bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic Branch Vagotomy Can Suppress Liver Regeneration in Partially Hepatectomized Rats
Authors: Ohtake Masahiro , Sakaguchi Takeo , Yoshida Keisuke , Muto Terukazu
Published: September 2007

The role of the vagus nerve in liver regeneration after partial hepatectomy was studied by comparing the
effects of hepatic branch vagotomy with those of hepatic branch sympathectomy in rats. The liver weight as a percentage of body weight decreased significantly 7 days after vagotomy compared with the controls and this was associated with a reduction in food intake. There was no difference in the liver weights between the control rats and the pair‐fed vagotomized rats. Hepatic sympathectomy had no significant effect on the liver weight. The serum scores indicating hepatic function showed no difference between the control and the vagotomized rats except alkaline phosphatase. The concentration of insulin was unchanged. The number of mitotic hepatocytes remained high at 7 days after vagotomy: These
observations led us to conclude that the vagus nerve stimulates liver regeneration, and its effect depends on vagal factors directly and specifically.
The Effect of Biliary Decompression on Bacterial Translocation in Jaundiced Rats
Authors: Ding Jin Wen , Andersson Roland , Soltesz Vasile , Willén Roger , Loft Steffen , Poulsen Henrik E. , Pärsson Håkan , Olsson Kjell , Bengmark Stig
Published: September 2007

Patients with obstructive jaundice are prone to septic complications after biliary tract operations.
Restoring bile flow to the intestine may help to decrease the complication rate. The present study is
aimed at evaluating the effect of biliary decompression on bacterial translocation in jaundiced rats.

Sixty‐six male Sprague‐Dawley rats were randomly allocated to six groups subjected to common bile
duct ligation (CBDL) and transection (groups 2–6) or sham operation (group 1). In groups and 2 the
incidence of enteric bacterial translocation was determined 2 weeks after sham operation or CBDL. In
groups 3–6, biliary decompression was achieved by performing a choledochoduodenostomy after 2
weeks of biliary decompression. Bacterial translocation was then studied 1,2,3 and 5 weeks following
biliary decompression.

The rate of bacterial translocation to mesenteric lymph nodes in obstructive jaundice was significantly
higher as compared with controls, and decreased with time to nil three weeks following biliary
decompression. The incidence of bacterial translocation was closely correlated (r = 0.844; p = 0.034) with serum alkaline phosphatase activity and seemed to fit with the morphological changes noted in the
small intestine. The decrease in bacterial translocation, however, lags behind the recovery of liver
function as measured by routine liver function tests and antipyrine clearance.

Obstructive jaundice thus promotes bacterial translocation in the rat. Biliary decompression gradually
decreases the rate of bacterial translocation.
The Role of Hormonal and Dietary Factors in Pancreatic Carcinogenesis
Authors: Christopoulou A. , Blanc F. , Joyeux H.
Published: September 2007

The pancreatic cancer continues to represent an important problem, as a cancer with extremely poor
prognosis.

To date more than 16 chemicals have been shown to induce pancreatic tumors, in animal models. The
tumors developed in rats are essentially of acinar type and those in hamsters mostly of ductal type.
Many studies proved the direct or indirect role of hormonal and dietary factors in pancreatic cancer.
The development of alternative treatments according to biological and biochemical steps of carcinogenesis
is available as adjuvant treatment.

We present herein an overview of current experimental and clinical results in order to understand the
evolution, histogenesis and biological behaviour of pancreatic cancer.
Structure and Innervation of the Extrahepatic Biliary System in the Australian Possum, Trichosurus Vulpecula
Authors: Padbury R. T. A. , Baker R. A. , Messenger J. P. , Toouli J. , Furness J. B.
Published: September 2007

The morphology, microanatomy and innervation of the biliary tree of the Australian possum,
Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic
ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of
Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the
pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to
form a common channel within the terminal intraduodenal segment.

Nerve cell bodies of the gallbladder were found in an inter‐connecting network of ganglia that were
located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the
mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve
trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most
ganglia were located in two plexuses, the first between the layers of the external sphincter muscle, which
was continuous with the external muscle of the duodenum, and the second was associated with the
internal sphincter muscle. Nerve fibres were numerous in the sphincter muscle, and were also found in
the subepithelial and periglandular plexuses of both the pancreatic and common bile ducts.
Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma
Authors: Henne-Bruns D. , Kremer B. , Lloyd D. M. , Meyer-Pannwitt U.
Published: September 2007

Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency
laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major
injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to
four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries.
Successful Arterial Embolisation of Giant Liver Haemangioma
Authors: Panis Yves , Fagniez Pierre-Louis , Cherqui Daniel , Roche Alain , Schaal Jean-Claude , Jaeck Daniel
Published: September 2007

A 28‐year old man presented with a symptomatic giant haemangioma. On June 26, 1983, at laparotomy,
no resection was attempted because the lesion involved the right lobe of the liver and a part of segments
II and III. The patient underwent a right hepatic arterial embolisation with gelatine sponge particles.
During follow‐up, the patient remained asymptomatic. Five‐year review by CT‐scan showed a diminution
of the size of the haemangioma and hypertrophy of the left lobe. On October 21, 1988, the patient
was reoperated on for liver abscess and complete necrosis of the haemangioma. A right hepatectomy
was performed. In conclusion, the long‐term effect of hepatic arterial embolisation, as demonstrated in
our case by regular CT‐scans, is useful in cases of diffuse haemangioma as an alternative to hazardous
major liver resection. To our knowledge, the long‐term effect of hepatic arterial embolisation on
symptoms and tumor size have never been reported for giant liver haemangioma.
Hepatic Resection Using a Water Jet Dissector
Authors: Baer H. U. , Stain S. C. , Guastella T. , Maddern G. J. , Blumgart L. H.
Published: September 2007

