Hemangiomatosis of the greater omentum - a case report.

Cavernous hemangiomas are benign tumours of mesodermal origin. Even though various localizations of hemangioma have been described in the literature, its occurrence in the greater omentum is very rare. Only symptomatic hemangiomas are indicated for surgical treatment. There are case reports presenting resection or surgical removal of the greater omentum with hemangioma because of mechanical syndrome, consumption coagulopathy, bleeding, infection or suspicion of a malignancy. This article presents a case report of a patient operated on for a suspicion of carcinomatosis of the greater omentum. Histological examination found hemangiomatosis in the resected greater omentum.

Treatment of liver injuries at the Trauma Centre of the University Hospital in Pilsen.

INTRODUCTION: Traumatic liver injury is the most frequent cause of death due to traumatic bleeding in the peritoneal cavity. The progress of pre-hospital emergency medical service, improved surgical techniques, and advanced post-operative care decreased the morbidity from 65% to 10% over the last 40 years. The management is either surgical or non-surgical. Operation is indicated in case of haemodynamic instability and failure of non-surgical treatment. The aim of the paper is to evaluate the aetiology of liver injury, the type of treatment, and therapeutic results in patients hospitalized between 2006 and 2018 at the Trauma Centre of the University Hospital in Pilsen. METHODS: Our retrospective study includes 322 patients. Assessed characteristics: Type of injury (polytraumatic or monotraumatic), cause of trauma, trauma grade according to The American Association for the Surgery of Trauma, type of treatment, complications, mortality and the length of stay. RESULTS: There were 191 male and 131 female patients included in the study; 18.9% of these were children below the age of 16. Polytraumata represented 53.1%, multiple traumata 35.4% and monotraumata 11.5% of all injuries; 94.7% of patients had a blunt trauma of the liver and the most common reason of injury was traffic accident (57.8%). Conservative management was applied in 66.1% of all patients. The following surgical procedures were performed: liver packing (34 cases), exploration and drainage (10), liver resection (5), laparoscopy (7), radiofrequency ablation (3), cholecystectomy (2), and one case of bile duct revision. Thirty-day mortality was 7.7%. One patient died of bilateral pneumonia; the other non-surviving patients died of decompensated hemorrhagic shock or due to craniocerebral injury. CONCLUSION: Complex and centralized medical care of patients with liver trauma not only allows appropriate primary therapy, but it is also a precondition for the management of further specific complications.

[Experimental promotion of liver regeneration after portal vein branch ligation]. / Moznosti experimentálního ovlivnení regenerace jaterního parenchymu v souvislosti s ligací vetví portální zíly.

INTRODUCTION: Portal vein embolization or ligation (PVE/PVL) is part of most multi-stage liver procedures in the case of low future liver remnant volume (FLRV). PVE initiates compensatory hypertrophy of non-occluded liver parenchyma. This hypertrophy is stimulated by an increased volume of portal blood in the non-occluded veins. PVE results in adequate FLRV growth necessary for resection only in 63-96% patients. The aim of this publication is to summarize the possibilities of influencing liver regeneration after PVE/PVL in an experiment using cytokines (TNF-α, IL-6), a monoclonal antibody against TGF-ß1 (MAB TGF-ß1) and mesenchymal stem cells (MSC). METHODS: The experimental model of PVE/PVL was chosen as best compatible for potential use in human medicine. 9 (control group), 9 (TNF-α group), 8 (IL-6 group), 6 (MSC group) and 7 piglets (MAB TGF-ß1 group) were enrolled in individual studies. We performed laparotomy with PVL of the right-sided liver lobes under general anaesthesia. The following amounts of substances were applied in the non-occluded portal vein branches immediately after PVL: physiological solution (control group), recombinant porcine TNF-α (5 µg/kg), recombinant porcine IL-6 (0.5 µg/kg) and MSC (8.75, 14.0, 17.0, 17.5, 43.0 and 61.0 x 106 MSC). MAB TGF-ß1 was applied 24 hours after PVL (40 µg/kg). Biochemical parameters were analysed repeatedly and FLRV ultrasound assessments were performed in the postoperative period. The experiments were ended on postoperative day 14 by sacryfiing the animals under general anaesthesia. Liver samples of hypertrophic and atrophic liver parenchyma were analysed. RESULTS: Repeated ultrasound assessments of the effects of MSC, TNF-α, IL-6 and MAB TGF-ß1 compared with the physiological solution in the control group demonstrated statistically significant acceleration of FLRV growth in the experimental groups. For MSC, maximum growth was observed between postoperative days 3 and 7, on day 7 for TNF-α, between days 3 and 7 for MAB TGF-ß1 and on day 7 for IL-6. Serum levels of AST and ALT increased after PVL and MSC whereas other biochemical parameters showed no statistically significant differences. We identified individual MSC using immunohistochemistry in the hypertrophic tissue of the MSC group. A statistically significant difference was observed in the number of binucleated hepatocytes, with their increased concentration in the IL-6 group. CONCLUSION: Application of IL-6, TNF-α, MAB TGF-ß1 and MSC seems to provide suitable stimulation for achieving faster FLRV growth. Nevertheless, many controversial questions still remain to be answered with respect to the mechanism of their respective effects.Key words: liver regeneration portal vein embolization large animal experiment mesenchymal stem cells cytokines.

