bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Treatment of Large Liver Cyst Evaluated with CA19‐9 in the Cystic Fluid
Authors: Ikeda Yasuharu , Kawasaki Katsumi , Ikeda Tetsuo , Uchida Hiroyuki , Morinaga Kazumasa 
Published: September 2007

A middle‐aged woman was admitted with a diagnosis of liver cysts. The patient was symptomatic and was
treated by injecting absolute ethanol into the largest cyst every week, but the secretion from the cyst
persisted. The patient was then treated by absolute ethanol injection every day with good results.
CA 19‐9 was measured in the cystic fluid. The secretion was related to CA 19‐9 activity.Thus, for patients with symptoms from a liver cyst, the injection of ethanol every day can be effective.
CA19‐9 level in the contents of the liver cyst was an important factor in assessing the effect of ethanol
injection on the liver cyst.
Results of Pancreatic Blood Shunting into the Systemic Blood Flow in Insulin‐Dependent Diabetics
Authors: Galperin E. I. , Diuzheva T. G. , Petrovsky P. F. , Chevokin A. Yu. , Dokuchayev K. V. , Rabinovich S. E. , Gitel E. P. , Kuzovlev N. F. , Platonov L. V. 
Published: September 2007

A new surgical method of treating patients with unstable insulin‐dependent diabetes (IDD) has been
developed‐that of surgically shunting pancreatic blood into the systemic blood flow with the purpose of
creating a more optimal interaction of subcutaneously administered insulin and pancreas‐secreted
glucagon.The long term results of the operation depend on the patency of a splenorenal anastomosis. This has
been studied by following up 137 patients over periods from half a year to three years. Anastomotic
patency was determined by renal and splenic venography and celiacy arteriography, which revealed a
patent anastomosis in 114 patients, and an obliterated one in 23.Patients with patent anastomoses showed a lowering of glycosylated hemoglobin (HbAlc) from
13.3±0.03% to 9.3±0.6%, p<0.05, a decrease of the injected insulin dose from 0.97±0.04 to 0.72±0.03 U/ kg, p<0.05, disappearance or considerable abatement of pain in the lower extremities, and of hypoglycemia. Improvement of clinical status was accompanied by an increase of glucagon in the systemic blood stream from 60.8±10.1 to 91.5±9.4 pg/ml, p<0.05, a rise of tissue oxygen pressure, PO2, from 49.2±2.4 to 58.1±1.9 mm Hg, p<0.05. In patients with oblivious anastomoses postoperative HbAlc levels did not change from preoperative values: 12.9±0.4% and 12.8±0.7%, p<0.05, respectively; the insulin dose remained the same‐0.91 ±0.07 U/kg and 0.85±0.07 U/kg, p<0.05, no rise of the systemic blood glucagon content was noted, and former complaints continued.The suggested method is not an alternative for insulin therapy, but considerably enhances its potential.
Hepatic Cryotherapy for Cancer: A Reviewand Critique
Authors: Morris D. L. 
Published: September 2007

Background: Wedge or other nonanatomic hepatic resections, performed in an
attempt to spare functional parenchyma, often are not accomplished with clear resection
margins and may be complicated by hemorrhage from the depth of the resection.Study Design: The current study describes a technique of cryoassisted hepatic
resection that allows for controlled resection with well‐defined margins. The early
experience in managing 16 tumors in 13 patients is reported.Results: A cryoprobe is inserted into the tumor and freezing performed to a predetermined
resection margin using ultrasound control. The ice ball, so formed, is then
maintained and excised. The management of these 13 patients was associated with one
intraoperative and two postoperative complications, including a death of a patient with
cirrhosis who had infected ascites and died as a result of hepatic failure.Conclusions: Cryoassisted hepatic resection seems to be safe and allows resection
with good tumor clearance and maximal preservation of functional parenchyma.
Changes in Hepatic Hemodynamics due to Primary Liver Tumours
Authors: Jakab F. , Ráth Z. , Schmal F. , Nagy P. , Faller J. 
Published: September 2007

