Sample records for hepatic parenchyma resection

  1. Simultaneous Parenchyma-Preserving Liver Resection, Cytoreductive Surgery and Intraperitoneal Chemotherapy for Stage IV Colorectal Cancer. (United States)

    Abreu de Carvalho, L F; Scuderi, V; Maes, H; Cupo, P; Geerts, B; Van Bockstal, M; Gremonprez, F; Willaert, W; Pattyn, P; Troisi, R; Ceelen, W


    The outcome of stage IV colorectal cancer (CRC) has improved with modern systemic therapy. However, the concomitant presence of liver metastases (LM) and peritoneal carcinomatosis (PC) remains associated with a dismal prognosis and surgery in this context remains exceptional. Stage IV CRC patients with LM and PC undergoing simultaneous cytoreductive surgery, intraperitoneal chemotherapy (IPC) and liver resection/ablation were identified from prospectively collected databases. We assessed response to neoadjuvant chemotherapy (NACT), postoperative complications, progression free survival (PFS), and overall survival (OS). Twenty-one patients with resectable disease were treated between 2007 and 2014. In 16 patients (76%), NACT was administered and tumour response defined their selection. The remaining 5 (24%) were selected according to the pattern of recurrence. Median peritoneal cancer index was 5 (range: 3-10.5). Liver surgery included 34 wedge resections, 5 ablations and one bisectionectomy to treat a total of 45 hepatic lesions with a median of 2 per patient (range: 1-2) and a median size of 1.35 cm (range: 0.8-2). Tumour regression grade 4 (fibrosis but residual cancer cells predominate) was seen in 50% of the resected metastases after NACT. Median hospital stay was 17 days (range: 14-24); severe morbidity (Clavien-Dindo grade 3-4) occurred in 24% and no perioperative mortality (0-90 days) was recorded. The median OS was 44 months (range: 31-57) while the median PFS was 10 months (range: 8-12). Combined parenchyma-preserving liver resection, cytoreductive surgery and IPC in patients with LM and PC from CRC can be performed safely and results in promising mid-term overall survival. © Acta Chirurgica Belgica.

  2. Biliary Stricture Following Hepatic Resection

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    Jeffrey B. Matthews


    Full Text Available Anatomic distortion and displacement of hilar structures due to liver lobe atrophy and hypertrophy occasionally complicates the surgical approach for biliary stricture repair. Benign biliary stricture following hepatic resection deserves special consideration in this regard because the inevitable hypertrophy of the residual liver causes marked rotation and displacement of the hepatic hilum that if not anticipated may render exposure for repair difficult and dangerous. Three patients with biliary stricture after hepatectomy illustrate the influence of hepatic regeneration on attempts at subsequent stricture repair. Following left hepatectomy, hypertrophy of the right and caudate lobes causes an anteromedial rotation and displacement of the portal structures. After right hepatectomy, the rotation is posterolateral, and a thoracoabdominal approach may be necessary for adequate exposure. Radiographs obtained in the standard anteroposterior projection may be deceptive, and lateral views are recommended to aid in operative planning.

  3. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases (United States)

    Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo


    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  4. Role of hepatic resection for patients with carcinoid heart disease

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    Bernheim, A.M.; Connolly, H.M.; Rubin, J.


    OBJECTIVE: To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005,...

  5. A Primary Hepatic Lymphoma Treated with Liver Resection and Chemotherapy

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    Konstantinos Bouliaris


    Full Text Available Primary hepatic lymphoma (PHL is a rare malignancy, which is frequently misdiagnosed. Although chemotherapy is the treatment of choice there are reports that a combination of surgery and adjuvant chemotherapy can offer better results. Herein we present an interesting case of a large primary non-Hodgkin lymphoma originating from liver was treated with a liver which resection and chemotherapy.

  6. Enucleation versus Anatomic Resection for Giant Hepatic Hemangioma: A Meta-Analysis. (United States)

    Liu, Yuhui; Wei, Xuyong; Wang, Kun; Shan, Qiaonan; Dai, Haojiang; Xie, Haiyang; Zhou, Lin; Xu, Xiao; Zheng, Shusen


    Hepatic hemangiomas are the most common benign liver tumors, and the management of giant hepatic hemangioma (GHH) is still in controversial. The aim of this meta-analysis was to compare the postoperative outcomes of enucleation versus anatomic resection for GHH. PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 1988 to December 2015 to identify studies comparing the outcomes of enucleation versus anatomic resection for GHH. Finally, we performed this meta-analysis using the Review Manager 5.3 software, and the results were presented as risk ratio (RR) or mean difference (MD) with corresponding 95% confidence interval (CI). The major limitation is that all data were derived from nonrandomized studies, and we cannot exclude potential selection bias. Nine studies involving 1,185 patients were included. The results showed that there was a lower incidence of complications (RR = 0.66, 95% CI 0.52 to 0.84, I(2) = 0%, p = 0.0007); no incidents of death occurred among the 9 included trials. Blood loss (MD = -419.07 mL, 95% CI -575.04 to -263.09, I(2) = 83%, p < 0.00001), duration of surgery (MD = -23.5 min, 95% CI -45.28 to -1.74, I(2) = 0%, p = 0.03), and length of hospital stay (MD = -1.59 days, 95% CI -3.06 to -0.13, I(2) = 0%, p = 0.03) were much lower in the enucleation group. GHH can be removed safely by either enucleation or anatomic resection. Enucleation can preserve more hepatic parenchyma and reduce postoperative complications, which is why it should be the preferred surgical procedure for suitable lesions.

  7. Use of radiofrequency hepatic parenchymal transection device in hepatic hemangioma resection: early experience and lessons learned (United States)

    Hering, J.; Garrean, S.; Saied, A.; Helton, W.S.


    Background. Control of intraoperative hemorrhage represents a significant challenge in hepatic surgery, particularly during resection of large, hypervascular hepatic hemangiomata (HH). Various devices to minimize blood loss from hepatic parenchymal transection are currently under investigation. Herein, we present our experience with a radiofrequency (RF)-powered multiarray for resection of HH. Patients and methods. From September 2005 to January 2006, we conducted a retrospective review of our hepatobiliary database to identify patients with symptomatic giant cavernous HH undergoing resection with a RF multiarray device. The purpose of this review was to assess the technical aspects of using RF energy to assist in the resection of HH. Results. The extent of operation varied depending on the size and location of the tumor. Two patients underwent two atypical subsectionectomies and two underwent trisectionectomies. The Habib™ sealer provided a safe and effective method for hepatic parenchymal transaction. No patients required blood transfusion, and no injuries to major biliary or vascular strictures were observed at 1 year follow-up. A seroma developed in one patient 6 months postoperatively, but was drained percutaneously. Conclusions.Hepatic parenchymal transection with the Habib sealer device is a feasible approach to resect HH. Further study is needed to objectively compare the efficacy of RF-assisted parenchymal transection with that of traditional parenchymal transection techniques. PMID:18345312

  8. Haemodynamic changes in hepatocellular carcinoma and liver parenchyma under balloon occlusion of the hepatic artery

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    Sugihara, Fumie; Murata, Satoru; Ueda, Tatsuo; Yasui, Daisuke; Yamaguchi, Hidenori; Miki, Izumi; Kumita, Shin-ichiro [Nippon Medical School, Department of Radiology, Center for Advanced Medical Technology, Tokyo (Japan); Kawamoto, Chiaki [Nippon Medical School, Department of Internal Medicine, Tokyo (Japan); Uchida, Eiji [Nippon Medical School, Department of Surgery, Tokyo (Japan)


    To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. (orig.)

  9. Transumbilical single-incision laparoscopic resection of focal hepatic lesions. (United States)

    Wu, Shuodong; Yu, Xiao-Peng; Tian, Yu; Siwo, Ernest Amos; Li, Yongnan; Yu, Hong; Yao, Dianbo; Lv, Chao


    Transumbilical single-incision laparoscopic surgery (SILS) is gaining in popularity as a minimally invasive technique. The reduced pain and superior cosmetic appearance it affords make it attractive to many patients. For this study, we focused on SILS, analyzing the outcomes of transumbilical single-incision laparoscopic liver resection (SILLR) achieved at our institution between January 2010 and February 2013. Pre- and postoperative data from 17 patients subjected to transumbilical SILLR for various hepatic lesions (8 hemangiomas, 2 hepatocellular carcinomas, 2 metastases, 2 calculi of left intrahepatic duct, and 3 adenomas) were assessed. Altogether, eight wedge resections, seven left lateral lobectomies, a combination wedge resection/left lateral lobectomy, and a proximal left hemihepatectomy segmentectomy were performed, as well as four simultaneous laparoscopic cholecystectomies. In each instance, three ports were installed through an umbilical incision. Once vessels and bleeding were controlled, the lesion(s) were resected with 5-mm margins of normal liver. Resected tissues were then bagged and withdrawn through the umbilical incision. The follow-up period lasted for a minimum of 6 months. All 17 patients were successfully treated through a single umbilical incision. The procedures required 55 to 185 minutes to complete, with blood loss of 30 to 830 mL. Subjects regained bowel activity 0.8 to 2.3 days postoperatively and were discharged after 3 to 10 days. There were few complications (23.5%), limited to pleural effusion, wound infection, and incisional hernia. Transumbilical SILLR is challenging to perform through conventional laparoscopic instrumentation. The risk of bleeding and technical difficulties is high for lesions of the posterosuperior hepatic segment. Surgical candidates should be carefully selected to optimize the benefits of this technique.

  10. The bioimpedance analysis of a parenchyma of a liver in the conditions of its extensive resection in experiment (United States)

    Agibalov, D. Y.; Panchenkov, D. N.; Chertyuk, V. B.; Leonov, S. D.; Astakhov, D. A.


    The liver failure which is result of disharmony of functionality of a liver to requirements of an organism is the main reason for unsatisfactory results of an extensive resection of a liver. However, uniform effective criterion of definition of degree of a liver failure it isn’t developed now. One of data acquisition methods about a morfo-functional condition of internals is the bioimpedance analysis (BIA) based on impedance assessment (full electric resistance) of a biological tissue. Measurements of an impedance are used in medicine and biology for the characteristic of physical properties of living tissue, studying of the changes bound to a functional state and its structural features. In experimental conditions we carried out an extensive resection of a liver on 27 white laboratory rats of the Vistar line. The comparative characteristic of data of a bioimpedansometriya in intraoperative and after the operational period with the main existing methods of assessment of a functional condition of a liver was carried out. By results of the work performed by us it is possible to claim that the bioimpedance analysis of a liver on the basis of an invasive bioimpedansometriya allows to estimate morphological features and functional activity of a liver before performance of an extensive resection of a liver. The data obtained during scientific work are experimental justification for use of an impedansometriya during complex assessment of functional reserves of a liver. Preliminary data of clinical approbation at a stage of introduction of a technique speak about rather high informational content of a bioimpedansometriya. The subsequent analysis of efficiency of the invasive bioimpedance analysis of a liver requires further accumulation of clinical data. However even at this stage the method showed the prospect for further use in clinical surgical hepathology.

  11. Hepatic resection using a bipolar vessel sealing device: technical and histological analysis. (United States)

    Romano, Fabrizio; Garancini, Mattia; Caprotti, Roberto; Bovo, Giorgio; Conti, Matteo; Perego, Elisa; Uggeri, Franco


    Blood loss and bile leakage are well-known risk factors for morbidity and mortality during liver resection. Bleeding usually occurs during parenchymal transection, and surgical technique should be considered an important factor in preventing intraoperative and postoperative complications. Many approaches and devices have been developed to limit bleeding and bile leakage. The aim of the present study was to determine whether a bipolar vessel sealing device allows a safe and careful liver transection without routine inflow occlusion, achieving a satisfactory hemostasis and bile stasis, thus reducing blood loss and bile leak and related complications. A total of 50 consecutive patients (24 males, 26 females, with a mean age of 57 years) underwent major and minor hepatic resections using a bipolar vessel sealing device. A clamp crushing technique followed by energy application was used to perform the parenchymal transection. Inflow occlusion was used when necessary to control blood loss but not as a routine. No other devices were applied to achieve hemostasis. The instrument was effective in 45 patients and failed to achieve hemostasis in 5 cases, all of whom had a cirrhotic liver. Median blood loss was 490 ml (range 100-2500 ml) and intraoperative blood transfusions were required in eight cases (16%). Mean operative time was 178 min (range 50-315 min). Inflow occlusion was necessary in 16 (32%) patients. The postoperative complication rate was 24%, with a postoperative hemorrhage in a cirrhotic patient. There was no clinical evidence of bile leak or procedure-related abdominal abscess. We conclude that the device is a useful tool in standard liver resection, achieving good hemostasis and bile stasis in patients with normal liver parenchyma, but its use should be avoided in cirrhotic patients.

  12. Hepatic resection for T2-3 gallbladder carcinoma: a retrospective analysis of 12 resectable cases

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    Manlio Basílio Speranzini


    Full Text Available Objective: To report on a group of 12 patients with advanced gallbladder adenocarcinoma at a General Hospital and describe the outcomes (surgical morbidity - mortality and long-term survival following hepatic resection. Methods: The authors present a series of twelve patients with invasive gallbladder adenocarcinoma who underwent hepatic resection at the General Surgery Service of the Hospital de Ensino da Faculdade de Medicina do ABC, in Santo Andre. The study period was from 2001 to 2007. There were twelve hepatic resections, all associated with hilar lymphadenectomy (IVB-V bisegmentectomy = 9 and right trisectionectomy = 3. There were ten women and two men and all patients were Caucasian. The age range was 52 to 72 years. The preoperative symptoms were biliary colic (n = 6, dyspepsia (n = 4, acute cholecystitis (n = 1 and jaundice (n = 1. The diagnosis was made by radiographic images in the preoperative period in seven patients; all of them were confirmed by frozen section during surgery. Five patients submitted to open cholecystectomy (n = 4 and laparoscopic cholecystectomy (n  = 1 had their diagnoses confirmed postoperatively by histological analysis. Rresults: The operative time varied between 180 and 340 minutes. Four patients received transfusions. The blood loss varied between 200 and 2500 ml. The hospital stay varied from 7 to 16 days. There were two major complications in two patients and both were treated conservatively, one biliary leakage and one reversible hepatic failure. There was no mortality. The TNM stage distribution was: T2N0M0 (n = 4, T2N1M0 (n = 2, T3N0M0 (n = 4 and T3N1M0 (n = 2. Only one patient presented affected surgical margin (T3N1M0 and died with both peritoneal and liver recurrence after a 9-month follow-up. Other three patients presented recurrence(13 to 28 months of follow-up and died. The three-year survival rate was 33.3% (n  = 4. Cconclusion: The radical surgical treatment with hepatectomy plus hilar

  13. Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. (United States)

    Schmandra, T C; Mierdl, S; Bauer, H; Gutt, C; Hanisch, E


    The ultrasonically activated scalpel (UAS) enables safe and effective laparoscopic tissue dissection, making hepatic resection feasible. This study compared blood loss and risk of gas embolism using the UAS during open hepatic resection and laparoscopic hepatic resection. Female pigs were divided into two groups for laparoscopic (n = 7) and open (n = 5) left hepatic lobectomy. The UAS was used for both tissue cutting and coagulation. Laparoscopic liver resection was performed under carbon dioxide pneumoperitoneum (intraperitoneal pressure 12 mmHg). During surgery animals were monitored haemodynamically by an arterial line and Swan-Ganz catheter. Two-dimensional transoesophageal echocardiography (2D-TEE) was used to detect gas emboli with special attention to the right atrium and ventricle. Gas emboli were graded according to size, and correlated with haemodynamic and blood gas data. During open and laparoscopic hepatic resection the UAS resulted in minimal blood loss and effective tissue dissection. No air embolism was seen during open surgery. With laparoscopic hepatic resection 2D-TEE revealed gas embolism in all animals. Gas embolism was accompanied by cardiac arrhythmia in four of seven animals. No direct correlation was observed between embolism episodes and blood gas variables. There were no deaths after episodes of embolization. A significant decrease in arterial partial pressure of oxygen was seen at the end of the laparoscopic procedure in all animals. The UAS causes minimal blood loss during both open and laparoscopic hepatic resection. Laparoscopic liver dissection under carbon dioxide pneumoperitoneum carries a high risk of gas embolism.

  14. Total Pancreatectomy with Celiac Axis Resection and Hepatic Artery Restoration Using Splenic Artery Autograft Interposition. (United States)

    Aosasa, Suefumi; Nishikawa, Makoto; Noro, Takuji; Yamamoto, Junji


    Although the indication of locally advanced pancreatic cancer with arterial involvement is controversial, the outcome of the patients with such disease treated by combined resection and reconstruction of the invaded artery has improved recently. For pancreatic body carcinoma invading the celiac axis, distal pancreatectomy with celiac axis resection has been safely performed. However, in case of pancreatic body carcinoma with involvement of the celiac axis, the common hepatic artery and the gastroduodenal artery, margin-negative resection requires total pancreatectomy with celiac axis resection and restoration of hepatic arterial flow. Here, we describe an interposition grafting technique using the splenic artery harvested from the resected specimen. This technique is effective and may widen the resectability of pancreatic cancer in selected patients.


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    Blood loss during partial hepatic resection is a major concern. Controlling haemorrhage by means of non-cutting compression sutures, without the risk of disrupting the liver tissue, was experimentally investigated. Twenty-two beagles underwent a partial resection of the right median liver lobe with

  16. A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma. (United States)

    Ichikawa, Tsuyoshi; Uenishi, Takahiro; Takemura, Shigekazu; Oba, Kazuki; Ogawa, Masao; Kodai, Shintaro; Shinkawa, Hiroji; Tanaka, Hiromu; Yamamoto, Takatsugu; Tanaka, Shogo; Yamamoto, Satoshi; Hai, Seikan; Shuto, Taichi; Hirohashi, Kazuhiro; Kubo, Shoji


    A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma. Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses. Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10. Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.

  17. Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma. (United States)

    Lee, Dong Ho; Lee, Jeong Min; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk; Lee, Jeong-Hoon; Lee, Kyung Bun; Han, Joon Koo


    To evaluate prognostic value of hepatic stiffness (HS) measurement using MR elastography (MRE) in patients with hepatocellular carcinoma (HCC) treated by hepatic resection (HR). We enrolled 144 patients with Barcelona Clinic Liver Cancer stage A HCCs initially treated by HR who underwent preoperative liver MRE between January 2010 and June 2013. HS values were measured using MRE. Receiver operating characteristics (ROC) and multivariate logistic regression analyses were used to determine significant predictive factors for posthepatecomy liver failure (PHLF). Overall survival (OS) was analyzed by evaluating prognostic factors using the Kaplan-Meier method and Cox proportional hazard regression model. After HR, 43 patients (29.9 %) experienced PHLF. HS values were significant predictive factors for PHLF. In ROC analysis, the area under the curve of HS was 0.740 (P = 0.001) for PHLF. Thirty-one patients had HS values ≥ 4.02 kPa; the estimated 1, 3, 5-year survival were 90.0 %, 74.7 % and 65.4 %, respectively, versus 98.1 %, 96.5 % and 96.5 % in 113 patients with HS values failure • Hepatic stiffness value was a significant affecting factor for OS • Hepatic stiffness value ≥ 4.02 kPa was a predictive factor for poor OS.

  18. Hepatic resection for metastatic melanoma in The Netherlands: survival and prognostic factors

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    de Ridder, Jannemarie; van Walsum, Marlies; Verhoef, Cornelis; Nagtegaal, Iris; de Wilt, Johannes; Ruers, Theo J.M.


    Patients with hepatic metastases of melanoma have a very poor prognosis, with a median overall survival of less than 6 months. There are several small heterogeneous studies that have shown an association with prolonged survival in those patients treated with hepatic resection, but the role of

  19. Stroke volume variation in hepatic resection: a replacement for standard central venous pressure monitoring. (United States)

    Dunki-Jacobs, Erik M; Philips, Prejesh; Scoggins, Charles R; McMasters, Kelly M; Martin, Robert C G


    Central venous pressure (CVP) is the standard method of volume status evaluation during hepatic resection. CVP monitoring requires preoperative placement of a central venous catheter (CVC), which can be associated with increased time, cost, and adverse events. Stroke volume variation (SVV) is a preload index that can be used to predict an individual's fluid responsiveness through an existing arterial line. The purpose of this study was to determine if SVV is as safe and effective as CVP in measuring volume status during hepatic resection. Two cohorts of 40 consecutive patients (80 total) were evaluated during hepatic resection between December 2010 and August 2012. The initial evaluation group of 40 patients had continuous CVP monitoring and SVV monitoring performed simultaneously to establish appropriate SVV parameters for hepatic resection. A validation group of 40 patients was then monitored with SVV alone to confirm the accuracy of the established SVV parameters. Type of hepatic resection, transection time, blood loss, complications, and additional operative and postoperative factors were collected prospectively. SVV was calculated using the Flotrac™/Vigileo™ System. The evaluation group included 40 patients [median age 62 (29-82) years; median body mass index (BMI) 27.7 (16.5-40.6)] with 18 laparoscopic, 22 open, and 24 undergoing major (≥3 segments) hepatectomy. Median transection times were 43 (range 20-65) min, median blood loss 250 (range 20-950) cc, with no Pringle maneuver utilized. In this evaluation group, a CVP of -1 to 1 significantly correlated to a SVV of 18-21 (R (2) = 0.85, p monitoring during hepatic resection with equivalent outcomes in terms of blood loss and parenchymal transection time. Using SVV as a predictor of fluid status could prove to be advantageous by avoiding the need for CVC insertion and therefor eliminating the risk of CVC related complications in patients undergoing hepatic resection.

  20. Comparison of the level of intraoperative nociception between laparoscopic and open hepatic resection. (United States)

    Hashimoto, Kazuma; Miyawaki, Hiroki; Iwayama, Sachiko; Kariya, Nobutaka; Tatara, Tsuneo; Hirose, Munetaka


    Sufficient suppression of perioperative nociception is important for ensuring favorable postoperative outcomes. Although the level of nociception during laparoscopic surgery is generally lower than during laparotomy, there is insufficient evidence to support this for hepatic resection. To develop a method to retrospectively evaluate the intraoperative nociceptive level, we collected data of intraoperative averaged values of heart rate, perfusion index, systolic blood pressure during three surgeries with different levels of intraoperative nociception. After we validated the utility of discriminant analysis using these variables for the retrospective evaluation of nociception during surgery, we performed this analysis in patients who underwent either laparoscopic or open hepatic resection. Although there was a significant difference in discriminant score between the open and the laparoscopic hepatic resection groups before propensity score matching, discriminant score showed no significant difference between two groups after matching. The level of nociception during laparoscopic hepatic resection is likely similar to that during open hepatic resection. An assertive anti-nociceptive strategy might be required for laparoscopic procedures under general anesthesia, as with open procedures.

  1. Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma

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    Lee, Dong Ho [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Lee, Jeong Min; Han, Joon Koo [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Hospital, Institute of Radiation Medicine, Seoul (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University Hospital, Department of Surgery, Seoul (Korea, Republic of); Lee, Jeong-Hoon [Seoul National University Hospital, Department of Internal Medicine, Seoul (Korea, Republic of); Lee, Kyung Bun [Seoul National University Hospital, Department of Pathology, Seoul (Korea, Republic of)


    To evaluate prognostic value of hepatic stiffness (HS) measurement using MR elastography (MRE) in patients with hepatocellular carcinoma (HCC) treated by hepatic resection (HR). We enrolled 144 patients with Barcelona Clinic Liver Cancer stage A HCCs initially treated by HR who underwent preoperative liver MRE between January 2010 and June 2013. HS values were measured using MRE. Receiver operating characteristics (ROC) and multivariate logistic regression analyses were used to determine significant predictive factors for posthepatecomy liver failure (PHLF). Overall survival (OS) was analyzed by evaluating prognostic factors using the Kaplan-Meier method and Cox proportional hazard regression model. After HR, 43 patients (29.9 %) experienced PHLF. HS values were significant predictive factors for PHLF. In ROC analysis, the area under the curve of HS was 0.740 (P = 0.001) for PHLF. Thirty-one patients had HS values ≥ 4.02 kPa; the estimated 1, 3, 5-year survival were 90.0 %, 74.7 % and 65.4 %, respectively, versus 98.1 %, 96.5 % and 96.5 % in 113 patients with HS values < 4.02 kPa (P = 0.015). An HS value ≥ 4.02 kPa was the only significant affecting factor for OS. HS values measured by MRE could predict PHLF development post-HR. Furthermore, an HS value ≥4.02 kPa was a significant predicting factor for poor OS post-HR. (orig.)

  2. Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries. (United States)

    Pattakos, Gregory; Tolpin, Daniel; Ott, David A


    Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options.

  3. Effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangioma

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    ZHANG Huaan


    Full Text Available ObjectiveTo evaluate the clinical effects of two methods for hepatic vascular occlusion in resection of giant hepatic hemangioma. MethodsA total of 20 patients with giant hepatic hemangioma who were hospitalized in Tianmen Hospital of Traditional Chinese Medicine from January 2008 to December 2014 were divided into group A and group B, with 10 patients in each group. Pringle maneuver was applied for group A, and Pringle maneuver combined with inferior vena cava (IVC clamping was applied for group B. The time of operation, time of portal triad clamping, intraoperative blood loss, blood transfusion rate, and indices for postoperative liver function were compared between the two groups. The t-test was applied for comparison of continuous data, and Fisher′s exact test was applied for comparison of categorical data. ResultsThe two groups showed no significant differences in time of operation and time of portal triad clamping (P>0.05, and compared with those in group A, the patients in group B had significantly less intraoperative blood loss and significantly lower volume and rate of blood transfusion (P<0.05. Compared with those in group A, the patients in group B had significantly lower levels of aspartate transaminase, alanine transaminase, and total bilirubin on the third and seventh days after surgery (all P<0.05. However, the incidence of postoperative complications showed no significant differences between the two groups (P>0.05. ConclusionThe method of IVC clamping combined with Pringle maneuver can reduce intraoperative blood loss and is beneficial to the recovery of postoperative liver function, and thus it is worthy of clinical promotion and application.

  4. Spontaneous Rupture of a Giant Hepatic Hemangioma – Sequential Management with Transcatheter Arterial Embolization and Resection (United States)

    Jain, Vaibhav; Ramachandran, Vijay; Garg, Rachana; Pal, Sujoy; Gamanagatti, Shivanand R.; Srivastava, Deep N.


    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery. PMID:20339183

  5. Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection. (United States)

    Jain, Vaibhav; Ramachandran, Vijay; Garg, Rachana; Pal, Sujoy; Gamanagatti, Shivanand R; Srivastava, Deep N


    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery.

  6. PTFE Graft as a "Bridge" to Communicating Veins Maturation in the Treatment of an Intrahepatic Cholangiocarcinoma Involving the 3 Hepatic Veins. The Minor-but-Complex Liver Resection. (United States)

    Urbani, Lucio; Balestri, Riccardo; Sidoti, Francesco; Bernardini, Juri Riccardo; Arces, Francesco; Licitra, Gabriella; Leoni, Chiara; Forfori, Francesco; Colombatto, Piero; Boraschi, Piero; Castagna, Maura; Buccianti, Piero


    Parenchyma-sparing liver surgery allows resecting hepatic veins (HV) at the hepatocaval confluence with minor (<3 adjacent segments) liver resections. PTFE graft can be used as a bridge to communicating-veins maturation to ensure the correct outflow of the spared liver. We present a video of an intrahepatic cholangiocarcinoma (IC) involving the three HV at the hepatocaval confluence treated with this approach. In a 50-year old obese (BMI 44.8) male a 6-cm IC involving the hepatocaval confluence was identified during the follow-up for a kidney malignancy. At the preoperative CT scan the left HV was not detectable, the middle HV was incorporated within the tumor, and right HV had a 3-cm contact with the tumor. No communicating veins were evident at preoperative imaging. After a J-shape thoracophrenolaparotomy, the resection of segments II-III-IVa was partially extended to segment VIII-VII and I. The right HV was detached from the tumor, and the middle HV was reconstructed with a 7-mm ringed-armed PTFE graft anastomosed to V8. Surgery lasted 20 h and 55 min with an estimated blood loss of 3500 ml, but the postoperative course was uneventful and the patient was discharged on the 14th postoperative day. One month later the CT scan showed a patent PTFE graft with the maturation of communicating-veins. One year later a complete thrombosis of the PTFE graft was observed with normal liver perfusion and function, and the patient was disease-free. PTFE-based parenchyma-sparing liver resection is a new tool to treat tumors located at the hepatocaval confluence exploiting the maturation of intrahepatic communicating-veins between main HV.

  7. Spontaneous Rupture of a Giant Hepatic Hemangioma ? Sequential Management with Transcatheter Arterial Embolization and Resection


    Jain Vaibhav; Ramachandran Vijay; Garg Rachana; Pal Sujoy; Gamanagatti Shivanand; Srivastava Deep


    Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneu...

  8. Laparoscopic resection of isolated hepatic splenosis mimicking liver tumors: case report with a literature review. (United States)

    Liu, Kun; Liang, Yuelong; Liang, Xiao; Yu, Hong; Wang, Yifan; Cai, Xiujun


    Isolated hepatic splenosis is a rare condition in hepatobiliary surgery. In this study, we report a case of this condition managed by laparoscopic surgery. A 38-year-old male hepatitis B virus carrier, who had a motorcycle accident and splenectomy 14 years before the current incident, was hospitalized due to a hepatic mass. His laboratory tests were consistent with a hyposplenic state, whereas radiologic images revealed a benign tumor in the left liver lobe located in a site difficult to access with preoperative biopsy. Therefore, we performed a laparoscopic exploration and total resection, which revealed a bluish oval encapsulated nodule in the narrow gap between the diaphragm, falciform ligament, and left hepatic capsule. The pathologic diagnosis was hepatic splenosis. Unlike other patients with multiple intraperitoneal lesions and relatively normal splenism, this is the first case of isolated hepatic splenosis with evident hyposplenism managed by laparoscopic approach in the English literature.

  9. Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection.

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    Clancy J Clark

    Full Text Available Enhanced recovery pathways (ERP have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection.A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS were compared between pre-ERP and ERP groups.126 patients (pre-ERP n = 73, ERP n = 53 were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343. Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7 vs. 5 (IQR 4-6 days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.02, p = 0.055 or LOS greater than 5 days (OR 1.21, 95% CI 0.56-2.62, p = 0.627.Routine use of a multimodal ERP is safe and is not associated with increased postoperative morbidity after open hepatic resection.

  10. Hepatic resections for colorectal metastases in The Netherlands. A multiinstitutional 10-year study

    NARCIS (Netherlands)

    van Ooijen, B.; Wiggers, T.; Meijer, S.; van der Heijde, M. N.; Slooff, M. J.; van de Velde, C. J.; Obertop, H.; Gouma, D. J.; Bruggink, E. D.; Lange, J. F.


    BACKGROUND AND METHODS: The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively. RESULTS: The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial

  11. Cellular Liver Regeneration after Extended Hepatic Resection in Pigs

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    Ruth Ladurner


    Full Text Available Background. The liver has an enormous capacity to regenerate itself. The aim of this study was to evaluate whether the regeneration is due to hypertrophy or hyperplasia of the remnant liver after extended resection and whether a portosystemic shunt is beneficial. Material and methods. An extended left hemihepatectomy was performed in 25 pigs, and in 14 after performing a portosystemic shunt. During follow up, liver regeneration was estimated by macroscopic markers such as liver volume and size of the portal fields [mm2] as well as the amount of hepatocytes per portal field and the amount of hepatocytes per mm2. Results. Regardless of the operation procedure, the volume of the remnant liver increased about 2.5 fold at the end of the first week after resection. The size of the portal fields increased significantly as well as the number of hepatocytes in the portal fields. Interestingly, the number of hepatocytes per mm2 remained the same. Conclusion. After extended resection, liver regeneration was achieved by an extensive and significant hyperplasia of hepatocytes within the preexisting portal fields and not by de novo synthesis of new portal fields. However, there was no difference in liver regeneration regarding the operation procedure performed with or without portosystemic shunt.

  12. Hepatic resection for non-colorectal and non-neuroendocrine metastatic cancer: indications and results in ten resectable cases

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    Sergio Renato Pais Costa


    Full Text Available Objective: To report the early postoperative results and long-termsurvival on ten patients undergoing hepatectomy for treatmentof non-colorectal and non-neuroendocrine hepatic metastases.The study was carried out by the General Surgery Service of theDepartment of Digestive Tract Surgery of the Teaching Hospital ofthe Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.Methods: Complete follow-up data were available on 28 patientswith hepatic metastases who were operated on between January2002 and January 2007. Ten patients presented non-colorectal andnon-neuroendocrine primary neoplasms, and comprised the sampleof this study. There were five males and five females, mean age of53 years (28 to 68 years. The right lobe was involved in five patientsand the left lobe in five individuals. The number of metastasesranged from one to four. All metastases were unilateral. All primarytumors were identified. The histological types were adenocarcinoma(n = 7, germinative tumor (n = 1, melanoma (n = 1 and sarcoma(n = 1. The primary sites were: gastric (n = 1, kidney (n = 1,adrenal (n = 1, breast (n = 2, testicle (n = 1, ovary (n = 2,acral melanoma (n = 1 and retroperitoneal sarcoma (n = 1. Allpatients presented metachronous metastases. The median intervalbetween primary tumor treatment and diagnosis of metastases was20 months (12 to 33 months. Six patients received chemotherapyand four patients underwent exclusively surgical treatment. Results:There were seven major hepatic resections (three or more Couinaudsegments and three minor hepatic resections. The operative timevaried from 180 to 425 minutes with a median duration of 240minutes. Five patients received transfusions; blood loss ranged from200 to 3,000 ml. There were two postoperative complications andboth patients were re-operated (biliary fistula = 1; intra-abdominalabscess = 1. There were no postoperative deaths. All resectionswere R0. The three-year overall survival rate was 50%. Five

  13. Simple resection of the lesion bile duct branch for treatment of regional hepatic bile duct stones. (United States)

    Enliang, Li; Rongshou, Wu; Shidai, Shi; Jingling, Zhang; Qian, Feng; Wenjun, Liao; Linquan, Wu


    To evaluate the effectiveness and safety of simple resections of bile duct branch lesions for the treatment of regional hepatic bile duct stones.A retrospective analysis of the clinical data from patients in our hospital from November 2008 to November 2015, who only underwent a simple resection of the lesion bile duct branch. The patients' clinical characteristics, surgical features, postoperative complications, stone clear rate, residual stone rate, and recurrence stone rate were analyzed.This study of 32 patients included 13 males and 19 females with intrahepatic bile duct stones confined to the right hepatic bile duct branch. The intraoperative blood loss, operation time, and postoperative hospital stay were 478.0 ± 86.5, 210.7 ± 6.6, and 10.8 ± 3.5, respectively. Postoperative complications occurred in 6 patients (18.8%), all of whom recovered with conservative management. There were no deaths during hospitalization. The intraoperative stone clearance rate was 95.8%. Three patients had a recurrence of stones at a mean of 22 months of follow-up (range, 4-36 months).Simple resection of bile duct branch lesions is safe and feasible for patients who have regional hepatic bile duct stones limited to the right hepatic bile duct branches.

  14. Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

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    Salah Termos


    Discussion and conclusion: Hepatic choristomas (HC are a rare entity, usually identified during abdominal surgeries. It had been reported in several studies with different presentations. Awareness of this unexpected finding and familiarity of its potential complications and carcinogenesis will improve care delivery when encountered. Surgical treatment should be considered when the choristoma is not attached to the liver, in light of its potential transformation into HCC.

  15. Outcomes of resection for colorectal cancer hepatic metastases stratified by evolving eras of treatment

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    Chan Kun-Ming


    Full Text Available Abstract Background and purpose The outcomes and management of colorectal cancer (CRC hepatic metastasis have undergone many evolutionary changes. In this study, we aimed to analyze the outcomes of patients with CRC hepatic metastasis in terms of the era of treatment. Methods We conducted a retrospective review of 279 patients who underwent liver resection (LR for CRC hepatic metastases. The prognoses of patients treated pre-2003 (era 1 and post-2003 (era 2 were examined. Results Of the patients included in the study, 210 (75.3% had CRC recurrence after LR. There was a significant difference in the ratio of CRC recurrence between the 2 eras (82.0% in era 1 vs. 69.5% in era 2; p = 0.008. Analysis of recurrence-free and overall survival rates also showed that the patient outcome was significantly better in the post-2003 era than in the pre-2003 era. Further analysis showed that a significantly higher percentage of patients in era 2 had received modern chemotherapeutic regimens including irinotecan and oxaliplatin, while patients in era 1 were mainly administered fluorouracil and leucovorin for adjuvant chemotherapy. Among patients with CRC recurrence, a significant ratio of those in era 2 underwent surgical resection for recurrent lesions, and these patients had a better survival curve than did patients without resection (34.1% vs. 2.2% for 5-year survival; p Conclusion The incidence of CRC recurrence after LR for hepatic metastasis remains very high. However, the management and outcomes of patients with CRC hepatic metastasis have greatly improved with time, suggesting that the current use of aggressive multimodality treatments including surgical resection combined with modern chemotherapeutic regimens effectively prolongs the life expectancy of these patients.

  16. Successful treatment of Caroli's disease by hepatic resection. Report of six patients. (United States)

    Nagasue, N


    Caroli's disease is a congenital disease of cystic or saccular dilatation of the intrahepatic bile ducts. There are two disease entities: a simple type and a periportal fibrosis type. Frequent complications with the simple type are recurrent cholangitis, liver abscess, intraductal lithiasis, abdominal pain, and fever that often lead to fatal sepsis. Development of portal hypertension and esophageal varices is usually a final feature of the periportal fibrosis type. Malignancies are also possible complications with Caroli's disease. During the recent 13 years, the author had experiences with eight patients with Caroli's disease of the simple type; six of these eight underwent hepatic resection: right lobectomy in two, left lobectomy in three, and left lateral segmentectomy in one. Other two patients died of sepsis and cholangiocellular carcinoma, respectively. All six patients with hepatic resections were relieved from the disabling symptoms after surgery and have had no recurrent hepatobiliary problems for 3 months to 13 years. Hepatic resection may be indicated for more patients than previously assumed in the treatment of Caroli's disease of the simple type. Images FIG. 1. FIG. 2. FIG. 3. FIG. 4. FIG. 5. FIG. 6. FIG. 7. FIG. 8. PMID:6508401

  17. Impact of the CUSA and Operative Ultrasound on Hepatic Resection

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    J. M. Little


    Full Text Available New technologies have been developed for liver surgery, and, like all new technologies, they have a glamour which makes them seem desirable. There is an understanding abroad that they make liver surgery easier and open up the field to those without special training. But there is no proof that the new devices are in any way cost-effective, and certainly no proof that liver surgery has become safer since their advent. Fifty consecutive elective liver resections have been studied, almost half performed with the aid of the ultrasonic dissector and aspirator and diagnostic intraoperative ultrasound. There was no mortality in the whole group, but a 24% morbidity. Operative diagnostic ultrasound was thought to allow more precise planning of surgery. Its use was not associated with any increase in operative time, nor was there any increase in postoperative morbidity. The ultrasonic dissector and aspirator improved technique, reflected in a lower blood loss for each case, in fewer transfusions required, in a shorter postoperative hospital stay and in an ability to achieve these benefits in older patients. Neither device could be said to offer an entree to instant liver surgery. The use of the two devices apparently offered savings measured by a fall in the median postoperative hospital stay of 4.5 days, by a saving of 700 mls in median blood requirement and by a fall in transfusion rate from 64% to 9%.

  18. Techniques of parenchyma-sparing hepatectomy for the treatment of tumors involving the hepatocaval confluence: A reliable way to assure an adequate future liver remnant volume. (United States)

    Urbani, Lucio; Colombatto, Piero; Balestri, Riccardo; Licitra, Gabriella; Leoni, Chiara; Forfori, Francesco; Masi, Gianluca; Boraschi, Piero; Castagna, Maura; Buccianti, Piero


    Parenchyma-sparing hepatectomy techniques allow a lesser volume resection (<3 adjacent segments) for tumors involving the hepatic veins at the hepatocaval confluence, assuring adequate volume of the future liver remnant. We report the ability to perform parenchyma-sparing hepatectomy as planned from the preoperative imaging and the type of vascular intervention used to preserve hepatic outflow. We analyzed 60 consecutive parenchyma-sparing hepatectomies in 54 patients for 7 primary and 53 metastatic tumors (48 colorectal), located in segments I, VII, VIII, or IVa and involving the hepatocaval confluence. Patients had a median of 2 (range: 1-18) lesions with median diameter of 4 cm (range: 1.2-16.5), which were bilateral in 43%. A parenchyma-sparing hepatectomy was performed in all of the 60 cases, only one case required the resection of 3 adjacent segments. In 16 (27%) hepatic veins-resections, the outflow was assured by preservation of the inferior-right-hepatic veins in 3 (5%), of the communicating-veins in 4 (7%), of the middle-hepatic veins in 3 (4%; middle-hepatic veins patch-reconstruction in 2 cases), by polytetrafluoroethylene-grafts in 4 (7%), and by hepatic veins-anastomosis in 2 (3%). In 15 (25%) cases, the hepatic veins were resected tangentially and reconstructed by direct suture venorraphy. In 29 (48%) cases, the hepatic veins were skeletonized from the tumor. Grade IIIb to IV complications occurred in 7%, median hospital-stay was 9 days, and 90-day mortality occurred in one cirrhotic patient. Median overall and disease-free survivals were 72 and 16 months (median follow-up: 34 months). A lesser volume parenchyma-sparing hepatectomy rather than a formal major hepatectomy for tumors involving the hepatocaval confluence can be performed with a low rate of major complications (7%). Parenchyma-sparing hepatectomy should be considered in highly selected patients when evaluating liver resection for tumors involving the hepatocaval confluence based on

  19. Economic model of observation versus immediate resection of hepatic adenomas. (United States)

    Vanounou, Tsafrir; Groeschl, Ryan T; Geller, David A; Marsh, J Wallis; Gamblin, T Clark


    For small asymptomatic hepatic adenomas (HA), available data are insufficient to establish the superiority of either observation or surgery. We sought to investigate the cost-effectiveness of two initial management strategies. We performed a comparative analysis of two theoretical cohorts of 100 patients with small (models compared the net present value (NPV) of both treatment options at year 10 under three distinct progression rate scenarios. A break-even (BE) analysis was used to determine the BE point at which the NPV for observation and immediate surgery intersect. The NPV for immediate surgery was $1,733,955. The NPV for observation varied between $2,065,315-$2,745,631 for computed tomography (CT), $2,264,575-$2,929,541 for magnetic resonance imaging (MRI), and $802,837-$1,580,413 for ultrasound (US). The BE point was between 6 and 8 years for CT and 5-7 years for MRI. The BE point for US was not reached except in the highest progression rate scenario (12 years). This study highlights the importance of the underlying progression rate and the cost of imaging when following patients with asymptomatic HA. Overall, US surveillance is the most cost-efficient approach to observing small asymptomatic HA. If cross-sectional imaging is utilized, then immediate surgery is the most cost-effective decision at 5-8 years. Copyright © 2012 Wiley Periodicals, Inc.

  20. How Far Can We Go with Laparoscopic Liver Resection for Hepatocellular Carcinoma? Laparoscopic Sectionectomy of the Liver Combined with the Resection of the Major Hepatic Vein Main Trunk

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    Zenichi Morise


    Full Text Available Although the reports of laparoscopic major liver resection are increasing, hepatocellular carcinomas (HCCs close to the liver hilum and/or major hepatic veins are still considered contraindications. There is virtually no report of laparoscopic liver resection (LLR for HCC which involves the main trunk of major hepatic veins. We present our method for the procedure. We experienced 6 cases: 3 right anterior, 2 left medial, and 1 right posterior extended sectionectomies with major hepatic vein resection; tumor sizes are within 40–75 (median: 60 mm. The operating time, intraoperative blood loss, and postoperative hospital stay are within 341–603 (median: 434 min, 100–750 (300 ml, and 8–44 (18 days. There was no mortality and 1 patient developed postoperative pleural effusion. For these procedures, we propose that the steps listed below are useful, taking advantages of the laparoscopy-specific view. (1 The Glissonian pedicle of the section is encircled and clamped. (2 Liver transection on the ischemic line is performed in the caudal to cranial direction. (3 During transection, the clamped Glissonian pedicle and the peripheral part of hepatic vein are divided. (4 The root of hepatic vein is divided in the good view from caudal and dorsal direction.

  1. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. (United States)

    Cucchetti, Alessandro; Piscaglia, Fabio; Cescon, Matteo; Colecchia, Antonio; Ercolani, Giorgio; Bolondi, Luigi; Pinna, Antonio D


    Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria). As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3996 patients underwent resection and 4424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care provider perspective. A Monte Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1000 patients for each treatment arm. In a 10-year perspective, for very early HCC (single nodule cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5 cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4200 per quality-adjusted life-year. In the presence of two or three nodules ≤3 cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA. For very early HCC and in the presence of two or three nodules ≤3 cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  2. Intratumoral coagulation by radiofrequency ablation facilitated the laparoscopic resection of giant hepatic hemangioma: a surgical technique report of two cases. (United States)

    Wang, Shaohong; Gao, Jun; Yang, Mengmeng; Ke, Shan; Ding, Xuemei; Kong, Jian; Xu, Li; Sun, Wenbing


    Traditionally, open hepatic resection is the first choice of treatment for symptomatic enlarging hepatic hemangiomas, which requires a large abdominal incision and is associated with substantial recovery time and morbidity. Minimally invasive laparoscopic resection has been used recently in liver surgery for treating selected hepatic hemangiomas. However, laparoscopic liver surgery poses the significant technical challenges and high rate of conversion. Radiofrequency (RF) ablation has been proved feasible in the treatment of hepatic hemangiomas with a size range of 5.0-9.9 cm. It is controversial to treat giant hepatic hemangiomas (≥10.0 cm) by means of RF ablation, due to the low technique success rate and high incidence of ablation-related complications. We aimed to assess the safety and efficacy of combined laparoscopic resection with intratumoral RF-induced coagulation for giant hepatic hemangiomas. We treated 2 patients with giant subcapsular hepatic hemangioma (12.0 cm and 13.1 cm in diameters respectively) by laparoscopic resection following intratumoral coagulation of the tumor with RF ablation. Blood loss during resection was 100 ml (case 1) and 300ml (case 2) respectively. No blood transfusion and dialysis were needed during perioperative period. The two patients were discharged 6 days (case 1) and 12 days (case 2) after surgery without any complications, respectively. Postoperative contrast-enhanced CT follow up showed there was no residual tumor. It is feasible to treat giant subcapsular hepatic hemangioma by laparoscopic tumor resection boosted by intratumoral coagulation using RF ablation, which may open a new avenue for treating giant hemangioma.

  3. Fulminant Hepatic Failure Caused by Diffuse Liver Metastases following Gastrointestinal Stromal Tumor Resection

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    Abdel-Rauf Zeina


    Full Text Available Metastatic tumors to the liver resulting in fulminant hepatic failure are a rare occurrence and have not been previously described in patients with gastrointestinal stromal tumor (GIST. A 70 year-old man was referred to hospital with postprandial discomfort. On examination a 19.5 cm large epithelioid GIST of the stomach was diagnosed. The mass exhibited unfavorable prognostic features: mitotic index 18/50 high-power fields, large primary tumor size and male sex. Complete tumor resection with negative margins was achieved and metastases were not detected. The patient presented six months later with jaundice, asterixis and elevated liver enzymes. Computerized tomography showed multiple liver hypodense lesions representing metastases. Treatment with imatinib mesylate was of no avail and the patient died 3 days later as the result of hepatic failure. Massive liver metastases can, even though rarely, be responsible for fulminant hepatic failure. Clinical and radiological follow-up are crucial in patients with GIST even after surgical resection.

  4. Surgical Resection of a Leiomyosarcoma of the Inferior Vena Cava Mimicking Hepatic Tumor

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    Junji Ueda


    Full Text Available Introduction. Leiomyosarcomas of vascular origin are particularly rare tumors occurring mainly in the inferior vena cava (IVC. They are malignant, slow-growing tumors with a poor prognosis. This paper reports on a rare case of surgical resection of an IVC leiomyosarcoma mimicking a hepatic tumor. Case Presentation. A 65-year-old Japanese male was admitted for evaluation of an abdominal tumor. Enhanced computed tomography of the abdomen revealed a slightly enhanced heterogeneous tumor, 18 mm in diameter, between the Spiegel lobe of the liver and the IVC in early-phase images, with no enhancement or washout in late-phase images. We diagnosed this tumor as either a hepatic tumor in the Spiegel lobe or a retroperitoneal tumor such as leiomyosarcoma or liposarcoma and performed a laparotomy. On the basis of surgical findings, we extirpated the tumor by performing a wedge resection of the wall of the IVC and suturing the primary IVC wall. Pathological findings led to a further diagnosis of the tumor as a leiomyosarcoma originating in the IVC. Thirty-seven months after the operation, multiple liver and lung metastases were detected, and the patient died from multiple organic failures. Conclusion. We experienced a rare case of a leiomyosarcoma of IVC mimicking hepatic tumor.

  5. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. (United States)

    Kopetz, Scott; Chang, George J; Overman, Michael J; Eng, Cathy; Sargent, Daniel J; Larson, David W; Grothey, Axel; Vauthey, Jean-Nicolas; Nagorney, David M; McWilliams, Robert R


    Fluorouracil/leucovorin as the sole therapy for metastatic colorectal cancer (CRC) provides an overall survival of 8 to 12 months. With an increase in surgical resections of metastatic disease and development of new chemotherapies, indirect evidence suggests that outcomes for patients are improving in the general population, although the incremental gain has not yet been quantified. We performed a retrospective review of patients newly diagnosed with metastatic CRC treated at two academic centers from 1990 through 2006. Landmark analysis evaluated the association of diagnosis year and liver resection with overall survival. Additional survival analysis of the Surveillance Epidemiology and End Results (SEER) database evaluated a similar population from 1990 through 2005. Two thousand four hundred seventy patients with metastatic CRC at diagnosis received their primary treatment at the two institutions during this time period. Median overall survival for those patients diagnosed from 1990 to 1997 was 14.2 months, which increased to 18.0, 18.6, and 29.3 months for patients diagnosed in 1998 to 2000, 2001 to 2003, and 2004 to 2006, respectively. Likewise, 5-year overall survival increased from 9.1% in the earliest time period to 19.2% in 2001 to 2003. Improved outcomes from 1998 to 2004 were a result of an increase in hepatic resection, which was performed in 20% of the patients. Improvements from 2004 to 2006 were temporally associated with increased utilization of new chemotherapeutics. In the SEER registry, overall survival for the 49,459 identified patients also increased in the most recent time period. Profound improvements in outcome in metastatic CRC seem to be associated with the sequential increase in the use of hepatic resection in selected patients (1998 to 2006) and advancements in medical therapy (2004 to 2006).

  6. Clinical Observation: Congenital Absence of the Left Portal Vein in a Patient Undergoing Hepatic Resection

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    C. K. Charny


    Full Text Available Congenital absence of the left portal vein is a rare vascular anomaly with a reported prevalence varying from one in 62 to one in 507 cases. A patient admitted for recurrent cholangitis secondary to extensive dilation of the left biliary ductal system associated with Caroli's Disease was determined by preoperative dynamic CT to have an excessively large right portal vein and no left portal vein. The surgeon must be aware of any variations in portal vascular anatomy in patients undergoing hepatic resection in order to prevent potentially fatal postoperative complications.

  7. Treatment of Non-Endemic Hepatolithiasis in a Western Country. The Role of Hepatic Resection (United States)

    Catena, Marco; Aldrighetti, Luca; Finazzi, Renato; Arzu, Giandomenico; Arru, Marcella; Pulitanò, Carlo; Ferla, Gianfranco


    INTRODUCTION The aim of this study was to assess the safety and the efficacy of hepatic resective surgery in the treatment of single lobe hepatolithiasis. PATIENTS AND METHODS Retrospective analysis and comparison between hepatic resections in patients with hepatolithiasis (hepatolithiasis group [HG]) and liver masses (control group [CG]). Seventeen consecutive Caucasian patients with single lobe hepatolithiasis (HG) and 30 patients with liver masses without chronic liver disease and previous chemotherapy (CG), were operated during the 5-year period 2000–2005, inclusive. Major hepatic resections including 4 right hepatectomies, 10 left hepatectomies, and 3 left lateral sectionectomy in HG, and 12 right hepatectomies, 3 extended right hepatectomy, 5 left hepatectomies, 4 left lateral sectionectomy, 5 bisegmentectomy, and 1 mesohepatectomy in CG. The main outcome measures were: type and length of surgical procedures, intra- and postoperative blood losses and transfusions (packed red blood cells [PRBC] and fresh frozen plasma [FFP]), intra- and postoperative course and complications (within 30 days of the operation), length of hospitalisation, histopathology, and recurrence of hepatolithiasis. RESULTS Mean operation time was 6.21 ± 2.38 h in HG versus 7.10 ± 2.21 h in CG (P = 0.33). Mean intra-operative blood loss in CG was higher than in HG (1010 ± 550 ml versus 560 ± 459 ml; P = 0.035). The other variables considered in the two groups were not statistically different. Intra-operative transfusion were 0.50 ± 0.85 units in HG versus 1.35 ± 2.25 units of PRBC in CG (P = 0.06), and 0.66 ± 1.34 units in HG versus 0.68 ± 1.20 units of FFP in CG (P = 0.44), respectively. No cases of death were registered. Postoperative complications occurred in 12 patients (25.5%) – 5 cases (10.6%) in HG and 7 cases (14.8%) in CG (P = 0.18). Mean postoperative transfusions were 0.47 ± 1.24 units in HG versus 1.10 ± 1.18 units of PRBC in CG (P = 0.35), and 0.65 ± 1.40 units

  8. Serum levels of hyaluronic acid during the perioperative period of hepatic resection

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    Mizoe, Akihiko; Fujioka, Hikaru; Azuma, Takashi; Furui, Junichiro; Tomioka, Tsutomu; Kanematsu, Takashi [Nagasaki Univ. (Japan). School of Medicine


    In the present study, in order to evaluate liver function during the perioperative period, serum levels of hyaluronic acid (HA) were measured. Blood samples were collected from 19 patients with hepatocellular carcinoma before hepatic resection and on the 1st, 3rd and 7th postoperative days (POD), and serum levels of HA were measured by the sandwich binding protein assay. The subjects were divided into 2 groups as follows. Group A, 14 patients, had an uneventful postoperative course, and Group B, 5 patients, had postoperative complications such as hepatic failure, liver abscess and intraperitoneal hemorrhage. The preoperative serum levels of HA had a significant correlation with the indocyanine green retention rate (ICG R15), the portal vein pressure, and the results of {sup 99m}Tc-GSA scintigraphy. The preoperative serum levels of HA in the patients with clinical stage II were significantly higher than those of the patients with clinical stage I (p<0.02). The rates of the postoperative complications in the patients with preoperative HA serum levels over 100 ng/ml were significantly higher than those in the patients with HA serum levels below 50 ng/ml (p<0.05). Moreover, the postoperative serum levels of HA in Group B tended to be higher than those in Group A. On the 1st POD, there was a significant difference in the serum levels of HA between Groups A and B (p<0.01), whereas there were no significant differences in other parameters of liver function. These results suggest that serum levels of HA are useful parameters for evaluating liver function and predicting the outcome after hepatic resection. (author)

  9. Biliary cystadenoma: short- and long-term outcome after radical hepatic resection. (United States)

    Ratti, Francesca; Ferla, Fabio; Paganelli, Michele; Cipriani, Federica; Aldrighetti, Luca; Ferla, Gianfranco


    The intrahepatic biliary cystadenoma is a rare benign tumor of the liver, originating from an intrahepatic bile duct: it becomes symptomatic only when it causes obstruction of the bile duct itself. Regardless of the various diagnostic modalities available, it is difficult to distinguish preoperatively the cystadenoma both from a simple liver cyst, and from a cystic carcinoma of the bile duct. An incomplete surgical removal of the cyst often results in a higher risk of size increase and recurrence, even considering that the lesion may degenerate into a cystadenocarcinoma. Between January 2004 and May 2011, 1,173 liver resections were carried out at the Hepatobiliary Surgery Unit of San Raffaele Hospital: 12 of these were performed for cystadenoma. Forty-six patients underwent laparoscopic liver cysts deroofing: definitive histological examination in six of these patients revealed instead the diagnosis of cystadenoma. In 50% of cases, the diagnosis of cystadenoma was therefore acquired as a result of an incidental finding. The patients were all female, median age 45 years. The liver resection included six cases of left hepatectomy, three left lobectomies, and three of the right hepatectomy. The operations were performed by laparotomy, with the exception of two left lobectomies completed laparoscopically. In all cases, the postoperative course was without major complications. The resection was radical in all cases and the median hospital stay was 5 days. At a median follow-up of 16 months (range 7-30), all patients are alive and disease free. Biliary cystadenomas can easily be misunderstood and interpreted as simple hepatic cysts. Radical surgical resection is necessary and provides good short- and long-term outcomes.

  10. Normal hepatic parenchyma visibility and ADC quantification on diffusion-weighted MRI at 3 T: influence of age, gender, and iron content

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    Metens, Thierry [MRI Clinics, Department of Radiology, Hopital Erasme, Bruxelles (Belgium); Universite Libre de Bruxelles, Magnetic Resonance Imaging Clinics, Department of Radiology, Hopital Erasme, Bruxelles (Belgium); Ferraresi, Kellen Fanstone; Farchione, Alessandra; Bali, Maria Antonietta; Matos, Celso [MRI Clinics, Department of Radiology, Hopital Erasme, Bruxelles (Belgium); Moreno, Christophe [Universite Libre de Bruxelles, Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Hopital Erasme, Bruxelles (Belgium)


    To investigate how normal liver parenchyma visibility on 3 T diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) quantification are influenced by age, gender, and iron content. Between February 2011 and April 2013, 86 patients (52 women) with normal livers who underwent respiratory-triggered abdominal 3 T DWI (b = 0, 150, 600, 1,000 s/mm{sup 2}) were retrospectively included. Normal liver and spleen parenchyma visibility was scored independently by two readers. Correlations between visibility scores or ADC with age, gender, T2*, or recent serum ferritin (SF) were investigated. Liver visibility scores in b = 1,000 s/mm{sup 2} images correlated with the age (Spearman R = -0.56 in women, -0.45 in men), T2* (R = 0.75) and SF (R = -0.64) and were significantly higher in women (P < 0.01). SF and T2* were within normal values (T2*: 13 - 31 ms, SF: 14 - 230 μg/L). Liver ADC correlated with visibility scores (R = 0.69) and T2* (R = 0.64) and was age- and gender-dependent. ADC ROI standard deviation negatively correlated with visibility scores (R = -0.65) and T2* (R = -0.62). The spleen visibility did not depend on age or gender. Normal liver parenchyma visibility in DWI is age- and gender-dependent, according to the iron content. Visibility scores and iron content significantly affect ADC quantification in the normal liver. (orig.)

  11. Surgical Approach to "Right Hepatic Core": Deepest Region Surrounded by Major Portal Pedicles and Right Hepatic Vein. (United States)

    Tani, Keigo; Ishizawa, Takeaki; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro


    The resection of hepatic tumors located in the region surrounded by the right hepatic vein (RHV) and the portal pedicles of the right paramedian/lateral sector (the right hepatic core) remains a challenge for liver surgeons. The aim of this study was to demonstrate the surgical techniques and outcomes of our atypical-parenchyma-sparing hepatectomy (atypical-PSH) approach for the removal of tumors in the right hepatic core. Perioperative records of 1,179 consecutive patients who had undergone hepatectomy for hepatocellular carcinoma or colorectal liver metastases from January 2006 to December 2014 were retrospectively reviewed. Twenty-six patients (2%) had a tumor in the right hepatic core. Among them, 20 patients underwent atypical-PSH, including the anterior approach (resection of the right paramedian hepatic parenchyma, n = 9), posterior approach (resection of the right lateral hepatic parenchyma, n = 10), and transhepatic approach (tumor enucleation from the raw surfaces along the RHV, n = 1). Their postoperative outcomes were similar to the remaining 6 patients who had undergone right hepatectomy. Atypical-PSH can be safely applied for the removal of tumors in the right hepatic core. This technique may have potential advantages in preserving hepatic function for postoperative chemotherapy and repeated hepatectomy for future recurrence. © 2017 S. Karger AG, Basel.

  12. Hepatic resection alone versus in combination with pre- and post-operative transarterial chemoembolization for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis (United States)

    Li, Hongyu; Su, Chunping; Guo, Xiaozhong


    Background and Aims The prognosis of hepatocellular carcinoma (HCC) treated with hepatic resection may be improved by the adjunctive use of transarterial chemoembolization (TACE). This study aimed to systematically compare the outcomes between hepatic resection with and without TACE groups. Methods All relevant randomized controlled trials (RCTs) and non-RCTs were searched by the PubMed, EMBASE, and Cochrane Library databases. Overall survival (OS) and disease-free survival (DFS) were two major outcomes. Meta-analyses were performed according to the timing of TACE (pre- or post-operative TACE). Subgroup analyses were also performed. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were calculated. Results Overall, 55 papers were included (14 RCTs and 41 non-RCTs). Overall meta-analyses demonstrated that OS and DFS were statistically similar between hepatic resection with and without pre-operative TACE groups (HR = 1.01, 95%CI = 0.87–1.19, P = 0.87; HR = 0.91, 95%CI = 0.82–1.01, P = 0.07). Subgroup analyses of RCTs or non-RCTs showed that OS and DFS remained statistically similar between hepatic resection with and without pre-operative TACE groups. Subgroup analysis of incomplete or no tumor necrosis showed that OS was worse in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. By contrast, subgroup analysis of complete tumor necrosis showed that DFS was better in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group. Overall meta-analyses demonstrated that OS and DFS were better in hepatic resection with post-operative TACE group than in hepatic resection without post-operative TACE group (HR = 0.85, 95%CI = 0.72–1.00, P = 0.06; HR = 0.83, 95%CI = 0.73–0.94, P = 0.004). Subgroup analyses of RCTs, vascular invasion, or large HCC showed that OS and DFS remained better in hepatic resection with post-operative TACE group than in hepatic

  13. Competing risk analysis on outcome after hepatic resection of hepatocellular carcinoma in cirrhotic patients. (United States)

    Cucchetti, Alessandro; Sposito, Carlo; Pinna, Antonio Daniele; Citterio, Davide; Cescon, Matteo; Bongini, Marco; Ercolani, Giorgio; Cotsoglou, Christian; Maroni, Lorenzo; Mazzaferro, Vincenzo


    To investigate death for liver failure and for tumor recurrence as competing events after hepatectomy of hepatocellular carcinoma. Data from 864 cirrhotic Child-Pugh class A consecutive patients, submitted to curative hepatectomy (1997-2013) at two tertiary referral hospitals, were used for competing-risk analysis through the Fine and Gray method, aimed at assessing in which circumstances the oncological benefit from tumour removal is greater than the risk of dying from hepatic decompensation. To accomplish this task, the average risk of these two competing events, over 5 years of follow-up, was calculated through the integral of each cumulative incidence function, and represented the main comparison parameter. Within a median follow-up of 5.6 years, death was attributable to tumor recurrence in 63.5%, and to liver failure in 21.2% of cases. In the first 16 mo, the risk of dying due to liver failure exceeded that of dying due to tumor relapse. Tumor stage only affects death from recurrence; whereas hepatitis C infection, Model for End-stage Liver Disease score, extent of hepatectomy and portal hypertension influence death from liver failure (P risk of dying from liver failure did not exceed the tumour-related mortality, representing optimal surgical candidates. It also identifies those clinical circumstances where the oncological benefit would be borderline or even where the surgery would be harmful. Having knowledge of these competing events can be used to weigh the risks and benefits of hepatic resection in each clinical circumstance, separating optimal from non-optimal surgical candidates.

