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PubMedDate not supplied

Prognostic value of peritoneoscopic findings in cirrhosis of the liver.

The prognostic value of peritoneoscopy was examined in 372 patients with liver cirrhosis according to the degree of development and size of regenerating nodules, the development of reddish markings, the development of small lymphatic vesicles, the presence or absence of patchy markings, the size of the right and left hepatic lobes, and the degree of splenomegaly. The cumulative survival rate was compared with these peritoneoscopic parameters. The usefulness of peritoneoscopic and histological findings in the prognosis of liver cirrhosis was evaluated using the proportional hazard model of Cox. Significant differences were observed in the cumulative survival rate with respect to the degree of development of regenerating nodules, the size of the right hepatic lobe, the formation of small lymphatic vesicles, and the degree of splenomegaly. Analysis using Cox's proportional hazard model indicated that peritoneoscopic findings are of greater clinical use than histological findings in determining the prognosis of liver cirrhosis.

Adult↗

PubMed1991

Pneumoscrotum after spontaneous pneumothorax with air leak.

A case of pneumoscrotum associated with a chest wall air leak following placement of a chest tube for spontaneous pneumothorax is reported. The patient recovered uneventfully once the air leak surrounding the tube was successfully closed at the entry wound. Two previous cases have described pneumoscrotum occurring after colonoscopy and after diagnostic peritoneoscopy. All 3 (previous and current) cases report the associated development of subcutaneous and retroperitoneal emphysema, which provides a possible etiological mechanism for this entity.

Chest Tubes↗

PubMed1986

Histologic and clinicopathologic features of Chinese patients with HBsAg-positive chronic active hepatitis.

Needle biopsies of both the right and left lobes of the liver were performed during peritoneoscopy in 20 male patients with chronic active hepatitis B in Taiwan. Microscopic study of these biopsy specimens led to the recognition of three groups: 1) five patients in whom the lobular architecture was easily recognizable but in whom necrosis and early intralobular fibrosis were present, along with severe chronic inflammation of the portal tracts; 2) seven patients in whom the livers were characterized by early septal formation and a good regenerative response, but few recognizable lobules with normal architecture; and 3) eight patients in whom the disease had progressed to severe fibrosis with septal formation and tiny pseudolobules, indicative of early cirrhosis. The left lobe was the more severely damaged in 16 of the 20 patients.

Adolescent↗

PubMed1984

Randomised trial comparing two combination chemotherapy regimens (Hexa-CAF vs CHAP-5) in advanced ovarian carcinoma.

186 patients with advanced epithelial ovarian carcinoma were treated with either a combination of hexamethylmelamine, cyclophosphamide, methotrexate, and 5-fluorouracil (Hexa-CAF) or cyclophosphamide and hexamethylmelamine alternating with doxorubicin and a 5-day course of cisplatin (CHAP-5). Treatment with CHAP-5 resulted in more complete remissions as determined by laparatomy or peritoneoscopy (p = 0.004), better overall response (p = 0.0001), and longer overall survival and progression-free survival (p less than 0.002). Therapy, histological grade, and Karnofsky index were reliable predictors of overall response, whereas therapy, FIGO-stage, and size of residual tumour before chemotherapy were independent predictors for complete remission and for prolonged survival. Peripheral neurotoxicity was a major problem in patients assigned to the CHAP-5-group and was likely to be due to the simultaneous administration of hexamethylmelamine and cisplatin. The CHAP-5 regimen is one of the most effective regimens for the initial treatment of ovarian cancer.

Altretamine↗

PubMed2000

Endosalpingiosis in laparoscopy.

STUDY OBJECTIVE: To estimate the laparoscopic frequency of endosalpingiosis versus other causes of peritoneal proliferation. DESIGN: Clinic-based, prospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: The 1107 consecutive women undergoing laparoscopy over 1 year. INTERVENTION: Peritoneoscopy was performed during laparoscopy. All peritoneal proliferations were excised and examined by histology. MEASUREMENTS AND MAIN RESULTS: In 7.6% of patients there was histologic evidence of endosalpingiosis. The frequency in asymptomatic women undergoing elective sterilization was 8.3%, and in infertile patients it was not significantly higher (11.7%, p = 0.6765). No significant difference was seen between patients with (7.3%) and without (7.9%) lower abdominal pain (p = 0. 7027). CONCLUSION: Endosalpingiosis is the second most common cause of peritoneal proliferation in the lower abdomen, with histologic evidence of the disorder in more than 7% of premenopausal women. In contrast to endometriosis, endosalpingiosis plays only a minor role in the evaluation of infertility and lower abdominal pain. Because of its relationship to serous ovarian neoplasms of low malignant potential, further prospective studies are urgently needed.

