bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphological and Functional Discrepancies in Endocrine Pancreas After Partial Hepatectomy in Dogs
Authors: Hirano Tetsuya , Manabe Tadao , Tobe Takayoshi 
Published: September 2007

To clarify the changes in pancreatic hormones and their role in the regeneration of the liver after partial hepatectomy, we measured the portal levels of insulin and pancreatic glucagon and their responses to a glucose load after about 40% hepatectomy in dogs. The changes in the A and B cells of the islets of Langerhans were examined histologically. In the early stages after hepatectomy portal insulin levels decreased significantly, and the response of portal insulin to a glucose load was lower than in the control sham‐operated dogs. Both islet size and the number of B cells increased significantly after hepatectomy. Portal pancreatic glucagon levels increased significantly after hepatectomy, and the response of pancreatic glucagon to a glucose load was not suppressed. The number of A cells also increased significantly.Thus, there were differencies between insulin and pancreatic glucagon in their morphological and functional effects after hepatectomy. Although this difference is not clearly understood, there is a possibility that insulin consumption is accelerated in the remnant liver after hepatectomy. Insulin and pancreatic glucagon appear to play important but different roles in the regenerating liver from the morphological point of view.
Hepatolithiasis Associated With Anomalous Biliary Anatomy and a Vascular Compression Hepatolithiasis and Anomalous Anatomy
Authors: Cullingford Graham , Davidson Brian , Dooley James , Habib Nagy 
Published: September 2007

Biliary tract abnormalities occur in about one of every three people, usually being minor and of no clinical significance.Major abnormalities, however, may present in an unusual manner and provide a major hazard to the unsuspecting surgeon.A patient presenting with cholangitis without jaundice or abnormal liver function tests is reported. Endoscopic retrograde cholangiography failed to demonstrate any bile ducts in the right postero‐lateral segments of the liver, the “naked segment sign”. A percutaneous transhepatic cholangiogram demonstrated a stricture obstructing the right posterior segmental hepatic duct with hepatolithiasis above the stricture. At operation an anomalous vessel was found at the site of the stricture.This case highlights the unusual way in which biliary tract anomalies may present and the importance of adequate pre‐operative investigation.
Long Term Variceal Sclerotherapy: Is Endoscopic Sclerosis a Unique Therapeutic Approach and a True Alternative to Surgery?
Authors: Paquet K-J. , Lazar A. , Rambach W. 
Published: September 2007

Endoscopic sclerotherapy has been used to control acute variceal haemorrhage which persists despite
conservative therapy, prevent recurrent variceal haemorrhage in patients with a history of oesophageal
haemorrhage, and to prevent a haemorrhage in patients with oesophageal varices who never bled.In this short paper I will cover our personal experience with more than 2000 patients receiving
particularly paravariceal endoscopic sclerotherapy of bleeding esophageal varices, and especially
present the results of our prospective and controlled randomized trials (Table 1) and underline
the thesis that endoscopic sclerotherapy and surgical procedures for patients with portal
hypertension are complementary supporting measures or options.
Selective Regional Chemotherapy of Unresectable Hepatic Tumours Using Lipiodol
Authors: Novell J. R. , Dusheiko G. , Markham N. I. , Reddy K. , Dick R. , Hobbs K. E. F. 
Published: September 2007

Over a 30 month period from 1987 to 1990, selective hepatic cannulation under fluoroscopic control was
performed in 57 consecutive patients with primary and secondary malignancies of the liver. Fifty‐three
patients were subsequently treated using intra‐arterial Lipiodol emulsified with epirubicin. The tumours
treated were hepatocellular carcinoma (n = 35), metastatic adenocarcinoma (n = 14), intrahepatic
cholangiocarcinoma (n = 3) and leiomyosarcoma (n = 1). For hepatocellular carcinoma the cumulative
survival was 38% at one year; the median survival was 12.2 months for Stage I, 6.3 months for Stage II
and 0.9 months for Stage III tumours.In metastatic disease the cumulative survival was 63% at one year.These data suggest that targeted intra‐arterial chemotherapy with Lipiodol‐epirubicin is a useful
palliative therapy for patients with Stage and II HCC, and that a controlled trial of this treatment
should be undertaken.
Retroperitoneal Biloma Secondary to Operative Common Bile Duct Injury
Authors: Čólović Radoje , Perišić-Savić Mirjana 
Published: September 2007

