Portal circulation time: A new method for its determination

Summary The concepts of hypertension and portal stasis have been reviewed. Since neither clinical nor laboratory studies express the real state of portal circulation, a new method is described for determining the circulation speed in that system.We believe that the proposed procedure, based on the measurement of the salivary-duodenal time by means of KI solution, has the advantages of eliminating subjective aspects, is convenient, well tolerated, and often accurate.     

A new method of biliary sampling for cytopathological examination during endoscopic retrograde cholangiography

OBJECTIVES: Biliary brushing during endoscopic retrograde cholangiography (ERC) may allow the diagnosis of cancer, but this technique is limited by a low (18-57%) sensitivity. We compared the cellular and diagnostic yields of a new sampling method (using stricture dilation and a grasping basket) with those of brushing. METHODS: Sixty consecutive patients with a suspected malignant obstruction of the common bile duct were included in a consecutive, nonrandomized order. They underwent sampling during ERC using the new method (study patients, N = 30) or a brush (control patients, N = 30). A final diagnosis of cancer was made in 22/30 (73%) study patients and 21/30 (70%) control patients. At the end of the study period, all smears were interpreted at cytopathological examination in a blind and random fashion for cellularity (insufficient, low, moderate, or high) and diagnosis (normal, atypical considered reactive, highly atypical suspicious for cancer, or malignant). "Highly atypical" and "malignant" diagnoses were considered as indicative of cancer. RESULTS: Compared with biliary brushing, the new method provided a high cellular yield in more cases (19/30 vs 10/30, P= 0.020), a higher sensitivity for the detection of cancer (19/22 [86%] vs 11/21 [52%], P= 0.015), and a higher diagnostic accuracy (27/30 [90%] vs 20/30 [67%], P= 0.028). Specificity for the detection of cancer was 100%. The 30-d complication rate observed with the new method was 3%. CONCLUSIONS: Significantly higher cellular and diagnostic yields can be obtained at ERC in patients with suspected malignant biliary stricture by combining stricture dilation and a grasping basket compared with brushing.     

Glissonean pedicle transection method for hepatic resection: A new concept of liver segmentation

A new concept of hepatic segmentation along with the Glissonean pedicle tree, and the basis of hepatic resection by the Glissonean pedicle transection method are presented. The portal triad continues from the hepato-duodenal ligament to the intra-hepatic portion as the Glissonean pedicle. That is, the artery, portal vein and bile duct, together with connective tissue, are sheathed by the peritoneum to form a fibroid bundle. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver and the trunks of the secondary and more peripheral branches run inside the liver. The ramification pattern of the tertiary branches which branch out from each secondary branch is different from patient to patient. The liver is nourished by the secondary branches of the Glissonean pedicle. Each secondary branch feeds one segment. The liver can thus be separated into three segments and an additional caudate area. The area fed by each one of the tertiary branches is cone-shaped; fermed a “cone unit”. Each segment conists of six to eight cone units. In limited resections, the number of cone units to be respected is adjusted and the tertiary branches which feed these areas must be transected selectively through a hilar or a parenchymal approach. To date we have experienced no complications with this procedure, employed for 832 patients with hepatocellular carcinoma.     

无创技术估测左室心肌松弛时间常数的研究

目的 :探讨无创技术计算左室心肌松弛时间常数 (τ)的可靠性。方法 :对 2 8例舒张性心力衰竭(DHF)患者应用多普勒超声心动图和颈动脉搏动图等无创技术估测左室等容舒张期始点、末点压力和等容舒张时间三项参数 ,在与心导管资料测值获得较好相关基础上 ,分别将无创估测的 3个参数代入下列三参数指数方程InPe =A·IVRT +InPo ,据此式导出心动图左室心肌松弛时间常数 (τn) ,并将τn 与心导管测量的左室心肌松弛时间常数 (τt)值进行对比研究。结果 :多普勒超声心动图和颈动脉搏动图两者之间高度相关 (r =0 .71,P <0 .0 1)。结论 :利用无创多普勒超声技术和颈动脉搏动图估测t的新方法是可靠的 ,为定量评价左室心肌松弛性开辟了一条新的蹊径     

Fiberoptic endoscopic examination of swallowing safety: A new procedure

A new procedure for assessing the pharyngeal stage of swallowing in patients with dysphagia is described. Called the fiberoptic endoscopic examination of swallowing safety (FEESS), it is being used to detect aspiration and to determine the safety of oral feeding in patients for whom the traditional videofluoroscopic evaluation may be difficult or impossible to perform. Patients for whom the FEESS procedure is indicated are identified and information obtainable via endoscopy is outlined.     

Whole liver engineering: A promising approach to develop functional liver surrogates

Liver donor shortage remains the biggest challenge for patients with end‐stage liver failures. While bioartificial liver devices have been developed as temporary supports for patients waiting for transplantation, their applications have been limited clinically. Whole liver engineering is a biological scaffold based regenerative medicine approach that holds promise for developing functional liver surrogates. Significant advancements have been made since the first report in 2010. This review focuses on the recent achievements of whole liver engineering studies.     