The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure,
high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty‐seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished.
Long Term Survival in a Patient Following Resection for Carcinoma of the Gallbladder and Rectum
Authors: Kelly S. B. , Habib N. A. , Blumgart L. H.
Published: September 2007

We describe a 66‐year‐old man who presented initially with acute cholecystitis. He was treated by
cholecystostomy and biopsy of the gallbladder mucosa which revealed carcinoma of the gallbladder.
Four weeks later a cholecystectomy was performed followed by resection of the common bile duct,
common hepatic duct and segments IV and V of the liver and a hepaticojejunostomy. Sixteen months
later an abdomino‐perineal resection was performed for a moderately differentiated Dukes′ stage C
carcinoma of the rectum. He is alive and without evidence of recurrence seven years later. Few patients
survive for this length of time following resection of either carcinoma of the gallbladder or rectum. This
case report demonstrates the value of aggressive surgical treatment in patients with early carcinoma of
the gallbladder.
A Case of Cholangitis Glandularis Proliferans and Cholangiocarcinoma of the Common Bile Duct
Authors: Richardson A. J. , Grierson J. M. , Tait N. , Williams S. J. , Little J. M.
Published: September 2007

A case of Cholangitis Glandularis Proliferans (CAGP) in association with a cholangiocarcinoma of the
common bile duct as described. This is the eighth case of CAGP described and the second association
with cholangiocarcinoma.
Splenic Vein Obstruction Due to a Solitary Echinococcal Splenic Cyst, Resulting in Gastric Fundus Varices: An Unusual Cause of Variceal Bleeding
Authors: Klompmaker I. J. , Haagsma E. B. , Slooff M. J. H.
Published: September 2007

A 27‐year old female patient, born and living in Morocco, suffered from severe variceal bleeding and
weight loss. Eventually a diagnosis of gastrict fundus varices was made supposedly resulting from partial
obstruction of the splenic vein and collateral blood flow via the short gastric veins. Splenectomy was
proposed. Peroperatively it became apparent that a solitary ecchinococcal cyst in the hilus of the spleen
obstructed the blood flow in the splenic vein. The cyst, the spleen, and part of the pancreatic tail were
removed. After splenectomy bleeding did not recur.
Portal Hypertension, Variceal Bleeding, and High Output Cardiac FailureSecondary to an Intrahepatic Arterioportal Fistula
Authors: Oishi Andrew J. , Nagorney David M. , Cherry Kenneth J.
Published: September 2007

Intrahepatic arterioportal fistulas (APF) are uncommon complications following hepatic trauma. Large
fistulas can result in portal hypertension and cardiovascular compromise. A 46‐year‐old patient is
described who presented with portal hypertension, variceal bleeding, and high output cardiac failure
due to a large intrahepatic APF. Surgical closure of the APF by hepatic resection successfully resolved
the portal hypertension, prevented further variceal hemorrhage, and restored normal cardiovascular
function.
Beware the Anomalous Portal Vein
Authors: Koh M. K. , Ahmad H. , Watanapa P. , Jalleh R. P. , Habib N. A.
Published: September 2007

Portal vein thrombosis is an unusual potential complication of liver resection. In our case it was due to
ligation of the right branch of the portal vein during right hepatectomy in a patient without portal vein
bifurcation. Hepatic angiography can delineate this abnormality and influence the choice of surgical
management.
The Effects on Liver Metastases of Circadian Patterned Continuous Hepatic Artery Infusion of FUDR
Authors: Kemeny M. Margaret , Alava Galo , Oliver Jorge M.
Published: September 2007

Although continuous hepatic artery infusions (CHAI) of (FUDR) Floxuridine have been effective in
reducing the size of colorectal hepatic metastases the toxicity of the infusions have been high with almost
a quarter of the patients developing biliary sclerosis. Techniques to lower toxicity, yet continue the
beneficial antitumor effects, are being investigated. One suggested strategy is to change the flow pattern
of the continuous infusion from a constant rate to a day cycled pattern. In this infusion a continuous rate
is given over a 24 hour period with 60% of the infusion delivered between 3 PM and 9 PM and the least
amount of infusion delivered between 3 AM and 9 PM. Previous research has suggested that this day
cycle pattern will lower the toxicity of the infusion. This experiment is a test of “day cycled” continuous
hepatic artery infusions in rats bearing hepatic metastases from a colon adenocarcinoma. Previous
research from our laboratory has shown a lowered toxicity when the constant infusion was replaced with
the day cycled pattern.