Encapsulated collections of bile (“biloma”) may be a sequela of liver trauma, operative injury or disease. Such collections may be intrahepatic or extrahepatic and usually in the supramesocolic compartment of the abdomen. This is a report of a retroperitoneal biloma, an entity that has been reported only twice to date but this is the first secondary to an operative common bile duct lesion.Evacuation of the biloma and reconstruction of the associated biliary stricture were successfully carried out. The patient remains sympton free with normal clinical and laboratory data more than 14 months after surgery.Operative common bile duct (CBD) injury may be followed by a number of complications. To our knowledge retroperitoneal biloma secondary to a CBD lesion has not been previously reported.
Controversy in the Management of Cholangitis Secondary to Hydatid Daughter Cysts
Authors: Davidson Brian , Ezaki T. , Habib Nagy 
Published: September 2007

A 36 year old Cypriot woman, resident in the U.K. since the age of three years, presented with pyrexia,
jaundice and upper abdominal pain. On ultrasound examination the biliary tree was dilated, contained
sludge and a cystic lesion was present in the liver. An endoscopic cholangiogram showed multiple filling
defects in the bile duct which were not felt to be removable endoscopically and a nasobiliary drain was
therefore inserted. On resolution of the cholangitis with drainage and antibiotics a laparotomy was
performed. The right lobe of the liver was largely replaced by a multiloculated cyst and the bile duct
contained multiple hydatid daughter cysts. A right hepatectomy was performed with t‐tube drainage of
the evacuated bile duct. She made an uneventful recovery and has had no problems on subsequent
follow up. Histology confirmed an intrabiliary rupture of a hydatid liver cyst.Cholangitis secondary to daughter cysts is a rare but recognised complication of hydatid liver cysts.
Management of hydatid liver cysts by formal resection is controversial but may be preferable in this
situation.
“Adenomatous Polyps of the Gallbladder” Adenomas of the Gallbladder
Authors: Farinon Attilio Maria , Pacella Antonio , Cetta Francesco , Sianesi Mario 
Published: September 2007

The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem.Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow‐up examinations.
Measurement of Liver Blood Flow: A Review
Authors: Seifalian A. M. , Stansby G. P. , Hobbs K. E. F. , Hawkes D. J. , Colchester A. C. F. 
Published: September 2007

The study of hepatic haemodynamics is of importance in understanding both hepatic physiology and
disease processes as well as assessing the effects of portosystemic shunting and liver transplantation. The
liver has the most complicated circulation of any organ and many physiological and pathological
processes can affect it1,2. This review surveys the methods available for assessing liver blood flow,
examines the different parameters being measured and outlines problems of applicability and interpretation
for each technique.The classification of these techniques is to some extent arbitrary and several so called “different”
methods may share certain common principles. The methods reviewed have been classified into two
groups (Table 1): those primarily reflecting flow through discrete vessels or to the whole organ and those
used to assess local microcirculatory blood flow. All techniques have their advantages and disadvantages
and in some situations a combination may provide the most information. In addition, because of the
many factors affecting liver blood flow and sinusoidal perfusion, readings in a single subject may vary
depending on positioning, recent food intake, anxiety, anaesthesia and drug therapy. This must be
borne in mind if different studies are to be meaningfully compared.
Percutaneous Aspiration, Lavage and Antibiotic Instillation. New Approach in the Management of Acute Calculous Cholecystitis
Authors: Salim Aws S. 
Published: September 2007