Molecular profile of 5-fluorouracil pathway genes in colorectal carcinoma.

BACKGROUND: This study addresses involvement of major 5-fluorouracil (5-FU) pathway genes in the prognosis of colorectal carcinoma patients. METHODS: Testing set and two validation sets comprising paired tumor and adjacent mucosa tissue samples from 151 patients were used for transcript profiling of 15 5-FU pathway genes by quantitative real-time PCR and DNA methylation profiling by high resolution melting analysis. Intratumoral molecular profiles were correlated with clinical data of patients. Protein levels of two most relevant candidate markers were assessed by immunoblotting. RESULTS: Downregulation of DPYD and upregulation of PPAT, UMPS, RRM2, and SLC29A1 transcripts were found in tumors compared to adjacent mucosa in testing and validation sets of patients. Low RRM2 transcript level significantly associated with poor response to the first-line palliative 5-FU-based chemotherapy in the testing set and with poor disease-free interval of patients in the validation set irrespective of 5-FU treatment. UPP2 was strongly methylated while its transcript absent in both tumors and adjacent mucosa. DPYS methylation level was significantly higher in tumor tissues compared to adjacent mucosa samples. Low intratumoral level of UPB1 methylation was prognostic for poor disease-free interval of the patients (P = 0.0002). The rest of the studied 5-FU genes were not methylated in tumors or adjacent mucosa. CONCLUSIONS: The observed overexpression of several 5-FU activating genes and DPYD downregulation deduce that chemotherapy naïve colorectal tumors share favorable gene expression profile for 5-FU therapy. Low RRM2 transcript and UPB1 methylation levels present separate poor prognosis factors for colorectal carcinoma patients and should be further investigated.

Protein expression of ATP-binding cassette transporters ABCC10 and ABCC11 associates with survival of colorectal cancer patients.

PURPOSE: This study investigated the prognostic importance of protein expression of ATP-binding cassette (ABC) transporters ABCC10 and ABCC11 in colorectal cancer. METHODS: Protein content of ABCC10 and ABCC11 was assessed in tumor tissue blocks of 140 colorectal cancer patients and associated with survival of patients with regard to 5-fluorouracil-based therapy. RESULTS: Low ABCC10 protein content in tumors increased hazard ratio of patient's death more than three times in comparison with high ABCC10-expressing tumors (P = 0.004). In contrast, the low ABCC11 content increased the hazard ratio of cancer recurrence in patients almost four times (P = 0.016). Analysis of patients treated with regimens based on 5-fluorouracil revealed that patients with low ABCC11 content in their tumors had shorter disease-free interval than those with higher content (P = 0.024). CONCLUSIONS: The present study shows for the first time that the protein expression of ABCC10 significantly associates with overall survival and the expression of ABCC11 with disease-free interval of colorectal cancer patients and provides strong impulse for further validation of their prognostic value in colorectal cancer.

[Diagnosis and treatment of billiary ileus]. / Diagnostika a lécba biliárního ileu.

