% ICK). Thus PTBD did not improve the metabolic capacity ofthe liver and mortality was
higher due to sepsis. Group (C) patientg received TC during PTBD (n = 16) and Group (D)
patients received TC without PTBD (n = 14). A significant improvement in PMN functions
occurred by 3 weeks in both groups (30.29 ± 4.68% phago, 30 ± 4.84% ICK in Group C and
30.4 ± 2.99% phago, 27.15 ± 6.19% ICK in Group D). The mortality in Groups C and D was
25% and 14.2% respectively during the preoperative period. There was no mortality after
surgery. It appears from this study that host defenses as reflected by PMN functions play an
important role in influencing prognosis. Further decompression of the biliary tree by PTBD
seems unwarranted.
Cryotherapy of Liver Tumours–A Practical Guide
Authors: Ross W. B. , Horton M. , Bertolino P. , Morris D. L.
Published: September 2007

The use of cryotherapy for the treatment of some unresectable liver tumours has been clearly
established as a therapeutic option. Intra‐operative ultrasound has enhanced the process by enabling
the surgeon to identify hepatic lesions and to allow visualisation of the freezing process to ensure that
the cryolesion will include the tumour mass. The purpose of this paper is to provide a practical guide to
surgeons who wish to perform cryotherapy of liver tumours. Patient selection and anaesthetic
considerations are important. The surgeon should be able to deal with the complications of
cryotherapy, particularly the intra‐operative haemorrhage which may arise from cracking of the
hepatic parenchyma as the iceball thaws. Follow‐up is based on tumour marker assay and imaging of
the liver and repeat cryotherapy can be considered for selected cases.
Somatostatin Reduces Bile Secretion and Loss of Bile Constituents in Patients with ExternalBiliary Drainage
Authors: Andersen Helene Bryde , Petronijevic Ljiljana , Giese Birgitte , Mygind Thorkild , Burcharth Flemming
Published: September 2007

The effect of 24‐hours continuous somatostatin 14 infusion on the volume of the bile secretion and on the
bile composition were studied in seven patients with malignant biliary obstruction who had transhepatic
external biliary drainage.

The bile acid composition was measured with high performance liquid chromatography (HPLC).
Somatostatin infusion significantly reduced the daily bile loss from median 473 ml to 140 ml (41 percent,
p=0.01) with a concomitant significant reduction in the daily molar loss of cholesterol, triglyceride, Na+, K+, CI−, Ca++ and Mg++. The loss of chloride and sodium was reduced with median 50 mmol/day each
(p=0.01). The relative concentrations of the measured bile constituents did not change significantly,
except for bile acids (p=0.02): the concentration of glycochenodeoxycholic acid increased significantly
(p=0.04). The molar loss of taurocholic acid decreased significantly (p=0.035), so the increased
concentration of glycochenodeoxycholic acid resulted only in a marginally significant reduction in the
total molar loss of bile acids (p=0.051).

Somatostatin is a potent inhibitor of bile secretion. The peptide may be used in severely bile depleted
patients for reducing their serious electrolyte and acidity problems. Analysis of bile acid composition by
HPLC is well suited for further investigations of the regulatory mechanisms of bile acid secretion.
A New Method to Measure Portal Venous and Hepatic Arterial Blood Flow Patients Intraoperatively
Authors: Jakab F. , Ráth Z. , Schmal F. , Nagy P. , Faller J.
Published: September 2007

The intraoperative measurement of the afferent circulation of the liver, namely the hepatic artery flow and portal venous flow was carried out upon 14 anesthetized patients having carcinoma in the splanchnic area,
mainly in the head of the pancreas by means of transit time ultrasonic volume flowmeter. The hepatic
artery flow, portal venous flow and total hepatic flow were 0.377±0.10; 0.614±0.21; 0.992±0.276 l/min respectively.

