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A rapid and accurate new bedside test to assess maximal liver function: a case report.

Authors :
Müller, Sascha A.
Tarantino, Ignazio
Corazza, Marcello
Pianka, Frank
Fornaro, Jürgen
Beutner, Ulrich
Lüthi, Cornelia
Schmied, Bruno M.
Source :
Patient Safety in Surgery; 2013, Vol. 7 Issue 1, Special section p1-4, 4p
Publication Year :
2013

Abstract

Background: In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As posthepatectomy liver failure is a major cause of mortality, a new and simple bedside test (LiMAx) has been developed to predict postoperative liver function in conjunction with preoperative volumetric analysis of the liver. Case presentation: A 45-year-old patient presented with a cecal carcinoma and a large synchronous liver metastasis for major liver surgery. Liver function was determined by the LiMAx-test for the enzymatic capacity of cytochrome P450 1A2, which is ubiquitously and solely active in the liver. A solution of 2 mg/kg body weight 13C-labeled methacetin was injected as a bolus into an intravenous catheter and, thereafter, was metabolized into acetaminophen and 13CO2 and pulmonarily exhaled. The analysis of the 13CO2/12CO2 ratio was performed using online breath sampling over a period of maximally 60 minutes. Based on this test, a value of more than 315 μg/kg/h represents normal liver function. A laparoscopic right hemihepatectomy was planned during virtual resection with a residual liver volume of 48% and a preoperative anticipated residual LiMAx of 301 μg/kg/h. After successful resection, the initial postoperative LiMAx value was 316 μg/kg/h, indicating good liver function and a correct prediction of the outcome. Conclusion: In the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry. This test might significantly improve preoperative evaluation and postoperative outcomes in liver surgery. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17549493
Volume :
7
Issue :
1
Database :
Complementary Index
Journal :
Patient Safety in Surgery
Publication Type :
Academic Journal
Accession number :
87456942
Full Text :
https://doi.org/10.1186/1754-9493-7-11