  14. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

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    Sonia Tewani Orcutt


    Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  15. Persistent T2*-hypointensity of the liver parenchyma after irradiation to the SPIO-accumulated liver: An imaging marker for responses to radiotherapy in hepatic malignancies. (United States)

    Furuta, Toshihiro; Yamaguchi, Masayuki; Minami, Manabu; Ohtomo, Kuni; Fujii, Hirofumi


    To determine whether T2*-weighted MRI has the ability to visualize the irradiated liver parenchyma and liver tumor after irradiation to the previously superparamagnetic iron oxide (SPIO)-accumulated liver. We examined 24 liver tumor-bearing rats. Nine rats (Group 1) received 20 µmol Fe/kg SPIO and subsequent 70-Gy irradiation to the tumor-bearing liver lobe. Four rats (Group 2) received SPIO and sham irradiation. Six rats (Group 3) received saline and irradiation. Finally, five rats (Group 4) received saline and sham irradiation. We acquired sequential 3 Tesla T2*-weighted images of the liver on day 7, and assessed MR image findings including signal intensity of the tumors and tumor-bearing liver lobes. In six rats in Group 1, tumors shrunk by 39-100% (303-0 mm3 ), and severely, well-defined hypointense irradiated areas were observed. In the other two rats, tumors enlarged by 25 and 172% (595 and 1148 mm3 ), and hypointense rings surrounded the tumors. The normalized relative signal intensity of the irradiated areas was significantly lower than that of the tumor (0.53 ± 0.06 versus 0.94 ± 0.06; P irradiated areas. The number of CD68-positive cells was higher in irradiated areas than in nonirradiated areas. T2*-weighted MR imaging visualized the irradiated liver parenchyma as markedly, well-defined hypointense areas and liver cancer lesions as hyperintense areas only when SPIO was administered before irradiation. The visualization of the hypointense area was associated with tumor regression after irradiation. 2 J. Magn. Reson. Imaging 2017;45:303-312. © 2016 International Society for Magnetic Resonance in Medicine.

  16. Routine extra-hepatic bile duct resection in gallbladder cancer patients without bile duct infiltration: A systematic review. (United States)

    Nigri, Giuseppe; Berardi, Giammauro; Mattana, Chiara; Mangogna, Livia; Petrucciani, Niccolò; Sagnotta, Andrea; Aurello, Paolo; D'Angelo, Francesco; Ramacciato, Giovanni


    The optimal treatment for advanced gallbladder cancer, in particular T2 stage cancer, is unclear. The use of "radical cholecystectomy" or more extended procedures with extra-hepatic bile duct resection are matter of debate. Due to the lack of consensus regarding the oncological significance of routine extra-hepatic bile duct (EBD) resection for gallbladder carcinoma, we decided to perform a systematic review investigating the real benefit of this procedure focusing on the primary outcomes of overall survival and disease-free survival. A systematic literature search was performed using PubMed, EMBASE, Scopus and the Cochrane Library Central according to the PRISMA statement guidelines for conducting and reporting systematic reviews. Multiple primary and secondary outcomes were analyzed. The selected articles included 424 patients who underwent routine EBD resection without bile duct infiltration. Only two papers discussed the number of dissected lymph nodes during EBD resection for gallbladder carcinoma. Four of the seven included papers reported on tumor involvement in lymph nodes at rates ranging between 39% and 83%. All of the studies included in this systematic review reported on results of overall survival. In general, 5-years OS rate of the EBD-resected patients was not significantly different than that of the EBD-preservation group, while the mobility was significantly higher in the EBD resection group. Routine EBD resection in gallbladder cancer patients without bile duct infiltration is not associated with improved overall survival, improved lymph-node harvesting or with minor recurrence rate, but it is associated with higher morbidity rates. Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  17. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection. (United States)

    Sand, L; Rizell, M; Houltz, E; Karlsen, K; Wiklund, J; Odenstedt Hergès, H; Stenqvist, O; Lundin, S


    It has been suggested that blood loss during liver resection may be reduced if central venous pressure (CVP) is kept at a low level. This can be achieved by changing patient position but it is not known how position changes affect portal (PVP) and hepatic (HVP) venous pressures. The aim of the study was to assess if changes in body position result in clinically significant changes in these pressures. We studied 10 patients undergoing liver resection. Mean arterial pressure (MAP) and CVP were measured using fluid-filled catheters, PVP and HVP with tip manometers. Measurements were performed in the horizontal, head up and head down tilt position with two positive end expiratory pressure (PEEP) levels. A 10° head down tilt at PEEP 5 cm H(2) O significantly increased CVP (11 ± 3 to 15 ± 3 mmHg) and MAP (72 ± 8 to 76 ± 8 mmHg) while head up tilt at PEEP 5 cm H(2) O decreased CVP (11 ± 3 to 6 ± 4 mmHg) and MAP (72 ± 8 to 63 ± 7 mmHg) with minimal changes in transhepatic venous pressures. Increasing PEEP from 5 to 10 resulted in small increases, around 1 mmHg in CVP, PVP and HVP. There was no significant correlation between changes in CVP vs. PVP and HVP during head up tilt and only a weak correlation between CVP and HVP by head down tilt. Changes of body position resulted in marked changes in CVP but not in HVPs. Head down or head up tilt to reduce venous pressures in the liver may therefore not be effective measures to reduce blood loss during liver surgery. 2011 The Authors Acta Anaesthesiologica Scandinavica, 2011 The Acta Anaesthesiologica Scandinavica Foundation.

  18. 3D haptic modelling for preoperative planning of hepatic resection: A systematic review. (United States)

    Soon, David S C; Chae, Michael P; Pilgrim, Charles H C; Rozen, Warren Matthew; Spychal, Robert T; Hunter-Smith, David J


    Three dimensional (3D) printing has gained popularity in the medical field because of increased research in the field of haptic 3D modeling. We review the role of 3D printing with specific reference to liver directed applications. A literature search was performed using the scientific databases Medline and PubMed. We performed this in-line with the PRISMA [20] statement. We only included articles in English, available in full text, published about adults, about liver surgery and published between 2005 and 2015. The 3D model of a patient's liver venous vasculature and metastasis was prepared from a CT scan using Osirix software (Pixmeo, Gineva, Switzerland) and printed using our 3D printer (MakerBot Replicator Z18, US). To validate the model, measurements from the inferior vena cava (IVC) were compared between the CT scan and the 3D printed model. A total of six studies were retrieved on 3D printing directly related to a liver application. While stereolithography (STL) remains the gold standard in medical additive manufacturing, Fused Filament Fabrication (FFF), is cheaper and may be more applicable. We found our liver 3D model made by FFF had a 0.1 ± 0.06 mm margin of error (mean ± standard deviation) compared with the CT scans. 3D printing in general surgery is yet to be thoroughly exploited. The most relevant feature of interest with regard to liver surgery is the ability to view the 3D dimensional relationship of the various hepatic and portal veins with respect to tumor deposits when planning hepatic resection. Systematic review registration number: researchregistry1348.

  19. Combined resection of the right liver lobe and retrohepatic inferior vena cava to treat hepatic alveolar echinococcosis: A case report. (United States)

    Du, Lei; Zhang, Ling-Qiang; Hou, Li-Zhao; Ren, Li; Wang, Hai-Jiu; Guo, Xin-Jian; Fan, Haining


    Hepatic alveolar echinococcosis (HAE) is a potentially fatal and chronically progressive infestation that is caused by the multivesicular metacestode of Echinococcus multilocularis (EM). HAE behaves like a malignant tumor and has been referred to as "worm cancer." The main treatment method for HAE is surgical resection. We present a 41-year-old Tibetan alveolar echinococcosis (AE) patient with AE lesions invading the right liver lobe and retrohepatic inferior vena cava (RHIVC). The patient was diagnosed with HAE based on results obtained from ultrasound examination, computed tomography, liver 3-dimensional reconstruction, serology tests, clinical presentation, and surgical exploration. The final pathology report confirmed the diagnosis as HAE. A radical surgery that combined resection of the liver and RHIVC was performed successfully. The patient had an uneventful postoperative recovery and a good prognosis. When lesions of the liver significantly violate the RHIVC, resecting the RHIVC without reconstruction may be considered if possible.

  20. Disease-free survival after hepatic resection in hepatocellular carcinoma patients: a prediction approach using artificial neural network.

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    Wen-Hsien Ho

    Full Text Available BACKGROUND: A database for hepatocellular carcinoma (HCC patients who had received hepatic resection was used to develop prediction models for 1-, 3- and 5-year disease-free survival based on a set of clinical parameters for this patient group. METHODS: The three prediction models included an artificial neural network (ANN model, a logistic regression (LR model, and a decision tree (DT model. Data for 427, 354 and 297 HCC patients with histories of 1-, 3- and 5-year disease-free survival after hepatic resection, respectively, were extracted from the HCC patient database. From each of the three groups, 80% of the cases (342, 283 and 238 cases of 1-, 3- and 5-year disease-free survival, respectively were selected to provide training data for the prediction models. The remaining 20% of cases in each group (85, 71 and 59 cases in the three respective groups were assigned to validation groups for performance comparisons of the three models. Area under receiver operating characteristics curve (AUROC was used as the performance index for evaluating the three models. CONCLUSIONS: The ANN model outperformed the LR and DT models in terms of prediction accuracy. This study demonstrated the feasibility of using ANNs in medical decision support systems for predicting disease-free survival based on clinical databases in HCC patients who have received hepatic resection.

  1. Hepatic resection is safe and effective for patients with hepatocellular carcinoma and portal hypertension.

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    Jian-Hong Zhong

    Full Text Available BACKGROUND & AIMS: Official guidelines do not recommend hepatic resection (HR for patients with hepatocellular carcinoma (HCC and portal hypertension (PHT. This study aims to investigate the safety and efficacy of HR for patients with HCC and PHT. METHODS: Mortality and survival after HR were analyzed retrospectively in a consecutive sample of 1738 HCC patients with PHT (n = 386 or without it (n = 1352. To assess the robustness of findings, we repeated the analysis using propensity score-matched analysis. We also comprehensively searched the PubMed database for studies evaluating the efficacy and safety of HR for patients with HCC and PHT. RESULTS: The 90-day mortality rate was 6.7% among those with PHT and 2.1% among those without it (P.05. Moreover, the recurrence rates were similar between the two groups. Consistent with our findings, all 9 studies identified in our literature search reported HR to be safe and effective for patients with HCC and PHT. CONCLUSIONS: HR is safe and effective in HCC patients with PHT and preserved liver function. This is especially true for patients who have early-stage HCC or who undergo minor hepatectomy.

  2. [Limitations of liver resections]. (United States)

    Laca, L; Urdzik, J; Dobrota, Fani M; Polácek, H


    Evaluation of the functional reserve before resectional performance and sufficient rest of liver parenchyma function is essential for the surgeon. From these factors, the decision based on operability, the maximum extent of liver parenchyma resection and the severity of post-operative course. In the period from December 2003 to December 2008, at the Dept of Transplant and Vascular surgery, JLF UK Martin, have been performed 161 resections of the liver in 144 patients, of which 91 large resections performances in the liver (hemihepatektomies or greater performance). Six patients have undergone repeated resection (4.1%), in 11 patients was performed Radio Frequency Ablation due to relaps of the disease (6.1%), and 3 patients were performed two steps resection. Of 91 major resection performance in the liver was 62 (68%) performed by anatomical boundaries of individual segments, in remaining 29 (32%) resections was reflected more to the localization of tumor itself as anatomical subdivision called combined anatomical and non-antomical resection. Radical resection R0 has been achieved in 76% of malignant tumors. In the post-operative course in 17% experienced complications, most often to the hematoma and biloma in place of the resection area, pleural effusion and 8 patients had postoperative liver dysfunction. Of this group, 5 patients had made volumetric examinations, and in all was the volume of residual liver parenchyma < 30% of the total volume of functional liver. Mortality within 30 days of the performance was 1.1%. The survival of patients was affected mainly by extent of resection, histological type of tumor, radicality of resection and necessity of the complex surgical procedures. Based on our evaluation of the results of a group of patients was arranged scheme measures for planning resectional procedures of the liver in our department. These include the adjustment of laboratory parameters, management of jaundice, preference of anatomical resections and

  3. Impact of surgical complications on the risk of hepatocellular carcinoma recurrence after hepatic resection. (United States)

    Pravisani, Riccardo; Baccarani, Umberto; Isola, Miriam; Adani, Gianluigi; Lorenzin, Dario; Terrosu, Giovanni; Risaliti, Andrea


    Surgery-related morbidity has been identified as prognostic risk factor for tumor recurrence for several tumor types, but data regarding hepatocellular carcinoma (HCC) are limited and controversial. The aim of this study was to analyze the impact of surgical complications on the risk of HCC recurrence after hepatic resection (HR). A Retrospective study was conducted on a cohort of patients submitted to HR in a tertiary teaching hospital, between January 2006 and December 2015. 112 patients were submitted to HR during the study period. Cirrhosis was present in 84% of cases, with portal hypertension in 19.6%. The median MELD score was 8 (range 6-15). The median number of lesions per patient was 1 (range 1-5) with a mean diameter of 5.4 ± 3.8 cm. Major HR were performed in 18.2% of cases. Overall post-op morbidity was 48.2% with Clavien-Dindo (CD) severity score ≥3 in 15.2% of cases. The most frequent complications were infected biloma (19.6%) and liver failure (14%). HCC recurred in 48% of patients. At univariate analysis overall post-op complications (HR 2.313, p = 0.003), CD score >2 (HR 2.075, p = 0.047), post-op liver failure (HR 2.990, p = 0.007), post-op iperbilirubinemia (HR 1.151, p = 0.049), post-op bleeding (HR 2.633, p failure (HR 4.081, p failure and infected biloma are risk factors for HCC recurrence.

  4. Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis. (United States)

    Zhang, Manka; Ma, Huimin; Zhang, Jian; He, Lingling; Ye, Xiaohui; Li, Xin


    Hepatic resection (HRN) and microwave ablation (MWA) have significant advantages in treating hepatocellular carcinoma; however, it remains unclear which way produces better outcomes. This meta-analysis of cohort studies compared the treatments in terms of effectiveness and safety. Six electronic databases (PubMed, Medline, EMBASE, Web of Science, EBSCO, and The Cochrane Library) were retrieved for studies comparing MWA and HRN. The meta-analysis was conducted based on statement of preferred reporting items for systematic reviews and meta-analyses. Nine studies met the inclusion criteria, with a total of 1,480 patients. The overall meta-analysis demonstrated no significant difference in overall survival between the MWA group and the HRN group (HR =0.98, 95% CI =0.76-1.26, P=0.878). There was no difference in disease-free survival between the MWA group and the HRN group (HR =1.16, 95% CI =0.79-1.71, P=0.442). Meanwhile, the meta-analysis demonstrated that MWA was associated with shorter operation time (standardized mean difference [SMD] =-1.37, 95% CI =-1.92 to -0.81, P=0.000), less amount of blood loss in operation (SWD =-1.19, 95% CI =-1.76 to -0.61, P=0.000), and less complications (OR =0.22, 95% CI =0.12-0.40, P=0.000) than HRN. In conclusion, our meta-analysis suggests that MWA may be superior to HRN as it is as effective as HRN in terms of overall survival, disease-free survival, tumor recurrence, and is associated with shorter operation time, less amount of blood loss, and fewer complications.

  5. Comparison of microwave ablation and hepatic resection for hepatocellular carcinoma: a meta-analysis (United States)

    Zhang, Manka; Ma, Huimin; Zhang, Jian; He, Lingling; Ye, Xiaohui; Li, Xin


    Background and aims Hepatic resection (HRN) and microwave ablation (MWA) have significant advantages in treating hepatocellular carcinoma; however, it remains unclear which way produces better outcomes. This meta-analysis of cohort studies compared the treatments in terms of effectiveness and safety. Methods Six electronic databases (PubMed, Medline, EMBASE, Web of Science, EBSCO, and The Cochrane Library) were retrieved for studies comparing MWA and HRN. The meta-analysis was conducted based on statement of preferred reporting items for systematic reviews and meta-analyses. Results Nine studies met the inclusion criteria, with a total of 1,480 patients. The overall meta-analysis demonstrated no significant difference in overall survival between the MWA group and the HRN group (HR =0.98, 95% CI =0.76–1.26, P=0.878). There was no difference in disease-free survival between the MWA group and the HRN group (HR =1.16, 95% CI =0.79–1.71, P=0.442). Meanwhile, the meta-analysis demonstrated that MWA was associated with shorter operation time (standardized mean difference [SMD] =−1.37, 95% CI =−1.92 to −0.81, P=0.000), less amount of blood loss in operation (SWD =−1.19, 95% CI =−1.76 to −0.61, P=0.000), and less complications (OR =0.22, 95% CI =0.12–0.40, P=0.000) than HRN. Conclusion In conclusion, our meta-analysis suggests that MWA may be superior to HRN as it is as effective as HRN in terms of overall survival, disease-free survival, tumor recurrence, and is associated with shorter operation time, less amount of blood loss, and fewer complications. PMID:29042794

  6. (90) Y radiation lobectomy: Outcomes following surgical resection in patients with hepatic tumors and small future liver remnant volumes. (United States)

    Lewandowski, Robert J; Donahue, Larry; Chokechanachaisakul, Attasit; Kulik, Laura; Mouli, Samdeep; Caicedo, Juan; Abecassis, Michael; Fryer, Jonathan; Salem, Riad; Baker, Talia


    The purpose of this study is to assess operative, post-operative, and long-term outcomes in patients who underwent radiation lobectomy (RL) for tumor control and/or hypertrophy of small future liver remnant (FLR) prior to resection. Right lobar +/- segment 4 radioembolization was performed prior to lobectomy/tri-segmentectomy in patients with hepatic tumor but inadequate FLR. Parenchymal/tumor volumes were calculated from pre/post-RL imaging; FLR/%FLR hypertrophy were determined. Complications were graded by the Clavien-Dindo classification. Thirteen patients (HCC n = 10, cholangiocarcinoma n = 2, mCRC n = 1) underwent RL prior to resection. The median time between RL and post-RL imaging was 40 days (23-190 days); the median time to resection was 86 days (30-210 days). Median FLR increased significantly [pre: 33% (22-43%); post: 43% (29-69%), P 50% pathologic necrosis. Median follow up time after surgery was 604 days (144-1,416 days); one death occurred. In this preliminary study, radiation lobectomy was a safe and effective method to achieve remnant liver hypertrophy while providing tumor control. This approach may facilitate safe resection and favorable post-operative outcomes.J. Surg. Oncol. 2016;114:99-105. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  7. Fate and Effect of Intravenously Infused Mesenchymal Stem Cells in a Mouse Model of Hepatic Ischemia Reperfusion Injury and Resection

    Directory of Open Access Journals (Sweden)

    T. C. Saat


    Full Text Available Liver ischemia reperfusion injury (IRI is inevitable during transplantation and resection and is characterized by hepatocellular injury. Therapeutic strategies to reduce IRI and accelerate regeneration could offer major benefits. Mesenchymal stem cells (MSC are reported to have anti-inflammatory and regeneration promoting properties. We investigated the effect of MSC in a model of combined IRI and partial resection in the mouse. Hepatic IRI was induced by occlusion of 70% of the blood flow during 60 minutes, followed by 30% hepatectomy. 2 × 105 MSC or PBS were infused 2 hours before or 1 hour after IRI. Six, 48, and 120 hours postoperatively mice were sacrificed. Liver damage was evaluated by liver enzymes, histology, and inflammatory markers. Regeneration was determined by liver/body weight ratio, proliferating hepatocytes, and TGF-β levels. Fate of MSC was visualized with 3D cryoimaging. Infusion of 2 × 105 MSC 2 hours before or 1 hour after IRI and resection showed no beneficial effects. Tracking revealed that MSC were trapped in the lungs and did not migrate to the site of injury and many cells had already disappeared 2 hours after infusion. Based on these findings we conclude that intravenously infused MSC disappear rapidly and were unable to induce beneficial effects in a clinically relevant model of IRI and resection.

  8. Improved Survival in Metastatic Colorectal Cancer Is Associated With Adoption of Hepatic Resection and Improved Chemotherapy

    National Research Council Canada - National Science Library

    Scott Kopetz; George J. Chang; Michael J. Overman; Cathy Eng; Daniel J. Sargent; David W. Larson; Axel Grothey; Jean-Nicolas Vauthey; David M. Nagorney; Robert R. McWilliams


    .... With an increase in surgical resections of metastatic disease and development of new chemotherapies, indirect evidence suggests that outcomes for patients are improving in the general population...

  9. A hepatic stellate cell gene expression signature associated with outcomes in hepatitis C cirrhosis and hepatocellular carcinoma after curative resection. (United States)

    Zhang, David Y; Goossens, Nicolas; Guo, Jinsheng; Tsai, Ming-Chao; Chou, Hsin-I; Altunkaynak, Civan; Sangiovanni, Angelo; Iavarone, Massimo; Colombo, Massomo; Kobayashi, Masahiro; Kumada, Hiromitsu; Villanueva, Augusto; Llovet, Josep M; Hoshida, Yujin; Friedman, Scott L


    We used an informatics approach to identify and validate genes whose expression is unique to hepatic stellate cells and assessed the prognostic capability of their expression in cirrhosis. We defined a hepatic stellate cell gene signature by comparing stellate, immune and hepatic transcriptome profiles. We then created a prognostic index using a combination of hepatic stellate cell signature expression and clinical variables. This signature was derived in a retrospective-prospective cohort of hepatitis C-related early-stage cirrhosis (prognostic index derivation set) and validated in an independent retrospective cohort of patients with postresection hepatocellular carcinoma (HCC). We then examined the association between hepatic stellate cell signature expression and decompensation, HCC development, progression of Child-Pugh class and survival. The 122-gene hepatic stellate cell signature consists of genes encoding extracellular matrix proteins and developmental factors and correlates with the extent of fibrosis in human, mouse and rat datasets. Importantly, association of clinical prognostic variables with overall survival was improved by adding the signature; we used these results to define a prognostic index in the derivation set. In the validation set, the same prognostic index was associated with overall survival. The prognostic index was associated with decompensation, HCC and progression of Child-Pugh class in the derivation set, and HCC recurrence in the validation set. This work highlights the unique transcriptional niche of stellate cells, and identifies potential stellate cell targets for tracking, targeting and isolation. Hepatic stellate cell signature expression may identify patients with HCV cirrhosis or postresection HCC with poor prognosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. Vasopressin-induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection. (United States)

    Bown, L Sand; Ricksten, S-E; Houltz, E; Einarsson, H; Söndergaard, S; Rizell, M; Lundin, S


    To minimize blood loss during hepatic surgery, various methods are used to reduce pressure and flow within the hepato-splanchnic circulation. In this study, the effect of low- to moderate doses of vasopressin, a potent splanchnic vasoconstrictor, on changes in portal and hepatic venous pressures and splanchnic and hepato-splanchnic blood flows were assessed in elective liver resection surgery. Twelve patients were studied. Cardiac output (CO), stroke volume (SV), mean arterial (MAP), central venous (CVP), portal venous (PVP) and hepatic venous pressures (HVP) were measured, intraoperatively, at baseline and during vasopressin infusion at two infusion rates (2.4 and 4.8 U/h). From arterial and venous blood gases, the portal (splanchnic) and hepato-splanchnic blood flow changes were calculated, using Fick's equation. CO, SV, MAP and CVP increased slightly, but significantly, while systemic vascular resistance and heart rate remained unchanged at the highest infusion rate of vasopressin. PVP was not affected by vasopressin, while HVP increased slightly. Vasopressin infusion at 2.4 and 4.8 U/h reduced portal blood flow (-26% and -37%, respectively) and to a lesser extent hepato-splanchnic blood flow (-9% and -14%, respectively). The arterial-portal vein lactate gradient was not significantly affected by vasopressin. Postoperative serum creatinine was not affected by vasopressin. Short-term low to moderate infusion rates of vasopressin induced a splanchnic vasoconstriction without metabolic signs of splanchnic hypoperfusion or subsequent renal impairment. Vasopressin caused a centralization of blood volume and increased cardiac output. Vasopressin does not lower portal or hepatic venous pressures in this clinical setting. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Intraoperative contrast-enhanced sonographic portography combined with indigo carmine dye injection for anatomic liver resection in hepatocellular carcinoma: a new technique. (United States)

    Park, Yang Shin; Lee, Chang Hee; Park, Pyoung-Jae; Kim, Kyeong Ah; Park, Cheol Min


    We present a method of intraoperative contrast-enhanced sonographic portography combined with indigo carmine dye injection for anatomic liver resection in hepatocellular carcinoma. During surgery, before dye infusion into the feeding portal vein, the targeted portal vein branch was directly punctured, and a microbubble contrast agent was administered under sonographic guidance. Simultaneous enhancement of the resected hepatic parenchyma with a microbubble contrast agent and blue dye improved estimation of the segmental border in the cutting plane and the tumor resection margin during liver surgery. © 2014 by the American Institute of Ultrasound in Medicine.

  12. The history of adoption of hepatic resection for metastatic colorectal cancer: 1984-95. (United States)

    Grünhagen, D; Jones, R P; Treasure, T; Vasilakis, C; Poston, G J


    Liver resection for metastatic colorectal cancer became established without randomized trials. Proponents of surgical resection point out 5-year survival approaching 50% whilst critics question how much of the apparent effect is due to patient selection. A 2006 systematic review of reported outcomes provided the starting point for citation analysis followed by thematic analysis of the texts of the most cited papers. 54 reports from 1988 to 2002 cited 709 unique publications a total of 1714 times. The 15 most cited papers were explored in detail, and showed clear examples of duplicate reporting and overlapping data sets. Textual analysis revealed proposals for a randomized controlled trial, but this was argued to be unethical by others, and no trial was undertaken. This critical review reveals how the case for this surgery was made, and examines the arguments that influenced acceptance and adoption of this surgery. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. Utility of Amplatzer Vascular Plug with Preoperative Common Hepatic Artery Embolization for Distal Pancreatectomy with En Bloc Celiac Axis Resection

    Energy Technology Data Exchange (ETDEWEB)

    Toguchi, Masafumi, E-mail:; Tsurusaki, Masakatsu; Numoto, Isao; Hidaka, Syojiro; Yamakawa, Miho [Kindai University, Department of Radiology, Faculty of Medicine (Japan); Asato, Nobuyuki [Kindai University, Department of Radiology, Faculty of Medicine, Nara Hospital (Japan); Im, SungWoon; Yagyu, Yukinobu; Matsuki, Mitsuru [Kindai University, Department of Radiology, Faculty of Medicine (Japan); Takeyama, Yoshifumi [Kindai University, Department of Surgery, Faculty of Medicine (Japan); Murakami, Takamichi [Kindai University, Department of Radiology, Faculty of Medicine (Japan)


    PurposeTo evaluate the feasibility and safety of the Amplatzer vascular plug (AVP) for preoperative common hepatic embolization (CHA) before distal pancreatectomy with en bloc celiac axis resection (DP-CAR) to redistribute blood flow to the stomach and liver via the superior mesenteric artery (SMA).Materials and MethodsFour patients (3 males, 1 female; median age 69 years) with locally advanced pancreatic body cancer underwent preoperative CHA embolization with AVP. After embolization, SMA arteriography was performed to confirm the alteration of blood flow from the SMA to the proper hepatic artery.ResultsIn three of four patients, technical successes were achieved with sufficient margin from the origin of gastroduodenal artery. In one patient, the margin was less than 5 mm, although surgery was successfully performed without any problem. Eventually, all patients underwent the DP-CAR without arterial reconstruction or liver ischemia.ConclusionsAVP application is feasible and safe as an embolic procedure for preoperative CHA embolization of DP-CAR.

  14. Hepatic resection versus transarterial chemoembolization for patients with Barcelona Clinic Liver Cancer intermediate stage Child-Pugh A hepatocellular carcinoma. (United States)

    Zhao, Yin-Nong; Zhang, Yong-Quan; Ye, Jia-Zhou; Liu, Xing; Yang, Hong-Zhi; Cong, Feng-Yun; Xiang, Bang-De; Wu, Fei-Xiang; Ma, Liang; Li, Le-Qun; Ye, Hai-Hong


    The present study aimed to compare the overall and recurrence-free survival rates following hepatic resection (HR) and transcatheter arterial chemoembolization (TACE) in patients with Barcelona Clinic Liver Cancer (BCLC) classified intermediate-stage Child-Pugh A hepatocellular carcinoma (HCC). A total of 443 patients were examined, among whom 274 underwent HR, whereas 169 received TACE. The overall survival, recurrence-free survival between groups and subgroups, and risk factors with respect to mortality and recurrence, were analyzed. The 1-, 3- and 5-year overall and recurrence-free survival rates were 70, 46 and 37% and 73, 52, and 37%, respectively after HR, compared with 38, 15, and 12% and 44, 25 and 16%, respectively after TACE. Overall and recurrence-free survival rates were significantly increased following HR compared with TACE. Subgroup analysis in the multi-nodule group showed that the 1-, 3- and 5-year overall survival rates were 68, 38 and 30% after HR, compared with 36, 10 and 0% following TACE. In the solitary tumor group, 1-, 3- and 5-year overall survival rates were 71, 50 and 38% after HR, and 41, 22 and 15% after TACE. The overall survival rate after HR was significantly increased compared with that after TACE in the solitary tumor and multi-nodule groups. The risk factors for mortality include solitary tumor diameter >10 cm, multi-nodules, serum albumin level ≥35 g/l, prothrombin time >13 sec, alphafetoprotein levels >400 ng/ml, and patients with hepatitis B virus. Solitary tumor diameter >10 cm, multi-nodules, and hepatitis B virus (P<0.001) were found to be associated with higher recurrence of HCC. Overall and recurrence-free survival rates were improved after HR compared with those after TACE in BCLC stage B, Child-Pugh A, HCC patients.

  15. Free Radical Oxidation in Rat Myocardium after Maximum Permissible Hepatic Resection. (United States)

    Ermolaev, P A; Khramykh, T P; Barskaya, L O


    Free radical oxidation in rat myocardial homogenate was studied by chemiluminescent assay during the early terms after maximum permissible liver resection. During this period, activation of free radical oxidation was biphasic. The critical terms characterized by dramatic intensification of free radical oxidation in the myocardium are the first hour and the first day after surgery. The period from 3 to 12 h after surgery, in which the indices of chemiluminescence decrease, can be tentatively termed as the period of "putative wellbeing". Normalization of the free radical oxidation processes in the myocardium occurred by day 7 after surgery.

  16. Preoperative lymphocyte-to-monocyte ratio predicts survival in primary hepatitis B-virus positive hepatocellular carcinoma after curative resection

    Directory of Open Access Journals (Sweden)

    Li G


    Full Text Available Guang-Jun Li,1 Juan-Juan Ji,2 Fang Yang,2 Hong-Wei Xu,1 Yu Bai3 1First Department of General Surgery, 2Department of Gastroenterology, 3Department of Pathology, The First Affiliated Hospital of Xin-Xiang Medical University, Henan, People’s Republic of China Background: Both inflammation and immunity are associated with the development of malignancy. The lymphocyte-to-monocyte ratio (LMR has been confirmed as a prognostic factor for several malignant diseases. The purpose of our study was to analyze prognostic significance of preoperative LMR in hepatitis B virus (HBV-related hepatocellular carcinoma after curative resection. Patients and methods: A total of 253 patients with primary HBV-positive hepatocellular carcinoma who underwent a curative operation were enrolled in this retrospective study. The relationship between preoperative LMR and survival outcomes was analyzed through Kaplan–Meier curves and multivariate Cox regression analyses. Results: Patients with a high LMR had a significantly higher mean overall survival than those with a low LMR (67 months vs 55 months, P=0.023, and high LMR remained significant for longer survival in the multivariate analysis (hazard ratio, 0.147; 95% confidence interval [CI]: 0.085–0.253; P=0.021. Furthermore, patients with a high LMR also had a higher median recurrence-free survival than those with a low LMR in univariate analyses (60 months vs 48 months, P=0.026 and multivariate analyses (hazard ratio, 0.317; 95% CI: 0.042–1.023; P=0.032. However, the survival benefit was limited to patients with advanced cancer. Conclusion: LMR was confirmed as an independent prognostic biomarker for primary HBV-positive hepatocellular carcinoma after curative resection. Keywords: lymphocyte-to-monocyte ratio, survival, HBV, hepatocellular carcinoma

  17. Prediction of Postoperative Hepatic Failure after Liver Resection for Hepatocellular Carcinoma: Significance of the Aspartate Aminotransferase-to-Platelet Ratio Index. (United States)

    Tanaka, Shogo; Iimuro, Yuji; Hirano, Tadamichi; Hai, Seikan; Suzumura, Kazuhiro; Fujimoto, Jiro


    The serum aspartate aminotransferase-to-platelet ratio index (APRI) is a biomarker for hepatic fibrosis. The relationship between the APRI and postoperative hepatic failure is unclear. The risk factors for postoperative hepatic failure and the APRI were evaluated in 457 patients who underwent liver resection for HCC. Nineteen patients (4.2%) experienced postoperative hepatic failure and five (1.1%) died. An increased APRI (p = 0.039), increased total bilirubin (p = 0.044), longer operation (p = 0.035) and increased intraoperative blood loss (p = 0.028) were independent risk factors in the multivariate analysis. Incidence of postoperative hepatic failure in patients with an APRI ≥ 1.57 (13/127, 10%) was significantly higher than in patients with an APRI failure in high APRI cases with both an operation ≥ 500 min and intraoperative blood loss ≥ 1L (6/33 (18.1%)) tended to be higher than in those with lower values (7/94 (7.4%), p = 0.051). Increased APRI (≥ 1.57) may be a preoperative predictor of postoperative hepatic failure. Meticulous surgery with shorter operations and reduced blood loss may reduce the incidence of postoperative hepatic failure, even in patients with a high APRI.

  18. Mortality Predicted Accuracy for Hepatocellular Carcinoma Patients with Hepatic Resection Using Artificial Neural Network

    Directory of Open Access Journals (Sweden)

    Herng-Chia Chiu


    Full Text Available The aim of this present study is firstly to compare significant predictors of mortality for hepatocellular carcinoma (HCC patients undergoing resection between artificial neural network (ANN and logistic regression (LR models and secondly to evaluate the predictive accuracy of ANN and LR in different survival year estimation models. We constructed a prognostic model for 434 patients with 21 potential input variables by Cox regression model. Model performance was measured by numbers of significant predictors and predictive accuracy. The results indicated that ANN had double to triple numbers of significant predictors at 1-, 3-, and 5-year survival models as compared with LR models. Scores of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC of 1-, 3-, and 5-year survival estimation models using ANN were superior to those of LR in all the training sets and most of the validation sets. The study demonstrated that ANN not only had a great number of predictors of mortality variables but also provided accurate prediction, as compared with conventional methods. It is suggested that physicians consider using data mining methods as supplemental tools for clinical decision-making and prognostic evaluation.

  19. Use of aspirin and bleeding-related complications after hepatic resection. (United States)

    Gelli, M; Allard, M A; Farges, O; Paugam-Burtz, C; Mabrut, J Y; Regimbeau, J M; Vibert, E; Boleslawski, E


    The operative risk of hepatectomy under antiplatelet therapy is unknown. This study sought to assess the outcomes of elective hepatectomy performed with or without aspirin continuation in a well balanced matched cohort. Data were retrieved from a multicentre prospective observational study. Aspirin and control groups were compared by non-standardized methods and by propensity score (PS) matching analysis. The main outcome was severe (Dindo-Clavien grade IIIa or more) haemorrhage. Other outcomes analysed were intraoperative transfusion, overall haemorrhage, major morbidity, comprehensive complication index (CCI) score, thromboembolic complications, ischaemic complications and mortality. Before matching, there were 118 patients in the aspirin group and 1685 in the control group. ASA fitness grade, cardiovascular disease, previous history of angina pectoris, angioplasty, diabetes, use of vitamin K antagonists, cirrhosis and type of hepatectomy were significantly different between the groups. After PS matching, 108 patients were included in each group. There were no statistically significant differences between the aspirin and control groups in severe haemorrhage (6·5 versus 5·6 per cent respectively; odds ratio (OR) 1·18, 95 per cent c.i. 0·38 to 3·62), intraoperative transfusion (23·4 versus 23·7 per cent; OR 0·98, 0·51 to 1·87), overall haemorrhage (10·2 versus 12·0 per cent; OR 0·83, 0·35 to 1·94), CCI score (24 versus 28; P = 0·520), major complications (23·1 versus 13·9 per cent; OR 1·82, 0·92 to 3·79) and 90-day mortality (5·6 versus 4·6 per cent; OR 1·21, 0·36 to 4·09) CONCLUSION: This observational study suggested that aspirin continuation is not associated with a higher rate of bleeding-related complications after elective hepatic surgery. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. Prognostic impact of hepatic resection for hepatocellular carcinoma: the role of the surgeon in achieving R0 resection--a retrospective cohort study. (United States)

    Chen, Huan-wei; Liao, Shan; Lau, Wan-Yee; Wang, Feng-jie; Deng, Fei-wen; Lai, Eric Chun-hung; Zhen, Zuo-jun


    Improvement in long-term survival of patients with hepatocellular carcinoma (HCC) has followed the developments in surgical techniques and multidisciplinary therapies. The role of the surgeon has rarely been studied and to fill this research gap we offer this study which has reviewed the outcome of surgery in attempted curative resection for this condition. The clinical data of patients who underwent partial hepatectomy for HCC from January 2003 to December 2010 at the First People's Hospital of Foshan were collected and retrospectively analyzed. Of 104 HCC patients, the 1-, 3-, and 5-year disease free survival (DFS) rates were 64.8%, 45.5%, and 38.5%, respectively, and the 1-, 3-, and 5-year overall survival (OS) rates were 86.3%, 63.6%, and 57.2%, respectively. Negative resection margin and tumor TNM stage were independent prognostic factors of DFS and OS (PNegative resection margin and tumor TNM stage were the two most significant prognostic factors of survival in HCC patients after partial hepatectomy. As TNM stage is a factor not subjected to control, surgeons can improve the long-term survival of patients with HCC by ensuring an appropriate negative resection margin. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Conversion to resection of liver metastases from colorectal cancer with hepatic artery infusion of combined chemotherapy and systemic cetuximab in multicenter trial OPTILIV. (United States)

    Lévi, F A; Boige, V; Hebbar, M; Smith, D; Lepère, C; Focan, C; Karaboué, A; Guimbaud, R; Carvalho, C; Tumolo, S; Innominato, P; Ajavon, Y; Truant, S; Castaing, D; De Baere, T; Kunstlinger, F; Bouchahda, M; Afshar, M; Rougier, P; Adam, R; Ducreux, M


    Systemic chemotherapy typically converts previously unresectable liver metastases (LM) from colorectal cancer to curative intent resection in ∼15% of patients. This European multicenter phase II trial tested whether hepatic artery infusion (HAI) with triplet chemotherapy and systemic cetuximab could increase this rate to 30% in previously treated patients. Participants had unresectable LM from wt KRAS colorectal cancer. Main non-inclusion criteria were advanced extra hepatic disease, prior HAI and grade 3 neuropathy. Irinotecan (180 mg/m(2)), oxaliplatin (85 mg/m(2)) and 5-fluorouracil (2800 mg/m(2)) were delivered via an implanted HAI access port and combined with i.v. cetuximab (500 mg/m(2)) every 14 days. Multidisciplinary decisions to resect LM were taken after every three courses. The rate of macroscopic complete resections (R0 + R1) of LM, progression-free survival (PFS) and overall survival (OS) were computed according to intent to treat. The patient population consisted of 42 men and 22 women, aged 33-76 years, with a median of 10 LM involving a median of six segments. Up to 3 extrahepatic lesions of liver-specific intensive chemotherapy and surgery had a high curative intent potential that deserves upfront randomized testing. EUDRACT 2007-004632-24, NCT00852228. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email:

  2. Effect of TU-100, a traditional Japanese medicine, administered after hepatic resection in patients with liver cancer: a multi-center, phase III trial (JFMC40-1001). (United States)

    Shimada, Mitsuo; Morine, Yuji; Nagano, Hiroaki; Hatano, Etsuro; Kaiho, Takashi; Miyazaki, Masaru; Kono, Toru; Kamiyama, Toshiya; Morita, Satoshi; Sakamoto, Junichi; Kusano, Mitsuo; Saji, Shigetoyo; Kanematsu, Takashi; Kitajima, Masaki


    This multi-center, phase III trial assesses the efficacy of daikenchuto (TU-100) on gastrointestinal disorders after hepatic resection (UMIN Registration No. 000003103). A total of 231 patients, who underwent hepatic resection at 26 Japanese centers, were enrolled. Patients were randomly assigned to receive either oral doses (15 g/day, three times a day) of TU-100 or placebo control from preoperative day 3 to postoperative day 10, except on the day of surgery. Primary end points were the time from extubation until the first postoperative bowel movement (FBM-T), serum C-reactive protein (CRP) and ammonia levels. Finally, 209 patients (TU-100: n = 108, placebo: n = 101) were included in the statistical analysis. The median FBM-T was 88.2 h (95 % CI 74.0-94.1) in the TU-100 group and 93.1 h (95 % CI 83.3-99.4) in the placebo group, demonstrating that TU-100 accelerated the time to first bowel movement significantly more than placebo control. Serum CRP levels did not differ significantly during the study period, although serum CRP levels in the TU-100 group tended to be lower than those in the placebo group in patients with grade B liver damage. Meanwhile, the two groups had similar serum ammonia levels. TU-100-related serious adverse events did not occur during the study. TU-100 appears to improve gastrointestinal dysmotility and reduce serum CRP levels in patients with grade B liver damage after hepatectomy. TU-100 is an effective treatment option after hepatic resection in patients with liver cancer.

  3. Effects of HIFU induced cavitation on flooded lung parenchyma. (United States)

    Wolfram, Frank; Dietrich, Georg; Boltze, Carsten; Jenderka, Klaus Vitold; Lesser, Thomas Günther


    High intensity focused ultrasound (HIFU) has gained clinical interest as a non-invasive local tumour therapy in many organs. In addition, it has been shown that lung cancer can be targeted by HIFU using One-Lung Flooding (OLF). OLF generates a gas free saline-lung compound in one lung wing and therefore acoustic access to central lung tumours. It can be assumed that lung parenchyma is exposed to ultrasound intensities in the pre-focal path and in cases of misguiding. If so, cavitation might be induced in the saline fraction of flooded lung and cause tissue damage. Therefore this study was aimed to determine the thresholds of HIFU induced cavitation and tissue erosion in flooded lung. Resected human lung lobes were flooded ex-vivo. HIFU (1,1 MHz) was targeted under sonographic guidance into flooded lung parenchyma. Cavitation events were counted using subharmonic passive cavitation detection (PCD). B-Mode imaging was used to detect cavitation and erosion sonographically. Tissue samples out of the focal zone were analysed histologically. In flooded lung, a PCD and a sonographic cavitation detection threshold of 625  Wcm - 2 ( p r  = 4, 3  MPa ) and 3.600  Wcm - 2 ( p r  = 8, 3  MPa ) was found. Cavitation in flooded lung appears as blurred hyperechoic focal region, which enhances echogenity with insonation time. Lung parenchyma erosion was detected at intensities above 7.200  Wcm - 2 ( p r  = 10, 9  MPa ). Cavitation occurs in flooded lung parenchyma, which can be detected passively and by B-Mode imaging. Focal intensities required for lung tumour ablation are below levels where erosive events occur. Therefore focal cavitation events can be monitored and potential risk from tissue erosion in flooded lung avoided.

  4. Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections

    Directory of Open Access Journals (Sweden)

    Gulec Seza A


    Full Text Available Abstract Background Extended liver resections are being performed more liberally than ever. The extent of resection of liver metastases, however, is restricted by the volume of the future liver remnant (FLR. An intervention that would both accomplish tumor control and induce compensatory hypertrophy, with good patient tolerability, could improve clinical outcomes. Case presentation A 53-year-old woman with a history of cervical cancer presented with a large liver mass. Subsequent biopsy indicated poorly differentiated carcinoma with necrosis suggestive of squamous cell origin. A decision was made to proceed with pre-operative chemotherapy and Y-90 microsphere SIRT with the intent to obtain systemic control over the disease, downsize the hepatic lesion, and improve the FLR. A surgical exploration was performed six months after the first SIRT (three months after the second. There was no extrahepatic disease. The tumor was found to be significantly decreased in size with central and peripheral scarring. The left lobe was satisfactorily hypertrophied. A formal right hepatic lobectomy was performed with macroscopic negative margins. Conclusion Selective internal radiation treatment (SIRT with yttrium-90 (Y-90 microspheres has emerged as an effective liver-directed therapy with a favorable therapeutic ratio. We present this case report to suggest that the portal vein radiation dose can be substantially increased with the intent of inducing portal/periportal fibrosis. Such a therapeutic manipulation in lobar Y-90 microsphere treatment could accomplish the end points of PVE with avoidance of the concern regarding tumor progression.

  5. Multimodal Treatment of Hepatic Metastasis in the Form of a Bile Duct Tumor Thrombus from Pancreatic Acinar Cell Carcinoma: Case Report of Successful Resection after Chemoradiation Therapy

    Directory of Open Access Journals (Sweden)

    Hirotada Kittaka


    Full Text Available Pancreatic acinar cell carcinoma (ACC is a rare tumor, and its pathophysiology has not been well understood. Treatment strategies for hepatic metastasis originating from ACC remain controversial. We report the case of a 66-year-old woman who had undergone total pancreatectomy from ACC 7 years prior to clinical presentation. Contrast-enhanced computed tomography imaging revealed a tumorous lesion measuring 7 cm in length and 1 cm in diameter and extending along the intrahepatic bile duct (B6, which showed mild enhancement in the early phase and modest washout in the late phase. This lesion was diagnosed as hepatic metastasis primarily in the form of a bile duct tumor thrombus originating from the prior ACC by the pathological evaluation of the fine needle biopsy specimen. The patient underwent preoperative gemcitabine-based chemoradiation therapy followed by subsequent surgical resection, which included subsegmentectomy (S6 of the liver and complete removal of the bile duct tumor thrombus. The patient has had no recurrence during the past 8 months since her last surgery. Multimodal treatment including preoperative chemoradiation therapy might be beneficial especially for marginally resectable cases of ACC.

  6. Ulinastatin Reduces Cancer Recurrence after Resection of Hepatic Metastases from Colon Cancer by Inhibiting MMP-9 Activation via the Antifibrinolytic Pathway

    Directory of Open Access Journals (Sweden)

    Bo Xu


    Full Text Available High recurrence of colon cancer liver metastasis is observed in patients after hepatic surgery, and the cause is believed to be mostly due to the growth of residual microscopic metastatic lesions within the residual liver. Therefore, triggering the progression of occult metastatic foci may be a novel strategy for improving survival from colon cancer liver metastases. In the present study, we identified an anti-recurrence effect of ulinastatin on colon cancer liver metastasis in mice after hepatectomy. Transwell cell invasion assays demonstrated that ulinastatin significantly inhibited the in vitro invasive ability of colon cancer HCT116 cells. Moreover, gelatin zymography and ELISA analysis showed that MMP-9 activity and plasmin activity of colon cancer HCT116 cells were inhibited by ulinastatin, respectively. Furthermore, in vivo BALB/C nu/nu mice model indicated that ulinastatin effectively reduced recurrence after resection of hepatic metastases from colon cancer. The optimum timing for ulinastatin administration was one week after hepatectomy. Taken together, our findings point to the potential of ulinastatin as an effective approach in controlling recurrence of hepatic metastases from colon cancer after hepatectomy via its anti-plasmin activity.

  7. Safety of implanting sustained-release 5-fluorouracil into hepatic cross-section and omentum majus after primary liver cancer resection. (United States)

    Chen, Jiangtao; Zhang, Junjie; Wang, Chenyu; Yao, Kunhou; Hua, Long; Zhang, Liping; Ren, Xuequn


    This study was designed to evaluate the short-term safety of implanting sustained-release 5-fluorouracil (5-FU) into hepatic cross-section and omentum majus after primary liver cancer resection and its impact on related indexes of liver. Forty patients were selected and divided into an implantation group (n = 20) and a control group (n = 20). On the first day after admission, first week after surgery, and first month after surgery, fasting venous blood was extracted from patients for measuring hematological indexes. The reduction rate of alpha fetoprotein (AFP) on the first week and first month after surgery was calculated, and moreover, drainage volume of the abdominal cavity drainage tube, length of stay after surgery, and wound healing condition were recorded. We found that levels of alanine aminotransferase, aspartate amino transferase, blood urea nitrogen, creatinine, total bilirubin, albumin, and white blood cells measured on the first week and first month after surgery, length of stay, and wound healing of patients in the two groups had no significant difference (P >0.05). Drainage volume and reduction rate of AFP of two groups were significantly different on the first week and first month after surgery (P liver cancer resection is proved to be safe as it has little impact on related indexes. © The Author(s) 2016.

  8. [Successful anesthetic management for resection of a giant hepatic hemangioma with Kasabach-Merritt syndrome using FloTrac system]. (United States)

    Wakabayashi, Saiko; Yamaguchi, Keisuke; Kugimiya, Toyoki; Inada, Eiichi


    Kasabach-Merritt syndrome (KMS) is a rare and severe coagulation disorder caused by vascular malformations within or outside the liver. It is characterized by profound thrombocytopenia, microangiopathic hemolytic anemia, and consumption coagulopathy. We successfully managed the anesthesia for a giant hemangioma resection complicated with KMS using FloTrac/Vigileo system. A 78-year-old woman (51 kg, 141 cm) was admitted for giant hemangioma with disseminated intravascular coagulation (DIC). General anesthesia was induced with sevoflurane and remifentanil. Epidural anesthesia was not induced because of coagulopathy. We evaluated arterial pressure-based cardiac output (APCO), stroke volume variation (SVV) as a predictor for fluid responsiveness, systolic blood pressure (SBP), and central venous pressure (CVP) during the operation. Prior to tumor resection, 6,000 ml of fluid was suctioned from the tumor. The increase of SVV and sudden decrease of APCO and SBP were recognized during surgical procedure. The SVV demonstrated marked changes in response to hemorrhage, and it was more sensitive than CVP change during operation. We conclude that SVV is an accurate predictor of intravascular hypovolemia, and it is a useful indicator for assessing the appropriateness and timing of applying fluid for improving circulatory stability during a giant hemoangioma resection.

  9. Hepatitis (United States)

    ... yourself against hepatitis A is by vaccination. Other ways to protect yourself include avoiding rimming and other anal and oral contact. While condom use is essential in preventing the spread of HIV, hepatitis B and other STDs, it does not ...

  10. [Optimum hepatic parenchymal dissection to prevent bile leak: a comparative study using electrosurgical and stapling devices in swine]. (United States)

    Ikeda, Tetsuo; Akahoshi, Tomohiko; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo-ichi; Morita, Masaru; Oki, Eiji; Saeki, Hiroshi; Sugimachi, Keishi; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Mimori, Koshi; Watanabe, Masayuki; Hashizume, Makoto; Maehara, Yoshihiko


    Bile leakage is a serious complication of liver resection, and its treatment is very time-consuming. In open liver resection, Glisson's sheaths are usually disconnected by ligation to the extent possible during the parenchyma dissection. However, in laparoscopic surgery, the ligation, suture, and hemostasis are more difficult than in open surgery. For this reason, in laparoscopic liver resection, liver parenchyma dissection is generally accomplished using electrosurgical or stapling devices. The purpose of this study was to verify the authenticity of electrosurgical devices attached an automatic irrigation function (AI) and stapling devices for laparoscopic liver parenchymal dissection. Four devices were used for liver parenchymal dissection in laparoscopic hepatic wedge resection, in pigs: monopolar high-frequency electric cautery attached AI (MCI) (n = 6), bipolar high-frequency electric cautery attached AI (BCI) (n = 6), bipolar tissue sealing system (LigaSure) attached AI (BSI) and an endoscopic stapling device (ECHELON FLEX ENDOPATH) (ES). In each group, burst pressures were tested using an electronic manometer, paying special attention to the location (s) of the first disruption (s). The dissected tissues were examined histologically. Pressures used in electrosurgical devices attach AI were significantly higher compared to pressures used in a ES (P automatic irrigation function are useful devices to dissect the liver parenchyma.

  11. Pedunculated Hepatic Hemangioma Masquerading as a Peritoneal Tumor. A Case Report. (United States)

    El Hajjam, Mostafa; Lacout, Alexis; Marzouqi, Mohamed Karji-Al; Lacombe, Pascal; Marcy, Pierre Yves


    Although being classically located inside the liver parenchyma, hemangiomas may occasionally develop outside the extra-hepatic capsule, thus appearing as a pedunculated mass. We report the case of a 66-year-old anal cancer female patient presenting with an asymptomatic sub-hepatic mass. Incidental diagnosis of a pedunculated hepatic hemangioma was strongly suggested by the typical imaging features on computed tomography (CT) and magnetic resonance (MR) examinations, and was confirmed by histopathological examination. Exophytic pedunculated growth is a rare and atypical feature of hepatic hemangioma. Thin contrast- enhanced sections and multiplanar CT and MR scan reformations helped to the final diagnosis of hemangioma, showing its origin from the liver edge. Surgical resection is mandatory to prevent threatening mass pedicle torsion.

  12. Adefovir dipivoxil is less expensive than lamivudine and associated with similar prognosis in patients with hepatitis B virus-related hepatocellular carcinoma after radical resection

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    Zhong JH


    Full Text Available Jian-Hong Zhong,1,* Yang Ke,1,2,* Shao-Liang Zhu,1,* Lin Wang,2 Cheng-Piao Luo,3 Wen-Feng Gong,1 Xue-Mei You,1 Liang Ma,1 Bang-De Xiang,1 Le-Qun Li1 1Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 2Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 3Department of Pathology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People’s Republic of China *These authors contributed equally to this work Aim: Lamivudine (LAM and adefovir dipivoxil (ADV are widely used in patients with hepatitis B virus (HBV-related hepatocellular carcinoma (HCC, but few studies have directly compared their therapeutic efficacy and treatment cost. This study aims to compare LAM with ADV head-to-head in these patients. Methods: We retrospectively analyzed 201 patients with HBV-related HCC who underwent radical resection and subsequently received LAM (n=155 or ADV (n=46. The two groups were compared in terms of HBV-DNA levels, liver function, antiviral resistance, recurrence-free, and overall survival, as well as antiviral medication costs. Results: Despite significant improvement in HBV-DNA and alanine aminotransferase level in the LAM group after 1 year of antiviral therapy, these parameters did not differ significantly between the two groups over the following 2 years. Incidence of antiviral resistance after 1, 2, and 3 years of antiviral treatment was significantly higher in the LAM group (19.5%, 45.7%, and 56.4% than in the ADV group (0%, 3.3%, and 14.5%; P<0.001. Overall survival at 1, 2, and 3 years after resection was similar for the LAM group (84.5%, 69.3%, and 64.6% and the ADV group (84.1%, 77.8%, and 63.4%; P=0.905. Recurrence-free survival at the three follow-up points was also similar for the LAM group (71.7%, 58.3%, and 43.9% and the ADV group (81.1%, 66.1%, and 53.0%; P=0.452. Cox regression analysis confirmed that both nucleos

  13. The preoperative alkaline phosphatase-to-platelet ratio index is an independent prognostic factor for hepatocellular carcinoma after hepatic resection. (United States)

    Yu, Ya-Qun; Li, Jun; Liao, Yan; Chen, Qian; Liao, Wei-Jia; Huang, Jian


    A simple, inexpensive, and readily available prognostic index is highly needed to accurately predict the prognosis of hepatocellular carcinoma (HCC). This study aimed to develop a simple prognostic index using routine laboratory tests, alkaline phosphatase-to-platelet count ratio index (APPRI), to predict the likelihood of postoperative survival in HCC patients.A total of 246 patients with HCC undergoing curative resection were retrospectively analyzed. Cutoff point for APPRI was calculated using receiver operating characteristic curve analysis, and then the patients were divided into the low-APPRI group (APPRI ≤ 4.0) and the high-APPRI group (APPRI > 4.0). The influences of APPRI on disease-free survival (DFS) and overall survival (OS) were tested by the Kaplan-Meier method, and multivariate analysis using Cox regression. Elevated APPRI was associated with age, cirrhosis, and aspartate aminotransferase (AST) in HCC. Univariate analysis showed that APPRI > 4.0, tumor size >6 cm, multiple tumors, Barcelona-clinic liver cancer stages B to C, and AST > 40 U/L were significant predictors of worse DFS and OS. A multivariate analysis suggested that APPRI > 4.0 was an independent factor for DFS (hazard ratio [HR] = 1.689; 95% confidence interval [CI], 1.139-2.505; P = 0.009) and OS (HR = 1.664; 95% CI, 1.123-2.466; P = 0.011). Preoperative APPRI > 4.0 was a powerful prognostic predictor of adverse DFS and OS in HCC after surgery. The APPRI may be a promising prognostic marker for HCC after surgical resection.

  14. Liver resection over the last decade

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    Wettergren, A.; Larsen, P.N.; Rasmussen, A.


    AIMS: The results after liver resection have improved over the last decade with an operative mortality rate of less than 5% in high-volume centres. The aim of the present study was to assess the perioperative outcome after hepatic resection and to assess the long-term survival after liver resection...... stay was 9 days (3-38). The most frequent complication was biliary leakage (7.8%), haemorrhage (2.8%) and hepatic insufficiency (2.8%). 30-days mortality was 1.4%. The actuarial 5-survival after hepatic resection for colorectal liver metastases and hepatocellular carcinoma was 39% and 42%, respectively...

  15. Better prognosis of hepatic resection combined with antiviral therapy for HBV-related hepatocellular carcinoma with BCLC Stage B/C. (United States)

    Wei, Qin; Tian, Huan; Luo, Huan-Xian; Zhang, Ying-Cai; Deng, Yi-Nan; Yao, Jia; Li, Hua; Chen, Gui-Hua; Yang, Yang


    Whether hepatic resection (HR) could be performed for patients with Barcelona Clinic Liver Cancer (BCLC) B/C stage hepatocellular carcinoma (HCC) is controversial, and the safety and clinical value of HR combined with antiviral therapy for hepatitis B virus (HBV)-related HCC with BCLC-B/C stage remain to be investigated. We retrospectively evaluated 126 patients with BCLC stage B/C HCC who underwent HR. These patients were divided into the antiviral group (Group A, n = 86) and the control group (Group B, n = 40). The operative indications and prognosis of 126 patients were analyzed. The 1-year, 3-year, and 5-year disease-free survival (DFS) rates for Group A and Group B were 55.4%, 36.1%, 33.7% and 53.8%, 28.2%, 23.1%, respectively. The corresponding overall survival (OS) rates for the two groups were 89.2%, 61.4%, 45.8% and 82.1%, 48.7%, 33.3%, respectively. The DFS and OS for Group A were better than for Group B (p = 0.013, and p = 0.038, respectively). Antiviral therapy was an independent protective factor of late tumor recurrence [hazard ratio (HR) = 0.391, 95% confidence interval (CI): 0.190-0.806, p = 0.011] but not of early tumor recurrence. It is safe and feasible to perform HR combined with antiviral therapy for HBV-related HCC with BCLC stage B/C. Copyright © 2016. Published by Elsevier Taiwan.

  16. Pre-, peri-, and postoperative oral administration of branched-chain amino acids for primary liver cancer patients for hepatic resection: a systematic review. (United States)

    Meng, Jianyuan; Zhong, Jianhong; Zhang, Hanguang; Zhong, Wenhe; Huang, Zhihong; Jin, Yuanming; Xu, Jing


    Pre-, peri-, and postoperative oral administration of branched-chain amino acids (BCAA) to patients with primary liver cancer (PLC) during hepatic resection (HR) remains controversial. The aim of this systematic review was to evaluate the efficacy and safety of this practice. Seven literature databases were systematically searched for randomized controlled trials (RCTs) that reported pre-, peri-, and postoperative oral administration of BCAA for PLC patients during HR. Three RCTs were included in a meta-analysis in which risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated. The 2 groups showed similar recurrence rates (RR = 1.03, 95% CI 0.78 to 1.36) and similar overall survival (RR = 0.91, 95% CI 0.71 to 1.18). Adverse events related to oral administration of BCAA were more than the control group, including nausea, vomiting, diarrhea, abdominal distension, abdominal pain, and hypertension. However, all adverse reactions disappeared after symptomatic treatment. The available evidence suggests that although pre-, peri-, and postoperative oral BCAA for patients with PLC is safe, it is of questionable clinical value. More RCTs are warranted to explore this question definitively.

  17. The effect of parenteral administration of copper on the weight gain, erithrograme and the hepatic and renal parenchymas in crossbred (Zebu x European confined bovines/ Efeito da administração parenteral de cobre sobre o ganho de peso, eritrograma e parênquimas, hepático e renal, em bovinos mestiços (Zebu x Europeu confinados

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    Pedro Paulo da Cunha Gonçalves


    Full Text Available This study evaluated the effect of the parenteral administration of etilenodinitrile tetracetate of calcium and copper on the weight gain, eritrograma and the hepatic and renal parenchymas in confined bovines, using 200 animals, distributed in four groups (G of 50 (I, II, III and IV. The groups I and II were constituted by bovines with the age of 24 months and the groups III and IV by animals of 12 months, which GI was given 100mg of active copper and GIII 75mg, both by subcutaneous way by the beginning of the study. The other groups were used as the control. The weight measure of the animals of all groups was done from 28 to 28 days during the 112 days of confinement. It was done the eritrograma in ten bovines of each group and the dosage of the hepatic and renal concentration of copper and the hystological evaluation, in the animals of the groups I and II. The values found on the eritrograma showed normality and the hepatic and renal concentrations of copper in bovines with the age of 24 months showed depletion levels. It was not verified differences about the hystological evaluation between the groups I and II. There was significant difference on the weight gain media between the groups I and II. On the groups III and IV, it was not observed difference over the weight gain media.Nesse estudo avaliou-se o efeito da administração parenteral de etilenodinitrilo tetracetato de cálcio e cobre sobre o ganho de peso, eritrograma e parênquimas, hepático e renais, em bovinos confinados, utilizando-se 200 animais, alocados em quatro grupos (G de 50 (I, II, III e IV. Os grupos I e II foram compostos por bovinos com 24 meses e os grupos III e IV por animais de doze meses, sendo que o GI recebeu 100 mg de cobre ativo e o GIII 75 mg, ambos por via subcutânea ao início do estudo. Os demais grupos foram utilizados como controle. A pesagem dos animais de todos os grupos foi realizada a cada 28 dias durante os 112 dias de confinamento. Realizou-se o

  18. Resection of Nonalcoholic Steatohepatitis-Associated Hepatocellular Carcinoma: A Western Experience

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    Brian Shrager


    Full Text Available Introduction. Hepatocellular carcinoma is now known to arise in association with nonalcoholic steatohepatitis. The aim of this study is to examine the clinicopathological features of this entity using liver resection cases at a large Western center. Methods. We retrospectively reviewed all cases of partial liver resection for hepatocellular carcinoma over a 10-year period. We included for the purpose of this study patients with histological evidence of nonalcoholic steatohepatitis and excluded patients with other chronic liver diseases such as viral hepatitis and alcoholic liver disease. Results. We identified 9 cases in which malignancy developed against a parenchymal background of histologically-active nonalcoholic steatohepatitis. The median age at diagnosis was 58 (52–82 years, and 8 of the patients were male. Median body mass index was 30.2 (22.7–39.4 kg/m2. Hypertension was present in 77.8% of the patients and diabetes mellitus, obesity, and hyperlipidemia in 66.7%, respectively. The background liver parenchyma was noncirrhotic in 44% of the cases. Average tumor diameter was 7.0±4.8 cm. Three-fourths of the patients developed recurrence within two years of resection, and 5-year survival was 44%. Conclusion. Hepatocellular carcinoma may arise in the context of nonalcoholic steatohepatitis, often before cirrhosis has developed. Locally advanced tumors are typical, and long-term failure rate following resection is high.