INTRODUCTION: Biliary ileus represents only 14% of mechanical obstructions of the gastrointestinal tract. However, the rate of non-strangulated small bowel obstructions reaches as much as 25% in patients over 65 years of age. Usually, a pressure necrosis is created by a large gallstone that passes through the developed biliodigestive fistula, subsequently obturating the gastrointestinal tract. CASE REPORTS: 35 patients underwent a surgical procedure at the Department of Surgery, Teaching Hospital Pilsen for biliary ileus from January 1, 2000 to January 31, 2015. Mean age was 79 years (median 78 years; min. 58 years; max. 92 years). Aerobilia was visible in abdominal X-ray scans in 7 cases (26%) of 27 acquired images. Preoperatively, colonoscopy was done 2 times and esophagogastroduodenoscopy 9 times. Regarding surgical procedures, enterolithotomy was done in 21 cases, extraction of the gallstone from gastrotomy was done 3 times, small bowel resection 7 times, Hartmann resection 1 time, resection of ileoascendentoanastomosis 1 time, and extraction of the gallstone from duodenotomy with duodenojejunoanastomosis and cholecystectomy was done in 1 case. Ileotransversoanastomosis was performed in 1 case. Postoperative 30-day mortality was 14.3%. Postoperative morbidity according Clavien-Dindo was 22.8% for grade 1, 5.7% for grade 2, 11.5% for grade 3, and 11.5% for grade 4. A recurrence was observed in 8.8%. Primary treatment of the fistula and cholecystectomy were done in 1 case. CONCLUSION: The indication of primary biliodigestive fistula treatment always depends on the general condition of the patient and on the local finding in the gallbladder area. Residual fistula increases the risk of reccurence, but primary treatment is associated with higher mortality. It is also important to duly revise the entire bowel to avoid an early reccurence due to multiple gallstones. KEY WORDS: biliary ileus diagnosis treatment.

[Liver metastases from colon and rectal cancer in terms of differences in their clinical parameters]. / Jaterní metastázy karcinomu kolon a rekta z pohledu rozdílu v klinických parametrech.

INTRODUCTION: From the clinical point of view, rectal cancer and colon cancer are clearly different nosological units in their progress and treatment. The aim of this study was to analyse and clarify the differences between the behaviour of liver metastases from colon and rectal cancer. The study of these factors is important for determining an accurate prognosis and indication of the most effective surgical therapy and oncologic treatment of colon and rectal cancer as a systemic disease. METHOD: 223 patients with metastatic disease of colorectal carcinoma operated at the Department of Surgery, University Hospital in Pilsen between January 1, 2006 and January 31, 2012 were included in our study. The group of patients comprised 145 men (65%) and 117 women (35%). 275 operations were performed. Resection was done in 177 patients and radiofrequency ablation (RFA) in the total of 98 cases. Our sample was divided into 3 categories according to the location of the primary tumor to C (colon), comprising 58 patients, S (c. sigmoideum) in 61 patients, and R (rectum), comprising 101 patients. Significance analysis of the studied factors (age, gender, staging [TNM classification], grading, presence of mucinous carcinoma, type of operation) was performed using ANOVA test. Overall survival (OS), disease-free interval (DFI) or no evidence of disease (NED) were estimated using Kaplan-Meier curves, which were compared with the log-rank and Wilcoxon tests. RESULTS: As regards the comparison of primary origin of colorectal metastases in liver regardless of their treatment (resection and RFA), our study indicated that rectal liver metastases showed a significantly earlier recurrence than colon liver metastases (shorter NED/DFI). Among other factors, a locally advanced finding, further R2 resection of liver metastases and positivity of lymph node metastases were statistically significant for the prognosis of an early recurrence of the primary colon and sigmoid tumor. Furthermore, we proved that in patients with primary rectal carcinoma, DFI (after the resection of liver metastases) was not influenced by the positivity of lymph node metastases of primary tumor or locally advanced primary tumor. The other factors studied (time from diagnosis of organ metastases to primary operation, grading, sex or age) were not shown to be statistically significant for the prognosis of OS and DFI (colorectal cancer in total). CONCLUSION: As proven by our study, rectal cancer and colon cancer are two different nosological units with specific prognostic factors with respect to their liver metastases. These differences have not been fully understood yet and require further exploration and classification based not only on histopathological, immunohistochemical and clinical factors, but also on molecular biological parameters. KEY WORDS: colon carcinoma metastases rectal carcinoma metastases prognostic factors overall survival - liver metastases.

Porcine liver vascular bed in Biodur E20 corrosion casts.