The ratio of hepatic arterical flow to portal venous flow was 0.66±0.259
There was a sharp, significant increase in hepatic arterial flow (29.8±6.1%, p<0,01) after the temporary occlusion of the portal vein, while the temporary occlusion of hepatic artery did not have any significant
effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow
is a much disputed question, but according to the presented data here, it is unquestionable, that the
decrease of portal venous flow immediately results a significant increase in hepatic artery circulation.
An Easier Technique for End to End Pancreatlcojejunostomy
Authors: Pedrazzoli Sergio , Sperti Cosimo , Pasquali Claudio
Published: September 2007

Breakdown of the pancreaticoenterostomy is responsible for a number of complications and for the
high mortality associated with pancreaticoduodenectomy. Although in recent years the postoperative
mortality has dropped to less than 10% and in some to less than 5%, pancreatic fistula remains
the most common and troublesome complication.

Various procedures, such as duct ligation or occlusion, resection of the pancreatic stump or
pancreaticogastrostomy, have been proposed to treat the pancreatic stump when it is considered
unsuitable for jejunal anastomosis. A little trick permitted us to perform 41 consecutive end to end
pancreaticojejunostomies, irrespective of the conditions of the pancreatic stump, with only 3
pancreatic fistulas (7%) and without fistula related deaths.
Transient Hemolytic Anemia after Transjugular Intrahepatic Portosystemic Stent Shunt
Authors: Garcia-Rebollo Sagrario , González-Reimers Emilio , Santolaria-Fernández Francisco , Diaz-Romero Francisco , Rodriguez-Moreno Fermin , Martinez-Riera Antonio
Published: September 2007

Management of variceal bleeding secondary to portal hypertension constitutes a challenging issue, particularly in child′s C cirrhotic patients. Recently, transjugular placement of self‐expanding metallic stents in the liver (TIPS), creating a shunt between the portal and hepatic branches has provided a safe and promising
therapeutic approach in this clinical situation. We report here the case of a 66‐year‐old male cirrhotic patient
who developed a moderately severe clinical picture of a Coombsnegative hemolytic anemia (serum
hemoglobin, 93 g/l, serum bilirubin 160.74 umol/L (9.4 mg/dl), indirect 6.3 mg/dl (107.73 umol/L); serum
LDH 1220 u/l, reticulocytes, 5.1%. serum ferritin, 1221 ug/1, schistocytes in peripheral blood smear) the week
after undergoing a TIPS, suggesting the development ofa microangiopathic hemolytic anaemia secondary to
red blood cell disruption by passing through the metallic network of the stent.
The Ability of Bile to Scavenge Superoxide Radicals and Pigment Gallstone Formation in Guinea Pigs
Authors: Lin Cong , Shen Tao , Fu Xianbo , Zhou Xiaosi
Published: September 2007

After partial ligation of the common bile duct (CBD) of guinea pigs, 14 of 16 animals developed pigment gallstones within one week (S group). Intraperitoneal injection of Vit. E and C, each 10 mg/kg daily from 3 days before CBD ligation to one week after the operation (S+V group), decreased the gallstone incidence to 5/14 (exact probability<0.01). The gallstone incidence in the control group, that only received laparotomy without ligation of the CBD, was 0/15. Biochemical analysis of the gallbladder bile showed that stricture of the CBD was associated with a significant increase in levels of unconjugated bilirubin (UCB) and Ca2+ (p<0.05 and <0.01). Simultaneously the scavenging rate (SR) of superoxide radical in bile significantly decreased (p<0.05). Comparing S+V group with S group, the effect of Vit. E and C on the concentrations of UCB and Ca2+ in bile was not significant (both p>0.05), but Vit. E and C normalized the SR, and the difference between S group and S+V group was significant (p<0.05). These results suggested that Vit. E and C, known as antioxidants, enhanced the ability to scavenge oxygen radical in S+V group; and that in addition to the increases of UCB and Ca2+ concentrations, the participation of oxygen radicals might be of importance for pigment gallstone formation induced by bile duct obstruction.
Two Cases of Spontaneous Liver Rupture and Literature Review
Authors: Cozzi P. J. , Morris D. L.
Published: September 2007

Spontaneous liver rupture is uncommon, difficult to diagnose and carries a universally high mortality. It
has been well documented to occur as a complication of primary or secondary hepatic malignancy.
Similarly, there are 28 cases of ruptured haemangiomata described in the world literature. It is also well
described in severe pregnancy‐induced hypertension and is said to carry a mortality of 18% for patients
treated by packing and drainage of the haematoma and 75% for patients treated with liver resection.

