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  • 1
    Electronic Resource
    Electronic Resource
    Hepatic regeneration following right lobectomy: Estimation of regenerative capacity (1994)
    Springer
    Surgery today 24 (1994), S. 44-48 
    Details
    ISSN: 1436-2813
    Keywords: major hepatectomy ; multiple regression analysis ; portal pressure ; aging ; liver cirrhosis ; chronic hepatitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The regenerative capacity of the liver was assessed using a volumetric method on computed tomography in 21 adults: 16 underwent a standard right hepatic lobectomy for hepatocellular carcinoma, there were hepatic metastases in 3 others, and 2 suffered from other diseases. The patients' ages ranged from 33 to 68 years with a mean age of 57.0 years. The regeneration rate was expressed as the rate of the volume increase of the remnant left lobe compared with the preoperative volume of the left lobe. A univariate regression analysis showed that the portal pressure had a highly inverse correlation with the regeneration rate of the liver (r = −0.4753,P = 0.0397), while a multiple regression analysis demonstrated the correlation between the portal pressure, age, and the regeneration rate (multipler = 0.5640). The regeneration rate of the normal liver (97.6 ± 53.5%) was significantly higher than that of the chronic hepatitic (43.0 ± 40.7%), and also tended to be higher than that of the cirrhotic liver (51.5 ± 13.2%). However, there were no differences between chronic hepatitic and cirrhotic livers. The portal pressure before hepatectomy of the normal liver (149 ± 19 mmH2O) was significantly lower than those of chronic hepatitic (188 ± 38 mmH2O) and cirrhotic (245 ±78 mmH2O) livers. We thus conclude that the regenerative capacity of the liver following a right hepatic lobectomy could be estimated on the basis of both portal pressure and age. The regenerative capacity was also influenced by underlying liver diseases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01676884
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  • 2
    Electronic Resource
    Electronic Resource
    Initiation of a fibrinolytic system in hepatic resection: The roles of tissue-type plasminogen activator and plasminogen activator inhibitor-1 (1994)
    Springer
    Surgery today 24 (1994), S. 780-784 
    Details
    ISSN: 1436-2813
    Keywords: hepatectomy ; fibrinolysis ; tissue-type plasminogen activator ; plasminogen activator inhibitor-1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The factors related to the initiation of fibrinolysis, especially with regard to the tissue-type plasminogen activator (tPA) and the plasminogen activator inhibitor-1 (PAI-1), were investigated in 15 patients who underwent hepatic resection, and the findings were compared between those with normal livers and those with diseased livers. It was found that tPA increased before hepatic division, whereas PAI-1 increased after hepatic division and reached a peak immediately following the operation. Plasminogen decreased during hepatectomy, reaching its lowest point on postoperative day 1, and increasing later. Decreased levels of both plasminogen and the α2-plasmin inhibitor were considered to be partly due to plasmin formation in the blood. Patients with a diseased liver tended to have higher intraoperative values of euglobulin lysis activity and higher postoperative values of plasminogen activator, but significantly lower postoperative values of α2-plasmin inhibitor than those with a normal liver. The results of this study suggest that activation of the fibrinolytic system occurs both during hepatectomy and in the early postoperative period, and that patients with a diseased liver are prone to develop hyperfibrinolysis during hepatectomy. Moreover, the increased levels of both tPA and PAI-1 can serve as one of the most sensitive markers for the vital reaction against surgical stress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01636306
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  • 3
    Electronic Resource
    Electronic Resource
    Hepatic Sclerosing Hemangioma Mimicking a Metastatic Liver Tumor: Report of a Case (2000)
    Springer
    Surgery today 30 (2000), S. 849-852 
    Details
    ISSN: 1436-2813
    Keywords: Key Words Hepatic sclerosing hemangioma ; Metastatic liver tumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We present herein the case of a sclerosing hemangioma of the liver which was extremely difficult to differentiate from liver metastasis of rectal cancer, in a 67-year-old woman. All the radiological findings were compatible with liver metastasis; however, marginal pooling of the tumor revealed by computed tomographic angiography and magnetic resonance imaging scans was inconsistent with a diagnosis of liver metastasis. At laparotomy, the tumor was macroscopically unusual in that it was yellowish elastic-hard with a very clear margin, and thus, it did not have the appearance of a metastatic tumor. Mile's operation and a partial hepatectomy