ABSTRACT
In 21 patients resected for gastric or esophageal malignancy an aberrant left hepatic artery from the left gastric artery was found. The study shows that in systematic lymphadenectomy ligation of the left gastric artery distally from the origin can safely preserve an aberrant hepatic artery without impairment of oncological quality. Related to a control group no difference in the number of resected lymph-nodes and the operation time was observed. Postoperatively there was no problem concerning liver function and surgical morbidity. In real-time sonography the aberrant artery could be postoperatively seen precisely in 19%, but duplex signal was found in 63%. Limited visualization in sonography may be caused by technical problems due to anatomy and overlying air from small-bowel reconstruction after gastrectomy.
Subject(s)
Carcinoma/surgery , Esophageal Neoplasms/surgery , Gastrectomy/methods , Hepatic Artery/abnormalities , Hepatic Artery/surgery , Leiomyosarcoma/surgery , Lymph Node Excision/methods , Stomach Neoplasms/surgery , Stomach/blood supply , Aged , Female , Humans , Liver Function Tests , Male , Middle Aged , Postoperative Complications/diagnosisABSTRACT
Orthotopic liver transplantation had been performed in 1983 in a now 40-year-old woman in the terminal stage of posthepatitis liver cirrhosis with recurrent oesophageal bleedings and precoma from complete liver-cell failure. She became pregnant in 1988 while under immunosuppression with cyclosporin (2.1-2.7 mg/kg body-weight) and prednisolone (5 or 7.5 mg daily in rotation). Pregnancy proceeded without complication and there were no side effects from cyclosporin. After premature membrane rupture in the 39th week of pregnancy uterine inertia developed during oxytocin stimulation of contractions, and caesarean section was performed. The female infant was normally developed without any malformations. Liver, kidney and adrenal functions were normal, as was haemopoiesis. But possible late sequelae of cyclosporin treatment in the child cannot as yet be assessed because of the short follow-up.
Subject(s)
Cyclosporins/adverse effects , Liver Transplantation , Pregnancy/drug effects , Abnormalities, Drug-Induced , Adult , Cesarean Section , Female , Follow-Up Studies , Humans , Infant, Newborn , Liver Cirrhosis/surgery , Pregnancy OutcomeABSTRACT
We report the case of a 44-year-old man who was transplanted in 1986 for hepatocellular carcinoma in a HBsAG-positive liver cirrhosis. The patient had no severe complications postoperatively. He received passive immunization for the prevention of hepatitis B reinfection during the first 6 months after liver grafting. Twelve months after the transplantation the new liver was reinfected with hepatitis B virus. Without any clinical or laboratory signs of severe hepatitis, the patient developed a histologically proven complete liver cirrhosis within 8 months after reinfection of the graft. The reasons for this might have been, first, a deleterious course of the infection under immunosuppressive therapy, and, second, the additional influence of a postoperatively acquired CMV infection or the combined toxic influence of cyclosporin A and its metabolites on the acute inflammation in the liver.
Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatitis B Surface Antigens/analysis , Hepatitis B/diagnosis , Liver Cirrhosis/diagnosis , Liver Neoplasms/surgery , Liver Transplantation , Postoperative Complications/diagnosis , Adult , Follow-Up Studies , Hepatitis B/surgery , Hepatitis B e Antigens/analysis , Humans , Liver Cirrhosis/surgery , Liver Function Tests , Male , RecurrenceABSTRACT
The most frequent benign liver tumors are hemangioma, focal nodular hyperplasia (FNH) and adenoma. It is essential for the diagnosis to differentiate these lesions from malignant tumors. While sonography, bolus-CT scan, chole-/bloodpool scintigraphy usually yield a safe diagnosis of hemangioma or FNH, adenomas do not show characteristic features. Operation is indicated for hemangioma of FNH only in case of tumor growth and/or symptoms. Operation for adenoma is as a rule indicated because of possible malignant transformation or uncertain differentiation from malignoma. Operative procedures include anatomical/atypical liver resection, ex situ resection or liver transplantation.
Subject(s)
Liver Neoplasms/surgery , Precancerous Conditions/surgery , Adolescent , Adult , Carcinoma, Hepatocellular/surgery , Diagnosis, Differential , Female , Hemangioma, Cavernous/surgery , Hepatectomy , Humans , Hyperplasia , Liver/pathology , Male , Middle AgedABSTRACT
A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months postoperatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.
Subject(s)
Hepatic Encephalopathy/surgery , Liver Cirrhosis/surgery , Liver Transplantation , Portacaval Shunt, Surgical/methods , Portal Vein/surgery , Thrombosis/surgery , Adult , Blood Flow Velocity , Humans , Hypertension, Portal/surgery , Iliac Vein/transplantation , Liver Function Tests , Male , Mesenteric Veins/surgery , Microsurgery/methods , Postoperative Complications/diagnosis , Ultrasonography/methodsABSTRACT
Kidney and liver transplantations are well established surgical procedures. During the past years survival rates have improved 3% of kidney transplantations have 1-year mortality. Subjective quality of life and professional rehabilitation are associated with the graft function parameters of successful therapy. Seventy-six percent of liver-transplanted patients consider their quality of life improved after the operation. 52% are able to return to work. Future efforts must focus on improving immunosuppression for specific tolerance and sensitizing the public to the problems of obtaining organs for transplantation.
