Surgical treatments in cystic diseases of the liver: experience at a single center in Japan

BACKGROUND/AIMS: Benign cystic diseases of the liver have recently been treated by non-surgical procedures; however, uncontrolled symptomatic patients often need surgical treatment. We report here our own experience of 5 patients with cystic liver diseases (CLD). METHODOLOGY: We examined retrospectively the clinicopathological findings and outcome in 5 CLD patients who underwent surgical treatment for 12 years. RESULTS: All patients complained of symptoms and the mean period of symptoms was 3.8 years. Two patients had perforation of cystic content. Three patients had multiple cysts in both lobes and 2 showed a solitary cyst. The mean cyst size was 13.2cm. Communication between cyst and bile duct was observed in 1 patient. Liver scintigraphy was good compared to the higher value of ICGR15 in 3 patients. Deroofing was performed in 3 patients including laparoscopic treatment and 2 underwent hemihepatectomy. The mean amount of the cystic fluid was 1560mL. All patients had benign liver cysts by histologic findings. One patient had a biloma after deroofing which was percutaneously drained and cured. Although liver cyst recurred in 2 patients, all patients have survived without severe symptoms. CONCLUSIONS: Surgical radical treatment provides good prognosis in CLD patients with uncontrolled symptoms.     

Clinical presentations and surgical management of liver hydatidosis: our 20 year experience

Background. Hydatidosis/echinococcosis of the liver is a very old problem in Greece and still exists, although it is declining. We have reviewed our 20 years’ experience, and here we report the various clinical presentations of the disease and evaluate the clinical outcome of the surgical procedures performed. Patients and methods. We conducted a retrospective analysis of the past 20 years’ medical records; 35 patients (males 34%, females 66%, mean age 58 years) were treated surgically. Results. The presenting symptoms or findings leading to the diagnosis of liver echinococcosis were jaundice (six cases, 17%), abdominal pain (five cases, 14%), gastrointestinal discomfort of the upper abdomen (e.g. nausea, vomiting, distention, anorexia) (two cases, 6%), acute pancreatitis (one case, 3%) and portal hypertension (one case, 3%). The rest of the cases were diagnosed incidentally (20 cases, 57%). External drainage and cystectomy with omentoplasty was performed in 21 cases (60%) and pericystectomy in 14 cases (40%). The mean hospital stay was 16.8 days. Morbidity and mortality were 18% and 3%, respectively, with no statistically significant differences between the two surgical approaches. The recurrence rate averaged 3%. Discussion. A high index of suspicion is recommended when variable clinical manifestations of the upper abdomen are present. Meeting all criteria for surgical treatment of hydatid disease, external drainage and cystectomy should be the standard surgical procedure. Pericystectomy could be used for peripherally located liver cysts that are only partially surrounded by parenchyma. Resection procedures are considered too radical for a benign disease. Appropriate randomized controlled studies are needed to establish the definite surgical management of liver hydatidosis, including modern techniques such as laparoscopy and transcutaneous puncture under US guidance (PAIR technique).     

Evidence-base guideline on management of colorectal liver metastases in the Netherlands

A dutch national evidence-based guideline on the diagnosis and treatment of patients with colorectal liver metastases has been developed. The most important recommendations are as follows. For synchronous liver metastases, spiral computed tomography (CT) or magnetic resonance imaging (MRI) should be used as imaging. For evaluation of lung metastases, imaging can be limited to chest radiography. For detection of metachronous liver metastases, ultrasonography could be performed as initial modality if the entire liver is adequately visualised. In doubtful cases or potential candidates for surgery, CT or MRI should be performed as additional imaging. For evaluation of extrahepatic disease, abdominal and chest CT could be performed. Fluorodeoxyglucose positron emission tomography could be valuable in patients selected for surgery based on CT (liver/abdomen/chest), for identifying additional extrahepatic disease. Surgical resection is the treatment of choice with a five-year survival of 30 to 40%. Variation in selection criteria for surgery is caused by inconclusive data in the literature concerning surgical margins.     

Intraoperative sonography in surgical diseases of the liver

Intraoperative ultrasonography was performed in 24 patients with single or multiple liver metastases of colorectal cancer, in 4 patients with a hepatocellular carcinoma, in 2 patients with an hepatic abscess and in one patient with a focal nodular hyperplasia and one with a liver hemangioma. In 9 of 32 patients with inflammatory or malignant liver disease the tumors were not palpable or visible. These hepatic lesions were localized by intraoperative ultrasound. In 5 cases preoperative unknown hepatic tumors were diagnosed by intraoperative sonography.     