In the present study 10 rats with hepatic adenocarcinoma metastases were placed on constant CHAI
of FUDR at 10mg/kg/day for 14 days. There was an 80% mortality from chemotherapy toxicity and a
90% objective response rate. Nine other rats were treated with “day cycled” CHAI of FUDR at 15mg/kg/d. There was no mortality in this group and the objective response rate was 90% as in the previous
group. This study demonstrated that “day cycled” CHAI of FUDR was substantially less toxic and that
the antitumor effect was identical to the constant infusion.
Portal Hypertension Promotes Bacterial Translocation in Rats Mono‐ and Non Mono‐Associated with Escherichia Coli C25
Authors: Vauthey Jean-Nicolas , Duda Petra , Wheatley Anthony M. , Gertsch Philippe
Published: September 2007

The basis for the high incidence of infectious complications in portal hypertension (PHT)
remains unclear. The hypothesis that PHT induces bacterial translocation (BT) was tested in
a rat model with or without mono‐association with streptomycin resistant Escherichia coli C25
and with or without hypovolemic shock. PHT was achieved by partial portal vein ligation and
three weeks later hypovolemic shock (HS) was induced. Blood, liver, spleen and mesenteric
lymph nodes cultures were performed twenty‐four hours later.

PHT promoted BT to mesenteric lymph nodes in indigenous flora (4/6 [67%]) and mono‐associated
animals (7/9 [78%]) compared to sham laparotomy and sham shock (SL + SS)
animals (0/6 [0%] and 2/9 [22%] respectively) (p = 0.03). The combination of PHT and HS
resulted in increased mortality in mono‐associated (7/15 [47%]) and non mono‐associated
animals (8/15 [53%]). No significant translocation was noted in liver and spleen and bacteremia
was found only in the PHT + HS mono‐associated animals (4/8 [50%]).

PHT induces BT to mesenteric lymph nodes and this may account for the high incidence of
septic complications associated witti PHT. In this model, the addition of HS to PHT leads to an
increased mortality but without uniform translocation of the gut flora beyond mesenteric lymph
nodes.
Complications After Laparoscopic and Conventional Cholecystectomy: A Comparative Study
Authors: Brune Iris B. , Schönleben K. , Omran S.
Published: September 2007

The growing popularity of laparoscopic cholecystectomy (LC) has made extensive series
comparing laparoscopic and conventional cholecystectomy in a prospective, randomized way
nearly impossible. To evaluate LC we compared retrospectively 800 laparoscopic with 748
conventional cholecystectomies (CC). Of the 800 LC, 10 (1.2%) were converted to laparotomy.
6 conversions were related to aberrant anatomical features or features making dissection very
difficult, 4 conversions were due to complications. There were 5 (0, 6%) intraoperative complications
during LC and 4 (0.5%) during CC. Postoperative morbidity was 2.1% (n = 17) after LC
and 3.7% (n = 28) after CC. Particularly the incidence of wound problems was only 0.5% (n = 4)
after LC while it was 1.3% (n = 10) after CC. Overall morbidity was 2.7% (n = 22) for LC and
4.2% (n = 32) for CC. Mortality rate after CC was 0.4% (n = 3), there were no deaths after LC.
Common bile duct‐injury rate was 0.2% (n = 2) for both groups. Complication rates after LC
have been rapidly decreasing with growing experience. Laparoscopic cholecystectomy can safely
be performed by appropriately trained surgeons in more than 90% of patients suffering from
gallbladder disease. The low morbidity and mortality together with the significant advantages to
patient recovery makes laparoscopic cholecystectomy the treatment of choice for symptomatic
cholecystolithiasis.
The Influence of Portal Deviation on the Effect of Repeat Dearterializations of a Transplantable Adenocarcinoma to the Rat Liver
Authors: Wang L. Q. , Persson B. G. , Bengmark S.
Published: September 2007

As liver tumours receive some of their blood supply from the portal vein, we wanted to illustrate
the influence of portal blood flow in combination with dearterialization in the treatment of liver
tumours. Forty male, inbred Wistar/Furth rats with an adenocarcinoma transplanted to the liver
were treated with various inflow occlusions repeated daily for 5 days. Deviation of the portal
blood flow alone with an end‐side porto‐caval shunt did not alter the tumour growth (p = 0.089).
Thirty min of repeat dearterializations was potentiated by portal deviation so that tumour
growth was delayed (p = 0.004). However, repeat dearterializations for 60 min in portal deviated
rats induced irreversible liver damage and all rats died in a few days. Repeated dearterializations
for 60 minutes alone retarded the tumour growth as efficiently (p = 0.007). Simultaneous
occlusion of the hepatic artery and the portal vein for 30 minutes with a side‐side porto‐caval
shunted (total devascularization) did not affect tumour growth (p = 0.154). Liver aminotransferases
(ASAT and ALAT) were substantially increased following dearterialization for 30 min in
rats with either an end‐side or a side‐side porto‐caval shunt. Dearterialization for 60 min in rats
with end‐side porto‐caval shunts gave a further release of ASAT and ALAT.

In conclusion, portal deviation did not augment the therapeutic benefit of repeat dearterializations
for the treatment of this experimental liver tumour. Repeat dearterializations alone
seemed to be a feasible and efficient therapy for liver tumours.
The Effect of Propofol on the Canine Sphincter of Oddi
Authors: Baron T. H. , Dalton C. B. , Cotton P. B. , May G. R. , Milton L. G. , Chari R. S. , Meyers W. C.
Published: September 2007

To assess the effect of propofol on the canine sphincter of Oddi (SO), sphincter of Oddi manometry (SOM)
was performed in fasting dogs which had undergone cholecystectomy and placement of modified Thomas
duodenal cannulae. Using two water‐perfused, single‐lumen manometric catheters, SO and duodenal
pressures were measured simultaneously. Baseline SO activity was recorded for at least one complete
interdigestive cycle followed by bolus injections of propofol (Diprivan ®) (N = 31) from 0.1 to 4.0 mg/kg
during Phase I of the Migrating Motor Complex (MMC).

