Increasing cycles of intermittent ischemia can effectively maintain liver function during the acute phase of ischemia reperfusion injury by promotion of bile flow and reduction in bile salt toxicity.

BACKGROUND/AIMS: Intermittent ischemia (INT) can improve liver function following inflow occlusion. The aim was to test whether the number of cycles of INT can be increased without impairing liver function. METHODS: Liver function in the acute phase of ischemia reperfusion injury was assessed by measuring bile flow in rat livers. Phospholipid and bile salts in bile, liver marker enzymes in blood, and liver histology were measured. Aged livers were compared with young livers. RESULTS: Clamping for 45 min reduced postperfusion bile flow to 13% of the initial value compared with 88 +/- 5% for control livers (means +/- SEM, n = 5-8), and substantially reduced the phospholipid:bile salt ratio in bile. Application of 3, 4, 5 and 6 cycles of INT (15 min) restored bile flow to 70 +/- 11, 61 +/- 4, 48 +/- 2 and 35 +/- 3% (p < 0.01) of the initial value, respectively, and restored the phospholipid:bile salt ratio. Multiple cycles of INT were less effective in aged rats. CONCLUSION: Several cycles of INT, through promotion of bile flow recovery and reduction in the cytotoxic actions of bile salts, may provide an effective clinical strategy for increasing clamping time in liver resections.

Polydactyly, campomelia, ambiguous genitalia, cystic dysplastic kidneys, and cerebral malformation in a fetus of consanguineous parents: a new multiple malformation syndrome, or a severe form of oral-facial-digital syndrome type IV?

We describe a 27-week fetus with occipitoschisis, polydactyly, campomelia, cleft palate, laryngeal dysplasia, ocular colobomata, hepatic fibrosis and intrahepatic cyst, ambiguous genitalia, cystic dysplastic kidneys, and brain malformation. This pattern of abnormalities appears unique. The differential diagnosis is discussed. The parents are first cousins, making autosomal recessive inheritance likely.

Agenesis of the right lobe of the liver: diagnosis by computed tomography.

Agenesis of the right lobe of the liver is a rare congenital anomaly with characteristic features on computed tomography (CT). We present a case diagnosed as an incidental finding and describe the CT appearances.

Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy.

A 45-minute infusion of an octapeptide of cholecystokinin (Kinevac; Squibb Diagnostics, New Brunswick, NJ) was used to measure the gallbladder ejection fraction during cholescintigraphy in 40 normal volunteers. Cholecystokinin cholescintigraphy was shown to be a reproducible test. The maximum mean gallbladder ejection fraction occurred 15 minutes after cholecystokinin infusion and was 74.5% +/- 1.9% (mean +/- SEM). A gallbladder ejection fraction greater than 40% (mean -3SD) was arbitrarily defined to be normal. The gallbladder ejection fraction test was then used to identify patients with acalculous biliary symptoms who may respond to cholecystectomy. A total of 103 patients was tested; 21 had abnormal gallbladder ejection fractions and were randomized into two groups, cholecystectomy or no operation. These patients were followed up symptomatically at 3-month intervals for 13-54 months (mean, 34 months). Of the 11 patients who underwent cholecystectomy, 10 (91%) lost their symptoms and 1 improved. Of the 10 patients in the group that did not undergo surgery, all continued to be symptomatic, 2 of whom requested cholecystectomy after 13 and 24 months, respectively. Of the 13 gallbladders obtained from surgery, 12 showed evidence of chronic cholecystitis, muscle hypertrophy, and/or narrowed cystic duct. A normal gallbladder ejection fraction was recorded in 82 patients, and further treatment was left to the discretion of their referring clinician. On follow-up, 50 patients were asymptomatic and 10 were symptomatic without specific treatment of the biliary tract; 14 underwent cholecystectomy, 8 of whom were asymptomatic. Pathological abnormalities were recorded in 6 of the removed gallbladders. It is concluded that the gallbladder ejection fraction obtained after a 45-minute infusion of cholecystokinin during cholescintigraphy is a reproducible measure of gallbladder emptying, and that cholecystectomy alleviates the biliary-type pain of patients with a reduced gallbladder ejection fraction.

Hemorrhagic myocardial infarction complicated by free wall-rupture: a case associated with unusual clinical features following intravenous thrombolytic therapy.

A patient is described who developed a systolic murmur soon after she was administered intravenous thrombolytic therapy for acute myocardial infarction. She died and autopsy revealed extensive hemorrhagic myocardial infarction and a free-wall rupture. A review of the literature suggests that this may be an unusual complication of thrombolytic therapy.

Calcified cerebral sinus thrombosis in infancy--CT appearances with pathological correlation.

A case of calcified cerebral venous sinus thrombosis in an infant is described, with autopsy correlation. Calcification of sinus thrombosis is rare. A triangular calcific density was demonstrated in the superior sagittal sinus, with extension of linear calcification laterally into the transverse sinuses. Following intravenous contrast administration there was intense enhancement of the superior sagittal and transverse sinuses around the calcified thrombus. The cerebral hemispheres showed generalised atrophy. Autopsy confirmed a calcified venous sinus thrombus. Triangular calcium density within the sagittal sinus or linear calcification within the transverse sinuses would appear to be characteristic of calcified cerebral sinus thrombus.