BACKGROUND: Pigs are frequently used as animal models in experimental medicine. To identify processes of vascular development or regression, vascular elements must be recognised and quantified in a three-dimensional (3D) arrangement. Vascular corrosion casts enable the creation of 3D replicas of vascular trees. The aim of our study was to identify suitable casting media and optimise the protocol for porcine liver vascular corrosion casting. MATERIALS AND METHODS: Mercox II® (Ladd Research, Williston, Vermont, USA) and Biodur E20® Plus (Biodur Products, Heidelberg, Germany) were tested in 4 porcine livers. The resins (volume approximately 700 mL) were injected via the portal vein. Corrosion casts were examined by macro-computed tomography, micro-computed tomography and scanning electron microscopy. RESULTS: For hepatectomies, the operating protocol was optimised to avoid gas or blood clot embolisation. We present a protocol for porcine liver vascular bed casting based on corrosion specimens prepared using Biodur E20® epoxy resin. CONCLUSIONS: Only Biodur E20®Plus appeared to be suitable for high-volume vascular corrosion casting due to its optimal permeability, sufficient processing time and minimum fragility. Biodur E20® Plus is slightly elastic, radio-opaque and alcohol-resistant. These properties make this acrylic resin suitable for not only vascular research but also teaching purposes.

[Chemoembolization with Drug Eluting Beads (TACE DEB) in patients with primary unresectable hepatocellular carcinoma (HCC)]. / Transarteriální chemoembolizace pomocí "drug eluting beads" (TACE DEB) u nemocných s radikálne neodstranitelným hepatocelulárním karcinomem (HCC).

INTRODUCTION: The incidence of HCC is growing all over the word. Liver resection and transplantation are the methods of choice in only 25% of patients, representing radical treatment approaches. TACE is a method of palliative treatment in patients with primary unresectable disease. MATERIAL AND METHODS: 35 patients (27 men and 8 women) of an average age of 73.4 ± 7.2 years with HCC of average cumulative diameter 83.8 ± 36.3 mm were treated by TACE DEB with Doxorubicin. Solitary and multiple lesions were presented in 28 and 7 patients, respectively. 31 patients were classified as Child A, and 4 as Child B. One year overall survival, disease-specific, disease-free interval and their correlation with patients age, gender, as well as the number and cumulative diameter of tumours and complications after procedure were evaluated. RESULTS: 30-day mortality and morbidity rate was 0 and 8.6%, respectively. The so-called postembolization syndrome developed in 25.7% of patients. Repeated TACE was performed in 14 (40%) patients due to tumour progression. In two patients (5.7%) we performed liver resection after TACE. According to the RECIST criteria there was no complete response, partial response was presented in 17.1, stable disease in 37.1 and progression of disease in 25.7% of patients. One year overall survival, tumour-specific survival and disease-free survival was 69.7%, 88.9 and 49.3%, respectively. Better overall survival (p < 0.02) was achieved in patients < 75 years old. Worse disease-free interval was observed in patients with complication after TACE (p < 0.01). No significant differences were found in the other evaluated parameters. CONCLUSION: TACE is the method of palliative treatment in patients with unresectable HCC. There is no progression of HCC in one-half of patients after TACE. Better results are achieved in younger patients and in patients with no complications of procedure.

[Prognostic clinical factors in colorectal cancer after radical therapy]. / Klinické prognostické faktory kolorektálního karcinomu po jeho radikální lécbe.

INTRODUCTION: Colorectal anastomoses frequently become the site of of complications after surgical procedures for colorectal cancer. Anastomotic dehiscence has a significant impact on the whole p postoperative disease course, may influence the overal survival (OS) and disease free interval (DFI). The aim of our study was to analyze clinical and histopathological factors, that could facilitate detection of dehiscences and are related to the prognosis of patients. MATERIAL AND METHODS: The authors performed statistical analysis of a cohort of patients (340 pacients, 207 males, 133 females) who underwent radical resection followed by anastomosis on the large intestine during 2003-2007. The following factors were assessed: age, gender, staging, protective stoma, neoadjuvant chemotherapy, neoadjuvant radiotherapy, adjuvant chemotherapy, adjuvant radiotherapy and anastomotic insufficiency. Complications were evaluated according to Clavien and Dindo classification. RESULTS: The analysis confirmed the following factors to be statistically significant for prognosis of OS and DFI: In stage T4 subjects, the risk of death was 2.5 x higher and the risk of recurrence was 1.9 x higher than in the lower disease stage subjects. The presence of N2 lymph node metastases increases the risk of death 3.7 x and the risk of recurrence 3.6 x, compared to N0 and N1 cases. The presence of postoperative complications classified asf III.-V. grade according to Clavien and Dindo classification increases the risk of death 4x. The risk of death was 5.5 x higher in patients with dehiscence of anastomosis. The surprising finding was that even protective stoma increases the risk of death 5.4 x. Patients who did not undergo adjuvant chemotherapy were at 2 x higher risk of death. In patients with IIIA, IIIB, IV, V complications, the following factors proved to be statistically significant for prognosis of OS: leakage, protective stoma, adjuvant chemotherapy and adjuvant oncological treatment. In patients with complications I and II, the following factors were proved to be statistically significant for prognosis of OS: staging and lymph nodes metastases. Multivariate analysis CART confirmed significant correlation between the lymph nodes positivity and the Clavien and Dindo classification of complications. CONCLUSION: Analysis of clinical and histopathological factors is important for prediction of prognosis in patients with colorectal cancer after radical surgical treatment. Detection and application of these prognostic factors in postoperative period could influence the strategy of treatment and thus the overal survival in patients with radical resections for colorectal carcinoma. Nonadministration of adjutant chemotherapy results in a significant decrease in OS and DFI.

