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  • 1
    ISSN: 1432-2307
    Keywords: Key words Foci of altered hepatocytes ; Liver cell dysplasia ; Liver cirrhosis ; Hepatocellular carcinoma ; Proliferating cell nuclear antigen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Foci of altered hepatocytes (FAH) represent preneoplastic lesions, as shown in various animal models of hepatocarcinogenesis, but their significance in the human liver has not been established. The cellular composition, size distribution and proliferation kinetics of FAH in 163 explanted and resected human livers with or without hepatocellular carcinoma (HCC) and their possible association with small-cell change of hepatocytes (SCC) were therefore studied. FAH, including glycogen-storing foci (GSF), mixed cell foci (MCF) and basophilic cell foci, were found in 84 of 111 cirrhotic livers, demonstrating higher incidences in cases with (29/32) than in those without HCC (55/79). FAH were observed more frequently in HCC-free cirrhosis associated with hepatitis B or C virus or chronic alcoholic abuse (high-risk group) (37/47) than in that due to other causes (low-risk group) (12/21). MCF, predominant in cirrhotic livers of the high-risk group, were more proliferative, larger and more often involved in formation of nodules of altered hepatocytes (39.3%) than were GSF (8.5%). The results suggest that the FAH are preneoplastic lesions, MCF being more advanced than GSF. Oncocytic and amphophilic cell foci were also observed, but their significance remains to be clarified. Two types of SCC, namely diffuse and intrafocal SCC, were identified, but only intrafocal SCC was found to be related to increased proliferative activity and more frequent nodular transformation of the FAH involved, suggesting a close association with progression from FAH to HCC.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Dans cet article, on décrit comment un score de facteurs de risques, aide à décider si un patient présentant des signes d'insuffisance hépatique après transplantation hépatique doit être traité ou si on doit envisager une retransplantation immédiate. Sur 78 patients ayant subi une première transplantation hépatique, 25 ont présenté des signes de rejet du transplant et ont demandé des explorations complémentaires. Neuf patients présentaient un problème initial irréversible; deux sont morts avant qu'une deuxième greffe soit envisagée; sept ont subi une retransplantation avec trois survivants à long terme. Chez les 16 autres patients, les lésions initiales étaient réversibles et ils ont survécu sans réopération. Puisque la retransplantation en case de non fonctionnement initial est couronnée de succès seulement si elle est pratiquée dans les premiers jours postopératoires, il est urgent de savoir si les lésions sévères sont irréversibles. Nous avons élaboré un système de score qui identifie et mesure les facteurs susceptibles de laisser prévoir si les lésions sont irréversibles. Les paramètres importants sont les transaminases, le volume de bile recueilli au drainage, la pente des enzymes LDH, la quantité de sang et de plasma frais nécessaire le jour de l'opération et le lendemain. L'analyse de régression logistique a donné un score numérique qui s'applique à un arbre décisionnel apportant des probabilités et des indications sur la reprise opératoire. Nous utilisons le système de score et nous pensons qu'il aide à prendre des décisions dans la période post-transplantation.
    Abstract: Resumen Este artículo describe como un sistema de calificación de factures de riesgo contribuye a la toma de decisión sobre si un paciente con signos de falla hepática en el período inmediato posttrasplante de hígado debe ser tratado en forma expectativa o debe ser sometido a retrasplante urgente. De 78 adultos receptores de un primer trasplante hepático, 25 presentaron evidencia de severa alteración, por lo cual fueron investigados más a fondo. Nueve presentaron ausencia de función inicial de tipo irreversible y 2 murieron antes de poder lograr un segundo trasplante; 7 fueron retrasplantados, con 3 sobrevivientes a largo plazo. Los otros 16 pacientes exhibieron severa alteración, pero reversible, y pudieron sobrevivir sin retrasplante. Puesto que el retrasplante por ausencia de función inicial es exitoso sólo cuando se realiza en los primeros días postoperatorios, surge una necesidad urgente de identificar si el daño hepático es de severidad irreversible. Hemos ideado un sistema de calificación que logró identificar y evaluar aquellos factores que permiten predecir la irreversibilidad. Las determinaciones de mayor pertinencia son las transaminasas, el volumen de bilis, la curva del nivel de la enzima GLDH, y las cantidades de sangre fresca y plasma fresco congelado requeridas como soporte en el día de la operación y en el día siguiente. El análisis logístico de regresión produjo una calificación numérica que aplicada a un esquema o árbol de flujo para la toma de decisiones indica probabilidades y utilidades sobre qué tan aconsejable es la reoperación. Hemos utilizado este sistema de calificación y creemos que es de ayuda para la toma de decisiones en el período inmediato posttrasplante.