Data regarding the afferent circulation of the liver in patients with primary hepatocellular carcinoma are
controversial, we have carried out measurement of hepatic arterial and portal venous flow
intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular
carcinoma the hepatic artery flow increased to 0.55±0.211 compared with the control value of 0.37±0.102
1/min. (p<0.01). The portal venous flow decreased from 0.61±0.212 l/min, to 0.47±l/min. p<0.01). Due to
the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly,
compared with controls.The ratio of hepatic arterial flow to portal vein flow increased to 1.239±0.246 in patients with
hepatocellular carcinoma, which is double of the control value (0.66±0.259 l/min). After resection this
ratio did not change.The resection did not alter hepatic artery or portal venous flow significantly, although the total hepatic
blood flow decreased significantly (p<0.01).On the basis of our early results it is possible that the ratio of the two circulations may be to deel
measured with doppler ultrasound and provide diagnostic information.
Laparoscopic vs Open Ultrasound of the Liver: An in vitro Study
Authors: Cozzi P. J. , McCall J. L. , Jorgensen J. O. , Morris D. L. 
Published: September 2007

Intra‐operative contact ultrasound is a sensitive method of detecting liver tumours. The aim of this study was to compare the sensitivity of open contact ultrasound (OUS) of the liver with laparoscopic contact ultrasound (LUS). Hypoechoic “lesions” were created in 5 fresh pig livers by inserting 28 grapes via small incisions in the inferior surface. The size (range 8–25 mm) and location of each grape was recorded. Scanning was undertaken in random order by two experienced independent observers with no knowledge of the size, number or position of the lesions, using an Aloka 650 series scanner and 7.5 MHz probes. The crude sensitivity with OUS was 96% and 100% respectively for the two observers, and 92% for each with LUS. One grape was interpreted as 2 seperate grapes on LUS by one observer. Absolute sensitivity (grapes identified in the correct location) was 86% and 93% respectively with OUS and 79% for each
observer with LUS.LUS was almost as sensitive as OUS in this model of hepatic metastases.
Isolated Resection of Segment I (Caudate Lobe): Is it Justified?
Authors: Blumgart Leslie H. 
Published: September 2007

Background: Isolated caudate lobectomy is a challenging surgical procedure for which safe and reliable techniques have yet to be developed.Methods: Isolated caudate lobectomy was performed by initial inflow control of the caudate lobe, full mobilization of the liver from the inferior vena cava by dividing all short hepatic veins, and parenchymal division dorsal to the major hepatic veins with a clockwise rotation of the liver while the liver was selectively devascularised by Pringle′s maneuver and occlusion of the confluence of the major hepatic veins flush with the inferior vena cava.Results: Two patients with cirrhosis underwent this procedure successfully without intraoperative hemodynamic instability or postoperative liver dysfunction.Conclusions: This technique allows safe and truly selective excision of the caudate lobe without the need for occlusion of the inferior vena cava or venovenous bypass.
Development of Collaterals in Intermittent and Permanent Ischemia of the Liver
Authors: Ok Engin , Yilmaz Zeki , Akgün Erhan , Sözüer Erdoğan M. , Yeşilkaya Yaşar , Öztürk Figen 
Published: September 2007

The ischemia caused by hepatic dearterialization as therapy for hepatic malignancies is transient because of the rapid formation of collaterals. In order to prevent this transient repeated ischemia has been suggested.An experimental study was planned to compare the collateral occurrence in persistent ischemia and transient repeated ischeamia of the liver. Fourteen dogs (seven persistent ischemia, seven transient repeated ischemia) were used in this study. Hepatic dearterialization were performed in both groups. In the first group (persistent ischemia), the hepatic artery was ligated proximal to the gastroduodenal artery. In the second group (transient repeated ischemia), the hepatic artery was occluded externally in the same region as the first group by means of a device modified from 8 guage Foley catheter and after occlusion for one hour it was reopened. Occlusions were repeated twice in a day. Five dogs in the first group and six dogs in the second group completed a three weeks ischemia period and angiography were then performed in all. The dogs were sacrificed after the angiography and examined for possible abscess formation, arterial thrombosis, peritoneal adhesions and liver necrosis. After angiography, the two groups were also examined for collateral occurrence. Only one collateral occurred in the transient repeated ischemia group, but in the persistent ischemia group, collaterals occurred in all dogs. This difference between two groups is statistically significant (Fischer Absolute Chi Square Test, p=0.013).Transient repeated ischemia is superior to persistent ischemia because of fewer collaterals, but in practise, total dearterialization of the liver is impossible.
Resection Margins for Colorectal Metastases to The Liver: Do They Make A Difference?
Authors: Adams Reid B. , Langer Bernard 
Published: September 2007