Two female patients aged 60 and 61 presented to our accident and emergency department. One had a
history of hypertension only and the other a history of a bleeding diathesis from the lupus anticoagulant.
Both presented with hypotension and abdominal pain and both were diagnosed by abdominal CT scan.
One was treated with hepatic artery ligation and tamponade and the other with liver resection and
correction of the coagulopathy. Neither had any evidence of a ruptured haemangioma or tumour at
laparotomy or on histological examination, and both are alive and well.

The conclusions to be drawn from this review and our own recent experience is that the treatment of
choice for ruptured haemangiomata is liver resection and, for rupture during pregnancy, is tamponade
with packs and evacuation of the haematoma. Hepatic arteriography and embolisation, if possible, is a
useful adjunct. Correction ofany coagulopathy is essential. We can only speculate that the aetiology in our
patients was uncontrolled hypertension in one and coagulopathy in the other.
Cystic Dilatations of the Common Bile Duct in Adults
Authors: Kouraklis Gr. , Misiakos E. , Glinavou A. , Karatzas G. , Gogas J. , Skalkeas G.
Published: September 2007

Cystic dilatations of the common bile duct are believed to be of congenital etiology with most cases presenting in childhood. During the last 20 years, 10 patients with cystic dilatations of the bile duct were treated in our Department. There were 5 men and 5 women with an age range of 35–81 years. Clinical presentation consisted of right hypohondrial pain, nausea, vomiting and a history of obstructive jaundice. Diagnosis was established by ultrasound, cholangiography and ERCP in most cases. According to the Todani classification system, 5 patients had type I cysts, 4 had type II and one had type III. At the time of surgery, main associated diseases were choledocholithiasis in 3 cases and cholangitis in 2 cases. One patient (type III) underwent endoscopic sphincterotomy; 4 patients underwent internal drainage and 2 of them developed mild cholangitis postoperatively; 5 patients underwent excision of the cyst and a biliary‐enteric bypass and developed no main complications. Patients remained in good health during long‐term follow‐up. We conclude that cyst excision is the treatment ofchoice for adults in order to reduce postoperative morbidity and the potential risk of malignancy.
Hepatic Segrnentectomy on Primary Liver Cancer with Situs Inversus Totalis
Authors: Kamiike W. , Itakura T. , Tanaka H. , Hatanaka N. , Nakamuro M. , Miyata M. , Izumi H.
Published: September 2007

We present the first case treated by hepatic segmentectomy in a 69‐year‐old woman with primary liver
cancer and situs inversus totalis. The situs inversus did not cause any technical problems during the
operation, which was conducted under guidance of intraoperative ultrasonography.
Hepatobiliary Cystadenomas and Cystadenocarcinoma. Report of Five Cases
Authors: Gadijev E. , Ferlan-Marolt V. , Grkman J.
Published: September 2007

Clinicopathologic correlation offive cases ofcystadenomas of the liver are reported. All patients
were female and radical surgical procedure, total excision or resection was performed four times,
and partial excision once. In all patients the postoperative course was uneventful and they are all
alive and well. Examined by conventional histological and special immuno‐histochemical stains
the tumors fulfilled diagnostic criteria for these rare cystic growths. The cyst wall was composed
of three, histologically distinct layers. From the viewpoint of histogenesis and differential
diagnosis immunohistochemical properties were analysed. CEA and EMA were demonstrated
in epithelial cells and Vimentin in stromal cells.
The Management of Extrahepatic Portal Vein Aneurysms: Observe or Treat?
Authors: Feliciano Philip D. , Cullen Joseph J. , Corson John D.
Published: September 2007