  19. 3D printing model of the intrahepatic vessels for navigation during anatomical resection of hepatocellular carcinoma. (United States)

    Kuroda, Shintaro; Kobayashi, Tsuyoshi; Ohdan, Hideki


    The 3D printing model of the intrahepatic vessels and regional anatomy are often used for navigation surgery. Here, we report the use of the model for anatomical resection of hepatocellular carcinoma. Case 1: A tumor, 31mm in diameter, was located in segment 7 of the liver. Using the 3D model, we identified the regional Glissonian pedicle and performed resection of segment 7. Case 2: The tumor was located in segment 4/8 and involved the middle hepatic vein. Radical resection of segment 4 and of the ventral area of the right anterior section was performed using the 3D model. The positional relationship between the intrahepatic vessels and liver tumors is the most important factor for anatomical resection for hepatocellular carcinoma. Therefore our simplified 3D model of intrahepatic vessels without liver parenchyma is sufficient for effective guidance during surgery and has the advantage of being feasible to use for all HCC surgeries. Use of 3D printed models might have many merits and contribute to the great improvement of the surgical quality. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Adjuvant Hepatic Arterial Infusion Chemotherapy After Resection for Pancreatic Cancer Using Coaxial Catheter-Port System Compared with Conventional System

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    Hashimoto, Aya; Tanaka, Toshihiro, E-mail: [Nara Medical University, Department of Radiology (Japan); Sho, Masayuki [Nara Medical University, Department of Surgery (Japan); Nishiofuku, Hideyuki; Masada, Tetsuya; Sato, Takeshi; Marugami, Nagaaki [Nara Medical University, Department of Radiology (Japan); Anai, Hiroshi [Nara City Hospital, Department of Radiology (Japan); Sakaguchi, Hiroshi [Nara Prefectural Western Medical Center, Department of Radiology (Japan); Kanno, Masatoshi [Nara Medical University, Oncology Center (Japan); Tamamoto, Tetsuro; Hasegawa, Masatoshi [Nara Medical University, Department of Radiation Oncology (Japan); Nakajima, Yoshiyuki [Nara Medical University, Department of Surgery (Japan); Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)


    PurposePrevious reports have shown the effectiveness of adjuvant hepatic arterial infusion chemotherapy (HAIC) in pancreatic cancer. However, percutaneous catheter placement is technically difficult after pancreatic surgery. The purpose of this study was to evaluate the feasibility and outcome of HAIC using a coaxial technique compared with conventional technique for postoperative pancreatic cancer.Materials and Methods93 consecutive patients who received percutaneous catheter-port system placement after pancreatectomy were enrolled. In 58 patients from March 2006 to August 2010 (Group A), a conventional technique with a 5-Fr indwelling catheter was used and in 35 patients from September 2010 to September 2012 (Group B), a coaxial technique with a 2.7-Fr coaxial catheter was used.ResultsThe overall technical success rates were 97.1 % in Group B and 86.2 % in Group A. In cases with arterial tortuousness and stenosis, the success rate was significantly higher in Group B (91.7 vs. 53.8 %; P = 0.046). Fluoroscopic and total procedure times were significantly shorter in Group B: 14.7 versus 26.7 min (P = 0.001) and 64.8 versus 80.7 min (P = 0.0051), respectively. No differences were seen in the complication rate. The 1 year liver metastasis rates were 9.9 % using the conventional system and 9.1 % using the coaxial system (P = 0.678). The overall median survival time was 44 months. There was no difference in the survival period between two systems (P = 0.312).ConclusionsThe coaxial technique is useful for catheter placement after pancreatectomy, achieving a high success rate and reducing fluoroscopic and procedure times, while maintaining the safety and efficacy for adjuvant HAIC in pancreatic cancer.

  1. Compressive stenosis of the left hepatic vein as a pathogenesis of postresectional liver failure: a case report

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    Ninomiya Mizuki


    Full Text Available Abstract Introduction Postresectional liver failure (PLF is a devastating and fatal complication of major hepatic resection, and we do not have a full understanding of the pathogenic mechanisms involved. No reliable treatment other than liver transplantation currently exists for PLF. Case presentation A 46-year-old Japanese man experienced PLF after an extended right hepatectomy for liver malignancy. Seven months after surgery, the patient's Model for End-Stage Liver Disease (MELD score had reached 23. Doppler ultrasound study and three-dimensional computed tomography images showed a stenosed left hepatic vein compressed by surrounding hypertrophied hepatic parenchyma. Transluminal balloon angioplasty and stent placement therapy were conducted eight months after surgery. The pressure gradient between the hepatic vein and right atrium decreased from 13 to 3 mmHg after stent placement. Thereafter, the patient recovered. Conclusion Hepatic venous compression by surrounding hypertrophied hepatic parenchyma might, at least in part, be associated with the occurrence of PLF. Surgeons should bear this possibility in mind when confronted with cases of PLF, as early diagnosis and stent placement improves patients' chances of recovery.

  2. A phase III, randomized, controlled, superiority trial evaluating the fibrin pad versus standard of care in controlling parenchymal bleeding during elective hepatic surgery. (United States)

    Koea, Jonathan B; Batiller, Jonathan; Patel, Babahai; Shen, Jessica; Hammond, Jeffrey; Hart, James; Fischer, Craig; Garden, O James


    Haemostasis after liver resection may be difficult to achieve as a result of the presence of challenging bleeding, the anatomic landscape of the liver and the quality of tissue making up the hepatic parenchyma. The fibrin pad (FP) is a topical absorbable haemostat designed to be effective in a variety of tissues and across multiple bleeding intensities. This is the first clinical trial to evaluate the hemostat's safety and effectiveness in controlling bleeding during elective hepatic resection. This prospective, randomized, controlled superiority trial enrolled 104 subjects undergoing elective hepatectomy in 5 countries. After parenchymal transection, subjects with an appropriately defined target bleeding site (TBS) were stratified according to the type of hepatic parenchyma and immediately randomized 1:1: FP versus Standard of Care (SoC). SoC comprised manual compression with the use of an approved topical absorbable haemostat. The primary endpoint was haemostasis at 4 min from identification of the TBS, with no re-bleeding requiring re-treatment prior to abdominal closure. Results were stratified for both normal and abnormal (steatosis or cirrhosis) hepatic parenchyma. All subjects were followed for 60 days post-operatively. The intent-to-treat (ITT) analysis showed an overall treatment difference of 53.0% (P haemostasis at 4 min with no re-bleeding requiring treatment up to wound closure. The per protocol analysis showed an overall treatment difference of 65.7% (P haemostasis during hepatic surgery. The success rate of achieving haemostasis with a FP remained high compared with the SOC group, especially in steatotic or cirrhotic liver tissue where the control success rates diminish. In addition, FP treatment of hepatic parenchymal surfaces may reduce the risk of post-operative biliary and fluid collections. © 2012 International Hepato-Pancreato-Biliary Association.

  3. É possível diminuir o sangramento em hepatectomias sem a realização de exclusão vascular total ou parcial?: Resultados do uso de radiofrequência bipolar com agulhas resfriadas Is it possible to reduce the bleeding in hepatic resections without conducting total or partial vascular exclusion?: Results of the use of bipolar radiofrequency with cold needles

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    José Artur Sampaio


    exames aos parâmetros pré-operatórios ao final do 1o mês. CONCLUSÃO: É possível, factível e válida a utilização de agulhas de radiofrequência para a realização de hepatectomias, mesmo maiores, reduzindo o sangramento.BACKGROUND: Although the resection is the chosen procedure in the therapeutic treatment of liver malign lesions, the bleeding represents a factor of morbidity with a great impact in the hepatic surgery. With the means of minimizing this complication, several technological options have been utilized, being radiofrequency more recently among them, allowing the procedure to be realized with smaller incisions, without the need of vascular clamping, with minimum hepatic dissection, or bleeding. AIM: To present the results of the use of a new technique of hepatic parenchyma resection through parallel needles of bipolar radiofrequency developed by the authors themselves, verifying the impact in the trans-operation bleeding of patients subjected to hepatectomies. METHODS: Sixty patients were submitted to hepatic resection through the use of bipolar radiofrequency. The pre-operation bleeding was evaluated through the medication of the collected volume in the vacuum and by the weight difference in the compresses utilized during the procedure. All cases were monitored in their hepatocitary function through laboratory tests during the first week of the post-operation. RESULTS: The hepatic resections were realized with the mean of 87 minutes, mean incision size of 14 cm and mean bleeding of 58 ml. None of the patients received blood transfusion or derivatives. Central venous catheters were not utilized. All patients obtained fast anesthetic recuperation, leaving the recuperation room to the ward in less than 12 hours. The post-operation drainage was noted down until the drain removal occurring in all patients. The mean hospitalization time was of 3,2 days. After the elevation peak of the hepatic function tests in the first three days, all patients presented

  4. Cirugías Conservadoras del Parénquima Pancreático / Converving Parenchyma Pancreatic Surgeries

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    Giunippero Alejandro


    Full Text Available After a classical pancreatic resection the risk of endocrine and exocrine insufficiency is in the order of : 8-20 % and 20-50 % respectively 1. Conservative surgery of pancreatic parenchyma decrease the risk of insufficiency and represents the clearest benefits of this type of surgery. They are optional techniques that help the surgeon to evaluate the decision which is best for each patient and each type of lesion. Among them we will approach three of them: uncinate process resection, enucleation, median pancreatectomy.

  5. Use of Cytokeratin-19 Concentration to Assess Early Recurrence and Prognosis of Hepatitis B Virus-Related Hepatocellular Carcinoma following Radical Resection in Patients with a Low Serum Alpha-Fetoprotein Concentration.

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    Zu-Sen Wang

    Full Text Available Cytokeratin 19 (CK-19 is a prognostic indicator of recurrence and metastasis of hepatocellular carcinoma (HCC following radical resection. To investigate the role of CK-19 in assessment of early recurrence and prognosis in patients with hepatitis B virus (HBV-related HCC following radical resection. In total, 235 patients with HBV-related HCC (age, 15-82 years; mean age, 54 ± 10 years undergoing radical resection were screened for inclusion from January 2005 to December 2010. Malignant tissues and adjacent non-malignant tissues were sampled during surgery, and CK-19 and Ki-67 expression was determined by tissue microarray and immunohistochemistry. CK-19 mRNA levels in 30 randomly selected frozen HCC specimens were examined by reverse transcription polymerase chain reaction from January 2011 to June 2011. Correlations of CK-19 and Ki-67 expression with tumor recurrence, metastasis, disease-free survival (DFS, and overall survival (OS were analyzed. Elevated CK-19 expression was correlated with early recurrence (P = 0.001, shorter DFS (P = 0.001, and reduced OS (P = 0.010. CK-19 expression was correlated with the Ki-67 index (P = 0.037, histological differentiation (P = 0.016, focal number (P = 0.044, and blood vessel tumor embolism (P = 0.002. Patients with metastasis within 1 year exhibited stronger CK-19 expression than did patients without metastasis (P < 0.05. Furthermore, early recurrence was associated with elevated CK-19 mRNA levels (χ2 = 5.761, P = 0.016.When confirmed by a low alpha-fetoprotein concentration (<400 μg/L, CK-19 expression in surgical biopsy specimens taken from patients with HCC during radical resection is an additional valuable indicator of early recurrence, distant metastasis, and poor prognosis in HBV-positive patients.

  6. Woodchuck hepatitis virus-induced carcinoma as a relevant natural model for therapy of human hepatoma. (United States)

    Gouillat, C; Manganas, D; Zoulim, F; Vitrey, D; Saguier, G; Guillaud, M; Ain, J F; Duque-Campos, R; Jamard, C; Praves, M; Trepo, C


    Eastern American woodchuck (Marmota monax), naturally infected with woodchuck hepatitis virus, a virus similar to human hepatitis B virus, develops liver cancer with a high prevalence. The aim of this work was to assess Marmota monax as a model of human hepatocellular carcinoma, especially to assess new potential adjuvant therapies after surgical resection. Forty-four woodchuck hepatitis virus-infected animals were regularly screened by ultrasound examination from the age of 18 months and for a 30-month period. One or more liver tumors were diagnosed in 31 animals (70%). Five of them with multifocal tumor or poor general status were considered unsuitable for surgery. The other 26 were operated on. At laparotomy no tumor was found in three. The 18 liver tumors studied were hepatocellular carcinomas, grossly and microscopically similar to human hepatocellular carcinoma. Peritumoral parenchyma studied in 13 specimens was always non-cirrhotic but adequate staining demonstrated patterns of fibrosis in four cases. Clear evidence of chronic active hepatitis, periportal hepatitis and steatosis were demonstrated in five, seven and one of the 13 specimens, respectively. Tumors were treated by tumorectomy in eight animals, by alcoholization in seven and by laser photocoagulation in one. A simple tumor biopsy was performed in the other seven. Ten animals died postoperatively. All the survivors in the tumorectomy group died from tumor recurrence within 10-18 months after surgery. It is concluded that woodchuck hepatitis virus-induced liver carcinoma is a natural model of human hepatocellular carcinoma with similar pathology and natural history, including early ultrasonic detection and tumor recurrence after resection. Tumor excision is feasible in this animal model, which now provides the basis for assessment of new potential adjuvant therapies for human hepatocellular carcinoma in an attempt to reduce the high recurrence rate after surgical resection in humans.

  7. [Laparoscopic liver resection: lessons learned after 132 resections]. (United States)

    Robles Campos, Ricardo; Marín Hernández, Caridad; Lopez-Conesa, Asunción; Olivares Ripoll, Vicente; Paredes Quiles, Miriam; Parrilla Paricio, Pascual


    After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. To report our experience in laparoscopic liver resections (LLRs). Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  8. Resection of Perihilar Cholangiocarcinoma. (United States)

    Hartog, Hermien; Ijzermans, Jan N M; van Gulik, Thomas M; Groot Koerkamp, Bas


    Perihilar cholangiocarcinoma presents at the biliary and vascular junction of the hepatic hilum with a tendency to extend longitudinally into segmental bile ducts. Most patients show metastatic or unresectable disease at time of presentation or surgical exploration. In patients eligible for surgical resection, challenges are to achieve negative bile duct margins, adequate liver remnant function, and adequate portal and arterial inflow to the liver remnant. Surgical treatment is characterized by high rates of postoperative morbidity and mortality. This article reviews the various strategies and techniques, the role of staging laparoscopy, intraoperative frozen section, caudate lobectomy, and vascular reconstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. LICC: L-BLP25 in patients with colorectal carcinoma after curative resection of hepatic metastases--a randomized, placebo-controlled, multicenter, multinational, double-blinded phase II trial

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    Schimanski Carl


    Full Text Available Abstract Background 15-20% of all patients initially diagnosed with colorectal cancer develop metastatic disease and surgical resection remains the only potentially curative treatment available. Current 5-year survival following R0-resection of liver metastases is 28-39%, but recurrence eventually occurs in up to 70%. To date, adjuvant chemotherapy has not improved clinical outcomes significantly. The primary objective of the ongoing LICC trial (L-BLP25 In Colorectal Cancer is to determine whether L-BLP25, an active cancer immunotherapy, extends recurrence-free survival (RFS time over placebo in colorectal cancer patients following R0/R1 resection of hepatic metastases. L-BLP25 targets MUC1 glycoprotein, which is highly expressed in hepatic metastases from colorectal cancer. In a phase IIB trial, L-BLP25 has shown acceptable tolerability and a trend towards longer survival in patients with stage IIIB locoregional NSCLC. Methods/Design This is a multinational, phase II, multicenter, randomized, double-blind, placebo-controlled trial with a sample size of 159 patients from 20 centers in 3 countries. Patients with stage IV colorectal adenocarcinoma limited to liver metastases are included. Following curative-intent complete resection of the primary tumor and of all synchronous/metachronous metastases, eligible patients are randomized 2:1 to receive either L-BLP25 or placebo. Those allocated to L-BLP25 receive a single dose of 300 mg/m2 cyclophosphamide (CP 3 days before first L-BLP25 dose, then primary treatment with s.c. L-BLP25 930 μg once weekly for 8 weeks, followed by s.c. L-BLP25 930 μg maintenance doses at 6-week (years 1&2 and 12-week (year 3 intervals unless recurrence occurs. In the control arm, CP is replaced by saline solution and L-BLP25 by placebo. Primary endpoint is the comparison of recurrence-free survival (RFS time between groups. Secondary endpoints are overall survival (OS time, safety, tolerability, RFS/OS in MUC-1 positive

  10. Pulmonary Endogenous Fluorescence Allows the Distinction of Primary Lung Cancer from the Perilesional Lung Parenchyma.

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    Lucile Gust

    Full Text Available Pre-therapeutic pathological diagnosis is a crucial step of the management of pulmonary nodules suspected of being non small cell lung cancer (NSCLC, especially in the frame of currently implemented lung cancer screening programs in high-risk patients. Based on a human ex vivo model, we hypothesized that an embedded device measuring endogenous fluorescence would be able to distinguish pulmonary malignant lesions from the perilesional lung tissue.Consecutive patients who underwent surgical resection of pulmonary lesions were included in this prospective and observational study over an 8-month period. Measurements were performed back table on surgical specimens in the operative room, both on suspicious lesions and the perilesional healthy parenchyma. Endogenous fluorescence signal was characterized according to three criteria: maximal intensity (Imax, wavelength, and shape of the signal (missing, stable, instable, photobleaching.Ninety-six patients with 111 suspicious lesions were included. Final pathological diagnoses were: primary lung cancers (n = 60, lung metastases of extra-thoracic malignancies (n = 27 and non-tumoral lesions (n = 24. Mean Imax was significantly higher in NSCLC targeted lesions when compared to the perilesional lung parenchyma (p<0,0001 or non-tumoral lesions (p<0,0001. Similarly, photobleaching was more frequently found in NSCLC than in perilesional lung (p<0,0001, or in non-tumoral lesions (p<0,001. Respective associated wavelengths were not statistically different between perilesional lung and either primary lung cancers or non-tumoral lesions. Considering lung metastases, both mean Imax and wavelength of the targeted lesions were not different from those of the perilesional lung tissue. In contrast, photobleaching was significantly more frequently observed in the targeted lesions than in the perilesional lung (p≤0,01.Our results demonstrate that endogenous fluorescence applied to the diagnosis of lung nodules allows

  11. Lesions of the segmental and lobar hepatic ducts. (United States)

    Longmire, W P; Tompkins, R K


    Despite reports to the contrary, unobstructed drainage of 50% of an otherwise normal liver through either the right or left uninfected hepatic duct is adequate to restore normal liver function, even if the obstructed lobe remains in place. An undrained liver lobe, if present, may require no further treatment. As long as it is completely obstructed and uninfected, it will undergo a progressive asymptomatic atrophy. Cholangitis invariably develops behind a partial lobar ductal obstruction, producing jaundice, pruritis, and fever. Unless unobstructed, uninfected biliary flow can be achieved through a segmental or lobar duct, it is better that the duct be completely obstructed and the affected liver parenchyma allowed to atrophy, provided there is normal biliary flow from the residual 50% of liver. This concept is important in the management of injured anomalous segmental or lobar hepatic duct and in the palliative treatment of bile duct carcinoma. Localized intrahepatic infections communicating with abnormal biliary ducts will require hepatic resection of the infected parenchyma and ducts for cure. The abnormality may be saccular dilatation of the intrahepatic ductal system with abscess formation or intrahepatic abscess associated with stenosis of the ductal system from trauma to the duct, to the duct and liver, or to retained intrahepatic stones. Diffusely situated intrahepatic abscesses secondary to ductal abnormalities can be treated with systemic antibiotics, local drainage of a dmoninant abscess, and efforts to improve biliary drainage. Images Fig. 4. Fig. 5. Fig. 6. Fig. 8. Fig. 9. Fig. 10. Figs. 11A and B Figs. 12A and B. Fig. 13. Fig. 14. Fig. 15. Fig. 16. Fig. 17. PMID:1180585

  12. Experimental Evidence of Mechanical Isotropy in Porcine Lung Parenchyma

    Directory of Open Access Journals (Sweden)

    Benjamin Weed


    Full Text Available Pulmonary injuries are a major source of morbidity and mortality associated with trauma. Trauma includes injuries associated with accidents and falls as well as blast injuries caused by explosives. The prevalence and mortality of these injuries has made research of pulmonary injury a major priority. Lungs have a complex structure, with multiple types of tissues necessary to allow successful respiration. The soft, porous parenchyma is the component of the lung which contains the alveoli responsible for gas exchange. Parenchyma is also the portion which is most susceptible to traumatic injury. Finite element simulations are an important tool for studying traumatic injury to the human body. These simulations rely on material properties to accurately recreate real world mechanical behaviors. Previous studies have explored the mechanical properties of lung tissues, specifically parenchyma. These studies have assumed material isotropy but, to our knowledge, no study has thoroughly tested and quantified this assumption. This study presents a novel methodology for assessing isotropy in a tissue, and applies these methods to porcine lung parenchyma. Briefly, lung parenchyma samples were dissected so as to be aligned with one of the three anatomical planes, sagittal, frontal, and transverse, and then subjected to compressive mechanical testing. Stress-strain curves from these tests were statistically compared by a novel method for differences in stresses and strains at percentages of the curve. Histological samples aligned with the anatomical planes were also examined by qualitative and quantitative methods to determine any differences in the microstructural morphology. Our study showed significant evidence to support the hypothesis that lung parenchyma behaves isotropically.

  13. Resection of Segments 4, 5 and 8 for a Cystic Liver Tumor Using the Double Liver Hanging Maneuver

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    Atsushi Nanashima


    Full Text Available To achieve complete anatomic central hepatectomy for a large tumor compressing surrounding vessels, transection by an anterior approach is preferred but a skillful technique is necessary. We propose the modified technique of Belghiti’s liver hanging maneuver (LHM. The case was a 77-year-old female with a 6-cm liver cystic tumor in the central liver compressing hilar vessels and the right hepatic vein. At the hepatic hilum, the spaces between Glisson’s pedicle and hepatic parenchyma were dissected, which were (1 the space between the right anterior and posterior Glisson pedicles and (2 the space adjacent to the umbilical Glisson pedicle. Two tubes were repositioned in each space and ‘double LHM’ was possible at the two resected planes of segments 4, 5 and 8. Cut planes were easily and adequately obtained and the compressed vessels were secured. Double LHM is a useful surgical technique for hepatectomy for a large tumor located in the central liver.

  14. Augmented reality in a tumor resection model. (United States)

    Chauvet, Pauline; Collins, Toby; Debize, Clement; Novais-Gameiro, Lorraine; Pereira, Bruno; Bartoli, Adrien; Canis, Michel; Bourdel, Nicolas


    Augmented Reality (AR) guidance is a technology that allows a surgeon to see sub-surface structures, by overlaying pre-operative imaging data on a live laparoscopic video. Our objectives were to evaluate a state-of-the-art AR guidance system in a tumor surgical resection model, comparing the accuracy of the resection with and without the system. Our system has three phases. Phase 1: using the MRI images, the kidney's and pseudotumor's surfaces are segmented to construct a 3D model. Phase 2: the intra-operative 3D model of the kidney is computed. Phase 3: the pre-operative and intra-operative models are registered, and the laparoscopic view is augmented with the pre-operative data. We performed a prospective experimental study on ex vivo porcine kidneys. Alginate was injected into the parenchyma to create pseudotumors measuring 4-10 mm. The kidneys were then analyzed by MRI. Next, the kidneys were placed into pelvictrainers, and the pseudotumors were laparoscopically resected. The AR guidance system allows the surgeon to see tumors and margins using classical laparoscopic instruments, and a classical screen. The resection margins were measured microscopically to evaluate the accuracy of resection. Ninety tumors were segmented: 28 were used to optimize the AR software, and 62 were used to randomly compare surgical resection: 29 tumors were resected using AR and 33 without AR. The analysis of our pathological results showed 4 failures (tumor with positive margins) (13.8%) in the AR group, and 10 (30.3%) in the Non-AR group. There was no complete miss in the AR group, while there were 4 complete misses in the non-AR group. In total, 14 (42.4%) tumors were completely missed or had a positive margin in the non-AR group. Our AR system enhances the accuracy of surgical resection, particularly for small tumors. Crucial information such as resection margins and vascularization could also be displayed.

  15. Myofibroblasts are increased in the lung parenchyma in asthma.

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    Stacey R Boser

    Full Text Available Increased airway smooth muscle is observed in large and small airways in asthma. Semi-quantitative estimates suggest that cells containing alpha smooth muscle actin (α-SMA are also increased in the lung parenchyma. This study quantified and characterized α-SMA positive cells (α-SMA+ in the lung parenchyma of non-asthmatic and asthmatic individuals.Post-mortem sections of peripheral lung from cases of fatal asthma (FA, persons with asthma dying of non-respiratory causes (NFA and non-asthma control subjects (NAC were stained for α-SMA, quantified using point-counting and normalised to alveolar basement membrane length and interstitial area.α-SMA+ fractional area was increased in alveolar parenchyma in both FA (14.7 ± 2.8% of tissue area and NFA (13.0 ± 1.2%, compared with NAC (7.4 ± 2.4%, p < 0.05 The difference was greater in upper lobes compared with lower lobes (p < 0.01 in both asthma groups. Similar changes were observed in alveolar ducts and alveolar walls. The electron microscopic features of the α-SMA+ cells were characteristic of myofibroblasts.We conclude that in asthma there is a marked increase in α-SMA+ myofibroblasts in the lung parenchyma. The physiologic consequences of this increase are unknown.


    Directory of Open Access Journals (Sweden)

    Laura Cudillo


    Liver histology is characterized by T cell infiltrating the parenchyma as reported in acute hepatitis. Recently in HAA it has been demonstrated intrahepatic  and blood lymphocytes with  T cell repertoire similar to that of confirmed viral acute hepatitis. The expanded T cell clones return to a normal distribution after response to immunosuppressive treatment, suggesting the antigen or T cell clearance. Therapeutic options are the same as acquired aplastic anemia.

  17. Photoacoustic tomography of human hepatic malignancies using intraoperative indocyanine green fluorescence imaging.

    Directory of Open Access Journals (Sweden)

    Akinori Miyata

    Full Text Available Recently, fluorescence imaging following the preoperative intravenous injection of indocyanine green has been used in clinical settings to identify hepatic malignancies during surgery. The aim of this study was to evaluate the ability of photoacoustic tomography using indocyanine green as a contrast agent to produce representative fluorescence images of hepatic tumors by visualizing the spatial distribution of indocyanine green on ultrasonographic images. Indocyanine green (0.5 mg/kg, intravenous was preoperatively administered to 9 patients undergoing hepatectomy. Intraoperatively, photoacoustic tomography was performed on the surface of the resected hepatic specimens (n = 10 under excitation with an 800 nm pulse laser. In 4 hepatocellular carcinoma nodules, photoacoustic imaging identified indocyanine green accumulation in the cancerous tissue. In contrast, in one hepatocellular carcinoma nodule and five adenocarcinoma foci (one intrahepatic cholangiocarcinoma and 4 colorectal liver metastases, photoacoustic imaging delineated indocyanine green accumulation not in the cancerous tissue but rather in the peri-cancerous hepatic parenchyma. Although photoacoustic tomography enabled to visualize spatial distribution of ICG on ultrasonographic images, which was consistent with fluorescence images on cut surfaces of the resected specimens, photoacoustic signals of ICG-containing tissues decreased approximately by 40% even at 4 mm depth from liver surfaces. Photoacoustic tomography using indocyanine green also failed to identify any hepatocellular carcinoma nodules from the body surface of model mice with non-alcoholic steatohepatitis. In conclusion, photoacoustic tomography has a potential to enhance cancer detectability and differential diagnosis by ultrasonographic examinations and intraoperative fluorescence imaging through visualization of stasis of bile-excreting imaging agents in and/or around hepatic tumors. However, further technical

  18. Liver resection for non-cirrhotic hepatocellular carcinoma in south ...

    African Journals Online (AJOL)

    Background. We describe the clinicopathologic features and outcome of South African patients who have undergone hepatic resection for hepatocellular carcinoma (HCC) arising in a non-cirrhotic liver. Methods. We utilised the prospective liver resection database in the Surgical Gastroenterology Unit at Groote Schuur ...

  19. A new boundary correction method for lung parenchyma (United States)

    Liang, Junfang; Jiang, Huiqin; Ma, Ling; Liu, Yumin; Toshiya, Nakaguchi


    In order to repair the boundary depressions caused by juxtapleural nodules and improve the lung segmentation accuracy, we propose a new boundary correction method for lung parenchyma. Firstly, the top-hat filter is used to enhance the image contrast; Secondly, we employ the Ostu algorithm for image binarization; Thirdly, the connected component labeling algorithm is utilized to remove the main trachea; Fourthly, the initial mask image is obtained by morphological region filling algorithm; Fifthly, the boundary tracing algorithm is applied to extract the initial lung contour; Afterwards, we design a sudden change degree algorithm to modify the initial lung contour; Finally, the complete lung parenchyma image is obtained. The novelty is that sudden change degree algorithm can detect the inflection points more accurately than other methods, which contributes to repairing lung contour efficiently. The experimental results show that the proposed method can incorporate the juxtapleural nodules into the lung parenchyma effectively, and the precision is increased by 6.46% and 2.72% respectively compared with the other two methods, providing favorable conditions for the accurate detection of pulmonary nodules and having important clinical value.

  20. A tree-parenchyma coupled model for lung ventilation simulation. (United States)

    Pozin, Nicolas; Montesantos, Spyridon; Katz, Ira; Pichelin, Marine; Vignon-Clementel, Irene; Grandmont, Céline


    In this article, we develop a lung ventilation model. The parenchyma is described as an elastic homogenized media. It is irrigated by a space-filling dyadic resistive pipe network, which represents the tracheobronchial tree. In this model, the tree and the parenchyma are strongly coupled. The tree induces an extra viscous term in the system constitutive relation, which leads, in the finite element framework, to a full matrix. We consider an efficient algorithm that takes advantage of the tree structure to enable a fast matrix-vector product computation. This framework can be used to model both free and mechanically induced respiration, in health and disease. Patient-specific lung geometries acquired from computed tomography scans are considered. Realistic Dirichlet boundary conditions can be deduced from surface registration on computed tomography images. The model is compared to a more classical exit compartment approach. Results illustrate the coupling between the tree and the parenchyma, at global and regional levels, and how conditions for the purely 0D model can be inferred. Different types of boundary conditions are tested, including a nonlinear Robin model of the surrounding lung structures. Copyright © 2017 John Wiley & Sons, Ltd.

  1. CD44 variant 9 is a potential biomarker of tumor initiating cells predicting survival outcome in hepatitis C virus-positive patients with resected hepatocellular carcinoma. (United States)

    Kakehashi, Anna; Ishii, Naomi; Sugihara, Eiji; Gi, Min; Saya, Hideyuki; Wanibuchi, Hideki


    This study investigated whether the expression of CD44 variant 9 (CD44v9) might be a functional marker of tumor-initiating stem-like cells in primary hepatocellular carcinomas (HCCs) of hepatitis C virus (HCV)(+) patients and provide an indicator of patient survival, as well as associated mechanisms. A total of 90 HCV(+) HCC patients who underwent surgery from 2006 to 2011 were enrolled and monitored for 2-8 years. Expression of CD44v9 was validated immunohistochemically in all HCCs, followed by comparative proteome, survival, and clinicopathological analyses. CD44 variant 8--10 was further evaluated in diethylnitrosamine-induced HCCs of C57Bl/6J mice. Focally localized CD44v(+) cells with a membranous staining pattern were detected in human HCV(+) and mouse HCCs. CD44v9(+) cells of HCCs were predominantly negative for Ki67 and P-p38, indicating decrease of cell proliferation in the CD44v9(+) tumor cell population, likely to be related to suppression of intracellular oxidative stress due to activation of Nrf2-mediated signaling, DNA repair, and inhibition of xenobiotic metabolism. CD44v9 IHC evaluation in 90 HCV(+) HCC cases revealed that positive expression was significantly associated with poor overall and recurrence-free survival, a younger age, poor histological differentiation of HCCs, and high alkaline phosphatase levels compared with patients with negative expression. CD44v9 is concluded to be a potential biomarker of tumor-initiating stem-like cells and a prognostic marker in HCV(+) HCC patients associated with Nrf2-mediated resistance to oxidative stress. © 2016 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

  2. The metastatic infiltration at the metastasis/brain parenchyma-interface is very heterogeneous and has a significant impact on survival in a prospective study (United States)

    Siam, Laila; Bleckmann, Annalen; Chaung, Han-Ning; Mohr, Alexander; Klemm, Florian; Barrantes-Freer, Alonso; Blazquez, Raquel; Wolff, Hendrik A.; Lüke, Florian; Rohde, Veit; Stadelmann, Christine; Pukrop, Tobias


    The current approach to brain metastases resection is macroscopic removal of metastasis until reaching the glial pseudo-capsule (gross total resection (GTR)). However, autopsy studies demonstrated infiltrating metastatic cells into the parenchyma at the metastasis/brain parenchyma (M/BP)-interface. Aims/Methods: To analyze the astrocyte reaction and metastatic infiltration pattern at the M/BP-interface with an organotypic brain slice coculture system. Secondly, to evaluate the significance of infiltrating metastatic tumor cells in a prospective biopsy study. Therefore, after GTR, biopsies were obtained from the brain parenchyma beyond the glial pseudo-capsule and analyzed histomorphologically. Results: The coculture revealed three types of cancer cell infiltration. Interestingly, the astrocyte reaction was significantly different in the coculture with a benign, neuroectodermal-derived cell line. In the prospective biopsy study 58/167 (34.7%) samples revealed infiltrating metastatic cells. Altogether, 25/39 patients (64.1%) had proven to exhibit infiltration in at least one biopsy specimen with significant impact on survival (OS) (3.4 HR; p = 0.009; 2-year OS was 6.6% versus 43.5%). Exceptionally, in the non-infiltrating cohort three patients were long-term survivors. Conclusions: Metastatic infiltration has a significant impact on prognosis. Secondly, the astrocyte reaction at the M/BP-interface is heterogeneous and supports our previous concept of the organ-specific defense against metastatic (organ-foreign) cells. PMID:26299612

  3. A cluster of Teflon pledgets manifesting as an intrathoracic cavitary mass following lung resection. (United States)

    Lee, J-I; Park, K-Y; Park, C-H


    Teflon pledgets are widely used for hemostasis and the reinforcement of friable tissue in surgery. However, rare but serious complications caused by the erosion of Teflon pledgets have been reported. We present an unusual case of an intrathoracic cavitary mass that was formed by the erosion of a cluster of Teflon pledgets into the lung parenchyma eight years after a lung resection.

  4. Effect of remote ischemic postconditioning in inflammatory changes of the lung parenchyma of rats submitted to ischemia and reperfusion (United States)

    Dorsa, Rafael Cantero; Pontes, José Carlos Dorsa Vieira; Antoniolli, Andréia Conceição Brochado; da Silva, Guilherme Viotto Rodrigues; Benfatti, Ricardo Adala; dos Santos, Carlos Henrique Marques; Pontes, Elenir Rose Cury; Goldiano, José Anderson Souza


    Objective To assess the effects of postconditioning remote in ischemia-reperfusion injury in rat lungs. Methods Wistar rats (n=24) divided into 3 groups: GA (I/R) n=8, GB (R-Po) n=8, CG (control) n=8, underwent ischemia for 30 minutes artery occlusion abdominal aorta, followed by reperfusion for 60 minutes. Resected lungs and performed histological analysis and classification of morphological findings in accordance with the degree of tissue injury. Statistical analysis of the mean rating of the degree of tissue injury. Results GA (3.6), GB (1.3) and CG (1.0). (GA GB X P<0.05). Conclusion The remote postconditioning was able to minimize the inflammatory lesion of the lung parenchyma of rats undergoing ischemia and reperfusion process. PMID:26313726

  5. Effect of remote ischemic postconditioning in inflammatory changes of the lung parenchyma of rats submitted to ischemia and reperfusion

    Directory of Open Access Journals (Sweden)

    Rafael Cantero Dorsa


    Full Text Available AbstractObjective:To assess the effects of postconditioning remote in ischemia-reperfusion injury in rat lungs.Methods:Wistar rats (n=24 divided into 3 groups: GA (I/R n=8, GB (R-Po n=8, CG (control n=8, underwent ischemia for 30 minutes artery occlusion abdominal aorta, followed by reperfusion for 60 minutes. Resected lungs and performed histological analysis and classification of morphological findings in accordance with the degree of tissue injury. Statistical analysis of the mean rating of the degree of tissue injury.Results:GA (3.6, GB (1.3 and CG (1.0. (GA GB X P<0.05.Conclusion:The remote postconditioning was able to minimize the inflammatory lesion of the lung parenchyma of rats undergoing ischemia and reperfusion process.

  6. Protozoal hepatitis in a western burrowing owl (Athene cunicularia hypugaea) (United States)

    Franson, J. Christian


    A western burrowing owl (Athene cunicularia hypugaea) found dead in southern California had many light-colored lesions visible grossly on its liver, and histopathology revealed extensive necrosis throughout the hepatic parenchyma. Single-celled organisms were seen in clear spaces within the areas of necrosis. The owl was diagnosed with protozoal hepatitis.

  7. Partial renal resection by LaparoNewPro: in vivo open and laparoscopic study in an animal model. (United States)

    Rossi, Piero; Montuori, Mauro; Bove, Pierluigi; De Majo, Adriano; Ricciardi, Edoardo; Mattei, Maurizio; Bernardini, Roberta; Calzetta, Luigino; Mauti, Paolo; Intini, Lorenzo; Quattrini, Valentino; Chiaramonte, Carlo; Mauriello, Alessandro; Vespasiani, Giuseppe


    The aim of this research project was to test an incremental bipolar radiofrequency generator with open and laparoscopic inline electrode probe for partial renal resection without vascular clamping. Sixteen polar resections with clamping and six without were performed in four pigs in the acute phase. Three pigs underwent laparoscopic polar resection and were live housed for ten days and reoperated to verify the presence of hematic and urinary collection and the condition of the renal edge. Five pigs underwent laparoscopic polar resection without clamping, and two of these were live housed and reoperated after ten days. Polar renal resection by our system (LaparoNewPro) turned out to be effective and safe, without cardio-respiratory complications or damage to the remaining parenchyma. Coagulation of the renal parenchyma before resection is effective and safe; at the reoperation, no complications were observed. The laparoscopic version of the probe is ergonomic and safe, with effective coagulation and a small amount of smoke produced. No complications occurred in the housed animals. No damage, local or to residual parenchyma, or thrombosis of the renal vessels were found. LaparoNewPro is able to deliver coagulation of the resection line effectively and independently of clamping of the vessels both in the open and laparoscopic approaches. Coagulation times are short, the automatism of the generator is reliable, and the open and laparoscopic probes are ergonomic.

  8. Biochemical liver function after partial hepatic resection with or without partial hepatic vascular exclusion Função bioquímica do fígado após ressecção hepática parcial com ou sem exclusão vascular hepática parcial

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    Orlando Castro e Silva


    Full Text Available PURPOSE: The aim of the present study was to assess the advantages and disadvantages of liver vascular partial exclusion (LVPE (liver dysfunction due to ischemia during liver resection in patients submitted to partial hepatectomy. METHODS: A total of 114 patients were submitted to partial hepatectomy (minor versus major resections with LPVE being used in 57 of them but not in the remaining 57. Patient age ranged from 35 to 73 years and 57 % were women. Mitochondrial function was assessed 30 minutes after liver resection in the remnant liver and serum aminotransferases were determined before surgery and for seven days postoperatively. LPVE time ranged from 30 to 60 minutes. Data were analyzed statistically by the Student T test (5 % level of significance. RESULTS: Mitochondrial function was similar in the minor and major liver resections. The maximum postoperative aminotransferase peak was similar in the groups with and without LPVE. CONCLUSION: LPVE did not induce mitochondrial changes in hepatic tissue in either type of surgery, and aminotransferase levels were similar for patients with and without LPVE. Thus, the results show that LPVE is a safe procedure that does not induce the significant changes typical of ischemia and reperfusion in the liver remnant.OBJETIVO: Avaliar as vantagens e desvantagens da oclusão vascular parcial do fígado durante ressecções hepáticas parciais. MÉTODOS: Cento e quatorze pacientes foram submetidos a hepatectomia parcial(ressecção maior versus ressecção menor com liver partial vascular exclusion (LPVE sendo utilizada em 57 deles. A idade dos pacientes variou entre 35 e 73 anos e 57% deles eram mulheres. A função mitocondrial foi avaliada por método polarografico avaliada 30 minutos após a ressecção hepática no fígado remanescente, e o perfil das aminotransferase foi determinado antes da cirurgia e durante sete dias de pós-operatório. A EVPH variou de 30 a 60 minutos. Dados foram analisados

  9. Role of intracellular contents to facilitate supercooling capability in beech (Fagus crenata) xylem parenchyma cells


    Kasuga, Jun; Mizuno, Kaoru; Miyaji, Natsuko; Arakawa, Keita; Fujikawa, Seizo


    In order to find the possible role of intracellular contents in facilitating the supercooling capability of xylem parenchyma cells, changes in the temperature of supercooling levels were compared before and after the release of intracellular substances from beech xylem parenchyma cells by DTA. Various methods were employed to release intracellular substances from xylem parenchyma cells and all resulted in a reduction of supercooling ability. It was concluded that the reduction of supercooling...

  10. Primary hepatic carcinoid tumor

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    Gao Jinbo


    Full Text Available Abstract Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

  11. Complex Therapy For Hepatic Trauma | Fengjun | East African ...

    African Journals Online (AJOL)

    The leading cause of death was the triad of coagulopathy, hypothermia and metabolic acidosis. Conclusion: Patients with major exanguinating injuries will not survive complex procedures such as formal hepatic resection or complex procedures such as formal hepatic resection or pancreaticoduodenectomy. The operating ...


    Tsagareli, Z; Kvachadze, T; Melikadze, E; Metreveli, L; Nikobadze, E; Gogiashvili, L


    The present study was designed to evaluate the participation and utility of Hǘrtle cells morphological requirment and transformation under Hashimoto autoimmune thyroiditis versus Riedel´s struma. Several markers have been evaluated to detect induced activities of Hǘrtle cells. Study subject - specimens (tissue fragments) collected from TG surgery (thyroidectomy) for mollecular (receptor) diagnosis of Hǘrtle cells activities using routine histological and immunohistochemical samples. 89 cases were selected in Hashimoto thyroiditis diagnosis with Hǘrtle cells history (adenoma and adenomatous grouth of oncocytes). Markers as: TSH receptors, TTF-1, S-100 protein, also anti-TPO and anti-TG levels in blood plasm were detected. It was shown that solid cell claster-nests like agregation of oncocytes and adenomatous growth foci in parafollicular areas with anti-TPO and anti-TG antibodies levels arising while Riedel´s struma shown only large intra- and extra glandular inflammatory proliferative fibrosing process. Large positive expression of TTF-1 and S-100 protein and the negative reaction of TSH receptor factor suggest that Thyroid parenchyma disorganization and mollecular biological atypia with Hǘrtle cells are proceses due to hypothyreoidismus, as well as neuroectodermal cells prominent activities in 70% of Hashimoto cases.

  13. [Esophageal resections and plastics]. (United States)

    Bagajevas, Aleksandras


    The aim was to evaluate interim results of surgery and plastics for esophageal diseases. From March 2002 to August 2003, 31 patients underwent esophageal resections in the Department of Thoracic Surgery of Klaipeda Hospital. The following operations were performed: 10 patients (32.3%) had transthoracic resections, 10 patients (32.3%) - transhiatal resections, 2 patients (6.5%) - Lewis type, 5 patients (16.1%) - Garlock type and 4 patients (12.9%) - first step of Thoreck type operations. Twenty-five patients (80.6%) underwent surgery due to cancer, 3 patients (9.7%) due to esophagus perforation, 1 patient (3.2%) due to peptic stricture, 1 patient (3.2%) due to post-burn stricture, and 1 patient (3.2%) due to gastric necrosis. In 7 cases (22.6%) combined esophageal resections were performed: 2 patients (6.5%) with lung segmentectomies, 2 patients (6.5%) with liver metastasis resections, 1 patient (3.25%) with right lower lobectomy, and 2 patients (6.5%) with proximal gastric metastasis resection. In 58% of patients we observed postoperative complications; lethal outcome was present in 5 patients (16.1%). Subtotal esophageal resection with gastric pipe reconstruction and two-level lymphadenectomies are sufficient radical treatment in cancer patients. Postoperative mortality (16.1%) after 31 resections depends on stage of disease, performance status, comorbidity, surgeon experience and type of operation.

  14. Liver parenchyma transection-first approach in hemihepatectomy with en bloc caudate lobectomy for hilar cholangiocarcinoma: A safe technique to secure favorable surgical outcomes. (United States)

    Kawabata, Yasunari; Hayashi, Hikota; Yano, Seiji; Tajima, Yoshitsugu


    Although hemihepatectomy with total caudate lobectomy (hemiHx-tc) is essential for the surgical treatment of hilar cholangiocarcinoma, the advantage of an anterior approach for hemiHx-tc has not been fully discussed technically; the significance of an anterior approach without liver mobilization for preventing infectious complications also remains unknown. The liver parenchyma transection-first approach (Hp-first) technique is an early transection of the hepatic parenchyma without mobilization of the liver that utilizes a modified liver-hanging maneuver to avoid damaging the future remnant liver. Between May 2010 and August 2016, a total of 40 consecutive patients underwent surgery for hilar cholangiocarcinoma. Of these, 19 patients underwent a conventional hemihepatectomy with total caudate lobectomy (cHx), while 21 patients received a Hp-first. The patients in the Hp-first group had significantly less intraoperative blood loss (P < 0.001) and blood transfusion (P < 0.001), a lower incidence of postoperative hyperbilirubinemia (p = 0.023), a lower incidence of liver failure (p = 0.038), a lower hospital death rate (p = 0.042), and a better 2-year disease-free survival rate (p = 0.010) than those in the cHx group. The liver parenchyma transection-first approach is the preferred technique for hemiHx-tc in hilar cholangiocarcinoma because it resulted in improved surgical outcomes as compared with the conventional approach. © 2017 Wiley Periodicals, Inc.

  15. Computed tomographic appearances of hepatic hemangiomas

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    Abe, Masahide; Onodera, Hiroyoshi; Oikawa, Masamichi; Ohta, Kei; Goto, Yoshio (Tohoku Univ., Sendai (Japan). School of Medicine)


    Fifteen patients with hepatic hemangioma (16 lesions) were examined by computed tomography (CT). CT appearances were classified into three groups. Initially the CT appearances of hepatic hemangioma was a well-defined and low density. Following contrast material injection, three lesions became hyperdense and two lesions became isodense as compared with surrounding normal liver parenchyma. And eight lesions showed early peripheral enhancement with delayed central opacification. As CT appearances of hepatic hemangioma is characteristic, CT is the procedure of choice to confirm the diagnosis.

  16. Massive intestinal resection in rats fed up on glutamine: hepatic glycogen content valuation Ressecção intestinal extensa em ratos tratados com oferta oral de glutamina: avaliação do conteúdo hepático de glicogênio

    Directory of Open Access Journals (Sweden)

    Ariney Costa de Miranda


    Full Text Available BACKGROUND: Glutamine has been widely used in treatment of small bowel syndrome and its metabolic effects on the small intestine are well known, however, it has been little studied its effects on hepatic metabolism under this condition. AIM: To verify through experimental model, a glutamine based supplemental diet, administered via oral to rats submitted to massive intestinal resection, evaluating weight evolution and hepatic glycogen content. MATERIAL AND METHODS: Male rats, Wistar, were allocated into three groups to undergo enterectomy. Following diets were applied: with glutamine (G group, without glutamine (NG group, and standard diet from the laboratory (R group. All animals had massive small intestine resection including ileocecal valve removal. After 20 days, all animals were sacrificed. The liver was removed to histological analysis by light microscopy. Slides were stained by periodic acid of Schiff with diastasis. RESULTS: All animals lost weight from the beginning to the end of experiment. Comparing weight loss average expressed in percentage, there was no difference statistically significant on this variance. In analyzed groups, the hepatic glycogen content did not differ statistically, in the histological method evaluated. CONCLUSION: Glutamine feeding via oral did not influence weight loss reduction of animal submitted to massive intestinal resection and did not stimulate glycogen synthesis and storage into hepatocytes.RACIONAL: A glutamina tem sido utilizada amplamente no tratamento da síndrome do intestino curto e seus efeitos metabólicos são bem conhecidos no intestino delgado, porém pouco se tem relatado sobre seus efeitos no metabolismo hepático nessa condição. OBJETIVO: Verificar em modelo experimental, o efeito de dieta suplementada com glutamina administrada por via oral, em ratos submetidos a ressecção intestinal extensa, na evolução ponderal e no conteúdo de glicogênio hepático. MATERIAL E MÉTODOS: Ratos

  17. Development of fibre and parenchyma cells in the bamboo Phyllostachys viridi-glaucescens

    CERN Document Server

    Crow, E


    The development of the shoot apex and the ontogeny of fibre and parenchyma cells in elongating shoots of the bamboo Phyllostachys viridi-glaucescens (Carr.) Riv. and Riv., seen under the light microscope is described. Fibre cells differentiated from cells of the procambium, whilst the parenchyma cells differentiated from cells of the primary thickening meristem which surround the procambium strands. Three stages of early fibre and parenchyma cell development were identified and these are referred to in subsequent studies of cell wall development. The cytology of developing internodal fibre and parenchyma cells seen under the transmission electron microscope (TEM) is described. There were few ultrastructural features to distinguish the two cell types. Thiery's PATAg test was performed to identify organelles which may be associated with the synthesis of polysaccharides destined for the cell wall. The ultrastructural results are discussed in terms of the process of cell wall deposition. Observations were made of...

  18. Totally laparoscopic pericystectomy in hepatic hydatid disease. (United States)

    Kapan, Metin; Yavuz, Nihat; Kapan, Selin; Polat, Semra; Goksoy, Ertugrul


    Hepatic hydatid disease is still a commonly seen problem in endemic areas as well as in our country. There is a wide spectrum of therapeutic modalities ranging from simple medical treatment to radical liver resection. Progress in laparoscopic procedures made it possible to consider laparoscopic approaches in selected patients with hepatic hydatid disease. The current laparoscopic approach seems to be limited to cystotomy and drainage. There are fewer reports on hepatic resections or pericystectomy in the literature. In this article we present a case of laparoscopic pericystectomy performed in a selected patient.

  19. A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors. (United States)

    Liang, Guanlin; Wen, Tianfu; Yan, Lunan; Li, B O; Wu, Guochang; Yang, Jian; Lu, Bo; Chen, Zheyu; Liao, Zhixue; Ran, Shun; Yu, Zhang


    To evaluate whether continuous hemihepatic inflow occlusion (HHO) during hepatectomy can be safer than and be as effective as intermittent total hepatic inflow occlusion (THO) in reducing blood loss. Eighty patients undergoing liver resections were included in a prospective randomized study comparing the intra- and postoperative course under THO (n=40) or HHO (n=40). THO was performed with periods of 20 minutes of occlusion and 5 minutes of releasing, while HHO was performed with continuous occlusion. The surface area of liver transection, amount of blood loss, measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and postoperative evolution were recorded. The two groups were similar at entry in terms of preoperative liver function and in the proportion of patients experiencing major hepatectomy. The total ischemic time of the two groups was similar (p=0.37), but the operative time in the THO group was longer than in the HHO group (p=0.02). No significant difference was found between the HHO and THO group in blood loss during liver parenchyma transection (p=0.14), the elevations of ALT and AST on the first postoperative day (ALT: p=0.12; AST: p=0.66) and postoperative morbidity (p=0.35). On the basis of our findings, if it is feasible, continuous HHO is recommended for complex liver resection.

  20. Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal Prognostic factors following liver resection for hepatic metastases from colorectal cancer

    Directory of Open Access Journals (Sweden)

    Aljamir Duarte Chedid


    Full Text Available OBJETIVO: Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. CASUÍSTICA E MÉTODOS: Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de abril de 1992 a setembro de 2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções. Todos haviam sido submetidos previamente a ressecção do tumor primário. Utilizou-se protocolo de rastreamento de metástases hepáticas que incluiu revisões clínicas trimestrais, ecografia abdominal e dosagem de CEA até se completarem 5 anos de seguimento e após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase 100 ng/mL, margens cirúrgicas AIM: To determine the impact of prognostic factors on survival of patients with metastases from colorectal cancer that underwent liver resection. METHODS: The records of 28 patients that underwent liver resection for metastases from colorectal cancer between April 1992 and September 2001 were retrospectively analyzed. Thirty-eight resections were performed (more than one resection in eight patients and two patients underwent re-resections. The primary tumor was resected in all the patients. A screening protocol for liver metastases including clinical examinations every three months, ultrassonography and CEA level until 5 years of follow-up and after every 6 months, was applied. The prognostic factors analyzed regarding the impact on survival were: Dukes C stage of primary tumor, size of metastasis >5 cm, a disease-free interval from primary tumor to metastasis 100 ng/mL, resection margins < 1 cm and extrahepatic disease. The Kaplan-Meier curves, log rank and Cox regression were used for

  1. [Hepatic hemangioma: the choice of treatment]. (United States)

    Aksenov, I V; Fedorchenko, A N


    117 patients with hepatic hemangioma were treated. 17 patients were operated on with the use of laser and plasmic scalpel. The possibility and technical features of liver resections by hepatic hemangiomas are discussed. In 8 of 17 operated patients, endovascular hemangiomatous vessel occlusion was effective. Authors state the necessity of reduction of surgical treatment of hepatic hemangiomas and substantiate the need of dynamic observation of such lesions of the liver.

  2. Morphological variation of the kidney secondary to junctional parenchyma on ultrasound

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    Lee, Ji Yoon; Park, Byeong Ho; Nam, Kyeong Jin; Choi, Jong Cheol; Koo, Bong Sig; Kim, Jou Yeoun; Ahn, Seung Eon; Lee, Yung Il [Donga Medical Center, Pusan (Korea, Republic of)


    To evaluate the prevalance of morphological variation of the kidney secondary to junctional parenchyma, as well as to analyze the ultrasonographic features of junctional parenchyma. Two hundred and eighty two kidneys of 141 patient without clinical or radiologic evidence of renal disease were prospectively analysed using ultrasound. In all patients, ultrasonograms were obtained in sagittal, coronal and transaxial planes. The kidney was considered to have morphological variation if the ultrasonogram demonstrated junctional parenchymal defect of line ; those showing such variation were classified as one of three types : continuous, discontinuous, or junctional parenchymal line or defect without junctional parenchyma. The prevalance and ultrasonographic features of the kidneys were evaluated. Morphological variation was noted in 71 cases(25%). the continuous type accounted for 54% of these, the discontinuous type for 38%, and junctional parenchymal defect or line without junctional parenchyma for 8%. In all cases, junctional parenchyma was located approximately at the junction of the upper and middle third of the kidney, and had the same echogenecity as the renal cortex. An understanding of the morphological variation of the kidney resulting from junctional renal parenchyma would be helpful in differentiating pseudotumor from true renal neoplasm.

  3. The Effect of Sunlight in Parenchyma Pith Cells Diameter of Manihot esculenta (United States)

    Susanti, D.; Aziz, D. N.; Astuti, W.; Nuraeni, E.


    Sunlight is one of the factors that effect on the grow of a plant. Manihot esculenta is one of the plants that easily found in Indonesia because its role as staple food. The aim of this research is to know the correlation between sunlight the grow of parenchyma pith cells diameter of Manihot esculenta. Independent variable in this research is sunlight, and dependent variable is the parenchyma pith cells diameter of Manihot esculenta. Data was collected is in qualitative and quantitative form. Qualitative data gotten gained by morphology observation. The parenchyma pith cells of Manihot esculenta that is affected by sunlight in 1310 x 10 Lux, morphologically has hexagon, cell walls thick, solid state, and regular composition. Meanwhile, the parenchyma pith cells that has less sunlight (363 x 10 Lux) has a hexagon shape, thin cell walls thin, soft state, and irregular composition. Qualitative data suported by quantitative data. The size of parenchyma pith cells diameter that is affected by sunlight in 1310 x 10 Lux 96,4 µm. While, the stem parenchyma pith cells diameter empulur that has less sunlight (363 x 10 Lux) is 129,8 µm.

  4. Hepatitis E (United States)

    ... sheets Fact files Questions & answers Features Multimedia Contacts Hepatitis E Fact sheet Updated July 2017 Key facts ... in 2005 . Report Global hepatitis report, 2017 World Hepatitis Day Know hepatitis - Act now Event notice Key ...

  5. Viral Hepatitis (United States)

    ... Home A-Z Health Topics Viral hepatitis Viral hepatitis > A-Z Health Topics Viral hepatitis (PDF, 90 ... liver. Source: National Cancer Institute Learn more about hepatitis Watch a video. Learn who is at risk ...

  6. Hepatitis A (United States)

    ... or care for someone who has hepatitis A People who travel to developing countries are more likely to get hepatitis A. What are the complications of hepatitis A? People typically recover from hepatitis A without complications. In ...

  7. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement

    Directory of Open Access Journals (Sweden)

    Olga N. Tucker


    Full Text Available Synchronous major vessel resection during pancreaticoduodenectomy (PD for borderline resectable pancreatic adenocarcinoma remains controversial. In the 1970s, regional pancreatectomy advocated by Fortner was associated with unacceptably high morbidity and mortality rates, with no impact on long-term survival. With the establishment of a multidisciplinary approach, improvements in preoperative staging techniques, surgical expertise, and perioperative care reduced mortality rates and improved 5-year-survival rates are now achieved following resection in high-volume centres. Perioperative morbidity and mortality following PD with portal vein resection are comparable to standard PD, with reported 5-year-survival rates of up to 17%. Segmental resection and reconstruction of the common hepatic artery/proper hepatic artery (CHA/PHA can be performed to achieve an R0 resection in selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA. PD with concomitant major vessel resection for borderline resectable tumours should be performed when a margin-negative resection is anticipated at high-volume centres with expertise in complex pancreatic surgery. Where an incomplete (R1 or R2 resection is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation as part of a clinical trial should be offered to all patients.

  8. The Role of Re-resection for Breast Cancer Liver Metastases-a Single Center Experience. (United States)

    BacalbaȘa, Nicolae; Balescu, Irina; Dima, Simona; Popescu, Irinel


    The aim of the present study was to evaluate the effectiveness and safety of hepatic re-resection for breast cancer liver metastases. Between January 2004 and December 2014 seven patients were submitted to liver re-resection for breast cancer liver metastases at our Center. The main inclusion criteria were presence of isolated liver metastases and absence of systemic recurrent disease Results: The median age at the time of breast surgery was 51 years (range=39-69 years). The first liver resection was performed after a median period of 34.7 months and consisted of minor hepatectomies in six and major hepatectomy in one patient. The second liver resection was performed after a median interval of 22 months from the first liver resection and consisted of major resection in one case and minor resection in the other six cases. Postoperative complications occurred in a single case after the first liver surgery and in two cases after the second hepatic resection, all cases being successfully managed conservatively. Overall postoperative mortality was 0. The median overall survival after the second liver resection was 28 months. Re-resection for breast cancer liver metastases can be safely performed and may bring survival benefit. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  9. Successful liver resection in a giant hemangioma with intestinal obstruction after embolization


    Zhou, Ji-Xiang; Huang, Ji-Wei; Wu, Hong; Zeng, Yong


    Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significant...

  10. Hepatoma polarization limits CD81 and hepatitis C virus dynamics

    NARCIS (Netherlands)

    Harris, H. J.; Clerte, C.; Farquhar, M. J.; Goodall, M.; Hu, K.; Rassam, P.; Dosset, P.; Wilson, G. K.; Balfe, P.; IJzendoorn, S. C.; Milhiet, P. E.; McKeating, J. A.

    Many viruses target the polarized epithelial apex during host invasion. In contrast, hepatitis C virus (HCV) engages receptors at the basal surface of hepatocytes in the polarized liver parenchyma. Hepatocyte polarization limits HCV entry by undefined mechanism(s). Given the recent reports

  11. Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings

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    Cakir, Banu [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Kirbas, Ismail [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Demirhan, Beyhan [Baskent University Faculty of Medicine Department of Pathology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Bozkurt, Alper [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Ozcay, Figen [Baskent University Faculty of Medicine Department of Pediatric Gastroenterology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:; Coskun, Mehmet [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail:


    Introduction: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. Materials and methods: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. Results: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. Conclusion: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

  12. Introduction of the resection severity index as independent risk factor limiting survival after resection of colorectal liver metastases. (United States)

    Gwiasda, Jill; Schrem, Harald; Kaltenborn, Alexander; Mahlmann, Jan; Mix, Heiko; Lehner, Frank; Kayser, Nicolas; Klempnauer, Jürgen; Kulik, Ulf


    The purpose of this study is to evaluate the influence of the recently introduced resection severity index (RSI) in patients with liver resection for hepatocellular carcinoma on survival after resection of colorectal liver metastases. The RSI quantifies pre-operatively the liver cellular damage, liver synthetic function and loss of organ parenchyma. All consecutive patients who underwent liver resection for metastases of colorectal cancer (CLM) between 2000 and 2015 were included in this study. Risk factors limiting survival were analyzed using univariable and multivariable Cox regression analyses. The median survival after liver resection for CLM was 3.0 years. Significant independent risk factors for mortality were the RSI (p = 0.029; hazard ratio (HR): 1.088, 95%-confidence interval (95%-CI): 1.009-1.174), age at resection in years (p = 0.001; HR: 1.017, 95%-CI: 1.007-1.027), pre-operative hemoglobin level (p = 0.041; HR: 0.932, 95%-CI: 0.891-0.997), the cecum as location of primary CRC (p < 0.001; HR: 2.023, 95%-CI: 1.403-2.833), adjuvant chemotherapy (p < 0.001; HR: 1.506, 95%-CI: 1.212-1.878), local relapse of the primary tumor (p = 0.027; HR: 1.591, 95%-CI: 1.057-2.297), the units of intra-operatively transfused packed red blood cells (p < 0.001; HR: 1.068, 95%-CI: 1.033-1.104), the size of the largest metastasis (p = 0.002; HR: 1.005, 95%-CI: 1.002-1.008) and the metastasis' distance to the resection margin (p = 0.014; HR: 0.984, 95%-CI: 0.972-0.997). The RSI is an independent prognostic factor for survival after liver resection for CLM. Besides the extent of liver resection certain primary tumor characteristics have to be taken into account to ensure long-term survival. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection? (United States)

    Golriz, Mohammad; Abbasi, Sepehr; Fathi, Parham; Majlesara, Ali; Brenner, Thorsten; Mehrabi, Arianeb


    Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco 2 values increased after 75% resection in the jugular vein. In contrast, arterial Po 2 increased after every resection, whereas the venous Po 2 decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco 2 in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation. NEW & NOTEWORTHY This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow

  14. Tissue distribution and deposition pattern of a cellulosic parenchyma-specific protein from cassava roots

    Directory of Open Access Journals (Sweden)

    Petrônio A.S. Souza


    Full Text Available A protein with a molecular mass of 22kDa was purified from the cellulosic parenchyma of cassava roots. The amino acid composition of the protein was determined and antibodies generated against the purified protein were used to show that the concentration of the protein remains unchanged during root "tuber" formation. By using a tissue printing technique, as well as western blot, it was shown that the cellulosic parenchyma was the only root tissue in which the protein was deposited.

