Benign solid liver tumors

Benign solid liver tumors are a heterogeneous group of lesions (adenoma, focal nodular hyperplasia, hemangioma, etc.) with highly varied epidemiological characteristics. Advances in diagnostic methods have improved preoperative diagnosis. Magnetic resonance imaging has become the key test, but there is still a percentage of cases in which definitive preoperative diagnosis is not feasible. The most frequent symptom is abdominal pain, although patients are frequently asymptomatic. Surgery is indicated when diagnosis is uncertain or there are complications (rupture, hemorrhage, etc.). Because of the risk of malignant transformation, adenomas should always be resected. Morbidity and mortality after resection of these tumors is very low since excision is limited, performed in young people without concomitant disease, and in healthy liver.     

Benign liver tumors: what is their relationship to oral contraceptives?

A series of eight cases of benign hepatocellular tumors from the New Orleans area is presented. Clinical and histological features of these unusual tumors are discussed. Also, a series of 56 similar cases reported in the literature is reviewed. We conclude that these tumors have shown definite evidence of hormonal sensitivity and there is strong circumstantial evidence that oral contraceptive medications have contributed to their recent increased incidence. Although the risk of this problem in the overall population of women taking oral contraceptives seems to be quite small, further clinical and experimental research on this problem is clearly indicated.     

Benign hepatic tumors: diagnostic management and therapeutic outcome

The number of non-malignant tumors of the liver diagnosis has greatly increased with widespread use of abdominal ultrasonography. Unlike hemangioma and focal nodular hyperplasia does not require surgery as does hepatocellular adenoma due to the risk of fatal complications. Differentiation between these three kinds of benign tumors is of prime importance to avoid unnecessary surgical interventions. Progress in medical imaging facilitates identification of hemangioma and focal nodular hyperplasia, but in case of doubt, histological proof must be obtained. Laparoscopy may be indicated not only for diagnostic but also for therapeutic purposes.     

Cross-sectional internal diameters of radial, thoracodorsal, and dorsalis pedis arteries in children: relationship to subject sex, age, and body size

The purpose of this study was to determine the average diameter of the radial, thoracodorsal, and dorsalis pedis arteries in a pediatric population and to evaluate the relationship of these measurements to the subject's age, sex, height, weight, and body mass index (BMI). The internal diameters of the radial, thoracodorsal, and dorsalis pedis arteries were non-invasively studied in 45 normotensive, presumed normal children of various ages (4 to 14 years) with the use of a Doppler system. The average diameters of the radial, thoracodorsal, and dorsalis pedis arteries in females and males were as follows: radial artery 1.39 (SD +/- 0.18) mm and 1.57 (SD +/- 0.18) mm; thoracodorsal artery 1.27 (SD +/- 0.11) mm and 1.36 (SD +/- 0.2) mm; and dorsalis pedis artery 1.22 (SD +/- 0.08) mm and 1.34 (SD +/- 0.12) mm. These were correlated with the age, height, weight, and BMI. Gender had a strong influence on the diameter of these arteries. In a linear regression model, weight was found to be statistically the best independent variable for predicting radial and dorsalis pedis diameters, whereas age was the best predictor for the diameter of the thoracodorsal artery. The diameters of these three arteries in an age group of 4 to 14 years ranged between 1 to 2 mm. The age and weight of the children predicted the diameters of the peripheral arteries.     

Benign liver tumors in adults: Diagnosis and management

Benign tumors of the liver are a heterogeneous group of lesions whose detection has greatly increased because of the widespread use of imaging techniques. Only a few types, such as cavernous hemangiomas, focal nodular hyperplasia (FNH), hepatic adenoma (HA), and cysts, are frequent enough to be of clinical importance. Although often asymptomatic, these tumors are sometimes associated with pain or digestive symptoms. In some of them, hormonal manipulation has a role in both the development and the course. Complications, such as spontaneous rupture or sudden increase in size, have been reported. Only in hepatic adenoma is malignant transformation considered possible. The clinical importance of these tumors lies mainly in making a correct diagnosis of the type of lesion, and in ruling out primary or metastatic tumors. Although most cases can now be identified through imaging techniques, in some, diagnosis remains uncertain even after percutaneous biopsy, making surgical exploration necessary. We here consider 104 patients with benign lesions: 60 underwent resection; the remaining 44 had follow up only. Of the former group, 35 had hemangiomas, 16 “cellular” tumors (either FNH or HA), and 9 cystic lesions. Forty-four were resected due to the presence of symptoms and 16 because of uncertain diagnosis. It is concluded that cavernous hemangioma, FNH, and most of the cysts have a favorable clinical evolution and, when the diagnosis is certain, resection is not indicated. Surgery can be considered for symptomatic or complicated cases and those in which the diagnosis remains uncertain with imaging work-up techniques. HA and cystic adenoma require surgical treatment even in asymptomatic patients.     

