Lobar dearterialization in liver trauma.

Two cases of blunt liver trauma managed by hepatic artery ligation are reported. Lobar dearterialization is a simple and effective method of achieving haemostasis in exsanguinating wounds of the liver. The postoperative management and scope of this procedure are discussed.     

Experimental vascularized segmentai pancreatic and islet transplantation in the baboon

The present study was undertaken to evaluate the effectiveness of cyclosporine (CYA) and total body irradiation (TBI) or total lymphoid irradiation (TLI) in suppressing segmental pancreatic allograft rejection in totally pancreatectomized outbred Chacma baboons. In addition, the study includes our preliminary results with subcapsular renal autotransplantation of dispersed autologous pancreas in the primate. CYA in doses of 25–50 mg/kg per day produced a slight but significant prolongation of graft survival. There was a wide variation of daily CYA serum trough levels exhibited between primates on the same daily oral dose, and there was no clear correlation between absolute CYA serum trough levels and rejection. Although heterotopic auto- or allotransplantation of the tail of the pancreas in the baboon was capable of maintaining normoglycemia in pancreatectomized baboons until rejection of the graft, glucose intolerance, reduced K-values, and hypoinsulinemia were consistent findings during glucose tolerance tests, suggesting transplantation of an insufficient islet cell mass. Animals that received 76 rad (TBI) remained normoglycemic between 14 and 36 days with a median of 22 days, which indicated a modest but significant prolongation of graft survival. Animals treated with TLI (600 rad) sustained graft function between 7 and 31 days with a median of 17 days. The optimal regimen of irradiation in terms of cumulative dose, dose per fraction, number of fractions, and frequency of irradiation still requires refinement in this model. Primates receiving subcapsular autologous dispersed pancreas failed to become normoglycemic and plasma glucose levels never dropped below 12 mmol/L. Postmortem examination revealed diffuse chemical peritonitis associated with surrounding fat necrosis and autodigestion of the retroperitoneal tissues, suggesting that this technique has no clinical application at present.

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Resumen Se emprendió el presente estudio con el fin de evaluar la efectividad de la ciclosporina (CIA) y de la irradiación corporal total (ICT) o la irradiación linfoide total (ILT) en la supresión del rechazo del alotransplante pancreático en mandriles Chacma totalmente pancreatectomizados. Además el estudio incluye nuestros resultados preliminares con el autotransplante subcapsular en el riñón de páncreas autólogo disperso en el primate.La CIA en dosis de 25 mg/kg/día o de 50 mg/kg/día produce una prolongación leve pero significativa de la supervivencia del transplante. Se observó una amplia variación en los niveles séricos de CIA en los primates bajo las mismas dosis orales, y no se vió una clara correlación entre los niveles séricos absolutos de CIA y el rechazo. Aun cuando el auto o alotransplante heterotópico de la cola del páncreas en el mandril fue capaz de mantener normoglicemia en los mandriles pancreatectomizados hasta el rechazo del transplante, la intolerancia a la glucosa, valores bajos de K e hipoinsulinemia fueron todos hallazgos consistentes en pruebas de tolerancia a la glucosa, lo cual sugiere que el transplante representó una masa insuficiente de islote.Los animales que recibieron 76 RAD (ICT) permanecieron normoglicémicos entre 14 y 36 días con una media de 22 días, lo cual indica prolongación de la supervivencia del transplante.Los animales tratados con ILT (600 RAD) mantuvieron la función del transplante entre 7 y 31 días, con una media de 17 días. El régimen óptimo de irradiación en términos de la dosis acumulativa, dosis por fracción, número de fracciones y frecuencia de la irradiación, todavía requiere mayor refinamiento en este modelo.Los primates que recibieron páncreas disperso autólogo en implantación subcapsular no lograron normoglicemia y los niveles plasmáticos de glucosa nunca descendieron de 12 mmol/L. El examen postmortem reveló peritonitis química difusa asociada a necrosis grasa de la vecindad y autodigestión de los tejidos retroperitoneales, lo cual sugiere que esta técnica no tiene aplicación clínica en la actualidad.