When propofol was administered in bolus doses ≤ 0.5 mg/kg, no change in SO or duodenal motor
function was seen. In doses ≥ 0.5 mg/kg, SO basal pressure, amplitude, and frequency of contractions
increased significantly. Increases in duodenal activity paralleled SO activity. Our results suggest that
propofol in low doses may be useful for sedation during Sphincter of Oddi manometry in humans. Further
studies of the effects of propofol on the human sphincter of Oddi are warranted.
Intraperitoneal Rupture of Ectopic Varices—a Rare Complication of Portal Hypertension
Authors: Graham Alastair N. J. , Mcaleese Paul , Moorehead R. John
Published: September 2007

A 50 year old man presented with sudden abdominal pain, abdominal distension and shock. At
emergency laparotomy a large amount of blood was found in the peritoneal cavity. There was
micronodular cirrhosis of the liver and the spleen was enlarged. The bleeding was traced to distended
veins in the right paracolic gutter which were oversewn and the abdomen closed. A coagulopathy was
diagnosed and treatment including high dose aprotinin commenced. However, he continued to bleed
and at a second laparotomy the area of previous haemorrhage was packed. Further deterioration
continued until death 12 hours later. Intraperitoneal haemorrhage from ectopic varices is a rare
occurrence. There is a high mortality rate usually due to an advanced coagulopathy. This is the first
report of aprotinin being used in an attempt to treat this. On the basis of this report aprotinin would not
seem to be of benefit for this condition.
Clinical and Enzymatic Investigation of Induction of Oxygen Free Radicals by Ischemia and Reperfusion in Human Hepatocellular Carcinoma and Adjacent Liver
Authors: Yamanoi Akira , Nagasue Naofumi , Kohno Hitoshi , Kimoto Takeo , Nakamura Terushisa
Published: September 2007

Serum concentration of thiobarbituric acid (TBA) reactants in the hepatic vein were measured before
and after transient dearterialization of the liver in five human subjects bearing unresectable
hepatocellular carcinoma (HCC). During 1 hour of the occlusion of the hepatic artery, change inTBA
reactants level was slight. However, the mean value of TBA reactants in 1 hour after the reflow
increased to 1.50 ± 0.11 nmol/ml (mean ± S.E.) and was significantly higher (p < 0.05) than those
before hepatic dearterialization (1.28 ± 0.11 nmol/ml) and just before the release of occlusion (1.32 ±
0.09 nmol/ml).

Further, two endogeneous scavenger enzymes, superoxide dismutase (SOD) and catalase (CAT),
and one of the major sources of oxygen free radicals, xanthine oxidase (XOD) were measured in
human untreated HCC and the corresponding adjacent liver tissue. The results demonstrated an
increase in SOD in 81.8% (9/11) of HCC, and a decrease in CAT in 72.7% (8/11) of HCC when
compared with the corresponding adjacent liver tissue. The mean value of SOD in HCC was
significantly higher (66.8 ± 6.5 vs 52.8 ± 3.8 U/mg protein; p < 0.05), and that of CAT was
significantly lower (22.6 ± 2.4 vs 36.0 ± 6.1 U/mg protein; p < 0.05) than those in liver tissue. All of
nine HCC samples had a significantly lower activity of XOD (6.4 ± 1.9 vs 20.3 ± 3.4 pmol/minute/mg
protein; p < 0.01) than the corresponding liver tissue. There was no obvious relation between the
content of SOD and CAT in HCC, or in liver tissue.

These data may suggest that oxygen free radicals can be generated in human HCC by ischemia
and reperfusion of the tumor‐ bearing liver. It is also indicated that the antioxidant system of HCC is
not always impaired, and that HCC might develop several lines of defence systems against the
oxidative attack. A possible strategy of the treatment for liver tumor with oxygen derived free radicals
induced by ischemia and reperfusion is hypothized here.
A Novel Method of Determining Portal Systemic Shunting using Biodegradable 99TCm Labelled Albumin Microspheres
Authors: Yates J. , Nott D. M. , Maltby P. J. , Billington D. , Baxter J. N. , Shields R. , Jenkins S. A.
Published: September 2007

Portal systemic shunting (PSS) and portal pressure were measured in control rats and in animals
with portal hypertension induced by partial portal vein ligation (PPVL). The portal pressure in
rats with partial portal vein ligation (13.4 ± 0.5 mm.Hg.) was significantly higher (p < 0.005) than
in the control group (9.6 ± 0.6 mm.Hg.). Portal systemic shunting measured by consecutive
injections of radiolabelled methylene diphosphonate (MDP), a non‐diffusable marker and
albumin microspheres directly into the splenic pulp was significantly increased (P < 0.005) in the
portal hypertensive animals (30.8 ± 2.5%) compared to sham operated rats (2.6 ± 1.5%). Similarly,
in portal hypertensive rats portal systemic shunting measured by intrasplenic injections of
radiolabelled cobalt microspheres (37.1 ± 3.9%) was significantly greater (p < 0.005) than in
control animals. There was a good correlation and agreement (r = 00.97) between the two
methods of measuring portal systemic shunting. However because the 99Tcm‐albumin microspheres
are biodegradable the method allows portal systemic shunting to be measured in man.
Furthermore since the computer adjusts the baseline to zero after each determination of portal
systemic shunting the methodology allows repeated measurements to be made.
Evaluation of Liver Function Tests to Predict Operative Risk in Liver Surgery
Authors: Zoedler Thomas , Ebener Christoph , Becker Heinz , Roeher Hans D.
Published: September 2007