  15. VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

    Directory of Open Access Journals (Sweden)

    Boutros Cherif


    Full Text Available Abstract Introduction Video-assisted thoracic surgery (VATS has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness. Several techniques have been described to localize peripheral pulmonary nodules, including pre-operative CT-guided tattooing with methylene blue, CT scan guided spiral/hook wire placement, and transthoracic ultrasound. As pulmonary surgeons well know, the lung and visceral pleura may appear featureless on top of a pulmonary nodule. Case description This paper presents a rapid, direct and inexpensive approach to peripheral lung lesion resection by marking the lung parenchyma on top of the nodule using direct methylene blue injection. Methods In two patients with peripherally located lung nodules (n = 3 scheduled for VATS, we used direct methylene blue injection for intraoperative localization of the pulmonary nodule. Our technique was the following: After finger palpation of the lung, a spinal 25 gauge needle was inserted through an existing port and 0.1 ml of methylene blue was used to tattoo the pleura perpendicular to the localized nodule. The methylene blue tattoo immediately marks the lung surface over the nodule. The surgeon avoids repeated finger palpation, while lining up stapler, graspers and camera, because of the visible tattoo. Our technique eliminates regrasping and repalpating the lung once again to identify a non marked lesion. Results Three lung nodules were resected in two patients. Once each lesion was palpated it was marked, and the area was resected with security of accurate localization. All lung nodules were resected in totality with normal lung parenchymal margins. Our technique added about one minute to the operative time. The two patients were discharged home on the second postoperative day, with no morbidity. Conclusion


    Directory of Open Access Journals (Sweden)

    V. F. Uchaikin


    Full Text Available We observed 43 patients with cholestasis (21 — with acute viral hepatitis A and B and 22 — with chronic viral hepatitis B and C. Etiological diagnosis was based on the identification of specific markers of the spectrum. These 43 patients in addition to basic therapy ursodeoxycholic acid as a drug Ursosan of company «PRO.MED.CS Praha a.s.» (CzechRepublic. The control group consisted of 17 patients with acute viral hepatitis. Clinical signs are jaundice and itching of the skin, abdominal pain, significant hepatomegaly. Serum bilirubin level rises due to the conjugated fraction, alkaline phosphatase, gamma-glutamyltranspeptidase. When ultrasound revealed dilated bile ducts in the liver parenchyma, reactive edema of the gallbladder wall, signs gipomotornoy dyskinesia. Appointment ursosan in acute and chronic viral hepatitis occurring with cholestasis leads to the clinical and biochemical effects, and has a beneficial effect on the state of the liver and gall bladder.

  17. Changes in energy metabolism of the juvenile Fasciola hepatica during its development in the liver parenchyma

    NARCIS (Netherlands)

    Tielens, A.G.M.; Heuvel, J.M. van den; Bergh, S.G. van den


    Juvenile Fasciola hepatica at different stages of development were isolated from the liver parenchyma of experimentally infected rats. Their energy metabolism was studied by incubation with D-[16-14C]glucose and compared with that of juveniles isolated immediately after in vitro emergence from the

  18. Risk Analysis for Pathological Changes in Pulmonary Parenchyma Based on Lung Computed Tomography Images. (United States)

    Jiang, Hong Yang; Ma, He; Qian, Wei; Wei, Guo Hui


    The purpose of this study is to design a content-based medical image retrieval system, which helps excavate and assess pathological change of pulmonary parenchyma for risks analysis. A data set including lung computed tomography images obtained from 115 patients who experienced pathological changes in pulmonary parenchyma is used. Using morphological theory, images are preprocessed and decomposed into groups of pixel blocks (words), which construct vocabulary. A latent Dirichlet allocation (LDA) model is constructed to assess each image for risk analysis with the method of leave-one-out cross-validation. The precision and recall rate are used as the performance assessment criteria. The LDA model generates a relevance rank of retrieval results from high to low. From the top 50 images, precision of identical tissue is 0.76 ± 0.031 and precision of each attribute of pulmonary parenchyma range from 0.776 ± 0.043 to 0.984 ± 0.008. The study results demonstrate that the proposed LDA model is conductive to lung computed tomography image retrieval and has reliable efficacy on risk analysis about pathological changes of pulmonary parenchyma.


    Gazizova, G R; Zabotin, Ya I; Golubev, A I


    The paper presents data on the ultrastructure of parenchyma that is involved in the digestion in turbellaria Convoluta convoluta (n = 15). Unusual connections between the nuclear envelope, endoplasmic reticulum and plasma membrane of parenchymal cells were found for the first time, which may indicate the origin of these cell structures. The double trophic role of zooxanthellae in the organism of Convoluta is described.

  20. Evaluation and proposal of novel resectability criteria for pancreatic cancer established by the Japan Pancreas Society. (United States)

    Yamada, Suguru; Fujii, Tsutomu; Takami, Hideki; Hayashi, Masamichi; Iwata, Naoki; Kanda, Mitsuro; Tanaka, Chie; Sugimoto, Hiroyuki; Nakayama, Goro; Koike, Masahiko; Fujiwara, Michitaka; Kodera, Yasuhiro


    The guidelines for the classification of the resectability of pancreatic cancer established by the National Comprehensive Cancer Network can be difficult to utilize in clinical practice. We evaluated novel criteria proposed by the Japan Pancreas Society. We analyzed 382 patients with pancreatic cancer between 2001 and 2015 for survival differences among subgroups classified according to the Japan Pancreas Society classification. Overall survival and disease-free survival were expressed as median values and compared with data based on the National Comprehensive Cancer Network classification, and differences in initial patterns of recurrence were analyzed. Overall survival times according to the Japan Pancreas Society criteria were 34.2, 29.7, 17.3, 14.3, and 15.8 months for the groups defined as resectable, resectable with portal vein invasion, borderline resectable with portal vein invasion, borderline resectable with arterial invasion, and unresectable by locally advanced disease respectively. The overall survival of the resectable group was better than those of the borderline resectable with portal vein invasion or borderline resectable with arterial invasion groups (P Cancer Network criteria were 30.5, 20.5, 15.8, and 13.8 months for the resectable, portal invasion, common hepatic artery and superior mesenteric artery invasion groups, respectively. Each survival curve was clearly separate. The borderline resectable with arterial invasion and unresectable by locally advanced groups exhibited high local recurrence rates (42.0% and 44.8%, respectively). The Japan Pancreas Society criteria, which are simpler, predicted survival differences between the resectable group and the other subgroups. Our data suggest that cancer patients with borderline resectable pancreatic cancer (borderline resectable with portal vein invasion and borderline resectable with arterial invasion) can be managed as a single subset. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Technical considerations for radical resection of a primary leiomyosarcoma of the vena cava (United States)

    Chan, Albert C Y; Chan, See Ching; Yiu, Ming Kwong; Ho, Kwan Lun; Wong, Edmond M H; Lo, Chung Mau


    Background Radical resection provides the best hope for cure in leiomyosarcoma of the inferior vena cava (IVC). Multi-visceral resection is often indicated by extensive tumour involvement. This report describes the technical challenges encountered during resection of a retrohepatic IVC leiomyosarcoma. Methods Computed tomography showed an IVC leiomyosarcoma measuring 7.8 × 10.0 × 19.3 cm in a 41-year-old patient. The tumour reached the confluence of the hepatic veins, displacing the caudate lobe anteriorly and extending towards the IVC bifurcation inferiorly. En bloc resection of the IVC tumour with a right hepatic and caudate lobectomy, and a right nephrectomy was performed. Results Subsequent to a Cattel manoeuvre, the operative procedures carried out can be broadly categorized in four major steps: (i) mobilization of the infrahepatic IVC and tumour; (ii) mobilization of the suprahepatic IVC from diaphragmatic attachments; (iii) right hepatectomy with complete caudate lobe resection, and (iv) en bloc resection of the IVC tumour. This approach allowed the entire length of tumour-bearing IVC to be freed from the retroperitoneum and avoided the risk for iatrogenic tumour rupture during dissection at the retrohepatic IVC. Reconstruction of the IVC was not performed in the presence of venous collaterals. Conclusions Experience in liver resection and transplantation, and appreciation of the hepatocaval anatomy facilitate the safe and radical resection of retrohepatic IVC leiomyosarcoma. PMID:22762406

  2. Hepatic Kaposi sarcoma. Sonographic and computed tomographic aspects

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    Defalque, D.; Menu, Y.; Nahum, H.; Matheron, S.; Girard, P.M.


    AIDS-related Kaposi sarcoma is most often multicentric and extensive. Hepatic involvement is unusual and asymptomatic. An anicteric cholestasis may exist. Ultrasonography shows a pedicular echogenic infiltration and a heterogeneous parenchyma with small hyperechoic nodules. On CT, these hypodense lesions are related to the involvement of the hepatic pedicle. This is linked to angiosarcomatous tumorous tissue infiltration of the liver evolving along portal branches. In a patient suffering from cutaneous or digestive Kaposi sarcoma lesions, these radiological aspects are suggestive of hepatic involvement.

  3. Wedge resection and segmentectomy in patients with stage I non-small cell lung carcinoma

    Directory of Open Access Journals (Sweden)

    Konstantinos Reveliotis


    Full Text Available The use of sublobar resections as definitive management in stage I non-small cell lung carcinoma is a controversial topic in the medical community. We intend to report the latest developments and trends in relative indications for each of the above-mentioned surgical approaches for the treatment of stage I non-small cell lung carcinoma as well as the results of studies regarding local recurrence, disease-free survival and five-year survival rates. We reviewed 45 prospective and retrospective studies conducted over the last 25 years listed in the Pubmed and Scopus electronic databases. Trials were identified through bibliographies and a manual search in journals. Authors, citations, objectives and results were extracted. No meta-analysis was performed. Validation of results was discussed. Segmentectomies are superior to wedge resections in terms of local recurrences and cancer-related mortality rates. Sublobar resections are superior to lobectomy in preserving the pulmonary parenchyma. High-risk patients should undergo segmentectomy, whereas lobectomies are superior to segmentectomies only for tumors >2 cm (T2bN0M0 in terms of disease-free and overall 5-year survival. In most studies no significant differences were found in tumors <2 cm. Disease-free surgical margins are crucial to prevent local recurrences. Systematic lymphadenectomy is mandatory regardless of the type of resection used. In sublobar resections with less thorough nodal dissections, adjuvant radiotherapy can be used. This approach is preferable in case of prior resection. In pure bronchoalveolar carcinoma, segmentectomy is recommended. Sublobar resections are associated with a shorter hospital stay. The selection of the type of resection in T1aN0M0 tumors should depend on characteristic of the patient and the tumor. Patient age, cardiopulmonary reserve and tumor size are the most important factors to be considered. However further prospective randomized trials are needed to

  4. Hepatitis B (United States)

    ... are 2 vaccines for hepatitis B on the market. There is 1 combination vaccine on the market for hepatitis A and B together. Vaccination Schedule ... hepatitis B vaccine with no risk to their babies. Resources Products and Publications Hepatitis B Fact Sheets ...

  5. Adjunctive role of preoperative liver magnetic resonance imaging for potentially resectable pancreatic cancer. (United States)

    Kim, Hyoung Woo; Lee, Jong-Chan; Paik, Kyu-Hyun; Kang, Jingu; Kim, Young Hoon; Yoon, Yoo-Seok; Han, Ho-Seong; Kim, Jaihwan; Hwang, Jin-Hyeok


    The adjunctive role of magnetic resonance imaging of the liver before pancreatic ductal adenocarcinoma has been unclear. We evaluated whether the combination of hepatic magnetic resonance imaging with multidetector computed tomography using a pancreatic protocol (pCT) could help surgeons select appropriate candidates and decrease the risk of early recurrence. We retrospectively enrolled 167 patients in whom complete resection was achieved without grossly visible residual tumor; 102 patients underwent pCT alone (CT group) and 65 underwent both hepatic magnetic resonance imaging and pCT (magnetic resonance imaging group). By adding hepatic magnetic resonance imaging during preoperative evaluation, hepatic metastases were newly discovered in 3 of 58 patients (5%) without hepatic lesions on pCT and 17 of 53 patients (32%) with indeterminate hepatic lesions on pCT. Patients with borderline resectability, a tumor size >3 cm, or preoperative carbohydrate antigen 19-9 level >1,000 U/mL had a greater rate of hepatic metastasis on subsequent hepatic magnetic resonance imaging. Among 167 patients in whom R0/R1 resection was achieved, the median overall survival was 18.2 vs 24.7 months (P = .020) and the disease-free survival was 8.5 vs 10.0 months (P = .016) in the CT and magnetic resonance imaging groups, respectively (median follow-up, 18.3 months). Recurrence developed in 82 (80%) and 43 (66%) patients in the CT and magnetic resonance imaging groups, respectively. The cumulative hepatic recurrence rate was greater in the CT group than in the magnetic resonance imaging group (P magnetic resonance imaging should be considered in patients with potentially resectable pancreatic ductal adenocarcinoma, especially those with high tumor burden. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Peritumoral Hyperplasia in Hepatic Sclerosed Hemangioma


    Shimada, Seitarou; Tajiri, Kazuto; Baba, Hayato; Minemura, Masami; Tsuneyama, Koichi; Nakano, Masayuki; Sugiyama, Toshiro


    Peritumoral hyperplasia (PTH) is a hyperplastic lesion located around hypervascular tumors. Hepatic sclerosed hemangioma is a very rare form of hemangioma with sclerotic changes and is distinct from sclerosing hemangioma. We present a patient with non-alcoholic steatohepatitis-induced cirrhosis who presented with a hypervascular tumor. The tumor showed atypical findings of hemangioma and was treated with surgical resection because hepatic malignancy could not be ruled out. Histopathologic exa...

  7. Isolation and characterization of cellulose nanocrystals from parenchyma and vascular bundle of oil palm trunk (Elaeis guineensis). (United States)

    Lamaming, Junidah; Hashim, Rokiah; Leh, Cheu Peng; Sulaiman, Othman; Sugimoto, Tomoko; Nasir, Mohammed


    In this study cellulose nanocrystals were isolated through acid hydrolysis process from parenchyma and vascular bundle of oil palm trunk (Elaeis guineensis). The morphological properties of obtained cellulose nanocrystals were studied by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The microscopy images showed smoother and cleaner surface of parenchyma cellulose nanocrystals when compared to vascular bundle cellulose nanocrystals. The TEM image shows a higher length and diameter for parenchyma cellulose nanocrystals compared to vascular bundle cellulose nanocrystals. The Fourier transform infrared (FTIR) spectra showed changes in functional groups after acid hydrolysis due to removal of lignin, hemicelluloses and other impurities in both type of cellulose nanocrystals. Crystallinity index of cellulose nanocrystals was observed higher for vascular bundle as compared to parenchyma. Thermogravimetric analysis (TGA) was performed to study the thermal stability of cellulose nanocrystals and it was observed higher for parenchyma cellulose nanocrystals compared to vascular bundle. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Local Effects on Lung Parenchyma Using a 600 µm Bare Fiber with the Diode-Pumped Nd:YAG Laser LIMAX® 120

    Directory of Open Access Journals (Sweden)

    Peter Rexin


    Full Text Available Lung metastases are frequently removed with an Nd:YAG laser. The aim is to perform a non-anatomic resection of all intraoperatively palpable lung metastases completely in order to preserve the largest possible amount of healthy lung parenchyma. The surgeon can either work with a focusing handpiece or use a laser fiber of the so-called bare fiber with direct contact to the lung parenchyma. We currently use a 600 µm bare fiber for applications involving the lung parenchyma. Precise data on the local effect of the laser fiber on the lung parenchyma are not available, especially with regard to an increase in the laser energy. We want to study this question within the scope of an experimental model in pig lungs by means of systematic and reproducible tests. The lung lobes were removed from animals recently slaughtered in the abattoir and taken to the laboratory immediately, where the lobes were stored such that the surface of the lungs was parallel to the floor. A 600 µm bare fiber was attached to a mounting bracket vertically above the lung surface at a distance of either 0, 5, or 10 mm. This mounting bracket was in turn connected to a hydraulic feed motor. The feed motor is capable of moving the bare fiber forward across the lungs consistently at three different speeds (5 mm/s, 10 mm/s, or 20 mm/s. The bare fiber itself was connected to the diode-pumped Nd: YAG Laser LIMAX® 120 (Gebrüder Martin GmbH & Co KG, Tuttlingen, Germany. We carried out the tests using three different laser powers: 20 W, 60 W, and 120 W. The lung lesions caused by the laser in each of the lungs were resected and sent in for histological analysis. The exact size of the vaporization and coagulation zone was measured using the HE sections, and the respective mean values (with standard deviations were ascertained. For all laser powers, the extent of the vaporization was greatest with a motion speed of 5 mm/s for the respective laser power: 756.4 ± 1.2 µm (20 W, 1411.0 ± 2

  9. Robotic Liver Resection: A Case-Matched Comparison. (United States)

    Kingham, T Peter; Leung, Universe; Kuk, Deborah; Gönen, Mithat; D'Angelica, Michael I; Allen, Peter J; DeMatteo, Ronald P; Laudone, Vincent P; Jarnagin, William R; Fong, Yuman


    In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic hepatectomy, however, is still in its infancy. Our goals were to examine the adoption of robotic hepatectomy and to compare outcomes between open and robotic liver resections. The robotic hepatectomy experience of 64 patients was compared to a modern case-matched series of 64 open hepatectomy patients at the same center. Matching was according to benign/malignant diagnosis and number of segments resected. Patient data were obtained retrospectively. The main outcomes and measures were operative time, estimated blood loss, conversion rate (robotic to open), Pringle maneuver use, single non-anatomic wedge resection rate, resection margin size, complication rates (infectious, hepatic, pulmonary, cardiac), hospital stay length, ICU stay length, readmission rate, and 90-day mortality rate. Sixty-four robotic hepatectomies were performed in 2010-2014. Forty-one percent were segmental and 34 % were wedge resections. There was a 6 % conversion rate, a 3 % 90-day mortality rate, and an 11 % morbidity rate. Compared to 64 matched patients who underwent open hepatectomy (2004-2012), there was a shorter median OR time (p = 0.02), lower median estimated blood loss (p optimization of outcomes and prospective examination of the economic cost of each approach.

  10. Evaluation of the effects of silicone implants on the breast parenchyma. (United States)

    Roxo, Ana Claudia Weck; Nahas, Fabio Xerfan; Bazi, Fernanda; de Castro, Claudio Cardoso; Aboudib, Jose Horacio; Marques, Ruy Garcia


    Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature. The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane. Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis. There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation. Breast augmentation caused reduction in the volume of the breast parenchyma. 3 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission:

  11. Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration

    Energy Technology Data Exchange (ETDEWEB)

    Senocak, Oezlem E-mail:; Manisali, Metin; Oezaksoy, Dinc; Sevinc, Can; Akalin, Elif


    Objective: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration. Material and methods: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration {<=}5 years (n: four patients), group 2: patients with disease duration {>=}6 years but {<=}10 years (n: four patients), group 3: patients with disease duration {>=}11 years (n: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients. Results: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers. Conclusion: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.


    Abudeev, S A; Popugaev, K A; Kruglyakov, N M; Belousova, K A; Terekhov, D A; Leushin, K Yu; Aronov, M S; Karpova, O V; Zelenkov, A V; Kiselev, K V; Fedin, A B; Zabelin, M V; Samoylov, A S


    Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself

  13. Microcalcification morphological descriptors and parenchyma fractal dimension hierarchically interact in breast cancer: A diagnostic perspective. (United States)

    Verma, Garima; Luciani, Maria Laura; Palombo, Alessandro; Metaxa, Linda; Panzironi, Giovanna; Pediconi, Federica; Giuliani, Alessandro; Bizzarri, Mariano; Todde, Virginia


    Herein, we propose a Systems Biology approach aimed at identifying quantitative morphological parameters useful in discriminating benign from malignant breast microcalcifications at digital mammography. The study includes 31 patients in which microcalcifications had been detected during XR mammography and were further confirmed by stereotactic (XR-guided) biopsies. Patients were classified according to the BIRADS (Breast Imaging-Reporting and Data System), along with their parenchyma fractal dimension and biopsy size. A geometrical-topological characterization of microcalcifications was obtained as well. The 'size of biopsy' was the parameter endowed with the highest discriminant power between malignant and benign lesions thus confirming the reliability of surgeon judgment. The quantitative shape evaluation of both lesions and parenchyma allowed for a promising prediction of the BIRADS score. The area of lesions and parenchyma fractal dimension show a complex distribution for malignant breast calcifications that are consistent with their qualitative morphological pattern. Fractal dimension analysis enables the user to obtain reliable results as proved by its efficiency in the prediction of the morphology of breast cancer. By reconstructing a phase-space distribution of biophysical parameters, different patterns of aggregation are recognized corresponding to different calcium deposition patterns, while the combination of tissue and microcalcification morphological descriptors provide a statistically significant prediction of tumour grade. The development of an automated morphology evaluation system can help during clinical evaluation while also sketching mechanistic hypotheses of microcalcification generation. Copyright © 2017 Elsevier Ltd. All rights reserved.


    African Journals Online (AJOL)

    1 1 10-5 704. African Journal of Urology. V0/. 9, NO. 1, 2003. 36-40. ENDOSCOPIC TRANSURETHRAL RESECTION OF BILHARZIAL. ULCERS OF THE URINARY BLADDER. SINGLE-CENTER ... ulcers (78% de novo and 22% recurrent ul- cers after previous open partial .... tion cf its tip is used for resection. However, it.


    African Journals Online (AJOL)

    1 1 10-5 704. African Journal of Urology. Vol. 9, NO. 1, 2003. 36-40. ENDOSCOPIC TRANSURETHRAL RESECTION OF BILHARZIAL. ULCERS OF THE URINARY BLADDER. SINGLE-CENTER ... ulcers (78% de novo and 22% recurrent ul- cers after previous open partial .... tion of its tip is used for resection. HoWever, it.

  16. Viscoelastic Model for Lung Parenchyma for Multi-Scale Modeling of Respiratory System, Phase II: Dodecahedral Micro-Model

    Energy Technology Data Exchange (ETDEWEB)

    Freed, Alan D.; Einstein, Daniel R.; Carson, James P.; Jacob, Rick E.


    In the first year of this contractual effort a hypo-elastic constitutive model was developed and shown to have great potential in modeling the elastic response of parenchyma. This model resides at the macroscopic level of the continuum. In this, the second year of our support, an isotropic dodecahedron is employed as an alveolar model. This is a microscopic model for parenchyma. A hopeful outcome is that the linkage between these two scales of modeling will be a source of insight and inspiration that will aid us in the final year's activity: creating a viscoelastic model for parenchyma.

  17. Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis? (United States)

    Herman, Paulo; Perini, Marcos V; Pugliese, Vincenzo; Pereira, Julio Cesar; Machado, Marcel Autran C; Saad, William A; D'Albuquerque, Luiz A C; Cecconello, Ivan


    To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis. Prognostic factors, especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed. Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection. Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of the extrahepatic biliary duct (> 2 cm). Late results and risk factors for recurrence of symptoms or stones were evaluated. There was no operative mortality. After a mean follow-up of 50.3 mo, good late results were observed in 82.9% of patients; all patients submitted to liver resection alone and 58.8% of those submitted to liver resection and hepaticojejunostomy were free of symptoms (P = 0.0006). Patients with unilateral and bilateral disease showed good late results in 94.1% and 28.6%, respectively (P < 0.001). Recurrence of symptoms in patients with hepaticojejunostomy showed that this may not be the ideal solution. Further studies are needed to establish the best treatment for patients with bilateral stones or unilateral disease and a dilated extrahepatic duct.

  18. Mortalidade após ressecção hepática: determinação de um fator de risco pós-operatório precoce e eficaz Mortality rates after hepatic resection: early and effective postoperative risk factor determination

    Directory of Open Access Journals (Sweden)

    Silvio M. P. Balzan


    it difficult to compare innovations concerning hepatic procedures as well as turning the use of postoperative therapeutic interventions a complex task. OBJECTIVES: To evaluate the usefulness and accuracy of diagnosing hepatic insufficiency post-hepatectomy, using prothrombin and seric bilirubin time as predictors of mortality. METHODS: 775 elective hepatectomies were studied. Non-tumoral spleens were abnormal in 43% of cases studied: stenosis > 30% in 107 (14%, fibrosis in 237 (43% and cirrhosis in 94 (12%. The impact over mortality with remark to prothrombin time being less than 50% and total seric bilirubin being greater than 50 μmol/L (criteria 50-50 in the postoperative days number 1, 3, 5 and 7, was analyzed. RESULTS: Postoperative kinetics regarding prothrombin and seric bilirubin time were distinct. The smallest prothrombin time level occurred in the first postoperative day, whereas seric bilirubin reached its peak in the third day. The tendency of these two biochemical factors to return to preoperative values was sustained in the fifth day. Overall surgical mortality rates were of 3,4% (26 patients, including 21 (81% cases of abnormal tumor parenchyma and 20 (77% after major hepatectomy. Mortality rates were higher in patients who presented prothrombin time 50 μmol/L post surgery. The junction of prothrombin time 50 μmol/ in the fifth day was a predictive factor for mortality, reaching 59% when this association occurred. CONCLUSION: Beginning from the fifth post surgery day, the association of prothrombin time 50 μml/L (3 mg/dL (criteria 50-50 became a practical and accurate predictor of post-hepatectomy mortality. Consequently, this criterion is proposed as a definition of postoperative hepatic insufficiency.

  19. Hepatitis A (United States)

    ... an inflammation of the liver. One type, hepatitis A, is caused by the hepatitis A virus (HAV). The disease spreads through contact with ... washed in untreated water Putting into your mouth a finger or object that came into contact with ...

  20. Hepatitis C (United States)

    ... Weight loss Confusion, drowsiness and slurred speech (hepatic encephalopathy) Spider-like blood vessels on your skin (spider angiomas) Every chronic hepatitis C infection starts with an acute phase. ...

  1. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Hepatic Encephalopathy Treatment Options Treatment Basics Treatment Medications Importance of Adhering to Your Treatment Plan Long-Term ... disease is. It’s important for you and your family to become familiar with the signs of Hepatic ...

  2. Hepatitis C (United States)

    ... especially important for people who are showing signs liver fibrosis or scarring. Medicines used to treat hepatitis C ... Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology . ...

  3. Hepatitis C (United States)

    ... Doctors treat hepatitis C with antiviral medicines that attack the virus and can cure the disease in most cases. ... Doctors treat hepatitis C with antiviral medicines that attack the virus. You may need to take medicines for 12 ...

  4. Hepatitis C: Treatment (United States)

    ... Public Home » Hepatitis C » Hepatitis C Treatment Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... Enter ZIP code here Enter ZIP code here Hepatitis C Treatment for Veterans and the Public Treatment ...

  5. Alcohol and Hepatitis (United States)

    ... Home » Living with Hepatitis » Daily Living: Alcohol Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... heavy drinking, most heavy drinkers have developed cirrhosis. Hepatitis C and cirrhosis In general, someone with hepatitis ...

  6. [Lupus hepatitis]. (United States)

    Ben Hadj, Yahia Chiraz; Chaabouni, Lilia; Montacer, Kchir Mohamed; Abid, Feriel; Zouari, Rafik


    We report the case of 42 year-old man who presents an acute polyarthritis associated with systemic manifestation and immunologic disorders related to systemic lupus erythematosus. Hepatic tests show cholostase and cytolysis. Hepatic involvement is linked with systemic lupus erythematosus after exclusion of hepatotoxic drugs, viral hepatitis and absence of anti mitochondrial and anti muscle antibodies. Lupus hepatitis seems to be correlated with autoantibodies to ribosomal P protein. Its treatment remains to be defined.

  7. Hepatitis C (United States)

    ... an inflammation of the liver. One type, hepatitis C, is caused by the hepatitis C virus (HCV). It usually spreads through contact with ... childbirth. Most people who are infected with hepatitis C don't have any symptoms for years. If ...

  8. Systematic review of actual 10-year survival following resection for hepatocellular carcinoma. (United States)

    Gluer, Annelise M; Cocco, Nicholas; Laurence, Jerome M; Johnston, Emma S; Hollands, Michael J; Pleass, Henry C C; Richardson, Arthur J; Lam, Vincent W T


    Hepatic resection is a potentially curative therapy for hepatocellular carcinoma (HCC), but recurrence of disease is very common. Few studies have reported 10-year actual survival rates following hepatic resection; instead, most have used actuarial measures based on the Kaplan-Meier method. This systematic review aims to document 10-year actual survival rates and to identify factors significant in determining prognosis. A comprehensive search was undertaken of MEDLINE and EMBASE. Only studies reporting the absolute number of patients alive at 10 years after first resection for HCC were included; these figures were used to calculate the actual 10-year survival rate. A qualitative review and analysis of the prognostic factors identified in the included studies were performed. Fourteen studies, all of which were retrospective case series, including data on 4197 patients with HCC were analysed. Ten years following resection, 303 of these patients were alive. The 10-year actual survival rate was 7.2%, whereas the actuarial survival quoted from the same studies was 26.8%. Positive prognostic factors included better hepatic function, a wider surgical margin and the absence of satellite lesions. The actual long-term survival rate after resection of HCC is significantly inferior to reported actuarial survival rates. The Kaplan-Meier method of actuarial survival analysis tends to overestimate survival outcomes as a result of censorship of data and subgroup analysis. © 2012 International Hepato-Pancreato-Biliary Association.

  9. Hypoksisk hepatitis

    DEFF Research Database (Denmark)

    Amadid, Hanan; Schiødt, Frank Vinholt


    Hypoxic hepatitis (HH), also known as ischaemic hepatitis or shock liver, is an acute liver injury caused by hepatic hypoxia. Cardiac failure, respiratory failure and septic shock are the main underlying conditions. In each of these conditions, several haemodynamic mechanisms lead to hepatic...... hypoxia. A shock state is observed in only 50% of cases. Thus, shock liver and ischaemic hepatitis are misnomers. HH can be a diagnostic pitfall but the diagnosis can be established when three criteria are met. Prognosis is poor and prompt identification and treatment of the underlying conditions...

  10. [Hepatocellular carcinoma originated in the caudate lobe. Surgical strategy for resection. A propos of a case]. (United States)

    Martínez-Mier, Gustavo; Esquivel-Torres, Sergio; Calzada-Grijalva, José Francisco; Grube-Pagola, Peter


    Hepatocellular carcinoma originating from the caudate lobe has a worse prognosis than other hepatocellular carcinoma in another segment of the liver. An isolated caudate lobe resection of the liver represents a significant technical challenge. Caudate lobe resection can be performed along with a lobectomy or as an isolated liver resection. There are very few reports about isolated caudate lobe liver resection. We report a case of successful isolated resection of hepatocellular carcinoma in the caudate lobe with excellent long-term survival. A 74 years old female with 8cm mass lesion in the caudate lobe without clinical or biochemical evidence of liver cirrhosis, serum alpha-fetoprotein 3.7 U/l, and negative hepatitis serology was evaluated for surgery. Complete resection of the lesion in 270minutes with Pringle maneuver for 13minutes was satisfactorily performed. Patient was discharged ten days after surgery without complications. Patient is currently asymptomatic, without deterioration of liver function and 48 month tumor free survival after the procedure. Isolated caudate lobe resection is an uncommon but technically possible procedure. In order to achieve a successful resection, one must have a detailed knowledge of complete liver anatomy. Tumor free margins must be obtained to provide long survival for these patients who have a malignancy in this anatomic location. Copyright © 2015. Published by Masson Doyma México S.A.

  11. Risk factors for central bile duct injury complicating partial liver resection

    NARCIS (Netherlands)

    Boonstra, E. A.; de Boer, M. T.; Sieders, E.; Peeters, P. M. J. G.; de Jong, K. P.; Slooff, M. J. H.; Porte, R. J.

    Background: Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct,

  12. [Surgical treatment of children with hepatic tumours

    DEFF Research Database (Denmark)

    Rasmussen, A.; Kvist, N.; Kirkegaard, P.


    %). There was no difference in survival dependent on the type of resection, and there was no impact of the extension of tumour growth at the time of diagnosis. CONCLUSION: The combination of neoadjuvant chemotherapy followed by liver resection or liver transplantation is the treatment of choice in all children...... with hepatoblastoma. The results have improved dramatically over the last decades. The results in Denmark compare well with international results. Since 2000, very effective chemotherapy has downstaged all referred patients, so subsequent liver resection have been possible Udgivelsesdato: 2008/4/14......INTRODUCTION: In this paper we review the results of surgical treatment of children with hepatic tumours. MATERIALS AND METHODS: The study comprises 33 children who have undergone lever resection or liver transplantation since 1990. 26 patients had hepatoblastoma, 3 had hepatocellular carcinoma, 2...

  13. Cavernous hemangioma concurrently involving the anterior and middle mediastinum and the lung parenchyma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jee Hyun; Lee, Soo Jung; Kim, Sung Jin; Cho, Bum Sang [Dept. of Radiology, Chungbuk National University Hospital, Cheongju (Korea, Republic of)


    Hemangioma is rarely found in the mediastinum or lung. In the mediastinum, this tumor is usually located in the anterior mediastinum and manifests as a nonspecific soft tissue mass. In the lung, it usually presents as a well-defined nodule. To the best of our knowledge, there is no case of cavernous hemangioma concurrently involving the mediastinum and lung parenchyma, except for one case of concurrent cardiac and pulmonary hemangiomas. Here, we present an interesting case of cystic anterior and middle mediastinal masses together with multiple pulmonary nodules and ground glass opacities, which were diagnosed as cavernous hemangiomas. When similar findings are encountered, clinicians should consider hemangioma in the differential diagnosis.

  14. Pulmonary lymphangioleiomyomatosis: Analysis of disease manifestation by region-based quantification of lung parenchyma

    Energy Technology Data Exchange (ETDEWEB)

    Theilig, D., E-mail: [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany); Doellinger, F. [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany); Kuhnigk, J.M. [Fraunhofer MEVIS, Universitaetsallee 29, 28359 Bremen (Germany); Temmesfeld-Wollbrueck, B.; Huebner, R.H. [Charité, Department of Pneumology, Augustenburger Platz 1, 13353 Berlin (Germany); Schreiter, N.; Poellinger, A. [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany)


    Highlights: •The distribution of cystic lesions in LAM was evaluated with quantitative CT. •There were more cystic lesions in the central lung compared to peripheral areas. •Cystic changes were more frequent in apical two thirds compared to lower third. •Results might help to obviate the need for biopsy in more cases. -- Abstract: Purpose: Lymphangioleiomyomatosis (LAM) is characterized by proliferation of smooth muscle tissue that causes bronchial obstruction and secondary cystic destruction of lung parenchyma. The aim of this study was to evaluate the typical distribution of cystic defects in LAM with quantitative volumetric chest computed tomography (CT). Materials and methods: CT examinations of 20 patients with confirmed LAM were evaluated with region-based quantification of lung parenchyma. Additionally, 10 consecutive patients were identified who had recently undergone CT imaging of the lung at our institution, in which no pathologies of the lung were found, to serve as a control group. Each lung was divided into three regions (upper, middle and lower thirds) with identical number of slices. In addition, we defined a “peel” and “core” of the lung comprising the 2 cm subpleural space and the remaining inner lung area. Computerized detection of lung volume and relative emphysema was performed with the PULMO 3D software (v3.42, Fraunhofer MEVIS, Bremen, Germany). This software package enables the quantification of emphysematous lung parenchyma by calculating the pixel index, which is defined as the ratio of lung voxels with a density <−950 HU to the total number of voxels in the lung. Results: Cystic changes accounted for 0.1–39.1% of the total lung volume in patients with LAM. Disease manifestation in the central lung was significantly higher than in peripheral areas (peel median: 15.1%, core median: 20.5%; p = 0.001). Lower thirds of lung parenchyma showed significantly less cystic changes than upper and middle lung areas combined (lower

  15. Percutaneous jejunostomy through the liver parenchyma for palliation of afferent loop syndrome. (United States)

    Kwon, Jae Hyun; Han, Yoon Hee


    In the treatment of afferent loop syndrome, jejunostomy or Roux-en-Y gastrojejunostomy have tended to represent the preferred procedures. In patients who are not good candidates for surgery, palliative treatment-i.e., percutaneous transhepatic biliary drainage or percutaneous direct transperitoneal jejunostomy techniques-have been applied. Transhepatic biliary drainage confers a risk of ascending cholangitis. Direct percutaneous transperitoneal drainage may be impractical when overlying bowel loops prevent access to deeply located afferent loops. In the present case, percutaneous jejunostomy through the liver parenchyma was performed successfully for palliation of afferent loop syndrome.

  16. Physically based nonrigid registration using smoothed particle hydrodynamics: application to hepatic metastasis volume-preserving registration. (United States)

    Pyo, Soon Hyoung; Lee, Jeongjin; Park, Seongjin; Kim, Kyoung Won; Shin, Yeong-Gil; Kim, Bohyung


    Recent advances in computing hardware have enabled the application of physically based simulation techniques to various research fields for improved accuracy. In this paper, we present a novel physically based nonrigid registration method using smoothed particle hydrodynamics for hepatic metastasis volume-preserving registration between follow-up liver CT images. Our method models the liver and hepatic metastasis as a set of particles carrying their own physical properties. Based on the fact that the hepatic metastasis is stiffer than other normal cells in the liver parenchyma, the candidate regions of hepatic metastasis are modeled with particles of higher stiffness compared to the liver parenchyma. Particles placed in the liver and candidate regions of hepatic metastasis in the source image are transformed along a gradient vector flow-based force field calculated in the target image. In this transformation, the particles are physically interacted and deformed by a novel deformable particle method which is proposed to preserve the hepatic metastasis to the best. In experimental results using ten clinical datasets, our method matches the liver effectively between follow-up CT images as well as preserves the volume of hepatic metastasis almost completely, enabling the accurate assessment of the volume change of the hepatic metastasis. These results demonstrated a potential of the proposed method that it can deliver a substantial aid in measuring the size change of index lesion (i.e., hepatic metastasis) after the chemotheraphy of metastasis patients in radiation oncology.

  17. Contrast enhanced ultrasound features of hepatic cystadenoma and hepatic cystadenocarcinoma. (United States)

    Dong, Yi; Wang, Wen-Ping; Mao, Feng; Fan, Mei; Ignee, Andre; Serra, Carla; Sparchez, Zeno; Sporea, Ioan; Braden, Barbara; Dietrich, Christoph F


    Hepatic (biliary) cystic tumor (HBCT) is a rare focal cystic liver lesion, which has been rarely described in the literature. In our current multicenter, retrospective study, we aimed to analyze contrast enhanced ultrasound (CEUS) features and its diagnostic performance in histologically proved HBCT. Twenty-three patients with single HBCT were retrospectively analyzed. Histologically, 17 (73.9%) were benign hepatic (biliary) cystadenoma (HBCA), 6 (26.1%) were hepatic (biliary) cystadenocarcinoma (HBCAC). All CEUS examinations were assessed by two independent radiologists in consensus. Criteria of CEUS imaging evaluation included the contrast enhancement pattern of lesion (hypoenhancing, hyperenhancing, isoenhancing in comparison to the surrounding liver parenchyma) during the arterial, portal venous and late phases. After injection of ultrasound contrast agents, most of the HBCTs (78.3%, 18/23) had typical honeycomb enhancement pattern of the cystic wall, septa or mural nodules. Comparing between HBCA and HBCAC, hyperenhancement of the honeycomb septa during the arterial phase was more common in HBCA (p = .047). However, hypoenhancement during the portal venous and late phases was the characteristic of HBCAC (p = .041). The EFSUMB algorithm for CEUS for characterization of solid focal liver lesions is also applicable to HBCT. CEUS evaluation can avoid further diagnostic investigations or invasive biopsy procedure.

  18. Awake craniotomy for cortical language mapping and resection of an arteriovenous malformation adjacent to eloquent areas under general anesthesia — A hybrid approach

    Directory of Open Access Journals (Sweden)

    Pree Nimmannitya


    Full Text Available Surgery of arteriovenous malformation (AVM is sometimes challenging and carries a high risk of morbidity, especially when the AVM is located in an eloquent area of the brain. Unlike gliomas, awake craniotomy has not been widely used for resection of AVM. The authors present a case of an AVM in the left frontal lobe which was successfully removed with the aid of awake craniotomy with cortical language mapping. In conclusion, awake craniotomy for functional cortical mapping is beneficial for AVM resection, especially when the lesion is located in or adjacent to eloquent areas of the brain. A hybrid approach with functional mapping in the awake condition and AVM resection under general anesthesia may be useful in selected cases. Furthermore, en bloc resection with the nidus embedded in the brain parenchyma may be a useful means of removal to reduce operation time and intraoperative blood loss if there is no apparent functional cortex surrounding the AVM, as in the present case.

  19. Transurethral resection of the prostate (United States)

    TURP; Prostate resection - transurethral ... used to remove the inside part of your prostate gland using electricity. ... if you have benign prostatic hyperplasia ( BPH ). The prostate gland often grows larger as men get older. ...

  20. Colorectal endoscopic mucosal resection (EMR). (United States)

    Kandel, Pujan; Wallace, Michael B


    Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%. There are several advantages of endoscopic resection technique over surgery; it is less invasive, less expensive, has rapid recovery, and preserves the normal gut functions. In addition patient satisfaction and efficacy of EMR is higher with minor complications. Thus, this has facilitated the development of advanced resection technique for the treatment of large colorectal polyps called as endoscopic mucosal resection (EMR). Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Replacement of Diseased Mouse Liver by Hepatic Cell Transplantation (United States)

    Rhim, Jonathan A.; Sandgren, Eric P.; Degen, Jay L.; Palmiter, Richard D.; Brinster, Ralph L.


    Adult liver has the unusual ability to fully regenerate after injury. Although regeneration is accomplished by the division of mature hepatocytes, the replicative potential of these cells is unknown. Here, the replicative capacity of adult liver cells and their medical usefulness as donor cells for transplantation were investigated by transfer of adult mouse liver cells into transgenic mice that display an endogenous defect in hepatic growth potential and function. The transplanted liver cell populations replaced up to 80 percent of the diseased recipient liver. These findings demonstrate the enormous growth potential of adult hepatocytes, indicating the feasibility of liver cell transplantation as a method to replace lost or diseased hepatic parenchyma.

  2. Correlation of neurocognitive function and brain parenchyma volumes in children surviving cancer (United States)

    Reddick, Wilburn E.; White, Holly A.; Glass, John O.; Mulhern, Raymond K.


    This research builds on our hypothesis that white matter damage and associated neurocognitive symptoms, in children treated for cancer with cranial spinal irradiation, spans a continuum of severity that can be reliably probed using non-invasive MR technology. Quantitative volumetric assessments of MR imaging and psychological assessments were obtained in 40 long-term survivors of malignant brain tumors treated with cranial irradiation. Neurocognitive assessments included a test of intellect (Wechsler Intelligence Test for Children, Wechsler Adult Intelligence Scale), attention (Conner's Continuous Performance Test), and memory (California Verbal Learning Test). One-sample t-tests were conducted to evaluate test performance of survivors against age-adjusted scores from the test norms; these analyses revealed significant impairments in all apriori selected measures of intelligence, attention, and memory. Partial correlation analyses were performed to assess the relationships between brain tissues volumes (normal appearing white matter (NAWM), gray matter, and CSF) and neurocognitive function. Global intelligence (r = 0.32, p = 0.05) and global attentional (r = 0.49, p < 0.01) were significantly positively correlated with NAWM volumes, whereas global memory was significantly positively correlated with overall brain parenchyma (r = 0.38, p = 0.04). We conclude that quantitative assessment of MR examinations in survivors of childhood cancer treated with cranial irradiation reveal that loss of NAWM is associated with decreased intellectual and attentional deficits, whereas overall parenchyma loss, as reflected by increased CSF and decreased white matter, is associated with memory-related deficits.

  3. Increased liver regeneration rate and decreased liver function after synchronous liver and colon resection in rats. (United States)

    Sasanuma, Hideki; Mortensen, Frank Viborg; Knudsen, Anders Riegels; Funch-Jensen, Peter; Okada, Masaki; Nagai, Hideo; Yasuda, Yoshikazu


    The surgical strategy for the treatment of colorectal cancer and synchronous liver metastases remains controversial. The aim of the present study was to investigate the effects of colonic resection on liver function and regeneration in a rat model. Ninety-six Sprague-Dawley rats were block-randomized into six groups: Group I had a laparotomy performed. Group II had 1 cm colon resected and anastomosed. Group III and V had 40% or 70% of the liver resected, respectively. Additionally Group IV and VI had 1 cm colon resected and anastomosed, respectively. Body weight was recorded on postoperative day 0, 3, 5 and 7. Rats were sacrificed on postoperative day 7 by rapid collection of blood from the inferior vena cava, and endotoxin levels were measured. Remnant liver function was evaluated by means of branched amino acids to tyrosine ratio. Liver regeneration was calculated by (liver weight per 100 g of the body weight at sacrifice/preoperative projected liver weight per 100 g of the body weight) x 100. The total number of complications was significantly higher in Group VI than Group I, III, IV, and V. Body weight and branched amino acids to tyrosine ratio were both significantly lower in rats that had simultaneous colonic and liver resection performed. Hepatic regeneration rate was significantly higher in the simultaneous colectomy group. Systemic endotoxin levels were unaffected by simultaneous colectomy on postoperative day 7. In our model morbidity seems to be related to the extent of hepatic resection. In rats undergoing liver resection, simultaneous colectomy induced a higher degree of hepatic regeneration rate. Body weight changes and branched amino acids to tyrosine ratio were negatively affected by simultaneous colectomy.

  4. Clinical outcomes of Y90 radioembolization for recurrent hepatocellular carcinoma following curative resection. (United States)

    Ali, Rehan; Riaz, Ahsun; Gabr, Ahmed; Abouchaleh, Nadine; Mora, Ronald; Al Asadi, Ali; Caicedo, Juan Carlos; Abecassis, Michael; Katariya, Nitin; Maddur, Haripriya; Kulik, Laura; Lewandowski, Robert J; Salem, Riad


    To assess safety/efficacy of yttrium-90 radioembolization (Y90) in patients with recurrent hepatocellular carcinoma (HCC) following curative surgical resection. With IRB approval, we searched our prospectively acquired database for patients that were treated with Y90 for recurrent disease following resection. Baseline characteristics and bilirubin toxicities following Y90 were evaluated. Intention-to-treat overall survival (OS) and time-to-progression (TTP) from Y90 were assessed. Forty-one patients met study inclusion criteria. Twenty-six (63%) patients had undergone minor (≤3 hepatic segments) resection while 15 (37%) patients underwent major (>3 hepatic segments) resections. Two patients (5%) had biliary-enteric anastomoses created during surgical resection. The median time from HCC resection to the first radioembolization was 17 months (95% CI: 13-37). The median number of Y90 treatment sessions was 1 (range: 1-5). Ten patients received (entire remnant) lobar Y90 treatment while 31 patients received selective (≤2 hepatic segments) treatment. Grades 1/2/3/4 bilirubin toxicity were seen in nine (22%), four (10%), four (10%), and zero (0%) patients following Y90. No differences in bilirubin toxicities were identified when comparing lobar with selective approaches (P = 0.20). No post-Y90 infectious complications were identified. Median TTP and OS were 11.3 (CI: 6.5-15.5) and 22.1 months (CI: 10.3-31.3), respectively. Radioembolization is a safe and effective method for treating recurrent HCC following surgical resection, with prolonged TTP and promising survival outcomes.

  5. Feature Hepatitis: Hepatitis Can Strike Anyone (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis Can Strike Anyone Past Issues / Spring 2009 Table ... from all walks of life are affected by hepatitis, especially hepatitis C, the most common form of ...

  6. Hepatitis A through E (Viral Hepatitis) (United States)

    ... Hepatitis B Hepatitis C Hepatitis D Hepatitis E Liver Transplant Definition & Facts Transplant Process Transplant Surgery Living with a Liver Transplant Clinical Trials Nonalcoholic Fatty Liver Disease & NASH Definition & ...

  7. Pediatric hepatic hemangiosarcoma in a rhesus macaque (Macaca mulatta) (United States)

    Mejía, A.F.; Gierbolini, L.; Jacob, B.; Westmoreland, S.V.


    Background Pediatric hepatic angiosarcoma is a rare condition in children with poor prognosis. Microscopically this neoplasm has a particular ‘Kaposi-form’ arrangement. Hemangiosarcoma in non-human primates is a rare finding. Methods Gross and microscopic examination of a 3-year-old rhesus were performed. Immunohistochemistry was used to characterize the hepatic hemangiosarcoma. Results The gross necropsy revealed hemoabdomen and a 4 × 3 × 3 cm mass in the liver with multiple smaller masses throughout the hepatic parenchyma. Histopathology confirmed a poorly differentiated hemangiosarcoma. Other organs submitted were free of metastases. Conclusions Hemangiosarcoma in non-human primates has been rarely reported. Diagnosis was confirmed by expression of endothelial-specific markers CD31 and vWF by immunohistochemistry. Due to the young age of this monkey and the particular solid pattern throughout the mass this neoplasm resembles pediatric hepatic angiosarcoma in humans. PMID:18671765

  8. Travelers' Health: Hepatitis C (United States)

    ... Chapter 3 - Hepatitis B Chapter 3 - Hepatitis E Hepatitis C Deborah Holtzman INFECTIOUS AGENT Hepatitis C virus ( ... mother to child. Map 3-05. Prevalence of hepatitis C virus infection 1 PDF Version (printable) 1 ...

  9. Travelers' Health: Hepatitis B (United States)

    ... Chapter 3 - Hepatitis A Chapter 3 - Hepatitis C Hepatitis B Francisco Averhoff INFECTIOUS AGENT Hepatitis B virus ( ... progression of disease. Map 3-04. Prevalence of hepatitis B virus infection 1 PDF Version (printable) 1 ...

  10. Travelers' Health: Hepatitis A (United States)

    ... 3 - Helminths, Soil-Transmitted Chapter 3 - Hepatitis B Hepatitis A Noele P. Nelson INFECTIOUS AGENT Hepatitis A ... hepatitis/HAV Table 3-02. Vaccines to prevent hepatitis A VACCINE TRADE NAME (MANUFACTURER) AGE (Y) DOSE ...

  11. Hepatitis C: Clinical Trials (United States)

    ... and Public Home » Hepatitis C » Treatment Decisions Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... can I find out about participating in a hepatitis C clinical trial? Many trials are being conducted ...

  12. Hepatitis (For Parents) (United States)

    ... Staying Safe Videos for Educators Search English Español Hepatitis KidsHealth / For Parents / Hepatitis Print en español Hepatitis What Is Hepatitis? Hepatitis is an inflammation of the liver. The ...

  13. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel. (United States)

    Reccia, Isabella; Kumar, Jayant; Kusano, Tomokazu; Zanellato, Artur; Draz, Ahmed; Spalding, Duncan; Habib, Nagy; Pai, Madhava


    Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Pancreatectomy for pancreatic cancer with reference to combined resection of the vessels, twenty nine year experience by a single surgeon. (United States)

    Sugiura, Yoshiaki; Horio, Takuya; Aiko, Satoshi; Ishizuka, Takamitu; Kumano, Isao; Kato, Yutaro; Kato, Ayu; Kitajima, Masaki


    Between 1978 and 2007 one hundred and seven patients consecutively underwent resection for primary pancreatic adenocarcinoma. There were 28 pN0 patients, 41 pN1 and 37 pN2 or more (one unknown). Combined resection of the portal vein was performed in 62 out of 107 patients (58%). The hepatic artery in 10 patients, superior mesenteric artery in 8 patients and celiac trunk in 7 patients were also resected additionally to the portal vein. The 5-year survival rate and 10-year survival rate of all 107 cases were 12.1% and 2.8% respectively. The 5-year survival rate of the pN0 group was 37%, significantly better than the 14% 5-year survival rate in the pN1 group (p=0.043). Of 69 patients with pN0 or pN1, 38 patients underwent combined resection of the portal vein. There was not significant difference between the 24% 5-year survival rate in the group without the portal vein resection and the 19% 5-year survival rate in the group with portal vein resection. The 20% 5-year survival rate of the portal vein only group and the 5-year survival rate of both the portal vein and hepatic artery group were the same. The groups of the further resection of the superior mesenteric artery and of the celiac trunk showed no long-term survival. It is concluded that aggressive combined resection of the portal vein or additional resection of the hepatic artery be feasible for a survival benefit in pN0 and pN1 diseases.

  15. Sporadic insulinomas on volume perfusion CT: dynamic enhancement patterns and timing of optimal tumour-parenchyma contrast

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Liang; Xue, Hua-dan; Liu, Wei; Wang, Xuan; Sun, Hao; Li, Ping; Jin, Zheng-yu [Peking Union Medical College Hospital, Department of Radiology, Beijing (China); Wu, Wen-ming; Zhao, Yu-pei [Peking Union Medical College Hospital, Department of General Surgery, Beijing (China)


    To assess enhancement patterns of sporadic insulinomas on volume perfusion CT (VPCT), and to identify timing of optimal tumour-parenchyma contrast. Consecutive patients who underwent VPCT for clinically suspected insulinomas were retrospectively identified. Patients with insulinomas confirmed by surgery were included, and patients with familial syndromes were excluded. Two radiologists evaluated VPCT images in consensus. Tumour-parenchyma contrast at each time point was measured, and timing of optimal contrast was determined. Time duration of hyperenhancement (tumour-parenchyma contrast >20 Hounsfield units, HU) was recorded. Perfusion parameters were evaluated. Three dynamic enhancement patterns were observed in 63 tumours: persistent hyperenhancement (hyperenhancement time window ≥10 s) in 39 (61.9%), transient hyperenhancement (hyperenhancement <10 s) in 19 (30.2%) and non-hyperenhancement in 5 (7.9%). Timing of optimal contrast was 9 s after abdominal aorta threshold (AAT) of 200 HU, with tumour-parenchyma contrast of 77.6 ± 57.2 HU. At 9 s after AAT, 14 (22.2%) tumours were non-hyperenhancing, nine of which had missed transient hyperenhancement. Insulinomas with transient and persistent hyperenhancement patterns had significantly increased perfusion. Insulinomas have variable enhancement patterns. Tumour-parenchyma contrast is time-dependent. Optimal timing of enhancement is 9 s after AAT. VPCT enables tumour detection even if the hyperenhancement is transient. (orig.)

  16. The texture quantitative analysis of the normal mammary parenchyma and in breast lesions: acoustic radiation force impulse (ARFI) technology. (United States)

    Li, Y; Liu, C; Geng, J; Zheng, X; Chen, B; Lu, Z; Wang, X


    The purpose of this work is to investigate the feasibility of acoustic radiation force impulse (ARFI) technology in the normal mammary parenchyma and in breast lesions. The virtual touch tissue quantification (VTQ) value was measured on a total of 150 cases in the normal mammary parenchyma and a total of 69 cases in breast lesions (19 cases of nodules, 28 cases of fibroadenoma, and 22 cases of cancer). Then the statistic analysis was carried out on the VTQ value combined with mammographic density, ages, menstrual stages, and pathological result. The VTQ value of mammary parenchyma rose with the increase of the mammographic density, and the value of VTQ had statistical differences in the comparison of group C with group B and in the comparison of group D with group C. The comparison of the VTQ value of the mammary parenchyma in patients with breast cancer and the nodule had statistical difference. The comparison of the VTQ value of the mammary parenchyma in patients with breast cancer, and the fibroadenoma had statistical difference. The value ofVTQ in masses gradually increased in the groups of nodule, fibroadenoma, and breast cancer. There was significant difference in the comparison of VTQ value of the nodule group and the fibroadenoma group with breast cancer group respectively. ARFI-VTQ technology has some reference value in assessing mammographic density. ARFI-VTQ can be used as the quantitative indicater for differentially diagnosing the breast lesions.

  17. Outdoor air pollution and risk for kidney parenchyma cancer in 14 European cohorts

    DEFF Research Database (Denmark)

    Raaschou-Nielsen, Ole; Pedersen, Marie; Stafoggia, Massimo


    Several studies have indicated weakly increased risk for kidney cancer among occupational groups exposed to gasoline vapors, engine exhaust, polycyclic aromatic hydrocarbons and other air pollutants, although not consistently. It was the aim to investigate possible associations between outdoor air...... pollution at the residence and the incidence of kidney parenchyma cancer in the general population. We used data from 14 European cohorts from the ESCAPE study. We geocoded and assessed air pollution concentrations at baseline addresses by land-use regression models for particulate matter (PM10 , PM2.......5 , PMcoarse , PM2.5 absorbance (soot)) and nitrogen oxides (NO2 , NOx ), and collected data on traffic. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effects models for meta-analyses to calculate summary hazard ratios (HRs). The 289,002 cohort...

  18. Organization of the cytoplasmic reticulum in the central vacuole of parenchyma cells in Allium cepa L.

    Directory of Open Access Journals (Sweden)

    Tomasz J. Wodzicki


    Full Text Available An elaborate and complex cytoplasmic reticulum composed of fine filaments and lamellae ranging from 0.1 to 4 microns in size is revealed by viewing the central vacuole of onion bulb parenchyma cells with the scanning election microscope. The larger cytoplasmic strands, visible with the light microscope, are composed of numerous smaller filaments (some tubular which might explain the observed bidirectional movement of particles in these larger strands. The finely divided cytoplasmic network of filaments is continuous with the parietal cytoplasm inclosing the vacuolar sap. In these highly vacuolated cells the mass of the protoplast is in the form of an intravacuolar reticulum immersed in the cell sap. The probable significance of the vacuolar sap in relation to physiological processes of the cell is discussed.

  19. Hepatitis amebiana


    Cortés Mendoza, Eduardo


    Se ha considerado habitualmente la hepatitis amebiana como una inflamación del parénquima hepático causada por localización del parásito mismo en el hígado, distinguiéndose la forma supurada o absceso y el estado presupurativo o hepatitis aguda.

  20. Strain wave elastography for evaluation of renal parenchyma in chronic kidney disease. (United States)

    Menzilcioglu, M S; Duymus, M; Citil, S; Avcu, S; Gungor, G; Sahin, T; Boysan, S N; Altunoren, O; Sarica, A


    Chronic kidney disease (CKD) is an important and costly health problem in developed countries and has a tendency to progress to end-stage renal disease regardless of the aetiology. This progress ends in interstitial fibrosis, which decreases the elasticity of tissue. Elastography is a developing technique to assess tissue elasticity. The aim of this study was to determine the difference of strain index (SI) value of renal parenchyma between patients with CKD and healthy individuals. In addition, SI differences of inter-stages were studied. Toshiba (Toshiba Medical Systems Corporation, Otawara, Japan) Aplio™ 500 ultrasound device and 3.5- to 5.0-MHz convex probe were used for the elastography examinations. A total of 58 patients with CKD from nephrology and endocrinology clinics (30 males and 28 females; mean age, 56.14 ± 11.60 years) and 40 normal healthy individuals (19 males and 21 females; mean age, 51.70 ± 11.71 years) were included in this prospective study. The mean SI of normal healthy individuals and patients with CKD (regardless of stages) was 0.42 ± 0.30 and 1.81 ± 0.88, respectively (p < 0.001). SI values were not statistically significant among the CKD stages (except CKD Stages 1 and 3). The area under the receiver operating characteristic curve was 0.956 for SI. The optimal cut-off value for the prediction of CKD was 0.935 (sensitivity, 88% and specificity, 95%). SI value of sonoelastography can be used to differentiate patients with CKD and healthy individuals. Sonoelastography is an acceptable technique to approach patients with CKD, but we have not shown that it can reliably differentiate different stages. Determining a cut-off SI value between normal and diseased renal parenchyma can help in the diagnosis of CKD.

  1. Diffusion tensor imaging of spinal cord parenchyma lesion in rat with chronic spinal cord injury. (United States)

    Zhao, Can; Rao, Jia-Sheng; Pei, Xiao-Jiao; Lei, Jian-Feng; Wang, Zhan-Jing; Zhao, Wen; Wei, Rui-Han; Yang, Zhao-Yang; Li, Xiao-Guang


    Adequate evaluation of spinal cord parenchyma and accurate identification of injury range are considered two premises for the research and treatment of chronic spinal cord injury (SCI). Diffusion tensor imaging (DTI) provides information about water diffusion in spinal cord, and thus makes it possible to realize these premises. In this study, we conducted magnetic resonance imaging (MRI) for Wistar rats 84days after spinal cord contusion. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) from different positions of the injured cord were collected, analyzed, and compared with the histological results and locomotor outcomes. Moreover, we performed fiber tractography, and examined the difference in cavity percentage obtained respectively via conventional MRI, DTI and histology. Results showed that the chronic SCI rats had the largest changes of all DTI metrics at the epicenter; the farther away from the epicenter, the smaller the variation. FA, AD and RD were all influenced by SCI in a greater space range than MD. The good consistency of FA values and histological results in specific regions evidenced FA's capability of reflecting Wallerian degeneration after SCI. DTI metrics at the epicenter in ventral funiculus also showed a close correlation with the BBB scores. Additionally, supported by the histological results, DTI enables a more accurate measurement of cavity percentage compared to the conventional MRI. DTI parameters might comprehensively reflect the post-SCI pathological status of spinal cord parenchyma at the epicenter and distal parts during the chronic stage, while showing good consistency with locomotor performance. DTI combined with tractography could intuitively display the distribution of spared fibers after SCI and accurately provide information such as cavity area. This may shed light on the research and treatment of chronic SCI. Copyright © 2017 Elsevier Inc. All rights

  2. Parenteral Nutrition in Liver Resection

    Directory of Open Access Journals (Sweden)

    Carlo Chiarla


    Full Text Available Albeit a very large number of experiments have assessed the impact of various substrates on liver regeneration after partial hepatectomy, a limited number of clinical studies have evaluated artificial nutrition in liver resection patients. This is a peculiar topic because many patients do not need artificial nutrition, while several patients need it because of malnutrition and/or prolonged inability to feeding caused by complications. The optimal nutritional regimen to support liver regeneration, within other postoperative problems or complications, is not yet exactly defined. This short review addresses relevant aspects and potential developments in the issue of postoperative parenteral nutrition after liver resection.