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Résumé Cette étude avait pour objectif de mesurer l'efficacité de la cyclosporine A (CYA) et de l'irradiation corporelle totale (ICT) ou de l'irradiation lymphoïde totale (ILT) dans la prévention du rejet des hétérogreffes segmentaires de pancréas, chez les babouins Chacma totalement pancréatectomisés. Nous présentons également nos résultats préliminaires concernant l'autotransplantation de tissu pancréatique dispersé sous la capsule rénale chez le primate.La CYA à la dose de 25 à 50 mg/kg/j entraîne une prolongation discrète mais significative de la survie du greffon. Le taux sérique de CYA varie largement d'un animal à l'autre pour une même dose orale quotidienne, et il n'y a pas de corrélation évidente entre le taux sérique de CYA et la survenue du rejet. Les auto et hétérogreffes de la queue du pancréas en position ectopique sont capables d'assurer la normalisation glycémique chez les babouins pancréatectomisés, jusqu'au rejet de la greffe; mais il persiste constamment une intolérance glucidique, des valeurs basses de K lors des épreuves d'hyperglycémie provoquée, ce qui suggère que la masse d'îlots transplantés est insuffisante.Les animaux recevant une dose de 76 rads (ICT) restent normoglycémiques pendant 14 à 36 jours avec une médiane de 22 jours, ce qui traduit une prolongation modeste mais significative de la survie de la greffe. Les animaux traités par ILT conservent un greffon fonctionnel pendant 7 à 31 jours (médiane = 17 jours). Le protocole optimal d'irradiation pour ce qui est de la dose totale, la dose par fraction, le nombre de fractions et la fréquence des séances d'irradiation, reste à définir dans ce modèle. Les primates greffés avec du pancréas autologue dispersé sous la capsule rénale ne redeviennent pas normoglycémiques, leurs glycémies restant au dessus de 12 mmol/l. L'examen post-mortem révèle des lésions de péritonite chimique diffuse entourées de cyto-stéatonécrose et une autodigestion du tissu rétropéritonéal, ce qui suggère que cette méthode n'a pas d'intérêt clinique pour le moment.

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Supported in part by grants from the Harry Crossley Fund, Medical Research Council, University of Stellen-bosch and The Cape Provincial Administration.     

A case of right liver atrophy

The authors report a case of right liver atrophy. This rare anomaly was suspected during post-operative period on abnormalities of cholangiogram. This biliary tract anomaly was diagnosed by CT scan. This congenital abnormality may be associated with biliary tract abnormalities, portal hypertension and other congenital abnormalities.     

Primary sclerosing cholangitis associated with liver atrophy

Of 27 patients with primary sclerosing cholangitis, 4 were found on investigation and subsequently at operation to have gross lobar atrophy. The disease was particularly severe in the hilar region. Three of the four patients were asymptomatic prior to the onset of jaundice. The presence of atrophy precipitated laparotomy to exclude cancer in two cases. Marked disparity in size between liver lobes precluded a hilar approach to relieve extrahepatic obstruction in two patients. Prolonged follow-up excluded coincident malignant disease. Selective liver atrophy should be considered part of the disease spectrum in primary sclerosing cholangitis.     

Segmental atrophy of the liver: a distinctive pseudotumor of the liver with variable histologic appearances

Segmental atrophy of the liver can lead to the formation of a pseudotumor that can pose a diagnostic challenge. To better understand the full clinicopathologic spectrum of this pseudotumor, 18 cases were studied. Ages at presentation ranged from 14 to 91 years (median, 63 y) with a modest female-patient predominance (13 of 18, 72%). Upper right quadrant abdominal pain was the most common clinical presentation (14 of 18, 78%), and all the cases were mass lesions. The majority of cases were subcapsular (15 of 18, 83%) and ranged in size from 1.8 to 10.0 cm. All the cases contained abnormally thick-walled and often thrombosed vessels, with both arteries and veins affected. Biliary cysts were a common finding (7 of 18, 39%). Examination of the entire series of cases suggested a sequence of changes, with early lesions (n = 4) composed of collapsed hepatic parenchyma with preservation of portal areas, occasional islands of residual hepatocytes, and brisk bile ductular proliferation. These cases showed very mild elastosis. Other cases (n = 10) showed little or no ductular proliferation but had increased levels of elastosis. More advanced lesions (n = 3) were composed almost solely of elastosis with small scattered islands of unremarkable hepatocytes, whereas an end-stage lesion (n = 1) was a discrete nodule of fibrosis. In conclusion, segmental atrophy of the liver is typically subcapsular, and is strongly associated with vascular injury. The lesion has multiple stages ranging from parenchymal collapse, to nodular elastosis, to nodular fibrosis. Recognizing the various morphologies will aid in proper diagnosis.     