Despite numerous studies in the past it is not possible yet to predict postoperative liver failure
and safe limits for hepatectomy. In this study the following liver function tests ICG‐ER
(indocyaninegreen elimination rate), GEC (galactose elimination capacity) and MEGX‐F
(monoethylglycinexylidid formation) are examined with regard to loss of liver tissue and
prediction of operative risk. Liver function tests were assessed in 20 patients prior to liver
resection and on the 10th. postoperative day. Liver and tumor volume were measured by
ultrasound and pathologic specimen and the parenchymal resection rate was calculated. In
patients without cirrhosis (n = 10) ICG‐ER and MEGX‐F remained unchanged after
resection, GEC was reduced but did not correspond to the resection rate. Patients with
cirrhosis (n = 10) had a significantly lower ICG‐ER and GEC before resection than patients
without cirrhosis. After resection these tests were unchanged. Patients with liver related
complications and cirrhosis (n = 5) had lower ICG‐ER and GEC than patients with cirrhosis
and no complications. In the postoperative course all liver function tests in these patients were
significantly lower compared to preoperative results. Comparing liver function tests ICG
serves best to indicate postoperative liver failure. Liver function tests do not correspond with
loss of liver tissue.
Emblica Officinalis: A Novel Therapy for Acute Pancreatitis — An Experimental Study
Authors: Thorat S. P. , Rege N. N. , Naik A. S. , Thatte U. M. , Joshi A. , Panicker K. N. S. , Bapat R. D. , Dahanukar S. A.
Published: September 2007

Acute necrotising pancreatitis is associated with an unacceptably high mortality for which no
satisfactory remedy exists. Emblica officinalis (E.o.) is a plant prescribed in Ayurveda, the
Indian traditional system of medicine, for pancreas‐related disorders. This study was carried
out to evaluate the protective effect of E.o. against acute necrotising pancreatitis in dogs.
Pancreatitis was induced by injecting a mixture of trypsin, bile and blood into the duodenal
opening of the pancreatic duct. Twenty eight dogs were divided into 4 groups (n = 6‐8 each):
GpI–control, GpII–acute pancreatitis, GpIII–sham‐operated, GpIV–pretreatment with
28 mg E.o./kg/day for 15 days before inducing pancreatitis. Serum amylase increased from
541.99 ± 129.13 IU/ml to 1592.63 ± 327.83 IU (p<0.02) 2 hrs after the induction of pancreatitis
in GpII. The rise in serum amylase in both GpIII and GpIV was not significant. On
light microscopic examination, acinar cell damage was less and the total inflammatory score
was significantly lower in the E.o. treated group as compared to GpII. Electron microscopy
confirmed this and showed an increased amount of smooth, endoplasmic reticulum and small,
condensed granules embedded in a vacuole. More studies are needed to explore the clinical
potential of E.o. and its mechanism of action.
Biochemical Prediction of Acute Cholangitis and Symptomatic Bile Duct Stones by Gallstone Hepatitis
Authors: Isogai M. , Hachisuka K. , Yamaguchi A. , Hori A.
Published: September 2007

We have adopted the clinical concept of gallstone hepatitis indicated by marked serum
transaminase elevation due to an acute inflammatory liver cell necrosis in the early stages of
gallstone impaction in the bile duct as clinical and biochemical criteria for identifying high‐risk
patients for acute cholangitis or bile duct stones causing symptoms (symptomatic bile duct
stones, SBDS).

One hundred and fifty‐eight (80.2%) of 197 patients with acute gallstone disease and
concomitant elevation of serum transaminase (gallstone hepatitis) underwent emergency
treatment, either surgery (138 patients) or percutaneous transhepatic biliary drainage
(PTBD)/endoscopic sphincterotomy (ES) (20 patients). One hundred and forty‐two (89.9%) and
67 (42.4%) were confirmed to have SBDS and acute cholangitis, respectively, in the early stage of
the disease. The majority of the patients who had no bile duct stones identified at surgery had
either biliary pancreatitis or multiple small stones in the gallbladder. They were assumed to have
migrating stones or false negative operative cholangiograms.

In conclusion, gallstone hepatitis indicates that SBDS and acute cholangitis are probable, and
facilitates rapid selection of patients for urgent biliary tract exploration in patients with acute
gallstone disease.
Palliative Resection of Pancreatic Adenocarcinoma
Authors: Johnson C. D.
Published: September 2007

A survey was carried out by postal questionnaire of the attitudes of British surgeons to pancreatic
resection as palliation for ductal adenocarcinoma of the pancreas. Replies from 24 surgeons related to
experience in over 700 resections. The incidence of estimated residual local disease after resection was
median 12.5 percent, range 0–35 percent. Half(12) of the surgeons felt that pancreatic resection with
residual macroscopic disease was justified. Only 3 (12.5 percent) surgeons accepted that palliative
resection in the presence of liver metastases was sometimes justifiable. Further evidence is required of
improved quality of life after resection before the majority of surgeons will accept palliative resection
in the management of pancreatic ductal adenocarcinoma.
Long‐Term Results of Hepatic Resection for Hepatolithiasis
Authors: Sato M. , Watanabe Y. , Horiuchi S. , Nakata Y. , Sato N. , Kashu Y. , Kimura S.
Published: September 2007

