Novel Noninvasive Paraclinical Study Method for Investigation of Liver Diseases.

Based on a prior university patent, the authors developed a novel type of bioimpedance-based test method to noninvasively detect nonalcoholic fatty liver disease (NAFLD). The development of a new potential NAFLD diagnostic procedure may help to understand the underlying mechanisms between NAFLD and severe liver diseases with a painless and easy-to-use paraclinical examination method, including the additional function to detect even the earlier stages of liver disease. The aim of this study is to present new results and the experiences gathered in relation to NAFLD progress during animal model and human clinical trials.

The Effect of Trimetazidine on Diathermy-related Thermic Injury of the Rat Liver.

BACKGROUND/AIM: Owing to new oncotherapy modalities, the importance of an R0 resection decreased in the last decade; however, liver metastasis of colorectal cancer significantly decreases survival. Furthermore, to prevent cardiovascular disease, more and more patients are treated with anti-ischemic drugs, which may influence oncologic treatments in such patients. This study aimed to examine the effect of Trimetazidine on liver surface injury after spray diathermy. MATERIALS AND METHODS: We performed standard liver resections with resection-margin spray coagulation in 36 rats on both liver lobes. In all procedures, a Pringle maneuver was performed on the right lobe, while on the left lobe, no vessel occlusion was applied. Half of the animals were on Trimetazidine therapy. In 12 animals, histologic samples were taken immediately after operation, while 12 animals were terminated 1 week later, and the remaining 12 animals 3 weeks later. After standard HE staining, histologic analysis was performed. RESULTS: When diathermy was used, a coagulation zone appeared. Destruction was slightly wider in case of Trimetazidine therapy (745.75 vs. 680.04 µm). In cases of 1-week-surviving animals, a necrotic zone was observed under the coagulated tissue, and a fibrotic zone appeared after 3 weeks. In TMZ medicated animals, the destruction zone was significantly thinner (645.08 vs. 893.76 µm; p<0.001) and the necrosis zone showed the same difference (2,430.05 vs. 3,238.45 µm; p<0.001). CONCLUSION: Administration of Trimetazidine can reduce the extent of thermic necrosis. Furthermore, a great effort should be applied to achieve R0 resection in patients on anti-ischemic therapy.

Short- and Long-term Histological Changes in Liver Parenchyma After Different Resection Methods and Their Potential Role in Treatment of Colorectal Liver Metastasis.

BACKGROUND/AIM: Optimal surgical margins, parenchymal-sparing technique and the effect of the surgical devices on the liver resection surface are currently hot topics. The aim of this study was to set up a surviving animal model to detect histological changes on the resection surface induced by the resection method and the thermal effect of monopolar electrocautery in 'spray mode'. MATERIALS AND METHODS: Eighteen male Wistar rats were used; all rats were subjected to standardized liver resection and resection surface coagulation. Resection surface samples were collected immediately after the operation from the first group, and at 1 week and 3 weeks after the operation from the second and third groups, respectively. The samples were histologically investigated. RESULTS: Spray diathermy was shown to cause parenchymaI destruction of varying depth on the resection surface due to immediate coagulation and consequent necrosis. CONCLUSION: Spray diathermy on the resection surface can also destroy the area that contains possible tumor cells after R1 resection and increases the tumor clearance without worse survival outcomes.

The Issue of Survival After Colorectal Liver Metastasis Surgery: Parenchyma Sparing vs. Radicality.

BACKGROUND/AIM: Nowadays, obtaining optimal surgical margin of the resected metastasis and the parenchyma- sparing surgical technique are a great challenge for hepatic surgeons. The aim of this follow-up study was to investigate the prognostic value of the surgical margin and the parenchyma- sparing liver resection technique. PATIENTS AND METHODS: We performed a retrospective analysis of the data of 319 patients [123 (36.6%) female and 196 (61.4%) male] who had colorectal cancer and underwent surgery to treat colorectal liver metastases in our Department between 2005 and 2014. RESULTS: The most commonly used resection type was the non-anatomic resection (43%). Multivariate analysis indicated that there was no significant difference in survival (p=0.473) between the microscopically-negative (R0) and microscopically-positive (R1) resections, as well as between the resection types (p=0.257). CONCLUSION: Parenchymal-sparing non-anatomic resection and spray diathermy on the resection surface of the liver should be applied not only for hemostasis, but also to destroy the area containing possible tumor cells after an R1 resection and not to have worse survival outcomes.

[Rare bile duct anatomy variant - Right bile duct intraparenchymal junction into the left bile duct]. / Az epeutak ritka anatómiai variánsa − A jobb ductus hepaticus intraparenchymalis csatlakozása a bal oldali ductus hepaticusba.

The authors present a case of a 67-year-old male patient, who previously had been diagnosed with a malignant liver tumor localized in segment II. He underwent bisegmentectomy (II and III) and partial IV segmentectomy. After the primary surgery jaundice developed, the level of bilirubin increased and after several imaging modalities reoperation was indicated. During the surgery a rare bile duct anatomy variant was found. The right hepatic duct joined the left duct in the parenchyma of the left lobe, and was ligated at the resection. As the liver hilum was not explored, the absence of the right duct was not discovered. Reconstruction of the biliary system was accomplished by a Roux-en-Y loop.

[Acute appendicitis in a patient with perianal Crohn's disease receiving infliximab]. / Infliximabterápia mellett kialakuló appendicitis perianalis Crohn-betegben.

The differential diagnosis of acute abdominal complaints is challenging in Crohn's disease. This is particularly true in patients in remission induced by biological therapy. In addition to the acute relapse of Crohn's disease, other common causes, such as acute appendicitis exhibiting similar and often atypical course, should be taken into consideration irrespective of the age. An ileocecal flare-up is unlikely to occur in patients with perianal Crohn's disease in remission induced by infliximab even if laboratory and radiological findings point towards this diagnosis. We report the case of a middle-aged woman in remission induced by infliximab who developed acute abdominal symptoms due to perforated appendicitis. Orv Hetil. 2018; 159(10): 405-409.

[Resection of liver and abdominal wall metastasis 11 years after pancreatoduodenectomy. Case report]. / Metasztázis miatt végzett máj- és hasfalreszekció 11 évvel a pancreatoduodenectomia után.

Pancreatic cancer has adverse prognosis. Disease recurrence is typical and it occurs mainly within the first 2 years postoperatively. However late and soliter metastases are rare. This case report shows the history of a male patient, who was radically operated on for pancreatic cancer. 11 years later a solitary liver metastasis has developed and it was completely removed by resection. 1 year postoperatively the patient is doing well. Our case demonstrates that in patients after resection for pancreatic cancer, redo surgery might be justified in case of late and isolated metastasis. Orv Hetil. 2017; 158(28): 1109-1111.