Quantitative studies of liver atrophy after portacaval shunt in the rat

BACKGROUND: It is well known that portacaval shunting ultimately leads to a decrease in liver volume and hepatic function, but the mechanism is uncertain. The aim of the present study was to evaluate the effect of portacaval shunting (PCS) upon the morphological changes that occur in the liver in rats after port caval anastomosis. MATERIALS AND METHODS: Sixty-six male rats underwent either PCS (n = 35) or sham operations (n = 31). Hormone levels were determined in blood samples taken just before removal and weighing of the livers. Hematoxylin and eosin-stained sections were used for quantitative morphometric analysis. Apoptosis, mitosis, and cellular organelles also were assessed quantitatively. RESULTS: There was a significant reduction in the liver mass together with testosterone levels in PCS rats in comparison with sham rats. The distance between presinusoidal and postsinusoidal vessels was reduced from 500 mum in the sham rats to 299 mum in the PCS rats (P = 0.000001). Within the same group, there was a significant reduction in the area of hepatocyte nuclei in zone 3 in comparison with zone 1. Electron microscopy revealed a highly significant (P = 0.0007) reduction in the membrane-bound cytoplasmic organelles of zone 3 hepatocytes in PCS rats in comparison with the sham rats. Apoptosis was increased in zone 3 in PCS rats (P = 0.00001), whereas in zone 1 of the same group, there was an associated increased in mitosis (P = 0.000001). Overall, the degree of apoptosis was in excess of mitosis, resulting in a general loss of liver mass. CONCLUSION: Morphometric analysis at cellular and subcellular levels confirms the morphological findings of liver atrophy in PCS rats. The mechanism of atrophy is a complex one. Portacaval shunting leads to hepatic atrophy that, in turn, results in microcirculatory and hormonal changes that further contribute to liver cell loss in this animal model.     

Arterialization of the liver prevents testicular atrophy in portacaval shunted rats

Portacaval anastomosis in male is known to induce testicular atrophy. The effect of liver revascularization by the right renal artery on the testes of portacaval shunted rats was examined. After shunting, there was a 75% decrease in testis weight compared to the control value and spermatogenesis was blocked in steps 8–9 of spermiogenesis. The in vitro binding of [¹²⁵I]hCG was only 10% of the control value on a per testis basis and labelled areas in the interstitium of frozen sections subjected to topical autoradiography with [¹²⁵I]hCG were also strikingly reduced. These parameters were maintained to normality in revascularized shunted rats which displayed also normal copulatory and fertilizing abilities. It is suggested that an adequate blood supply to the liver, as provided by arterialization, can preserve testicular integrity in shunted rats, even though the blood is arterial instead of portal.     

Glutamine prevents pancreatic atrophy and fatty liver during elemental feeding

Rats fed an elemental, enteral diet (STD) developed pancreatic atrophy and hepatic steatosis following 60% jejunoileal intestinal resection. An isonitrogenous, isocaloric 2 g/100 ml glutamine-supplemented diet (GLN) significantly attenuated the development of pancreatic atrophy and hepatic steatosis associated with elemental feeding. Pancreatic weight, DNA, and protein were 27, 22, and 40% increased, respectively, in GLN animals. The pancreata of all animals appeared normal by light and electron microscopic examination. GLN animals had 12% less total liver wet weight, 3% less hepatic water content, and 47% less hepatic fat relative to STD rats. Histologic examination of the liver revealed extensive centrilobular fatty vacuolization in STD animals whereas GLN rats had normal looking hepatic parenchyma. Glutamine should be viewed as an important nutrient in elemental diets with trophic effects on the pancreas and protective effects against the development of hepatic steatosis.