Distension of the gallbladder and bacterial infection can perpetuate an attack of acute calculous cholecystitis and produce its local and systemic complications. This prospective randomized trial was conducted on patients with their first episode of acute calculous cholecystitis which was associated with pyrexia and tachycardia to examine whether ultrasound guided percutaneous aspiration and lavage of the gallbladder followed by intra‐lumenal instillation of 500 mg ampicillin (PALA) enhanced recovery from cholecystitis. Twenty patients were randomized to receive 500 mg of ampicillin every 6 hours for 5 days and another 20 patients were randomized to receive this treatment in addition to PALA within 12 hours of admission. Twenty four hours after admission to hospital, all the patients treated with PALA were apyrexial and had no residual right hypochondrial tenderness or guarding, a result superior (p < 0.001) to that of the group without PALA where at least 75% of patients were still showing these signs. Two days after admission the WBC count of the PALA group was significantly (p < 0.05) lower than that of the other group (6.32 ± 0.1 × 109/L vs 10.31 ± 0.4 × 109/L, mean ± SEM, n = 20). Four days after admission, all members of the PALA group were comfortably tolerating solid food for the previous 24 hours and were, therefore, discharged home whereas all members of the other group were still in hospital and 85% of them were discharged home after hospitalization for 6 to 7 days. Three members (15%) of this group deteriorated and underwent emergency surgery.The results show that addition of PALA to the conventional non‐operative treatment of acute cholecystitis enhances recovery and avoids the complications necessitating emergency surgery.
Successful Surgical Treatment of Hepatocellular Carcinoma Invading Into Biliary Tree
Authors: Tanoue Kazuo , Kanematsu Takashi , Matsumata Takashi , Shirabe Ken , Sugimachi Keizo , Yasunaga Chikao 
Published: September 2007

A 41‐year‐old woman was admitted to hospital with obstructive jaundice. Computed tomography
showed a large mass in the right hepatic lobe and marked dilatation of the biliary tree in the left lateral
segment of the liver. Angiography showed evidence of neovascularity. Percutaneous transhepatic
cholangiography revealed complete obstruction of the common bile duct just below the bifurcation. The
serum level of alpha‐fetoprotein on admission was 1,080,000 ng/ml. These findings suggested to us a
primary hepatocellular carcinoma invading the intrahepatic bile duct. Extended right lobectomy and
hepaticojejunostomy for bile drainage was carried out. The patient is doing well 3 years after surgery.Hepatocellular carcinoma (HCC) invading to the portal vein is not so rare, but invasion into the bile
duct is much less common. In 1947, Mallory1 described a single case of HCC invading the gallbladder
and obstructing extrahepatic bile ducts. In 1975, Lin2 termed this HCC “Icteric type hepatoma”. The
incidence of such HCC in Japan was reported to be 1.9‐9%2,3.Obstructive jaundice is a clinical manifestation of the terminal stage in HCC. We describe here our
treatment of a woman with HCC invading the common bile duct. Right extended lobectomy and
reconstruction of hepaticojejunostomy were effective.
Blunt Liver Trauma at SunnybrookMedical Centre: A 13 Year Experience
Authors: Hanna Sherif S. , Pagliarello G. , Taylor G. , Miller H. , Scarth H. M. C. , Brenneman F. 
Published: September 2007