结石类型与年龄、性别的相关性研究

目的:对结石成分进行定量分析,探讨结石类型与患者人口学特征、基础疾病等因素的关系。方法:回顾性分析336例泌尿系结石患者,根据结石类型分为单纯草酸钙结石组、草酸钙混合结石组、磷酸钙混合结石组、尿酸结石组、磷酸铵镁结石组、其他成分组。比较不同组间患者年龄、性别、BMI、基础疾病的差异。对单因素分析中P<0.20的影响因素进行多分类Logistic回归分析。结果:所有结石患者中,上尿路结石322例,依次为单纯草酸钙结石(53.1%)、草酸钙混合结石(26.7%)、磷酸钙混合结石(10.9%)、尿酸结石(6.5%)、磷酸铵镁结石(2.2%)、其他结石(0.6%)。单因素分析结果显示,不同组间患者的性别、年龄差异有统计学意义(P<0.05),不同组间患者的BMI、基础疾病差异无统计学意义(P>0.05)。多因素分析结果显示,与老年患者相比,青年患者草酸钙混合结石、磷酸钙混合结石和尿酸结石的优势比(OR)分别为2.47、20.74和0.20(P<0.05);中年患者草酸钙混合结石和磷酸钙混合结石的OR值分别为2.31和7.70(P<0.05)。与男性患者相比,女性患者磷酸钙混合结石和磷酸铵镁结石的OR值分别为5.20和6.74(P<0.05)。结论:不同结石类型的患者具有不同的人口学特征,在年龄和性别上均有明显差异。     

Primary benign solid tumors of the liver.

The benign solid primary tumors of the liver separate into three major groups: (1) the most common lesions--small, nodular tumors, often found incidentally with histologic features suggesting a reactive etiology, that never rupture or metastasize, that seem to grow most rapidly in children and pregnant women, and that are probably unrelated to birth control medication; (2) the less common adenomas that are purely epithelial, that most often occur in menstruating females, that often show necrosis and rupture, and that are closely associated with oral contraceptive agents; and (3) very rare tumors, usually mesenchymal, occurring solely in children. The therapeutic and prognostic implications of these tumors are defined based upon a study of 111 patients, all but one of whom have undergone resection.     

皮肤颜色和部位、年龄及性别的相关性研究

目的：采用无创性皮肤颜色测量技术,研究汉族人肤色特征与部位、年龄及性别的关系.方法：用分光测色仪CM-2600d测量200名健康自愿者额部、颊部、侧胸、前臂伸侧、前臂屈侧及手背皮肤颜色.结果：所测部位间皮肤颜色均有不同程度的差异.额部、颊部、前臂屈侧、手背L＊值随年龄增加而降低,颊部a＊值和b＊值随年龄增加而增大.男性L＊值小于女性（P＜0.05）,a＊值大于女性（P＜0.05）.颊部、侧胸、前臂屈侧,男性b＊值大于女性（P＜0.05）.结论：无创性皮肤颜色测量能比较准确、客观地反映汉族人不同部位、年龄、性别的肤色变化规律.     

Benign liver tumors in children: a 25-year experience.

The most common benign liver tumors are hemangiomas and hamartomas, both of mesenchymal origin. Mortality for patients with these tumors has traditionally been substantial despite benign histology. Between 1965 and 1989, 22 patients were treated for a benign liver tumor. This represents 42% of all primary neoplasms of the liver observed during this period. Incidental findings of liver tumors at autopsy were excluded from this series. There were 9 boys and 13 girls with a mean age at presentation of 2.3 years (range, birth to 14 years). Sixteen had hemangiomas and presented earlier in life (mean age, 4.4 months). In this subgroup, high-output cardiac failure was present in 58% of the newborns. Seven hemangiomas were resected, four were observed, three were treated with digitalis, diuretics, and steroids, and one received epsilon-aminocaproic acid. Nonhemangiomatous tumors included four hamartomas, one focal nodular hyperplasia, and one nodular transformation. All six were resected. There was one death early in the series. At a mean follow-up of 38 months, 21 of the 22 patients are cured or asymptomatic. In the past, mortality rates of close to 90% have prompted many investigators to advocate resection of every symptomatic hemangioma. With the availability of more sophisticated imaging techniques and refinements in the treatment of cardiac failure, surgery can be used more selectively. Hepatic resections, once considered heroic, can now be performed with minimal morbidity and virtually no mortality. The 96% survival in this series of benign liver tumors contrasts with high mortality rates reported in the literature and illustrates the spectacular improvements that have been made in the diagnosis and management of these once ill-reputed tumors.     

