Bile-duct cysts or congenital bile-duct dilatation are rare but important abnormalities often mimicking calculous biliary tract disease. Bile-duct cysts are most often classified according to Todani. In a retrospective study of percutaneous, peroperative or endoscopic cholangiograms from 25 patients, diagnosed and treated during a 20-year period, images of different types of bile-duct cysts are presented and classified. The disease usually presents with vague symptoms and has a female preponderance. Current opinion on aetiology and complications is discussed. Cholangiography is a necessary prerequisite to surgical therapy.

Adolescent↗

PubMedDate not supplied

Angiographic studies of the totally arterialized rat liver.

Twenty-three angiographies were performed in 20 rats with a totally arterialized liver. The arterialization was obtained by the construction of an end-to-side portacaval shunt (PCS) and an arteriovenous (AV) fistula between the left gastric artery and the portal stump. Microsurgical technique was necessary because of the small diameter of the AV fistula (0.5 mm). The angiographic examinations showed an AV fistula patency rate of 70% and a PCS rate of 100%. A successively increasing diameter of the fistula with dilation of the intrahepatic portal vessels was demonstrated in the rats with a patent arterioportal fistula. Tortuous and irregular vessels were also observed. All these signs suggest an overarterialization which developed despite the use of a very small AV fistula. None of the three rats examined histologically had cirrhosis of the liver. Further research is needed to attempt to avoid or minimize the deleterious effects of overarterialization of the portal tree, while utilizing the advantages of a dual liver blood supply in patients with decompressive PCS.

Angiography↗

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Amino acids and indoleamines in the brain after infusion of branched-chain amino acids to rats with liver ischemia.

Rats with a portacaval anastomosis and ligation of the hepatic artery 2 days later were infused for 6 hr with a 10% glucose solution (group I) or the same solution combined with 0.24 M/liter branched-chain amino acids (BCAA, group II). Control animals with portacaval anastomosis and sham-operation (group III) or two sham-operations (group IV) were infused with a 10% glucose solution. The rats were killed by decapitation and indoleamines and amino acids were determined in the brain. Rats with liver ischemia were stuporous at the end of the experiment irrespective of treatment. The concentrations in the cortex of lysine, methionine, phenylalanine, threonine, alanine, glutamine, glycine, histidine, and tyrosine were significantly increased in group I compared to group IV. Infusion of BCAA to rats with liver-ischemia (group II) resulted in significantly lower concentrations of lysine, methionine, phenylalanine, threonine, histidine and tyrosine and increased concentrations of isoleucine, leucine, valine, and arginine compared to group I. The content of serotonin in the cortex and brain stem was significantly increased in group I compared with the BCAA-treated animals (group II) and the control groups III and IV. The concentrations of 5-hydroxyindoleacetic acid (5-HIAA) in the cortex and brain stem were higher in group I than in group IV. Infusion of BCAA to rats with liver ischemia normalized the concentrations of 5-HIAA in the cortex and brain stem.

Amino Acids↗

PubMedDate not supplied

Prospective investigation of radiologic methods in the diagnosis of intra-abdominal abscesses.

A prospective investigation of conventional abdominal radiography, ultrasonography, computed tomography and 111In-labelled leucocyte scintigraphy was performed in 40 patients suspected of having an intra-abdominal abscess. There were 23 confirmed abscesses in the material. When conventional abdominal radiography indicated an abscess, such a lesion was usually present. The ability of abdominal radiography to exclude an abscess was, however, low. Both ultrasonography and 111In-labelled leucocyte scintigraphy detected 65 to 85 per cent of the confirmed abscesses, but both also revealed many abscess-like areas in patients where no unequivocal abscess was confirmed at follow-up. Computed tomography was, when employed as a single method, the most reliable one both to show and to exclude an abscess, However, the combination of ultrasonography and 111In-labelled leucocyte scintigraphy disclosed all the lesions demonstrated by any one of the four methods used in the investigation.

Abdomen↗

PubMedDate not supplied

Segmental liver resection with linear stapling device. An experimental study on pigs.

