bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Outcome of Cholangitis After Percutaneous Biliary Drainage in Neoplastic Jaundice
Authors: Audisio Riccardo A. , Morosi Carlo , Bozzetti Federico , Cozzi Guido , Bellomi Massimo , Pisani Paola , Pestalozza Alessandra , Gennari Leandro , Severini Aldo 
Published: September 2007

The purpose of this paper is to evaluate factors affecting the outcome of cholangitis after PTBD in jaundiced cancer patients. Twenty nine patients with neoplastic jaundice (male/female ratio 13/16, median age 55 years) with full clinical data, were treated by PTBD and developed cholangitis at a median of 9 days later. Four patients (14%) died of biliary sepsis a median of one month after PTBD while the other 25 survived a median of 6 months, with one week median duration of cholangitis. The probability of the cholangitis resolving was analyzed by time to resolution and it was found that 50% and 100% of the recoveries occurred 5 and 9 months respectively from the onset of the complication.The series was analyzed to determine the role of several variables (disease/patient/treatment related)
in the resolution of cholangitis. Only a low stricture site, a large initial drainage catheter (10F) and a
temperature increase exceeding 39° C were correlated with a positive outcome. We conclude that
PTBD‐related cholangitis has, in our experience, a good chance of cure, low mortality rate and
satisfactory 6 months median survival.
Malignant Pancreatic Polypeptide Secreting Tumour of Islet Cells: A Case for Aggressive Surgical Palliation
Authors: Pullan R. D. , Scriven M. W. , O′dowd J. , Edwards A. T. , Lewis M. H. 
Published: September 2007

A case of a malignant pancreatic polypeptide secreting tumour is reported. The tumour was metastatic
at presentation at which time it was excised. Pancreatic duct obstruction occurred 3 years after excision causing severe pain on eating. Major palliative surgery, in the form of a pancreatico‐jejunostomy, cured the severe symptoms. The patient survives, largely symptom free, over six years after original excision. This case illustrates the need for aggressive management of symptoms in tumours in which long term survival is possible despite locally advanced or metastatic disease.
ABBREVIATIONS: VIP — vasoactive intestinal peptide. CT — computed tomography. GI — gastrointestinal. HPP — human pancreatic polypeptide. APUD — amine precursor uptake and decarboxylation.
Maxon is an Optimal Suture for Bile Duct Anastomoses in Pigs
Authors: Jeans Phil , Hall Pauline , Liu Yong-Feng , Baker Robert A. , Holt Andrew , Saccone Gino T. P. , Harvey John R. , Scicchitano Jan , Toouli James 
Published: September 2007

Background. Three commonly used sutures were tested in a pig model of bile duct anastomosis to assess
their relative contributions to inflammation and scarring.Methods. Thirty pigs were randomised to bile duct division and anastomosis with either polyglyconate
(Maxon), polyglactin 910 (Vicryl) or polypropylene (Prolene). Half the animals were sacrificed at two
weeks and the remainder at 23 weeks. Anastomoses were assessed by cholangiography, scanning
electron microscopy and light microscopy.Results. There was less short term histological reaction with the two monofilament materials, Prolene
and Maxon, compared to the braided suture Vicryl. Maxon was associated with less long term
inflammation than Prolene, was found to handle better, and has an advantage over Prolene by being
absorbable.Conclusion. Maxon is an optimal suture for bile duct anastomoses. Its long term absorption
characteristics make it suitable for situations where bile duct healing may be delayed.
Adenocarcinoma in Caroli′s Disease Treated by Liver Transplantation
Authors: Balsells J. , Margarit C. , Murio E. , Lazaro J. L. , Charco R. , Vidal M. T. , Bonnin J. 
Published: September 2007

Caroli′s disease is characterized by congenital cystic dilatation of the intrahepatic bile ducts. In 7% of
casea a malignant tumor develops complicating the course of the disease.We report the case of a 25 year‐old woman in whom Caroli′s disease was diagnosed at the age of 11.
From that time on, she had several episodes of cholangitis. In 1989, the abdominal ultrasound and CT
scan showed dilatation of the intrahepatic bile ducts, intracystic lithiasis and a solid mass. FNA cytology
showed a papillary adenocarcinoma. At laparotomy a tumor was found occupying both hepatic lobes,
and intraoperative US showed another two nodules in the left lobe. The tumor was considered
unresectable. Examination of the hilar lymph nodes was tumor‐negative. Two weeks later, the patient
underwent an ortothopic liver transplantation (OLT). The pathological examination confirmed Caroli′s
disease with adenocarcinoma. Two years after OLT, the patient is alive with normal liver function and
no evidence of disease.To our knowledge this is the first case report of adenocarcinoma in Caroli′s disease treated by OLT.
Biliary Duct Granular Cell Tumor: A Rare But Surgically Curable Benign Tumor
Authors: Lewis W. David , Buell Joseph F. , Jenkins Roger L. , Burke Peter A. 
Published: September 2007