    Notes: Abstract This article describes how a system of scoring risk factors contributes to deciding whether a patient showing signs of liver failure soon after hepatic transplantation should be treated expectedly or should undergo immediate retransplantation. Of 78 adult patients receiving a first liver graft, 25 had evidence of severe damage of the graft and were further investigated. Nine had failure due to irreversible initial nonfunction, and 2 of the 9 died before a second graft was available. Seven were retransplanted with 3 long-term survivors. The other 16 patients showed reversible severe damage and survived without retransplantation. Since retransplantation for irreversible initial nonfunction is successful only in the first postoperative days, there is an urgent need to identify the degree of the observed damage. We devised a scoring system which identified and weighted factors that were predictable in determining irreversibility. Measurements of highest relevance are transaminases, bile volume, the slope of the enzyme GLDH, and the amount of fresh blood and fresh-frozen plasma required for support on the day of operation and the following day. Logistic regressional analysis produced a numerical score which was applied to a decision tree and produced probabilities and utilities to indicate whether reoperation is advisable. We use this scoring system and believe it assists our decisions in the early posttransplant period.
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  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La gamme thérapeutique de l'hémorragie par rupture de varices oesophagiennes comprend des mesures les unes conservatrices et les autres chirurgicales. Avant d'envisager la transplantation comme un moyen potentiellement curateur de l'étiologie sousjacente, les interventions visant la décompression du système portocave restent l'essentiel de l'arsenal thérapeutique palliatif. Notre expérience dans le traitement des maladies hépatiques avancées et de l'hypertension portale sur ces 20 dernières années comporte 803 transplantations hépatiques et 201 anastomoses portocaves, mettant l'accent sur nos objectifs de traitement primaire des maladies hépatiques Les résultats des anastomoses sont favorables lorsqui'il s'agit d'anastomose de décompression sélective, réalisée électivement, chez les patients du stade Child A. Après transplantation, hépatique, l'état clinique du patient, sa fonction hépatique, et la survenue de complications extrahépatiques ont fortement influencé l'évolution à court et à long terme. Avec l'expérience le risque supplémentaire encouru par une chirurgie de décompression antérieure est réduite. D'après notre expérience et la littérature, il existe des arguments en faveur des deux formes de traitement, qui, en fait, sont complémentaires. Les deux modalités devraient être idéalement disponibles dans le même centre traitant des patients ayant une maladie susceptible d'évoluer soit vers une insuffisance hépatique ou une hypertension portale. La sélection d'un ou de l'autre des procédés dépend de l'étiologie, du stade de la maladie, et du moment évolutif où la thérapeutique se discute. Les anastomoses portocaves sont indiquées plutôt chez le patient stable ayant un risque d'hémorragie après sclérothérapie, en cas de contreindication ou en attendant la transplantation. Le rôle de la transplantation est bien établi chez le patient ayant une maladie hépatique évolutive ou terminale, autrement incurable.
    Abstract: Resumen El manejo de la hemorragia por várices esofágicas va desde una modalidad conservadora hasta la intervención quirúrgica. Antes de la introducción del trasplante de hígado como una forma de terapia potencialmente curativa de la causa etiológica primaria, las operaciones de descompresión porta-sistémicas eran la modalidad de preferencia entre los procedimientos quirúrgicos fundamentalmente paliativos. Nuestra propia experiencia con la cirugía en pacientes con enfermedad hepática avanzada e hipertensión portal en más de 20 años, incluye 803 trasplantes hepáticos y 201 “shunts’ porta-sistémicos. Los resultados de los “shunts” fueron favorables en pacientes Child A, cuando fueron realizados en forma electiva y fueron del tipo de la descompresión selectiva. Luego de trasplante hepático, el estado clínico, del paciente, incluyendo la función hepática y las complicaciones extrahepáticas, demostró tener una fuerte influencia sobre el resultado postoperatorio, con excelente posibilidad de sobrevida a largo plazo. Se ha logrado reducir el riesgo adicional que representa un “shunt” realizado con anterioridad al trasplante. Nuestra experiencia y los informes de otros autores constituyen suficiente y razonable argumentación en favor de la cirugía derivativa (“shunts”) y trasplante. En vez de plantear controversia, se considera que estas dos modalidades terapéuticas son complementarias.
