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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'incidence de la positivité d'anticorps du virus de l'hépatite C (HCV) n'est pas connue avec précision. L'objectif de cette étude a été de déterminer la prévalence de l'infection HCV parmi les patients en chirurgie et d'identifier les patients à risque. On a dosé les anticorps HCV chez 789 patients en chirurgie entre Avril 1991 et Mars 1992. Parmi ceux-ci, 129 (16.3%) ont été positifs, un taux bien plus élevé que dans la population Japonaise générale. Les maladies hépatobiliaires et l'hypertension portale ont été associées à un taux de positivité plus élevée que les autres maladies (94/206, 45.6% vs 35/583, 6%; p〈0.0001). La positivité HCV a été retrouvée chez 54.1% (119/220) des patients en chirurgie avec des facteurs de risque connus, contrastant avec 1.9% (10/569) des patients sans ces mêmes risques. Nous concluons que les patients venant à la chirurgie ont a fort risque d'infection HCV et que le personnel médical doit en être averti.
    Abstract: Resumen Se desconoce la incidencia de seropositividad del anticuerpo al virus de la hepatitis C (HCV). El propósito del presente estudio fue clarificar la prevalencia de infección por HCV en los pacientes quirúrgicos y de identificar aquellos de alto riesgo. Entre abril de 1991 y marzo de 1992 se practicaron pruebas de anticuerpo antiHCV en 789 pacientes quirúrgicos. De éstos, 129 (16.3%) presentaron prueba positiva, lo cual es una tasa de positividad bastante más alta que la observada en la población japonesa general. Las enfermedades hepatobiliares y la hipertensión portal aparecieron asociadas con una mayor tasa de positividad que otras entidades (94/206, 45.6% vs. 35/583, 6%; p〈0.0001). Los pacientes mayores de 50 años exhibieron tasa de positividad más elevada que los más jóvenes (118/578, 20.4% vs. 11/211, 5.3%; p〈0.0001). La tasa de positividad HCV ascendió hasta 54.1% (119/220) entre los pacientes quirúrgicos con riesgos conocidos de hepatitis, en contraste con sólo 1.9% (10/569) en aquellos carentes de tales factores de riesgo. Nuestra conclusión es que los pacientes quirúrgicos exhiben una alta incidencia de infección HCV, a lo cual los profesionales de la salud deben prestar especial atención a fin de evitar contagio.
    Notes: Abstract The incidence of hepatitis C virus (HCV) antibody positivity is unknown. The purpose of this study was to clarify the prevalence of HCV infection among surgical patients and to identify high risk surgical patients. HCV antibody tests were performed in 789 surgical patients between April 1991 and March 1992. Of these patients, 129 (16.3%) tested positive, which was much higher than the positivity of the ordinary Japanese. Hepatobiliary diseases and portal hypertension were associated with a higher positivity than other disease categories (94 of 206, 45.6% versus 35 of 583, 6%; p〈0.0001). Patients above 50 years of age had a higher positivity than their younger counterparts (118 of 578, 20.4% versus 11 of 211, 5.3%; p〈0.0001). The HCV positivity was as high as 54.1% (119 of 220) among surgical patients with known risk factors for hepatitis, in contrast to only 1.9% (10 of 569) among those without such risk factors. We conclude that surgical patients have a high incidence of HCV infection, for whom medical professionals should pay special attention to avoid disease transmission.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les auteurs ont étudié les suites opératoires de 50 malades qui avaient subi une résection hépatique en comparant les taux de rétention de l'indocyanine green (ICG) mesurés lors du 3ème jour post-opératoire par rapport à ceux appréciés immédiatement après l'opération. Ce rapport étant l'expression de l'index ICG du parenchyme restant. Le groupe A de 22 malades avec un index restant de moins de 1.0, (qui signifie le taux de rétention de ICG à 15 mm lors du 3ème jour post-opératoire) a montré une amélioration par comparaison aux faits qui ont succédé immédiatement à l'intervention. Un groupe B de 28 malades chez qui l'index au 3ème jour était supérieur à 1.0, indiquant par conséquent une élévation du taux de clarance de l'ICG après résection hépatique, a été individualisé. De sérieuses complications comprenant infection abdominale et hyperbilirubinémie se sont manifestées en post-opératoire respectivement chez 2 (9.1%) du groupe A et 16 (57.1%) du groupe B (p〈0.001). Un malade (4.5%) du groupe A décéda cependant que 9 malades (32.1%) du groupe B moururent pendant l'hospitalisation (p〈0.02). Il ne fut pas constaté de différence significative en ce qui concerne la fonction hépatique préopératoire et les paramètres cliniques. Ces observations suggèrent que l'amélioration du taux de la clairance de l'ICG au 3ème jour post-opératoire par comparaison au taux déterminé immédiatement après l'intervention permet de préjuger des suites post-opératoire après résection hépatique.