Granulosa cell tumors are rare benign tumors which may be found throughout the body. Rare cases are
isolated within the biliary tree. If completely resected, surgical excision is curative.A case of biliary duct granulosa cell tumor is presented with review of the world’s literature on this
topic.
Unresectable Malignant Biliary Obstruction: Treatment by Self‐Expandable Biliary Endoprostheses
Authors: Glättli Andreas , Stain Steven C. , Baer Hans U. , Schweizer Walter , Triller Jürgen , Blumgart Leslie H. 
Published: September 2007

The primary goal in the treatment of malignant obstruction is the relief of jaundice. Although operative
biliary bypass is a reliable method of palliation, nonoperative palliation may be desirable in selected patients.We report our experience with forty‐eight self expandable metallic biliary endoprostheses (Wallstent)
percutaneously placed in 35 patients with irresectable malignant biliary obstruction. In twelve patients more than one stent was necessary to bridge the entire length of the biliary stenosis. The obstruction was due to primary tumors in 14 and to lymph node metastases in 12. In nine patients transanastomotic stents were placed after previous bilioenteric anastomosis because of malignant obstruction. Complications occurred in 11 patients (31.4%), and five patients died within 30 days of stent placement (14.3%). The mean stent patency to date of patients discharged is 6.1 months, and the mean survival 7.2 months. Follow up data is available for 29 patients, and excellent palliation was achieved for more than 75% of the survival time in 22 (76%). Seven patients have had documented stent occlusion requiring
further intervention (24%).In this selected group of patients, the results of percutaneous self‐expandable stents are encouraging.
However, our data does not support the initial reports of self‐expandable endoprostheses that suggest an
improved result compared to conventional plastic stents. A randomized study using either expandable
stents as compared to operative biliary enteric bypass is necessary.
Flushable Exo‐Endodrainage: A Modified Palliative Approach to Non‐Resectable Malignant BiliaryObstruction
Authors: Stierer M. , Wasl H. , Rosen H. R. , Marczell A. P. , Spoula H. 
Published: September 2007

The introduction of new imaging techniques has markedly improved the diagnosis of hepatobiliary
disorders. Due to their anatomic situation, a substantial percentage of malignancies located near the
hilus is not suitable for surgical management. We discuss an effective palliative intervention to relieve
jaundice. In many instances drainage is a superior choice when biliodigestive anastomoses are not
technically feasible and palliative resection carries a high complication rate.We present an irrigatable exo‐endodrainage method employing a modified port‐a‐cath system as a
new alternative. In four patients, all older than 75 years, this system was implanted because of jaundice
due to unresectable malignant stenosis of the extrahepatic bile duct. One patient (80 years old) died of
pre‐existing acute necrotizing pancreatitis, although hyperbilirubinemia was found to decrease on the
7th postoperative day. The other three patients showed complete normalization of their bilirubin levels
and their port‐a‐cath systems remained open until their death (at 3 weeks, 6 months and 7 months
respectively).
Acute Fulminant Pancreatitis: Debridement or Formal Resection of the Pancreas
Authors: Kiviniemi Heikki , MäKelä Jyrki , Kairaluoma Matti I. 
Published: September 2007

During the ten year period from 1980 to 1989, 51 patients were treated at Oulu University Central
Hospital for fulminant acute pancreatitis. Five were in a moribund state on admission and died shortly
afterwards, 6 were treated conservatively and survived, and 40 were operated on, 17 by primary
pancreatic resection and 23 by debridement of the peripancreatic area. Mortality rates were 53 per cent
for the resection group and for the debridement group 22 per cent.Reoperations were performed in 24 per cent of patients in the pancreatic resection group and in 60 per cent of those in the debridement group.The high mortality rate associated with primary pancreatic resection has caused us to adopt a more
conservative strategy, and surgical treatment is directed towards later complications of this severe
disease.
Percutaneous Alcohol Sclerotherapy of Simple Hepatic Cysts. Results From a Multicentre Survey in Italy
Authors: Montorsi Marco , Torzilli Guido , Fumagalli Uberto , Bona Stefano , Rosati Riccardo , de Simone Matilde , Rovati Vittorio , Mosca Franco , Filice Carlo 
Published: September 2007