Liver resection for benign liver tumors: indications and outcome

BACKGROUND: The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS: Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS: The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS: Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.     

The diameter of the common femoral artery in healthy human: influence of sex, age, and body size

PURPOSE: To determine the relevance of dilatations of the common femoral artery (CFA), knowledge of the normal CFA diameter is essential. The diameter of the CFA in healthy male and female subjects of different ages was investigated. METHODS: The diameter of the CFA was measured in 122 healthy volunteers (59 male, 63 female; 8 to 81 years of age) with echo-tracking B-mode ultrasound scan. The influence of age, sex, height, weight, body surface area (BSA), and systolic blood pressure was analyzed by means of a multiple regression model. RESULTS: The CFA increased steadily in diameter throughout life. From 25 years onwards, the diameter was larger in men than in women. Significant correlations were found between the CFA diameter and weight (r = 0.58 and r = 0.57 in male and female subjects, respectively; P <.0001), height (r = 0.49 and r = 0.54 in male and female subjects, respectively; P <.0001), and BSA (r = 0.60 and r = 0.62 in male and female subjects, respectively; P <.0001). Age and BSA were used to create a model for prediction of the CFA diameter (r = 0.71 and r = 0.77 in male and female subjects, respectively; P <.0001). CONCLUSION: The diameter of the CFA increases with age, initially during growth but also in adults. This is related to age, body size, and sex male subjects have larger arteries than female subjects. It is now possible to predict the normal CFA diameter, and nomograms that may be used in the study of aneurysmal disease are presented.     

Impact of age on the outcome of liver resections

The purpose of this study was to evaluate the influence of age on the outcome of liver resections. One hundred five consecutive hepatic resections were divided into two groups: > or = 65 years old [old group (O-group)] and < 65 years old [young group (Y-group)]. The two groups were first compared to evaluate the distribution of the variables potentially affecting the postoperative course, including primary diagnosis, concomitant diseases, previous upper abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of hepatic resections in the two groups was comparatively evaluated in terms of postoperative mortality, morbidity, transfusions, and length of postoperative hospitalization. The Y-group included 61 resections in 60 patients, mean age 52 +/- 10 years (mean +/- SD), range 23-64 years, whereas the O-group included 44 resections in 43 patients, mean age 71 +/- 4 years (mean +/- SD ), range 65-82 years. The O-group included more hepatocellular carcinomas (45.4% vs 18.0%, P = 0.002) and chronic liver diseases (40.9% vs 18.7%, P = 0.017); the median length of operation was slightly higher in the Y-group (300 minutes vs 270 minutes, P = 0.003). Both O-group and Y-group were comparable (P = n.s.) when evaluated for all other listed variables. As far as concerns the outcome of hepatic resections in the two groups, the length of postoperative hospitalization was identical (median 9 days, 5-60 days), whereas transfusions of packed red cells (O-group vs Y-group: 25.0% vs 16.3%, P = 0.30) or fresh frozen plasma (O-group vs Y-group: 13.6% vs 6.5%, P = 0.053) were not statistically different. Postoperative mortality included one case among young patients whereas no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y-group than in O-group (31.5% vs 20.5%, P = 0.59). The age factor does not negatively affect the outcome of liver resections.     

Airspace size in lungs of lifelong non-smokers: effect of age and sex.

BACKGROUND: Emphysema is defined as the abnormal enlargement of airspaces distal to the terminal bronchiole, but the limits of normality of airspace size have never been defined. The aims of the study were to examine the effects of age and sex on airspace size in non-smokers and to define the limits of normal airspace size. METHODS: Airspace size was measured in terms of airspace wall surface area per unit volume of lung tissue (AWUV). AWUV was measured on histological sections of lung tissue with an automated scanning system, the fast interval processor. Thirty eight lifelong non-smokers were studied, 15 male and 23 female, with an age range of 21-93 years. Macroscopic emphysema was assessed semi-quantitatively on the midsagittal slice of each lung specimen. RESULTS: The relation between mean AWUV and age was negative (r = -0.78). This relation was linear, and the 95% prediction limits of its regression line were used as the limits of normality of AWUV in this sample. The AWUV-age relationship was similar in the men and women studied. Localised areas of macroscopic emphysema were found in three specimens whose mean AWUV measurements were within the normal range. CONCLUSIONS: There is a normal increase in airspace size associated with advancing age in adult lungs. The limits of normal AWUV between ages 21 and 93 years have been defined, and it is proposed that lungs with a mean AWUV below the 95% prediction limit should be considered as having emphysema.