Visualization of central stellate fibrosis in hyaline vascular type Castleman's disease.

Hyaline vascular type Castleman's disease (HVCD) is a benign cause of lymph node hypertrophy which radiologically resembles tumours such as paraganglioma and lymphoma. However, a distinguishing pathological characteristic of HVCD is the presence of central stellate fibrosis. Since conventional CT and MRI scans failed to differentiate areas of fibrosis, three-phase dynamic CT was performed on a patient who was thought to have HVCD. The images showed central fibrosis and consequently the correct pre-operative diagnosis of HVCD was made.

A new strategy for management of retroperitoneal tumors with supradiaphragmatic vena caval thrombi.

A new surgical technique to treat retroperitoneal tumors with supradiaphragmatic vena caval invasion is described. In this technique, hepatic warm ischemia can be avoided with reversed hepatic outflow through the portal vein and neither hypothermic circulatory arrest nor cardiopulmonary bypass is necessary using centrifugal blood pump-driven bypass.

Fibrin sealant of the cut surface of partial liver grafts from living donors.

Complete hemostasis and proof against bile leakage on the cut surface of the partial liver graft and the remnant liver of the donor are basic desiderata for a successful outcome in living related liver transplantation (LRLT). This study evaluated the efficacy of fibrin glue sealant on the cut surface of a graft in human living related liver transplantation and canine partial liver transplantation in terms of postoperative complications. From June 1990 to August 1993, a series of 70 LRLTs were performed on children with end-stage liver disease. In harvesting the graft from living donor, hepatic parenchyma was transected by ultrasonic aspirator. Clearly exposed vessels were either ligated or suture ligated. Fibrous connecting tissues of the glissonian branches and tiny vessels were coagulated by a newly devised bipolar electric cautery equipped with saline dripping system. Fibrin sealant was sprayed on the cut surface of the liver graft and the remnant liver of the donor. All donors were discharged from hospital at 10 to 17 (mean = 11.6) days after surgery without any complications that required surgical intervention, and were able to return to normal life. At reperfusion of the graft in the recipients, no blood loss from the cut surface was observed. However, bile oozing on the cut surface was observed in 3 of the 70 cases. No infection or foreign body reactions were observed in the fibrin-sealed cut surface of the graft. Actuarial recipient survival rate was 89% (48/54) in elective cases and 69% (11/16) in emergency cases. In canine transplantation, 16 out of 23 beagles survived for 4 days or longer (longest 20 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of gabexate mesilate on thrombin and plasmin generation after hepatic resection in cirrhotic patients.

The effect of the gabexate mesilate (Gab) on thrombin and plasmin generation following liver resection in cirrhotic patients was studied. Six cirrhotic patients received an infusion of Gab after liver resection (Gab group), and another 6 patients did not receive such treatment (Con group). The parameters measured were thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PAP) and D-dimer. The real increases of D-dimer and PAP were significantly higher in Con group after surgery while no significant difference was observed in the increase of TAT. These results show that Gab suppresses plasmin generation and following D-dimer production more effectively than thrombin generation after hepatic resection.

Deterioration of platelet energy metabolism following energy crisis of liver after hepatectomy.

The aim of this study is to investigate the relationship in energy metabolism between the platelet and the liver. The adenylate energy charge of human platelets and arterial ketone body ratio (AKBR:acetoacetate/3-hydroxybutyrate) were measured in 11 patients after hepatectomy. Hepatic energy crisis was defined as the decrease of AKBR below 0.7. The platelet energy charge was measured on the first (Day 1), the second (Day 2), third (Day 3) and sixth (Day 6) day during AKBR decreased and remained under 0.7. The values before AKBR decreased were employed as the control. The values of the platelet energy charge were 0.917 +/- 0.008 in the control (n = 11) and 0.896 +/- 0.009 in all samples after AKBR decreased under 0.7 (n = 30). There was no significant difference between them. The values of energy charge were divided into four groups according to the periods of time after AKBR decreased and remained under 0.7 and compared. The energy charge was 0.923 +/- 0.006 (Day 1, n = 11), 0.907 +/- 0.008 (Day 2, n = 10), 0.890 +/- 0.005 (Day 3, n = 5), and 0.815 +/- 0.012 (Day 6, n = 4). The energy charge of Day 3 was significantly lower than that of Day 1 (p < 0.01). The energy charge of Day 6 was significantly lower than that of Day 1, 2, 3 (p < 0.001, p < 0.001, and p < 0.01, respectively). The 4 patients whose AKBR remained under 0.7 for more than 6 days had hemostatic disorder. The deterioration of the platelet energy charge metabolism lags behind that of the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of retroperitoneal ganglioneuroma].

A 50-year-old woman was admitted under a diagnosis of abdominal tumor. Ultrasonography and CT scanning were performed, and a right retroperitoneal tumor was detected. Absolute curative resection was performed. The resected tumor was 13.5 x 11.5 x 9.0 cm, and histologically diagnosed as ganglioneuroma. To our knowledge, 99 cases have been reported in Japan. During a twelve-month follow-up period, the postoperative course was uneventful and no recurrence had been noted.

Sequential decrease in platelet energy charge after hepatic resection in cirrhotics.

The adenylate energy charge of human platelets was measured in the early postoperative period after hepatic resection in cirrhotic and noncirrhotic patients to evaluate the metabolic status of platelets in this period. The adenylate energy charge of platelets decreased on the first, second, and third postoperative days in the cirrhotic group, whereas no significant decrease was found in the noncirrhotic group. A decrease in the percentage of adenosine triphosphate and an increase in that of hypoxanthine also occurred concomitant with a decrease in the adenylate energy charge, which was considered to be the result of an increased utilization of adenosine triphosphate. These findings indicate that in cirrhotic patients, the intravascular activation of platelets takes place and platelet function is damaged during the period immediately after hepatic resection, even when there is no clinical evidence of intravascular coagulation.