  3. Intramedullary ependymoma: Microsurgical resection technique. (United States)

    Giammattei, L; Penet, N; Parker, F; Messerer, M


    Spinal ependymomas are predominantly slow-growing lesions constituting approximately 30-88% of primary spinal intramedullary tumors. They usually present as circumscribed lesions, with regular margins and a clear surgical plane. Gross-total resection is often feasible and potentially curative but neurosurgeons should keep in mind that the ultimate goal of surgery is the preservation of spinal cord function. We present the surgical technique to safely resect an intramedullary ependymoma using a posterior median sulcus approach. A brief description of current management of this pathology is also presented. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  4. Chemotherapy-induced Sinusoidal Injury (CSI) score: a novel histologic assessment of chemotherapy-related hepatic sinusoidal injury in patients with colorectal liver metastasis. (United States)

    Stevenson, Heather L; Prats, Mariana M; Sasatomi, Eizaburo


    Preoperative neoadjuvant therapy for colorectal liver metastases (CRLM) is increasing in use and can lead to chemotherapy-induced damage to sinusoidal integrity, namely sinusoidal obstruction syndrome (SOS). SOS has been associated with an increased need for intraoperative blood transfusions, increased length of hospitalization post-surgery, decreased tumor response, and a shorter overall survival after resection due to liver insufficiency. It is critical for clinicians and pathologists to be aware of this type of liver injury, and for pathologists to include the status of the background, non-neoplastic liver parenchyma in their pathology reports. In this study, expression of CD34 by sinusoidal endothelial cells (SECs), increased expression of smooth muscle actin (SMA) by hepatic stellate cells (HSCs), and aberrant expression of glutamine synthetase (GS) by noncentrizonal hepatocytes were semiquantitatively evaluated in liver resection or biopsy specimens from patients with CRLM to determine their diagnostic value for assessing chemotherapy-induced sinusoidal injury (CSI). The expression of each marker was compared among 22 patients with CRLM with histologically evident SOS (SOS+) and 8 patients with CRLM who had not undergone chemotherapy. Each case was given a histologic grade using the sinusoidal obstruction syndrome index score (SOS-I) to assess the likelihood of SOS. Cases were also given an immunohistochemical grade using the total CSI score calculated as the sum of CD34, SMA, and GS scores. Abnormal staining patterns for CD34 and SMA were significantly more frequent and extensive in SOS+ cases than in the controls (81.8% vs. 25%, P CSI score was significantly higher in the SOS+ cases when compared to controls (P CSI score, calculated using an immunohistochemical panel consisting of CD34, SMA, and GS, may serve as an objective marker of chemotherapy-induced sinusoidal injury and could help diagnose this peculiar form of liver injury.

  5. Interstitial ablative techniques for hepatic tumours. (United States)

    Erce, C; Parks, R W


    Most patients with liver tumours are not suitable for surgery but interstitial ablative techniques may control disease progression and improve survival rates. A review was undertaken using Medline of all reported studies of cryoablation, radiofrequency ablation, microwave ablation, interstitial laser photocoagulation, high-intensity focused ultrasound and ethanol ablation of primary liver tumours and hepatic metastases. Although there are no randomized clinical trials, cryoablation, thermal ablation and ethanol ablation have all been shown to be associated with improved palliation in patients with primary and secondary liver cancer. The techniques can be undertaken safely with minimal morbidity and mortality. Although surgical resection remains the first line of treatment for selected patients with primary and secondary liver malignancies, interstitial ablative techniques are promising therapies for patients not suitable for hepatic resection or as an adjunct to liver surgery. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  6. Bowel resection in Nigerian children

    Directory of Open Access Journals (Sweden)

    Abdur-Rahman L


    Full Text Available Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years was retrospectively collected over eight years (January 1999 to December 2006. The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung′s disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls. The age ranged between four hours to 15 years (median, five months. There were 16 (22.9% neonates, 26 (37.1% infants, and 28 (40% grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5% infants had intussusception, 2 (7.7% had midgut vovulusm and 1 (3.8% had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP was seen in 14 (50.0%, intussusception in 5 (17.9%, and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days. The overall mortality was 17.1% -; which was highest among neonates (56.3%, followed by the infants (26.9% -. Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition

  7. Milestones in the Evolution of Hepatic Surgery

    Directory of Open Access Journals (Sweden)

    Henri Bismuth


    Full Text Available This paper describes the rapid evolution of modern liver surgery, starting in the middle of the twentieth century. Claude Couinaud studied and described the segmental anatomy of the liver, Thomas Starzl performed the first liver transplantations, and Henri Bismuth introduced the concept of anatomical resections. Hepatic surgery has developed significantly since those early days. To date, innovative techniques are applied, using cutting-edge technologies: Intraoperative ultrasound, techniques of vascular exclusion of the liver, new devices for performing homeostasis and dissection, laparoscopy for resections, and new drugs that allow the resection of previously unresectable tumors. The next stage in liver surgery will probably be the implementation of a multidisciplinary holistic approach to the liver-diseased patient that will ensure the best and most efficient treatments in the future.

  8. Quantitative computed tomography of lung parenchyma in patients with emphysema: analysis of higher-density lung regions (United States)

    Lederman, Dror; Leader, Joseph K.; Zheng, Bin; Sciurba, Frank C.; Tan, Jun; Gur, David


    Quantitative computed tomography (CT) has been widely used to detect and evaluate the presence (or absence) of emphysema applying the density masks at specific thresholds, e.g., -910 or -950 Hounsfield Unit (HU). However, it has also been observed that subjects with similar density-mask based emphysema scores could have varying lung function, possibly indicating differences of disease severity. To assess this possible discrepancy, we investigated whether density distribution of "viable" lung parenchyma regions with pixel values > -910 HU correlates with lung function. A dataset of 38 subjects, who underwent both pulmonary function testing and CT examinations in a COPD SCCOR study, was assembled. After the lung regions depicted on CT images were automatically segmented by a computerized scheme, we systematically divided the lung parenchyma into different density groups (bins) and computed a number of statistical features (i.e., mean, standard deviation (STD), skewness of the pixel value distributions) in these density bins. We then analyzed the correlations between each feature and lung function. The correlation between diffusion lung capacity (DLCO) and STD of pixel values in the bin of -910HU volume in 1 second (FEV1) dividing the forced vital capacity (FVC) and the STD of pixel values in the bin of -1024HU lung parenchyma and lung function, which indicates that similar to the conventional density mask method, the pixel value distribution features in "viable" lung parenchyma areas may also provide clinically useful information to improve assessments of lung disease severity as measured by lung functional tests.

  9. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When ... travel through your body until they reach your brain, causing mental and physical symptoms of HE. Hepatic ...

  10. Hepatic Encephalopathy

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    Full Text Available ... the Stages of Hepatic Encephalopathy? What Triggers or Can Cause HE to Get Worse? How is HE ... liver disease. When your liver is damaged it can no longer remove toxic substances from your blood. ...

  11. Hepatic Encephalopathy

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    Full Text Available ... Hepatic Encephalopathy so you can tell your doctor right away if you think you may have it. ... American Liver Foundation © 2018 American Liver Foundation. All rights reserved. Funding for the HE123 - Diagnosis, Treatment and ...

  12. Hepatic Encephalopathy

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    Full Text Available ... Get Worse? How is HE Diagnosed? Prior to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment Medications Importance of Adhering ...

  13. Hepatic Encephalopathy

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    Full Text Available ... Hepatic Encephalopathy so you can tell your doctor right away if you think you may have it. ... American Liver Foundation © 2017 American Liver Foundation. All rights reserved. Funding for the HE123 - Diagnosis, Treatment and ...

  14. Viral Hepatitis (United States)

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  15. Hepatitis B (United States)

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  16. Hepatic Encephalopathy

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    Full Text Available ... to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment ... treatment. Being a fully-informed participant in your medical care is an important factor in staying as ...

  17. Hepatic Encephalopathy

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    Full Text Available ... Symptoms to look for Caregiver Support Caregiver Stories Home › What is Hepatic Encephalopathy? Why Your Liver is ... questions about HE, one step at a time. Home About Us Ways to Give Contact Us Privacy ...

  18. Hepatic Encephalopathy

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    Full Text Available ... Stages of Hepatic Encephalopathy? What Triggers or Can Cause HE to Get Worse? How is HE Diagnosed? ... portosystemic encephalopathy or PSE, is a condition that causes temporary worsening of brain function in people with ...

  19. Hepatic Encephalopathy

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    Full Text Available ... Reading Webinars Caregivers The Role of a Caregiver Signs and Symptoms to look for Caregiver Support Caregiver ... and your family to become familiar with the signs of Hepatic Encephalopathy so you can tell your ...

  20. Hepatic Encephalopathy

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    Full Text Available ... Are the Symptoms of HE? What Are the Stages of Hepatic Encephalopathy? What Triggers or Can Cause ... may not be aware you have it. The stages of HE span from mild to severe and ...

  1. Autoimmune Hepatitis (United States)

    ... person usually needs blood tests for an exact diagnosis because a person with autoimmune hepatitis can have the same symptoms as those of other liver diseases or metabolic disorders. Blood tests. A blood test involves drawing ...

  2. Hepatic hemangioma (United States)

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  3. Hepatic ischemia (United States)

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  5. Hepatic Encephalopathy

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    Full Text Available ... Cirrhosis of the Liver & Symptoms Why it’s Important to Treat HE Symptoms of Liver Failure Glossary of ... Hepatic Encephalopathy? What Triggers or Can Cause HE to Get Worse? How is HE Diagnosed? Prior to ...

  6. Hepatic Encephalopathy

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    Full Text Available ... liver is damaged it can no longer remove toxic substances from your blood. These toxins build up ... disease is. It’s important for you and your family to become familiar with the signs of Hepatic ...

  7. Hepatic Encephalopathy

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    Full Text Available ... ALF HE Materials Suggested Reading Webinars Caregivers The Role of a Caregiver Signs and Symptoms to look ... disease is. It’s important for you and your family to become familiar with the signs of Hepatic ...

  8. Augmented reality in bone tumour resection (United States)

    Park, Y. K.; Gupta, S.; Yoon, C.; Han, I.; Kim, H-S.; Choi, H.; Hong, J.


    Objectives We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. Methods We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. Results The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137–143. PMID:28258117

  9. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins (United States)


    Leiomyosarcoma of the inferior vena cava (IVCL) is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins) IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on. PMID:22742531

  10. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

    Directory of Open Access Journals (Sweden)

    Wang Quan


    Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

  11. Endothelial- and Platelet-Derived Microparticles Are Generated During Liver Resection in Humans. (United States)

    Banz, Yara; Item, Gian-Marco; Vogt, Andreas; Rieben, Robert; Candinas, Daniel; Beldi, Guido


    Cell-derived plasma microparticles (microparticles generated during hepatic surgery co-regulate postoperative procoagulant and proinflammatory events. In 30 patients undergoing liver resection, plasma microparticles were isolated, quantitated, and characterized as endothelial (CD31+, CD41-), platelet (CD41+), or leukocyte (CD11b+) origin by flow cytometry and their procoagulant and proinflammatory activity was measured by immunoassays. During liver resection, the total numbers of microparticles increased with significantly more Annexin V-positive, endothelial and platelet-derived microparticles following extended hepatectomy compared to standard and minor liver resections. After liver resection, microparticle tissue factor and procoagulant activity increased along with overall coagulation as assessed by thrombelastography. Levels of leukocyte-derived microparticles specifically increased in patients with systemic inflammation as assessed by C-reactive protein but are independent of the extent of liver resection. Endothelial and platelet-derived microparticles are specifically elevated during liver resection, accompanied by increased procoagulant activity. Leukocyte-derived microparticles are a potential marker for systemic inflammation. Plasma microparticles may represent a specific response to surgical stress and may be an important mediator of postoperative coagulation and inflammation.

  12. A retrospective analysis of liver resection performed without central venous pressure monitoring. (United States)

    Wax, D B; Zerillo, J; Tabrizian, P; Schwartz, M; Hill, B; Lin, H-M; DeMaria, S


    Studies have suggested that blood loss can be reduced during liver resection by monitoring and maintaining low central venous pressure (CVP) through fluid restriction or other means, but such a strategy carries risks to the patient including those inherent to central venous catheterization. We sought to characterize fluid management and blood loss during liver resections done without CVP monitoring. Retrospective data were extracted from electronic anesthesia records for 993 liver resections. For 135 resections, between 2011 through 2013, where a documentation template was used that recorded fluid administration prior to hepatic inflow occlusion, multivariate analysis was performed to test for an association between pre-clamp fluid volumes administered and blood loss and other adverse outcomes. The median estimated blood loss was 300 mL and overall rate of transfusion was 8.6%. There was no statistically significant association between crystalloid volume administered prior to inflow clamping (median 900 mL) and blood loss, mortality or length of stay in the subset of patients with supplemental fluid data. Liver resection can be performed safely without either CVP monitoring or non-invasive continuous cardiac output monitoring. Additionally, there was no disadvantage to a practical approach to fluid administration prior to inflow clamping during liver resections in the absence of CVP monitoring with regard to blood loss or short-term outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Risk factors for incomplete resection and complications in endoscopic mucosal resection for lateral spreading tumors. (United States)

    Kim, Hyung Hun; Kim, Joo Hoon; Park, Seun Ja; Park, Moo In; Moon, Won


    Lateral spreading tumors (LST) are relatively large flat lesions with diameters exceeding 10 mm in length. Endoscopic mucosal resection (EMR) is a commonly used technique for removing LST. We aimed to evaluate the risk factors for incomplete resection and complications of EMR for LST. Between January 2004 and December 2010, 497 patients who underwent EMR for LST were retrospectively reviewed. Risk factors for endoscopic and histopathological complete resection, complications, and clinical outcomes were investigated. Risks for incomplete resection by piecemeal resection and en bloc resection of a lesion ≥ 30 mm were higher than for en bloc resection of a lesion LST ≥ 30 mm, hospitalize patients for 12 h and note risk for incomplete resection. (iii) Following en bloc resection for LST<30 mm, hospitalize the patient for 12 h and expect complete resection. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

  14. Technical knacks and outcomes of extended extrahepatic bile duct resection in patients with mid bile duct cancer (United States)

    Lee, Seung-Jae; Ha, Tae-Yong; Kim, Ki-Hun; Ahn, Chul-Soo; Moon, Deok-Bog; Song, Gi-Won; Jung, Dong-Hwan; Park, Gil-Chun; Lee, Sung-Gyu


    Backgrounds/Aims Mid bile duct cancers often involve the proximal intrapancreatic bile duct, and resection of the extrahepatic bile duct (EHBD) can result in a tumor-positive distal resection margin (RM). We attempted a customized surgical procedure to obtain a tumor-free distal RM during EHBD resection, so that R0 resection can be achieved without performing pancreaticoduodenectomy through extended EHBD resection. Methods We previously reported the surgical procedures of extended EHBD resection, in which the intrapancreatic duct excavation resembles a ≥2 cm-long funnel. This unique procedure was performed in 11 cases of mid bile duct cancer occurring in elderly patients between the ages of 70 and 83 years. Results The tumor involved the intrapancreatic duct in all cases. Deep pancreatic excavation per se required about 30-60 minutes. Cancer-free hepatic duct RM was obtained in 10 patients. Prolonged leakage of pancreatic juice occurred in 2 patients, but all were controlled with supportive care. Adjuvant therapies were primarily applied to RM-positive or lymph node-positive patients. Their 1-year and 3-year survival rates were 90.9% and 60.6%, respectively. Conclusions We suggest that extended EHBD resection can be performed as a beneficial option to achieve R0 resection in cases in which pancreaticoduodenectomy should be avoided due to various causes including old age and expectation of a poor outcome. PMID:26155223

  15. Resistance to alveolar shape change limits range of force propagation in lung parenchyma. (United States)

    Ma, Baoshun; Smith, Bradford J; Bates, Jason H T


    We have recently shown that if the lung parenchyma is modeled in 2 dimensions as a network of springs arranged in a pattern of repeating hexagonal cells, the distortional forces around a contracting airway propagate much further from the airway wall than classic continuum theory predicts. In the present study we tested the hypothesis that this occurs because of the negligible shear modulus of a hexagonal spring network. We simulated the narrowing of an airway embedded in a hexagonal network of elastic alveolar walls when the hexagonal cells of the network offered some resistance to a change in shape. We found that as the forces resisting shape change approach about 10% of the forces resisting length change of an individual spring the range of distortional force propagation in the spring network fell of rapidly as in an elastic continuum. We repeated these investigations in a 3-dimensional spring network composed of space-filling polyhedral cells and found similar results. This suggests that force propagation away from a point of local parenchymal distortion also falls off rapidly in real lung tissue. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Microscopic quantification of cell integrity in raw and processed onion parenchyma cells. (United States)

    Gonzalez, M E; Jernstedt, J A; Slaughter, D C; Barrett, D M


    A cell viability assessment method based computer vision analysis of the uptake of neutral red dye was used to quantify cell membrane integrity in raw and processed parenchyma cells of onion tissues. The presence of stained vacuoles was used as an indicator of tonoplast membrane integrity and photomicrographs were acquired for microscopic image analysis and cell integrity quantification. Two different image analysis methods, involving the analysis of the saturation and green components of RGB (red, green, blue) images, were compared to the conventional cell count method. Use of the saturation component of RGB images allowed for the visualization and quantification of viable and inviable cells as well as extracellular air spaces. The combination of neutral red uptake, as visualization by light field microscopy, and saturation image analysis, allowed for quantitative determination of the effects of high pressure processing on onion cell integrity. Preservation of vegetable tissues may involve heating or other methods that result in the loss of tissue integrity and potentially quality deterioration. In this study, we stained unprocessed and processed onion tissues with neutral red dye and then used a microscope and a computer imaging program to quantify how many cells were intact or ruptured.

  17. [Molecular and cellular mechanisms of damage to renal parenchyma in renal warm ischemia]. (United States)

    Popov, S V; Guseinov, R G; Martov, A G; Muratov, T M; Tabynbaev, N B


    Warm ischemia of the renal parenchyma is a forced feature of laparoscopic partial nephrectomy. It is accompanied by oxygen deprivation of the organ and followed by re-oxygenation, which can cause additional damage to the renal tissue. This damage can result in acute functional and structural disorders of individual parts of the nephron, increasing the risk for a renal dysfunction. Timely diagnosis of the dysfunction is vital for the success of the treatment. The article provides an overview of current scientific data on the mechanisms of ischemic and reperfusion injuries at the molecular-cellular level and describes the current methods of their detection. Experimental and clinical study of the molecular-cellular mechanisms of ischemic-reperfusion injury of the renal tissue made it possible, first, to determine the main targets of alteration (cytolemma, mitochondria, lysosomes), and second, to establish its consequences, among which the most important are hypoergosis, DNA damage, simultaneous activation of intracellular systems of the suicidal program and induction of electrical breakdown of membranes of target nephrocytes; thirdly, to reveal the range of possibilities for limiting the consequences of hypoxia and/or re-oxygenation, among which interference in the metabolism of purines, measures ensuring the preservation of colloid osmotic pressure inside and outside the cell and membrane stabilization, antioxidant defense and inhibition of cysteine proteinases, etc. However, despite the advances in understanding the pathogenesis of cell damage, including ischemic-hypoxic injury, the problem of intraoperative ischemia-reperfusion safety remains relevant.

  18. Effect of polidocanol foam administration into rat peripheral veins on pulmonary parenchyma. (United States)

    de Moraes Silva, Melissa A; Ferreira, Rimarcs G; de Jesus-Silva, Seleno G; Cardoso, Rodolfo S; Miranda, Fausto


    Background Sclerotherapy has been gaining increased acceptance and popularity as an effective therapy for the treatment of varicose veins. This attention has fed growing interest into the safety and potential complications of this procedure. There is no evidence of pulmonary complications from foam sclerotherapy in humans; however, animal studies have shown possible damage. The aim of this study is to show the changes in rat pulmonary parenchyma after the injection of 1% polidocanol Tessari foam into the peripheral vein using histological analysis of the inflammatory and fibrosis processes. Methods Twenty-four Wistar rats were divided into the following four groups: 24 h polidocanol, seven-day polidocanol, 28-day polidocanol, and control group. After the foam was injected into the lateral saphenous vein, the lungs of the rats were removed for histological analysis. Results Alveolar edema was observed in only the 24 h group (P < 0.005). Vessel thickening was observed in the seven-and 28-day groups (P < 0.001). Interstitial fibrosis was found in only the 28-day group (P = 0.006). There was no evidence of venous or arterial thrombosis in either group. Conclusion Polidocanol Tessari foam injection into rat peripheral veins causes alveolar edema, vessel thickening, and interstitial fibrosis.

  19. Areas of normal pulmonary parenchyma on HRCT exhibit increased FDG PET signal in IPF patients

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    Win, Thida [Lister Hospital, Respiratory Medicine, Stevenage (United Kingdom); Thomas, Benjamin A.; Lambrou, Tryphon; Hutton, Brian F.; Endozo, Raymondo; Shortman, Robert I.; Afaq, Asim; Ell, Peter J.; Groves, Ashley M. [University College London, Institute of Nuclear Medicine, University College Hospital, London (United Kingdom); Screaton, Nicholas J. [Papworth Hospital, Radiology Department, Papworth Everard (United Kingdom); Porter, Joanna C. [University College London, Centre for Respiratory Diseases, University College Hospital, London (United Kingdom); Maher, Toby M. [Royal Brompton Hospital, Interstitial Lung Disease Unit, London (United Kingdom); Lukey, Pauline [GSK, Fibrosis DPU, Research and Development, Stevenage (United Kingdom)


    Patients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF. Consecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent {sup 18}F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of {sup 18}F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances). The pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001). IPF patients have increased pulmonary uptake of {sup 18}F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring. (orig.)

  20. Related B cell clones populate the meninges and parenchyma of patients with multiple sclerosis (United States)

    Lovato, Laura; Willis, Simon N.; Rodig, Scott J.; Caron, Tyler; Almendinger, Stefany E.; Howell, Owain W.; Reynolds, Richard; Hafler, David A.


    In the central nervous system of patients with multiple sclerosis, B cell aggregates populate the meninges, raising the central question as to whether these structures relate to the B cell infiltrates found in parenchymal lesions or instead, represent a separate central nervous system immune compartment. We characterized the repertoires derived from meningeal B cell aggregates and the corresponding parenchymal infiltrates from brain tissue derived primarily from patients with progressive multiple sclerosis. The majority of expanded antigen-experienced B cell clones derived from meningeal aggregates were also present in the parenchyma. We extended this investigation to include 20 grey matter specimens containing meninges, 26 inflammatory plaques, 19 areas of normal appearing white matter and cerebral spinal fluid. Analysis of 1833 B cell receptor heavy chain variable region sequences demonstrated that antigen-experienced clones were consistently shared among these distinct compartments. This study establishes a relationship between extraparenchymal lymphoid tissue and parenchymal infiltrates and defines the arrangement of B cell clones that populate the central nervous system of patients with multiple sclerosis. PMID:21216828

  1. Morphological peculiarity of the renal parenchyma on S10 thin plastinated pig kidneys

    Directory of Open Access Journals (Sweden)

    Pendovski Lazo


    Full Text Available The aim of this study is to investigate the morphological structures on the renal parenchyma on the pig kidneys, prepared in thin slices by S10 sheet plastination method. A total number of 60 kidneys taken form two adult breeds are plastinated in 2mm sagital thin sections. The morphological structure on thin kidney slices is analyzed and their anatomic-topographical relationship is investigated. The prepared thin kidney slices are permanent, flexible, dry, and odorless with smooth surfaces anatomical models with clear distinction between renal medulla and renal cortex. In cross-bread landras/yorkshire, the number of renal pyramids is ranged between 8-14 (average 10.63 while in breed dalland the number is ranged between 8- 13(average 9.94(p>0.05. Three morphological forms are found in pig kidneys based of the variation of adhesion of renal pyramids and derange of their renal papilla into renal pelvis. According the results can be concluded that the S10 sheet plastination method could be used for preparing of thin anatomical models that are suitable for education and research purposes enabling three-dimensional plan view of anatomical structures inside of kidneys.

  2. Hepatitis B Foundation (United States)

    ... worldwide 2 Billion People have been infected with Hepatitis B Worldwide The Hepatitis B Foundation is working ... of people living with hepatitis B. Learn About Hepatitis B in 11 Other Languages . Resource Video See ...

  3. Hepatitis A FAQs (United States)

    ... Professional Resources Patient Education Resources Quick Links to Hepatitis … A | B | C | D | E Viral Hepatitis Home ... Grantees Policy and Programs Resource Center Viral Hepatitis Hepatitis A Questions and Answers for the Public Recommend ...

  4. Minor-but-Complex Liver Resection: An Alternative to Major Resections for Colorectal Liver Metastases Involving the Hepato-Caval Confluence. (United States)

    Urbani, Lucio; Masi, Gianluca; Puccini, Marco; Colombatto, Piero; Vivaldi, Caterina; Balestri, Riccardo; Marioni, Antonio; Prosperi, Valerio; Forfori, Francesco; Licitra, Gabriella; Leoni, Chiara; Paolicchi, Adriana; Boraschi, Piero; Lunardi, Alessandro; Tascini, Carlo; Castagna, Maura; Buccianti, Piero


    Major hepatectomy (MH) is often considered the only possible approach for colorectal liver metastasis (CRLM) at the hepato-caval confluence (CC), but it is associated with high morbidity and mortality. With the aim to reduce MH, we developed the "minor-but-complex" (MbC) technique, which consists in the resection of less than 3 adjacent liver segments with exposure of the CC and preservation of hepatic outflow until spontaneous maturation of peripheral intrahepatic shunts between main hepatic veins. We have evaluated applicability and outcome of MbC resections for the treatment of CRLM involving the CC. In this retrospective cohort study, all consecutive liver resections (LR) performed for CRLM located in segments 1, 7, 8, or 4a were classified as MINOR - removal of <3 adjacent segments; MbC - removal of <3 adjacent segments with CC exposure; and MH - removal of ≥ 3 adjacent segments. The rate of avoided MH was obtained by the difference between the rate of potentially MH (PMH) plus potentially inoperable cases and the rate of the MH performed. Taking into account that postoperative mortality is mainly related to the amount of resected liver, MbC was compared with minor resections for safety, complexity, and outcome. Of the 59 LR analyzed, 29 (49.1%) were deemed PMH and 4 (6.8%) potentially inoperable. Eventually, MH was performed only in 8 (13.5%) with a decrease rate of 42.4%. Minor LR was performed in 23 (39.0%) and MbC LR in 28 (47.5%) patients. Among MbC cases, 32.1% had previous liver treatments, 39.3% required vascular reconstruction (no reconstructed vessel thrombosis occurred before maturation of peripheral intrahepatic shunts between main hepatic veins), and 7.1% had grade IIIb-IV complications, their median hospital stay was 9 days and 90-day mortality was 0%. After a median follow-up of 22.2 months, oncological results were comparable with those of minor resections. MbC hepatectomy lowers the need for MH and allows for the resection of potentially

  5. Feature Hepatitis: Hepatitis Symptoms, Diagnosis, Treatment & Prevention (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis: Symptoms, Diagnosis, Treatment & Prevention Past Issues / Spring 2009 ... No appetite Fever Headaches Diagnosis To check for hepatitis viruses, your doctor will test your blood. You ...

  6. Management of Hepatic Rupture Diagnosed after an Emergency Cesarean Section

    Directory of Open Access Journals (Sweden)

    Gianluca Raffaello Damiani


    Full Text Available A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management.

  7. Endolaryngeal laser resection of larynx

    Directory of Open Access Journals (Sweden)

    A. M. Mudunov


    Full Text Available Laryngeal cancer takes the leading position among malignant tumors of head and neck. Currently, endolaryngeal laser resection is the leading treatment option for localized processes (T1-T2. In the period from December 2014 to January 2016 such surgeries were performed in 76 patients in our clinic. Carcinoma in situ was detected in 19 (25 %, T1a in 27 (35 %, T1b in 24 (31 %, T2 in 6 (8 % patients. As result of the planned histological examination, in all cases surgical procedures had microscopically radical character. Endolaryngeal CO2 -laser resections allow to perform enough large radical surgical interventions with satisfactory functional and cosmetic results, without compromising long-term outcomes. 

  8. [Robot-assisted pancreatic resection]. (United States)

    Müssle, B; Distler, M; Weitz, J; Welsch, T


    Although robot-assisted pancreatic surgery has been considered critically in the past, it is nowadays an established standard technique in some centers, for distal pancreatectomy and pancreatic head resection. Compared with the laparoscopic approach, the use of robot-assisted surgery seems to be advantageous for acquiring the skills for pancreatic, bile duct and vascular anastomoses during pancreatic head resection and total pancreatectomy. On the other hand, the use of the robot is associated with increased costs and only highly effective and professional robotic programs in centers for pancreatic surgery will achieve top surgical and oncological quality, acceptable operation times and a reduction in duration of hospital stay. Moreover, new technologies, such as intraoperative fluorescence guidance and augmented reality will define additional indications for robot-assisted pancreatic surgery.

  9. Embryonic Origin of Primary Colon Cancer Predicts Pathologic Response and Survival in Patients Undergoing Resection for Colon Cancer Liver Metastases. (United States)

    Yamashita, Suguru; Brudvik, Kristoffer Watten; Kopetz, Scott E; Maru, Dipen; Clarke, Callisia N; Passot, Guillaume; Conrad, Claudius; Chun, Yun Shin; Aloia, Thomas A; Vauthey, Jean-Nicolas


    The aim of this study was to determine the prognostic value of embryonic origin in patients undergoing resection after chemotherapy for colon cancer liver metastases (CCLM). We identified 725 patients with primary colon cancer and known RAS mutation status who underwent hepatic resection after preoperative chemotherapy for CCLM (1990 to 2015). Survival after resection of CCLM from midgut origin (n = 238) and hindgut origin (n = 487) was analyzed. Predictors of pathologic response and survival were determined. Prognostic value of embryonic origin was validated with a separate cohort of 252 patients with primary colon cancer who underwent resection of CCLM without preoperative chemotherapy. Recurrence-free survival (RFS) and overall survival (OS) after hepatic resection were worse in patients with midgut origin tumors (RFS rate at 3 years: 15% vs 27%, P origin [odds ratio (OR) 1.55, P = 0.010], absence of bevacizumab (OR 1.42, P = 0.034), and mutant RAS (OR 1.41, P = 0.043). Independent factors associated with worse OS were midgut embryonic origin [hazard ratio (HR) 2.04, P origin had a worse 3-year OS rate (55% vs 78%, P = 0.003). Compared with CCLM from hindgut origin, CCLM from midgut origin are associated with worse pathologic response to chemotherapy and worse survival after resection. This effect appears to be independent of RAS mutation status.

  10. Treatment of hemorrhagic hepatic cysts with omentalization in a serval

    African Journals Online (AJOL)

    The cysts were drained, omentalized and partially closed with a surgical stapler and suture. Histopatological evaluation of the resected tissue was consistent with a chronic hepatic hematoma. The patient recovered well and was discharged 3 days postoperatively. Two years later, the patient was readmitted with the same ...

  11. DNA End Resection: Facts and

    Directory of Open Access Journals (Sweden)

    Ting Liu


    Full Text Available DNA double-strand breaks (DSBs, which arise following exposure to a number of endogenous and exogenous agents, can be repaired by either the homologous recombination (HR or non-homologous end-joining (NHEJ pathways in eukaryotic cells. A vital step in HR repair is DNA end resection, which generates a long 3′ single-stranded DNA (ssDNA tail that can invade the homologous DNA strand. The generation of 3′ ssDNA is not only essential for HR repair, but also promotes activation of the ataxia telangiectasia and Rad3-related protein (ATR. Multiple factors, including the MRN/X complex, C-terminal-binding protein interacting protein (CtIP/Sae2, exonuclease 1 (EXO1, Bloom syndrome protein (BLM/Sgs1, DNA2 nuclease/helicase, and several chromatin remodelers, cooperate to complete the process of end resection. Here we review the basic machinery involved in DNA end resection in eukaryotic cells.

  12. Robotic-assisted resection of liver and diaphragm recurrent ovarian carcinoma: description of technique. (United States)

    Holloway, Robert W; Brudie, Lorna A; Rakowski, Joseph A; Ahmad, Sarfraz


    To describe port placement and operative technique for resection of right hepatic and full-thickness diaphragm metastatic ovarian carcinoma in a patient with recurrent disease using the da Vinci® Surgical System. A 60-year-old female with recurrent platinum sensitive ovarian cancer presented with disease confined to the liver by PET-CT scan. The lesion measured 3.4 cm on the dome of the right hepatic lobe. After two attempts at intra-hepatic arterial chemo-embolization the lesion remained stable. She subsequently agreed to robotic-assisted resection of the right lobe liver mass after refusing laparotomy for 9 months. Pnuemoperitoneum was established in the left upper quadrant by directly inserting a 5-mm laparoscope. There were no midline adhesions. The 12-mm camera port was placed in the midclavicular line on the right 10 cm off the costal margin with the right and left operative arms 10 cm from the camera near the costal margin, and the third arm in the right flank. The robot was docked from the right shoulder. Resection was accomplished with a monopolar spatula in the right, fenestrated bipolar grasper in the left, and double fenestrated grasper in the third operative arm. Adhesions between diaphragm and liver were separated, the liver lesion was excised, the diaphragm lesion was resected full thickness, and diaphragm was closed with running prolene. Surgicel® was placed on the liver for hemostasis. Console time was 82 min and the patient discharged on day-5 after drainage of a cytology negative pleural effusion day-4. Robotic resection of liver and full-thickness diaphragm lesions is possible. The port placement used in this patient was efficient and without operative arm collisions. Patients with isolated upper-abdominal recurrence are candidates for robotic secondary cytoreduction. Copyright © 2010 Elsevier Inc. All rights reserved.

  13. Phylogenetic analyses of the hepatic architecture in vertebrates. (United States)

    Shiojiri, Nobuyoshi; Kametani, Harunobu; Ota, Noriaki; Akai, Yusuke; Fukuchi, Tomokazu; Abo, Tomoka; Tanaka, Sho; Sekiguchi, Junri; Matsubara, Sachie; Kawakami, Hayato


    The mammalian liver has a structural and functional unit called the liver lobule, in the periphery of which the portal triad consisting of the portal vein, bile duct and hepatic artery is developed. This type of hepatic architecture is detectable in many other vertebrates, including amphibians and birds, whereas intrahepatic bile ducts run independently of portal vein distribution in actinopterygians such as the salmon and tilapia. It remains to be clarified how the hepatic architectures are phylogenetically developed among vertebrates. The present study morphologically and immunohistochemically analyzed the hepatic structures of various vertebrates, including as many classes and subclasses as possible, with reference to intrahepatic bile duct distribution. The livers of vertebrates belonging to the Agnatha, Chondrichthyes, Amphibia, Aves, Mammalia, and Actinopterygii before Elopomorpha, had the portal triad-type architecture. The Anguilliformes livers developed both periportal bile ducts and non-periportal bile ducts. The Otocephala and Euteleostei livers had independent configuration of bile ducts and portal veins. Pancreatic tissues penetrated the liver parenchyma along portal veins in the Euteleostei. The liver of the lungfish, which shares the same origin with amphibians, did not have the portal triad-type architecture. Teleostei and lungfish livers had ductular development in the liver parenchyma similar to oval cell proliferation in injured mammalian livers. Euteleostei livers had penetration of significant numbers of independent portal veins from their intestines, suggesting that each liver lobe might receive a different blood supply. The hepatic architectures of the portal triad-type changed to non-portal triad-type architecture along the evolution of the Actinopterygii. The hepatic architecture of the lungfish resembles that of the Actinopterygii after Elopomorpha in intrahepatic biliary configuration, which may be an example of convergent evolution.

  14. Liver Cancer and Hepatitis B (United States)

    ... Clinical Trials Physician Directory HBV Meeting What Is Hepatitis B? What Is Hepatitis B? The ABCs of Viral Hepatitis Liver Cancer and Hepatitis B Hepatitis Delta Coinfection Hepatitis C Coinfection HIV/AIDS ...

  15. Hepatitis B & C and HIV (United States)

    ... Find Services HIV SERVICES LOCATOR Locator Search Search Hepatitis B & C Topics Hepatitis B Hepatitis C Hepatitis ... Infections Sexually Transmitted Diseases Smoking Women's Health Issues Hepatitis B Virus and Hepatitis C Virus Infection People ...

  16. Hepatitis C: Sex and Sexuality (United States)

    ... with Hepatitis » Sex and Sexuality: Entire Lesson Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... hepatitis C virus through sex. Can you pass hepatitis C to a sex partner? Yes, but it ...

  17. Hepatitis C: Diet and Nutrition (United States)

    ... with Hepatitis » Daily Living: Diet and Nutrition Viral Hepatitis Menu Menu Viral Hepatitis Viral Hepatitis Home For ... have high cholesterol and have fatty liver. How hepatitis C affects diet If you have hepatitis, you ...

  18. Percutaneous Liver Biopsy after Living Donor Liver Transplantation Resulting in Fulminant Hepatic Failure: The First Reported Case of Hepatic Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Nicholas N. Nissen


    Full Text Available A 28-year-old female who underwent live donor liver transplantation 3 years prior presented after percutaneous liver biopsy with abdominal and shoulder pain, nausea, vomiting, and elevated liver enzymes. Computed tomography (CT showed an intrahepatic and subcapsular hematoma. There was a progressive increase in liver enzymes, bilirubin, and INR and a decline in hemoglobin. Subsequent CT imaging revealed flattening of the portal vein consistent with compression by the enlarging hematoma. Liver failure ensued and the patient required urgent retransplantation. The explant demonstrated ischemic necrosis of greater than 90% of the liver parenchyma. We report this case of “Hepatic Compartment Syndrome” leading to fulminant hepatic failure.

  19. Robotic liver resection: initial experience with three-arm robotic and single-port robotic technique. (United States)

    Kandil, Emad; Noureldine, Salem I; Saggi, Bob; Buell, Joseph F


    Robotic-assisted surgery offers a solution to fundamental limitations of conventional laparoscopic surgery, and its use is gaining wide popularity. However, the application of this technology has yet to be established in hepatic surgery. A retrospective analysis of our prospectively collected liver surgery database was performed. Over a 6-month period, all consecutive patients who underwent robotic-assisted hepatic resection for a liver neoplasm were included. Demographics, operative time, and morbidity encountered were evaluated. A total of 7 robotic-assisted liver resections were performed, including 2 robotic-assisted single-port access liver resections with the da Vinci-Si Surgical System (Intuitive Surgical Sunnyvalle, Calif.) USA. The mean age was 44.6 years (range, 21-68 years); there were 5 male and 2 female patients. The mean operative time (± SD) was 61.4 ± 26.7 minutes; the mean operative console time (± SD) was 38.2 ± 23 minutes. No conversions were required. The mean blood loss was 100.7 mL (range, 10-200 mL). The mean hospital stay (± SD) was 2 ± 0.4 days. No postoperative morbidity related to the procedure or death was encountered. Our initial experience with robotic liver resection confirms that this technique is both feasible and safe. Robotic-assisted technology appears to improve the precision and ergonomics of single-access surgery while preserving the known benefits of laparoscopic surgery, including cosmesis, minimal morbidity, and faster recovery.

  20. Is pancreatic exocrine insufficiency in celiac disease related to structural alterations in pancreatic parenchyma? (United States)

    Rana, Surinder S; Dambalkar, Arvind; Chhabra, Puneet; Sharma, Ravi; Nada, Ritambhra; Sharma, Vishal; Rana, Satyavati; Bhasin, Deepak K


    Although exocrine pancreatic insufficiency (EPI) has been reported in a number of patients with celiac disease (CD), it is not clear if this is primarily a functional or a structural defect. We studied pancreatic structural abnormalities by endoscopic ultrasound (EUS) in adult CD patients with EPI. Pancreatic exocrine function was prospectively assessed in 36 recently diagnosed CD patients (mean age: 29.8 years) by measuring fecal elastase. Pancreatic structural changes were assessed in CD patients with EPI by EUS and elastography. Exocrine functions were reassessed after 3 months of gluten-free diet. Of the 36 CD patients included, 30 (83%) had anemia, 21 (58%) diarrhea, and 7 (19%) hypothyroidism. Ten (28%) patients had EPI with mean elastase levels of 141.6 μg/g of stool, of whom only one had a history of recurrent acute pancreatitis while the rest 9 patients had no history of acute or chronic pancreatitis. Of these 10 patients, 8 (80%) had diarrhea, 8 (80%) anemia, and 2 (20%) hypothyroidism. EUS was done in 8 patients which showed: normal pancreas in 5 (50%), hyperechoic strands in 3 (30%), and hyperechoic foci without shadowing in 2 (20%) patients. None had lobularity or parenchymal calcification. All patients except the patient with recurrent pancreatitis had normal strain ratio. Follow-up fecal elastase was within normal range in 6 of 7 (86%) patients. EPI, assessed by fecal elastase levels in adult CD patients, possibly does not relate to structural alterations in the pancreatic parenchyma and may be reversible by following a gluten-free diet.

  1. Perioperative hepatocyte growth factor (HGF) infusions improve hepatic regeneration following portal branch ligation (PBL) in rodents. (United States)

    Mangieri, Christopher W; McCartt, Jason C; Strode, Matthew A; Lowry, John E; Balakrishna, Prasad M


    As hepatic surgery has become safer and more commonly performed, the extent of hepatic resections has increased. When there is not enough expected hepatic reserve to facilitate primary resection of hepatic tumors, a clinical adjunct to facilitating primary resection is portal vein embolization (PVE). PVE allows the hepatic remnant to increase to an appropriate size prior to resection via hepatocyte regeneration; however, PVE is not always successful in facilitating adequate regeneration. One of the strongest trophic factors for hepatocyte regeneration is hepatocyte growth factor (HGF). The purpose of this study was to improve hepatic regeneration with perioperative HGF infusions in an animal model that mimics PVE. Portal branch ligation (PBL) in rodents is equivalent to PVE in humans. We performed left-sided PBL in Sprague-Dawley rodents with the experimental group receiving perioperative HGF infusions. Baseline and postoperative liver volumetrics were obtained with CT scanning methods as performed in clinical practice. Baseline and postoperative liver functions were assessed via indocyanine green (ICG) elimination testing. HGF infused rodents had statistically significant increase in all postoperative liver volumetrics. Most clinically relevant were increased right liver volumes (RLV), 14.10 versus 7.85 cm(3) (p value 0.0001), and increased degree of hypertrophy (DH %), 159.23 versus 47.11 % (p value 0.0079). HGF infused rodents also had a quick return to baseline liver function, 2.38 days compared to 6.13 days (p value 0.0001). Perioperative HGF infusions significantly increase hepatic regeneration following PBL in rodents. Perioperative HGF infusions following PVE are a possible adjunct to increase the amount of patients able to successfully undergo primary resection for hepatic tumors. Further basic science is warranted in examining the use of HGF infusions to increase hepatic regeneration and translating that basic science work to clinical practice.


    Directory of Open Access Journals (Sweden)

    Laura Cudillo


    target organ of the immune  response is the liver as suggested by the time interval between hepatitis and the onset of bone marrow failure.

    Liver histology is characterized by T cell infiltrating the parenchyma as reported in acute hepatitis.

    Recently in HAA it has been demonstrated intrahepatic  and blood lymphocytes with  T cell repertoire similar to that of confirmed viral acute hepatitis. The expanded T cell clones return to a normal distribution after response to immunosuppressive treatment, suggesting the antigen or T cell clearance. Therapeutic options are the same as acquired aplastic anemia.

  3. Histopathological Features of Non-Neoplastic Breast Parenchyma Do Not Predict BRCA Mutation Status of Patients with Invasive Breast Cancer

    Directory of Open Access Journals (Sweden)

    Soley Bayraktar


    Full Text Available Background Several studies have evaluated histologic features of nonneoplastic breast parenchyma in patients with BRCA1/2 mutations, but the results are conflicting. The limited data suggest a much higher prevalence of high-risk precursor lesions in BRCA carriers. Therefore, we designed this study to compare the clinicopathological characteristics of peritumoral benign breast tissue in patients with and without deleterious BRCA mutations. Methods Women with breast cancer (BC who were referred for genetic counseling and underwent BRCA genetic testing in 2010 and 2011 were included in the study. Results Of the six benign histological features analyzed in this study, only stromal fibrosis grade 2/3 was found to be statistically different, with more BRCA noncarriers having stromal fibrosis grade 2/3 than BRCA1/2 carriers ( P = 0.04. Conclusion There is no significant association between mutation risk and the presence of benign histologic features of peritumoral breast parenchyma.

  4. Effect of Macerase, Oxalic Acid, and EGTA on Deep Supercooling and Pit Membrane Structure of Xylem Parenchyma of Peach. (United States)

    Wisniewski, M; Davis, G; Arora, R


    The object of this study was to determine if calcium cross-linking of pectin in the pit membrane of xylem parenchyma restricts water movement which results in deep supercooling. Current year shoots of ;Loring' peach (Prunus persica) were infiltrated with oxalic acid or EGTA solutions for 24 or 48 hours and then either prepared for ultrastructural analysis or subjected to differential thermal analysis. The effect of 0.25 to 1.0% pectinase (weight/volume) on deep supercooling was also investigated. The use of 5 to 50 millimolar oxalic acid and pectinase resulted in a significant reduction (flattening) of the low temperature exotherm and a distinct swelling and partial degradation of the pit membrane. EGTA (10 millimolar) for 24 or 48 hours shifted the low temperature exotherm to warmer temperatures and effected the outermost layer of the pit membrane. A hypothesis is presented on pectin-mediated regulation of deep supercooling of xylem parenchyma.

  5. Anti-ice nucleation activity in xylem extracts from trees that contain deep supercooling xylem parenchyma cells


    Kasuga, Jun; Mizuno, Kaoru; Arakawa, Keita; Fujikawa, Seizo


    Boreal hardwood species, including Japanese white birch (Betula platyphylla Sukat. var. japonica Hara), Japanese chestnut (Castanea crenata Sieb. et Zucc.), katsura tree (Cercidiphyllum japonicum Sieb. et Zucc.), Siebold's beech (Fagus crenata Blume), mulberry (Morus bombycis Koidz.), and Japanese rowan (Sorbus commixta Hedl.), had xylem parenchyma cells (XPCs) that adapt to subfreezing temperatures by deep supercooling. Crude extracts from xylem in all these trees were found to have anti-ice...

  6. Contemporary management and classification of hepatic leiomyosarcoma. (United States)

    Hamed, Mazin O; Roberts, Keith J; Merchant, William; Lodge, J Peter A


    Hepatic leiomyosarcomas are rare soft-tissue tumours. The majority of lesions previously considered as leiomyosarcomas have been identified as gastrointestinal stromal tumours (GISTs). Consequently, understanding of the role of liver resection for true leiomyosarcoma is limited, a fact that is exacerbated by the increasing recognition of leiomyosarcoma subtypes. This study presents data on the outcomes of liver resection for leiomyosarcoma and suggests an algorithm for its pathological assessment and treatment. Patients were identified from a prospectively collected departmental database. All tumours were negative for c-kit expression. Immunohistochemistry was performed to identify the presence of oestrogen or progesterone receptor (OR/PR) expression or Epstein-Barr virus (EBV) and patients were stratified according to this profile. Eight patients (of whom seven were female) underwent a total of 11 liver resections over a 12-year period. One patient had a primary hepatic leiomyosarcoma. Of those with metastatic leiomyosarcomas, the primary tumours were located in the mesentery, gynaecological organs and retroperitoneum in four, two and one patient, respectively. Both leiomyosarcomas of gynaecological origin stained positive for OR/PR expression. One patient had previously undergone renal transplantation; this leiomyosarcoma was associated with EBV expression. Median survival was 56 months (range: 22-132 months) and eight, six and four patients remained alive at 1, 3 and 5 years, respectively. Hepatic resection for leiomyosarcoma is associated with encouraging rates of 5-year overall and disease-free survival. The worse outcome that had been expected based on data derived from historical cohorts (partly comprising subjects with GIST) was not observed. An algorithm for pathological classification and treatment is suggested. © 2014 International Hepato-Pancreato-Biliary Association.

  7. Long-term survival after an aggressive surgical approach in patients with breast cancer hepatic metastases. (United States)

    Vlastos, Georges; Smith, David L; Singletary, S Eva; Mirza, Nadeem Q; Tuttle, Todd M; Popat, Reena J; Curley, Steven A; Ellis, Lee M; Roh, Mark S; Vauthey, Jean-Nicolas


    Metastatic breast cancer is generally believed to be associated with a poor prognosis. Therapeutic advances over the past two decades, however, have resulted in improved outcomes for selected patients with limited metastatic disease. Between March 1991 and October 2002, 31 patients had hepatic resection for breast cancer metastases limited to the liver. Clinical and pathologic data were collected prospectively from breast and hepatobiliary databases. Median age of patients was 46 years (range, 31 to 70). Liver metastases were solitary in 20 patients and multiple in 11 patients. Median size of the largest liver metastasis was 2.9 cm (range, 1 to 8). Major liver resections (three or more segments resected) were performed in 14 patients, whereas minor resections (fewer than three segments resected) with or without radiofrequency ablation (RFA) were performed in 17 patients. No postoperative mortality occurred. Of the 31 patients, 27 (87%) received either preoperative or postoperative systemic therapy as treatment for metastatic disease. The median survival was 63 months; a single patient died within 12 months of hepatic resection. The overall 2- and 5-year survival rates were 86% and 61%, respectively, whereas the 2- and 5-year disease-free survival rates were 39% and 31%, respectively. No treatment- or patient-specific variables were found to correlate with survival rates. In selected patients with liver metastases from breast cancer, an aggressive surgical approach is associated with favorable long-term survival. Hepatic resection should be considered a component of multimodality treatment of breast cancer in these patients.

  8. Ultrastructural changes in aster yellows phytoplasma affected Limonium sinuatum Mill. plants II. Pathology of cortex parenchyma cells

    Directory of Open Access Journals (Sweden)

    Anna Rudzińska-Langwald


    Full Text Available In Limonium sinuatum Mill, plants with severe symptoms of aster yellows infection phytoplasmas were present not only in the phloem but also in some cortex parenchymas cells. These parenchyma cells were situated at some distance from the conducting bundles. The phytoplasmas were observed directly in parenchyma cells cytoplasm. The number of phytoplasmas present in each selected cell varies. The cells with a small number of phytoplasmas show little pathological changes compared with the unaffected cells of the same zone of the stem as well with the cells of healthy plants. The cells filled with a number of phytoplasmas had their protoplast very much changed. The vacuole was reduced and in the cytoplasm a reduction of the number of ribosomes was noted and regions of homogenous structure appeared. Mitochondria were moved in the direction of the tonoplast and plasma membrane. Compared to the cells unaffected by phytoplasma, the mitochondria were smaller and had an enlarged cristae internal space. The chloroplasts from affected cells had a very significant reduction in size and the tylacoids system had disappeared. The role of these changes for creating phytoplasma friendly enviroment is discused.

  9. Pulmonary parenchyma segmentation in thin CT image sequences with spectral clustering and geodesic active contour model based on similarity (United States)

    He, Nana; Zhang, Xiaolong; Zhao, Juanjuan; Zhao, Huilan; Qiang, Yan


    While the popular thin layer scanning technology of spiral CT has helped to improve diagnoses of lung diseases, the large volumes of scanning images produced by the technology also dramatically increase the load of physicians in lesion detection. Computer-aided diagnosis techniques like lesions segmentation in thin CT sequences have been developed to address this issue, but it remains a challenge to achieve high segmentation efficiency and accuracy without much involvement of human manual intervention. In this paper, we present our research on automated segmentation of lung parenchyma with an improved geodesic active contour model that is geodesic active contour model based on similarity (GACBS). Combining spectral clustering algorithm based on Nystrom (SCN) with GACBS, this algorithm first extracts key image slices, then uses these slices to generate an initial contour of pulmonary parenchyma of un-segmented slices with an interpolation algorithm, and finally segments lung parenchyma of un-segmented slices. Experimental results show that the segmentation results generated by our method are close to what manual segmentation can produce, with an average volume overlap ratio of 91.48%.

  10. A comparisonof lymphocytic thyroiditis with papillary thyroid carcinoma showing suspicious ultrasonographic findings in a background of heterogeneous parenchyma

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Sang Yu; Shin, Jung Hee; Ko, Eun Young; Hahn, Soo Yeon [Dept. of Radiology, Samsung Medicine Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    The aim of this study was to compare ultrasonographic features in patients with lymphocytic thyroiditis (LT) and papillary thyroid carcinoma (PTC) having suspicious thyroid nodule(s) in a background of heterogeneous parenchyma and to determine the clinical and radiological predictors of malignancy. We reviewed the cases of 100 patients who underwent ultrasonography between April 2011 and October 2012, and showed suspicious thyroid nodule(s) in a background of heterogeneous parenchyma. Eight patients who did not undergo ultrasonography-guided fineneedle aspiration cytology (FNAC) and 34 cases of follow-up ultrasonography after initial FNAC were excluded. We compared the benign and malignant nodules in terms of their clinical and radiological factors. For the 58 nodules including 31 LTs (53.4%) and 27 PTCs (46.6%), the mean tumor sizes of the two groups were 0.96 cm for LT and 0.97 cm for PTC. A univariate analysis revealed that PTCs were more frequent in patients younger than 45 years and having microcalcifications than was LT. An independent predictor of PTC after adjustment was an age of <45 years. LT mimics malignancy in a background of heterogeneous parenchyma on ultrasonography. A young age of <45 years is the most important predictor of malignancy in this condition.

  11. Test of the 'glymphatic' hypothesis demonstrates diffusive and aquaporin-4-independent solute transport in rodent brain parenchyma (United States)

    Yao, Xiaoming; Dix, James A; Jin, Byung-Ju


    Transport of solutes through brain involves diffusion and convection. The importance of convective flow in the subarachnoid and paravascular spaces has long been recognized; a recently proposed ‘glymphatic’ clearance mechanism additionally suggests that aquaporin-4 (AQP4) water channels facilitate convective transport through brain parenchyma. Here, the major experimental underpinnings of the glymphatic mechanism were re-examined by measurements of solute movement in mouse brain following intracisternal or intraparenchymal solute injection. We found that: (i) transport of fluorescent dextrans in brain parenchyma depended on dextran size in a manner consistent with diffusive rather than convective transport; (ii) transport of dextrans in the parenchymal extracellular space, measured by 2-photon fluorescence recovery after photobleaching, was not affected just after cardiorespiratory arrest; and (iii) Aqp4 gene deletion did not impair transport of fluorescent solutes from sub-arachnoid space to brain in mice or rats. Our results do not support the proposed glymphatic mechanism of convective solute transport in brain parenchyma. PMID:28826498

  12. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... toxic substances from your blood. These toxins build up and can travel through your body until they reach your brain, causing mental and physical symptoms of HE. Hepatic Encephalopathy often starts slowly, and at first you may not be ...

  13. Alcoholic Hepatitis (United States)

    ... stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death. Symptoms The ... amount of alcohol you consume. The amount of alcohol intake that puts a person at risk of alcoholic hepatitis isn't known. But most ...

  14. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Triggers or Can Cause HE to Get Worse? How is HE Diagnosed? Prior to Treatment Who treats HE? Preparing for your Medical ... mild to severe and symptoms vary depending on how bad your liver disease is. It’s important for you and your family to become familiar with the signs of Hepatic Encephalopathy ...

  15. Hepatitis C (United States)

    ... liver diseases like hepatitis C. An occasional alcoholic drink may be okay, but check with your doctor first.What are the side ... family doctor to find out if this information applies to you and to get more information on ... Urticaria Check Your Symptoms Find out what else could be ...

  16. Hepatic autoregulation

    DEFF Research Database (Denmark)

    Staehr, Peter; Hother-Nielsen, Ole; Beck-Nielsen, Henning


    The effect of increased glycogenolysis, simulated by galactose's conversion to glucose, on the contribution of gluconeogenesis (GNG) to hepatic glucose production (GP) was determined. The conversion of galactose to glucose is by the same pathway as glycogen's conversion to glucose, i.e., glucose 1...

  17. Chronic hepatitis

    African Journals Online (AJOL)

    Lemon SM, Brown CO, Brookes OS, et al. Specific IgM response to hepatitis A virus determined by solid-phase radioimmunoassay. Infect Immun 1980 ..... benefit from review by a specialist centre interested in liver disease. It is our experience that many patients referred to the Liver Clinic of the University of Cape Town for.

  18. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Caregiver Signs and Symptoms to look for Caregiver Support Caregiver Stories Home › What is Hepatic Encephalopathy? Why Your Liver is ... questions about HE, one step at a time. Home About Us Ways to ... Funding for the HE123 - Diagnosis, Treatment and Support program is provided by Salix Pharmaceuticals

  19. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When your liver is damaged it can no longer remove toxic substances from your blood. ... reach your brain, causing mental and physical symptoms of HE. Hepatic ...

  20. CT and MR imaging characteristics of infantile hepatic hemangioendothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Feng Shiting, E-mail: [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen Univeristy, 58th, The Second Zhongshan Road, Guangzhou (China); Chan Tao, E-mail: [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Ching, A.S.C., E-mail: [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen Univeristy, 58th, The Second Zhongshan Road, Guangzhou (China); Guo Huanyi, E-mail: [Department of Medical ultrasonics, The Third Affiliated Hospital, Sun Yat-Sen Univeristy, 600th, Tianhe Road, Guangzhou (China); Fan Miao, E-mail: [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen Univeristy, 58th, The Second Zhongshan Road, Guangzhou (China); Meng Quanfei, E-mail: [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen Univeristy, 58th, The Second Zhongshan Road, Guangzhou (China); Li Ziping, E-mail: [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen Univeristy, 58th, The Second Zhongshan Road, Guangzhou (China)


    Aim: This study aims to analyze computed tomography (CT) and magnetic resonance (MR) imaging features of infantile hepatic hemangioendotheliomas before and after treatment. Materials and methods: CT and MR examinations of seven infants with biopsy proven hepatic hemangioendotheliomas were retrospectively analyzed. The distribution, number, size, imaging appearance, enhancement pattern and post-treatment changes of the tumors were evaluated. Results: A total of 153 hepatic hemangioendotheliomas were detected on CT (111) and MR (42) imaging. In six infants, 109/111 (98.2%) tumors were hypodense and 2/111 (1.8%) lesions contained calcification on unenhanced CT. On MR imaging, all 42 lesions in one infant were heterogeneously T1-hypointense and T2-hyperintense compared to the normal liver parenchyma. Contrast-enhanced CT and MRI showed peripheral rim (51.6%), uniform (48.4%), fibrillary (33.3%), and nodular (28.8%) contrast enhancement in the hepatic arterial phase. Homogeneous (100%), rim (98.2%) and mixed enhancement patterns were noted in tumors <1.0 cm, >2.0 cm and 1.0-2.0 cm in diameter respectively in the hepatic arterial phase. In three patients who underwent steroid therapy, follow-up CT examination demonstrated tumor size reduction and increased intra-tumoral calcification in two patients. Conclusion: Infantile hepatic hemangioendotheliomas show some typical imaging features and size-dependent pattern of contrast enhancement on CT and MR imaging, which allow accurate imaging diagnosis and post-treatment evaluation.


    Khor, Huai Hao; Bryne, Paul; Basu, Surajit


    INTRODUCTION: Awake craniotomy for resection of tumours from eloquent brain area is an established technique. We describe six year outcome data of awake surgery for radiological low grade glial series tumours resected using natural subpial and vascular intergyral planes. We describe immediate post-operative radiological findings and its correlation with long term outcome. METHOD: This is a retrospective analysis of clinical and radiological records of awake craniotomies undertaken between 2007-2014. Patients were identified from operative department records and radiological data were retrieved from hospital's electronic image archive. A correlative analysis was done between immediate post-operative T2 changes and long term tumour progression. RESULTS: 38 patients underwent awake craniotomy with average age of 41.1 yrs(range 21-79). 6 patients have died (average survival 2.69 years, range 1-84 months) due to tumour progression. 5 of these had initial diagnosis of grade 3 tumour or above; 1 patient had malignant melanoma. 32 (85%) patients have survived the survey period(2.38 years, range 1-72 months). On MRI most patients had post-operative T2 hyperintensity around the resection margins. The T2 hyperintensity persisted in 6 patient. This was correlated with either a peri-operative decision to sub-totally resect, or subsequent tumour progression. In other 32 patients the T2 changes either reduced or remained static. Histology of these patients showed 4 grade 2, 22 grade 3, and 6 grade 4 tumours. CONCLUSION: T2 changes in peri-resection brain parenchyma following a macroscopic complete resection of low grade tumours using awake techniques is not a reliable marker of tumour residual or recurrence. 85% of such changes resolved.

  2. Patient-specific metrics of invasiveness reveal significant prognostic benefit of resection in a predictable subset of gliomas.

    Directory of Open Access Journals (Sweden)

    Anne L Baldock

    Full Text Available Malignant gliomas are incurable, primary brain neoplasms noted for their potential to extensively invade brain parenchyma. Current methods of clinical imaging do not elucidate the full extent of brain invasion, making it difficult to predict which, if any, patients are likely to benefit from gross total resection. Our goal was to apply a mathematical modeling approach to estimate the overall tumor invasiveness on a patient-by-patient basis and determine whether gross total resection would improve survival in patients with relatively less invasive gliomas.In 243 patients presenting with contrast-enhancing gliomas, estimates of the relative invasiveness of each patient's tumor, in terms of the ratio of net proliferation rate of the glioma cells to their net dispersal rate, were derived by applying a patient-specific mathematical model to routine pretreatment MR imaging. The effect of varying degrees of extent of resection on overall survival was assessed for cohorts of patients grouped by tumor invasiveness.We demonstrate that patients with more diffuse tumors showed no survival benefit (P = 0.532 from gross total resection over subtotal/biopsy, while those with nodular (less diffuse tumors showed a significant benefit (P = 0.00142 with a striking median survival benefit of over eight months compared to sub-totally resected tumors in the same cohort (an 80% improvement in survival time for GTR only seen for nodular tumors.These results suggest that our patient-specific, model-based estimates of tumor invasiveness have clinical utility in surgical decision making. Quantification of relative invasiveness assessed from routinely obtained pre-operative imaging provides a practical predictor of the benefit of gross total resection.

  3. Micronuclei formation in liver fibrosis samples from patients infected by hepatitis C virus (United States)


    Genetic research on fibrosis outset and its progression in chronic hepatitis (CH) by hepatitis C virus (HCV) are limited. The lack of cytogenetic data led us to investigate the presence of micronuclei (MNi), as a sign of genomic damage. Hepatocytes of hepatic parenchyma from 62 cases diagnosed with CH associated with HCV and displaying different degrees of fibrosis (F1-F4) were analyzed. These data were compared to 15 cases without fibrosis (F0). Twelve healthy liver parenchyma samples were included as control. All samples were obtained from paraffin-embedded archival material. Micronucleated hepatocytes (MN-Heps) were analyzed through Feulgen/Fast-green staining. Results showed that the rates of MN-Heps in the F4 group were statistically significant (p 0.05) on comparing F0, F1, F2, F3, one against the other, as well as individual versus control. Although chromosomal losses in CH were detected, it was shown that liver parenchyma with fibrosis in the initial stages (F1-F3) cannot be considered cytogenetically abnormal. PMID:21637406

  4. Severe pentasomide Armillifer armillatus infestation complicated by hepatic encephalopathy. (United States)

    Adeyekun, Ademola A; Ukadike, Ikechukwu; Adetiloye, Victor A


    Diagnosis of Armillifer armillatus infestation is usually incidental, commonly via autopsy or radiography. Affected individual are usually asymptomatic. The case presented here, however, had severe thoracic and abdominal involvement with clinical manifestations. To report a case of heavy A. armillatus infestation in an adult female Nigerian rural dweller complicated by hepatic parenchyma damage. Case report from semi-urban southern Nigeria, using clinical records and imaging findings. Clinical case records, including laboratory results and radiographic /computed tomography images. Parenchymal damage with organ dysfunction can be seen with severe A. armillatus infestation. Thus, there is a need for regular health education regarding the risk of A. armillatus infestation for individuals who consume snake meat.