Objective: The authors determined an appropriate surgical treatment for liver metastases from
colorectal cancers. Clinicopathologic featuresof metastatic lesions of colorectal cancers
were studied.Summary Background Data: Major hepatic resection is the usual procedure for treatment of hepatic metastases from colorectal cancers.Methods: Forty consecutive patients who underwent hepatic resections were prospectively studied,
for a total of 89 metastatic liver tumors.Results: Metastatic tumor often extended along Glisson’s capsule, including invasion to the portal
vein (9 cases), the hepatic vein (3 cases), the bile duct (16 cases), and the nerve (6 cases).
The main tumor had small satellite nodules in only one patient, and there were no
microscopic deposits in the parenchyma, even within 10 mm from the metastatic tumors.
Fibrous pseudocapsule formation was observed in 28 patients.Discussion: The rarity of intrahepatic metastasis from metastatic tumor supports nonanatomic
limited hepatic resection as the procedure of choice for metastatic colorectal cancer in the
liver. The spread via Glisson′s capsule should be taken into consideration for complete
tumor clearance.
Treatment of a Giant Haemangioma of the Liver With Kasabach‐Merritt Syndrome by Orthotopic Liver Transplant
Authors: Longeville J-H. , Hall P. De La M. , Dolan P. , Holt A. W. , Lillie P. E. , Williams J. A. R. , Padbury R. T. A. 
Published: September 2007

We describe a case of giant cavernous haemangioma of the liver with disseminated intravascular coagulopathy (Kasabach‐Merritt syndrome) which was cured by orthotopic liver transplant.A 47 year old man presented with bleeding and tender massive hepatomegaly after tooth extraction. Investigations showed disseminated intravascular coagulopathy and a giant hepatic haemangioma involving both lobes of the liver. Initial treatment failed to resolve the coagulopathy and liver resection was attempted. At laparotomy the turnout was unresectable and the only option for cure was to offer a liver transplantation. The orthotopic liver transplant was performed 20 days after initial laparotomy. Subsequently, all coagulation parameters returned to normal and the patient remains well after 12 months. Orthotopic liver transplant can be considered for giant hepatic haemangioma with Kasabach‐Merritt syndrome when resection is necessary and a partial hepatectomy is not technically feasible.
Is there a Role for Preoperative Infusion or Intraoperative Cholangiography?
Authors: Lau W. Y. , Li Arthur K. C. 
Published: September 2007

Background: There has been a resurgence of interest in recent years in preoperative infusion cholangiography (PIC). The role of routine PIC compared to routine intraoperative cholangiography (IOC) has not been clearly defined.Study design: In our department between 1985 and 1991, 1,042 of 1,576 consecutive patients with biliary calculous disease had elective cholecystectomy: 694 patients were prospectively scheduled for PIC, and 348 patients were randomly allocated to IOC. The patients in the PIC and IOC groups were similar with regard to age, history of biliopancreatic complications, and laboratory findings. The cost of PIC in Sweden is nearly five times greater than the cost of IOC.Results: Satisfactory opacification of the biliary system was obtained in 90.1 and 96.8 percent of patients who underwent PIC and IOC, respectively. Preoperative infusion cholangiography required support by IOC in 19.5 percent of patients. There were no statistically significant differences between the PIC and IOC groups with regard to the incidence (7 percent in both groups) of or positive predictive value (68 and 80 percent, respectively) for bile duct stones, rate of retained stones (6 and 20 percent, respectively), intraoperative (5.6 and 6.3 percent, respectively) or postoperative (13.3 and 15.9 percent, respectively) morbidity, or incidence of bile duct anomalies (0.9 and 0.3 percent, respectively). Median operative time was longer in .patients with (95 minutes) compared to those without (75 minutes) IOC (p<0.001). More postoperative complications occurred after bile duct exploration (26 of 75 patients) compared to cholecystectomy alone (114 of 917 patients, p<0.001). The 30‐day mortality was zero. Minor bile duct injuries occurred in two patients (0.2 percent) at cholecystectomy, (one with and one without bile duct exploration). In no patient was the cholangiographic finding of a biliary anomaly crucial for the safe execution of cholecystectomy.Conclusions: In our study, PIC and IOC were comparable, but routine use of either method did not promote the safety of cholecystectomy and thus their routine use is not warranted. The shorter operative time and preoperative identification of common bile duct (CBD) stones provided by PIC might favor this examination when applied selectively in patients with increased risk of having CBD stones. However, this potential advantage is offset by the need for PIC to be supported by IOC in approximately 20 percent of patients. Also, the cost of PIC is greater than the cost of IOC.
Is There a Role for Perioperative Nutritional Support in Liver Resection?
Authors: Bothe Albert , Steele Glenn 
Published: September 2007

