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  • 1
    Electronic Resource
    Electronic Resource
    Vascular access for intra-arterial chemotherapy for nonresectable hepatic tumor (1981)
    Springer
    Surgery today 11 (1981), S. 388-390 
    Details
    ISSN: 1436-2813
    Keywords: nonresectable hepatic tumor ; vascular accessgraft ; intraarterial chemotherapy ; liver cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02468967
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  • 2
    Electronic Resource
    Electronic Resource
    Occurrence of intraperitoneal septic complications after hepatic resections between 1985 and 1990 (1995)
    Springer
    Surgery today 25 (1995), S. 49-54 
    Details
    ISSN: 1436-2813
    Keywords: intraperitoneal sepsis ; hepatic resection ; bile leakage ; blood transfusion ; gut-origin sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this study, the risk factors related to intraperitoneal septic complications occurring after hepatectomy (IPSCH) as well as the effect of various perioperative variables on the outcome of IPSCH between 1985 and 1990 were analyzed. Twenty-one of 211 patients (10.0%) developed IPSCH. The findings in the patients with IPSCH were compared with those in 190 patients without IPSCH. The significant variables associated with the development of IPSCH included a high incidence of accompanying chronic renal failure (14.3% vs 2.1%), a larger blood loss during surgery (2,130 vs 1,340 ml) as well as a greater amount of intraoperative blood replacement (1,130 vs 570 ml), and a greater weight of the resected liver (367 vs 233g). IPSCH occurred in 10 of 12 patients who had postoperative bile leakage. Eighteen patients (85.7%) with IPSCH were discharged from the hospital after non-operative management; however, the hospital death rate (14.3% vs 1.1%) was significantly higher in patients with IPSCH. This review suggests that the incidence of IPSCH has not decreased recently. Thus, to prevent IPSCH, at least following bile leakage, it is necessary to perform a careful division of the liver parenchyma followed by a bile leakage test, and when this complication occurs unexpectedly in patients who have a good functional reserve of the remnant liver, IPSCH can be effectively drained percutaneously under ultrasound guidance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00309385
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    The prediction of portal pressure: A multivariate analysis of clinical data and intraoperative portal pressure (1994)
    Springer
    Surgery today 24 (1994), S. 309-312 
    Details
    ISSN: 1436-2813
    Keywords: portal pressure ; hepatic resection ; platelet count ; indocyanine green retention rate ; prothrombin time index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Portal pressures were estimated non-invasively in 100 patients who underwent hepatic resection and completely fulfilled the 21 variables evaluated. Ten variables were selected from among all those in the univariate analysis, and a stepwise discriminant analysis revealed four independent significant variables, namely: The indocyanine green dye retention test at 15 min (ICGR15); the prothrombin time index; the platelet count; and the globulin fraction. An equation to estimate the portal pressure was made using the coefficients in the analysis, the reliability of which was confirmed (r=0.70484,P=0.0001). The univariate analysis revealed ten significant variables to discriminate portal hypertension, defined as a portal pressure of over 200 mmH2O. A multiple logistic regression analysis of these variables revealed two independent variables, being ICGR15 and the platelet count. Thus, we consider that our equation for estimating portal pressure is potentially useful, and that the platelet count and ICGR15 are the most significant parameters in discriminating between the presence or absence of portal hypertension. Moreover, a platelet count of less than 120×103/mm3 and an ICGR15 value of more than 15% correlated well with portal hypertension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02348558
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  • 4
    Electronic Resource
    Electronic Resource
    Small liver cancer (1983)
    Springer
    Surgery today 13 (1983), S. 32-36 
    Details
    ISSN: 1436-2813
    Keywords: small liver cancer ; early detection ; diagnostic sensitivity ; operative management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report eight cirrhotic patients with liver cancer of less than 2 cm in diameter, and who were successfully treated by surgery. The sensitivities of diagnostic procedures for small lesions showed that alpha-fetoprotein (AFP) was 75 per cent, radionuclide scanning 25 per cent, CT 33 per cent, ultrasonography 40 per cent and angiography 88 per cent. Serial measurement of AFP appears to be the most helpful for detection of hepatocellular carcinoma at the early stage, particularly in cirrhotic patients. Although hepatic imagings are of limited value for small hepatic tumors, those tools are often useful as a back-up for the routine tests but not for initial procedures. It should also be kept in mind that hepatic arteriography performed in the high risk group often leads to detection of small cancers. In cirrhotic patients with small hepatocellular carcinoma, surgical resection should be done, providing the clinical status and hepatocellular reserve are adequate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02469687