  5. Referral patterns of patients with liver metastases due to colorectal cancer for resection.

    LENUS (Irish Health Repository)

    Al-Sahaf, O


    INTRODUCTION: Colorectal carcinoma accounts for 10% of cancer deaths in the Western World, with the liver being the most common site of distant metastases. Resection of liver metastases is the treatment of choice, with a 5-year survival rate of 35%. However, only 5-10% of patients are suitable for resection at presentation. AIMS: To examine the referral pattern of patients with liver metastases to a specialist hepatic unit for resection. METHODOLOGY: Retrospective review of patient\\'s charts diagnosed with colorectal liver metastases over a 10-year period. RESULTS: One hundred nine (38 women, 71 men) patients with liver metastases were included, mean age 61 years; 79 and 30 patients had synchronous and metachronus metastases, respectively. Ten criteria for referral were identified; the referral rate was 8.25%, with a resection rate of 0.9%. Forty two percent of the patients had palliative chemotherapy; 42% had symptomatic treatment. CONCLUSION: This study highlights the advanced stage of colorectal cancer at presentation; in light of modern evidence-based, centre-oriented therapy of liver metastasis, we conclude that criteria of referral for resection should be based on the availability of treatment modalities.

  6. Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct. (United States)

    Luvira, Vor; Pugkhem, Ake; Bhudhisawasdi, Vajarabhongsa; Pairojkul, Chawalit; Sathitkarnmanee, Egapong; Luvira, Varisara; Kamsa-Ard, Supot


    Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. Studies about the surgical outcomes for IPNB are few; therefore, we investigated the survival of patients who underwent curative surgical resection of IPNB. We retrospectively reviewed the medical and pathological records of 148 IPNB patients who underwent curative-intent hepatic resection between January 2005 and December 2011, to examine the prognosis of IPNB. All demographic and operative parameters were analyzed the effect on survival of patients. The median survival of IPNB patients was 1326 days with a respective 1, 3, and 5 year overall survival of 83.6% (95%CI: 76.5-88.7), 64.4% (95%CI: 56.0-71.6), and 47% (95%CI: 38.4-55.7). The level of invasiveness of IPNB predicted survival very well. For malignant IPNB, univariate analysis showed that serum CA19-9 level, lymph node metastasis, and completeness of resection were significant prognostic factors. Lymph node metastasis and completeness of resection were found in multivariate analysis to be significantly related to survival of the patients. The level of invasiveness and lymph node status were found to be associated with patient survival, as was adequacy of surgery. We recommend R0 resection be attempted for patients with IPNB. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  7. Vaginoscopic resection of vaginal septum. (United States)

    Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmed Toufic; Ghulmiyyah, Labib


    We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect.

  8. Effect of gamma irradiated parenchyma on the growth of irradiated potato tuber buds; Efecto del parenquina irradiado sobre el desarrollo de las yemas de tuberculos de patata tratados por radiacion GAMMA

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez Gonzalez, J.; Garcia Collantes, M. A.


    The development of buds greffed on irradiated potato parenchyma was studied. The irradiated parenchyma does not influence the sprouting capacity of buds, but it affects the way they develop. (Author) 9 refs.

  9. Transient acute liver failure complicating transurethral resection syndrome. (United States)

    Tuccori, Marco; Guidi, Benedetta; Montagnani, Sabrina; Fornai, Matteo; Antonioli, Luca; Blandizzi, Corrado; di Paolo, Marco


    Transurethral resection (TUR) syndrome, resulting from dilutional hyponatraemia for excessive absorption of irrigating fluid, represents the most relevant complication of transurethral resection of prostate (TURP). Ethanol is used as a tracer in the irrigant solution to monitor fluid absorption with a breathalyser. An unusual case of transient acute liver failure complicating TUR syndrome is reported. A 54-year-old male patient, without risk factors for the development of toxic hepatitis, was subjected to TURP for treatment of benign prostatic hyperplasia. Fluid absorption (2275 ml), estimated by breathalyser, exceeded maximum allowed absorption (2000 ml) only at the end of the surgical intervention. No signs of possible toxicity were evident in the few hours following the intervention. About 10 h after the end of TURP, the patient developed sweating, vomiting and diarrhoea. Laboratory analysis revealed severe hyponatraemia (116 meq/l) with signs of severe liver impairment (total bilirubin 5.8 mg/dl, alanine aminotransferase 56,500 U/l, aspartate aminotransferase 32,700 U/l), kidney failure (serum creatinine 1.93 mg/dl) and serum ethanol levels of 219 mg/dl (0.2%). The patient was treated with acetylcysteine 150 mg/kg i.v. and furosemide 50 mg i.v. Liver and renal functions improved in few days and recovered completely within 30 days. The TUR syndrome observed in this case was probably extravascular in nature, and could have been identified and prevented by measuring ethanol levels 10 min after ending the surgical procedure. The performance of such a test should be strongly recommended to all surgeons. The clinicians attributed the development of liver impairment in this case to ethanol toxicity. However, further studies are warranted to confirm whether hepatic injury can represent a possible complication of TUR syndrome when ethanol solution is used as irrigant fluid.

  10. Hepatitis B (HBV) (United States)

    ... Staying Safe Videos for Educators Search English Español Hepatitis B KidsHealth / For Teens / Hepatitis B What's in ... Prevented? Print en español Hepatitis B What Is Hepatitis B? Hepatitis B is an infection of the ...

  11. Spontaneous rupture of a giant hepatic hemangioma. Sequential treatment with preoperative transcatheter arterial embolization and conservative hepatectomy. (United States)

    Lupinacci, R M; Szejnfeld, D; Farah, J F M


    Hemangioma is the most common benign tumor of the liver and it is often asymptomatic. Spontaneous rupture of liver hemangiomas is a rare but potentially lethal complication. Emergent hepatic resection has been the treatment of choice but carries high operative morbidity and mortality. Recently, preoperative transcatheter arterial embolization (TAE) has been used successfully for the management of bleeding ruptured liver tumors and non-operative treatment of symptomatic giant liver hemangiomas. We report a case of spontaneous rupture of a giant hepatic hemangioma that presented with thoracic and abdominal pain and shock due to hemoperitoneum. Once proper diagnosis was made the patient was successfully managed by TAE, followed by conservative hepatic resection.

  12. Quantitative hepatic CT perfusion measurement: Comparison of Couinaud's hepatic segments with dual-source 128-slice CT

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Xuan [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Xue, Hua-dan, E-mail: [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Jin, Zheng-yu, E-mail: [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Su, Bai-yan; Li, Zhuo; Sun, Hao; Chen, Yu; Liu, Wei [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China)


    Purpose: To compare the quantitative liver computed tomography perfusion (CTP) differences among eight hepatic segments. Materials and methods: This retrospective study was based on 72 acquired upper abdomen CTP scans for detecting suspected pancreas tumor. Patients with primary or metastatic liver tumor, any focal liver lesions except simple cyst (<3 cm in diameter), history of liver operation or splenectomy, evidence of liver cirrhosis or invasion of portal vein were excluded. The final analysis included 50 patients (M:F = 21:29, mean age = 43.2 years, 15–76 years). Arterial liver perfusion (ALP), portal-venous perfusion (PVP), total hepatic perfusion (THP = ALP + PVP), and hepatic perfusion index (HPI) of each hepatic segment were calculated and compared by means of one-way analysis of variance (ANOVA) and the Bonferonni correction method. Results: Compared to hepatic segments 5, 6, 7 and 8, segments 2 and 3 showed a tendency of higher ALPs, lower PVPs, and higher HPIs, most of which were statistically significant (p < 0.05). Hepatic segments 1 and 4 had higher mean values of ALP and HPI and lower mean values of PVP than segments 5, 6, 7 and 8 as well, although no significant differences were detected except for ALP and HPI for liver segments 1 and 7 (p = 0.001 and 0.035 respectively), and ALP for liver segments 1 and 5 (p = 0.039). Higher ALP and HPI were showed in hepatic segment 3 compared to segment 4 (p = 0.000 and 0.000 respectively). No significant differences were found for THP among eight segments. Conclusions: Intra-hepatic perfusion differences exist in normal hepatic parenchyma especially between lateral sector (segments 2 and 3) and right lobe (segments 5, 6, 7 and 8). This might have potential clinical significance in liver-perfusion-related protocol design and result analysis.

  13. Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

    Directory of Open Access Journals (Sweden)

    Manuel Eckenschwiller


    Full Text Available Background and Aims. Biliary complications are the most frequent complications after common liver surgeries. In this study, accuracy of hepatobiliary scintigraphy (HBS and impact of hyperbilirubinemia were evaluated. Methods. Between November 2007 and February 2016, 131 patients underwent hepatobiliary scintigraphy after having liver surgery. 39 patients with 42 scans after LTX (n=13 or hepatic resection (n=26 were evaluated in the study; 27 were male, with mean age 60 years. The subjects underwent hepatobiliary scintigraphy with Tc-99m labeled Mebrofenin. The results were compared to ERCP as gold standard performed within one month after HBS. We calculated sensitivity, specificity, PPV, and NPV. We compared LTX patients to patients with other liver surgeries. Furthermore the influence of hyperbilirubinemia on HBS scans was evaluated. Results. HBS always provided the correct diagnosis in cases of bile leak in the liver-resected group (14/14. Overall diagnostic accuracy was 76% (19/25 in this group and 54% (7/13 in the LTX group. False negative (FN diagnoses occurred more often among LTX patients (p=0.011. Hyperbilirubinemia (>5 mg/dL significantly influenced the excretion function of the liver, prolonging HBS’s time-activity-curve (p=0.001. Conclusions. Hepatobiliary scintigraphy is a reliable tool to detect biliary complications, but reduced accuracy must be considered after LTX.


    Directory of Open Access Journals (Sweden)

    Yusri Dianne Jurnalis


    Full Text Available AbstrakHepatitis autoimun merupakan penyakit inflamasi hati yang berat dengan penyebab pasti yang tidak diketahui yang mengakibatkan morbiditas dan mortalitas yang tinggi. Semua usia dan jenis kelamin dapat dikenai dengan insiden tertinggi pada anak perempuan usia prepubertas, meskipun dapat didiagnosis pada usia 6 bulan. Hepatitis autoimun dapat diklasifikasikan menjadi 2 bagian berdasarkan adanya antibodi spesifik: Smooth Muscle Antibody (SMA dengan anti-actin specificity dan/atau Anti Nuclear Antibody (ANA pada tipe 1 dan Liver-Kidney Microsome antibody (LKM1 dan/atau anti-liver cytosol pada tipe 2. Gambaran histologisnya berupa “interface hepatitis”, dengan infiltrasi sel mononuklear pada saluran portal, berbagai tingkat nekrosis, dan fibrosis yang progresf. Penyakit berjalan secara kronik tetapi keadaan yang berat biasanya menjadi sirosis dan gagal hati.Tipe onset yang paling sering sama dengan hepatitis virus akut dengan gagal hati akut pada beberapa pasien; sekitar sepertiga pasien dengan onset tersembunyi dengan kelemahan dan ikterik progresif ketika 10-15% asimptomatik dan mendadak ditemukan hepatomegali dan/atau peningkatan kadar aminotransferase serum. Adanya predominasi perempuan pada kedua tipe. Pasien LKM1 positif menunjukkan keadaan lebih akut, pada usia yang lebih muda, dan biasanya dengan defisiensi Immunoglobulin A (IgA, dengan durasi gejala sebelum diagnosis, tanda klinis, riwayat penyakit autoimun pada keluarga, adanya kaitan dengan gangguan autoimun, respon pengobatan dan prognosis jangka panjang sama pada kedua tipe.Kortikosteroid yang digunakan secara tunggal atau kombinasi azathioprine merupakan terapi pilihan yang dapat menimbulkan remisi pada lebih dari 90% kasus. Strategi terapi alternatif adalah cyclosporine. Penurunan imunosupresi dikaitkan dengan tingginya relap. Transplantasi hati dianjurkan pada penyakit hati dekom-pensata yang tidak respon dengan pengobatan medis lainnya.Kata kunci : hepatitis Autoimmune

  15. The resection angle in apical surgery

    DEFF Research Database (Denmark)

    von Arx, Thomas; Janner, Simone F M; Jensen, Simon S


    study, cone beam computed tomography (CBCT) scans were taken before and 1 year after apical surgery to measure the angle of the resection plane relative to the longitudinal axis of the root. Further, the surgical depth (distance from the buccal cortex to the most lingual/palatal point of the resection...

  16. Successful Surgical Resection of Advanced Gastrointestinal Stromal ...

    African Journals Online (AJOL)

    It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is ...

  17. Hepatitis B virus (image) (United States)

    Hepatitis B is also known as serum hepatitis and is spread through blood and sexual contact. It is ... population. This photograph is an electronmicroscopic image of hepatitis B virus particles. (Image courtesy of the Centers for ...

  18. Hepatic (Liver) Function Panel (United States)

    ... for Educators Search English Español Blood Test: Hepatic (Liver) Function Panel KidsHealth / For Parents / Blood Test: Hepatic ( ... or kidneys ) is working. What Is a Hepatic (Liver) Function Panel? A liver function panel is a ...

  19. Hepatitis Risk Assessment (United States)

    ... visit this page: About . Hepatitis Risk Assessment Recommend on Facebook Tweet Share Compartir Viral Hepatitis. ... at risk? Take this 5 minute Hepatitis Risk Assessment developed by the CDC and get a personalized ...

  20. Preventing hepatitis A (United States)

    Hepatitis A is inflammation (irritation and swelling) of the liver caused by the hepatitis A virus. You can take several steps to ... reduce your risk of spreading or catching the hepatitis A virus: Always wash your hands thoroughly after ...

  1. Hepatic lesions that mimic metastasis on radiological imaging during chemotherapy for gastrointestinal malignancy: Recent updates

    Energy Technology Data Exchange (ETDEWEB)

    You, Sung Hye; Park, Beom Jin; Kim, Yeul Hong [Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)


    During chemotherapy in patients with gastrointestinal malignancy, the hepatic lesions may occur as chemotherapy-induced lesions or tumor-associated lesions, with exceptions for infectious conditions and other incidentalomas. Focal hepatic lesions arising from chemotherapy-induced hepatopathies (such as chemotherapy-induced sinusoidal injury and steatosis) and tumor-associated eosinophilic abscess should be considered a mimicker of metastasis in patients with gastrointestinal malignancy. Accumulating evidence suggests that chemotherapy for gastrointestinal malignancy in the liver has roles in both the therapeutic effects for hepatic metastasis and injury to the non-tumor bearing hepatic parenchyma. In this article, we reviewed the updated concept of chemotherapy-induced hepatopathies and tumor-associated eosinophilic abscess in the liver, focusing on the pathological and radiological findings. Awareness of the causative chemo-agent, pathophysiology, and characteristic imaging findings of these mimickers is critical for accurate diagnosis and avoidance of unnecessary exposure of the patient to invasive tissue-based diagnosis and operation.

  2. Intramedullary hemangioblastoma: Microsurgical resection technique. (United States)

    Messerer, M; Cossu, G; Pralong, E; Daniel, R T


    Spinal hemangioblastomas are benign and highly vascular tumors accounting for 1-5% of intramedullary spinal tumors in surgical series. Surgery is curative in sporadic cases. We present the description of a surgical technique to safely resect an intramedullary hemangioblastoma. A dorsal midline myelotomy provides an excellent exposure of the tumor and identification of the feeding arteries. Interruption of these arteries and precise dissection of the tumor from the cord tissue followed by division of the venous drainage allow the in toto excision of the tumor. Closure of the dorsal myelotomy may be achieved with sequential fusion of the pial and arachnoid edges using a "welding" technique. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Hepatitis in Children


    Tsuji, Yoshiro; Doi, Hiroshi; Yoshida, Yasuharu; Tohya, Yoshikazu; Yanagi, Tadamichi


    115 patients (71 male and 44 female) with infectious hepatitis were hospitalized in Nagasaki University Hospital during 1974-1984. They were all the hospitalized patients in our pediatric department. The total patient was 8150 and that of hepatitis was 115, that is 1.4%. On the classification of hepatitis, infectious mononucleosis patients were the most. Next was HB hepatitis. HA hepatitis were less than we had expected. Generally in Japan, childrens HA hepatitis patients are less usual than ...

  4. Hepatitis A: Questions and Answers (United States)

    Hepatitis A: Questions and Answers Information about the disease and vaccines What causes hepatitis A? Hepatitis A is an infectious liver disease caused by hepatitis A virus (HAV). How does hepatitis A virus ...

  5. [Laparoscope hepatectomy for hepatic hemangioma: a report of 18 cases]. (United States)

    Jiang, Wen-shu; Lu, Bang-yu; Cai, Xiao-yong; Lu, Wen-qi; Liu, Zu-jun; Huang, Fei; Jin, Xiao-jian


    To evaluate the feasibility and practicality of laparoscopic hepatectomy for hepatic hemangioma. Candidate for laparoscopic liver resection were 18 cases of hepatic hemangioma from January 2002 to October 2006. The portal bloods stream was blocked by the laparoscope portal blood blocker. The Electric-cautery and ultracision were used for liver transection. Operative procedures included anatomical left hepatectomy in 2 cases, non-anatomical left hepatectomy 1 case, left lobectomy 5 cases, local liver resection 10 cases. Two cases of hepatic hemangioma associated with gallbladder stone were performed cholecystectomy synchronously, 1 case associated with chronic appendicitis were performed appendectomy synchronously. Laparoscopic left liver resection was successfully performed in all 18 cases. The operative duration was (185.4 +/- 55.7) min. The quantity of blood lost during the operation was (416.2 +/- 128.8) ml. The postoperative recovery was smooth and good. No critical complications occurred. The duration for hospitalization was (6.2 +/- 1.0) d. Laparoscope hepatectomy for hepatic hemangioma is safe and feasible.

  6. Colon resection for ovarian cancer: intraoperative decisions. (United States)

    Hoffman, Mitchel S; Zervose, Emmanuel


    To discuss the benefits and morbidity of and indications for colon resection during cytoreductive operations for ovarian cancer. The history of cytoreductive surgery for ovarian cancer is discussed, with special attention to the incorporation of colon resection. Literature regarding cytoreductive surgery for ovarian cancer is then reviewed, again with attention to the role of colon resection. The focus of the review is directed at broad technical considerations and rationales, for both primary and secondary cytoreduction. Over the past 15 to 20 years the standard cytoreductive operation for ovarian cancer has shifted from an abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy to an en bloc radical resection of the pelvic tumor and an omentectomy, and more recently to include increasing use of extensive upper abdominal surgery. En bloc pelvic resection frequently includes rectosigmoid resection, almost always accompanied by a primary anastomosis. Other portions of the colon are at risk for metastatic involvement and sometimes require resection in order to achieve optimal cytoreduction. The data regarding colon resection for the purpose of surgical cytoreduction of ovarian cancer are conflicting (in terms of benefit) and all retrospective. However, the preponderance of information supports a benefit in terms of survival when cytoreduction is clearly optimal. Similar to primary surgery, benefit from secondary cytoreduction of ovarian cancer occurs when only a small volume of disease is left behind. The preponderance of data suggests that colon resection to achieve optimal cytoreduction has a positive impact on survival. In order to better understand the role of colon resection as well as other extensive cytoreductive procedures for ovarian cancer, it will be important to continue to improve our understanding of prognostic variables such as the nuances of metastatic bowel involvement in order to better guide appropriate surgical management.

  7. Hepatitis B Vaccine (United States)

    ... a combination product containing Haemophilus influenzae type b, Hepatitis B Vaccine) ... combination product containing Diphtheria, Tetanus Toxoids, Acellular Pertussis, Hepatitis B, Polio Vaccine)

  8. Simultaneous measurements of intracranial pressure parameters in the epidural space and in brain parenchyma in patients with hydrocephalus. (United States)

    Eide, Per Kristian; Sorteberg, Wilhelm


    In this study, the authors compare simultaneous measurements of static and pulsatile pressure parameters in the epidural space and brain parenchyma of hydrocephalic patients. Simultaneous intracranial pressure (ICP) signals from the epidural space (ICPEPI) and the brain parenchyma (ICPPAR) were compared in 12 patients undergoing continuous ICP monitoring as part of their diagnostic workup for hydrocephalus. The static ICP was characterized by mean ICP and the frequency of B waves quantified in the time domain, while the pulsatile ICP was determined from the cardiac beat-induced single ICP waves and expressed by the ICP pulse pressure amplitude (dP) and latency (dT; that is, rise time). The 12 patients underwent a median of 22.5 hours (range 5.9-24.8 hours) of ICP monitoring. Considering the total recording period of each patient, the mean ICP (static ICP) differed between the 2 compartments by ≥5 mm Hg in 8 patients (67%) and by ≥10 mm Hg in 4 patients (33%). In contrast, for every patient the ICP pulse pressure readings from the 2 compartments showed near-identical results. Consequently, when sorting patients to shunt/no shunt treatment according to pulsatile ICP values, selection was independent of sensor placement. The frequency of B waves also compared well between the 2 compartments. The pulsatile ICP is measured with equal confidence from the ICPEPI and ICPPAR signals. When using the pulsatile ICP for evaluation of hydrocephalic patients, valid measurements may thus be obtained from pressure monitoring in the epidural space. Recorded differences in the mean ICP between the epidural space and the brain parenchyma are best explained by differences in the zero setting of different sensors.

  9. A novel supervised approach for segmentation of lung parenchyma from chest CT for computer-aided diagnosis. (United States)

    Darmanayagam, Shiloah Elizabeth; Harichandran, Khanna Nehemiah; Cyril, Sunil Retmin Raj; Arputharaj, Kannan


    Segmentation of lung parenchyma from the chest computed tomography is an important task in analysis of chest computed tomography for diagnosis of lung disorders. It is a challenging task especially in the presence of peripherally placed pathology bearing regions. In this work, we propose a segmentation approach to segment lung parenchyma from chest. The first step is to segment the lungs using iterative thresholding followed by morphological operations. If the two lungs are not separated, the lung junction and its neighborhood are identified and local thresholding is applied. The second step is to extract shape features of the two lungs. The third step is to use a multilayer feed forward neural network to determine if the segmented lung parenchyma is complete, based on the extracted features. The final step is to reconstruct the two lungs in case of incomplete segmentation, by exploiting the fact that in majority of the cases, at least one of the two lungs would have been segmented correctly by the first step. Hence, the complete lung is determined based on the shape and region properties and the incomplete lung is reconstructed by applying graphical methods, namely, reflection and translation. The proposed approach has been tested in a computer-aided diagnosis system for diagnosis of lung disorders, namely, bronchiectasis, tuberculosis, and pneumonia. An accuracy of 97.37 % has been achieved by the proposed approach whereas the conventional thresholding approach was unable to detect peripheral pathology-bearing regions. The results obtained prove to be better than that achieved using conventional thresholding and morphological operations.

  10. Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

    Directory of Open Access Journals (Sweden)

    Chiang Kun-Chun


    Full Text Available Abstract Background Pancreatic adenocarcinoma (PCA is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors. Methods We retrospectively reviewed the medical files of 688 patients (422 men and 266 women who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection. Results A carbohydrate antigen 19–9 (CA 19–9 level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl, radical resection, early tumor stage and better-differentiated tumors were associated with favorable survival. Conclusions Besides traditional imaging studies, preoperative CA 19–9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and well

  11. Histological and submicroscopical findings on the seminiferous parenchyma in rams after copper oxide intoxication from industrial emissions. (United States)

    Vrzgulová, M


    In this work the author examined the histological and submicroscopical picture of the seminiferous parenchyma in 5 breeding rams from a herd in which intoxication with copper oxide from industrial emissions of a copper producing plant had been diagnosed. The toxic effect irreversibly damages all developmental stages of the germ cells. It injures the cell membranes of both germ cells and Sertoli cells. Similar changes were observed on the interstitial cells. The degree of injury to the germinative epithelium confirms its significant role in the decreased reproduction rate of the herd under examination.

  12. The compartments of the parenchyma of the lymph nodes in newborn bull calves of domestic cattle (Bos taurus

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    P. N. Gavrilin


    Full Text Available The article analyzes the features of the structure of the lymphoid lobules of the parenchyma of the superficial somatic (Limphonodi subiliaci, L. cervicales superficiales, profund somatic (L. axillares proprii L. poplitei, somatovisceral (L. iliaci mediales, L. retropharyngei mediales and visceral (L. mediastinales caudales, L. ileocolici lymph nodes of newborn bull calves of domestic cattle. To visualize clearly the boundaries of the structural components of lymphoid lobules we used the author’s modification of the impregnation of total median frozen histological sections with silver nitrate. We have established a high level of tissue differentiation of the lymph nodes, a significant development of the lymphoid parenchyma, the division of the parenchyma into lymphoid lobules, the presence in the lobules of all the main structural components that are represented by two morphotypes. The first morphotype is ribbon-like perisinusoidal cords (interfollicular zone, paracortical and medullary cords. The second morphotype is rounded lymphoid formations (central zones of deep cortex units, lymphatic nodules. Lymphoid lobules are located along the marginal sinus in one row, they are better developed and differentiated in the visceral lymph nodes. In all the lymph nodes, the lymphoid lobules have a similar histoarchitectonic, and each structural component of the lymphoid lobules has a specific architectonic of the reticular meshwork and the density of the location of the fibroblastic reticulocytes. We determined that the structures of the first morphotype which provide the migration of lymphocytes, the detection of antigens and the accumulation of plasmocytes are more developed. We have established that the relative volume of structures of the first morphotype is 4.5–8.0 times larger than the volume of the structures of the second morphotype, which provide clonal proliferation of T and B lymphocytes, especially in deep somatic lymph nodes. Among the

  13. Lung metastasectomy for postoperative colorectal cancer in patients with a history of hepatic metastasis. (United States)

    Kamiyoshihara, Mitsuhiro; Igai, Hitoshi; Kawatani, Natsuko; Ibe, Takashi; Tomizawa, Naoki; Obayashi, Kai; Shimizu, Kimihiro; Takeyoshi, Izumi


    Our objective was to evaluate the efficacy of pulmonary metastasectomy for postoperative colorectal cancer with hepatic metastasis, and to investigate the role of clinicopathological factors as predictors of outcome. Consecutive patients undergoing pulmonary metastasectomy for colorectal cancer with (group PH, n = 27) or without (group P, n = 46) a history of hepatic metastasis were included in the study. Clinicopathological variables, including sex, age, site, carcinoembryonic antigen in the primary tumor, disease-free interval, prior hepatic resection, timing of pulmonary metastases, preoperative chemotherapy, type of pulmonary resection, and number, size, and location of pulmonary metastases were retrospectively collected and investigated for prognostic significance. Five-year survival rates were 59.5 and 70.0 % for patients with and without a history of hepatic metastasis, respectively; these values did not differ significantly. Among all investigated prognostic variables, sex and number of pulmonary metastases (1 vs. >1) were the most important factors affecting the outcome after colorectal and pulmonary resection. There was no significant difference in overall survival whether it was calculated from the time of resection of the primary colorectal cancer or of pulmonary metastases. Pulmonary resection is not contraindicated in clinical practice. Significant factors indicating a good prognosis were female sex and the number of pulmonary metastases. Special attention should be paid to comparison of survival among studies.

  14. Doppler Examination Informativity in Children with Chronic Viral Hepatitis

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    F. I. Inoyatova


    Full Text Available In this article presents the data of ultrasound examination of 150 children with chronic hepatitis В (ChHB. Ultrasound research which combined with clinical and laboratory data do not always reflect the true picture of the pathological process in the liver, while differences may vary between 14—37%. It is shown that the inclusion of additional Doppler echography in allow not only improve the efficiency of diagnosis of ChHB activity (by 35.3%, but also broaden our understanding about the state of the parenchyma of the liver and spleen, collateral circulation disorders and severity of portal hypertension. Regardless of the age, set to the same orientation of structural and functional disorders of hepatic vessels, the basic and indirect diagnostic criteria of portal hypertension has been developed.

  15. Borderline resectable pancreatic cancer: Definitions and management (United States)

    Lopez, Nicole E; Prendergast, Cristina; Lowy, Andrew M


    Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving long-term survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multi-institutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer. PMID:25152577

  16. Extended Distal Pancreatectomy with En Bloc Resection of the Celiac Axis for Locally Advanced Pancreatic Cancer: A Case Report and Review of the Literature

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    Patrick H. Alizai


    Full Text Available Due to a lack of early symptoms, pancreatic cancers of the body and tail are discovered mostly at advanced stages. These locally advanced cancers often involve the celiac axis or the common hepatic artery and are therefore declared unresectable. The extended distal pancreatectomy with en bloc resection of the celiac artery may offer a chance of complete resection. We present the case of a 48-year-old female with pancreatic body cancer invading the celiac axis. The patient underwent laparoscopy to exclude hepatic and peritoneal metastasis. Subsequently, a selective embolization of the common hepatic artery was performed to enlarge arterial flow to the hepatobiliary system and the stomach via the pancreatoduodenal arcades from the superior mesenteric artery. Fifteen days after embolization, the extended distal pancreatectomy with splenectomy and en bloc resection of the celiac axis was carried out. The postoperative course was uneventful, and complete tumor resection was achieved. This case report and a review of the literature show the feasibility and safety of the extended distal pancreatectomy with en bloc resection of the celiac axis. A preoperative embolization of the celiac axis may avoid ischemia-related complications of the stomach or the liver.

  17. Liver resection morbidity, mortality, and risk factors at the departments of hepatobiliary surgery in Veracruz, Mexico. (United States)

    Martínez-Mier, G; Esquivel-Torres, S; Alvarado-Arenas, R A; Ortiz-Bayliss, A B; Lajud-Barquín, F A; Zilli-Hernandez, S

    Liver resection has been associated with high morbidity and mortality, and the most serious complication is liver failure. Patient evaluation is limited to risk scales. The 50-50 criteria and bilirubin peak>7mg/dl have been used as mortality predictors. The aim of this study was to determine the risk factors associated with morbidity and mortality for liver resection in our population. A retrospective study was carried out on 51 patients that underwent liver resection. Sociodemographic variables, pathology, and the surgical act were analyzed, together with morbidity and mortality and their associated factors. Fifty-one patients, 23 men and 28 women, were analyzed. They had a mean age of 51.4±19.13 years, 64.7% had concomitant disease, and their mean MELD score was 7.49±1.79. The mean size of the resected lesions was 7.34±3.47cm, 51% were malignant, and 34 minor resections were performed. The Pringle maneuver was used in 64.7% of the cases and the mean blood loss was 1,090±121.76ml. Morbidity of 25.5% was associated with viral hepatitis infection, greater blood loss, transfusion requirement, the Pringle maneuver, lower hemoglobin and PTT values, and higher MELD, INR, bilirubin, and glucose values. A total 3.9% mortality was associated with hyperbilirubinemia, hyperglycemia, and greater blood loss and transfusions. The main risk factors associated with the morbidity and mortality of liver resection in our population were those related to the preoperative biochemical parameters of the patient and the factors that occurred during the surgical act. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Safety of epicenter versus intact parenchyma as a transplantation site for human neural stem cells for spinal cord injury therapy. (United States)

    Piltti, Katja M; Salazar, Desirée L; Uchida, Nobuko; Cummings, Brian J; Anderson, Aileen J


    Neural stem cell transplantation may have the potential to yield repair and recovery of function in central nervous system injury and disease, including spinal cord injury (SCI). Multiple pathological processes are initiated at the epicenter of a traumatic spinal cord injury; these are generally thought to make the epicenter a particularly hostile microenvironment. Conversely, the injury epicenter is an appealing potential site of therapeutic human central nervous system-derived neural stem cell (hCNS-SCns) transplantation because of both its surgical accessibility and the avoidance of spared spinal cord tissue. In this study, we compared hCNS-SCns transplantation into the SCI epicenter (EPI) versus intact rostral/caudal (R/C) parenchyma in contusion-injured athymic nude rats, and assessed the cell survival, differentiation, and migration. Regardless of transplantation site, hCNS-SCns survived and proliferated; however, the total number of hCNS-SCns quantified in the R/C transplant animals was twice that in the EPI animals, demonstrating increased overall engraftment. Migration and fate profile were unaffected by transplantation site. However, although transplantation site did not alter the proportion of human astrocytes, EPI transplantation shifted the localization of these cells and exhibited a correlation with calcitonin gene-related peptide fiber sprouting. Critically, no changes in mechanical allodynia or thermal hyperalgesia were observed. Taken together, these data suggest that the intact parenchyma may be a more favorable transplantation site than the injury epicenter in the subacute period post-SCI.

  19. Intraoperative MRI and Maximizing Extent of Resection. (United States)

    Rao, Ganesh


    Intraoperative MRI (iMRI) is a neurosurgical adjunct used to maximize the removal of glioma, the most common primary brain tumor. Increased extent of resection of gliomas has been shown to correlate with longer survival times. iMRI units are variable in design and magnet strength, which can affect patient selection and image quality. Multiple studies have shown that surgical resection of gliomas using iMRI results in increased extent of resection and survival time. Level II evidence supports the use of iMRI in the surgical treatment of glioma. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Robot assisted tumor resection devices. (United States)

    Saito, Yutaka; Sumiyama, Kazuki; Chiu, Philip Wai-Yan


    In Japan, colorectal endoscopic submucosal dissection (ESD) is being conducted safely and effectively as shown by the increased number of the cases, however, it is still regarded as a complicated and challenging procedure. Therefore, piecemeal endoscopic mucosal resection (p-EMR) is still regarded as an appropriate treatment, rather than ESD for large colorectal tumors, especially in Western countries. Areas covered: There are several factors those are responsible for colorectal ESD difficulty. Firstly, there is no adequate traction or counter-traction in colorectal ESD. Secondly, it is challenging to handle the colonoscope in a redundant and narrow colonic lumen. Thirdly, the risk of perforation is estimated to be relatively higher compared to the stomach or esophagus Expert commentary: To overcome these difficulties, various traction and counter-traction methods have been reported and finally, the new concept of the Master and Slave Transluminal Endoscopic Robot (MASTER) has been developed and is soon to be available for clinical use. The authors have reviewed the history of colorectal ESD and MASTER in this paper.

  1. [A case of curative resection after downsizing chemotherapy in initially unresectable locally advanced intrahepatic cholangiocarcinoma]. (United States)

    Aoki, Yu; Suzuki, Takayuki; Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Takano, Shigetsugu; Okamura, Daiki; Suzuki, Daisuke; Sakai, Nozomu; Kagawa, Shingo; Miyazaki, Masaru


    This case report describes an 83-year-old man with intrahepatic cholangiocarcinoma who was referred by a local hospital. Abdominal computed tomography (CT) showed a large tumor in hepatic segments 4, 5, and 8 involving the right hepatic vein and inferior vena cava, which is normally indicative of an unresectable locally advanced tumor. After systemic chemotherapy with gemcitabine and cisplatin, the observed decrease in the level of tumor marker suggested that the cancer was responding to treatment, while radiological findings showed the main tumor shrunk without the presence of distant metastases. Thus, hepatic left trisectionectomy with bile duct resection was performed after portal vein embolization. Pathological examination revealed negative margins (R0). Eighteen months after surgery, the patient is free of disease and shows no signs of recurrence. An initially unresectable, locally advanced biliary tract cancer may be down sized by chemotherapy, which makes radical resection possible, at least in a proportion of patients. This approach provides longer survival and may have a potential for disease eradication as a new multidisciplinary approach for patients with unresectable locally advanced biliary tract cancer.

  2. What Is Hepatitis? (United States)

    ... сский Español What is hepatitis? Online Q&A Reviewed July 2016 Q: What ... Question and answer archives Submit a question World Hepatitis Day Posters: Eliminate hepatitis World Hepatitis Day 2017 ...

  3. A symptomatic giant hepatic hemangioma treated with hepatectomy. (United States)

    Uetama, Toshifumi; Yoshida, Hiroshi; Hirakata, Atsushi; Yokoyama, Tadashi; Maruyama, Hiroshi; Suzuki, Seiji; Matsutani, Takeshi; Matsushita, Akira; Sasajima, Koji; Uchida, Eiji


    We describe a patient with symptomatic giant hepatic hemangioma treated with hepatectomy. A 53-year-old woman presented with upper abdominal distension and appetite loss. The medical history included multiple hepatic hemangiomas that had been detected 2 years earlier but were left untreated. Initial laboratory tests revealed pancytopenia and mild coagulopathy. Computed tomography and magnetic resonance imaging demonstrated a giant hemangioma, 27 cm in diameter, in the enlarged right lobe of the liver. The inferior vena cava was compressed by tumor without thrombus in the infrahepatic vena cava. The portal venous phase of supramesenteric arteriography revealed compression of the portal vein. There were several hemangiomas in the left lobe. Gastric outlet obstruction due to giant hepatic hemangioma in the right lobe was diagnosed. Laparotomy was performed, and a markedly enlarged liver was detected. Right hepatectomy was performed with an anterior approach. The liver-hanging maneuver could not be performed because of tumor compression of the inferior vena cava. Right hepatectomy was performed with intermittent clamping (Pringle maneuver). Hepatic hemangiomas of the left lobe were not resected because the remnant liver would be reduced. The weight of the resected specimen was 2,100 g. Pathologic examination of the surgical specimen confirmed the presence of benign hepatic hemangiomas. The postoperative course was uneventful, and the patient's appetite improved. The patient was discharged 8 days after the operation. Abdominal distension decreased and laboratory data improved after the operation. Computed tomography revealed hypertrophy of the left lobe of the liver after the operation.

  4. Predictors of quality-of-life improvement following pulmonary resection due to lung cancer

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    Ivete Alonso Bredda Saad

    Full Text Available CONTEXT AND OBJECTIVE: There is increasing involvement of health professionals in organizing protocols to determine the impact of lung surgery on functional state and activities of daily living, with the aim of improving quality of life (QoL. The objective of this study was to investigate predictors of QoL improvement among patients undergoing parenchyma resection due to lung cancer. DESIGN AND SETTING: Prospective study, at teaching hospital of Universidade Estadual de Campinas (Unicamp. METHODS: 36 patients with lung cancer diagnosis were assessed before surgery and on the 30th, 90th and 180th days after surgery. The Short-Form Health Survey (SF-36 was used as the dependent variable. The independent variables were the Hospital Anxiety and Depression (HAD scale, a six-minute walking test (6-MWT, a visual analogue scale for pain, forced vital capacity (FVC, type of surgery and use of radiotherapy and chemotherapy. Generalized estimation equations (GEE were utilized. RESULTS: The median age for these 20 men and 16 women was 55.5 ± 13.4 years. Both FVC and 6-MWT were predictors of improvement in the physical dimensions of QoL (p = 0.011 and 0.0003, respectively, as was smaller extent of surgical resection (p = 0.04. The social component of QoL had improved by the third postoperative month (p = 0.0005. CONCLUSION: The predictors that affected QoL positively were better FVC and 6-MWT results and less extensive lung resection. Three months after the surgery, an improvement in social life was already seen.

  5. Implication of the presence of a variant hepatic artery during the Whipple procedure

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    Mercedes Rubio-Manzanares-Dorado


    Full Text Available Introduction: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%. The most frequent variant was an aberrant right hepatic artery (n = 7, following by the accessory right hepatic artery (n = 2 and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2. In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

  6. Current evidence for the use of N-acetylcysteine following liver resection. (United States)

    Kemp, Richard; Mole, Jonathan; Gomez, Dhanny


    N-acetylcysteine (NAC) has many uses in medicine; notable in the management of paracetamol toxicity, acute liver failure and liver surgery. The aim of this review was to critically appraise the published literature for the routine use of NAC in liver resection surgery. An electronic search was performed of EBSCOhost (Medline and CINAHL database), PubMed and the Cochrane Library for the period 1990-2016. MeSH headings: 'acetyl-cysteine', 'liver resection' and 'hepatectomy' were used to identify all relevant articles published in English. Following the search criteria used, three articles were included. Two of these studies were randomized controlled trials. All the studies collated data on morbidity and mortality. All three studies did not show a significant difference in overall complications rates in patients that underwent hepatic resection that had NAC infusion compared with patients that did not. In one study, NAC administration was associated with a higher frequency of grade A post-hepatectomy liver failure. In another study, a significantly higher incidence of delirium was observed in the NAC group, which led to the trial to be terminated early. The current published data do not support the routine use of NAC following liver resection. © 2017 Royal Australasian College of Surgeons.

  7. Pancreatic Resections for Advanced M1-Pancreatic Carcinoma: The Value of Synchronous Metastasectomy

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    S. K. Seelig


    Materials and Methods. From January 1, 2004 to December, 2007 a total of 20 patients with pancreatic malignancies were retrospectively evaluated who underwent pancreatic surgery with synchronous resection of hepatic, adjacent organ, or peritoneal metastases for proven UICC stage IV periampullary cancer of the pancreas. Perioperative as well as clinicopathological parameters were evaluated. Results. There were 20 patients (9 men, 11 women; mean age 58 years identified. The primary tumor was located in the pancreatic head (n=9, 45%, in pancreatic tail (n=9, 45%, and in the papilla Vateri (n=2, 10%. Metastases were located in the liver (n=14, 70%, peritoneum (n=5, 25%, and omentum majus (n=2, 10%. Lymphnode metastases were present in 16 patients (80%. All patients received resection of their tumors together with metastasectomy. Pylorus preserving duodenopancreatectomy was performed in 8 patients, distal pancreatectomy in 8, duodenopancreatectomy in 2, and total pancreatectomy in 2. Morbidity was 45% and there was no perioperative mortality. Median postoperative survival was 10.7 months (2.6–37.7 months which was not significantly different from a matched-pair group of patients who underwent pancreatic resection for UICC adenocarcinoma of the pancreas (median survival 15.6 months; P=.1. Conclusion. Pancreatic resection for M1 periampullary cancer of the pancreas can be performed safely in well-selected patients. However, indication for surgery has to be made on an individual basis.

  8. Hepatic Cell Adenoma: A Report of Four Cases (United States)

    Albritton, David R.; Tompkins, Ronald K.; Longmire, William P.


    Four patients with hepatic cell adenoma have been treated at the UCLA Hospital since 1965. The most recent was a 22-year-old woman who underwent subtotal resection of a giant hepatic cell adenoma after an unusual and confusing clinical presentation. The tumor may be the largest reported to date and may have excreted metabolically-active substances. Increased familiarity with the varying clinical and radiographic presentations of these rare tumors may facilitate earlier diagnosis and management. ImagesFig. 1.Fig. 2.Fig. 3.Fig. 6.Fig. 7. PMID:4366047

  9. Liver resection for colorectal cancer metastases (United States)

    Gallinger, S.; Biagi, J.J.; Fletcher, G.G.; Nhan, C.; Ruo, L.; McLeod, R.S.


    Questions Should surgery be considered for colorectal cancer (crc) patients who have liver metastases plus (a) pulmonary metastases, (b) portal nodal disease, or (c) other extrahepatic metastases (ehms)? What is the role of chemotherapy in the surgical management of crc with liver metastases in (a) patients with resectable disease in the liver, or (b) patients with initially unresectable disease in the liver that is downsized with chemotherapy (“conversion”)? What is the role of liver resection when one or more crc liver metastases have radiographic complete response (rcr) after chemotherapy? Perspectives Advances in chemotherapy have improved survival in crc patients with liver metastases. The 5-year survival with chemotherapy alone is typically less than 1%, although two recent studies with folfox or folfoxiri (or both) reported rates of 5%–10%. However, liver resection is the treatment that is most effective in achieving long-term survival and offering the possibility of a cure in stage iv crc patients with liver metastases. This guideline deals with the role of chemotherapy with surgery, and the role of surgery when there are liver metastases plus ehms. Because only a proportion of patients with crc metastatic disease are considered for liver resection, and because management of this patient population is complex, multidisciplinary management is required. Methodology Recommendations in the present guideline were formulated based on a prepublication version of a recent systematic review on this topic. The draft methodology experts, and external review by clinical practitioners. Feedback was incorporated into the final version of the guideline. Practice Guideline These recommendations apply to patients with liver metastases from crc who have had or will have a complete (R0) resection of the primary cancer and who are being considered for resection of the liver, or liver plus specific and limited ehms, with curative intent. 1(a). Patients with liver and lung

  10. Extended esophagolaryngeal resection with parathyroid autotransplantation. (United States)

    Kourias, E; Arkadopoulos, N; Kostopanagiotou, G; Kinoglou, G; Smyrniotis, V


    Esopharyngolaryngeal resection for carcinoma of the cervical esophagus must be accompanied by resection of the thyroid gland, parathyroid bodies, and regional lymph nodes. In order to reduce long-term morbidity associated with the procedure, we performed parathyroid autotransplantation in two patients who underwent esophagolaryngeal resections. Grafting of the upper two parathyroid glands into the sternocleidomastoid muscle was carried out successfully in both cases. Graft function was rapidly restored. During the third postoperative week, blood levels of intact parathormone (PTH) reached 20 pg ml(-1) in the first case and 15 pg ml(-1) in the second, and the patients were successfully weaned off calcium and vitamin D supplementation. Parathyroid autotransplantation should be attempted in all cases of esophagolaryngeal resections provided that parathyroid glands are free of malignancy.

  11. Hepatitis B in pregnancy.


    Arevalo, J A


    Chronic infection with the hepatitis B virus can result in the development of serious liver disease such as chronic active hepatitis, cirrhosis, and hepatocellular carcinoma. Vertical transmission from infected mothers to infants is thought to be partially responsible for the high prevalence of infection in certain high-risk groups. Immunoprophylaxis using hepatitis B vaccine and hepatitis immune globulin has been highly effective in decreasing the probability of chronic hepatitis B virus inf...

  12. Open resections for congenital lung malformations

    Directory of Open Access Journals (Sweden)

    Mullassery Dhanya


    Full Text Available Aim: Pediatric lung resection is a relatively uncommon procedure that is usually performed for congenital lesions. In recent years, thoracoscopic resection has become increasingly popular, particularly for small peripheral lesions. The aim of this study was to review our experience with traditional open lung resection in order to evaluate the existing "gold standard." Materials and Methods: We carried out a retrospective analysis of all children having lung resection for congenital lesions at our institution between 1997 and 2004. Data were collected from analysis of case notes, operative records and clinical consultation. The mean follow-up was 37.95 months. The data were analyzed using SPSS. Results: Forty-one children (13 F/28 M underwent major lung resections during the study period. Their median age was 4.66 months (1 day-9 years. The resected lesions included 21 congenital cystic adenomatoid malformations, 14 congenital lobar emphysema, four sequestrations and one bronchogenic cyst. Fifty percent of the lesions were diagnosed antenatally. Twenty-six patients had a complete lobectomy while 15 patients had parenchymal sparing resection of the lesion alone. Mean postoperative stay was 5.7 days. There have been no complications in any of the patients. All patients are currently alive, asymptomatic and well. None of the patients have any significant chest deformity. Conclusions: We conclude that open lung resection enables parenchymal sparing surgery, is versatile, has few complications and produces very good long-term results. It remains the "gold standard" against which minimally invasive techniques may be judged.

  13. Complications following resection of the olecranon bursa. (United States)

    Degreef, Ilse; De Smet, Luc


    We retrospectively reviewed 37 cases of resection of the olecranon bursa and noted wound healing problems in 10 (27%) and recurrence in 8 (22%). A lateral arm flap was necessary in one patient. Conservative treatment remains the treatment of choice for olecranon bursitis. Differentiation between septic and non-septic cases is challenging. The risk of wound healing problems and recurrence should be taken into account when planning surgical resection.

  14. [Surgical therapy of hepatic fibrolamellar carcinoma]. (United States)

    Meriggi, Francesco; Forni, Eugenio


    Hepatic fibrolamellar carcinoma (FLC) is an uncommon tumour that differs from hepatocellular carcinoma (HCC) in demographics, condition of the affected liver, tumour markers, and prognosis. FLC characteristically manifests as a large hepatic mass in adolescents or young adults with female predominance (mean age 23 years). Cirrhosis, elevated alpha-fetoprotein levels, and risk factors for HCC such as viral hepatitis are typically absent. FLC is usually associated with serum tumour markers such as vitamin B12 binding protein, and neurotensin. FLC is characterized pathologically by cords of tumour cells surrounded by abundant collagenous fibrous tissue arranged in a parallel or lamellar distribution. FLC usually appears on radiologic images as a lobulated heterogeneous mass with a central scar in an otherwise normal liver. The clinical presentation of patients with FLC is variable. These patients commonly have pain, and palpable right upper quadrant abdominal mass. An uncommon presenting sign is gynaecomastia in men. Use of percutaneous biopsy (FNAB) is beneficial if there is diagnostic uncertainty about the radiologic diagnosis (US, CT MRI). Although FLC is frequently recurrent, patients have a better prognosis than those with HCC, and aggressive surgical liver resection with extended lymphadenectomy or liver transplantation may be indicated. The presence of advanced-stage disease, direct invasion of adjacent organs, lymphadenopathy, or limited metastasis does not preclude attempts at curative resection. In inoperable cases, the patient may benefit from chemotherapy, permitting in up to 50% of these cases a curative resection. The case is reported of a 18-year-old man with bilateral gynecomastia secondary to an unknown hepatic fibrolamellar carcinoma producing oestrogens. Serum alpha-fetoprotein was negative; des-gamma-carboxy prothrombin (DCP) level was elevated. CT scan and MRI showed a solid hepatic tumour (theta 10 cm) without evidence of extrahepatic spreading

  15. Endoscopic Resection of a Prominent Median Lobe During TURP: a ...

    African Journals Online (AJOL)

    Endoscopic Resection of a Prominent Median Lobe During TURP: a Simple Technique to Avoid Sub- Trigonal Resection. AA Attia, MTA Al-Hak. Abstract. No Abstract. Key Words: Benign prostatic hyperplasia, surgery, Transurethral resection of prostate, Endoscopic resection, prominent median lobe. Full Text: EMAIL FREE ...

  16. Fully automatized renal parenchyma volumetry using a support vector machine based recognition system for subject-specific probability map generation in native MR volume data (United States)

    Gloger, Oliver; Tönnies, Klaus; Mensel, Birger; Völzke, Henry


    In epidemiological studies as well as in clinical practice the amount of produced medical image data strongly increased in the last decade. In this context organ segmentation in MR volume data gained increasing attention for medical applications. Especially in large-scale population-based studies organ volumetry is highly relevant requiring exact organ segmentation. Since manual segmentation is time-consuming and prone to reader variability, large-scale studies need automatized methods to perform organ segmentation. Fully automatic organ segmentation in native MR image data has proven to be a very challenging task. Imaging artifacts as well as inter- and intrasubject MR-intensity differences complicate the application of supervised learning strategies. Thus, we propose a modularized framework of a two-stepped probabilistic approach that generates subject-specific probability maps for renal parenchyma tissue, which are refined subsequently by using several, extended segmentation strategies. We present a three class-based support vector machine recognition system that incorporates Fourier descriptors as shape features to recognize and segment characteristic parenchyma parts. Probabilistic methods use the segmented characteristic parenchyma parts to generate high quality subject-specific parenchyma probability maps. Several refinement strategies including a final shape-based 3D level set segmentation technique are used in subsequent processing modules to segment renal parenchyma. Furthermore, our framework recognizes and excludes renal cysts from parenchymal volume, which is important to analyze renal functions. Volume errors and Dice coefficients show that our presented framework outperforms existing approaches.

  17. Normal breast parenchyma: contrast enhancement kinetics at dynamic MR mammography--influence of anthropometric measures and menopausal status. (United States)

    Hegenscheid, Katrin; Schmidt, Carsten O; Seipel, Rebecca; Laqua, René; Ohlinger, Ralf; Kühn, Jens-Peter; Hosten, Norbert; Puls, Ralf


    To study T1 baseline signal intensity (SI) and contrast material enhancement kinetics of normal breast parenchyma by using dynamic contrast-enhanced (DCE) magnetic resonance (MR) mammography and to determine the influence of anthropometric measures and menopausal status on the variability of these features. Institutional review board approval and written informed consent were obtained. Between June 2008 and September 2011, 345 women (age range, 26-81 years; mean age, 51.3 years ± 11.6 [standard deviation]) underwent DCE MR mammography, with T1-weighted three-dimensional MR images (repetition time msec/echo time msec, 8.86/4.51; flip angle, 25°) acquired with a 1.5-T whole-body MR unit before and 1, 2, 3, 4, and 5 minutes after a gadobutrol bolus injection of 0.1 mmol per kilogram of body weight. Regions of interest were traced manually, and T1 SI of parenchyma was recorded. The influence of different predictors of T1 baseline SI and contrast enhancement was studied by using random-effects models. T1 baseline SI varied considerably between women, with a mean of 167.7 ± 49.2 (71.4-424.7 [range]) and 175.9 ± 48.9 (51.8-458.3) in the right and the left breast, respectively (P contrast material delivery, relative percentage of enhancement was 8.1%, 13.8%, 18.2%, 22.1%, and 24.6% at 1, 2, 3, 4, and 5 minutes, respectively, but varied considerably between women. Contrast enhancement was 9.3% in the lowest quintile and 47.4% in the highest. Contrast enhancement increased with body weight (P contrast enhancement slope. Anthropometric measures and menopausal status contribute to a large variability in contrast enhancement of normal breast parenchyma. This might influence the interpretation of contrast enhancement kinetics of breast lesions and current strategies for determining contrast medium dose for breast MR imaging. RSNA, 2012

  18. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. (United States)

    Isaji, Shuji; Mizuno, Shugo; Windsor, John A; Bassi, Claudio; Fernández-Del Castillo, Carlos; Hackert, Thilo; Hayasaki, Aoi; Katz, Matthew H G; Kim, Sun-Whe; Kishiwada, Masashi; Kitagawa, Hirohisa; Michalski, Christoph W; Wolfgang, Christopher L


    This statement was developed to promote international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) which was adopted by the National Comprehensive Cancer Network (NCCN) in 2006, but which has changed yearly and become more complicated. Based on a symposium held during the 20th meeting of the International Association of Pancreatology (IAP) in Sendai, Japan, in 2016, the presenters sought consensus on issues related to BR-PDAC. We defined patients with BR-PDAC according to the three distinct dimensions: anatomical (A), biological (B), and conditional (C). Anatomic factors include tumor contact with the superior mesenteric artery and/or celiac artery of less than 180° without showing stenosis or deformity, tumor contact with the common hepatic artery without showing tumor contact with the proper hepatic artery and/or celiac artery, and tumor contact with the superior mesenteric vein and/or portal vein including bilateral narrowing or occlusion without extending beyond the inferior border of the duodenum. Biological factors include potentially resectable disease based on anatomic criteria but with clinical findings suspicious for (but unproven) distant metastases or regional lymph nodes metastases diagnosed by biopsy or positron emission tomography-computed tomography. This also includes a serum carbohydrate antigen (CA) 19-9 level more than 500 units/ml. Conditional factors include the patients with potentially resectable disease based on anatomic and biologic criteria and with Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. The definition of BR-PDAC requires one or more positive dimensions (e.g. A, B, C, AB, AC, BC or ABC). The present definition acknowledges that resectability is not just about the anatomic relationship between the tumor and vessels, but that biological and conditional dimensions are also important. The aim in presenting this consensus definition is also to highlight

  19. "Pseudo washout" sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. (United States)

    Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min


    The purpose of this article is to describe the "pseudo washout" sign of high-flow hepatic hemangioma that mimics hypervascular tumor on gadoxetic acid-enhanced MRI. High-flow hemangiomas might show relatively low signal intensity because of gadoxetic acid contrast uptake in the surrounding normal liver parenchyma during the equilibrium (3-minute delay) phase. Such findings are called pseudo washout and can mimic hypervascular hepatic tumors. However, high-flow hemangioma can be diagnosed by observing bright signal intensity on T2-weighted imaging, arterial phase-dominant enhancement, pseudo washout sign during the equilibrium phase, and isointense or slightly increased signal intensity on subtraction images.

  20. [Resection as elective treatment of hilar cholangiocarcinoma (Klatskin tumor)]. (United States)

    Figueras, J; Lladó-Garriga, L; Lama, C; Pujol-Ràfols, J; Navarro, M; Martínez-Villacampa, M; Domínguez, J; Sancho, C; Rafecas, A; Fabregat, J; Torras, J; Ramos, E; Xiol, X; Baliellas, C; Casanovas, T; Jaurrieta, E


    A retrospective analysis of our experience in the treatment of hiliary cholangiocarcinoma or Klatskin tumor was performed with the aim of evaluating the morbi-mortality and prognosis of its treatment to thereby determine the usefulness of the different therapeutic options. From 1989 to 1997, 51 patients diagnosed with hiliary cholangiocarcinoma were treated in our hospital. Surgery was indicated in 16 with curative aims (group I) while palliative treatment with percutaneous biliary drainage was indicated in 35 (group II). Biliary resection was carried out in 8 patients being associated with hepatic resection in 4 (group IA) and in 8 patients undergoing liver transplantation (group IB). Clinico-epidemiologic data and hospital stay were similar in all the groups. The frequency of complications was similar in groups I and II although the frequency of cholangitis (49%) in group II was noticeable. The percentage of readmissions was also greater in group II (12 vs 46%, respectively; p = 0.03) with prosthesis obstruction being the most frequent cause. Accumulated survival at 1, 2, and 3 years in group I was 84, 64 and 48% with a median survival of 33 months, while in group II the median survival was of 6 months with no patient surviving more than 2 years (p = 0.0001). When groups IA and IB were compared, greater frequency of complications in groups IA (100 vs 37%; p = 0.002), similar frequency of readmissions (87 vs 75%; p = NS), median survival greater in group IB (12.5 months vs 48 months) and significantly higher actuarial survival in group IB (48% in 2 years vs 83% to 2 years; p = 0.02) was observed. In conclusion, surgery is the treatment of choice in hiliary cholangiocarcinoma whenever possible, given the greater survival without a significant increase in morbimortality. Likewise, we consider that liver transplantation is a useful option in the treatment of patients with cholangiocarcinoma type IV of Bismuth.

  1. The effects of aqueous extract of babassu (Orbignya phalerata) on the pleura and lung parenchyma in rats. (United States)

    Amorim, Elias; Saad Junior, Roberto; Salgado Filho, Natalino; Melo, George Castro Figueira de; Silva, Gyl Eanes Barros; Santos, Rennan Abud Pinheiro; Marchi, Danilo Dallago de; Carli, Ricardo Comunello de; Malafaia, Osvaldo; Ribas-Filho, Jurandir


    To evaluate macro and microscopically, changes following the use of the aqueous extract of babassu (Orbignya phalerata) in the lung parenchyma and pleura of rats. Sixty adult male rats with average weight of 350 g, were randomized into two groups of 30 animals (experimental and control) further divided into sub-groups of 10 to be sacrificed at 48 h, 72 h and 21 days. The substance was injected into the right pleura of the animals. There was intense pleuropulmonary macroscopic reaction with statistically significant differences between groups respectively (p0.05). The aqueous extract of babassu (Orbignya phalerata) was found to be highly irritating to the pleura and lung of rats, evidenced macroscopically by numerous adhesions and inflammation while no major changes were evident microscopically.

  2. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer


    Kim, Sang Gyun


    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For in...

  3. Spontaneous perforation of the bile duct in a neonate: Drainage or resection?

    Directory of Open Access Journals (Sweden)

    Te-Zhung Chen


    Full Text Available Spontaneous perforation of the bile duct is a rare disease, and delayed diagnosis without optimal treatment can be fatal. Abdominal drainage with or without repair of perforation seems to be adequate in most case series. We report on a 10-day-old female neonate with spontaneous perforation of the bile duct over the junction of cystic duct and common hepatic duct, who recovered uneventfully with follow-up for 3 years after receiving a single-stage operation of cholecystectomy and biliary reconstruction. Drainage only or resection of the gall bladder or bile duct should depend on the patient's clinical conditions and intraoperative findings.

  4. A Randomised Clinical Trial to Compare Coaxial and Noncoaxial Techniques in Percutaneous Core Needle Biopsy of Renal Parenchyma

    Energy Technology Data Exchange (ETDEWEB)

    Babaei Jandaghi, Ali [Guilan University of Medical Sciences, Department of Radiology, Poursina Hospital (Iran, Islamic Republic of); Lebady, Mohammadkazem; Zamani, Athar-Alsadat [Guilan University of Medical Sciences, Urology Research Center, Razi Hospital (Iran, Islamic Republic of); Heidarzadeh, Abtin [Guilan University of Medical Sciences, Department of Community Medicine (Iran, Islamic Republic of); Monfared, Ali [Guilan University of Medical Sciences, Urology Research Center, Razi Hospital (Iran, Islamic Republic of); Pourghorban, Ramin, E-mail: [Tehran University of Medical Sciences, Department of Radiology, Imam Khomeini Hospital Complex (Iran, Islamic Republic of)


    PurposeTo compare the coaxial and noncoaxial techniques of renal parenchymal core needle biopsy.Materials and MethodsThis is an institutional review board-approved randomised controlled trial comparing 83 patients (male, n = 49) who underwent renal parenchymal core biopsy with coaxial method and 83 patients (male, n = 40) with noncoaxial method. The rate of complications, the number of glomerular profiles, and the procedural time were evaluated in a comparison of the two methods. Correlation between the presence of renal parenchymal disease and the rate of complication was also evaluated.ResultsThe procedural time was significantly shorter in the coaxial technique (coaxial group, 5 ± 1 min; noncoaxial group, 14 ± 2 min; p < 0.001). The rates of complications for the coaxial method was significantly lower than the noncoaxial method (coaxial group, 10.8 %; noncoaxial group, 24.1 %; p = 0.025). There was no significant correlation between gender and the rate of complication. The number of glomerular profiles was significantly higher in patents who underwent renal biopsy with the coaxial method (coaxial group, 18.2 ± 9.1; noncoaxial group, 8.6 ± 5.5; p < 0.001). In the whole study population, the rate of complications was significantly higher in patients with a pathologic renal parenchyma compared to those with a normal parenchyma (19/71 vs. 10/95; p = 0.006).ConclusionsRenal parenchymal biopsy using a coaxial needle is a faster and safer method with a lower rate of complications.

  5. Predictors of long-term compensatory response of pulmonary function following major lung resection for non-small cell lung cancer. (United States)

    Takahashi, Yusuke; Matsutani, Noriyuki; Morita, Shigeki; Dejima, Hitoshi; Nakayama, Takashi; Uehara, Hirofumi; Kawamura, Masafumi


    Long-term pulmonary function which might include compensatory response (CR) significantly influences quality of life of long-term survivor after major lung resection. We investigated long-term pulmonary function after major lung resection. A total of 137 patients who had undergone lobar resection for non-small cell lung cancer (NSCLC) from May 2013 to June 2014 had spirometry at 10-14 months after surgery. Actual post-operative forced expiratory volume in 1 s (FEV1 ) (FEV1apo )/predicted post-operative FEV1 (FEV1ppo ), actual post-operative forced vital capacity (FVC) (FVCapo )/predicted post-operative FVC (FVCppo ), its relationship with clinicopathological factors and immunohistochemistry for pro-surfactant protein C (pro-SPC), thyroid transcription factor-1 (TTF-1) and vascular endothelial growth factor receptor 2 (VEGFR2) were investigated. FEV1apo /FEV1ppo showed strong correlation with FVCapo /FVCppo (r = 0.628; P 120%. Greater CR was significantly associated with decreased smoking index (P lung parenchyma of greater CR group was significantly higher than those of lesser CR group (P lung resection. Decreased expression of pro-SPC, TTF-1 and VEGFR2 may indicate decreased capacity of CR, especially in patients who smoke. © 2016 Asian Pacific Society of Respirology.

  6. Immunoglobulins for preventing hepatitis A

    DEFF Research Database (Denmark)

    Liu, Jian Ping; Nikolova, Dimitrinka; Fei, Yutong


    Hepatitis A (infectious hepatitis) is a common epidemic disease. Immunoglobulins for passive immunisation are used as prevention.......Hepatitis A (infectious hepatitis) is a common epidemic disease. Immunoglobulins for passive immunisation are used as prevention....