Background: Resection of hepatocellular carcinoma is associated with high rates of morbidity and mortality. Since intensive nutritional support can reduce the catabolic response and improve protein synthesis and liver regeneration, we performed a prospective study to investigate whether perioperative nutritional support could improve outcome in patients undergoing hepatectomy for hepatocellular carcinoma.Methods: We studied 124 patients undergoing resection of hepatocellular carcinoma. Sixty‐four patients (39 with cirrhosis, 18 with chronic active hepatitis, and 7 with no associated liver disease) were randomly assigned to receive perioperative intravenous nutritional support in addition to their oral diet, and 60 patients (33 with cirrhosis, 12 with chronic active hepatitis, and 15 with no associated liver disease) were randomly assigned to a control group. The perioperative nutritional therapy consisted of a solution enriched with 35 percent branched chain amino acids, dextrose, and lipid emulsion (50 percent medium‐chain trigylcerides) given intravenously for 14 days perioperatively).Results: There was a reduction in the overall postoperative morbidity rate in the perioperative‐nutrition group as compared with the control group (34 percent vs. 55 percent; relative risk, 0.66; 95 percent confidence interval, 0.45 to 0.96), predominantly because of fewer septic complications (17 percent vs. 37 percent; relative risk, 0.57; 95 percent confidence interval, 0.34 to 0.96). There were also a reduction in the requirement for diuretic agents to control ascites (25 percent vs. 50 percent; relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87), less weight loss after hepatectomy (median loss, 0 kg vs. 1.4 kg; P=0.01), and less deterioration of liver function as measured by the change in the rate of clearance of indocyanine green (–2.8 percent vs. –4.8 percent at 20 minutes, P=0.05). These benefits were seen predominantly in the patients with underlying cirrhosis who underwent major hepatechtomy. There were five deaths during hospitalization in the perioperativenutrition group, and nine in the control group (P not significant).Conclusions: Perioperative nutritional support can reduce complications after major hepatectomy for hepatocellular carcinoma associated with cirrhosis.
ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection
Authors: Kitano Seigo , Kim Yang-II 
Published: September 2007

Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high (26% to 50%). Previous workers recommended that only selected patients with Child′s A status or indocyanine green (ICG) retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.Setting: A tertiary referral center.Patients: The preoperative, intraoperative, and post‐operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher (P=.01), but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates (13%, 16%, and 14%, respectively) were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.
The Role of Laparoscopy and Ultrasonography in Pancreatic Head Carcinoma
Authors: Beger Hans G. , Schoenberg Michael H. 
Published: September 2007

Objective: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with
carcinomas of the pancreatic head and periampullary region.Summary Background Data: Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy.Methods: A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region).Results: “Occult” metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively).Conclusions: Staging laparoscopy is indispensable in the detection of “occult” intraabdominal metastases. Laparoscopic ultrasonography improves the accuracy of laparoscopic staging in patients with potentially resectable pancreatic and periampullary carcinomas.
Nesidioblastosis in the Adult Surgical Management
Authors: Garcia J. Palla , França Teresa , Pedroso Consiglieri , Cardoso Carlos , Cid M′Olímpia 
Published: September 2007

Nesidioblastosis is an exceedingly rare occurrence in the adult and, when it appears, it is usually part of a MEA1 syndrome.We present a case of nesidioblastosis in a young woman, with no concurrent endocrine pathology, while we discuss in detail the diagnostic and therapeutic problems posed by this condition.The selected treatment was sub‐total pancreatectomy (70–80%) and the histopathologic and immunohistochemical tests of the surgical specimen showed: “Diffuse Nesidioblastosis”.The histopathologic and immuno‐histochemical features of the resected pancreas are analysed in detail.