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  • 5
    Electronic Resource
    Electronic Resource
    Open and closed suction drainage after hepatic resection (1993)
    Springer
    Surgery today 23 (1993), S. 871-874 
    Details
    ISSN: 1436-2813
    Keywords: hepatic resection ; intraperitoneal septic complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A retrospective study was conducted to compare open conduit drains with closed suction drains, with regard to the occurrence of intraperitoneal septic complications after hepatectomy (IPSCH). The subjects comprised 50 consecutive Japanese patients who underwent hepatic resection followed by the insertion of a closed suction drain and the control group comprised 50 patients in whom a simple conduit drain had been placed following liver surgery. There were no significant differences between the two groups in sex, age, underlying liver disease, or the type of hepatectomy performed; nor was there a significant difference in the incidence of IPSCH, the simple conduit drain group versus the closed suction drain group being (10% versus 8%, respectively). However, bile leakage was highly related to IPSCH, the incidence being 60% and 100% in the simple conduit drain and closed suction drain groups, respectively. Thus, to prevent IPSCH, the treatment of bile leakage is a much more important factor than the type of drain used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311364
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  • 6
    Electronic Resource
    Electronic Resource
    The significance of methicillin-resistant Staphylococcus Aureus infection in general surgery: A multivariate analysis of risk factors and preventive approaches (1993)
    Springer
    Surgery today 23 (1993), S. 880-884 
    Details
    ISSN: 1436-2813
    Keywords: MRSA ; Staphyloccus aureus ; risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the characteristics, risk factors, and prevention of methicillin-resistant Staphylococcus aureus (MRSA), a total of 3,627 patients were studied. Among these, 1,336 patients with various infections were used in a risk factor analysis of MRSA to determine the relationship between the use of antibiotics and the incidence of MRSA. Only 3.0% of infections were attributed to MRSA, the esophagus and colorectal region being highly involved, as anastomotic or pelvic abscesses, while the lung had a lower incidence. Almost half the patients with MRSA infections (47.6%) had concomitant infections. A univariate analysis revealed the following significant factors: The coexistence of gastrointestinal or metastatic malignancy, sepsis, tracheostomy, and the prior use of antibiotics such as the β-lactam compounds or aminoglycosides. A multivariate analysis showed that gastrointestinal malignancy, sepsis, and the prior use of aminoglycosides, tetracycline, macrolides, and carbapenems were independently significant factors. To promote the education of doctors and nurses, regular in-service meetings on MRSA were held in the ward. Moreover, preventive approaches such as patient isolation, strategically placed hand washing equipment, and the use of disposable gloves and contaminated waste bags, have been initiated, and the incidence of MRSA has decreased significantly since then. Thus, to control MRSA, the following steps should be taken: (1) constant and careful surveillance, (2) regular risk factor analyses, (3) the optimal administration of antibiotics, and (4) the education of all hospital staff.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311366
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  • 7
    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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  • 8
    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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  • 9
    Electronic Resource
    Electronic Resource
    The clinical characteristics of patients with synchronous squamous cell carcinoma of the esopohagus and hepatocellular carcinoma (1994)
    Springer
    Surgery today 24 (1994), S. 803-808 
    Details
    ISSN: 1436-2813
    Keywords: synchronous double cancer ; esophageal cancer ; hepatocellular carcinoma ; etiology ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An ongoing analysis of 762 patients with esophageal cancer revealed 4 (0.52%) male patients with synchronous hepatocellular carcinoma (HCC). A long history of habitual alcohol intake and heavy cigarette smoking was recognized in all four patients and, therefore, the possibility of these two factors being independent risk factors for this double cancer was suggested. Palliative treatment was undertaken since either one or both cancers were too far advanced, or because liver function was poor even in those patients with resectable cancers. The prognosis correlated more closely to the TNM stage of esophageal cancer rather than the HCC and the causes of death were related to the esophageal cancer in all four patients. These findings suggest that, in patients with this combination of double cancer, the state of the esophageal cancer may be a more reliable prognostic factor than that of the HCC and thus, the curability of esophageal cancer is of primary importance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01636310
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  • 10
    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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