    Abstract: Resumen Hemos valorado la evolución postoperatoria de 50 pacientes sometidos a resección hepática, utilizando la relación entre las tasas de retención del verde de indocianina (VIC) medidas en el tercer día postoperatorio y los valores estimados inmediatamente después de la operación. Esta relación fue expresada en forma del indice VIC de remanente hepático. El grupo A incluyó 22 pacientes con un indice de menos de 1.0, lo cual significa que la tasa de retención VIC a los 15 minutos en el tercer día postoperatorio mostró mejoría en comparación con los hallazgos inmediatamente al término de la operación. En el grupo B hubo 28 pacientes cuyos indices en el tercer día postoperatorio fue superior a 1.0, lo cual indica exacerbación de la tasa de depuración de VIC después de la resección hepática. Se presentaron complicaciones postoperatorias graves, incluso sepsis intraabdominal e hiperbilirrubinemia en 2 (9.1%) en el grupo A y 16 (57.1%) en el grupo B (p〈0.001). Murió un paciente (4.5%) en el grupo A contra 9 pacientes (32.1%) que murieron en el grupo B en el curso de la hospitalización (p〈 0.02). No se observaron diferencias significativas en cuanto a las pruebas preoperatorias de función hepática o los parámetros clínicos. Estas observaciones sugieren que la mejoría en la tasa de depuración de VIC en el tercer día postoperatorio, comparada con aquella inmediatamente al término de la operación, es un paramétro de utilidad en la predicción del curso postoperatorio de pacientes hepatectomizados.
    Notes: Abstract We evaluated the postoperative course of 50 patients who underwent hepatic resection, using the ratio of indocyanine green (ICG) retention rates measured on the third postoperative day to values estimated immediately after the operation. This ratio was expressed as the remnant liver ICG index. Group A included 22 patients with a remnamt liver ICG index of less than 1.0, which meant that the ICG retention rate at 15 minutes on the third postoperative day showed improvement, compared to events immediately after the operation. In group B, there were 28 patients whose index on the third postoperative day was over 1.0, thereby indicating exacerbation of the ICG clearance rate after hepatic resection. Serious complications including intraabdominal sepsis and hyperbilirubinemia occurred postoperatively in 2 (9.1%) in group A and 16 (57.1%) in group B (p〈0.001). One patient (4.5%) in group A died, while 9 patients (32.1%) in group B died during hospitalization (p〈 0.02). There were no significant differences with regard to preoperative liver function and clinical parameters. These observations suggest that improvement in the ICG clearance rate on the third postoperative day, compared to that immediately after the operation, is useful to predict the postoperative course of hepatectomized patients.
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  • 3
    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.
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  • 4
    ISSN: 1436-2813
    Keywords: Key Words Liver transplantation ; Biliary atresia ; Development
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of twins, one of whom suffered from biliary atresia, is described herein. Although the patient had been doing well until 11 years of age after previously undergoing a primary hepatic portoenterostomy, she had to then undergo a liver transplantation due to severe refractory cholangitis at 14 years of age. Although the patient's intellectual performance had severely declined due to the progression of her illness for several years, it completely recovered after the liver transplantation. In cases where the physical development in childhood has been well preserved, liver transplantation might therefore offer the chance for a full recovery of deteriorated intellectual performance.
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  • 5
    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
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  • 6
    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.
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  • 7
    ISSN: 1573-689X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A simple outpatient follow-up system was developed with a laptop personal computer to assist management of patients with hepatocellular carcinoma after hepatic resections. Since it is based on a non-relational database program and the graphical user interface of Macintosh operating system, those who are not a specialist of the computer operation can use it. It is helpful to promptly recognize current status and problems of the patients, to diagnose recurrences of the disease and to prevent lost from follow-up cases. A portability of the computer also facilitates utilization of these data everywhere, such as in clinical conferences and laboratories.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-2277
    Keywords: Tuberculosis, liver transplantation ; Liver transplantation, tuberculosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report on a 44-year-old man who developed tuberculosis 4 months after liver transplantation. The diagnosis was confirmed using a polymerase chain reaction (PCR) technique in bronchial alveolar lavage (BAL) fluid, and the patient was successfully treated by reducing his immunosuppression and administering antituberculous drugs. The patient became afebrile 20 days after starting antituberculous therapy and remains well at home. A review of the literature revealed that tuberculosis after liver transplantation is a rare complication with a reported mortality rate of as high as 40%. The mortality is highest for patients who become symptomatic within 3 months after transplantation (83% vs 0%, P〈0.01; Fisher's exact test) and for those with an interval between the initial symptom and diagnosis of more than 2 weeks (71% vs 0%, P〈0.05). Early diagnosis is, therefore, essential for successful resolution of tuberculosis after liver transplantation.
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  • 9
    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.
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  • 10
    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.
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