Long‐term results of hepatic resection for hepatolithiasis in 34 patients having intrahepatic
biliary strictures were studied. The left lateral and the right posterior segmental ducts were
commonly and often simultaneously involved. Fourteen patients had multiple segmental
involvement. Hepatic resection included left sided resection (n=27), right sided resection (n=6), and repeated bilateral resection (n=1). Seven patients had biliary tumors: 3 cholangiocarcinomas, 2 gall bladder cancers, cystadenocarcinoma, and dysplasia of intrahepatic
ducts. Nineteen patients received bilioenteric anastomosis. Retained stones and recurrent
stones developed in 3 and 4 patients, respectively. Twenty‐six patients had no remaining
symptoms; 2 died of operative complication or cholangiocarcinoma; 6 presented symptoms
caused by retained stones (n=2), recurrent stones (n=2), bile stasis (n=1), or neuralgia (n=1). In
4 of the 6 patients, unrelieved posterior duct strictures caused the symptoms. With a mean
follow‐up period of 4.5 years, 30 patients are symptoms free, and 27 are stone free. In patients
with right lobar or bilobar type, intra‐ and extrahepatic type, and confluence strictures,
bilioenteric anastomosis is required. Hepatic resection is a rational treatment for hepatolithiasis,
however, meticulous management of biliary tract abnormalities, particularly the
posterior duct stricture, is mandatory.
ERCP Following Laparoscopic Cholecystectomy: A Safe and Effective way to Manage CBD Stones and Complications
Authors: Schmitt Colleen M. , Baillie John , Cotton Peter B.
Published: September 2007

The efficacy of ERCP in detecting and treating post‐laparoscopic cholecystectomy problems was
examined in a series of consecutive patients undergoing directed examination of the biliary tree over a
two‐year period. Three major diagnostic groups were identified: leaks and bile duct injuries (n = 9),
retained common bile duct stones (n = 18), and post‐cholecystectomy pain (n = 13). These diagnostic
groups differed in degree of abnormal bilirubin (p = .004) and time between surgery and ERCP
(p = .0005). Diagnosis of a post‐operative complication was successful in 92% of attempted cases.
Therapy was successful in 92% of attempted cases. Three patients developed mild pancreatitis as a
result of ERCP. This series underscores the efficacy of a multi‐disciplinary approach to problems
which occur after laparoscopic cholecystectomy.
Is Late Recurrence after Radical Resection for Ampullary Carcinoma A Problem?
Authors: Strasberg Steven M.
Published: September 2007

Of 36 patients with carcinoma of the ampulla of Vater who underwent surgery between
1971 and 1990, 31 had a radical operation. There was one operative death. The overall
5‐ and 10‐year survival rates were 56 and 37 per cent respectively. Survival was
significantly influenced by tumour stage (p=0.0002), lymph node sthtus (p=0.006) and
the degree of differentiation of the lesion (P=0.01). Three patients developed local
recurrence after local excision of the tumour. Local or hepatic recurrence was common,
even 5 years after pancreatoduodenectomy (four of 18 patients who suffered relapse).
Radical resection can be curative in selected patients with ampullary carcinoma but late
recurrence suggests the need for careful lifelong follow‐up.
Review Article: Spectrum of Biliary Infections in the West and in the East
Authors: Beger H. G. , Schwarz A.
Published: September 2007

Biliary infections are an important cause of morbidity in the Western world. With regard to
epidemiology, etiology, microbiological spectrum, prevalence, location and composition of
gallstones, pathogenesis, clinical sign and therapy, there are large differences between the
spectrum of biliary infections in the East and in the West (Table 1). In Western countries,
gallstones are found in 10 to 40%. In Eastern countries, the incidence of gallstones is only 2 to
6%. Some eighty – five percent of the gallstones in the West are cholesterol stones, in contrast to
the East, where 97% are bile pigment stones. The most important difference is characterized by
the origin of common bile duct stones. In the West, common bile duct stones generally originate
in the gallbladder, in contrast to the East, where primary common bile duct stones are often
found – especially in the intrahepatic segments – with no evidence of gallbladder stones. The sex
distribution male to female in the West is 1:2, in the East 1:1. In the West, biliary infections occur
mainly in an elderly population, 50% being older than 70 years. In the East, biliary infections
appear also in younger people, 50% being younger than 40 years. Parasites play an aetiological
role in the East, but not in the West. The typical therapy of gallstones in the West is
cholecystectomy, and of common bile duct stones endoscopic sphincterotomy. Due to the
frequency of intrahepatic stones in Eastern Countries, the therapeutic spectrum there includes
even large hepatic resections and biliary enteric anastomoses.
Evaluation of Adaptive Changes by Non‐Invasive Imaging in Hepatic Vein Outflow Obstruction
Authors: Gertsch P. , Vauthey J.-N. , Looser C. , Triller J. , Blumgart L. H.
Published: September 2007