Between June 1, 1976 and June 30, 1989 The Regional Trauma Unit at Sunnybrook Medical Centre in
Toronto, Ontario, Canada received 3730 patients. Of these 335 (9%) sustained a liver injury, 95% being
due to blunt trauma. Open peritoneal lavage was performed on 80% of liver trauma patients (267/335),
99% being true positive.A laparotomy was performed on 97% of patients (324/335). Major surgical treatment was required in
132 patients (41%) and minor treatment in 192 patients (59%). The remaining 11 patients were treated
conservatively (n = 3) or died during resuscitation (n = 8).Morbidity directly related to the liver injury was seen in 29 of 249 surviving patients (11%) although
overall morbidity was 27% (67/249). Reoperation was required in 6% (14/249) with abscess or
hematoma accounting for 11 of 14 operations.The overall mortality rate was 26% (86/335). Eighty two percent of patients (n = 276) had a grade I, II
or III liver trauma according to Moore’s classification with a mortality of 12% (n = 32). The remaining
18% of patients (n = 59) had a grade IV or V liver trauma with a mortality of 44% (n = 26). Of the 86
deaths, head injury accounted for 48 (56% of deaths); liver hemorrhage for 17 (20%), liver sepsis for
(1%) and other causes for 20 deaths (23%). Thus death due to the liver injury itself (hemorrhage and
sepsis) occurred in 18 out of 335 patients (5% overall). Head injury accounted for the death of 48 out of
335 patients (14% overall).Over the past 13 years a trend has occurred at our institution whereby we are seeing less liver trauma
in our population of multiply injured patients from 12% (1976–1983) down to 7% (1985–1989); with a
gradual decline in overall mortality from 32% (1976–1983) to 19% (1985–1989), whereas the precentage
of deaths due to head injuries and liver injury have increased.
Etiology and Pathogenesis of Marked Elevation of Serum Transaminase in Patients With Acute Gallstone Disease
Authors: Isogai Masatoshi , Hachisuka Kitao , Yamaguchi Akihiro , Nakano Satoshi 
Published: September 2007

From 1980 through 1988, biliary surgery was performed in 197 patients with acute gallstone disease and
concomitant elevation of serum glutamic oxalacetic transaminase (SGOT) or serum glutamic pyruvic
transaminase (SGPT) of over 300 Karmen units. In 137 patients, anatomic inspection and liver biopsy
were performed during the acute stage of the disease. Impacted and floating bile duct stones were found
in 69 (50%) and in 43 (32%) of the 137 patients, respectively. The main liver histology was necrosis of
liver cells. After surgery, high serum transaminase fell rapidly with immediate recovery in 99% of the
patients. In the remaining 60 patients, their signs and symptoms settled soon after initial conservative
treatment and surgery was performed after an average time of 21 days. At laparotomy, impacted bile
duct stones were found in 2 (3%) and liver histology revealed regeneration of liver cells.These findings suggest that marked elevation of serum transaminase in patients with acute gallstone
disease might be due to an acute inflammatory liver cell injury caused by impacted bile duct stones or
migrating stones, which would be transient and reversible after early resolution of the bile duct
obstruction.
Multiple Biliary Papillomatosis
Authors: Tireli Mustafa , Uslu Adam 
Published: September 2007

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary
papillomatosis treated surgically with a transhepatic stent.Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is
regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis
with obstructive jaundice is presented.
Standard Surgical Approaches to Primary Choledocholithiasis — Definitive VersusTemporary Decompression
Authors: de Almeida António Castro Mendes , Aldeia Fernando José , dos Santos Noel Medina , Gracias Caetano Winston 
Published: September 2007

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T‐tube
decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of
sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction,
due to dysmotility of the SO, lies behind most stone‐containing ducts. Thus it seems logical to us that a
permanent “fenestration” should be the management of most such ducts.We prospectively followed‐up, for one to 10 years, two groups of patients submitted to primary
CBDE aiming to assess the short and long‐term results of two different surgical approaches to duct
lithiasis. In one (Group A) 162 CBDE′s were performed, out of 680 CHE′s (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE′s, out of 438 CHE′s (18%), with a “positivity” of 70%. In Group A a T‐tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T‐tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T‐tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long‐term results, though, were significantly worse among patients of Group A whose ducts were temporarily
decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent
stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for
bilio‐digestive anastomotic complications with cholangitis.It is concluded that it is against the long‐term efficiency of the approach utilized in Group B that the
new laparoscopic techniques should be compared.
Diagnosis and Surgical Treatment of Hepatic Hydatid Disease
Authors: Bilge Ahmet , Sözüer Erdoğan M. 
Published: September 2007