Abdominal Pain↗

PubMed2000

Distinction between chronic hepatitis and liver cirrhosis in patients with hepatitis C virus infection. Practical discriminant function using common laboratory data.

In order to distinguish patients with cirrhosis from those with chronic hepatitis, multivariate discriminant analysis was performed using common laboratory data. A total of 205 consecutive patients were diagnosed by peritoneoscopy and biopsy as having chronic liver disease caused by hepatitis C virus (HCV), 168 with chronic hepatitis and 37 with cirrhosis. Twenty variables and their natural logarithmic transformation were employed in the multivariate analysis. After stepwise variable selection, the following function was finally obtained to discriminate the disease severity, z=0.120xgamma-globulin (%)+0.423xln (hyaluronate) (µg l(-1))-0.059xplatelet (x10(4) counts per mm(3))-0.364xsex (male, 1; female, 2)-3.953. Since the function contained an expression of logarithm and was slightly troublesome to apply, we prepared another discriminant function composed of usual figures without logarithmic transformation, z=0.124x(gamma-globulin (%))+0.001x(hyaluronate) (µg l(-1))-0.075x(platelet (x10(4) counts per mm(3)))-0.413xgender (male, 1; female, 2)-2.005. When a positive result is calculated in the latter equation, the diagnosis of the liver disease indicates cirrhosis, and negative result chronic hepatitis. Accuracy of the two discriminant functions was 90.3 and 91.2%, respectively. A concise linear discriminant function could successfully differentiate liver cirrhosis from chronic hepatitis with an accuracy of 91.2%.

Journal Article↗

PubMed2002

Clinical significance of intrahepatic interleukin-8 in chronic hepatitis C patients.

Background/AIM: Interleukin-8 (IL-8) is known as a chemotactic and angiogenetic cytokine and is a potential mediator of host response to injury or inflammation. In order to identify the role of IL-8 in the pathogenesis of chronic hepatitis C (CHC), we assessed semiquantitatively the messenger RNA (mRNA) expression of IL-8 and other cytokines in liver biopsy specimens of CHC patients. METHOD: Liver biopsy specimens were obtained under peritoneoscopy from 35 patients with CHC. The mRNA expression of IL-8 and other cytokines in the liver were determined by real-time PCR and the correlation between the mRNA expression and histological classification of liver were studied. Liver histology was classified by both staging of fibrosis (F0-F4) and grading of activity (A1, mild; A2, moderate and A3, severe). RESULTS: Patients were classified into F1, 8; F2, 9; F3, 9 and F4, 9 and A1, 6; A2, 14 and A3, 15, by staging of fibrosis and grading of activity, respectively. Expression of IL-8 mRNA increased with staging of fibrosis (F1, 0.402+/-0.65; F2, 0.413+/-0.246; F3, 1.388+/-2.166; F4, 1.991+/-1.879) and grading of activity (A1, 0.560+/-0.808; A2, 0.780+/-1.268; A3, 1.548+/-1.957). The mRNA expressions of IL-2, IL-1alpha, IL-1beta, IL-15 and TNF-alpha were found to be closely correlated with IL-8 mRNA (R=0.638; 0.522; 0.487; 0.465 and 0.495, respectively, in all P<0.05). CONCLUSION: In CHC, intra-hepatic expression of both IL-8 and IL-2 increased with fibrosis and inflammatory activity. Positive correlations were found between IL-8 and other cytokines and between cytokines themselves. These findings suggest that these interacting cytokines play an active role in the pathogenesis of CHC, and maybe involved in the upregulation or induction of one and other.

Journal Article↗

PubMed2002

Immunohistochemical localization of CEA, CA19-9 and DU-PAN-2 in hepatitis C virus-infected liver tissues.