A case of a 70 year old man who was found to have an extrahepatic portal vein aneurysm during an evaluation for hematuria is reported. Extrahepatic portal vein aneurysms are rare with only twenty cases reported in the literature. Typically, patients present with hemorrhage requiring surgical exploration or the aneurysm is discovered during evaluation of another abdominal process. Management includes careful follow‐up in the asymptomatic patient without underlying liver disease or portal hypertension.
Prophylactic Sclerotherapy: Yes or No!
Authors: Burroughs A. K.
Published: September 2007

Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal
hemorrhage have given controversial results. We continued a previously reported study
and randomly assigned 141 patients with esophageal varics and no prior gastrointestinal
bleeding to either prophylactic sclerotherapy (n=70) or no treatment (n=71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent
varics were treated with repeat sclerotherapy. The groups were well balanced in terms of
demographic and clinical characteristics. Patients in both groups who bled from varices
received sclerotherapy whenever possible.

During a median follow‐up of 56 months, variceal bleeding occurred in 7% in
sclerotherapy patients and 44% on control patients (p < 0.01). In the sclerotherapy
group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate
increased with the severity of liver function impairment. Sclerotherapy was not found to
improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or
nonalcoholic) or variceal size (low‐grade or high‐grade). We conclude that sclerotherapy
is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does
not appear to have an effect on survival.
Octreotide in the Control of Post‐Sclerotherapy Bleeding from Oesophageal Varices, Ulcers and Oesophagitis
Authors: Jenkins Spencer A. , Kingsnorth Andrew N. , Ellenbogen Simon , Copeland Graham , Davies Nicholas , Sutton Robert , Shields Robert
Published: September 2007

Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of postsclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure < 100 mm Hg, pulse >
100 beats per min or the need to transfuse 2 or more units of blood to restore the haemoglobin level) following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 μg/h) for between 40–140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 μg) for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 μg octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection sclerotherapy.
Primary Extrahepatic Bile Duct Carcinoids
Authors: Belli Giulio , Rotondano Gianluca , D′Agostino Alberto , Marano Ines
Published: September 2007

Biliary tact carcinoids are extremely rare: only ten cases have been reported up to now. The
Authors describe a successfully treated carcinoid tumour ofthe proximal bile duct and review the
literature about these rare malignancies.

Despite extensive preoperative work‐up, including ultrasound, CT scan and ERCP, a definite
diagnosis is hardly possible prior to histologic examination of the operative or necropsy
specimen.

Due to the slow‐growing nature and the non‐aggressive behaviour of these malignancies,
surgical resection followed by biliodigestive anastomosis should be the treatment of choice.
Liver Resection: Prolonged Inflow Occlusion in Human Cirrhotic Livers
Authors: Jeppsson Bengt
Published: September 2007

To evaluate the tolerance of the cirrhotic liver to extended warm ischaemia, 47 patients with cirrhosis who underwent liver,resection over a 4‐year period were studied retrospectively. Three groups of patients were identified. In group 1 (14 patients) liver resection was performed under conditions of portal triad occlusion ranging from 50 to 75 (mean 57.1) min. Group 2 (12 patients) was treated with portal occlusion for a period ranging from 30 to 42 (mean 33.1) min. Group 3 comprised 21 patients who underwent hepatectomy using conventional techniques. Mean blood loss was significantly reduced by portal triad occlusion (819 ml in group 1,523 ml in group 2) compared with the conventional techniques (1652 ml in group 3) (P<0.05, group 1 versus group 3; P<0.01, group 2 versus group 3). Hospital death occurred in three of the 21 patients in group 3 but in no patient who underwent portal triad occlusion. The morbidity rate was lower in the two occlusion groups (four of 26 patients) than in group 3 (six of 21). Bilirubin metabolism was substantially better after surgery in the occlusion groups (P<0.05, groups 1 and 2 versus group 3 at day 14). Although the serum levels of transaminases were significantly raised until day 3 in patients undergoing long term occlusion, the cirrhotic liver withstood the ischaemia‐reperfusion insult, as assessed by changes in hepatic microcirculation, lipid peroxidation and the morphology of hepatic sinusoids. It is concluded that prolonged ischaemia during liver resection can be sustained in patients with cirrhosis and without high‐risk factors.
Long‐Term Hemodynamic Effects of Portocaval Shunt and Sugiura Procedure in Patients with Cirrhosis
Authors: Vons Corinne , Hadengue Antoine , Smadja Claude , Franco Dominique , Lebrec Didier
Published: September 2007

