Search

Background Omega-3 fatty acids (FAs) have been shown to reduce experimental hepatic steatosis and protect the liver from ischaemia-reperfusion injury. The aim of this study was to examine the effects of omega-3 FAs on regeneration of steatotic liver. Methods Steatosis was induced in rats by a 3-week methionine/choline-deficient diet, which was continued for an additional 2 weeks in conjunction with oral administration of omega-3 FAs or saline solution. Steatosis was graded histologically and quantified by proton magnetic resonance spectroscopy (1H-MRS) before and after the diet/treatment. Liver function was determined by 99mTc-labelled mebrofenin hepatobiliary scintigraphy (HBS). In separate experiments, the hepatic regenerative capacity and functional recovery of omega-3 FA-treated, saline-treated or non-steatotic (control) rats were investigated 1, 2, 3 and 5 days after partial (70 per cent) liver resection by measurement of liver weight change and hepatocyte proliferation (Ki-67) and HBS. Results Severe steatosis (over 66 per cent) in the saline group was reduced by omega-3 FAs to mild steatosis (less than 33 per cent), and hepatic fat content as assessed by 1H-MRS decreased 2·2-fold. 99mTc-mebrofenin uptake in the saline group was more than 50 per cent lower than in the control group, confirming the functional effects of steatosis. 99mTc-mebrofenin uptake and regenerated liver mass were significantly greater in the omega-3 group compared with the saline group on days 1 and 3. The posthepatectomy proliferation peak response was delayed until day 2 in saline-treated rats, compared with day 1 in the omega-3 and control groups. Conclusion Omega-3 FAs effectively reduced severe hepatic steatosis, which was associated with improved liver regeneration and functional recovery following partial hepatectomy. [ABSTRACT FROM AUTHOR]

Purpose: This is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE).Methods: A systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases.Results: Forty-four articles were selected, including 1,791 patients with a mean age of 61 ± 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 ± 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy.Conclusions: Preoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used. [ABSTRACT FROM AUTHOR]

Background: Preoperative portal vein embolization (PVE) is performed in patients with insufficient future remnant liver (FRL) to allow safe resection. Although many studies have demonstrated an increase in FRL volume after PVE, little is known about the increase in FRL function. This study evaluated the increase in FRL function after PVE using 99mTc-labelled mebrofenin hepatobiliary scintigraphy (HBS) with single photon emission computed tomography (SPECT) and compared this with the increase in FRL volume. Methods: In 24 patients, computed tomography volumetry and 99mTc-labelled mebrofenin HBS with SPECT were performed before and 3-4 weeks after PVE to measure FRL volume, standardized FRL and FRL function. A hypothetical model was used to assess safe resectability after PVE. The limit for safe resection for FRL function was set at an uptake of 2.69 per cent per min per m². For FRL volume and standardized FRL, 25 or 40 per cent of total liver volume was used, depending on the presence of underlying liver disease. Results: After PVE, FRL function increased significantly more than FRL volume. The correlation between the increase in FRL volume and FRL function was poor. Using the hypothetical model, seven patients did not achieve a sufficient increase in FRL function to allow safe resection 3-4 weeks after PVE, compared with 12 and nine patients based on FRL volume and standardized FRL respectively. Conclusion: The increase in FRL function after PVE is more pronounced than the increase in FRL volume, suggesting that the necessary waiting time until resection may be shorter than indicated by volumetric parameters. [ABSTRACT FROM AUTHOR]

Background: Mucinous cystadenomas of the liver are rare cystic neoplasms. The aim of this study was to assess management of a consecutive series of patients who underwent laparotomy for a suspected cystadenoma or cystadenocarcinoma. Secondly, the origin of ovarian stroma (OS) in mucinous liver cystadenomas was examined during early embryonic development. Patients and Methods: Patients diagnosed with mucinous liver cystadenomas or cystadenocarcinoma between 1994 and 2009 were included. Pathology specimens of patients who had undergone resection were reviewed for OS. Furthermore, in human embryos, morphology of the peritoneal epithelium and the position of the gonads in relation to the embryonic liver, pancreas and spleen were examined. Results: 15 surgically treated patients (13 female, 2 male) with hepatic tumors were eventually diagnosed with mucinous liver cystadenomas (12) or cystadenocarcinomas (3). OS was present in all female patients with mucinous cystadenoma or cystadenocarcinoma. The 2 male patients were rediagnosed as intraductal papillary mucinous neoplasm (IPMN) or cystadenocarcinoma with features of IPMN. In human embryos, preceding their ‘descent’, the gonads are situated directly under the diaphragm, dorsal to the liver, the tail of the pancreas and the spleen, but separated from these organs by the peritoneal cavity. In contrast to the peritoneal epithelium elsewhere, the cells covering the gonads show an activated morphology. Conclusion: For the diagnosis of mucinous liver cystadenoma, the presence of OS is prerequisite. This may be explained by the common origin of cystadenoma and OS in epithelial cells that cover the embryonic gonads in early fetal life. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The atricle presents a study on the effectiveness of a pulsatile machine perfusion combined with Polysol® to preserve warm ischaemia-damaged kidney grafts using swine autotransplantation models. The study compares the cold storage (CS) preservation of kidney grafts using histidine-tryptophan-ketoglutarate (HTK) or Polysol® and machine preservation (MP) with Polysol® (MP-PS). Results show that grafts subjected to MP-PS and CS-PS have improved renal function of the models.

Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center. Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the “goodness-of-fit” with the linear analysis method. Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM ( P < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07–2.80). Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectomy. [ABSTRACT FROM AUTHOR]