In this report two hundred and twenty six patients with hydatid disease were admitted to the Surgical
Department of Erciyes University (Kayseri) and Şişli Etfal Hospital (Istanbul) between 1978 and 1990
and reviewed retrospectively. One hundred and two patients (45.1%) were male and 124 (54.9%)
female. In the patients with hydatid cysts the most frequent symptom was right upper abdominal pain
(66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). One hundred
and sixty seven patients (73.9%) were examined with ultrasonography which has a diagnostic value of
94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic
shock (0.4%). All patients were operated on by using various surgical techniques; omentoplasty
(101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion
(10), pericystectomy (6), and hepatic resection (5).The main postoperative complications were wound infection (12%) and biliary fistula (2.6%). The
total mortality rate was 1.8% in this series.
Experimental and Clinical Evaluation of Capsular and Parenchymal Total LiverPerfusion
Authors: Kotzampassi Katerina , Eleftheriadis Efthimios , Aletras Homeros 
Published: September 2007

Liver blood flow measurements obtained from both the liver surface and deep within the parenchyma,
were correlated in an effort to assess the usefulness of laser‐Doppler flowmetry for non‐invasive
monitoring of total liver blood flow, the probe being positioned on either the surface or within the liver
parenchyma.In 23 Wistar rats and 10 biliary surgery patients, anaesthetized prior to gallbladder removal, liver
microcirculation was measured at 4 points on the capsular surface, and consequently at 4 points deep
within the parenchyma, using probes connected to a laser‐Doppler flowmeter. The findings revealed
that laser‐Doppler measurements on the liver surface and within the parenchyma were well correlated,
as no statistically significant differences were found either in rats or humans. It is concluded that laser‐
Doppler flowmetry for monitoring of total liver perfusion can be applied either on the capsular surface
or within the hepatic parenchyma.
A Comparison of Sms 201‐995 and Oesophageal Tamponade in the Control of Acute Variceal Haemorrhage
Authors: Mckee Ruth F. , Garden O. J. , Anderson J. R. , Carter D. C. 
Published: September 2007

Forty endoscopically proven active variceal bleeds were entered in a prospective trial comparing
oesophageal tamponade with SMS 201‐995 infusion.Oesophageal tamponade controlled 19 of 20 bleeds over the first four hours and 14 of 18 bleeds over
48 hours. SMS 201‐995 infusion controlled 18 of 20 bleeds over the first four hours and 10 of 20 bleeds
over 48 hours (p = 0.15). No significant differences between the groups were seen in time to control of
bleeding, amount of blood transfused or number of patients crossed over to the opposite treatment.
Complications in the oesophageal tamponade group were discomfort due to the tube (17 patients) and
chest infection (10 patients), while in the SMS 201‐995 group 7 chest infections and one episode of
hyperglycaemia occurred, with no symptomatic complaints. The patient survived the admission in 15 of
the oesophageal tamponade bleeds and all of the SMS 201‐995 bleeds (p = 0.047).An intravenous infusion of SMS 201‐995 appears to have comparable efficacy to oesophageal
tamponade in variceal bleeding.
Clinical Diversity in Biliary Pancreatitis — Classification of Two Types
Authors: Isogai Masatoshi , Hachisuksa Kitao , Yamaguchi Akihiro , Nakano Satoshi 
Published: September 2007

One hundred and seven patients with biliary pancreatitis undergoing operation from 1976 to 1989 were
reviewed. To clarify the reason for failure to respond to conventional supportive therapy, 73 patients (68%) who underwent emergency surgery were retrospectively divided into two groups according to the severity of the pancreatitis evaluated at laparotomy and compared. Sixty‐two had minimal or mild pancreatitis (Group I), among whom 44 (71%) had life‐threatening acute biliary tract disease. All underwent biliary surgery and 4 (6%) subsequently died, 2 due to acute obstructive suppurative cholangitis. Eleven had hemorrhagic necrotizing pancreatitis (Group II), among whom 7 had complications of acute pancreatitis such as pancreatic ascites or abscess. These underwent pancreatic and/or
biliary surgery and 3 (27%) died of multi‐organ failure.There appears to be two types of biliary pancreatitis refractory to conventional supportive therapy, which differ in the extent of surgery required and in mortality: (1) minimal or mild pancreatitis with persistent life‐threatening acute biliary tract disease (biliary type), and (2) more severe pancreatitis (pancreas type) early in the course of the disease.