Systemic and splanchnic hemodynamics were studied before and six months after a portal systemic shunt
(n=6) or a Sugiura procedure (n=9) in 15 patients with cirrhosis and a past history of variceal bleeding.
Hepatic blood flow was estimated by hepatic extraction and clearance of continuous indocyanine green
infusion. Azygos blood flow was measured with a continuous thermodilution catheter. After portocaval
shunt, the cardiac index increased significantly from 4.0±1.4 to 5.4±0.8 l/min m2 (p<0.05), the hepatic venous pressure gradient and hepatic blood flow were significantly decreased from 21±3 to 13±5 mm Hg (p<0.05) and from 1.20±0.35 to 0.37±0.16 l/min (p<0.05) respectively. The decrease in azygos blood flow was not significant (0.51±0.31 vs 0.25±0.33 l/min; p=0.1). After Sugiura procedure, there was no significant change in cardiac index, hepatic venous pressure gradient, hepatic blood flow or azygos blood flow. This is the first study to show the long‐term maintenance of splanchnic and systemic hemodynamics
in patients with cirrhosis after Sugiura procedure. The absence of long‐term hemodynamic alterations
could explain the absence of encephalopathy after this procedure.
Choledochoduodenostomy in the Management of Common Duct Stones or Associated Pathology – An Obsolete Method?
Authors: de Almeida António Castro Mendes , dos Santos Noel Medina , Aldeia Fernando José
Published: September 2007

Choledochoduodenostomy (CDD) has been reported as a more effective treatment of CBD stones than T‐tube drainage but it is regarded as a last resort or obsolete therapeutic method due to fears of higher mobidity, cholangitis, “sump” syndrome and liver dysfunction. We aimed to assess the aforementioned issues analyzing prospectively our experience from 1976 through Dec.92.

Methods: CDD was performed in 89 females and 36 males, aged 60.2±8.7 years, 26 during repeat surgery. Duct stones were the indication in 94, Sphincter of oddi (SO) dysfunction in 23 and obstructive pancreatitis nodule in 8. Peroperative liver biopsies were obtained in 44 patients. The “follow‐up” schedule (> 2.5 years in 110) included clinical interview and LFT′s on an yearly basis. Ultra sound (USG) was obtained every one or two years. ERC was done in 10 symptomatic patients and in 25 others for protocul purposes. Liver
biopsies were taken four to nine years post surgery in 11 patients‐five at relaparotomy for non‐biliary causes and six percutaneously by fine needle. Ductal mucosa biopsy could safely be performed in one patient 10 years after surgery. The long‐term results were classified as excellent, good, fair or poor. Poor meant the need for further invasive therapy (resurgery or EST).

Results: There were two operative deaths (1.6%). The long‐term results (123 survivors) were considered excellent in 89, good in 22, fair in 9 and poor in three. Three patients died from unrelated causes and eight others ceased the “follow‐up” evaluation three to five years post surgery. All of them were considered as having excellent or good results. A widely patent anastomosis of approximately 20 mms without mucosal inflammatory changes was documented in every patient assessed via ERC. food “debris” was detected within the distal duct of four patients yet it was easily flushed through the stoma. Normal tissue patterns were observed in all long‐term liver biopsies. Likewise the ductal mucosa biopsy failed to reveal any acute or chronic inflammatory changes.