Decrease in hepatic mitochondrial redox state by massive infusion of citrate-phosphate-dextrose solution in jaundiced rabbits.

To clarify the mechanism of metabolic derangement by massive blood transfusion to the damaged liver, the changes in the hepatic mitochondrial redox state, as reflected in arterial ketone body ratio (acetoacetate/3-hydroxybutyrate), were studied in jaundiced rabbits by infusion of massive citrate-phosphate-dextrose (CPD) solution. The jaundiced rabbits received common bile duct ligation (BDL group), and the sham group had a simple exploration of the bile duct. CPD solution was infused for 3 h at a rate of 9 ml/kg/h in each group. As metabolic parameters, blood gas, pyruvate, lactate, citrate and ketone body ratio were analyzed in the arterial blood. During the course, arterial ketone body ratio decreased significantly (p less than 0.01) in the BDL group with severe metabolic acidosis, while it was maintained at high value in the sham group with metabolic alkalosis. Organic acids were more highly accumulated in the BDL group than in the sham group. These results suggested a hepatodepressant effect of massive blood transfusion, especially in the damaged liver.

Pyridine nucleotide fluorometry in preserved porcine liver with fluorocarbon emulsion.

Oxidation-reduction changes in pyridine nucleotide fluorescence were investigated in perfused and preserved porcine liver. A fluorocarbon emulsion (FC-43) was administered to the perfusate as an oxygen carrier to obtain full oxidation level by portal perfusion at a physiological low flow rate. A satisfactory reading was obtained by portal perfusion with EuroCollins' solution containing 10% v/v FC-43 at a rate of 0.5 ml/min/g liver. The amplitude (R x A) and the changing velocity (R x V) from full oxidation to full reduction were determined in the resultant trace curve. Both R x A and R x V decreased in inverse proportion to the duration of preservation period (3, 6, 12 hr). Adenine nucleotide content, hepatic energy charge level, and ketone body ratio in the tissue were simultaneously measured, and they also decreased proportionally to the duration of preservation. There were close positive correlations between R x A and total adenine nucleotide concentration (r = 0.841, P less than 0.01), between R x V and energy charge (r = 0.787, P less than 0.01), and between R x V and tissue ketone body ratio (r = 0.881, P less than 0.01). These results suggest that pyridine nucleotide fluorometry can accurately follow the cellular function of isolated porcine liver by administration of FC-43 in perfusate. This fluorometry may also have potential application in evaluating viability of a large organ like the human liver graft.

Orthotopic partial liver transplantation in dogs can be performed without cold perfusion of the donor liver. Evaluation of its feasibility in terms of energy metabolism.

To investigate the feasibility of obtaining grafts from living, genetically related adult donors without any complicated harvesting techniques, orthotopic partial liver transplantation (PLT) without cold perfusion of the donor graft was evaluated in beagles by assessing the graft viability using ketone body ratio (KBR). Ten PLT were performed under venovenous bypass. The left half of the donor liver was transected in situ followed by systemic heparinization, and immediately implanted with care taken to leave the recipient's inferior vena cava intact, and to maintain the normothermic state without cold perfusion. Four of ten dogs survived for 5 days or longer (longest survival was 9 days) and died of other causes than graft dysfunction. Four others died of thromboembolitic episode, accidental bleeding or technical failure. Two dogs died of graft dysfunction. The changes in KBR in 5 dogs without fatal complications after transplantation were maintained within normal range thereafter. These results suggest that the PLT without cold perfusion of donor graft is possible from the viewpoint of energy metabolism.

Graft transection and warm perfusion in situ in canine partial orthotopic liver transplantation.

Liver transplantation is now proven therapy for various forms of end-stage liver disease in children; however, the problem of donor liver shortage remains. To investigate the feasibility of graft procurement from living, genetically related adult donors without injury to either donor or recipient, partial orthotopic liver transplantation (PLT) using a graft transected and warm perfused in situ was evaluated in beagles; the viability of the graft was assessed in terms of energy metabolism, including blood ketone body ratio (KBR), as well as of recipient survival. PLT was performed in two groups with venovenous bypass. The left half of the donor liver was transected in situ, flush perfused with 2 l lactated Ringer's solution (4 degrees C in group A, 20 degrees C in group B), and immediately implanted into the recipient, who was totally hepatectomized, care having been taken to leave the inferior vena cava intact. Four of seven dogs survived for 5 days or longer (longest, 8 days) in group A and six of eight dogs (longest, 20 days) in group B. Causes of death were gastrointestinal bleeding, intussusception, or infection but not graft dysfunction. In both groups the KBR decreased significantly during the anhepatic period, recovered rapidly to the pre-anhepatic level after revascularization, and was maintained within a normal range thereafter. No significant differences in the time course of changes in KBR were seen between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine nucleotide metabolism of blood platelets in human liver cirrhosis.

The adenylate energy charge of human platelets was measured in normal subjects and cirrhotic patients using a method by labelling the adenine nucleotide pool of platelets with radioactive adenine. Using the above method, it was demonstrated that a reliable value for the adenylate energy charge can be obtained from platelet rich plasma containing more than 10(4) platelets per microliter after 30 minutes incubation. A significant difference was found in the distribution of adenine nucleotide metabolites between normal subjects and cirrhotic patients. However, no significant difference was found in the adenylate energy charge between two groups. These results indicate that energy metabolism of platelets is impaired to some extent in liver cirrhosis.