were performed, followed by an uneventful postoperative course and no signs of recurrence. The carcinoembryonic antigen (CEA) level in the peripheral blood was not elevated at any time. The postoperative pathological diagnosis was a rare hepatic tumor, namely, a "sclerosing hemangioma," based on the findings of cellular fibrous stroma containing vascular channels with flattened endothelial cells. Preoperatively differentiating between sclerosing hemangioma and a metastatic liver tumor from colorectal cancer may be very difficult; however, this case demonstrated some interesting characteristics, namely, the serum CEA level was not elevated, marginal pooling of the tumor was found in the enhanced radiological findings, and the tumor was macroscopically unusual. Therefore, the possibility of sclerosing hemangioma should be borne in mind when considering the differential diagnosis of patients suspected of having colorectal liver metastasis. A preoperative biopsy should be carried out and when a laparotomy is performed under the misdiagnosis of colorectal liver metastasis, it is advisable that either an intraoperative needle biopsy or a frozen histological analysis be undertaken to avoid unnecessary extended hepatic resection of this rare benign hepatic tumor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070072
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  • 4
    Electronic Resource
    Electronic Resource
    The Mechanism of Hepatic Graft Protection Against Reperfusion Injury by Prostaglandin E1 (1999)
    Springer
    Surgery today 29 (1999), S. 526-532 
    Details
    ISSN: 1436-2813
    Keywords: Key Words: sinusoidal endothelial cell ; prostaglandin E1 ; viability ; cold preservation ; rat liver
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: 1 (PGE1) on protecting against hepatic endothelial cell damage and increasing graft viability after cold preservation and reperfusion, using an isolated perfused rat liver (IPRL) model. The grafts were divided into three groups, according to the cold preservation time and PGE1 administration, namely: 4 h preservation (group 1, n = 9), 6 h preservation (group 2, n = 9), and 6 h preservation followed by PGE1 infusion (group 3, n = 9). After cold storage, the grafts were put on the recirculating IPRL system, then reperfused for 120 min at 37°C with oxygenated Krebs-Henseleit buffer containing hyaluronic acid (HA). To examine the function of the sinusoidal endothelial cells and hepatocytes, serial measurements of HA, tumor necrosis factor-α (TNFα), thromboxane B2 (TXB2), acid phosphatase, and conventional parameters in the perfusate were made. After perfusion, the trypan blue exclusion test was performed to assess the presence of any microscopic sinusoidal lining cell damage. In group 3, the bile output and HA clearance were significantly greater, while glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, TNFα, TXB2, and acid phosphatase in the perfusate were significantly lower than in group 2. Histologically, less endothelial cell damage and hepatocyte damage than in group 2 was also confirmed. These results therefore suggest that the improvement of hepatic graft viability by PGE1 administration is mainly due to sinusoidal endothelial cell protection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950050456
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  • 5
    Electronic Resource
    Electronic Resource
    The mechanism of hepatic graft protection against reperfusion injury by prostaglandin E1 (1999)
    Springer
    Surgery today 29 (1999), S. 526-532 
    Details
    ISSN: 1436-2813
    Keywords: sinusoidal endothelial cell ; prostaglandin E1 ; viability ; cold preservation ; rat liver
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to evaluate the effect of prostaglandin E1 (PGE1) on protecting against hepatic endothelial cell damage and increasing graft viability after cold preservation and reperfusion, using an isolated perfused rat liver (IPRL) model. The grafts were divided into three groups, according to the cold preservation time and PGE1 administration, namely: 4h preservation (group 1,n=9), 6h preservation (group 2,n=9), and 6h preservation followed by PGE1 infusion (group 3,n=9). After cold storage, the grafts were put on the recirculating IPRL system, then reperfused for 120 min at 37°C with oxygenated Krebs-Henseleit buffer containing hyaluronic acid (HA). To examine the function of the sinusoidal endothelial cells and hepatocytes, serial measurements of HA, tumor necrosis factor-α (TNFα), thromboxane B2 (TXB2), acid phosphatase, and conventional parameters in the perfusate were made. After perfusion, the trypan blue exclusion test was performed to assess the presence of any microscopic sinusoidal lining cell damage. In group 3, the bile output and HA clearance were significantly greater, while glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, TNFα, TXB2, and acid phosphatase in the perfusate were significantly lower than in group 2. Histologically, less endothelial cell damage and hepatocyte damage than in group 2 was also confirmed. These results therefore suggest that the improvement of hepatic graft viability by PGE1 administration is mainly due to sinusoidal endothelial cell protection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02482347