Conclusions: 1) CDD is ahighly effective short and long‐term treatment of CBD lithiasis.2) It does not lead to bacterial or “chemical” cholangitis, to “sump” syndrome or to hepatic dysfunction, provided a wide anastomosis is accomplished.3) CDD should only be considered as obsolete after extensive, long‐term, prospective, randomized assessments of laparoscopic or combined laparoendoscopic approaches have been shown to be as effective as or superior to CDD.
Liver Transplantation: Does Prolonged Storage Promote Non‐Anastomatic Biliary Structures?
Authors: Kahn D.
Published: September 2007

The occurrence of biliary stricutures in allografts following liver transplantation correlates
with the duration of preservation time. The correlation between preservation time
and biliary strictures suggests that anoxic or reperfusion injury of the bile duct epithelium
causes stricture formation. However, the relative susceptibility of bile duct cells to anoxic
or reoxygenation injury is unknown. Our aims were to determine the vulnerability of rat
liver bile duct cells to anoxic and reoxygenation injury and to compare the results with
hepatocytes. During anoxia, bile duct epithelial cells were significantly more resistant to
cell killing than hepatocytes. Rates of cellular proteolysis were also 2.5‐fold lower in bile
duct cells than in hepatocytes during anoxia. In contrast to anoxia, reoxygenation of
anoxic cells increased cell killing of bile duct cells but improved viability of hepatocytes.
The rate of toxic oxygen species formation by bile duct cells was 5‐fold greater than in
hepatocytes during reoxygenation. In addition, basal levels of glutathione are lower in bile
duct cells than in hepatocytes. These data suggests that bile duct cells are more susceptible
to reoxygenation injury than to anoxia. These studies support the hypothesis that
reoxygenation injury during liver preservation leads to bile duct injury during liver
transplantation.
Carcinoid Tumor of the Common Bile Duct
Authors: Kopelman Doron , Schein Moshe , Kerner Hedviga , Bahuss Hany , Hashmonai Moshe
Published: September 2007

A case of a primary carcinoid tumor of the common bile duct is presented. Diagnostic and therapeutic uncertainties of this extremely rare cause of jaundice are discussed.
“A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Rouxon a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”
Authors: Pescio Gianluigi , Cariati Erminio
Published: September 2007

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y
on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to
reconstitute the alimentary tract.

The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear
Stapler 3‐4 centimeters from the biliary anastomosis. In this way, by employing the same loop without
mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested
model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a
stagnant cul‐de‐sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of
leakage, a pure biliary and/or pancreatic fistula as far as is possible.

99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction,
showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any
alkaline enterogastric reflux.
Isolated Late Metastasis of a Renal Cell Cancer Treated by Radical Distal Pancreatectomy
Authors: Barras J. P. , Baer H. , Stenzl A. , Czerniak A.
Published: September 2007

A 53–year‐old man underwent right nephrectomy for a locally advanced renal cell carcinoma with concomitant resection of a solitary metastasis in the right lung. Ten years later, he presented with haematochezia caused by a tumour in the tail of pancreas, invading the transverse colon and the greater curvature of the stomach. The tumour was radically resected, and histological examination revealed a solitary metastasis of the previous renal cell carcinoma. This case illustrates a rare indication for pancreatic resection because of pancreatic metastasis.
Are Hepatic Adenomas Premalignant?
Authors: Nagorney David M.
Published: September 2007

Objective: To investigate clinical experience with the apparent malignant transformation of benign liver cell adenomas.

Design: Retrospective review of personal experience and literature.

Setting: University hospital and affiliated community hospitals.

Patients: All patients diagnosed with liver cell adenomas over a 30‐year period.

Interventions: Liver resection and/or tumor biopsy.

Main Outcome Measures: Gender, age, drug associations, alpha‐fetoprotein levels, response to treatment, and survival.

Results: Thirteen patients from personal experience and 26 patients from the reports of others had liver cell adenomas that were not resected. Five of these patients subsequently developed hepatocellular carcinoma.