  7. Hepatitis Information for the Public (United States)

    ... Hepatitis Contact Us Anonymous Feedback Quick Links to Hepatitis … A | B | C | D | E Viral Hepatitis Home ... Local Partners & Grantees Policy and Programs Resource Center Hepatitis Information for the Public Recommend on Facebook Tweet ...

  8. Re-resection of remnant Caroli syndrome six years after the first resection (case report

    Directory of Open Access Journals (Sweden)

    Ahmed Zidan


    Conclusion: Imaging is essential in planning the operative treatment to detect the extent of the Caroli disease and define the extent of resection. Any residual disease due to inappropriate imaging planning may cost the patient another cycle of suffering and may need another surgical intervention as in our case. We recommend using intraoperative ultrasound for accurate determination of the line of resection.

  9. Características construtivas e funcionais das agulhas de radiofrequência bipolares resfriadas para reduzir o sangramento nas ressecções hepáticas Construction of radiofrequency cold bipolar needles and its functional aspects to reduce the bleeding in hepatic resections

    Directory of Open Access Journals (Sweden)

    José Artur Sampaio


    Full Text Available RACIONAL: Para diminuir o sangramento em ressecções hepáticas diversas opções tecnológicas têm sido divulgadas, dentre elas a radiofrequência. A intenção dos vários métodos é evitar o clampeamento vascular, fazer menor dissecção hepática e obter menor sangramento. OBJETIVO: Apresentar uma nova técnica de agulhas paralelas de radiofrequência bipolar desenvolvidas pelos próprios autores e os detalhes técnicos de seu uso. MÉTODOS: O sistema de agulhas apresenta dois eletrodos paralelos (18 gauge cada de 25 cm de comprimento, separados entre si por uma distância de 1,5 cm, onde apenas os 4 cm distais dissipam energia gerada por um eletrobisturi bipolar. Estas agulhas são refrigeradas através de um sistema de resfriamento interno por fluxo contínuo de água destilada gelada estéril a 0oC, cuja temperatura é mantida através da presença de gelo, formado também por água destilada estéril. A operação é realizada sob anestesia geral, não sendo utilizados cateteres venosos centrais durante ou após o procedimento. As incisões realizadas podem ser subcostal direita e mediana supra-umbilical. RESULTADOS: A experiência inicial de sua utilização nas ressecções hepáticas mostraram média de 87 minutos, tamanho médio da incisão abdominal de 14 cm e sangramento médio de 58 ml. Nenhum paciente do grupo inicial recebeu transfusão de sangue ou derivados. CONCLUSÃO: As agulhas de radiofrequência bipolares resfriadas são viáveis e reduzem o sangramento nas ressecções hepáticas.BACKGROUND: To reduce bleeding in liver resection various technological options have been disclosed, among them the radiofrequency. The intent of the various methods is to avoid vascular clamping, less liver dissection and minimize bleeding. AIM: To present a new technique of parallel bipolar radiofrequency needles developed by the authors and the technical details. METHODS: The needle system has two parallel electrodes (18 gauge each of 25

  10. Hepatic Splenosis Preoperatively Diagnosed as Hepatocellular Carcinoma in a Patient with Chronic Hepatitis B: A Case Report (United States)

    Choi, Gi-Hong; Ju, Man-Ki; Kim, June-Young; Kang, Chang-Moo; Kim, Kyung-Sik; Han, Kwang-Hyub; Park, Mi-Suk; Park, Young-Nyun; Lee, Woo-Jung; Kim, Byong-Ro


    We report on a case of hepatic splenosis. A 32-yr-old man underwent a splenectomy due to trauma at the age of 6. He had been diagnosed as being a chronic hepatitis B-virus carrier 16 yr prior to the surgery. The dynamic computer tomography (CT) performed due to elevated serum alpha-fetoprotein (128 ng/mL) demonstrated two hepatic nodules, which were located near the liver capsule. A nodule in Segment IVa had a slight enhancement during both the arterial and portal phases, and another nodule in Segment VI showed a slight enhancement only in the portal phases. Dynamic magnetic resonance imaging (MRI) of the mass in Segment VI showed enhanced development in the arterial phases and slight hyperintensivity to the liver parenchyma in the portal phases. These imaging findings suggested a hypervascular tumor in the liver, which could be either focal nodular hyperplasia, adenoma, or hepatocellular carcinoma (HCC). Even though these lesions were diagnosed as HCC, some of the findings were not compatible with typical HCC. On dynamic CT and MRI, all lesions showed a slight arterial enhancement and did not show early venous washout. All lesions were located near the liver capsule. These findings, along with a history of splenectomy, suggested a diagnosis of hepatic splenosis. PMID:18437023

  11. Natural history of hepatic metastases from colorectal cancer--pathobiological pathways with clinical significance. (United States)

    Paschos, Konstantinos A; Majeed, Ali W; Bird, Nigel C


    Colorectal cancer hepatic metastases represent the final stage of a multi-step biological process. This process starts with a series of mutations in colonic epithelial cells, continues with their detachment from the large intestine, dissemination through the blood and/or lymphatic circulation, attachment to the hepatic sinusoids and interactions with the sinusoidal cells, such as sinusoidal endothelial cells, Kupffer cells, stellate cells and pit cells. The metastatic sequence terminates with colorectal cancer cell invasion, adaptation and colonisation of the hepatic parenchyma. All these events, termed the colorectal cancer invasion-metastasis cascade, include multiple molecular pathways, intercellular interactions and expression of a plethora of chemokines and growth factors, and adhesion molecules, such as the selectins, the integrins or the cadherins, as well as enzymes including matrix metalloproteinases. This review aims to present recent advances that provide insights into these cell-biological events and emphasizes those that may be amenable to therapeutic targeting.

  12. Natural history of hepatic metastases from colorectal cancer - pathobiological pathways with clinical significance (United States)

    Paschos, Konstantinos A; Majeed, Ali W; Bird, Nigel C


    Colorectal cancer hepatic metastases represent the final stage of a multi-step biological process. This process starts with a series of mutations in colonic epithelial cells, continues with their detachment from the large intestine, dissemination through the blood and/or lymphatic circulation, attachment to the hepatic sinusoids and interactions with the sinusoidal cells, such as sinusoidal endothelial cells, Kupffer cells, stellate cells and pit cells. The metastatic sequence terminates with colorectal cancer cell invasion, adaptation and colonisation of the hepatic parenchyma. All these events, termed the colorectal cancer invasion-metastasis cascade, include multiple molecular pathways, intercellular interactions and expression of a plethora of chemokines and growth factors, and adhesion molecules, such as the selectins, the integrins or the cadherins, as well as enzymes including matrix metalloproteinases. This review aims to present recent advances that provide insights into these cell-biological events and emphasizes those that may be amenable to therapeutic targeting. PMID:24744570

  13. Microbiological diagnostics of viral hepatitis


    HASDEMİR, Ufuk


    Viral hepatitis is an infection that primarily affects the liverbut may also have systemic clinical manifestations. The vastmajority of viral hepatitis are caused by one of five hepatotropicviruses: hepatitis A virus (HAV), hepatitis B virus (HBV),hepatitis C virus (HCV), hepatitis D (delta) virus (HDV), andhepatitis E virus (HEV) (Table I) [1]. HBV, HCV, and HDValso cause chronic hepatitis, whereas HAV does not. HEVcauses acute hepatitis in normal hosts but can cause protractedand chronic he...

  14. Hot-clot artifacts in the lung parenchyma on F-18-fluorodeoxyglucose position emission tomography/CT due to faulty injection techniques: Two case report

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemir, Elif; Yildirim, Nilufer; Keskin, Mutlay; Kandemir, Zuhai; Turkolmez, Seyda [Dept. of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara (Turkmenistan)


    F-18-fluorodeoxyglucose (FDG) positron emission tomography/CT is an important whole-body imaging tool in the oncology and widely utilized to stage and restage various malignancies. The findings of significant focal accumulation of FDG in the lung parenchyma in the absence of corresponding CT abnormalities are related to the lung microembolism and known as hot-clot artifacts. Herein we present two cases with focal FDG uptake in the lung parenchyma with no structural lesions on the CT scan and discuss the possible mechanisms.

  15. Conversion to Resection in Patients Receiving Systemic Chemotherapy for Unresectable and/or Metastatic Colorectal Cancer-Predictive Factors and Prognosis. (United States)

    Nozawa, Hiroaki; Ishihara, Soichiro; Kawai, Kazushige; Hata, Keisuke; Kiyomatsu, Tomomichi; Tanaka, Toshiaki; Nishikawa, Takeshi; Otani, Kensuke; Yasuda, Koji; Sasaki, Kazuhito; Kaneko, Manabu; Murono, Koji


    Systemic chemotherapy increases the possibility of resection in patients with initially unresectable colorectal cancer (CRC), especially patients with hepatic metastasis. However, the predictive factors and prognosis of conversion to resection after chemotherapy in patients with various organ metastases remain largely unknown. We reviewed the data from metastatic CRC (mCRC) patients who had received oxaliplatin- or irinotecan-based systemic chemotherapy from 2005 to 2016. The predictors for conversion to surgery were assessed by multivariate analyses. Cancer-free survival and overall survival after the initiation of treatment were compared between patients who had undergone successful conversion therapy and those who had undergone surgery first for resectable stage IV CRC. Of 99 mCRC patients receiving first-line chemotherapy, 23 underwent secondary surgical resection. Single organ metastasis, the presence of liver metastases, and the use of biologic agents were independent predictors of successful conversion therapy. The long-term survival of patients who underwent successful secondary surgery did not differ significantly from that of the 112 patients with resectable stage IV CRC who had undergone surgery first. Liver metastases and single organ metastasis were more likely to be resected after chemotherapy than were other metastatic lesions in mCRC. The use of biologic agents contributed to the increased conversion rate. Successful conversion resulted in outcomes similar to those of resectable stage IV CRC. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Preoperative Prognostic Factors After Liver Resection for Non-Colorectal, Non-Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population. (United States)

    Sim, Dayna P Y; Goh, Brian K P; Lee, Ser-Yee; Chan, Chung-Yip; Tan, Iain B H; Cheow, Peng-Chung; Jeyaraj, Premaraj; Chow, Pierce K H; Ooi, London L P J; Chung, Alexander Y F


    Historically, the benefit of liver resection for non-colorectal, non-neuroendocrine (NCNN) liver metastases has been controversial. This study aims to determine the preoperative prognostic factors of liver resection for NCNN liver metastases and validate the Adam score in an Asian population. Consecutive patients who underwent liver resection for NCNN liver metastases were identified retrospectively from a prospective liver resection database of the single institution between 2001 and 2014. Univariate Cox regression models were used to identify associations with outcome variables. Recurrence-free interval and overall survival were determined using the Kaplan-Meier method and compared using log-rank test. Seventy-eight consecutive patients were identified, which met the study criteria. Univariate analysis demonstrated that adenocarcinoma histology of primary cancer, disease-free interval and number of nodules were significant predictors of survival. Four of the six components of Adam score were significant predictors of survival. These were the presence of extrahepatic metastases, R2 resection, disease-free interval and type of a primary tumour. The total Adam score was also a significant predictor of survival. Liver resection for NCNN liver metastases is a safe and viable treatment option in carefully selected patients. Significant preoperative prognostic factors include adenocarcinoma primary tumours, disease-free interval and number of nodules. The total Adam score was a good predictor of overall survival and can be used to risk stratify patients undergoing hepatic resection for NCNN liver metastases.

  17. Establishment and evaluation of a new severe hepatic trauma model

    Directory of Open Access Journals (Sweden)

    Can-rong LU


    Full Text Available Objective To establish and evaluate a severe hepatic trauma model.Methods Eleven Chinese miniature swine for experiments were used in the current study.Using the self-made explosive-actuated device(MT-1,the explosive substance was prepared from 0.4 g black gunpowder and was placed on the diaphragmatic surface of the target hepatic lobe after the miniature swine had received celiotomy.Protective isolation for adjacent structure was then conducted,and then "fire".The parenchyma area(S was destroyed,and the mean arterial pressure(MAP and blood loss(V were measured to evaluate the local injury of the model animals and the changes of hemodynamics after being injured.Results The area(S of the destroyed parenchyma was 12.19±2.28 cm2.MAP presents the linear decline from 2 min to 7 min in the early stage post injury,with a decreasing rate of 6.58±2.30 mmHg/min and a period of 7.22±0.37 min when dropped to half.Blood loss was 466±79 ml when MAP drops to half of the level before injury.Treatment was not initiated for the first three animals and the time to death was between 23 min and 31 min.Conclusions The prepared model of severe hepatic trauma miniature swine corresponds with grade IV(AAST in human.The current model can be used to study war and traffic accident traumas due to its good repeatability and strong controllability.

  18. Multipolar radiofrequency ablation for colorectal liver metastases close to major hepatic vessels

    NARCIS (Netherlands)

    Snoeren, Nikol; Nijkamp, Maarten W.; Berendsen, Tim; Govaert, Klaas M.; van Kessel, Charlotte S.; Borel Rinkes, Inne H M; Van Hillegersberg, Richard


    Background: Resection of colorectal liver metastases (CRLM) is often hindered by their location close to the major hepatic vessels. So far, radiofrequency ablation for perivascular tumours was thought to be ineffective and unsafe due to either the heat sink effect or vascular thrombosis. The aim of

  19. Vertebral Column Resection for Rigid Spinal Deformity. (United States)

    Saifi, Comron; Laratta, Joseph L; Petridis, Petros; Shillingford, Jamal N; Lehman, Ronald A; Lenke, Lawrence G


    Broad narrative review. To review the evolution, operative technique, outcomes, and complications associated with posterior vertebral column resection. A literature review of posterior vertebral column resection was performed. The authors' surgical technique is outlined in detail. The authors' experience and the literature regarding vertebral column resection are discussed at length. Treatment of severe, rigid coronal and/or sagittal malalignment with posterior vertebral column resection results in approximately 50-70% correction depending on the type of deformity. Surgical site infection rates range from 2.9% to 9.7%. Transient and permanent neurologic injury rates range from 0% to 13.8% and 0% to 6.3%, respectively. Although there are significant variations in EBL throughout the literature, it can be minimized by utilizing tranexamic acid intraoperatively. The ability to correct a rigid deformity in the spine relies on osteotomies. Each osteotomy is associated with a particular magnitude of correction at a single level. Posterior vertebral column resection is the most powerful posterior osteotomy method providing a successful correction of fixed complex deformities. Despite meticulous surgical technique and precision, this robust osteotomy technique can be associated with significant morbidity even in the most experienced hands.

  20. Resection for secondary malignancy of the pancreas. (United States)

    Hung, Jui-Hsia; Wang, Shin-E; Shyr, Yi-Ming; Su, Cheng-Hsi; Chen, Tien-Hua; Wu, Chew-Wun


    This study tried to clarify the role of pancreatic resection in the treatment of secondary malignancy with metastasis or local invasion to the pancreas in terms of surgical risk and survival benefit. Data of secondary malignancy of the pancreas from our 19 patients and cases reported in the English literature were pooled together for analysis. There were 329 cases of resected secondary malignancy of the pancreas, including 241 cases of metastasis and 88 cases of local invasion. The most common primary tumor metastatic to the pancreas and amenable to resection was renal cell carcinoma (RCC) (73.9%). More than half (52.3%) of the primary cancers with local invasion to the pancreas were colon cancer, and nearly half (40.9%) were stomach cancer. The median metastatic interval was 84 months (7 years) for overall primary tumors and 108 months (9 years) for RCC. The 5-year survival for secondary malignancy of the pancreas after resection was 61.1% for metastasis and 58.9% for local invasion, with 72.8% for RCC metastasis, 69.0% for colon cancer, and 43.8% for stomach cancer with local invasion to the pancreas. Pancreatic resection should not be precluded for secondary malignancy of the pancreas because long-term survival could be achieved with acceptable surgical risk in selected patients.

  1. [Viral hepatitis in travellers]. (United States)

    Abreu, Cândida


    Considering the geographical asymmetric distribution of viral hepatitis A, B and E, having a much higher prevalence in the less developed world, travellers from developed countries are exposed to a considerable and often underestimated risk of hepatitis infection. In fact a significant percentage of viral hepatitis occurring in developed countries is travel related. This results from globalization and increased mobility from tourism, international work, humanitarian and religious missions or other travel related activities. Several studies published in Europe and North America shown that more than 50% of reported cases of hepatitis A are travel related. On the other hand frequent outbreaks of hepatitis A and E in specific geographic areas raise the risk of infection in these restricted zones and that should be clearly identified. Selected aspects related with the distribution of hepatitis A, B and E are reviewed, particularly the situation in Portugal according to the published studies, as well as relevant clinical manifestations and differential diagnosis of viral hepatitis. Basic prevention rules considering enteric transmitted hepatitis (hepatitis A and hepatitis E) and parenteral transmitted (hepatitis B) are reviewed as well as hepatitis A and B immunoprophylaxis. Common clinical situations and daily practice "pre travel" advice issues are discussed according to WHO/CDC recommendations and the Portuguese National Vaccination Program. Implications from near future availability of a hepatitis E vaccine, a currently in phase 2 trial, are highlighted. Potential indications for travellers to endemic countries like India, Nepal and some regions of China, where up to 30% of sporadic cases of acute viral hepatitis are caused by hepatitis E virus, are considered. Continued epidemiological surveillance for viral hepatitis is essential to recognize and control possible outbreaks, but also to identify new viral hepatitis agents that may emerge as important global health

  2. Survival benefit of transplantation for recurrence of hepatocellular carcinoma after liver resection. (United States)

    Tuci, F; Vitale, A; D'Amico, F; Gringeri, E; Neri, D; Zanus, G; Bassi, D; Polacco, M; Boetto, R; Lodo, E; Germani, G; Burra, P; Angeli, P; Cillo, U


    Liver transplantation (LT) for hepatocellular carcinoma (HCC) can be used for tumor recurrence after liver resection (LR) both for initially transplant-eligible patients as conventional salvage therapy (ST) and for non-transplant-eligible patients (beyond Milan criteria) with a goal of downstaging (DW). The aim of this study was to compare the intention-to-treat (ITT) survival rates of patients who are listed for LT, according to these two strategies. We analyzed a prospective database of 399 consecutive patients who underwent hepatic resection for HCC from 2002 to 2011 to identify patients included in the waiting list for tumor recurrence. Intention-to-treat (ITT) survivals were compared with those of patients resected for HCC within and beyond Milan criteria in the same period and not included in the LT waiting list. The study group consisted of 42 patients, 28 in the ST group (within Milan) and 14 in the DW group (beyond Milan). The 5-year ITT survival rate was similar between the 2 groups, being 64% for ST and 60% for DW (P=.84). Twenty-five patients (15 ST and 10 DW) underwent LT, 13 (10 ST and 3 DW) were still awaiting LT, 4 (3 ST and 1 DW) dropped out of the waiting list because of tumor progression, and 7 (5 ST [33%] and 2 DW [20%]) had tumor recurrence. The 5-year ITT survival of ST patients was similar to that of 252 in-Milan HCC patients resected only (P=.3), whereas 5-year ITT survival of DW patients was significantly higher (P<.01) than that of 105 beyond-Milan HCC patients resected only. LR seems to be a safe and effective therapy both as alternative to transplantation and as downstaging strategy for intermediate-advanced HCC. The survival benefit of salvage LT, however, seems to be higher in the 2nd than in the 1st group. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. In vivo study of partial liver resection on pigs using a 1.9 μm thulium fiber laser (United States)

    Theisen-Kunde, D.; Wolken, H.; Danicke, V.; Brinkmann, R.; Bruch, H.; Kleemann, M.


    Dissection of liver tissue can be performed by different techniques (ultrasound, mono and bipolar dissection, water jet dissection and by stapler). In this animal study the potential of a Thulium fiber laser system was investigated for open parenchyma dissection. Based on a cw Thulium fiber laser (IPG laser GmbH, Burbach, Germany), emitting a wavelength at 1.9 μm and a maximal power at 50 W, a surgical dissection device was developed at the Medical Laser Centre Luebeck. Cw laser radiation (40 Watt) was transmitted via a 365 μm fiber with a polished distal fiber tip. Procedure was performed in contact mode; irradiance at the distal fiber tip was 38.2 kW/cm2. After general anesthesia and a median laparotomy an atypical laser resection of the liver was performed in 3 pigs. Healing process was controlled after 2-3 weeks by histological analysis (H&E staining). The final evaluation data included total resection time, blood loss, bile leakage and mass of dissected tissue. All animals treated in this study were cared for in accordance to the European convention on animal care. In general the dissection with the 1.9 μm laser radiation was easily performed. Hemostasis was highly sufficient so blood loss and bile leakage was negligible. Total resection time including hemostasis of the remaining tissue was 26 +/- 12 min. Weight of resected tissue was 17 +/- 8 g. During survival period no complications (bleeding or inflammation) occurred. After 2 weeks histology showed ongoing scar formation about 1 - 2 mm in depth of the dissected area.

  4. [Liver resection in the treatment of intrahepatic lithiasis. Immediate and long-term results in a single-center series]. (United States)

    Marín, C; Robles, R; Pastor, P; Parrilla, P


    intrahepatic lithiasis (IHL) is an uncommon entity in our environment. When associated with Caroli s disease or stenosis of the biliary radicals it may be necessary to perform liver resection to provide definitive resolution. We present immediate and long term results in a Spanish series of patients with hepatic resection to treat hepatolithiasis. between January 1996 and December 2007 we performed a liver resection (LR) in 8 patients for IHL. The IHL was associated with Caroli s disease in 3 cases and with stenosis of segmentary radicals in the other 5 cases. It manifested itself as acute cholangitis in 5 cases, as biliary colic in two cases and recurrent pancreatitis in one case. The surgical technique was 1 right hepatectomy, 2 left hepatectomies and 5 segmentary resections. there was no intra- or postoperative mortality. The morbidity rate was 25%. One patient (12%) with Caroli s disease which had malignised to cholangiocarcinoma died in the follow-up period. The remaining 7 patients have had no IHL recurrence after a mean follow-up of 62 +/- 2 months (range: 31-106). in our experience liver resection, either lobar or segmentary, is the treatment for patients with IHL associated with stenosis and dilatation of the bile duct, as it provides complete resolution of the disease with low rates of morbidity and mortality.


    RODRIGUES, Túlio Felício da Cunha; SILVEIRA, Bianca; TAVARES, Flávia Pádua; MADEIRA, Gustavo Moreira; XAVIER, Iara Proença; RIBEIRO, Jorge Henrique Costa; PEREIRA, Rayanna Mara de Oliveira Santos; SIQUEIRA, Sávio Lana


    ABSTRACT Introduction: Several factors have made hepatectomy an increasingly safe surgery and new drugs allowed surgical treatment for patients who initially were not candidates for resection. Lesions often require resection, which can be performed by open, laparoscopic, or robotic assisted hepatectomy. Aim: Compare the surgical techniques in open, laparoscopic, and robotic assisted hepatectomy for resection of liver tumors. Methods: Literature review based on scientific papers published on Lilacs/Pubmed/Scielo in the last 17 years regarding the indications of these techniques for liver tumor resections and on papers comparing such techniques. Results: The comparative study shows the benefits of laparoscopic surgery over open surgery, such as smaller incisions, less postoperative pain, shorter recovery time, smaller immune and metabolic response, and quicker restoration of oral ingestion as well as lower morbidity rates. However, the need for a specialized surgical team and the reduction in handling area still remain as disadvantages in the laparoscopic technique. It is yet not clear whether robotic assistance presents considerable benefits over the laparoscopic technique considering that high acquisition and maintenance costs are limiting factors. Conclusion: Despite all challenges, laparoscopic hepatectomy presents many benefits over open surgery. The robotic assisted technique is still in evolution as many centers in the world perform hepatic resections with the platforms but only after a thorough patient selection. Thus, laparoscopy stands as the best option, unless there is some contraindication to the procedure. PMID:29257855

  6. Hepatitis virus panel (United States)

    ... this page: // Hepatitis virus panel To use the sharing features on this page, please enable JavaScript. The hepatitis virus panel is a series of blood tests used ...

  7. Hepatitis A - children (United States)

    ... attends day care: Make sure the children and staff at the day care center have had their hepatitis A vaccine. Inspect the area where diapers are changed to ensure that proper hygiene is followed. If your child gets hepatitis A, ...

  8. Delta agent (Hepatitis D) (United States)

    ... this page: // Hepatitis D (Delta agent) To use the sharing features on this page, please enable JavaScript. Hepatitis D is a viral infection caused by the ...

  9. Hepatitis B Vaccination Protection (United States)

    Fact Sheet Hepatitis B Vaccination Protection Hepatitis B virus (HBV) is a pathogenic microorganism that can cause potentially life- threatening disease in humans. HBV infection is transmitted through exposure ...

  10. Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. (United States)

    El Sharkawy, Osama A; Refaat, Emad K; Ibraheem, Abdel Elmoniem M; Mahdy, Wafiya R; Fayed, Nirmeen A; Mourad, Wesam S; Abd Elhafez, Hanaa S; Yassen, Khaled A


    Major hepatic resections may result in hemodynamic changes. Aim is to study transesophageal Doppler (TED) monitoring and fluid management in comparison to central venous pressure (CVP) monitoring. A follow-up comparative hospital based study. 59 consecutive cirrhotic patients (CHILD A) undergoing major hepatotomy. CVP monitoring only (CVP group), (n=30) and TED (Doppler group), (n=29) with CVP transduced but not available on the monitor. Exclusion criteria include contra-indication for Doppler probe insertion or bleeding tendency. An attempt to reduce CVP during the resection in both groups with colloid restriction, but crystalloids infusion of 6 ml/kg/h was allowed to replace insensible loss. Post-resection colloids infusion were CVP guided in CVP group (5-10 mmHg) and corrected flow time (FTc) aortic guided in Doppler group (>0.4 s) blood products given according to the laboratory data. Using the FTc to guide Hydroxyethyl starch 130/0.4 significantly decreased intake in TED versus CVP (1.03 [0.49] versus 1.74 [0.41] Liter; P 0.05). Cardiac index and stroke volume of TED increased post-resection compared to baseline, 3.0 (0.9) versus 3.6 (0.9) L/min/m(2), Pmonitoring was able to reduced colloids administration post-resection, lower morbidity and shorten hospital stay. TED consumed less time to insert and was also able to present significant hemodynamic changes. Advanced surgical techniques of resection play a key role in reducing blood loss despite CVP more than 5 cm H2O. TED fluid management protocols during resection need to be developed.

  11. Hepatitis B Foundation Newsletter: B Informed (United States)

    ... Clinical Trials Physician Directory HBV Meeting What Is Hepatitis B? What Is Hepatitis B? The ABCs of Viral Hepatitis Liver Cancer and Hepatitis B Hepatitis Delta Coinfection Hepatitis C Coinfection HIV/AIDS ...

  12. Extralevator abdominoperineal resection in the prone position. (United States)

    Flor-Lorente, Blas; Frasson, Matteo; Montilla, Erick


    The Miles operation is every day more in the limelight. The abdominoperineal resection compared to anterior resection results in increased rate of circumferential resection margin (CRM) infiltration, increased iatrogenic tumor perforation rate and poorer quality of the mesorectum. These worse results may be caused by excessive dissection between the distal mesorectum and the plane of the levator ani and the consequent "resection waist" or "cone" effect in the specimen. A wider excision of the pelvic floor muscles, known as extraelevator abdominoperineal resection (ELAPE), would provide a "cylindrical" specimen which would hypothetically reduce the risk of tumor perforation and CRM infiltration and local recurrence rate. However, there is insufficient evidence to conclude that the ELAPE is oncologically superior compared to standard abdominoperineal resection. Independently from the surgical technique adopted, another actual point of discussion is the position of the patient during the perineal part of the operation. The position on "prone" provides excellent pelvic exposure, a top-down dissection under direct vision and is very comfortable for the operating surgeons. However, there is no clear scientific evidence of the superiority of prone ELAPE over supine ELAPE in terms of oncologic results, morbidity and mortality. The laparoscopy seems to be the best surgical approach for the abdominal part of the operation, although it has not been validated so far by large prospective studies. Prospective, controlled and randomized trials are necessary to resolve all these issues. The current interest in a more accurate and standardized perineal surgery to obtain a cylindrical specimen, undoubtedly, will improve results. Copyright © 2014 Asociación Española de Cirujanos. Published by Elsevier Espana. All rights reserved.

  13. Hepatitis viruses overview

    African Journals Online (AJOL)

    Hepatitis is major cause of morbidity or mortality worldwide, particularly in the developing world. The major causes of infective hepatitis are hepatitis viruses. A, B, C, D or E. In the acute phase, there are no clinical features that can reliably differentiate between these viruses. Infection may be asymptomatic or can present as.

  14. Know More Hepatitis (United States)

    ... death. In fact, Hepatitis C is a leading cause of liver cancer and the #1 cause of liver transplants. Many people can get lifesaving care and treatment. Knowing you have Hepatitis C can help you make important decisions about your health. Successful treatments can eliminate the ... “Hepatitis C: Did You Know?” Watch this video ...

  15. Hepatitis E Virus

    African Journals Online (AJOL)

    Abstract. Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the developing world. It is a waterborne virus that can cause epidemics in the face of overcrowding and poor sanitation. Although the hepatitis illness is usually self-limiting, it has a high mortality in pregnant women and can become a ...

  16. Hepatitis B and Hepatitis C in Pregnancy (United States)

    ... who are infected never get rid of the hepatitis B virus. This is called chronic infection. These people keep the virus for the rest of their lives. They are known as carriers . Most carriers do not have ... and early death. Can hepatitis B virus infection be cured? There is no ...

  17. Spontaneous rupture of giant hepatic hemangioma: a rare source of hemoperitoneum. Case report. (United States)

    Santos Rodrigues, A L; Silva Santana, A C; Carvalho Araújo, K; Crociati Meguins, L; Felgueiras Rolo, D; Pereira Ferreira, M


    Hemoperitoneum due to spontaneous rupture of a hepatic hemangioma is a rare and serious clinical event with a high mortality rate. 25-year-old woman under hormonal treatment for pregnancy with abdominal pain with distension followed by vomits, palpable epigastric mass and paleness of the skin and mucosas. Computed tomography of the abdomen without oral and venous contrast showed a heterogeneous and capsulated tumor of the liver. Exploratory laparotomy was carried out that revealed a large tumor occupying the gastro-hepatic site with partial rupture of the tumor's capsule with bleeding. Because of the close relationship between the tumor and the retro-hepatic inferior vena cava, the partial resection of the tumor was realized. The patient had a good post-operative evolution. The study of the tumor revealed hepatic hemangioma. Hepatic Hemangiomas may evolve to spontaneous rupture leading to hemorrhagic acute abdomen. Surgery is mandatory and the resection of the Hemangioma will depend on the clinical condition of the patient and on the relationship of the tumor with the vascular structures of the liver. Partial resection is a safe choice that saves lives in urgency situations, as the one described herein.

  18. Primary hepatic leiomyosarcoma with liver metastasis of rectal cancer (United States)

    Takehara, Kiyoto; Aoki, Hideki; Takehara, Yuko; Yamasaki, Rie; Tanakaya, Kohji; Takeuchi, Hitoshi


    Primary hepatic leiomyosarcoma is a particularly rare tumor with a poor prognosis. Curative resection is currently the only effective treatment, and the efficacy of chemotherapy is unclear. This represents the first case report of a patient with primary hepatic leiomyosarcoma co-existing with metastatic liver carcinoma. We present a 59-year-old man who was diagnosed preoperatively with rectal cancer with multiple liver metastases. He underwent a curative hepatectomy after a series of chemotherapy regimens with modified FOLFOX6 consisting of 5-fluorouracil, leucovorin and oxaliplatin plus bevacizumab, FOLFIRI consisting of 5-fluorouracil, leucovorin and irinotecan plus bevacizumab, and irinotecan plus cetuximab. One of the liver tumors showed a different response to chemotherapy and was diagnosed as a leiomyosarcoma following histopathological examination. This case suggests that irinotecan has the potential to inhibit the growth of hepatic leiomyosarcomas. The possibility of comorbid different histological types of tumors should be suspected when considering the treatment of multiple liver tumors. PMID:23082067

  19. A Case of Peripheral Ulcerative Keratitis Associated with Autoimmune Hepatitis

    Directory of Open Access Journals (Sweden)

    Hamoon Eshraghi


    Full Text Available Purpose. To describe a case of peripheral ulcerative keratitis in the setting of autoimmune hepatitis and possible overlap syndrome with primary sclerosing cholangitis. Case Report. A 48-year-old African American female with autoimmune hepatitis with possible overlap syndrome with primary sclerosing cholangitis presented with tearing, irritation, and injection of the left eye that was determined to be peripheral ulcerative keratitis. The patient was treated with topical and systemic steroids, immunosuppressant drugs (azathioprine and mycophenolate mofetil, a biologic (rituximab, and surgery (conjunctival resection, and the peripheral ulcerative keratitis epithelialized but ultimately led to corneal perforation. Conclusion. In this unique case, a patient with peripheral ulcerative keratitis who underwent treatment ultimately had a corneal perforation. This case may suggest a possible relationship between autoimmune hepatitis and peripheral ulcerative keratitis.

  20. High-resolution computed tomography in chronic diffuse diseases of the pulmonary parenchyma. La tomodensitometrie haute resolution dans les maladies chroniques diffuses du parenchyme pulmonaire

    Energy Technology Data Exchange (ETDEWEB)

    Brauner, M. (Hopital Avicenne, 93 Bobigny (FR))


    High-resolution CT is a new method for the study of the pulmonary parenchyma which has several merits. It allows screening subradiographic lesions of the lungs, accurately locating the lesions, quantifying them, suggesting the etiological diagnosis, contributing in the assessment of the activity of the disease and following its evolution. A new semiology is being developed.

  1. A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach. (United States)

    Moon, Han Kook; Kim, Hyoung Su; Heo, Gyeong Mi; Shin, Woon Geon; Kim, Kyung Ho; Jang, Myoung Kuk; Lee, Jin Heon; Kim, Hak Yang; Kim, Doo Jin; Cho, Seong Jin


    Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.

  2. Robotic right segmental hepatectomy for the treatment of a giant hepatic hemangioma—a case report (United States)

    Efthimiadis, Christoforos; Ioannidis, Aristeidis; Grigoriou, Marios; Lazaridis, Michael; Kosmidis, Christoforos


    Abstract Hemangioma is the most common benign hepatic tumor. We present the case of a patient with a giant symptomatic hemangioma, treated with segmental liver resection using the Da Vinci Robotic System. A 38-year-old woman presented to our surgical out-patient Department complaining about abdominal discomfort and recurrent episodes of acute abdominal pain. CT-scan and MRI imaging of the abdomen revealed the presence of a giant hepatic hemangioma (>5 cm) involving segments VI and VII. Robotic right segmental hepatectomy was performed. The procedure was successfully completed in 120 min and with intraoperative blood loss of only 450 ml. Postoperative period was uneventful and the patient was discharged on the second postoperative day. In case of giant hemangiomas, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal complications. A careful preoperative and intraoperative strategy is required, while significant experience in liver and robotic surgery is mandatory. PMID:28698794

  3. Robotic right segmental hepatectomy for the treatment of a giant hepatic hemangioma-a case report. (United States)

    Efthimiadis, Christoforos; Ioannidis, Aristeidis; Grigoriou, Marios; Kofina, Konstantinia; Lazaridis, Michael; Kosmidis, Christoforos


    Hemangioma is the most common benign hepatic tumor. We present the case of a patient with a giant symptomatic hemangioma, treated with segmental liver resection using the Da Vinci Robotic System. A 38-year-old woman presented to our surgical out-patient Department complaining about abdominal discomfort and recurrent episodes of acute abdominal pain. CT-scan and MRI imaging of the abdomen revealed the presence of a giant hepatic hemangioma (>5 cm) involving segments VI and VII. Robotic right segmental hepatectomy was performed. The procedure was successfully completed in 120 min and with intraoperative blood loss of only 450 ml. Postoperative period was uneventful and the patient was discharged on the second postoperative day. In case of giant hemangiomas, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal complications. A careful preoperative and intraoperative strategy is required, while significant experience in liver and robotic surgery is mandatory.

  4. Marked enlargement and post-op recurrence of hepatic hemangiomas : two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Woon; Chang, Jay Chun; Cho, Jae Ho; Park, Bok Hwan; Kim, Hong Jin; Kwun, Koing Bo [Yeungnam University, Taegu (Korea, Republic of). Coll. of Medicine


    Hepatic hemangiomas are the most common benign tumor of the liver, and follow-up radiologic imaging studies have normally shown no interval change in the diameter of the tumor. Among the very few tumors in which such change have been seen, growth has been minimal. However, we experienced some marked enlargement of the tumor follow-up imaging studies. First, the marked enlargement of the tumor followed by resection, and as a result, hepatic hemangioma was confirmed. Second, hepatic hemangioma was confirmed after resection, but recurred. Tumor enlargement seems to be caused by ectasia of blood-filled cystic space or estrogen stimulation, through we found no specific etiology. (author). 10 refs., 4 figs.

  5. Use and dissemination of the brisbane 2000 nomenclature of liver anatomy and resections. (United States)

    Strasberg, Steven M; Phillips, Carolyn


    The Brisbane 2000 Nomenclature of Hepatic Anatomy and Resections was created to standardize terminology in an area, which previously was characterized by redundant and confusing terms. The purpose of this study was to evaluate the use and dissemination of the nomenclature 10 years after its introduction. Two strategies were used to evaluate implementation of the terminology. The first depended on an examination of terms used to describe the anatomy and resection of one half of the liver over the 20-year period from 1990 to 2009. The second approach evaluated the use of the terms "section," "sectionectomy," and "trisectionectomy," which, in reference to the liver, are unique to the Brisbane 2000 Nomenclature. The use of the Brisbane 2000 terms "right and left hemihepatectomy/hepatectomy" increased dramatically versus the use of the discarded terms "right and left hepatic lobectomy" after the Nomenclature was introduced in 2000. This was especially true in the Americas and Asia where the terms were used in less than 50% of papers from 1990 to 1999 but reached 80% utilization by 2006. Likewise, use of the terms "section," "sectionectomy," and "trisectionectomy" increased sharply especially in between 2006 and 2009. The Brisbane terminology is being adopted worldwide but its adoption is still incomplete.

  6. Alcoholic hepatitis. (United States)

    Damgaard Sandahl, Thomas


    Alcoholic hepatitis (AH) is an acute inflammatory syndrome causing significant morbidity and mortality. The prognosis is strongly dependent on disease severity, as assessed by clinical scoring systems. Reliable epidemiological data as well as knowledge of the clinical course of AH are essential for planning and resource allocation within the health care system. Likewise, individual evaluation of risk is desirable in the clinical handling of patients with AH as it can guide treatment, improve patient information, and serve as strata in clinical trials. The present PhD thesis is based on three studies using a cohort of nearly 2000 patients diagnosed with AH in Denmark from 1999 to 2008 as a cohort, in a population-based study design. The aims of this thesis were as follows. (1) To describe the incidence and short- and long-term mortality, of AH in Denmark (Study I). (2) To validate and compare the ability of the currently available prognostic scores to predict mortality in AH (Study II). (3) To investigate the short- and long-term causes of death of patients with AH (Study III). During the study decade, the annual incidence rate in the Danish population rose from 37 to 46 per 106 for men and from 24 to 34 per 106 for women. Both short- and long-term mortality rose for men and women, and the increase in short-term mortality was attributable to increasing patient age and prevalence of cirrhosis. Our evaluation of the most commonly used prognostic scores for predicting the mortality of patients with AH showed that all scores performed similarly, with Area under the Receiver Operator Characteristics curves giving values between 0.74 and 0.78 for 28-day mortality assessed on admission. Our study on causes of death showed that in the short-term (information about AH that shows increasing incidence and mortality rates. Consequently, it reiterates the fact that AH is a life-threatening disease and suggests that AH is an increasing public health concern. The most widely used

  7. Pathogenesis of Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Irena Ciećko-Michalska


    Full Text Available Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy.

  8. Pathogenesis of Hepatic Encephalopathy (United States)

    Ciećko-Michalska, Irena; Szczepanek, Małgorzata; Słowik, Agnieszka; Mach, Tomasz


    Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO) on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy. PMID:23316223

  9. Resection planning for robotic acoustic neuroma surgery (United States)

    McBrayer, Kepra L.; Wanna, George B.; Dawant, Benoit M.; Balachandran, Ramya; Labadie, Robert F.; Noble, Jack H.


    Acoustic neuroma surgery is a procedure in which a benign mass is removed from the Internal Auditory Canal (IAC). Currently this surgical procedure requires manual drilling of the temporal bone followed by exposure and removal of the acoustic neuroma. This procedure is physically and mentally taxing to the surgeon. Our group is working to develop an Acoustic Neuroma Surgery Robot (ANSR) to perform the initial drilling procedure. Planning the ANSR's drilling region using pre-operative CT requires expertise and around 35 minutes' time. We propose an approach for automatically producing a resection plan for the ANSR that would avoid damage to sensitive ear structures and require minimal editing by the surgeon. We first compute an atlas-based segmentation of the mastoid section of the temporal bone, refine it based on the position of anatomical landmarks, and apply a safety margin to the result to produce the automatic resection plan. In experiments with CTs from 9 subjects, our automated process resulted in a resection plan that was verified to be safe in every case. Approximately 2 minutes were required in each case for the surgeon to verify and edit the plan to permit functional access to the IAC. We measured a mean Dice coefficient of 0.99 and surface error of 0.08 mm between the final and automatically proposed plans. These preliminary results indicate that our approach is a viable method for resection planning for the ANSR and drastically reduces the surgeon's planning effort.

  10. Complications of liver resection in geriatric patients. (United States)

    Dedinská, Ivana; Laca, Ludovít; Miklušica, Juraj; Palkoci, Blazej; Skálová, Petra; Lauková, Slavomíra; Osinová, Denisa; Strmeňová, Simona; Janík, Ján; Mokáň, Marián


    Introduction and aims. Liver resection is the treatment of choice for many primary and secondary liver diseases. Most studies in the elderly have reported resection of primary and secondary liver tumors, especially hepatocellular carcinoma and colorectal metastatic cancer. However, over the last two decades, hepatectomy has become safe and is now performed in the older population, implying a paradigm shift in the approach to these patients. We retrospectively evaluated the risk factors for postoperative complications in patients over 65 years of age in comparison with those under 65 years of age after liver resection (n = 360). The set comprised 127 patients older than 65 years (35%) and 233 patients younger than 65 years (65%). In patients younger than 65 years, there was a significantly higher incidence of benign liver tumors (P = 0.0073); in those older than 65 years, there was a significantly higher incidence of metastasis of colorectal carcinoma to the liver (0.0058). In patients older than 65 years, there were significantly more postoperative cardiovascular complications (P = 0.0028). Applying multivariate analysis, we did not identify any independent risk factors for postoperative complications. The 12-month survival was not significantly different (younger versus older patients), and the 5-year survival was significantly worse in older patients (P = 0.0454). In the case of liver resection, age should not be a contraindication. An individualized approach to the patient and multidisciplinary postoperative care are the important issues.

  11. Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection

    Directory of Open Access Journals (Sweden)

    M. Wayne


    Full Text Available Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late of proximal gastrojejunal (PGJ reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.

  12. Root resection: Apropos of 6 cases

    Directory of Open Access Journals (Sweden)

    H Rajesh


    Full Text Available Root resection procedures are indicated in the treatment of advanced Grade II and Grade III furcation involvement. Their long-term prognosis is comparable to that of implants. The objective of this article is to present case reports of hemisection in mandibular first molar and root amputation in maxillary second molar, employed successfully as a part of the oral rehabilitation procedure.

  13. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)


    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  14. Hysteroscopic Endometrial Resection in the Management of ...

    African Journals Online (AJOL)

    Background: Abnormal uterine bleeding (AUB) is a major health problem and it is a substantial cause of ill health in women. Medical treatment has a high failure rate and adverse effects. There are few published data on hysteroscopic endometrial resection (HER) in the management of patients with AUB. Objective: To ...

  15. Resection methodology for PSP data processing: Recent ...

    Indian Academy of Sciences (India)

    A processing software based on these methodologies has been successfully developed and validated and is currently in use at the Experimental Aerodynamics Division of the National Aerospace laboratories, Bangalore. In this paper, we show the merits of resection methodology through two examples: a wing-body model ...

  16. Outcome of colorectal cancer resection in octogenarians

    African Journals Online (AJOL)

    Absolute number of postoperative complications in patients aged >80 years and 60 - 70 years undergoing colorectal resection (CVA = cerebrovascular accident; DVT = deep-vein thrombosis; PE = pulmonary embolism; CDT = Clostridium difficile; UTI = urinary tract infection; MI = myocardial infarction; AF = atrial fibrillation).

  17. Manual Colostomy Reversals Following Wide Colorectal Resections ...

    African Journals Online (AJOL)

    Manual Colostomy Reversals Following Wide Colorectal Resections at Poorly Equipped Surgical Facilities. EBFK Odimba, M Nthele, M Mbambiko. Abstract. Background: The decision for colostomy reversal is usually not easy and often reflects patient's desire, fully analyzed and agreed by the surgeon. The unavailability of ...

  18. [Curative resection of stage IV advanced gallbladder cancer following combined treatment with gemcitabine and CDDP]. (United States)

    Adikrisna, Rama; Nakamura, Noriaki; Irie, Takumi; Matsumura, Satoshi; Tanaka, Shinji; Arii, Shigeki


    A 74-year-old woman was referred to our hospital following the diagnosis of advanced gallbladder cancer with para-aortic lymph node metastasis. Combination treatment involving gemcitabine(1,000mg/m / 2 body surface area)and CDDP(50mg/ m2 body surface area)was initiated and repeated for 4 courses; gemcitabine was administrated on day 1 and day 8, whereas CDDP was administrated on day 8, followed by 1 week of no treatment. After 4 courses, abdominal computed tomography (CT)indicated a reduction in size of the main lesion and disappearance of para -aortic lymph nodes. The remarkable response to the chemotherapy, which resulted in tumor downstaging, enabled us to perform the curative surgery procedure. Thus, cholecystectomy with resection of the hepatic bed and lymph node dissection were performed. The resected specimens indicated papillary adenocarcinoma of the gallbladder infiltrating the muscular wall of the gallbladder. In addition, the resected para-aortic lymph nodes indicated hyalinization and fibrosis as a result of the chemotherapy. Moreover, the pericholedocal lymph nodes were necrotic and no viable tumor was noted, thus indicating the excellent response to the chemotherapy.

  19. Long-term Survivors After Liver Resection for Breast Cancer Liver Metastases. (United States)

    BacalbaȘa, Nicolae; Balescu, Irina; Dima, Simona; Popescu, Irinel


    Although breast cancer liver metastases are considered a sign of systemic recurrence and are considered a poor prognostic factor that transforms the patient into a candidate for palliative chemotherapy, surgery might be performed with good results. Success reported after liver resection for colorectal hepatic metastases encouraged the oncological surgeon to apply similar protocols in breast cancer liver metastases. Data of patients submitted to hepatectomies for breast cancer liver metastases in the "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest were retrospectively reviewed. Among five cases survival after liver surgery surpassed 5 years and was considered long-term survival. One of the five cases was submitted to a second liver resection. Most often long-term survivors were reported among patients with single, metachronous and smaller than 5-cm lesions. In selected cases liver resection for breast cancer liver metastases can be associated with a significant increase in survival. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  20. Aggressive surgery for borderline resectable pancreatic cancer: evaluation of National Comprehensive Cancer Network guidelines. (United States)

    Yamada, Suguru; Fujii, Tsutomu; Sugimoto, Hiroyuki; Nomoto, Shuji; Takeda, Shin; Kodera, Yasuhiro; Nakao, Akimasa


    The objective of this study was to evaluate the relevance of defining borderline resectable (BR) pancreatic cancer as a distinct entity in the treatment scheme of pancreatic cancer as proposed by the National Comprehensive Cancer Network. Among 375 patients with pancreatic cancer, 137 patients were deemed to have resectable disease (R) by preoperative imaging studies, whereas 96 were found to have an unresectable disease during surgery. The remaining 142 patients fulfilled the definition of BR and were further classified into 3 subgroups based on the National Comprehensive Cancer Network guidelines: portal vein invasion (PV[+]), common hepatic artery invasion (CHA[+]), and superior mesenteric artery invasion (SMA[+]). PV(+) was subdivided into types B, C, and D according to the degree of portal vein invasion. Patients in the R group had significantly better survival than those in the PV(+) group (P = 0.0038), who in turn survived significantly longer than those classified as SMA(+) (P = 0.041). Type B patients survived significantly longer than did types C and D patients (P = 0.013 and P = 0.030, respectively). In PV(+) patients, compliance with postoperative chemotherapy at 3 and 6 months was 56.9% and 44.6%, respectively, substantially inferior to patients with resectable disease (72.6% and 54.7%, respectively). The optimal treatment strategy may differ among various subgroups within the BR category.

  1. Dynamic CT vs 0.5 T MR imaging in the detection of surgically proven hepatic metastases. (United States)

    Zeman, R K; Dritschilo, A; Silverman, P M; Clark, L R; Garra, B S; Thomas, D S; Ahlgren, J D; Smith, F P; Korec, S M; Nauta, R J


    Seventeen patients with 52 surgically proven hepatic metastases were studied preoperatively with dynamic CT and 0.5 T magnetic resonance (MR). Dynamic CT detected 38 metastases (73%), and the combination of short echo time (T1-weighted) and T2-weighted pulse sequences detected 46 lesions (88%). Magnetic resonance was also superior at assessing potential resectability. This study suggests that MR excels in detecting and anatomically localizing individual hepatic metastases.

  2. Mannitol-enhanced, fluid-phase endocytosis in storage parenchyma cells of celery (Apium graveolens; Apiaceae) petioles. (United States)

    Etxeberria, Ed; Gonzalez, Pedro; Pozueta-Romero, Javier


    We recently demonstrated the occurrence of a sucrose-enhanced, fluid-phase endocytic (FPE) mechanism of nutrient uptake in heterotrophic cells. In the present work, the possible enhancement/induction of FPE by photoassimilates other than sucrose was investigated by measuring the incorporation of the fluorescent endocytosis marker d-TR (dextran-Texas red, 3000 mw) into celery (Apium graveolens) petiole storage parenchyma (CSP), a tissue that transports and accumulates mannitol. Mannitol uptake in these cells is biphasic, with a hyperbolic phase at concentrations below 20 mM and a linear phase above 20 mM external solute concentration. In the absence of mannitol, or in its presence at concentrations within the hyperbolic phase, CSP cells accumulated low levels of d-TR. Conversely, d-TR accumulation by CSP cells was greatly enhanced in the presence of mannitol at concentrations within the linear phase. At high external mannitol concentration, d-TR accumulation was prevented by the endocytic inhibitors LY294002 and latrunculin B. In addition, d-TR uptake was temperature dependent under high mannitol concentration. Microscopic observations revealed that d-TR accumulated in the vacuole. These data support the occurrence of an FPE mechanism in CSP cells that participates in trapping and transport of photoassimilates to the vacuole. The FPE mechanism is enhanced by high mannitol concentrations.

  3. Intra-Arterially Delivered Mesenchymal Stem Cells Are Not Detected in the Brain Parenchyma in an Alzheimer's Disease Mouse Model.

    Directory of Open Access Journals (Sweden)

    Na Kyung Lee

    Full Text Available Mesenchymal stem cells (MSCs have a promising role as a therapeutic agent for neurodegenerative diseases such as Alzheimer's disease (AD. Prior studies suggested that intra-arterially administered MSCs are engrafted into the brain in stroke or traumatic brain injury (TBI animal models. However, a controversial standpoint exists in terms of the integrity of the blood brain barrier (BBB in transgenic AD mice. The primary goal of this study was to explore the feasibility of delivering human umbilical cord-blood derived mesenchymal stem cells (hUCB-MSCs into the brains of non-transgenic WT (C3H/C57 and transgenic AD (APP/PS1 mice through the intra-arterial (IA route. Through two experiments, mice were infused with hUCB-MSCs via the right internal carotid artery and were sacrificed at two different time points: 6 hours (experiment 1 or 5 minutes (experiment 2 after infusion. In both experiments, no cells were detected in the brain parenchyma while MSCs were detected in the cerebrovasculature in experiment 2. The results from this study highlight that intra-arterial delivery of MSCs is not the most favorable route to be implemented as a potential therapeutic approach for AD.

  4. Anti-ice nucleation activity in xylem extracts from trees that contain deep supercooling xylem parenchyma cells. (United States)

    Kasuga, Jun; Mizuno, Kaoru; Arakawa, Keita; Fujikawa, Seizo


    Boreal hardwood species, including Japanese white birch (Betula platyphylla Sukat. var. japonica Hara), Japanese chestnut (Castanea crenata Sieb. et Zucc.), katsura tree (Cercidiphyllum japonicum Sieb. et Zucc.), Siebold's beech (Fagus crenata Blume), mulberry (Morus bombycis Koidz.), and Japanese rowan (Sorbus commixta Hedl.), had xylem parenchyma cells (XPCs) that adapt to subfreezing temperatures by deep supercooling. Crude extracts from xylem in all these trees were found to have anti-ice nucleation activity that promoted supercooling capability of water as measured by a droplet freezing assay. The magnitude of increase in supercooling capability of water droplets in the presence of ice-nucleation bacteria, Erwinia ananas, was higher in the ranges from 0.1 to 1.7 degrees C on addition of crude xylem extracts than freezing temperature of water droplets on addition of glucose in the same concentration (100 mosmol/kg). Crude xylem extracts from C. japonicum provided the highest supercooling capability of water droplets. Our additional examination showed that crude xylem extracts from C. japonicum exhibited anti-ice nucleation activity toward water droplets containing a variety of heterogeneous ice nucleators, including ice-nucleation bacteria, not only E. ananas but also Pseudomonas syringae (NBRC3310) or Xanthomonas campestris, silver iodide or airborne impurities. However, crude xylem extracts from C. japonicum did not affect homogeneous ice nucleation temperature as analyzed by emulsified micro-water droplets. The possible role of such anti-ice nucleation activity in crude xylem extracts in deep supercooling of XPCs is discussed.

  5. Good results after repeated resection for colorectal liver metastases

    DEFF Research Database (Denmark)

    Rolff, Hans Christian; Calatayud, Dan; Larsen, Peter Nørgaard


    Our study aim was to evaluate the perioperative events, postoperative events and survival after a second liver resection due to colorectal liver metastases (CLM), compared with a matched control group that had only undergone primary liver resection due to CLM....

  6. Surgical resection for hepatocellular carcinoma in Cape Town - A ...

    African Journals Online (AJOL)

    BCC) at our institution between 1990 and 1996, histology of resected specimens, and clinical outcome. Design, Retrospective and prospective study of 14 patients who underwent resection for HCC. Setting. The Hepatobiliary Unit and Liver ...

  7. [Enteral resection in the nursing rabbit (an experimental study)]. (United States)

    Villegas Alvarez, F; Cárdenas Orihuela, A; Vigueras Villaseñor, R M


    The response to enteral resection in human newborns and nursing babies depends on the site and magnitude of the resection: usually these patients have a satisfactory recovery although long term supportive measures are required in order to prevent nutritional and digestive complications. This study assessed the post-surgical response of six groups of nursing rabbits with 0, 40, 50, 60, 75 and 90% selective resection of the small intestine. A greater number of surgical complications was observed in those cases with more manipulation and greater resection. Villi hypertrophic was found at the distal extremes of the enteral remnants only with 40% jejunal resection and 75 and 90% jejunum-ileum resections. None of the groups showed growth interruption. Only in rabbits with resections greater than 60% a significant decrease in weight was found. Forty and sixty percent enteral resections, mainly proximal and distal respectively, did not yield weight or length deficits as compared with the control group.

  8. Good results after repeated resection for colorectal liver metastases

    DEFF Research Database (Denmark)

    Rolff, Hans Christian; Calatayud, Dan; Larsen, Peter Nørgaard


    Our study aim was to evaluate the perioperative events, postoperative events and survival after a second liver resection due to colorectal liver metastases (CLM), compared with a matched control group that had only undergone primary liver resection due to CLM.......Our study aim was to evaluate the perioperative events, postoperative events and survival after a second liver resection due to colorectal liver metastases (CLM), compared with a matched control group that had only undergone primary liver resection due to CLM....

  9. Pleuropulmonary Blastoma (PPB in an infant: Is the timing of an elective resection of neonatal lung lesions challenged?

    Directory of Open Access Journals (Sweden)

    Robert Simon


    Full Text Available Congenital Pulmonary Airway Malformations (CPAMs are abnormalities of lung parenchyma that are often diagnosed upon prenatal imaging as opposed to postnatal symptoms. With a clinical presentation identical to CPAMs, Pleuropulmonary Blastoma (PPB is a rare pulmonary neoplasm of highly malignant potential. We present a rare case of a female infant with a vague medical history of respiratory distress syndrome (RDS at birth, presenting with a tension pneumothorax at three months of age, thought initially to be secondary to CPAM, but found to be PPB upon surgical resection and histological analysis. PPB is a rare pulmonary neoplasm of childhood that originates from the primitive interstitium of the lung, resulting in lesions that can be highly malignant. It is classified as type I (cystic, type II (cystic/solid or type III (solid, with a progression of disease and worsening prognosis from type I to type III. Due to the cystic nature of CPAM and PPB it is difficult to differentiate on imaging alone; diagnosis must be made based on histological analysis. The highly malignant nature and potential for morbidity and mortality of PPB should make clinicians consider early resection of cystic lung lesions preferentially on an elective basis.

  10. Short-term outcomes following laparoscopic resection for colon cancer.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O


    Laparoscopic resection for colon cancer has been proven to have a similar oncological efficacy compared to open resection. Despite this, it is performed by a minority of colorectal surgeons. The aim of our study was to evaluate the short-term clinical, oncological and survival outcomes in all patients undergoing laparoscopic resection for colon cancer.

  11. Augmented reality in bone tumour resection: An experimental study. (United States)

    Cho, H S; Park, Y K; Gupta, S; Yoon, C; Han, I; Kim, H-S; Choi, H; Hong, J


    We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137-143. © 2017 Cho et al.

  12. Transanal submucosal endoscopic resection (TASER) by TEO system®. (United States)

    Muñoz de Nova, José Luis; Viamontes Ugalde, Francisco Eduardo; Mendoza Jiménez-Ridruejo, Jorge


    Given the higher incidence of non-invasive colorectal tumors due to the further implementation of screening techniques, multiple endoscopic techniques have emerged for its resection. Recently described, transanal submucosal endoscopic resection (TASER) pools the concepts of endoscopic resection with the transanal surgery. We report our initial experience and reflections on this new technique.

  13. Diffuse Hepatic Epithelioid Hemangioendothelioma Developed in a Patient with Hepatitis C Cirrhosis

    Directory of Open Access Journals (Sweden)

    Pedro W. Baron


    Full Text Available Hepatic epithelioid hemangioendothelioma (HEHE is an infrequent vascular tumor of endothelial origin that primarily occurs in women in the mid-fifth decade of life without underlying chronic liver disease or cirrhosis. Liver transplant should be the first-line of therapy in patients with large or diffuse unresectable tumors even in the presence of metastatic disease due to the favorable long-term outcome. We report the case of a 48-year-old female who complained of abdominal pain and weight loss. She has a history of cirrhosis secondary to chronic hepatitis C (HCV and was treated with interferon and ribavirin with sustained virological response. Her work-up revealed multiple confluent infiltrating bilobar liver masses diagnosed as HEHE. She underwent a successful liver transplant without evidence of recurrent HCV infection. She developed cervical spine (C4-C6 HEHE metastases 4 years after transplant. She underwent surgical resection and local radiotherapy after resection with good clinical response. To the best of our knowledge, this is the first report of HEHE that developed in a patient with HCV cirrhosis successfully treated with antiviral therapy before transplant and liver transplant with good allograft function without evidence of recurrent liver tumor or HCV infection but developed metastases to the cervical spine 4 years after transplant.

  14. Gallbladder Function and Hepatic Structural Changes in Children with Nonalcoholic Fatty Liver Disease

    Directory of Open Access Journals (Sweden)

    N.Yu. Zavgorodnya


    Full Text Available During the last decade, pediatric nonalcoholic liver disease has reached epidemic proportions, becoming one of the most frequent chronic liver diseases in the global child population. Purpose: to study the relationship of the functional state of the gallbladder with structural changes in the liver in children with nonalcoholic fatty liver disease. Materials and methods. We examined 34 children aged from 8 to 17 years old. Hepatic steatosis was determined using the FibroScan® 502 touch with controlled attenuation parameter (CAP. According to the results of transient elastometry and ultrasound of the abdomen with the gallbladder function study, patients were divided into 4 groups: the 1st group consisted of 7 patients with steatosis and hypofunction of gallbladder (20.5 %, group 2 included 6 patients with steatosis and gallbladder normofunction (17.65 %, group 3 consisted of 11 patients without hepatic steatosis with hypofunction of gallbladder (32.35 %, group 4 included 10 patients without hepatic steatosis with gallbladder normofunction (29.4 %. Results. The sonographic studies demonstrated children of the 1st group (steatosis with gallbladder hypokinesia to have significantly larger sizes of liver lobes compared to group 4 (children without steatosis with gallbladder normofunction. Also, the stiffness of the liver parenchyma was highest in patients with hepatic steatosis and gallbladder hypokinesia. Discussion. The combination of hepatic steatosis and hypokinesia of the gallbladder in children is accompanied by a significant increase in liver size, increased stiffness of the liver parenchyma and increasing degree of steatosis. The data indicate the relationship of the gallbladder function and the liver structural changes.

  15. Total intermittent Pringle maneuver during liver resection can induce intestinal epithelial cell damage and endotoxemia.

    Directory of Open Access Journals (Sweden)

    Simon A W G Dello

    Full Text Available OBJECTIVES: The intermittent Pringle maneuver (IPM is frequently applied to minimize blood loss during liver transection. Clamping the hepatoduodenal ligament blocks the hepatic inflow, which leads to a non circulating (hepatosplanchnic outflow. Also, IPM blocks the mesenteric venous drainage (as well as the splenic drainage with raising pressure in the microvascular network of the intestinal structures. It is unknown whether the IPM is harmful to the gut. The aim was to investigate intestinal epithelial cell damage reflected by circulating intestinal fatty acid binding protein levels (I-FABP in patients undergoing liver resection with IPM. METHODS: Patients who underwent liver surgery received total IPM (total-IPM or selective IPM (sel-IPM. A selective IPM was performed by selectively clamping the right portal pedicle. Patients without IPM served as controls (no-IPM. Arterial blood samples were taken immediately after incision, ischemia and reperfusion of the liver, transection, 8 hours after start of surgery and on the first post-operative day. RESULTS: 24 patients (13 males were included. 7 patients received cycles of 15 minutes and 5 patients received cycles of 30 minutes of hepatic inflow occlusion. 6 patients received cycles of 15 minutes selective hepatic occlusion and 6 patients underwent surgery without inflow occlusion. Application of total-IPM resulted in a significant increase in I-FABP 8 hours after start of surgery compared to baseline (p<0.005. In the no-IPM group and sel-IPM group no significant increase in I-FABP at any time point compared to baseline was observed. CONCLUSION: Total-IPM in patients undergoing liver resection is associated with a substantial increase in arterial I-FABP, pointing to intestinal epithelial injury during liver surgery. TRIAL REGISTRATION: NCT01099475.

