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Bleeding from ectopic varices of the ileum associated with portal hypertension is occasionally life-threatening. However, it is not easy to make an accurate preoperative diagnosis. A 62-year-old woman presented with hematochezia and anemia. Conventional examinations could not locate the bleeding point, but subsequent capsule endoscopy indicated gastrointestinal bleeding from hemorrhaging ileal varices. Contrast-enhanced abdominal computed tomography, three-dimensioned abdominal computed tomography, and mesenteric angiography demonstrated the presence of ileal and right ovarian varices. The patient then underwent an exploratory laparotomy which confirmed these findings, and resection of the affected ileum and right ovary was performed safely. Capsule endoscopy should be a diagnostic option for patients with obscure gastrointestinal bleeding, and ileal varices should be considered as one of the differential diagnoses. [ABSTRACT FROM AUTHOR]

An inflammatory myofibroblastic tumor (IMT) of the ileum is a very rare lesion of the gastrointestinal tract. A 36-year-old female presented with abdominal fullness and colicky pain of 5 days' duration. Plain abdominal radiography showed an intestinal obstruction with dilated jejunal loops. Abdominal computed tomography and ultrasonography demonstrated a well-defined intraluminal solid mass surrounded by the typical mural layers of an invaginated ileum. The patient then underwent an exploratory laparotomy under a clinical diagnosis of intussusception caused by a small bowel tumor. The surgical findings revealed a large mass leading to an ileoileal intussusception, with regional lymph node enlargement and a small bowel resection accompanied by lymph node dissection was performed. The definitive diagnosis of IMT was confirmed by both conventional histopathology and minute immunohistochemistry. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Rupture of a pseudoaneurysm is an unusual complication after surgical and interventional treatments in patients with hepatobiliary pancreatic diseases. However, it occurs abruptly and often results in a lethal outcome. The aim of this study was to retrospectively analyze our experiences of cases of rupture of pseudoaneurysms for providing appropriate therapeutic planning. METHODS: Between 1985 and 1998, we observed ruptures of pseudoaneurysms in 14 of 910 patients with hepatobiliary pancreatic diseases--six after pancreaticoduodenectomy, three after hepatic resection, two after hepatopancreaticoduodenectomy, two after percutaneous transhepatic biliary drainage, and one after gastrojejunostomy. Thirteen of the 14 patients underwent emergency angiography and transcatheter arterial embolization (TAE) or infusion therapies, and one of the 13 patients underwent surgical hemostasis because of incomplete hemostasis with TAE. The other patient, who did not undergo emergency angiography. had surgical hemostasis initially. RESULTS: TAE achieved hemostasis in M of 13 patients (85%). but only incomplete hemostasis in the remaining two patients. Of these two patients, one underwent laparotomy, but died of multiple organ failure (MOF) at 6 days after surgical hemostasis. The other died at 1 day after emergency angiography. Ten of 11 patients who obtained complete hemostasis by means of TAE could later be discharged, but one patient died of liver failure, and/or MOF. One patient who underwent laparotomy initially without angiography died of MOF at 43 days after the operation. The onset of rupture of a pseudoaneurysm was a mean of 35.4 days (range 12-76) after surgical or interventional procedures. The warning prodromal symptoms were upper abdominal oppression, nausea, and backache before the rupture of pseudoaneurysms. Fever, leukocytosis, hyperbilirubinemia, anastomotic leak, and intraabdominal abscess were frequent persistent signs in these patients. CONCLUSIONS: If the warning prodromal symptoms appear in patients along with these persistent signs, the impending rupture of pseudoaneurysms should be suspected. Thereafter, a diagnostic angiography should be performed immediately to enable early diagnosis and embolization therapy for rupture of pseudoaneurysms when hemorrhagic episodes appear in these patients. Early detection and immediate embolization might bring about a favorable outcome in patients with hepatobiliary pancreatic diseases who encounter rupture of pseudoaneurysms after surgical and interventional treatments. [ABSTRACT FROM AUTHOR]

OBJECTIVE: A high incidence of complications has been documented in patients with cirrhosis after operations. Recently, polymorphonuclear neutrophils (PMN) have been revealed to have the capacity to injure vascular endothelium and to cause organ damage. Furthermore, the altered function of PMN has been shown in patients with cirrhosis. However, there are few reports investigating the interaction between PMN and endothelial cells and its relation to a high incidence of postoperative complications in cirrhosis. The aim of this study was to evaluate PMN-mediated endothelial cell injury in patients with cirrhosis. METHODS: Patients were divided into two groups: those who had normal liver with metastatic liver carcinoma and those who had cirrhosis with hepatocellular carcinoma. All patients in both groups underwent hepatic resection. PMN were isolated from patients before operation. Human umbilical vein endothelial cells and PMN were cocultured after addition of phorbol myristate acetate. The release of lactate dehydrogenase (LDH) and thrombomodulin in the cocultured medium and the elastase activity in PMN suspension were measured. RESULTS: The release of both LDH and thrombomodulin in the group with cirrhosis was significantly higher than in the group with normal liver. The elastase activity was similarly higher in the group with cirrhosis than in the group with normal liver. The surgical morbidity rate was remarkably higher in the group with cirrhosis (50%) than in the group with normal liver (0%). CONCLUSIONS: This study shows that PMN have an enhanced potential to cause endothelial cell injury in patients with cirrhosis. This PMN "priming" may be responsible for the occurrence of postoperative complications in patients with cirrhosis after hepatectomy. [ABSTRACT FROM AUTHOR]