Conclusions: Malignant transformation of a liver cell adenoma is a rare phenomenon, but it does occur. Alphafetoprotein levels may be more helpful in diagnosis than expected from previous reports. Solitary benign adenomas should be resected whenever possible. Patients with diffuse multiple tumors should be observed closely over a long period.
Hanging Noncalculous Gallbladder
Authors: Tzardinoglou E. , Prousalidis J. , Apostolidis S. , Katsohis C. , Aletras H.
Published: September 2007

The removal of acalculous and not acutely inflamed gall‐bladder in patients with typical biliary pain
remains a questionable procedure. This study was conducted to present our experience. In the period 1982‐
90, 1089 cases of calculous and acalculous gallbladder disease were treated in our clinic. In this period, 27
patients were subjected to cholecystectomy because of an acalculous, non inflamed gallbladder which was
elongated lying in an abnormal position with a long cystic duct. The mean duration ofsymptoms supportive
of cholelithiasis, was 5 years. Oral cholecystogram and ultrasonography led to the diagnosis and other
causes ofchronic abdominal pain were excluded. There were 13 lumbar, 9 pelvic and 5 iliac gallbladders, with
poor function in 20 of them. During cholecystectomy, the organ was invested by peritoneum and suspended
in 7 cases from a mesentery. On pathological examination mild chronic inflammation was reported in
19 cases and minimal changes in 8. The minimum follow up was one year and the maximum 9 years. Complete
relief of symptoms was achieved in all the cases. In conclusion, cholecystectomy should be offered in these
symptomatic "hanging" gallbladders.
Prospective Randomized Trial Comparing Endoscopic Sphincterotomy Followed bySurgery with Surgery Alone in Good Risk Patients with Choledocholithiasis
Authors: Kapoor R. , Kaushik S. P. , Saraswat V. A. , Choudhuri G. , Sikora S. S. , Saxena R. , Kapoor V. K.
Published: September 2007

Background: Role of endoscopic sphincterotomy (ES) in high risk patients with choledocholithiasis is established but its role in good risk patients is unclear.

Design: A prospective randomized trial of endoscopic sphincterotomy followed by surgery (ES + S) versus surgery alone (SA) in good risk patients with choledocholithiasis.

Setting: A tertiary level referral hospital in north India; July 1991 to October 1993.

Patients and methods: Thirty three out of 60 patients with choledocholithiasis were found suitable for
randomization‐16 were randomised to ES+S group and 17 to SA group.

Results: Common bile duct clearance was achieved in 11/13 (85%) patients in ES+S group and in 13/15 (87%) in SA group. Major complications occurred in 4/13 (31%) patients in ES+S group and 3/16 (19%) patients in SA group. These differences were not statistically significant, but patients in ES+S group were exposed to morbidity twice, procedure related morbidity of ES being 23%. No significant differences were observed in hospital stay and cost of treatment.

Conclusions: Results of this trial do not support use of precholecystectomy ES in good risk patients with choledocholithiasis, since it did not offer any advantage over surgery alone.
Masswe Colonic Haemorrhage from a Solitary Caecal Varix
Authors: Shaper K. R. L. , Jarmulowicz M. , Dick R. , Cuthbert N. D. , Davidson B. R.
Published: September 2007

A 51 year old lady with chronic active hepatitis presented with massive lower gastrointestinal tract bleeding. Angiography demonstrated a solitary varix in the caecum which was found at laparotomy to be entering the bowel wall at the site ofadhesions from a previous appendicectomy. The portal pressure was found to be raised.
Aright hemicolectomy stopped the blood loss, but she subsequently died ofliver failure. Solitary colonic varices
associated with adhesions are extremely rare and their optimal management has not been established.
Laparoscopic Cholecystectomy in Cirrhotic Patient
Authors: Gugenheim Jean , Casaccia Marco , Mazza Davide , Toouli James , Laura Vanna , Fabiani Pascal , Mouiel Jean
Published: September 2007

Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child‐Pugh′s stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per‐ or post‐operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.