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  • 6
    Electronic Resource
    Electronic Resource
    Evaluation of indications for the surgical treatment of cavernous hemangioma of the liver (1996)
    Springer
    Journal of hepato-biliary-pancreatic surgery 3 (1996), S. 98-100 
    Details
    ISSN: 1436-0691
    Keywords: hemangioma of the liver ; resection ; operative indications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The indications for liver resection performed in 18 patients with cavernous hemangioma of the liver at the Second Department of Surgery, Kyushu University Hospital, from 1985 to 1993, were reevaluated. The mean age of the patients was 49.7 years. Two patients had abdominal pain and 3 had gastric symptoms. Hepatocellular carcinoma could not be ruled out in 4 patients. None of the other patients had any clinical manifestations other than detection of the tumor. The average size of the tumors was 7.8cm (range 1–21 cm). In all, five partial resections, three subsegmentectomies, seven segmentectomies, and three bisegmentectomies of the liver were performed. No severe complications were encountered postoperatively, and no recurrences were found after the operation. A review of the literature revealed that spontaneous rupture of such tumors is infrequent. It therefore seems that there was no indications for surgery in our patients, except for the 4 in whom hepatocellular carcinoma could not be ruled out. Although elective liver resection for cavernous hemangioma is safe, the indications for surgery should be more narrowly defined in the future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02350917
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  • 7
    Electronic Resource
    Electronic Resource
    Recent developments in imaging diagnostics for HCC: CT arteriography and CT arterioportography evaluation of vascular changes in premalignant and malignant hepatic nodules (2000)
    Springer
    Journal of hepato-biliary-pancreatic surgery 7 (2000), S. 245-251 
    Details
    ISSN: 1436-0691
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: We analyzed the hemodynamic properties and vascular supply changes in relation to the carcinogenesis of hepatocellular carcinoma (HCC), selecting 18 premalignant and malignant nodules less than 3 cm diameter (from 14 patients) for our study. The computed tomographic (CT) arteriography and CT arterioportography (CTAP) findings for these nodules were correlated with the histopathologic findings. The ratios of all microscopically counted arteries (normal hepatic and abnormal arteries), normal hepatic arteries, and portal veins in each nodule to those in the surrounding liver were calculated. Well differentiated lesions had low attenuation on CT arteriography and isoattenuation on CTAP. Moderately-to-poorly differentiated lesions had high attenuation on CT arteriography and low attenuation on CTAP. In well differentiated lesions, the ratios of all arteries, normal hepatic arteries, and portal veins were 1.17 ± 0.10, 0.66 ± 0.12, and 0.80 ± 0.10, respectively. In moderately-to-poorly differentiated lesions, the ratios were 2.64 ± 0.23, 0.09 ± 0.03, and 0.07 ± 0.03, respectively. We concluded that blood flow does not parallel the actual number of arteries seen on the histological examination of tumors. In well differentiated lesions, the combination of normal hepatic arterial degeneration and preserved portal veins results in low attenuation on CT arteriography and isoattenuation on CTAP. In advanced HCC, the combination of neoplastic (abnormal) arterial development by angiogenesis and obliteration of portal veins results in high attenuation on CTA and low attenuation on CTAP. These findings are characteristic of early and advanced stage HCC, and may reflect a combination of sequential changes in their hemodynamic states.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005340070044
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  • 8
    Electronic Resource
    Electronic Resource
    A random allocation system with the minimization method for multi-institutional clinical trials (1991)
    Springer
    Journal of medical systems 15 (1991), S. 311-319 
    Details
    ISSN: 1573-689X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper describes the random allocation system used to perform precise and rapid treatment assignments in multi-institutional clinical trials. This system is based on sophisticated randomization procedures, according to Pocock and Simon's minimization method and Zelen's method for institution balancing. The major advantage of randomized treatment assignments with this system is to balance treatment numbers for each level of various prognostic factors over the entire trial and at the same time balance the allocation of treatments within an institution. Therefore, the randomized treatment assignments by this system can prevent degrading of the statistical power of a particular treatment factor. This system is designed to run on a small-sized notebook computer and therefore can be set up beside a telephone for registration, without occupying a large space. At present, this system is conveniently being used in two clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00999168