Hepatic vein outflow obstruction induces remarkable changes of intra–hepatic blood circulation;
the significance of these changes remains uncertain. Six patients with obstruction of the
hepatic veins were evaluated by duplex Doppler ultrasound and computed tomography. The
adaptive changes secondary to obstruction were analyzed and their significance was correlated
with the clinical findings. Four patients presenting unilateral hepatic vein occlusion had
unilateral reversed portal flow. Two of them, with lobar liver atrophy and contralateral
compensatory hypertrophy required operation; the other two, with normal appearance of the
liver, benefitted from conservative treatment. Two patients with bilateral hepatic vein occlusion,
intra‐hepatic bypasses, bilateral lobar atrophy and caudate lobe hypertrophy, received operations.
Intrahepatic unilateral portal flow reversal compensates for unilateral hepatic outflow
obstruction. The combination of complete or subtotal hepatic vein obstruction and atrophy–hypertrophy
complex predicates advanced disease despite flow reversal or spontaneous shunt.
Plasma Cholesterol Ester Fatty Acids: A New Biochemical Abnormality in Obstructive Jaundice
Authors: Scriven M. W. , Horrobin D. F. , Puntis M. C. A.
Published: September 2007

Changes in fatty acid patterns may explain many of the observed abnormalities found in
obstructive jaundice. This study looked at fatty acids in plasma cholesterol esters, in a group of
patients with obstructive jaundice and a matched group of controls. Significant abnormalities
were demonstrated, most importantly a fall in essential fatty acids, in the jaundiced group.
Overall the saturation of this fraction, as assessed by double bond index, rose. The essential fatty
acids are important as factors in membrane function and as precursors of eicosanoids. The
abnormalities found in this study provide further evidence of the significance of EFA in patients
with obstructive jaundice.
Papillary Adenocarcinoma of the Common Bile Duct
Authors: Arioğul O. , Güvenç B. H. , Emre A. , Acarli K. , Alper A. , Ökten A.
Published: September 2007

Five patients with papillary adenocarcinoma of the common bile duct (CBD) are described.
These are rare tumors and make up 5% of all malignant tumors of the biliary tract. The
symptoms and signs at the time of initial diagnosis resemble benign obstructive lesions of the bile
ducts. The tumor is soft, less invasive to adjacent tissues and tends to grow into the lumen. The
early onset of the symptoms results in early intervention, with a better prognosis. Two of our
patients are doing well after two and four years, where as three others were readmitted with
recurrent disease.
Pancreatic Enzyme Supplementation in Acute Pancreatitis
Authors: Patankar R. V. , Chand R. , Johnson C. D.
Published: September 2007

This study evaluates the effect of oral pancreatic enzyme supplements on pain, analgesic requirement
and the incidence of complications in patients with acute pancreatitis. This double blind, prospectively
randomised placebo controlled study included 23 patients. Pain was monitored using a visual analogue
scale; the analgesic requirement was assessed with a numerical score.

No significant differences were noted between the median (range) pain scores of patients who
received placebo: 22 (17.1–58) and those who received enzymes: 23 (11.3–63). Hospital stay was 7
(5–10) days in patients on placebo and 8 (6–24) days in the enzyme group (p = 0.069). Analgesic
requirements were: placebo 20 (6–60) and enzymes: 16 (0–63) (p = 0.56). This study has shown no
beneficial effect of oral pancreatic enzyme supplements in the initial management of patients with
acute pancreatitis.
Gall‐Bladder Agenesis and Associated Anomalies
Authors: Yiangou Constantinos , Shorey Brian , Spigelman Allan D.
Published: September 2007

Congenital absence of the gall‐bladder is a rare condition. It is sometimes associated with other
congenital defects. We report here two cases of gall‐bladder agenesis discovered at laparoscopy.
Both had a history of skeletal and cardiovascular anomalies. The investigation of patients with
absent gall‐bladder can be very difficult. Ultrasound scanning is usually inconclusive and
further noninvasive tests should be performed to establish the diagnosis and prevent an
unnecessary operation. The presence of other congenital defects should alert the clinician to the
possibility of gall‐bladder agenesis.
Surgical Workshop on Liver Surgery Using Isolated Perfused Livers in Moulded Casts of the Upper Abdomen
Authors: Eldar Gadžijev , Dean Ravnik , Valentin Sojar
Published: September 2007

The basic training in liver surgery on isolated perfused livers used at the workshop in the First Surgical Course of the Alps—Adriatic Hepatobiliary School is presented. The methods for the excision, preservation, perfusion and preparation of the liver are described, as is the manner of manufacturing the upper abdomen moulded casts, into which an isolated perfused liver is placed for training. The methods proved to be sufficiently successful, enabling participants to perform basic liver surgery like an intraoperative ultrasound investigation, as well as liver dissection techniques, liver suturing, segmental resection and even hepatectomy. Some technical improvements are proposed for future surgical workshops, such as washing out the blood from the liver, and a triple perfusion.
Duodenal Malignant Somatostatinoma
Authors: Ferrante A. M. R. , Frontera D. , Doglietto G. B. , de Santis G. , Viola G. , Crucitti F.
Published: September 2007

The authors report a case of hormonally silent duodenal somatostatinoma. The main clinical
features, the natural history and the currently available therapies of these rare neoplasms are
described on the basis of this case and of the scientific literature. Although the antiblastic
therapies are still debated, the patient showed a surprising outcome following chemotherapy.
Repeated Hepatic Dearterialization for Unresectable Liver Metastases From Gastric Cancer: Review of Five Cases
Authors: Kimoto Takeo , Nagasue Naofumi , Kohno Hitoshi , Chang Yu-Chung , Taniura Hiroyuki , Yamanoi Akira , Uchida Masaaki , Takemoto Yoshinari , Makino Yoshinari , Nakamura Teruhisa
Published: September 2007