Immediately preoperative use of biological therapy does not influence liver regeneration after large resection--porcine experimental model with monoclonal antibody against epidermal growth factor.

BACKGROUND: The aim of this work was to study the influence of isolated biological therapy administered immediately before extended liver resection on liver function and regenerative capacity of future liver remnant (FLR) in a large-animal experiment. MATERIALS AND METHODS: Nineteen piglets were included in this study (10 in the control group and 9 in the experimental group). A port-a-cath was introduced into the superior caval vein. On days 11 and 4 before liver resection, cetuximab was administered via this port at 400 mg/m2 of piglet body surface. Physiological solution was applied to the control group. Resection of the left lateral, left medial and right medial hepatic lobes was followingly performed (reduction of 50-60% of liver parenchyma). Blood samples were collected at different times before the operation and after liver resection. Serum levels of bilirubin, urea, creatinine, alkaline phosphatase, gamma glutamyltransferase, cholinesterase, aspartate aminotransferase, alanine aminotransferase, albumin, C-reactive protein and transforming growth factor-ß1 were assessed. The ultrasonographic examinations at different time points were performed pre-operatively and after liver resection in order to assess the liver volume. The biopsies from the liver parenchyma were examined for proliferative activity, binocluated hepatocytes, size of hepatocytes, and the length of the lobuli. The comparison of distribution of the studied parameters between the groups was carried out using the Wilcoxon test. The Spearman rank correlation co-efficient was used because of the non-Gaussian distribution of the parameter values. The whole development of the studied parameters over time was compared between the groups using ANOVA. RESULTS: There were no important complications of administration of biologic therapy during the operation or throughout the peri-operative period. There was no statistically significant difference in the regeneration of FLR nor were any differences in biochemical, immunoanalytical and histological parameters detected. CONCLUSION: The achieved results of comparable liver regeneration in both the experimental and control groups confirms the use of biological treatment with cetuximab in the pre-operative period for minimizing the recovery period.

The role of ABC transporters in progression and clinical outcome of colorectal cancer.

Worldwide, colorectal cancer (CRC) is the third most common cancer, with the highest mortality rates occurring in Central Europe. The use of chemotherapy to treat CRC is limited by the inter-individual variability in drug response and the development of cancer cell resistance. ATP-binding cassette (ABC) transporters play a crucial role in the development of resistance by the efflux of anticancer agents outside of cancer cells. The aim of this study was to explore transcript levels of all human ABCs in tumours and non-neoplastic control tissues from CRC patients collected before the first line of treatment by 5-fluorouracil (5-FU)-containing regimen. The prognostic potential of ABCs was evaluated by the correlation of transcript levels with clinical factors. Relations between transcript levels of ABCs in tumours and chemotherapy efficacy were also addressed. The transcript profile of all known human ABCs was assessed using real-time polymerase chain reaction with a relative standard curve. The majority of the studied ABCs were down-regulated or unchanged between tumours and control tissues. ABCA12, ABCA13, ABCB6, ABCC1, ABCC2 and ABCE1 were up-regulated in tumours versus control tissues. Transcript levels of ABCA12, ABCC7 and ABCC8 increased in direction from colon to rectum. Additionally, transcript levels of ABCB9, ABCB11, ABCG5 and ABCG8 followed the reverse significant trend, i.e. a decrease in direction from colon to rectum. The transcript level of ABCC10 in tumours correlated with the grade (P = 0.01). Transcript levels of ABCC6, ABCC11, ABCF1 and ABCF2 were significantly lower in non-responders to palliative chemotherapy in comparison with responders. The disease-free interval of patients treated by adjuvant chemotherapy was significantly shorter in patients with low transcript levels of ABCA7, ABCA13, ABCB4, ABCC11 and ABCD4. In conclusion, ABCC11 may be a promising candidate marker for a validation study on 5-FU therapy outcome.