AIMS: We investigated expression of CEA, CA19-9 and DU-PAN-2 in liver tissues of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, measuring their serum value to clarify their clinical significance, and proliferating cell nuclear antigen (PCNA) was assessed in serial sections to determine whether expression of these molecules in chronic liver disease was related to regeneration of biliary ducts. METHODS AND RESULTS: Liver tissues were biopsied under peritoneoscopy or echo-guidance and resected surgically among 63 patients with anti-hepatitis C virus-positive sera. There were 26 cases of chronic hepatitis, 21 cases of liver cirrhosis and 16 cases of hepatocellular carcinoma (four cases of mixed type). They were simultaneously used for immunocytochemistry for CEA, CA19-9 and DU-PAN-2, and PCNA was demonstrated in serial liver tissues by immunohistochemistry. Serum CEA, CA19-9 and DU-PAN-2 were measured by radioimmunoassay or enzyme immunoassay. In chronic hepatitis and liver cirrhosis CEA immunoreactivity was seen on membranes facing bile canaliculi and in bile ductules. Both CA19-9 and DU-PAN-2 immunoreactivity were observed in bile ductules in chronic hepatitis liver cirrhosis and non-neoplastic areas surrounding hepatocellular carcinoma, and CA19-9 was also present in interlobular bile ducts. PCNA immunoreactivity was not detected in marker-positive bile ductules or interlobular bile ducts. In hepatocellular carcinoma CEA immunoreactivity was seen on membrane facing dilated bile canaliculi in glandular structures, and CEA, CA19-9 and DU-PAN-2 immunoreactivity was observed in cholangiolar areas in mixed type of hepatocellular carcinoma. CONCLUSIONS: CEA in chronic hepatitis and liver cirrhosis is expressed not only in bile ductules but also on membrane facing bile canaliculi, and both CA19-9 and DU-PAN-2 were seen in different levels of biliary ducts. These molecules were expressed in bile ductules in surrounding non-neoplastic areas of hepatocellular carcinoma, and their expression was not associated with regeneration of biliary ducts. CEA expression was present in the trabecular type of hepatocellular carcinoma, and CA19-9 and DU-PAN-2 were observed in cholangiolar areas in mixed type of hepatocellular carcinoma.

Antigens, Neoplasm↗

PubMed1977

A case of primary undifferentiated sarcoma of the liver.

The authors report a case of primary undifferentiated sarcoma of the liver, observed in a 36-year-old man. Diagnosis was established at peritoneoscopy and guided biopsy, and confirmed by autopsy two months later.

Adult↗

PubMed1976

Peritoneoscopic evaluation of the effect of chemotherapeutic agents on liver metastases of breast cancer (report of 2 cases).

Two cases of breast cancer are presented in which massive liver metastases were proved by biopsies prior to treatment. Use of alternate cyclical hormonal cytotoxic combination chemotherapy (EORTC Clinical Trial, protocol, no 10741/3) was followed by a dramatic disappearance of neoplastic tissue. Peritoneoscopy associated with needle biopsy proved extremely useful to provide objective evaluation of the response to chemotherapy.

Antineoplastic Agents↗

PubMed1991

SISCOPE: a multiuser information system for gastrointestinal endoscopy.

SISCOPE is an integrated data management system for use in gastrointestinal endoscopy units which operates in the multiuser mode on UNIX minicomputers or MS-DOS personal computers and can be used for patient bookings, endoscopic data entry and retrieval, and automatic report generation in upper gastrointestinal endoscopy, proctologic examinations, colonoscopy and peritoneoscopy. The description of endoscopic findings is remarkably detailed and data entry very rapid due to an advanced design of input screens that incorporates several recent concepts, including windows, menu bars and pull-down menus; typing is eliminated as data is entered with a mouse by pointing at options within menus. Endoscopic findings can be described under eight headings: morphology, topography, qualifiers, modifiers, signs of bleeding, endoscopic diagnosis, pathological diagnosis and etiology. Terminology is based strictly 3on the OMED system. SISCOPE also allows recording of details on endoscopic procedures, indications for the examination, preparation, premedication, complications and late entry of pathology reports. After entering all data, a report in natural language is produced automatically, the entire process taking one minute on average. Data retrieval programs give on-line access to previous examinations of a given patient and automatically generate activity reports. A formal language allows direct queries to the database and transfer of data for statistical analysis or other data processing. The system is simple to learn and use because operation is intuitive and all endoscopic techniques share the same basic menu structure and screen design.

Computer Systems↗

PubMed1989

Idiopathic esophageal varices with longitudinal erosion.