The increased use of Ultrasonography (US) has led to increased detection of simple hepatic cysts. For symptomatic cysts treatment is necessary. Until some years ago surgery was the only therapy. We have treated a large number of patients with Percutaneous Alcohol Sclerotherapy (PAS) and evaluated retrospectively the efficacy of this approach.Data on 21 patients with symptomatic simple hepatic cysts were reviewed retrospectively. Cysts had a mean diameter of 9 cm (range: 7–15 cm). PAS was always performed under local anesthesia and US guidance. 25% of the volume was replaced with 95% ethanol and then completely aspirated after 20–30 minutes.No complications or deaths occurred. In all patients symptoms disappeared after treatment. In 15 out of 21 cases there was no evidence of residual cyst on US, computed tomography (CT) or magnetic resonance (MRI). In 6 patients with shorter follow‐up, cysts showed a mean reduction in diameter of 50%. The mean follow‐up was 18 months (range 6–60 months).We conclude that PAS is easy with low risk for the patients and with good long‐term results; it should therefore become the procedure of choice for simple hepatic cysts.
The Effect of Communication Between the Right and Left Liver on the Outcome of Surgical Drainage for Jaundice due to Malignant Obstruction at the Hilus of the Liver
Authors: Baer H. U. , Rhyner M. , Stain S. C. , Glauser P. W. , Dennison A. R. , Maddern G. J. , Blumgart L. H. 
Published: September 2007

Debate continues regarding the optimal management of irresectable malignant proximal biliary
obstruction. Controversy exists concerning the ability of unilateral drainage to provide adequate
biliary decompression with tumors that have occluded the communication between the right and
left hepatic ductal systems.Between October 1986 and October 1989, 18 patients with malignant proximal biliary
obstruction were treated by an intrahepatic biliary enteric bypass. Patients were divided into two
groups based on the presence or absence of a communication between the right and left biliary
systems. In Group I (n = 9), there was free communication; and in Group II (n = 9) there was no
communication. There were two perioperative deaths (11%) one due to persistent cholangitis
and the other to myocardial insufficiency both with one death in each group. The median
survival (excluding perioperative deaths) was 5.6 months. Comparison of pre‐ and postoperative
serum levels of bilirubin and alkaline phosphatase showed a significant decrease in each group,
but no difference between the groups in the size of the reduction. Sixteen patients survived at least
three months and the palliation was judged as excellent in eight, fair in five, and unchanged
in three.These results demonstrate the effectiveness of biliary enteric bypass regardless of communication
between the left and right biliary ductal systems.
The Effects of Long‐Term Graft Preservation on Intraoperative Hemostatic Changes in Liver Transplantation
Authors: Bakker C. Minke , Blankensteijn Jan D. , Schlejen Peter , Porte Robert J. , Gomes Maria J. , Lampe Harald I. H. , Stibbe Jeanne , Terpstra Onno T. 
Published: September 2007

We compared hemostatic changes during OLT and HLT after various periods of graft storage, to
investigate whether the host liver in HLT protects the recipient from hemostatic deterioration induced
by severe graft storage damage. In particular, the mechanism of fibrinolytic deterioration was
investigated. The effect of prostaglandin E1 (PGE1) on these parameters was also studied.Material and Methods: 69 pigs underwent either OLT (N = 32) or HLT (N = 37) with a graft stored for
2 hr (N = 31), 24 hr (N = 16), 48 hr (N = 7), or 72 hr (N = 15). PGE1 was given intravenously to both
donor and recipient animals and was added to the preservation and flushing solutions. Fibrinolysis
(euglobulin clot lysis time, t‐PA activity and α2‐antiplasmin) and coagulation parameters (activated partial thromboplasmin time, prothrombin time, fibrinogen and platelet count) were measured at
several intervals during transplantation.Statistics: Univariate non‐parametric tests were used for analysis of coagulation and fibrinolysis
parameters. For the three main variables‐ i.e., the type of transplantation, the use of PGE1, and the
preservation time, multiple regression analysis was performed.Results: Fibrinolytic activity increased during the anhepatic period of OLT. Graft reperfusion was
followed by a rise in t‐PA in both OLT and HLT. In HLT, t‐PA quickly returned to normal, whereas a
continuous increase was found in OLT. The coagulation parameters, in turn, remained unchanged
during the anhepatic period and deteriorated in OLT compared to HLT. The duration of graft storage
was directly related to the severity of the hemostatic changes, although this effect was more apparent in
OLT than in HLT.Conclusions: Changes in hemostasis are more pronounced in OLT than in HLT. This suggests that the
host liver protects the recipient from the effects of graft storage damage, even after long preservation
times. Early postreperfusion fibrinolytic activity was presumably due to t‐PA release from the graft both
in OLT and HLT. The further rise t‐PA in OLT might be caused by the release of cytokines from the
graft, that subsequently evoke endothelial t‐PA release. In HLT, t‐PA and cytokines may be cleared by
the native liver. No positive or negative effect of PGE1 on coagulation or fibrinolysis parameters was
noticed.
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.
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.
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.
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.