  16. Hepatic alveolar echinococcosis: correlative US and CT study

    Energy Technology Data Exchange (ETDEWEB)

    Didier, D.; Weiler, S.; Rohmer, P.; Lasseque, A.; Deschamps, J.P.; Vuitton, D.; Miguet, J.P.; Weill, F.


    A total of 24 cases of hepatic alveolar echinococcosis (HAE) due to Echinococcus multilocularis was assessed by US and CT. The diagnosis was confirmed in all cases by immunologic and histologic study. Both US and CT patterns of HAE showed changes of liver morphology in both contour and size. Abnormal areas of parenchyma were nodular or in fields, irregular, heterogeneous, and basically echogenic. Clustered microcalcifications were encountered within the abnormal parenchymal fields in 50% of cases, and necrotized zones occurred in 40% of cases. Dilatation of intrahepatic bile ducts was commonly seen, especially on US; hilar involvement was frequent. Follow-up by both techniques can display increases of primary lesions, occurrence of new foci, and local or regional extensions. Precise evaluations of the lesions arising from correlative use of US and CT permits adequate therapeutic management.

  17. Totally laparoscopic anatomical liver resection for centrally located tumors: A single center experience. (United States)

    Kim, Wan-Joon; Kim, Ki-Hun; Shin, Min-Ho; Yoon, Young-In; Lee, Sung-Gyu


    Laparoscopic major hepatectomy is a common procedure that has been reported frequently; however, laparoscopic resection of centrally located tumors involving segments 4, 5, and 8 remains a technically difficult procedure because it requires 2 transection planes and dissection of numerous branches of the hepatic vein and glissonean capsule compared to hemi-hepatectomy. Here, we present 7 cases of totally laparoscopic right anterior sectionectomy (Lap-RAS) and 3 cases of totally laparoscopic central bisectionectomy (Lap-CBS).Between May 2013 and January 2015, 10 totally laparoscopic anatomical resections of centrally located tumors were performed in our institution. The median age of the patients was 54.2 (38-72) years and the median ICG-R15 was 10.4 (3.9-17.4). There were 8 patients with hepatocellular carcinoma (HCC) and 2 with metastatic colorectal cancer. All the HCC patients has the liver function impairment on the degree of Child-Pugh score A.The mean operation time was 330 ± 92.7 minutes with an estimated blood loss of 325 ± 234.5 mL. Only 1 patient required transfusion during surgery. Mean postoperative hospital stay was 9.5 ± 3.4 day and postop complication was reported only 1 case that has the fluid collection at the resection margin of the liver. Mean resection margin was 8.5 ± 6.1 mm and tumor size was 2.9 ± 1.9 cm.Totally lap-RAS and lap-CBS are feasible operative procedures in patients with centrally located tumor of the liver and particularly in patients with limited liver function such as those with cirrhosis.

  18. Advances in multidisciplinary individualized treatment of refractory hepatic alveolar echinococcosis

    Directory of Open Access Journals (Sweden)

    ABUDUAINI Abulizi


    Full Text Available Hepatic alveolar echinococcosis (HAE is a zoonotic parasitic disease that seriously threatens the population in western China and compromises patients′ quality of life. With the continuous improvement in radical resection rate in recent years, late-stage HAE patients that were incurable in the past now have the opportunity for radical resection. However, patients who are not suitable candidates for radical resection still suffer from various complications and poor quality of life. Therefore, HAE is still considered a refractory and complex disease. The simple empirical treatment model provided by traditional professional discussion is unable to satisfy the treatment of advanced refractory HAE as it is unable to integrate specialized, standardized clinical skills for diagnosis and treatment. Multidisciplinary individualized treatment (MDT organically integrates the advantages of the available treatment into a reasonable individualized comprehensive treatment regimen. This review summarizes the advances in MDT for HAE as the best option to increase long-term survival, and suggests MDT as the first-line treatment for late-stage refractory hepatic alveolar echinococcosis.

  19. Light and turgor affect the water permeability (aquaporins) of parenchyma cells in the midrib of leaves of Zea mays. (United States)

    Kim, Yangmin X; Steudle, Ernst


    In response to light, water relation parameters (turgor, half-time of water exchange, T(1/2), and hydraulic conductivity, Lp; T(1/2) proportional 1/Lp) of individual cells of parenchyma sitting in the midrib of leaves of intact corn (Zea mays L.) plants were investigated using a cell pressure probe. Parenchyma cells were used as model cells for the leaf mesophyll, because they are close to photosynthetically active cells at the abaxial surface, and there are stomata at both the adaxial and abaxial sides. Turgor ranged from 0.2 to 1.0 MPa under laboratory light condition (40 micromol m(-2) s(-1) at the tissue level), and individual cells could be measured for up to 6 h avoiding the variability between cells. In accordance with earlier findings, there was a big variability in T(1/2)s measured ranging from 0.5 s to 100 s, but the action of light on T(1/2)s could nevertheless be worked out for cells having T(1/2)s greater than 2 s. Increasing light intensity ranging from 100 micromol m(-2) s(-1) to 650 micromol m(-2) s(-1) decreased T(1/2) by a factor up to five within 10 min and increased Lp (and aquaporin activity) by the same factor. In the presence of light, turgor decreased due to an increase in transpiration, and this tended to compensate or even overcompensated for the effect of light on T(1/2). For example, during prolonged illumination, cell turgor dropped from 0.2 to 1.0 MPa to -0.03 to 0.4 MPa, and this drop caused an increase of T(1/2) and a reduction of cell Lp, i.e. there was an effect of turgor on cell Lp besides that of light. To separate the two effects, cell turgor (water potential) was kept constant while changing light intensity by applying gas pressure to the roots using a pressure chamber. At a light intensity of 160 micromol m(-2) s(-1), there was a reduction of T(1/2) by a factor of 2.5 after 10-30 min, when turgor was constant within +/-0.05 MPa. Overall, the effects of light on T(1/2) (Lp) were overriding those of turgor only when decreases in

  20. Carcinoma of Gall bladder with distant metastasis to breast parenchyma. Report of a case and review of literature. (United States)

    Kumaran, Damodara; Anamalai, Manikandan; Velu, Umesh; Nambirajan, Aruna; Julka, Pramod Kumar


    Gall bladder carcinoma is one of the most common cancers in India. Gall bladder cancer with metastasis to the breast is very rare. Herein we intend to report a case of carcinoma gall bladder with breast metastasis and a short review of the literature. This report describes an interesting and unusual case of gall bladder carcinoma presenting with breast metastasis. A 38-year lady presented with complaints of right abdominal pain. Bilateral breast examination showed 2×2cm palpable lump in the upper outer quadrant of the left breast. Contrast-enhanced CT of the abdomen and pelvis showed circumferential thickening of gall bladder with the loss of fat plane with the adjacent liver parenchyma. Biopsy from the breast lump was reported as metastatic adenocarcinoma compatible with primary in the gall bladder. Whole body PET-CT showed gall bladder mass with abdominal and pelvic nodes with metastasis to liver, left breast, C7 vertebral body and left supra-clavicular node. She was diagnosed to have disseminated carcinoma gall bladder with liver, breast and supraclavicular nodal metastasis. She received palliative chemotherapy with gemcitabine and carboplatin and radiotherapy to C7 vertebra. After receiving 3 cycles of chemotherapy, chemotherapy was changed to the second line with single agent capecitabine. In spite of two lines of chemotherapy, she succumbed to disease progression and expired. There are limited examples of gall bladder adenocarcinoma with simultaneous metastasis to breast in the English literature. Our case showed an unusual dissemination of gall bladder cancer. Copyright © 2016 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Maida Šahinović


    Full Text Available Research in this study had the character of retrospective study for which we used 24 adult female Wistar rats, who we reared under standardized laboratory conditions and divided into two groups: experimental and control. The experimental group consisted of a total of 12 animals who were classified into 2 subgroups: Z1 and Z2. The control group consisted of 12 untreated animals who were divided into 2 subgroups: K1 and K2. Once a day at regular intervals we applied by the gastric probe mycotoxin zearalenone previously dissolved in sunflower oil. To the animals in the control group we applied sunflower oil only. Dose of toxin administered was 0,5 mg/kg body weight, and a period of observation spanned two different time intervals-14 and 28 days.After completing the application of toxins, the animals were sacrificed under the general ether anesthesia and by the rules of autopsy techniques. Taken ovaries were prepared for histological and stereological analysis.Structural changes in the ovaries of treated animals were observed as degenerative changes, primarily at the level of the ovarian follicles and corpora lutea. The apparent findings in the stroma were in terms of its hipercelularity and marked hyperemia of the blood vessels. The longer the application period, the more pronounced the changes.The resulting qualitative histological changes in the ovaries of treated rats were objectified quantitatively - by stereology. We found changes in terms of decreasing volume density of functional elements of the parenchyma (ovarian follicles and corpora lutea, and increased volume density of ovarian stroma with blood vessels.Key words: zearalenone, rat, ovary, qualitative changes, stereology

  2. Hepatic sarcoidosis complicating treatment-naive viral hepatitis


    Aravinthan, Aloysious; Gelson, William; Limbu, Anita; Brais, Rebecca; Richardson, Paul


    Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome. Co-existence of viral hepatitis and hepatic sarcoidosis is a rare, but recognised phenomenon. Obtaining a balance between immune suppression and anti-viral therapy may be problematic. Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease. Similarly, anti-viral therapy may exacerbate granulomatous hepatitis. Here we present two cases of viral hepatitis ...

  3. Autophagy in Hepatic Fibrosis

    Directory of Open Access Journals (Sweden)

    Yang Song


    Full Text Available Hepatic fibrosis is a leading cause of morbidity and mortality worldwide. Hepatic fibrosis is usually associated with chronic liver diseases caused by infection, drugs, metabolic disorders, or autoimmune imbalances. Effective clinical therapies are still lacking. Autophagy is a cellular process that degrades damaged organelles or protein aggregation, which participates in many pathological processes including liver diseases. Autophagy participates in hepatic fibrosis by activating hepatic stellate cells and may participate as well through influencing other fibrogenic cells. Besides that, autophagy can induce some liver diseases to develop while it may play a protective role in hepatocellular abnormal aggregates related liver diseases and reduces fibrosis. With a better understanding of the potential effects of autophagy on hepatic fibrosis, targeting autophagy might be a novel therapeutic strategy for hepatic fibrosis in the near future.

  4. Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection. (United States)

    Barkhoudarian, Garni; Cutler, Aaron R; Yost, Sam; Lobo, Bjorn; Eisenberg, Amalia; Kelly, Daniel F


    With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis. Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group. Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

  5. Hepatitis isquémica Ischemic hepatitis

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    Marcos Amuchástegui (h


    Full Text Available La hepatitis isquémica es una complicación sumamente infrecuente de cirugía cardiovascular. Las biopsias muestran necrosis centrolobulillar. El término de "hepatitis" fue propuesto debido al aumento de transaminasas similar a aquellas de origen infeccioso, e "isquémica" por falla en la perfusión hepática. Posteriormente se definió el término de hepatitis isquémica como cuadro de elevación aguda y reversible (dentro de las 72 horas de transaminasas de hasta 20 veces el valor normal, asociado a trastornos en la perfusión hepática, luego de haber excluido otras causas de hepatitis aguda o daño hepatocelular. Se describe el caso de un paciente de 53 años que consulta por dolor epigástrico de 12 h de evolución sin fiebre, náuseas ni vómitos, resistente a la medicación. Tenía antecedentes inmediatos de reemplazo de válvula aórtica, y estaba anticoagulado. Evolucionó con shock y fallo multiorgánico. El examen evidenció marcada ictericia y signos de taponamiento pericárdico, asociado a un aumento considerable de enzimas hepáticas. Un ecocardiograma informó signos de taponamiento cardíaco y ausencia de disección aórtica. Se decidió pericardiocentesis, extrayéndose 970 cc. de líquido sanguinolento, y hemodiálisis, con notable mejoría de su estado hemodinámico. Los valores enzimáticos disminuyeron. Los marcadores virales fueron negativos.Ischemic hepatitis is an uncommon cardiovascular surgery complication. Hepatic biopsies show centrolobulillar necrosis. The term "hepatitis" was proposed because of a raise in hepatic enzymes similar with infectious disease, and "ischemic" because of failure in hepatic perfusion. Ischemic hepatitis was then defined as an acute and reversible elevation of hepatic enzymes (within 72 h, associated with disturbance in hepatic perfusion after excluding other causes of acute hepatitis. A 53 year-old male presented complaining of a 12 h epigastric pain, without nausea or vomiting, resistant

  6. Hepatitis E Virus

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    Christina Levick


    Full Text Available Hepatitis E virus (HEV is the most common cause of acute viral hepatitis in the developing world. It is a waterborne virus that can cause epidemics in the face of overcrowding and poor sanitation. Although the hepatitis illness is usually self-limiting, it has a high mortality in pregnant women and can become a chronic infection in the immunosuppressed. Treatment is mostly supportive and prevention is by good water hygiene.

  7. Thoracic wall reconstruction after tumor resection

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    Kamran eHarati


    Full Text Available Introduction: Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft tissue reconstruction of the thoracic wall improves life quality and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Material und methods: This article is based on a review of the current literature and the evaluation of a patient database.Results: Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft tissue defects after tumor resection can be covered by local, pedicled or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the life quality of these patients. Discussion: In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, stadium plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve

  8. Use of Amiodarone after Major Lung Resection (United States)

    Berry, Mark F.; D’Amico, Thomas A.; Onaitis, Mark W.


    BACKGROUND We evaluated the association of respiratory complications and amiodarone use in patients with atrial fibrillation (AF) after major lung resection. METHODS Outcomes of patients who had postoperative AF treated with or without amiodarone after lobectomy, bilobectomy, or pneumonectomy at a single institution between 2003 and 2010 were evaluated using multivariable logistic modeling. RESULTS Of 1412 patients who underwent lobectomy, bilobectomy, or pneumonectomy, AF occurred in 232 (16%). AF developed after a respiratory complication in 31 patients, who were excluded from subsequent analysis. The remaining 201 patients that had AF without an antecedent respiratory complication had similar mortality (3.0% [6/201] versus 2.5% [30 /1180], p=0.6) and respiratory morbidity (10% [20/201] versus 9% [101/1180], p=0.5) but longer hospital stays (5 [4,7] versus 4 days [3,6], pAmiodarone was used in 101 (50%) of these 201 patients, including 5 patients who had a pneumonectomy. Age, pulmonary function, and operative resection were similar between the patients treated with/without amiodarone. Amiodarone use was not associated with a significant difference in the incidence of subsequent respiratory complications [12% (12/101 amiodarone patients) versus 8% (8/100 non-amiodarone patients), p=0.5)]. CONCLUSIONS AF that occurs without an antecedent respiratory complication in patients after major lung resection results in longer hospital stay but not increased mortality or respiratory morbidity. Using amiodarone to treat atrial fibrillation after major lung resection is not associated with an increased incidence of respiratory complications. PMID:25106684

  9. Painful Spastic Hip Dislocation: Proximal Femoral Resection


    Albiñana, Javier; Gonzalez-Moran, Gaspar


    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despit...

  10. Neuropraxia following resection of a retroperitoneal liposarcoma

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    Stevenson Tsiao


    Discussion: The patient required only physical therapy and oral prednisone following surgery for treatment of the neuropraxia. She responded well and has regained significant neuromotor function of the affected limb. Cases presenting with post-resection neurological sequelae without any known intraoperative nerve injury may respond very well to conservative treatment. Hence, it is very important to collaborate with Neurology and Physical Therapy to achieve best possible outcome.

  11. Neuropraxia following resection of a retroperitoneal liposarcoma. (United States)

    Tsiao, Stevenson; Aydin, Nail; Misra, Subhasis


    This is a unique case of neuropraxia of femoral nerve seen after resection of retroperitoneal liposarcoma which has not been reported before in the literature. Neuropraxia, a transient paralysis due to blockage of nerve conduction, commonly associated with athletes and orthopedic procedures, has not been previously reported as a complication following resection of retroperitoneal sarcoma. This is an 81-year-old female who, on CT for evaluation of her atherosclerosis, was found to have an incidental right-sided retroperitoneal mass extending from the right renal capsule inferiorly through the inguinal canal. At this point, the patient reported mild right sided abdominal pain and right lower back pain, but reported no neuromotor deficits of the right lower extremity. Given the symptoms of the patient as well as the size, location and the density of the lesion, surgical intervention was pursued. On exploration, the lipomatous lesion, suggestive of liposarcoma, was invading the right genitofemoral nerve and ilioinguinal nerve which were sacrificed to ensure a complete oncologic resection. Following complete removal of the mass, she developed right side femoral nerve neuropraxia, suffering complete loss of motor function in the femoral distribution. Pathology revealed the mass to be a low grade liposarcoma. The patient required only physical therapy and oral prednisone following surgery for treatment of the neuropraxia. She responded well and has regained significant neuromotor function of the affected limb. Cases presenting with post-resection neurological sequelae without any known intraoperative nerve injury may respond very well to conservative treatment. Hence, it is very important to collaborate with Neurology and Physical Therapy to achieve best possible outcome. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. Van Nes rotationplasty with segmental limb resection. (United States)

    Krajbich, J I; Carroll, N C


    Segmental limb resection is becoming a practical alternative to limb ablation in tumor surgery. The addition of Van Nes rotationplasty to provide a pseudo knee joint has been found to be a practical, functional addition facilitating prosthesis use. This procedure has now been used successfully in 21 children with malignant neoplasms, with few complications. The surgical technique, as outlined, produces significantly improved functional results over an above-knee amputation or hip disarticulation.

  13. Preventing hepatitis B or C (United States)

    ... page: // Preventing hepatitis B or C To use the sharing features on this page, please enable JavaScript. Hepatitis B and hepatitis C infections cause irritation and ...

  14. Laparoscopic caecal wedge resection with intraoperative endoscopic assistance. (United States)

    Giavarini, Luisa; Boni, Luigi; Cortellezzi, Camillo Claudio; Segato, Sergio; Cassinotti, Elisa; Rausei, Stefano; Dionigi, Gianlorenzo; Rovera, Francesca; Marzorati, Alessandro; Spampatti, Sebastiano; Sambucci, Daniele; Dionigi, Renzo


    Cancer is a potential evolution of adenomatous polyps, that is why nowadays screening programs for colorectal cancer are widely diffused. Colonoscopy is the gold standard procedure for identifying and resecting polyps; however, for some polyps resection during colonoscopy is not possible. The aim of the present study is to identify a fast and safe procedure for endoscopically resecting unresectable polyps. Patients with endoscopically unresectable polyps were scheduled for laparoscopic wedge resection under colonoscopic assistance. From November 2010 to November 2012 we treated 15 patients with endoscopically unresectable adenomatous polyps. All patients underwent a laparoscopic caecal wedge resection with intraoperative endoscopic assistance. All procedures were completed without complications and in all cases complete resection of the polyps was achieved. Laparoscopic wedge caecal resection with intraoperative colonoscopy is a fast and safe procedure that can be performed for large polyps that could not be treated endoscopically. Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd. All rights reserved.

  15. Resection of pancreatic cancer in Europe and USA

    DEFF Research Database (Denmark)

    Huang, Lei; Jansen, Lina; Balavarca, Yesilda


    OBJECTIVE: Resection can potentially cure resectable pancreatic cancer (PaC) and significantly prolong survival in some patients. This large-scale international study aimed to investigate variations in resection for PaC in Europe and USA and determinants for its utilisation. DESIGN: Data from six...... European population-based cancer registries and the US Surveillance, Epidemiology, and End Results Program database during 2003-2016 were analysed. Age-standardised resection rates for overall and stage I-II PaCs were computed. Associations between resection and demographic and clinical parameters were...... performance status, tumour location and size were also associated with resection application. CONCLUSION: Rates of PaC resection remain low in Europe and USA with great international variations. Further studies are warranted to explore reasons for these variations....

  16. Mesenchymal stem cells correct haemodynamic dysfunction associated with liver injury after extended resection in a pig model. (United States)

    Tautenhahn, Hans-Michael; Brückner, Sandra; Uder, Christiane; Erler, Silvio; Hempel, Madlen; von Bergen, Martin; Brach, Janine; Winkler, Sandra; Pankow, Franziska; Gittel, Claudia; Baunack, Manja; Lange, Undine; Broschewitz, Johannes; Dollinger, Matthias; Bartels, Michael; Pietsch, Uta; Amann, Kerstin; Christ, Bruno


    In patients, acute kidney injury (AKI) is often due to haemodynamic impairment associated with hepatic decompensation following extended liver surgery. Mesenchymal stem cells (MSCs) supported tissue protection in a variety of acute and chronic diseases, and might hence ameliorate AKI induced by extended liver resection. Here, 70% liver resection was performed in male pigs. MSCs were infused through a central venous catheter and haemodynamic parameters as well as markers of acute kidney damage were monitored under intensive care conditions for 24 h post-surgery. Cytokine profiles were established to anticipate the MSCs' potential mode of action. After extended liver resection, hyperdynamic circulation, associated with hyponatraemia, hyperkalaemia, an increase in serum aldosterone and low urine production developed. These signs of hepatorenal dysfunction and haemodynamic impairment were corrected by MSC treatment. MSCs elevated PDGF levels in the serum, possibly contributing to circulatory homeostasis. Another 14 cytokines were increased in the kidney, most of which are known to support tissue regeneration. In conclusion, MSCs supported kidney and liver function after extended liver resection. They probably acted through paracrine mechanisms improving haemodynamics and tissue homeostasis. They might thus provide a promising strategy to prevent acute kidney injury in the context of post-surgery acute liver failure.

  17. Extension Large Colon Resection in 12 Horses (United States)

    Arighi, Mimi; Ducharme, Norman G.; Horney, F. Donald.; Livesey, Michael A.


    Extensive resection (50-75%) of the large colon was performed in 12 horses. Indications for resection were: loss of viability due to large colon volvulus (seven), thromboembolic episode (three), impairment of flow of ingesta due to adhesions (one), or congenital abnormalities (one). The time required to correct the primary cause of abdominal pain and complete the resection ranged from 2.5 to 4.75 hours. Three horses had severe musculoskeletal problems postoperatively and were euthanized in the recovery stall. Four other horses were euthanized early in the postoperative period because of: further large colon infarction (two), ileus (one), or small intestinal problems (one). Five horses survived with no apparent nutritional or metabolic problems during two to three weeks of hospitalization. Clinical data were obtained from these horses from nine months to eighteen months postoperatively and revealed no clinical or clinicopathological abnormalities in four of them; the fifth horse exhibited diarrhea and weight loss four months postoperatively but responded to diet change. PMID:17422768

  18. [Resection of intracardiac myxoma. Case report]. (United States)

    Carmona-Delgado, Víctor Manuel; Deloya-Maldonado, Angélica María; Carranza-Bernal, María Lourdes; Hinojosa-Pérez, Arturo; Farías-Mayene, Leobardo


    Myxomas are the most common benign cardiac tumors, which are considered emergency surgery. The resection should not be delayed because 8-9% of affected patients may die due to intracardiac blood flow obstruction. We presente a clinical case of a 47 year old female, history of dyslipidemia. Disease starts with retrosternal oppression feeling, dyspnea on moderate exercise, dizziness, pain in joints hands. Arrhytmic heart sounds, diastolic mitral murmur II/IV, breth sounds present, no lymph. Laboratory: hemoglobin 11.0, leucocyte 9000, glucose 96 mg/dL, chest RX medium arch prominence cardiac silhouette. ECO transthoracic LVEF 60 %, with left atrial intracardiac tumor 13x11 cm, pedicle fixed the interatrial septum, the mitral valve bulges, with mild mitral valve. Half sternotomy is performed intracardiac tumor resection, pericardial placement interatrial with extracorporeal circulation support 65', aortic clamping time of 40'. Intracardiac tumor surgical findings interatrial septum fixed to left side, pedicle, rounded, yellow, multiloculated, soft, 13x10 cm in diameter. Histopathological diagnosis cardiac myxoma. We conclude that the tumor resection was carried in a timely manner with satisfactory evolution.

  19. Postoperative Acute Pulmonary Embolism Following Pulmonary Resections (United States)

    Shonyela, Felix Samuel; Liu, Bo; Jiao, Jia


    Postoperative acute pulmonary embolism after pulmonary resections is highly fatal complication. Many literatures have documented cancer to be the highest risk factor for acute pulmonary embolism after pulmonary resections. Early diagnosis of acute pulmonary embolism is highly recommended and computed tomographic pulmonary angiography is the gold standard in diagnosis of acute pulmonary embolism. Anticoagulants and thrombolytic therapy have shown a great success in treatment of acute pulmonary embolism. Surgical therapies (embolectomy and inferior vena cava filter replacement) proved to be lifesaving but many literatures favored medical therapy as the first choice. Prophylaxis pre and post operation is highly recommended, because there were statistical significant results in different studies which supported the use of prophylaxis in prevention of acute pulmonary embolism. Having reviewed satisfactory number of literatures, it is suggested that thoroughly preoperative assessment of patient conditions, determining their risk factors complicating to pulmonary embolism and the use of appropriate prophylaxis measures are the key options to the successful minimization or eradication of acute pulmonary embolism after lung resections. PMID:26354232

  20. Sarcopenia Adversely Impacts Postoperative Complications Following Resection or Transplantation in Patients with Primary Liver Tumors (United States)

    Valero, Vicente; Amini, Neda; Spolverato, Gaya; Weiss, Matthew J.; Hirose, Kenzo; Dagher, Nabil N.; Wolfgang, Christopher L.; Cameron, Andrew A.; Philosophe, Benjamin; Kamel, Ihab R.


    Background Sarcopenia is a surrogate marker of patient frailty that estimates the physiologic reserve of an individual patient. We sought to investigate the impact of sarcopenia on short- and long-term outcomes in patients having undergone surgical intervention for primary hepatic malignancies. Methods Ninety-six patients who underwent hepatic resection or liver transplantation for HCC or ICC at the John Hopkins Hospital between 2000 and 2013 met inclusion criteria. Sarcopenia was assessed by the measurement of total psoas major volume (TPV) and total psoas area (TPA). The impact of sarcopenia on perioperative complications and survival was assessed. Results Mean age was 61.9 years and most patients were men (61.4 %). Mean adjusted TPV was lower in women (23.3 cm3/m) versus men (34.9 cm3/m) (Psarcopenia. The incidence of a postoperative complication was 40.4 % among patients with sarcopenia versus 18.4 % among patients who did not have sarcopenia (P=0.01). Of note, all Clavien grade ≥3 complications (n=11, 23.4 %) occurred in the sarcopenic group. On multivariable analysis, the presence of sarcopenia was an independent predictive factor of postoperative complications (OR=3.06). Sarcopenia was not associated with long-term survival (HR=1.23; P=0.51). Conclusions Sarcopenia, as assessed by TPV, was an independent factor predictive of postoperative complications following surgical intervention for primary hepatic malignancies. PMID:25389056

  1. Comparison of the collagen haemostat Sangustop® versus a carrier-bound fibrin sealant during liver resection; ESSCALIVER-Study

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    Hoexter Godehard


    Full Text Available Abstract Background Haemostasis in liver surgery remains a challenge despite improved resection techniques. Oozing from blood vessels too small to be ligated necessitate a treatment with haemostats in order to prevent complications attributed to bleeding. There is good evidence from randomised trials for the efficacy of fibrin sealants, on their own or in combination with a carrier material. A new haemostatic device is Sangustop®. It is a collagen based material without any coagulation factors. Pre-clinical data for Sangustop® showed superior haemostatic effect. This present study aims to show that in the clinical situation Sangustop® is not inferior to a carrier-bound fibrin sealant (Tachosil® as a haemostatic treatment in hepatic resection. Methods/Design This is a multi-centre, patient-blinded, intra-operatively randomised controlled trial. A total of 126 patients planned for an elective liver resection will be enrolled in eight surgical centres. The primary objective of this study is to show the non-inferiority of Sangustop® versus a carrier-bound fibrin sealant (Tachosil® in achieving haemostasis after hepatic resection. The surgical intervention is standardised with regard to devices and techniques used for resection and primary haemostasis. Patients will be followed-up for three months for complications and adverse events. Discussion This randomised controlled trial (ESSCALIVER aims to compare the new collagen haemostat Sangustop® with a carrier-bound fibrin sealant which can be seen as a "gold standard" in hepatic and other visceral organ surgery. If non-inferiority is shown other criteria than the haemostatic efficacy (e.g. costs, adverse events rate may be considered for the choice of the most appropriate treatment. Trial Registration NCT00918619

  2. Ressecões hepáticas por videolaparoscopia Current status of laparoscopic liver resections

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    Paulo Herman


    Full Text Available INTRODUÇÃO: As ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia videolaparoscópica. Apesar da complexidade do procedimento, da demanda de grande incorporação de tecnologia e necessidade de experiência em cirurgia hepática e laparoscópica, a indicação do método tem crescido de forma expressiva nos últimos anos. OBJETIVO: Realizar análise crítica do método, baseada nos trabalhos existentes na literatura, ressaltando o estado atual de suas indicações, exequibilidade, segurança, resultados e aspectos técnicos primordiais. MÉTODO: Foram identificados e analisados os trabalhos pertinentes nas bases de dados LILACS e PUBMED até dezembro de 2009, utilizando-se os descritores "liver resection", "laparoscopic" e "liver surgery". Não foram encontrados trabalhos prospectivos e randomizados sobre o tema, sendo os dados disponíveis provenientes de série de casos, estudos caso-controle e alguns estudos multicêntricos e metanálises. CONCLUSÃO: A hepatectomia por videolaparoscopia é hoje operação segura e factível, mesmo para as ressecções hepáticas maiores, com baixo índice de morbimortalidade. O método pode ser utilizado para lesões malignas sem prejuízo dos princípios oncológicos e com vantagens nos pacientes com cirrose ou disfunção hepática. A melhor indicação recai sobre as lesões benignas, em especial o adenoma hepatocelular. Em mãos experientes e casos selecionados, como as lesões benignas localizadas nos segmentos anterolaterais hepáticos, principalmente no segmento lateral esquerdo, a ressecção videolaparoscópica pode ser considerada hoje como tratamento padrão.INTRODUCTION: Hepatic resection is the last frontier to be surpassed by laparoscopic surgery. Although a highly complex procedure, the need of advanced technology and experience in both laparoscopic and hepatic surgery, the indications and number of cases done worldwide had a major growth in the last few

  3. Minimally invasive treatment of hepatic adenoma in special cases

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    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Odisio, Bruno Calazans [MD Anderson Cancer Center, Houston (United States); Garcia, Rodrigo Gobbo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)


    Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

  4. Hepatitis C: Information on Testing and Diagnosis (United States)

    HEPATITIS C Information on Testing & Diagnosis What is Hepatitis C? Hepatitis C is a serious liver disease that results from infection with the Hepatitis C virus. Hepatitis C has been called a silent ...

  5. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. (United States)

    Hurlstone, D P; Sanders, D S; Cross, S S; Adam, I; Shorthouse, A J; Brown, S; Drew, K; Lobo, A J


    Lateral spreading tumours are superficial spreading neoplasms now increasingly diagnosed using chromoscopic colonoscopy. The clinicopathological features and safety of endoscopic mucosal resection for lateral spreading tumours (G-type "aggregate" and F-type "flat") has yet to be clarified in Western cohorts. Eighty two patients underwent magnification chromoscopic colonoscopy using the Olympus CF240Z by a single endoscopist. All patients had received a previous colonoscopy where an endoscopic diagnosis of lateral spreading tumour was made. All lesions were examined initially using indigo carmine chromoscopy to delineate contour followed by crystal violet for magnification crypt pattern analysis. A 20 MHz "mini probe" ultrasound was used if T2 disease was suspected. Following endoscopic mucosal resection, patients were followed up at 3, 6, 12, and 24 months using total colonoscopy. Eighty two lateral spreading tumours were diagnosed in 80 patients (32% (26/82) F-type and 68% (56/82) G-type). G-type lesions were larger than F-type (G-type mean 42 (SD 14) mm v F-type 24 (6.4) mm; plateral spreading tumours using endoscopic mucosal resection at two years of follow-up was 96% (56/58). Endoscopic mucosal resection for lateral spreading tumours, staged as T1, is a safe and effective treatment despite their large size. Endoscopic mucosal resection may be an alternative to surgery in selected patients.

  6. The effect of some endogenic substances contained in the cortical parenchyma of apple trees on growth in vitro of the fungus Phytophthora cactorum (Leb. of Cohn Schroeter

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    A. Bielenin


    Full Text Available Gel filtration of an alkaline extract of the cortical parenchyma yielded four fractions of which two had activity in vitro on the growth of Phytophthora cactorum. Fraction I was stimulatory and fraction IV inhibitory; one of the inhibitors in fraction IV was identified as phloridzin. When the extraction solvent contained sodium sulphite in addition to sodium hydroxide, fraction II showed inhibitory activity.

  7. Distal splenorenal shunt with partial spleen resection

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    Gajin Predrag


    Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt (Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. Objective. The aim of our study was to present the advantages of distal splenorenal shunt (Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. Method. From 1995 to 2003, 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients (11 male, mean age 42.3 years who were treated by distal splenorenal shunt with partial spleen resection. The second group consisted of 21 patients (13 male, mean age 49.4 years that were treated by distal splenorenal shunt only. All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Results In the first group, only one patient had splenomegaly postoperatively (5%, while in the second group there were 13 patients with splenomegaly (68%. Before surgery, the mean platelet count in the first group was 51.6±18.3x109/l, to 118.6±25.4x109/l postoperatively. The mean platelet count in the second group was 67.6±22.8x109/l, to 87.8±32.1x109/l postoperatively. Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group (p<0.05. Comparing the

  8. Hepatic abscess: Diagnosis and management. (United States)

    Lardière-Deguelte, S; Ragot, E; Amroun, K; Piardi, T; Dokmak, S; Bruno, O; Appere, F; Sibert, A; Hoeffel, C; Sommacale, D; Kianmanesh, R


    Microbial contamination of the liver parenchyma leading to hepatic abscess (HA) can occur via the bile ducts or vessels (arterial or portal) or directly, by contiguity. Infection is usually bacterial, sometimes parasitic, or very rarely fungal. In the Western world, bacterial (pyogenic) HA is most prevalent; the mortality is high approaching 15%, due mostly to patient debilitation and persistence of the underlying cause. In South-East Asia and Africa, amebic infection is the most frequent cause. The etiologies of HA are multiple including lithiasic biliary disease (cholecystitis, cholangitis), intra-abdominal collections (appendicitis, sigmoid diverticulitis, Crohn's disease), and bile duct ischemia secondary to pancreatoduodenectomy, liver transplantation, interventional techniques (radio-frequency ablation, intra-arterial chemo-embolization), and/or liver trauma. More rarely, HA occurs in the wake of septicemia either on healthy or preexisting liver diseases (biliary cysts, hydatid cyst, cystic or necrotic metastases). The incidence of HA secondary to Klebsiella pneumoniae is increasing and can give rise to other distant septic metastases. The diagnosis of HA depends mainly on imaging (sonography and/or CT scan), with confirmation by needle aspiration for bacteriology studies. The therapeutic strategy consists of bactericidal antibiotics, adapted to the germs, sometimes in combination with percutaneous or surgical drainage, and control of the primary source. The presence of bile in the aspirate or drainage fluid attests to communication with the biliary tree and calls for biliary MRI looking for obstruction. When faced with HA, the attending physician should seek advice from a multi-specialty team including an interventional radiologist, a hepatobiliary surgeon and an infectious disease specialist. This should help to determine the origin and mechanisms responsible for the abscess, and to then propose the best appropriate treatment. The presence of chronic

  9. MR imaging of hepatic hemangiomas of infancy and changes seen with interferon alpha-2a treatment

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    Chung, T. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States); Hoffer, F.A. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States); Burrows, P.E. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States); Paltiel, H.J. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States)


    The purpose of this study was to describe the appearance on magnetic resonance (MR) imaging of hepatic hemangioma, and how the appearance changes in infants who have received interferon alpha-2a (IFN) treatment. We retrospectively studied 16 MR examinations in seven infants (mean age 3.2 months; range 5 days to 13 months) who were symptomatic with hepatic hemangiomas. Five of these seven patients had MR examinations both before and after treatment with IFN. In six of the seven patients, the hepatic hemangiomas were multicentric; they were usually discrete, well-defined nodules, best seen on T2-weighted images as high intensity lesions. One patient had a large solitary heterogeneous lesion. They all exhibited fast flow (seen as flow voids on spin-echo images and high signal intensity structures on gradient-recalled echo images) and enlarged hepatic arteries and veins. There was enlargement of the proximal abdominal aorta with distal tapering. Treatment was followed by accelerated regression of the hemangiomas in size and number and variable shrinkage of the enlarged vessels. As the tumor nodules regressed, they were replaced by normal-appearing hepatic parenchyma; neither fat nor fibrosis was detected by MR imaging. (orig.). With 4 figs., 1 tab.

  10. Review of outcomes of primary liver cancers in children: our institutional experience with resection and transplantation. (United States)

    Malek, Marcus M; Shah, Sohail R; Atri, Prashant; Paredes, Jose L; DiCicco, Leigh Anne; Sindhi, Rakesh; Soltys, Kyle A; Mazariegos, George V; Kane, Timothy D


    Operative intervention plays an important role in the management of primary liver cancers in children. Recent improvements in diagnostic modalities, pre- and postoperative chemotherapy, and operative technique have all led to improved survival in these patients. Both hepatic resection and orthotopic liver transplantation are effective operations for pediatric liver tumors; which intervention is pursued is based on preoperative extent of disease. This is a review of our institution's experience with operative management of pediatric liver cancer over an 18-year period. A retrospective chart review from 1990 to 2007 identified patients who were ≤18 years old who underwent operative intervention for primary liver cancer. Demographics, type of operation, intraoperative details, pre- and postoperative management, as well as outcomes were recorded for all patients. Fifty-four patients underwent 57 operations for primary liver cancer, 30 of whom underwent resection; the remaining 27 underwent orthotopic liver transplantation. The mean age at diagnosis was 41 months. Twenty patients had stage 1 or 2 disease and 34 patients had stage 3 or 4 disease. Forty-eight (89%) patients received preoperative chemotherapy. Postoperative chemotherapy was given to 92% of patients. Mean overall and intensive care unit duration of stay were 18 and 6 days, respectively. About 45% of patients had a postoperative complication, including hepatic artery thrombosis (n = 8), line sepsis (n = 6), mild acute rejection (n = 3), biliary stricture (n = 2), pneumothorax (n = 2), incarcerated omentum (n = 1), Horner's syndrome (n = 1), and urosepsis (n = 1). Only 6 patients had a recurrence of their cancer, 5 after liver resection, 3 of whom later received a transplant. There was only 1 recurrence after liver transplantation. There was 1 perioperative mortality from cardiac arrest. Overall survival was 93%. Operative intervention plays a critical role in the management of primary liver cancer in the

  11. Modified Levator Muscle Resection Using Putterman Muller's Muscle-Conjunctival Resection-Ptosis Clamp. (United States)

    Yang, Ju-Wen


    The traditional technique for levator muscle resection includes a time-consuming dissection procedure that causes tissue trauma and swelling. The Putterman ptosis clamp has been popularly used in recent years for conjunctival müllerectomy. In this paper, we describe a modified surgical technique for ptosis treatment using the Putterman ptosis clamp. The modified technique improves the surgical results of levator muscle resection. We performed a retrospective case-series study to determine the outcomes and complications associated with the use of the Putterman ptosis clamp in levator muscle resection. Adults aged ≥18 years with moderate-to-severe ptosis underwent the modified technique for levator muscle resection. We first performed dissection to expose the aponeurosis and tarsus. Then, we placed the Putterman ptosis clamp to measure redundant aponeurotic and septal tissues and to perform the resection. Following the adjustment of the eyelid fissure, we refixed the levator muscle to the tarsus with 4-0 vicryl stitches. Seventeen patients (34 eyes) were included in the study. Of the 34 eyes, 31 (91.2%) experienced the complete resolution of ptosis after the surgery. One patient (2 eyes, 5.9%) had mild bilateral dermatochalasis and received revision surgery 6 months postoperative. One patient (1 eye, 2.9%) lost the crease of the left eye and received revision surgeries 2 and 6 months after the first surgery. No residual ptosis or severe adverse events were noted in the patients. Modified levator muscle resection using the Putterman ptosis clamp is an effective procedure for ptosis treatment. 4.

  12. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate

    Directory of Open Access Journals (Sweden)

    Guan Hee Tan


    Full Text Available Purpose: This study aimed to determine the urethral stricture (US rate and identify clinical and surgical risk factors associated with US occurrence after transurethral resection of the prostate using the bipolar Gyrus PlasmaKinetic Tissue Management System (PKTURP. Materials and Methods: This was an age-matched case-control study of US occurrence after PK-TURP. Retrospective data were collected from the hospital records of patients who had a minimum of 36 months of follow-up information. Among the data collected for analysis were prostate-specific antigen level, estimated prostate weight, the amount of prostate resected, operative time, history of urinary tract infection, previous transurethral resection of the prostate, and whether the PK-TURP was combined with other endourological procedures. The resection rate was calculated from the collected data. Univariate and multivariate analyses were performed to identify clinical and surgical risk factors related to US formation. Results: A total of 373 patients underwent PK-TURP between 2003 and 2009. There were 13 cases of US (3.5%, and most of them (10 of 13, 76.9% presented within 24 months of surgery. Most of the US cases (11 of 13, 84.6% occurred at the bulbar urethra. Multivariable logistic regression analyses identified slow resection rate as the only risk factor significantly associated with US occurrence. Conclusions: The US rate of 3.5% after PK-TURP in this study is comparable to contemporary series. A slow resection rate seems to be related to US occurrence. This should be confirmed by further studies; meanwhile, we must be mindful of this possibility when operating with the PK-TURP system.

  13. Echo-time and field strength dependence of BOLD reactivity in veins and parenchyma using flow-normalized hypercapnic manipulation.

    Directory of Open Access Journals (Sweden)

    Christina Triantafyllou

    Full Text Available While the BOLD (Blood Oxygenation Level Dependent contrast mechanism has demonstrated excellent sensitivity to neuronal activation, its specificity with regards to differentiating vascular and parenchymal responses has been an area of ongoing concern. By inducing a global increase in Cerebral Blood Flow (CBF, we examined the effect of magnetic field strength and echo-time (TE on the gradient-echo BOLD response in areas of cortical gray matter and in resolvable veins. In order to define a quantitative index of BOLD reactivity, we measured the percent BOLD response per unit fractional change in global gray matter CBF induced by inhaling carbon dioxide (CO(2. By normalizing the BOLD response to the underlying CBF change and determining the BOLD response as a function of TE, we calculated the change in R(2(* (ΔR(2(* per unit fractional flow change; the Flow Relaxation Coefficient, (FRC for 3T and 1.5T in parenchymal and large vein compartments. The FRC in parenchymal voxels was 1.76±0.54 fold higher at 3T than at 1.5T and was 2.96±0.66 and 3.12±0.76 fold higher for veins than parenchyma at 1.5T and 3T respectively, showing a quantitative measure of the increase in specificity to parenchymal sources at 3T compared to 1.5T. Additionally, the results allow optimization of the TE to prioritize either maximum parenchymal BOLD response or maximum parenchymal specificity. Parenchymal signals peaked at TE values of 62.0±11.5 ms and 41.5±7.5 ms for 1.5T and 3T, respectively, while the response in the major veins peaked at shorter TE values; 41.0±6.9 ms and 21.5±1.0 ms for 1.5T and 3T. These experiments showed that at 3T, the BOLD CNR in parenchymal voxels exceeded that of 1.5T by a factor of 1.9±0.4 at the optimal TE for each field.

  14. Hepatitis E og graviditet

    DEFF Research Database (Denmark)

    Mannheimer, Ebba Elisabeth; Harritshøj, Lene Holm; Katzenstein, Terese Lea


    Hepatitis E virus (HEV) infection among pregnant women is severe, often leading to fulminant hepatic failure and death, with mortality rates up to 15-25%. Studies suggest that differences in genotypes/subgenotypes, hormonal and immunological changes during pregnancy may contribute to the severe...

  15. hy viral hepatitis?

    African Journals Online (AJOL)

    randomized, controlled trial of interferon alfa-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B. The Hepatitis Interventional. Therapy Group. N Engl J Med 1990; 323: 295-301. 14. Ncayiyana DJ. Coming to grips with the future of health care - the ANC National. Health Plan. 5 Air Med J 1994; ...

  16. Cytomegalovirus Hepatitis During Pregnancy

    Directory of Open Access Journals (Sweden)

    Ying Chan


    Full Text Available Background: Although cytomegalovirus (CMV is an uncommon cause of viral hepatitis during pregnancy, a definitive diagnosis is important because of the potential for congenital CMV. In the case reported here, a diagnosis of hepatitis caused by CMV was made after the more common viral pathogens had been ruled out.

  17. Hepatitis - Multiple Languages (United States)

    ... URL of this page: Other topics A-Z Expand Section A B C D E F G H I J K L M N O P Q R S T U V W XYZ List of All Topics All Hepatitis - Multiple Languages To use the sharing features on ...

  18. Hepatitis B Test (United States)

    ... for IV drug use or through unprotected sex. People who live in or travel to areas of the world where hepatitis B ... patients, people with chronic liver or kidney disease , people with ... drug treatment, and those who travel to countries where hepatitis B is common. Unless ...

  19. Hepatitis C and Incarceration (United States)

    ... Hepatitis C virus can be spread when tattoo, body art, or piercing equipment has tiny amounts of blood on it. Many people get tattoos, piercings, or other marks ... if the Hepatitis C virus is still in the body. If this test is positive, it means a ...

  20. Pentoxifylline for alcoholic hepatitis

    DEFF Research Database (Denmark)

    Whitfield, Kate; Rambaldi, Andrea; Wetterslev, Jørn


    BACKGROUND: Alcoholic hepatitis is a life-threatening disease, with an average mortality of approximately 40%. There is no widely accepted, effective treatment for alcoholic hepatitis. Pentoxifylline is used to treat alcoholic hepatitis, but there has been no systematic review to assess its effects....... OBJECTIVES: To assess the benefits and harms of pentoxifylline in alcoholic hepatitis. SEARCH STRATEGY: The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, LILACS......,, and full text searches were conducted until August 2009. Manufacturers and authors were contacted. SELECTION CRITERIA: All randomised clinical trials of pentoxifylline in participants with alcoholic hepatitis compared to control were selected for inclusion. DATA COLLECTION AND ANALYSIS: Two...

  1. Serum Hepatitis C virus and hepatitis B surface antigenaemia in ...

    African Journals Online (AJOL)

    Summary. Acute hepatitis is common in Nigeria and hepatitis B virus (HBV) infection has been a major aetiological factor. However, the role of Hepatitis C Virus (HCV) infection is yet undetermined. Forty-five consecutive Nigerian patients with. Acute Icteric hepatitis (AIH) attending the Medical Clinic of the University College ...

  2. Sphinganine-1-phosphate attenuates both hepatic and renal injury induced by hepatic ischemia and reperfusion in mice. (United States)

    Park, Sang Won; Kim, Mihwa; Chen, Sean W C; D'Agati, Vivette D; Lee, H Thomas


    Hepatic ischemia/reperfusion (I/R) injury is a major complication after liver transplantation, major hepatic resection, or prolonged portal vein occlusion. Furthermore, acute kidney injury is frequent after hepatic I/R and greatly increases postoperative complications. Sphinganine-1-phosphate is a sphingolipid with uncharacterized physiological effects. We serendipitously determined that plasma levels of sphinganine-1-phosphate fell significantly after liver I/R in mice. In this study, we hypothesized that repletion of plasma sphinganine-1-phosphate would protect against liver and kidney injuries after liver I/R. C57BL/6 mice were subjected to 60 min of partial hepatic I/R and treated with either vehicle or with sphinganine-1-phosphate (given immediately before and 2 h after reperfusion). Vehicle-treated mice subjected to liver I/R developed acute liver and kidney injuries with elevated plasma alanine aminotransferase and creatinine 5 and 24 h after liver I/R. However, liver and kidney injuries were significantly attenuated with sphinganine-1-phosphate treatment. Sphinganine-1-phosphate markedly inhibited liver and kidney necrosis and apoptosis 24 h after liver I/R. Moreover, sphinganine-1-phosphate attenuated neutrophil infiltration, reduced plasma IL-6 and TNF-alpha upregulation, and preserved liver and kidney vascular integrity while reducing liver and kidney F-actin degradation after liver I/R. Finally, sphinganine-1-phosphate-mediated hepatic and renal protection was blocked by VPC23019, an antagonist for sphingosine-1-phosphate type 1 receptor. Therefore, sphinganine-1-phosphate improves acute liver and kidney injuries after hepatic I/R via sphingosine-1-phosphate type 1 receptor-mediated inhibition of necrosis and apoptosis and by improving vascular integrity. Harnessing the mechanisms of cytoprotection with sphinganine-1-phosphate activation may lead to new therapies for perioperative hepatic I/R injury and subsequent remote organ injury.

  3. Pulmonary resection for metastases of colorectal adenocarcinoma. (United States)

    Riquet, Marc; Foucault, Christophe; Cazes, Aurélie; Mitry, Emmanuel; Dujon, Antoine; Le Pimpec Barthes, Françoise; Médioni, Jacques; Rougier, Philippe


    Surgery is a safe and effective treatment for patients with lung metastases from colorectal carcinoma. Combining chemotherapy and surgery seems to prolong survival time after metastasectomy. Our purpose was to review the effectiveness of surgery with time and evolving managements. The records of 127 patients were retrospectively analyzed. The characteristics of primary cancer, lung metastases, resections, and associated therapy were studied according to their incidence on survival. There were 74 male and 53 female patients (mean age, 65 years); 223 operations were performed and 314 metastases were resected. Completeness of surgery (n = 117) was the main factor for prolonged survival (5- and 10-year survival, 41% and 27%, versus 0%). There was no factor of significantly better prognosis, but a tendency to higher survival rates was observed in cases of single metastasis, in patients undergoing several lung operations, and in patients in whom liver metastases were previously removed. Three of 7 patients with mediastinal lymph node involvement survived more than 5 years; 58 patients were operated on before January 2000, and 59 between January 2000 and December 2007. Five-year survival rates were 35.1% versus 63.5%, respectively (p = 0.0096), probably related to better selection with modern workup, more frequent use of chemotherapy, and repeated pulmonary resections. Different treatment protocols were reported in the literature and in our series with time, resulting in better survival rates and a more aggressive surgical tendency. The beneficial role of such combined therapy justifies further research, including prospective trials. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Paraneoplastic pemphigus regression after thymoma resection

    Directory of Open Access Journals (Sweden)

    Stergiou Eleni


    Full Text Available Abstract Background Among human neoplasms thymomas are associated with highest frequency with paraneoplastic autoimmune diseases. Case presentation A case of a 42-year-old woman with paraneoplastic pemphigus as the first manifestation of thymoma is reported. Transsternal complete thymoma resection achieved pemphigus regression. The clinical correlations between pemphigus and thymoma are presented. Conclusion Our case report provides further evidence for the important role of autoantibodies in the pathogenesis of paraneoplastic skin diseases in thymoma patients. It also documents the improvement of the associated pemphigus after radical treatment of the thymoma.

  5. [Resection margins in conservative breast cancer surgery]. (United States)

    Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián


    Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  6. Transrectal Mesh Erosion Requiring Bowel Resection. (United States)

    Kemp, Marta Maria; Slim, Karem; Rabischong, Benoît; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

    To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions. Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8]. A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence

  7. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer (United States)

    Kim, Sang Gyun


    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period. PMID:27435699

  8. New developments in hepatitis C

    NARCIS (Netherlands)

    Reesink, H. W.; Bresters, D.; van der Poel, C. L.; Cuypers, H. T.; Lelie, P. N.


    Since the detection of hepatitis B virus (HBV) in the 1960s and hepatitis A virus in the 1970s, a considerable proportion of infections of (probably viral) hepatitis could not be classified. About 90% of transfusion-related hepatitis was identified as non-A/non-B. In 1988 investigators from the

  9. Glucocorticosteroids for viral hepatitis C

    DEFF Research Database (Denmark)

    Brok, J; Mellerup, M T; Krogsgaard, K


    Hepatitis C virus may cause liver inflammation and fibrosis. It is not known whether glucocorticosteroids are beneficial or harmful for patients with hepatitis C infection.......Hepatitis C virus may cause liver inflammation and fibrosis. It is not known whether glucocorticosteroids are beneficial or harmful for patients with hepatitis C infection....

  10. Viral Hepatitis: Information for Gay and Bisexual Men (United States)

    VIRAL HEPATITIS Information for Gay and Bisexual Men What is viral hepatitis? Viral hepatitis is an infection of the liver caused by ... United States, the most common types of viral hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C. ...

  11. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection


    Hurlstone, D P; Sanders, D S; Cross, S S; Adam, I; Shorthouse, A J; Brown, S; Drew, K; Lobo, A J


    Background: Lateral spreading tumours are superficial spreading neoplasms now increasingly diagnosed using chromoscopic colonoscopy. The clinicopathological features and safety of endoscopic mucosal resection for lateral spreading tumours (G-type “aggregate” and F-type “flat”) has yet to be clarified in Western cohorts.

  12. Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: a single-center experience. (United States)

    Chan, Albert C Y; Poon, Ronnie T P; Cheung, Tan To; Chok, Kenneth S H; Dai, Wing Chiu; Chan, See Ching; Lo, Chung Mau


    Laparoscopic liver resection is associated with less perioperative blood loss, shorter hospital stay, and fewer postoperative complications in younger patients. However, it remains unclear if these short-term benefits could also be applicable to elderly patients with medical comorbidities. To evaluate the perioperative outcomes of laparoscopic liver resection in patients with advanced age. Patients aged ≥ 70 years old who received liver resections for malignant liver tumors between January 2002 and December 2012 were included. The perioperative outcomes of 17 patients with laparoscopic approach were matched and compared with 34 patients with conventional open approach in a 1:2 ratio. There was no significant difference with regard to age, gender, incidence of comorbid illness, hepatitis B positivity, and Child grading of liver function. The median tumor size was 3 cm for both groups. The types of liver resection were similar between the two groups with no significant difference in the duration of operation (laparoscopic: 195 min vs open: 210 min, P = 0.436). The perioperative blood loss was 150 mL in the laparoscopic group and 330 mL in the open group (P = 0.046) with no significant difference in the number of patients with blood transfusion. The duration of hospital stay was 6 days (3-15 days) for the laparoscopic group and 8 days (5-105 days) for the open group (P = 0.005). Laparoscopic liver resection is safe and feasible for elderly patients. The short-term benefits of laparoscopic approach continued to be evident for geriatric oncological liver surgery. © 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  13. A Case of Hypereosinophilia-Associated Multiple Mass Lesions of Liver Showing Non-Granulomatous Eosinophilic Hepatic Necrosis (United States)

    Ikeda, Hiroko; Katayanagi, Kazuyoshi; Kurumaya, Hiroshi; Harada, Kenichi; sato, Yasunori; Sasaki, Motoko; Nakanuma, Yasuni


    Hypereosinophilic syndrome (HES) is defined by elevation more than 1.5×109/L of presence of a peripheral blood count, evidence of organ involvement, and exclusion of secondary eosinophilia such as allergic, vasculitis, drugs, or parasite infection and also clonal eosinophilia. We present the HES case with hepatic involvement. The patient is 70-year-old male. He complained fever and back pain. Blood examination showed marked peripheral eosinophilia, elevation of transaminase and biliary enzymes. Multiple irregular mass lesions of the liver were pointed out by CT and MRI. The liver biopsy was done for differentiation from malignancy. In parenchyma, hepatic necrotic lesion was observed accompanying severe eosinophilic infiltration with Charcot-Leyden’s crystals. There was granulomatous reaction. He was diagnosed as HES and got recovery due to steroid therapy. From the review of HES article, the hepatic histology is categorized into four types as below: 1) cholangitis type; 2) chronic active hepatitis type; 3) vasculopathic type, 4) hepatic necrosis type. Our case is classified in hepatic necrosis type. This type seems to be important to distinguish malignant tumor and also visceral larva migrans by liver biopsy. PMID:27942335

  14. Ischemic preconditioning attenuates remote pulmonary inflammatory infiltration of diabetic rats with an intestinal and hepatic ischemia-reperfusion injury

    Directory of Open Access Journals (Sweden)

    Farid José Thomaz Neto


    Full Text Available PURPOSE: To assess ischemic preconditioning (IPC effects in pulmonary lesion in intestinal and hepatic ischemia-reperfusion (IR injury models using diabetic rats. METHODS: Diabetes (DM was induced in 28 male Wistar rats by alloxan (42 mg/kg, IV. After 28 days, severe DM rats were submitted to intestinal or hepatic IR injury with or without IPC. Intestinal IR (30 min of mesenteric artery occlusion and 30 min of reperfusion; n=6 and IPC groups (10 min ischemia, 10 min reperfusion, followed by intestinal IR; n=6, and Hepatic IR (30 min of hepatic pedicle occlusion and 30 min of reperfusion; n=5 and IPC groups (10 min ischemia, 10 min reperfusion, followed by hepatic IR; n=5, were compared to DM rats group (n=6. Plasmatic lactate, glycemia were measured before and after IR injury. Histomorphology of lung was performed counting inflammatory cells. Data was expressed in mean± SE. P<0.05. RESULTS: Glycemia and lactate were similar among groups. IPC did not interfere in these parameters. On histological evaluation, IR increased inflammatory cells infiltration in pulmonary parenchyma compared to control in both IR injury models. IPC attenuated inflammatory infiltration in lungs. CONCLUSION: Ischemic preconditioning protects against remote ischemia-reperfusion injury in lung on intestinal or hepatic ischemia-reperfusion model with acute diabetes.

  15. Local resection of the stomach for gastric cancer. (United States)

    Kinami, Shinichi; Funaki, Hiroshi; Fujita, Hideto; Nakano, Yasuharu; Ueda, Nobuhiko; Kosaka, Takeo


    The local resection of the stomach is an ideal method for preventing postoperative symptoms. There are various procedures for performing local resection, such as the laparoscopic lesion lifting method, non-touch lesion lifting method, endoscopic full-thickness resection, and laparoscopic endoscopic cooperative surgery. After the invention and widespread use of endoscopic submucosal dissection, local resection has become outdated as a curative surgical technique for gastric cancer. Nevertheless, local resection of the stomach in the treatment of gastric cancer in now expected to make a comeback with the clinical use of sentinel node navigation surgery. However, there are many issues associated with local resection for gastric cancer, other than the normal indications. These include gastric deformation, functional impairment, ensuring a safe surgical margin, the possibility of inducing peritoneal dissemination, and the associated increase in the risk of metachronous gastric cancer. In view of these issues, there is a tendency to regard local resection as an investigative treatment, to be applied only in carefully selected cases. The ideal model for local resection of the stomach for gastric cancer would be a combination of endoscopic full-thickness resection of the stomach using an ESD device and hand sutured closure using a laparoscope or a surgical robot, for achieving both oncological safety and preserved functions.

  16. Accelerated carcinogenesis following liver resection in chronically inflamed livers: A window of opportunity for treatment. (United States)

    Sonnenblick, Amir; Zahavi, Tamar


    The long-term prognosis following resection of hepatocellular carcinoma (HCC) remains unsatisfactory as a result of a high incidence of recurrence. Prevention of recurrence is the most important strategy to improve the long-term survival results. The role of hepatectomy itself, as an accelerator of carcinogenesis, has not been adequately evaluated in HCC patients. Studies in animal models have revealed a link between liver regeneration under chronic inflammation and hepatic tumorigenesis. Inhibiting different signal transduction pathways during liver regeneration without compromising the ability of the liver to regenerate appears to be a rational strategy and may decrease HCC development and recurrence. If this hypothesis is proven using animal models, this strategy could be evaluated in future clinical trials in humans.

  17. Smoldering medullary thyroid carcinoma liver metastasis 37 years after resection of an organ-confined tumor. (United States)

    Waters, Kevin M; Ali, Syed Z; Erozan, Yener S; Olson, Matthew T


    Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor that usually behaves aggressively. After resection, serological surveillance for calcitonin and carcinoembryonic antigen (CEA) is used to prompt a radiographic search for metastatic disease. We report a case of a 65-year-old woman who presented with a large liver metastasis 37 years after she underwent thyroidectomy for organ-confined MTC. Her clinical course over that time showed a smoldering pattern in which she was symptom free until presentation even though her serum calcitonin and CEA concentrations were elevated for 17 years, and a small equivocal radiographic lesion in the liver was detected 10 years prior to presentation. Cytopathology from an ultrasound guided fine needle aspiration of the hepatic lesion was diagnostic for metastatic MTC. This case highlights the ability for smoldering residual MTC to suddenly transform to aggressive biological behavior after a long period of clinical remission. © 2014 Wiley Periodicals, Inc.

  18. Laparoscopic versus Open Liver Resection: Differences in Intraoperative and Early Postoperative Outcome among Cirrhotic Patients with Hepatocellular Carcinoma—A Retrospective Observational Study

    Directory of Open Access Journals (Sweden)

    Antonio Siniscalchi


    Full Text Available Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients or laparotomy (LT group: 133 patients. Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.

  19. Cheledochal cyst resection and laparoscopic hepaticoduodenostomy

    Directory of Open Access Journals (Sweden)

    Jiménez Urueta Pedro Salvador


    Full Text Available Background. Choledochal cyst is a rare abnormality. Its esti- mated incidence is of 1:100,000 to 150,000 live births. Todani et al. in 1981 reported the main objection for performing a simpler procedure, i.e., hepaticoduodenostomy, has been the risk of an “ascending cholangitis”. This hazard, however, seems to be exaggerated. Methods: A laparoscopic procedure was performed in 8 consecutive patients with choledochal cyst between January 2010 and Septem- ber 2012; 6 females and 2 males mean age was 8 years. Results. Abdominal pain was the main symptom in everyone, jaundice in 1 patient and a palpable mass in 3 patients. Lapa- roscopic surgical treatment was complete resection of the cyst with cholecystectomy and hepaticoduodenostomy laparoscopy in every patient. Discussion and conclusion. A laparoscopic approach to chole- dochal cyst resection and hepaticoduodenostomy is feasible and safe. The hepaticoduodenal anastomosis may confer additional benefits over hepaticojejunostomy in the setting of a laparoscopic approach. The creation of a single anastomosis can decrease operative time and anesthetic exposure.

  20. Enhanced recovery after surgery in gastric resections. (United States)

    Bruna Esteban, Marcos; Vorwald, Peter; Ortega Lucea, Sonia; Ramírez Rodríguez, Jose Manuel


    Enhanced recovery after surgery is a modality of perioperative management with the purpose of improving results and providing a faster recovery of patients. This kind of protocol has been applied frequently in colorectal surgery, presenting less available experience and evidence in gastric surgery. According to the RICA guidelines published in 2015, a review of the bibliography and the consensus established in a multidisciplinary meeting in Zaragoza on the 9th of October 2015, we present a protocol that contains the basic procedures of fast-track for resective gastric surgery. The measures to be applied are divided in a preoperative, perioperative and postoperative stage. This document provides recommendations concerning the appropriate information, limited fasting and administration of carbohydrate drinks 2hours before surgery, specialized anesthetic strategies, minimal invasive surgery, no routine use of drainages and tubes, mobilization and early oral tolerance during the immediate postoperative period, as well as criteria for discharge. The application of a protocol of enhanced recovery after surgery in resective gastric surgery can improve and accelerate the functional recovery of our patients, requiring an appropriate multidisciplinary coordination, the evaluation of obtained results with the application of these measures and the investigation of controversial topics about which we currently have limited evidence. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.