A new examination for both biliary and gastrointestinal function after pancreatobiliary surgery--single-isotope two-day method

BACKGROUND/AIMS: There are no established tests for both biliary and gastrointestinal function after pancreatobiliary surgery. In this study, mixing of ingested food with bile after long-term postoperative period was evaluated. METHODOLOGY: Sixteen patients having undergone Imanaga pancreatoduodenectomy (postoperative years = 6.2 +/- 2.0) were evaluated concerning physiologic function of biliary tract and residual stomach using gastric emptying and hepatobiliary scintigraphy. RESULTS: At least 24 months after Imanaga pancreatoduodenectomy, postoperative patients had reached 95.8 +/- 4.9% of the pre-illness bodyweight. Gastric emptying half-time (GET1/2) ranged from 9-147 min (mean: 60.6 +/- 35.0). The time of bile excretion from liver to jejunum ranged from 5-45 min (mean: 11.3 +/- 7.8). Asynchrony time ranged from -5-40 min (mean: 11.3 +/- 7.8). There was no significant correlation between GET1/2 and recovery of bodyweight (r = -0.042, P = 0.8809). Similarly, there was no significant correlation between the time of bile excretion and recovery of bodyweight (r = 0.042, P = 0.8791). On the other hand, asynchrony time had a significant inverse correlation with recovery of bodyweight (r = -0.590, P = 0.0146). CONCLUSIONS: Single-isotope two-day method is an original and useful technique to evaluate biliary and gastrointestinal physiologic function after long-term postoperative period.     

A new quantitative ultrasonic method for diagnosis of chronic parenchymal liver disease

The degree of echogenicity of the hepatic parenchyma was measured by an objective method comparing patient's sonograms with a tissue-mimicking phantom obtained with available real-time ultrasound machines. A single sonographic image of the liver and the phantom was taken using identical setting in each case. The ratio of the mean density of the phantom to that of the liver was obtained. The mean of the ratio in 30 normal subjects was 1.04 +/- 0.01, in 26 patients with early alcoholic liver disease 1.23 +/- 0.04, and in 74 cirrhotic subjects 1.54 +/- 0.03, with a significant difference among the three groups (p less than 0.05). A significant correlation was also obtained between the ratio and a modified Child's classification (r = 0.553, p less than 0.05) in cirrhotic subjects. Follow-up studies were available in a limited number of patients with early alcoholic liver disease showing progression or improvement paralleling alcohol use. Using this method, ultrasound may have considerable potential in the diagnosis and follow-up of alcoholic liver disease.     

A new method of functional scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin

BACKGROUND/AIMS: We investigated whether a new method for scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin could visualize the portal venous system and simultaneously assess hepatic function. METHODOLOGY: Thirty-two patients underwent scintiphotosplenoportography, including 4 with metastatic tumor in an otherwise normal liver, 5 with chronic hepatitis, 9 with cirrhosis, and 14 with both hepatocellular carcinoma and cirrhosis. The tracer (3 mg, 185 MBq) was injected into the spleen under ultrasonic guidance. Hepatic function was evaluated using the receptor index and the index of blood clearance, both calculated by regions of interest for liver and for heart. Spleen-to-liver times were calculated by subtracting peak activity times over the spleen from those over the portal vein. RESULTS: Correlations of blood clearance and receptor indices with plasma retention rate of indocyanine green at 15 min (respectively, r = 0.616, P < 0.0005 and r = -0.669, P < 0.0001), prothrombin time (r = -0.605, P < 0.0005 and r = 0.710, P < 0.0001), the hepaplastin test (r = -0.526, P < 0.005 and r = 0.605, P < 0.0005), serum albumin (r = -0.488, P < 0.005 and r = 0.640, P < 0.0001), and serum cholinesterase (r = -0.600, P < 0.0005 and r = 0.671, P < 0.0001) were significant. Blood clearance and receptor indices also were significantly related to clinical stage, underlying liver disease, features of radioisotopic images, and presence of esophagogastric varices (P < 0.01). Additionally spleen-to-liver time reflected progressive hepatic damage. CONCLUSIONS: Our new method of scintiphotosplenoportography using technetium-99m-DTPA-galactosylated human serum albumin can assess hepatic function and portal hemodynamics simultaneously. Results correlate with accepted, conventional diagnostic techniques. This method represents a potent new method for evaluating the hepatic system.     

Aging and the liver: functional aspects

The drastic decline in the function of the hepatic microsomal cytochrome monooxygenase system, initially reported in male rat livers, was shown to be due to a feminization of male rat livers with aging. In female rat livers as well as in mouse livers, this system was found to stay unchanged with age. Phase II reactions which showed some decline with aging in male rat livers again stayed fairly stable with age in female rat and mouse livers. Glutathione S-transferase (GST) enzyme activities, which are very stable with age in female rat and mouse livers, demonstrated highly age-dependent changes when dietary conditions were manipulated, suggesting a potential age difference in the homeostatic regulation of this enzyme system. Using the fluorescence recovery after photobleaching (FRAP) technique, unique studies revealed an age-dependent decline in the lateral mobility of proteins in hepatocyte surface membranes. The protease inhibitor model of aging, initially proposed by Ivy for brain cells, has been validated in hepatocytes, demonstrating an accumulation of lipofuscin-like granules in young animals treated with i.p. infusion of leupeptin for only 2 weeks. Antioxidant enzyme activities such as superoxide dismutase (SOD) and catalase (CAT) in the liver were clearly demonstrated no to be reduced in general terms with aging. Rather, a clear increase in CAT enzyme activities with age was demonstrated in female rat livers, thus challenging the concept that intracellular enzyme activities generally decline with aging. In this paper, studies performed in Japan on aging and the liver over the past 30 years, with a focus on its functional aspects, are critically reviewed in terms of the clinical implications of these studies as well as on theories of aging in general.