    Notes: Abstract The management of esophageal variceal hemorrhage ranges from conservative to surgical modalities. Before introduction of liver transplantation as a potentially curative therapy of the underlying etiology, decompressive portosystemic shunt operations have been the mainstay of mostly palliative procedures Our own experience with surgery for advanced hepatic disease and portal hypertension over 20 years includes 803 liver transplantations and 201 portosystemic shunts, emphasizing our primary objective of treatment. The results after shunt surgery were favorable in Child class A candidates when performed electively and with selective decompression. After liver replacement the clinical status of the patient, including hepatic function and extrahepatic complications, had a strong influence on postoperative outcome, with the chance of excellent long-term survival. The additional risk of previous shunt surgery for subsequent transplantation could be reduced over time. Based on this experience and reports from others there are enough reasonable arguments for shunt and transplantation. Instead of the choice being controversial, the two forms of therapy should supplement each other and be available in the same center that specializes in the treatment of patients with diseases that eventually lead to liver failure and portal hypertension Selection of either approach must depend on etiology, stage of the disease, and proper timing. Shunt procedures may be indicated in stable patients with the risk of bleeding after sclerotherapy failure, in those with contraindications to transplantation, or as a bridge to transplantation. The role of liver transplantation has been clearly established in patients with progressive or endstage (otherwise intractable) hepatobiliary disease.
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  • 4
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. There are several theories about the physiologic regeneration of adrenals and maintenance of physiologic steroid secretion after subtotal loss of adrenal cortical cells. According to the cell migration theory, adrenocytes from the zona glomerulosa migrate centripetally toward the medulla. This theory is opposed by the zonal theory according to which each zone resplenishes its cells independently. What these theories have in common is that they are based on data from the intact adrenal gland. We transplanted purified glomerulosa cells under the kidney’s capsule of Lewis rats. The tissue was removed 30, 60, 90, and 150 days after transplantation to investigate the presence of two specific enzymes that are responsible for the secretion of aldosterone and corticosterone. Cytochrome p-450as is specific for glomerulosa cells producing aldosterone, and cytochrome p-45011β is specific for fasciculata cells producing corticosterone. After sequencing the genetic code of these enzymes it became possible to demonstrate expression of the enzymes by in situ hybridization. The transplanted glomerulosa cells turned their enzymatic property to fasciculata cells expressing cytochrome p-45011β. Our results suggest that glomerulosa cells are able to take over the physiologic function of a whole adrenal cortex in the absence of fasciculata cells, and that they are sufficient to maintain the function of the adrenal cortex.
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 8 (1984), S. 344-345 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 15 (1991), S. 520-521 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1432-2277
    Keywords: Liver transplantation, chronic rejection ; Rejection, liver transplantation ; Viral infections, liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this retrospective study, we have investigated the early intragraft inflammatory events of 12 liver allografts leading to chronic rejection. The cytological findings and clinical follow-up were analyzed in detail. Nine patients underwent at least one typical lymphoid activation of acute rejection, and three of them were treated more than once. Diagnosis of rejection was based on biopsy histology, cytology and liver dysfunction. In addition to the acute rejections, cytological analysis demonstrated in 11 of 12 grafts an unidentified lymphoid episode that differed from that of rejection. These lymphoid responses were associated with viral infections; cytomegalovirus (CMV) infection in 10 of 12 patients, hepatitis C virus (HCV) infection in 2 of 12 patients, 1 combined with CMV, and hepatitis B virus (HBV) infection in 1 patient. Graft dysfunction was still seen at the end of the follow-up. Thus, intragraft inflammation caused either by acute rejection or by viral infections may be involved in the induction of chronic rejection.
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  • 8
    ISSN: 1432-2277
    Keywords: Liver transplantation, primary nonfunction, tissue oxygen saturation, near-infrared spectroscopy ; Tissue oxygen consumption, sinusoidal shunt
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study investigated the pathophysiology of primary nonfunction (PNF) of grafted livers with regard to hepatic tissue oxygenation. Hemoglobin oxygen saturation in hepatic tissue (H−So 2) after reperfusion was determined using near-infrared spectroscopy. Graft tissue oxygen consumption was also estimated according to Fick's principle. Six grafts with PNF were compared with 40 functioning grafts. One PNF graft with extremely low and heterogenous H−So 2 after reperfusion was found to contain multiple intrahepatic portal thrombi. However, five other PNF grafts showed no lower and, on the contrary, more homogeneous H−So 2 at the end of the operation. As a whole, mean H−So 2 was negatively correlated and the coefficient of variation (CV) of H−So 2 was positively correlated with graft tissue oxygen consumption at the end of the operation; grafts whose H−So 2 showed a secondary decrease had better initial function. In later relaparotomy, the H−So 2 of the five PNF grafts was significantly higher and more homogeneous than that of the functioning grafts. These results suggest that the H−So 2 level reflects tissue oxygen consumption as well as oxygenation, and that the dissociation of both factors can occur in hepatic graft reperfusion. Not only low and heterogeneous H−So 2 but also high and homogenous H−So 2, suggesting some shunt mechanism, can be signs of poor graft function.