A 60-year-old man with idiopathic esophageal varices is presented. Endoscopy and endoscopic ultrasonography clearly demonstrated a longitudinal erosion on one of two straight varices. There was no evidence of portal hypertension, and no abnormality in the superior vena cava system. Peritoneoscopy and liver biopsy were normal. These varices with longitudinal erosion represent unique endoscopic findings as compared with previously reported cases. There has been no variceal bleeding during a 6-year follow-up.

Esophageal and Gastric Varices↗

PubMed1980

Chiba-needle percutaneous cholangiography - a method without risk to the patient?

This critical review of PTC with the skinny needle was prompted by an unexpected complication - an intrahepatic hematoma. A negative PTC does not exclude the presence of dilated bile ducts. In the case of an obstructed biliary tree, bile leakage occurs in approximately 5%. Even after the Chiba needle or other techniques have become established, peritoneoscopy is still of value in the diagnosis of cholestasis. Thus, this method is not without some risk and optimistic reports should be judged with a certain reserve.

Aged↗

PubMed1980

Peritoneoscopic findings and liver function in chronic liver disease.

In 100 cases with chronic liver disease, peritoneoscopy and liver biopsy were performed, and the association between peritoneoscopic findings and liver function was studied. With respect to liver function, a series of tests which seem to indicate residual liver function were selected as follows; dye excretion, serum levels of albumin and cholinesterase, and subfractions of serum proteins. In evaluating the periotoneoscopic view, new criteria for the classification of liver surface findings are proposed. All cases were divided into 5 types in accordance with these criteria. Analysis of the correlation between peritoneoscopic findings and liver function showed that the degree of liver dysfunction was clearly indicated by liver surface alterations. As a result, the residual liver function may be determined quite well by using this classification.

Biopsy↗

PubMed1978

Advanced ovarian adenocarcinoma. A prospective clinical trial of melphalan (L-PAM) versus combination chemotherapy.

Eighty patients with advanced ovarian adenocarcinoma were treated in a prospective, randomized trial comparing a four-drug combination--hexamethylmelamine, cyclophosphamide, methotrexate and 5-fluorouracil--with the oral alkylating agent, melphalan. Treatment with the four-drug combination was associated with a significantly increased overall response rate (75 vs. 54 per cent) (P less than 0.05), more complete remissions (33 vs. 16 per cent) and longer median survival (29 vs. 17 months) (P less than 0.02) but more severe toxicity than occurred with melphalan. Patients with minimal residual disease had a significantly higher overall response rate than patients with extensive residual disease (84 vs. 53 per cent) (P less than 0.05). Patients with advanced disease who achieved a complete remission documented by peritoneoscopy or laparotomy (or both) have a median survival that will exceed three years. The four-drug regimen is more effective than melphalan in the management of advanced ovarian adenocarcinoma.

Adenocarcinoma↗

PubMed1975

Nuclear diagnosis of disseminated cancer of the breast. Results of liver-, brain-, and tumor-directed imaging studies.

Radionuclide imaging technics to identify metastases in liver and brain have preductive values that show the expected variation depending upon the prevalence of metastatic disease in the population studied. Liver scanning combined with peritoneoscopy may prove more accurate than either study alone for routine use in staging. Brain scanning is most useful when reserved for patients selected because of suspicious neurologic findings or in following the response to therapy of established metastatic disease. "Tumor-directed" scanning agents are useful in certain cases where soft-tissue metastases are suspected but cannot be identified with more conventional procedures.

Bleomycin↗

PubMed1980

False positive liver scan due to a thin left hepatic lobe.

A young man with pectus excavatum and Gilbert's syndrome was found to have an abnormal hepatic photoscan, repeatedly interpreted as showing a mass lesion in the left lobe. Although his habitus suggested that it was a normal anatomic variant, numerous diagnostic procedures did not convincingly exclude disease of the liver. Peritoneoscopy confirmed that the left lobe was thin but otherwise normal. We review the causes of false positive liver scans.

Adult↗

PubMed1984

Cholangiocarcinoma in hepatolithiasis.

During the period of 1979-1982, 10 cases of cholangiocarcinoma associated with hepatolithiasis were seen. We report the clinical features of 10 cases of cholangiocarcinoma in association with hepatolithiasis, along with detailed histopathology from the four resected specimens. Our observations suggest that whenever intrahepatic stones are encountered in patients over 50 years of age with a long history of recurrent cholangitis and intractable pain, further examination including echo-guided aspiration cytology, liver scanning, and peritoneoscopy should be performed to rule out a coexisting cholangiocarcinoma.

Adenoma, Bile Duct↗