Objectives: Previous reports have indicated that results of the surgical resection of hepatic metastases from gastric carcinoma have been unsatisfactory. We therefore evaluated the results of aggressive surgical resection for bepatic metastases from gastric carcinoma, to identify candidates with a better likelihood of survival. Meth-ods and Results: Twenty-one patients with synchronous or metachronous hepatic metastases from gastric carcinoma underwent hepatic resections. Five patients were still alive, without recurrence, at 10,41,46, 117, and 176 months after their hepatic resection. Sixteen patients died of recurrence 5-33 months (mean, 10 months) after bepatic resection. A significant difference in the number of node metastases (solitary or multiple) and in the tumor-free margin of the re,section (<10 mm or >10 mm) was found between survivors and those who died. Conclusion: Hepatic resection for hepatic metastases from gastric carcinoma may improve the prognosis in patients with a solitary metastasis if adequate tumor-free margins (>1O mm) can be obtained. [ABSTRACT FROM AUTHOR]

Objective/Method: It has been reported that inflammatory cytokines up-regulate human hepatocyte growth factor synthesis in vitro. To demonstrate the relation of this growth factor to interleukin-6 and tumor necrosis factor a, the changes in the levels of these cytokines were measured in serum and peritoneal fluid in 22 patients after partial hepatectomy. Results: Serum and fluids levels of cytokines showed a maximum within 3 days after surgery. Cytokines concentrations were much higher in fluid than in serum (p < 0.05). The maximum serum levels of human hepatocyte growth factor were significantly correlated with those of interleukin-6, intraoperative blood loss, and operating time (p < 0.05) but not with resected liver weights. In fluid level, the growth factor was also correlated with interleukin-6 (p < 0.05) but not with tumor necrosis factor α. Conclusions: These results suggest that human hepatocyte growth factor might be locally produced in the injured tissue associated with interleukin-6 and independently of resected liver weights. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess serum type IV collagen 7-S domain (IV 7-S) levels in colorectal cancer patients with hepatic metastasis and to investigate the relation between serum IV 7-S levels and type IV collagenase activities in tumor tissue. Methods: Tissue type IV collagenase activity and serum IV 7-S were measured in 50 colorectal cancer patients without hepatic metastasis and in 26 patients with hepatic metastasis. Results: Type IV collagenase showed significantly higher activities in colorectal cancer (n = 36) than in colorectal normal mucosa (n = 36) (p < 0.001), but significantly lower activities were shown in the hepatic metastatic tumor (n = 18) than in the primary tumor (n = 36) and normal liver tissue (n = 18) (p < 0.001). No significant correlation was found between type IV collagenase activities in the tumor and serum IV 7-S levels. Colorectal cancer patients with hepatic metastasis (n = 26) had significantly higher serum IV 7-S levels than those without hepatic metastasis (n = 50) (p < 0.001). Moreover, serum IV 7-S levels correlated significantly with hepatic metastatic tumor volume in patients with synchronous (r = 0.719, p < 0.001, n = 26) and in patients with metachronous (r = 0,910, p < 0.001, n = 16) hepatic metastasis. Conclusion: We suggest that serum IV 7-S levels may increase in hepatic metastasis, not by the degradation of type IV collagen in the primary and secondary tumors, but by the enhanced production of type IV collagen responsive to hepatic metastasis. The measurement of serum IV 7-S levels might be a useful tumor marker of hepatic metastasis reflecting hepatic metastatic tumor volume. [ABSTRACT FROM AUTHOR]

The purpose of this prospective study was to evaluate the prognostic value of the type IV collagenase (IVase) activity in colorectal cancer tissue on disease-free and overall survival in 31 colorectal cancer patients. The clinicopathologic factors studied for prognostic value were age, tumor location, tumor differentiation, preoperative serum levels of carcinoembryonic antigen, Dukes' stage, and IVase activity in colorectal cancer tissue. IVase activities in colorectal cancer tissue were significantly higher in the group of patients with recurrences than in the group without recurrences (P = 0.019). Patients with high IVase activity in colorectal cancer tissue had a significantly shorter disease-free survival (P = 0.0016) and overall survival (P = 0.022) time than those with low IVase activity. Univariate and multivariate analysis showed that significant prognostic factors for disease-free survival were Dukes' stage (P = 0.029, P = 0.046, respectively) and IVase activity status (P = 0.0016, P = 0.0026, respectively). With respect to overall survival, only IVase activity status provided significant predictive value in multivariate analysis (P = 0.041). This prospective study suggests that IVase activity is a valuable prognostic factor in colorectal cancer patients. [ABSTRACT FROM AUTHOR]

To avoid intraabdominal abscess and biliary fistula, which may lengthen hospital stay or result in lethal complications after major hepatic resection, it is important to control postoperative bleeding and bile leakage. We employed a technique for preventing postoperative bleeding and bile leakage, using omental packing with fibrin glue for the transected surface of the remnant liver after hepatic resection. This procedure was employed in 50 patients who underwent major hepatic resection. There was no postoperative bleeding or biliary fistula, and drain tubes were removed within 5 days in all patients. Omental packing with fibrin glue could be a very useful procedure of preventing postoperative biliary fistula, bleeding, and abscess after major hepatic resection. [ABSTRACT FROM AUTHOR]