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  • 9
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The differential diagnosis for hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma may be difficult. Reliable diagnosis is mandatory for the decision of whether to apply surgery or observation. Experience with long-term observation in nonoperated patients with hemangioma and FNH is limited. A group of 437 patients from a single institution were analyzed with regard to a diagnostic algorithm, the indications for surgery, and observation. There were 238 hemangiomas, 150 cases of FNH, 44 adenomas, and 5 mixed tumors. Of the 437 patients, 173 underwent surgery; 103 with hemangioma and 54 with FNH were observed at our own institution, whereas 117 patients underwent follow-up elsewhere or were lost. Among the operated patients with confirmed histology, a good diagnostic yield was found for a combination of ultrasonography (US), contrast (bolus)-enhanced computed tomography (CT), and labeled red blood cell (RBC) scanning: sensitivity 85.7%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 81.8%, and accuracy 91.3%. For FNH the combination of US and CT plus cholescintigraphy showed a sensitivity 82.1%, specificity 97.1%, PPV 95.8%, NPV 84.6%, and accuracy 90.3%. Surgical mortality was 0.6%. Observation of patients with hemangioma and FNH for a median of 32 months revealed no increase in tumor size in 80% and a decrease in fewer than 7%. There was no tumor rupture and no evidence of malignant transformation. We concluded that liver hemangioma and FNH can be differentiated from adenoma with high sensitivity, specificity, and accuracy by labeled RBC scanning and cholescintigraphy in combination with US and contrast-enhanced CT. In the case of symptoms or an equivocal diagnosis with respect to adenoma or hepatocellular carcinoma, surgery can be performed with very low risk. Because in asymptomatic patients with observed hemangioma or FNH no increase of tumor size can be expected for many years, the indications for surgery must be carefully evaluated.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 6 (1982), S. 93-97 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La vagotomie tronculaire par voie thoracique a été employée pour traiter 47 cas d'ulcère peptique post opératoire. Chez 24 malades les risques d'une voie d'abord abdominale étaient importants en raison des ré-interventions qu'avaient déjà subi les patients pour des récidives due à l'intensité de la maladie ulcéreuse. Ainsi 17 opérés avaient subi une nouvelle résection, 4 deux résections successives, 1 une résection avec vagotomie simultanée. Après vagotomie tronculaire trans thoracique aucun décès ne fut à déplorer et les complications locales ne furent jamais importantes. La cicatrisation de l'ulcère peptique post opératoire fut atteinte en moins de 3 mois chez 46 opérés, chez un seul malade l'ulcère persista 5 mois mais cicatrisa ensuite sous l'effet de la cimétidine. La cicatrisation fut mÊme obtenue dans 6 cas où l'antre avait été conservé. Cependant 3 malades présentent des troubles d'évacuation du réservoir gastrique, troubles qui persistent chez l'un d'entre eux seulement. 37 opérés ont été suivis plus de 10 ans, 31 par l'opérateur à l'aide de la gastroscopie, 6 par le médecin de famille. Aucun n'a présenté de récidive. Sur lespremiers et en se reférant à la classification de Visick, 27 entrent dans les groupes I et II, 4 dans le groupe III. Sur les 4 opérés du groupe III, 2 présentent des troubles inhérents à la vagotomie, 1 accuse un syndrome de dumping et de la diarrhée qu'il est facile de contrÔler par les moyens médicaux.
    Notes: Abstract Transthoracic truncal vagotomy for anastomotic ulceration was performed in 47 patients. In 24 cases, the risk for any procedure requiring a transabdominal approach was considered high because of the presence of multiple risk factors, the majority of which involved complicated prior laparotomies. The high virulence of the underlying ulcer diathesis was demonstrated by the number of previous unsuccessful reresections. In 17 patients 1 reresection; in 4 patients 2 reresections; and in 1 patient a reresection plus abdominal vagotomy had failed. No mortality and only minor local complications were observed after thoracic vagotomy. Within 3 months ulcer healing was found in 46 patients. In 1 patient the ulcer persisted for 5 months, then healed under additional cimetidine treatment. Uniform healing was also achieved in 6 cases of retained gastric antrum. Complaints of gastric outlet obstruction resolved in 3 patients and persisted in one. Thirty-seven patients were followed for up to 10 years: 31 personally, with gastroscopy in 26; 6 were followed by their house physicians. In no case was ulcer recurrence detected. Visick grading of those 31 patients reexamined in the clinic showed 27 in groups I and II, 4 in III, none in IV. Of the complaints requiring a classification as Visick III, only 2 syndromes are a direct consequence of cutting the vagus at the truncal level; these are 1 case each of moderate diarrhea and dumping, both controlled by conservative measures. Thus thoracic vagotomy has proven to be a low-risk procedure as well as a potent therapy for anastomotic ulceration. The morbidity seems acceptable. We recommend this method for standard surgical treatment for anastomotic ulcer in place of any transabdominal procedure.
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