Segmental liver resection was performed in 14 pigs. The pigs were randomized either to resection with conventional finger fracture technique or resection with linear stapling device (TA-90R, US Surgical Corporation). The median time for resection was shorter in the stapled group, although the difference was not statistically significant. The median weight of the specimen was the same in both groups. The median postoperative Haemoglobin value was somewhat lower in the finger fracture resected group as compared to the stapler resected group, 82.5 g/l versus 87.5 g/l, but there was no statistically significant difference between the groups. Blood loss, estimated by counting the number of compresses, amounted to 188 ml for the finger fracture resected group and 181 ml for the stapler resected group. At the post-mortem examination there were no signs of bile leakage or postoperative blood loss in any of the operated animals. This study demonstrates that hepatic resection in the pig can be performed quickly and safely by using linear stapling device. Stapler resection was easier and somewhat quicker to perform than conventional hepatic resection.

Animals↗

PubMedDate not supplied

Balloon catheter dilatation of stenotic common bile duct anastomoses in the pig. A preliminary investigation.

Fibrotic stenosing anastomoses of the common bile duct were surgically created in pigs in order to investigate the effects of percutaneous transhepatic balloon catheter dilatation. In a group of 6 animals, not treated with balloon dilatation, percutaneous transhepatic cholangiography and microscopic examination of the stricture were performed 5 to 25 weeks postoperatively. A persistent stenosis and slight to moderate fibrosis of the bile duct wall and peribiliary tissue were observed. In 5 animals the stenotic anastomosis was dilated 4 to 10 weeks postoperatively and this resulted in widening of the stricture and necrosis of the mucosa at the stricture site. Rupture of the fibrotic tissue in the bile duct wall and thrombus formation in the peribiliary veins also occurred in one of these 5 animals. Short-term follow-up in 3 animals 4 to 6 weeks after balloon dilatation showed almost complete fibrotic healing and partial re-stenosis of the anastomoses.

Animals↗

PubMedDate not supplied

Effect of repeated normothermic ischaemia on normal liver parenchyma. An experimental study in pigs.

Hepatic ischaemia was induced in 8 mesenterico-cavally shunted pigs. The hepatic artery was occluded with biodegradable starch microspheres and the portal vein with a balloon catheter. The liver was kept ischaemic for 90 minutes at the beginning, and 90 minutes at the end, of a 24-hour period. At histopathologic examination 6 of the livers had multiple, small areas of necrosis. The total volume of these necroses accounted for no more than 10 to 15 per cent of each liver. No necrosis was evident in 2 livers. Thus normothermic ischaemia for 2 periods of 90 minutes each within a 24-hour period caused minimal damage to the liver. An alternative treatment in patients with liver tumours could therefore be simultaneous occlusion of the hepatic artery and the portal vein.

Animals↗

PubMedDate not supplied

Fatty meal provocation monitored by ultrasonography. A method to diagnose ambiguous gallbladder disease.

Impaired gallbladder emptying is a recognized sign of acalculous gallbladder disease (AGBD). The emptying function was studied by ultrasonographic monitoring before and after ingestion of fat-containing food in a prospective study comprising 124 patients (136 examinations). In 17 patients the antero-posterior diameter of the gallbladder was unchanged or increased postprandially in addition to the onset of abdominal pain and nausea, signs interpreted as consistent with AGBD. Cholecystectomy, performed in 12 of these individuals, revealed histopathologic changes of different degree in 11 and adhesions of the gallbladder to adjacent organs in 8. The method is simple to perform, cheap, has no side effects and gives a low rate of false positive diagnoses.

Adolescent↗

PubMedDate not supplied

Routine operative cholangiography or pre-operative infusion cholangiography at elective cholecystectomy--a cost-effectiveness analysis.

Previous data from our surgical department suggests that routine operative cholangiography (strategy I) can be replaced by a combination of pre-operative intravenous infusion cholangiography and selective operative cholangiography (strategy II). The general clinical results with the two strategies were similar during a follow-up period of one year. The present study compares the costs for the two strategies through cost-effectiveness analysis. The calculated average total hospital costs with the two strategies did not differ significantly. The costs obtained were SEK 9,150 for strategy I and SEK 9,430 for strategy II. These findings support the opinion that strategy II is approximately as cost-effective as strategy I in the management of patients subjected to cholecystectomy.

Adolescent↗