[Liver metastases of other than colorectal origin]. / Jaterní metastázy jiného nez kolorektálního puvodu.

AIM: Colorectal carcinoma is the commonest malignancy with liver metastases. Approximately 25-30% of these metastases are resectable with good long-term outcomes. Liver metastases of so called non-colorectal carcinomas are significantly less common, and considering different biological character of these metastases, compared to colorectal ones, surgical management of some of these types is debatable, however, in some cases remains highly successful. The aim of this study was to assess the authors' outcomes of surgical and termoablation therapy of non-colorectal liver metastases. METHODS: The authors present their experience with surgical treatment in 68 patients - mean age of 58.2 y.o.a (33.1-77.5) with liver metastases of non-colorectal carcinomas- NKJM (the commonest types: breast carcinoma--32.4%, carcinoid--20.6%, renal carcinoma--13.3%, gynecological tumors--13.3%, gastrointestinal stromal tumor--4.4%, gastric carcinoma--4.4% ) during 2001-2008. The mean time after primary surgery for carcinoma was 3.9 years (0-8.5 let). The surgical procedures included the following: radiofrequency ablation (RFA)--50 patients (73.5%), resections in 26.5%. Preoperative chemotherapeutical "downstaging" or portal vein embolization on the tumor side, in order to improve the NKJM resecability, was performed in 10 subjects (14.7%). Resecable or RFA--manageable extrahepatic metastases were removed using one- or more- step procedures in 25 subjects (36.7%). The total number of liver metastases within the whole study group ranged from 1 (28x) to 8 (1x) metastases. Postoperative adjuvant chemotherapy, combined with biological treatment in some patients, was administered to a total of 33 patients (48.5%). RESULTS: One year after the procedure and RFA, a total of 88.6% of patients were surviving, at 3 years 72.5 % and at 5 years 36.9% of the subjects. Considering four commonest tumors (breast carcinoma, carcinoid, gynecological carcinomas and renal carcinoma), the best 5-year survival rates were recorded in patients with carcinoid metastases (100%), 33.8% of patients with breast metastases were surviving at 5 years, 44.4% of patients with renal carcinoma metastases were surviving at 3 years and 72.9% of patients with gynecological tumors were surviving at 2 years. There were no statistically significant differences in long-term survival rates between RFA and resections. Patients with extrahepatic metastases had worse prognosis (p < 0.01). CONCLUSION: Liver resection and RFA have their definite place in multimodal treatment strategy in the management of non- colorectal carcinoma liver metastases (NKJM). Indication for surgery must be made on strictly individual basis, in particular in patients with NKJM, in order to achieve quality long-term survival in these patients.

Cytokines and liver regeneration after partial portal vein ligation in porcine experimental model.

THE AIM OF STUDY: The limits of liver surgery are restricted today by the functional reserves of remnant parenchyma. The aim of this article was to acquaint the general surgical and medical public with the results of experimental liver regeneration stimulated by cytokines and thus to enhance their effort to carry on with implementing the research results in clinical practice. METHODS: Authors present their experimental model of liver regeneration after ligation of portal branches for caudate and right lateral, and right medial liver lobes. The regeneration was induced by application of TNF-alpha and IL-6 into the non-occluded portal branches, and compared with the results of other experimental teams. RESULTS AND CONCLUSION: The absolute volume of hypertrophic lobes increases after application of TNF-alpha more rapidly, whereas in the control group, practically no changes were recorded in hypertrophic liver lobes volumes in first three days. The achieved acceleration of growth of hypertrophic liver lobes after application of TNF-alpha and IL-6 confirmed the key role of studied pleiotropic cytokines in the priming of liver parenchyma regeneration after portal vein ligation (Fig. 3, Ref. 26).