重视我国自身免疫性肝病的研究

自身免疫性肝病是肝病中一种相对较少见的疾病,包括自身免疫性肝炎（autoimmunehe patitis,AIH）．原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）、原发性硬化性胆管炎（primary sclerosing cholangitis,PSC）及相互重叠的疾病。该病与自身免疫机制和遗传易感性及病毒感染有关,具有发展成肝硬化的倾向。近年来,由于我国临床医师的重视及检测技术的进步,该组疾病检出率呈逐年增高的趋势。检索国内主要数据库中国生物医学文摘数据库和中国医院知识仓库,自2000年至2005年共报告PBC病例1417例。     

The current management of infectious diseases in the liver transplant recipient

The spectrum of major infections after transplantation has undergone a striking evolution. The epidemiologic trends in infectious diseases through the last decade have been most notable for a dramatic decrease in the incidence of several opportunistic infections, largely because of advances in prophylaxis against these pathogens. Paralleling these trends has been an exponential rise in the proportion of infections caused by antimicrobial-resistant bacteria. These multiresistant organisms have now emerged as leading pathogens at many transplant centers, and their management is a daunting challenge.     

《2014年美国肠胃病学会临床实践指南：肝脏局灶性病变的诊断及管理》推荐意见

2014年美国胃肠病学会发布了关于肝脏局灶性病变（fo-cal liver lesions,FLL）的诊疗指南,在此翻译全文推荐意见以供临床医生参考。推荐强度及证据质量分级参考表1。     

The surgical management of anorectal diseases in AIDS and pre-AIDS patients

The charts of 340 patients with Acquired Immunodeficiency Syndrome (AIDS), AIDS-related complex (ARC), or AIDS-prodrome (AIDS-P), treated between January 1982 and April 1986 at the Roosevelt Division of the St. Luke's-Roosevelt Hospital Center, were reviewed. The incidence of anorectal disease was 34 percent. Fifty-two patients (15 percent) presentes with anorectal complaints prior to the diagnosis of AIDS, ARC, or AIDS-P. Over 50 percent of these patients were dead within 7.4 months. Fifty-one patients (15 percent) underwent 73 anorectal surgical procedures. Twenty-two of these patients (43 percent) were dead within six months, and only six patients had satisfactory wound healing 30 days after surgery. In addition to an 88 percent rate of poor healing, there was a 16 percent rate of major complications. Identification of these high-risk groups prior to any anorectal surgery is imperative to avoid unacceptable surgical complications. Aggressive surgical intervention should be reserved only for patients who did not fall into the high-risk groups presented. This paper received the New York Society of Colon and Rectal Surgeons A. W. Martin Marino, Sr., M.D., Award at the meeting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 15, 1986.     

The management of autoimmunity in patients with cholestatic liver diseases

Cholestatic liver diseases are rare diseases that often lead to cirrhosis and its consequent complications. In addition to liver-related morbidity, patients with cholestatic liver diseases often suffer from autoimmune diseases that affect several organs and tissues. The robust and efficient data collection and collaboration between hepatologists and rheumatologists have led to significant advancements in understanding the relationship between the cholestatic liver diseases and associated autoimmune diseases. In this paper, we discuss the cholestatic liver diseases (primary biliary cirrhosis, primary sclerosing cholangitis and immunoglobulin G4 associated cholangitis) and associated autoimmune diseases.     

A guideline based approach of percutaneous coronary intervention in acute myocardial infarction: Single center experience

AimTo determine the outcomes of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) according to PCI guidelines.MethodsThis study was conducted between January 2008 and December 2010. A total of 450 patients presenting with STEMI underwent PCI: 288 patients underwent primary PCI, and 162 patients underwent non-primary PCI.ResultsThe mean age at presentation was 55 ± 11.10 years and 89.8% were male. The door-to-balloon time was 60 min in primary PCI group (288 patients). The median time between end of failed thrombolytic therapy and the rescue PCI was 420 min (95 patients) versus 810 min after successful thrombolytic therapy (35 patients). Only 32 patients underwent late PCI ? 24 h and ?48 h without thrombolytic therapy; median time was 2160 min. In-hospital, 30 days and 6-months mortality were respectively 2.1%, 0.7% and 1.1% in primary PCI group while 2.5%, 3.2% and 2.6% in non-primary PCI group. In-hospital, 30 days and 6-months reinfarction occurred in 0.3%, 1.1% and 0.7% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively. In-hospital, 30 days and 6-months TVR occurred in 0.7%, 0.7% and 1.1% of patients in primary PCI group while 0.0%, 1.3% and 0.7% in non-primary PCI group respectively.ConclusionsThis is the first report from Egyptian hospital to provide a comprehensive review of patient characteristics and outcomes of PCI for STEMI. We reported a high initial success rate, excellent short and intermediate-term outcomes.     

Surgical dilemmas in the management of colorectal liver metastases: the role of timing

Colorectal cancer (CRC) is an emerging health problem in the Western World both for its raising tendency as well as for its metastatic potential. Almost half of the patients with CRC will develop liver metastases during the course of their disease. The liver surgeon dealing with colorectal liver metastases faces several surgical dilemmas especially in the setting of the timing of operation. Synchronous resectable metastases should be treated prior or after induction chemotherapy? Furthermore in the case of synchronous colorectal liver metastases which organ should we first deal with, the liver or the colon? All these questions are set in the editorial and impulse for further investigation is put focusing on multidisciplinary approach and individualization of treatment modalities.