Determining standard liver volume: assessment of existing formulae in Indian population.

BACKGROUND: With the increasing numbers of living-related donor liver transplantation, accurate means of calculating standard liver volume (SLV) based on patient body indices becomes important. Three formulae reported in literature for this purpose have been derived from studies on Western and Japanese populations. AIM: To assess the existing formulae for calculation of SLV in Indian population. METHOD: Total liver volume (TLV) of 238 patients was measured using axial helical CT images obtained for conditions unrelated to the hepatobiliary system. Body surface area (BSA) was calculated from height and weight. Measurements obtained using CT were compared with the SLV calculated based on the previously reported formulae. RESULTS: Though there was significant difference (p< 0.001) between the TLV obtained by CT and the SLV calculated using the three formulae, they also showed good agreement. On an average the formula derived from the Japanese population underestimated the SLV by 63 (202) cc (p< 0.001). Regression models for SLV (SLV = 243 + [186 x BSA] + [11.4 x Weight], SLV = 375.23 + [14.24 x body weight], SLV = -204.092 + [874.461 x BSA]) were derived from the data obtained from our population. Age and gender had no effect on the SLV. CONCLUSIONS: Formulae derived from Japanese population for calculation of SLV is not suitable for the Indian population. The newly described formulae may prove useful in the Indian population.

Direct intrahepatic cavo-portal shunts in Budd-Chiari syndrome: Role of simultaneous fluoroscopy and trans-abdominal ultrasonography.

BACKGROUND: Transjugular intrahepatic porto-systemic shunt (TIPS) for Budd-Chiari syndrome (BCS) can be inserted from inferior vena cava or hepatic vein to portal vein. The former is performed when hepatic veins are not suitable and is technically more challenging. METHODS: In this retrospective study, 7 patients with chronic BCS needed cavo-portal shunt as hepatic veins were neither amenable to plasty nor provided access for TIPS placement. Simultaneous fluoroscopic and trans-abdominal ultrasound guidance was used at the time of portal vein puncture. RESULTS: Technical success and clinical improvement were obtained in all patients. Median 3 (range 1-4) attempts were needed to puncture the portal vein. There were no significant complications. Uncovered stents were used in six patients and stent occlusion was common, but could be managed by re-intervention. CONCLUSION: Cavo-portal shunt is an effective technique for patients with BCS uncontrolled by medical therapy. Additional trans-abdominal ultrasound in oblique parasagittal plane keeps the procedure safe.

Primary lymph node gastrinoma in jejunal mesentery.

Primary gastrinomas have been reported in lymph nodes within the gastrinoma triangle. We report a 56-year-old woman with possible primary lymph node gastrinoma in the jejunal mesentery. Six months after excision of the tumor, she is asymptomatic and serum gastrin level is normal.

Retroperitoneal leiomyosarcoma infiltrating the inferior vena cava (IVC)--a case report.

Retroperitoneal soft tissue sarcomas are difficult to treat because the retroperitoneal organs and great vessels are often involved by the time the patients come to a surgeon. We present the case of a 48 year old woman with a retroperitoneal leiomyosarcoma that had infiltrated the IVC and the renal veins.

Autoimmune pancreatitis--an uncommon type of chronic pancreatitis.

Autoimmune pancreatitis is a recently recognized clinical entity characterized by narrow strictured main pancreatic duct on ERCP, diffusely enlarged sausage-shaped pancreas on CT scan and MRI, seropositivity for antinuclear antibodies, hypergammaglobulinemia, and excellent response to steroids. We report a 25-year-old man and a 53-year-old man with this condition.