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  • 9
    Electronic Resource
    Electronic Resource
    Pretransplant assessment of human liver grafts by plasma lecithin: cholesterol acyltransferase (LCAT) activity in multiple organ donors (1992)
    Springer
    Transplant international 5 (1992), S. 27-30 
    Details
    ISSN: 1432-2277
    Keywords: Viability test, human livers ; Liver transplantation, plasma lecithin assessment ; Lecithin, viability, liver donors ; Cholesterol acyltransferase, in liver donors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In spite of the improved outcome of orthotopic liver transplantation (OLTx), primary graft nonfunction remains one of the life-threatening problems following OLTx. The purpose of this study was to evaluate plasma lecithin: cholesterol acyltransferase (LCAT) activity in multiple organ donors as a predictor of liver allograft viability prior to OLTx. Thirty-nine donors were studied during a 5-month period between April and August 1988. Allograft hepatectomy was performed using a rapid technique or its minor modification with hilar dissections, and the allografts were stored cold (4°C) in University of Wisconsin (UW) solution. Early post-transplant allograft function was classified as good, fair, or poor, according to the highest SGOT, SGPT, and prothrombin time within 5 days following OLTx. Procurement records were reviewed to identify donor data, which included conventional liver function tests, duration of hospital stay, history of cardiac arrest, and graft ischemic time. Blood samples from the donors were drawn immediately prior to aortic crossclamp, and from these plasma LCAT activity was determined. Plasma LCAT activity of all donors was significantly lower than that of healthy controls (12.4±8.0 vs 39.2±13.3 μg/ml per hour, P〈0.01). LCAT activity (16.4±8.3 μg/ml per hour) in donors of grafts with good function was significantly higher than that in those with fair (8.6±4.5 μg/ml per hour, P〈0.01) or poor (7.3±2.4 μg/ml per hour, P〈0.01) function. Information regarding procurement, which was complete in the records of 31 of 39 donors, was used in a multiple logistic regression analysis that revealed plasma LCAT activity to be the only factor able to discriminate the quality of the hepatic graft from other variables in multiple organ donors. The present study suggests that the determination of plasma LCAT activity in multiple organ donors is extremely useful for the assessment of hepatic allograft viability prior to OLTx.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00337186
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  • 10
    Electronic Resource
    Electronic Resource
    The significance of tissue-type plasminogen activator for pretransplant assessment of liver graft viability: analysis of effluent from the graft in rats (1994)
    Springer
    Transplant international 7 (1994), S. 233-236 
    Details
    ISSN: 1432-2277
    Keywords: Liver graft viability, rat ; Plasminogen activator, rat, liver viability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We studied the significance of tissue-type plasminogen activator (tPA) on the pretransplant assessment of liver graft viability in rats. The liver grafts were excised from the rats and then divided into two groups. Group 1 consisted of grafts preserved for 4 h in chilled, lactated Ringer's solution (4°C) and group 2 consisted of grafts preserved for 6 h in the same solution. After preservation, the liver grafts were flushed out through the portal vein using 5 ml of chilled, lactated Ringer's solution (4°C). The entire effluent from the hepatic veins was then collected and analyzed for tPA, ammonia, lactate, pyruvate, glutamic oxaloacetic transaminase, and lactate dehydrogenase. The tPA concentration of effluent in group 2 was significantly higher than that in group 1 (0.80±0.23 ng/ml vs 0.42±0.08 ng/ml, P〈0.05). The lactate, pyruvate, and ammonia levels in group 2 were also higher than those in group 1 (134±13 mg/dl vs 120±2 mg/dl, 0.34±0.40 mg/dl vs 0.09±0.01 mg/dl, and 183±79 μg/dl vs 102±40 μg/dl, respectively). However, the discriminative power of tPA was stronger than that of the other parameters. Histological findings revealed a higher number of trypan blue-stained sinusoidal lining cells that were detached and swollen in group 2. We conclude that the amount of tPA in the effluent flushed from the graft can serve as a sensitive and reliable indicator of cold-preserved liver grafts in rats.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00327148
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