A novel method of repeated hepatic dearterialization was evaluated in five patients with multiple
metastases from gastric cancer in both hepatic lobes. After gastrectomy with extensive lymph node
dissection (R2/3), all patients underwent implantation of a vascular occluder around the hepatic
artery. Cannulation of the hepatic artery was added for later chemotherapy. The hepatic artery was
occluded repeatedly for 1 hour twice daily in combination with intrahepatic infusion of anticancer
drugs for as long as possible. Three of five patients demonstrated marked tumour regression with
unexpectedly long survival (16 months in two patients and one still alive at 15 months).
Carcinoembryonic antigen (CEA) levels decreased to almost normal in four patients who had initially
high levels. The present experiences seems to indicate that long survival can be hoped for in patients
with advanced gastric cancer with unresectable liver metastases.
Hepatic Metastases of Granulosa Cell Tumour of the Ovary
Authors: García José I. Rodríguez , González Juan. J. González , Flórez Luis J. García , Rodríguez Paloma Floriano , Rodríguez Enrique Martínez
Published: September 2007

A case of metastatic granulosa cell tumour of the ovary is reported. Investigations revealed a secondary tumour in segment VI and VII of the liver. Right hepatic resection was performed. Microscopic findings revealed a tumour with histological features identical to that removed eleven years before.
Subtotal Cholecystectomy
Authors: Katsohis C. , Prousalidis J. , Tzardinoglou E. , Michalopoulos A. , Fahandidis E. , Apostolidis S. , Aletras H.
Published: September 2007

Subtotal cholecystectomy has been carried out in 34 patients from 1972 to 1992. In the same period 1620
total cholecystectomies were performed. The indications were severe inflammation and/or severe fibrosis
in 31 patients, and Mirizzi syndrome type in 3 patients. The morbidity was insignificant, but one patient
died, due to severe sepsis. In follow up studies ranging from 6 months to 9 years, there was one patient
with retained stones in the common bile duct. No other post cholecystectomy sequelae were noticed in the
remaining 32 patients. Subtotal cholecystectomy is a safe, feasible and definitive operation in patients for
whom the standard operation could be dangerous. This operation is less burdensome to the patient, and
is accompanied by fewer complications than ordinary cholecystostomy.
Type IVA Choledochal Cyst: Is Hepatic Resection Necessary?
Authors: Strong Russell
Published: September 2007

Background: This study concerns patients who have choledochal cyst with intrahepatic and extrahepatic involvement (type IVA cyst). The extent of excision and the necessity of hepatectomy, including the intrahepatic cyst in these patients have not been clarified.

Study design: We have performed excision of the extrahepatic cyst with hepaticojejunostomy upon 13 patients with type IVA cyst during a 16 year period. The present study was done to examine the size of the anastomotic opening by direct cholangiography two weeks postoperatively. The long‐term results were assessed to find the appropriate operative management for patients with type IVA cysts.

Results: Intrahepatic cysts were present in both hepatic lobes in 11 patients (85 percent). None of the patients had carcinoma after excision of extrahepatic cyst during the follow‐up period, which ranged from two months to 16 years. Postoperative late complications occurred in three patients (23 percent), hepatolithiasis in two and cholangitis in one. The anastomotic opening of hepaticojejunostomy was 13.3±4.5 mm in diameter two weeks postoperatively, which was not significantly different when compared with that in ten patients without late complications (13.4±4.9 mm). The late complications were successfully treated with either antibiotics or percutaneous transhepatic cholangioscopy, and none required a reoperation.

Conclusions: The results suggest that additional hepatectomy is not required because carcinoma has rarely occurred from the intrahepatic cyst. Excision of an extrahepatic cyst with a wide hepaticojejunostomy is an acceptable operative management for patients with type IVA cysts.
‘Latent’ Portal Hypertension in Benign Biliary Obstruction
Authors: Ibrarullah Md. , Sikora S. S. , Agarwal D. K. , Kapoor V. K. , Kaushik S. P.
Published: September 2007

A prospective study was undertaken to evaluate the changes in portal venous pressure in patients with
benign biliary obstruction (BBO) but without overt clinical, endoscopic or radiological evidence of portal
hypertension. Portal venous pressure was measured at laparotomy in 20 patients (10 each with either
benign biliary stricture or choledocholithiasis) before and after biliary decompression. Pressure was found
to be on the high side in seven patients (>25 cm of saline in three patients and > 30 cm of saline in four).
The mean fall of pressure was 3.4 cm of saline after biliary decompression. No correlation could, however,
be found between portal venous pressure and duration of biliary obstruction, serum bilirubin or bile duct
pressure. Liver histology showed mild to moderate cholestatic changes but maintained portal architecture
in all. Benign biliary obstruction may therefore, lead to elevation of portal pressure, even though the
patient may not necessarily have any clinical, endoscopic or radiological manifestations of portal hypertension.
The pathogenesis of this ‘latent’ portal hypertension is probably multifactorial. If biliary obstruction
is left untreated the development of overt portal hypertension may become a possibility in the future.