No abstract

clinicaltrials.gov Identifier: NCT01015417.

In patients with chronic Budd-Chiari syndrome, multiple (> 10) small (< 4-cm) lesions are suggestive of benignity.

We have investigated whether liver resection and needle liver biopsy cause dissemination of liver cells into peripheral blood circulation, using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay targeted against ␣-fetoprotein (AFP) mRNA. Twelve patients with and 16 without primary liver cancer (PLC) undergoing liver resection were tested before skin incision, after liver mobilization, after hepatic parenchyma transection, after abdominal wall suture, and 4 days after surgery. Two patients with and 20 without PLC were tested before, 20 minutes after, and 24 hours after needle liver biopsy. Six of 14 patients with and 0 of 36 patients without PLC scored positive before intervention (P F .001). Liver cell spreading was induced at different times after surgery and liver biopsy in 14 of 14 patients with but also 23 of 36 without PLC (P F .05). We conclude that liver resection and needle liver biopsy induce release of cells from the liver, which are not necessarily liver tumor cells, into the peripheral blood circulation. This may be, however, an important mechanism of liver cancer cell dissemination deserving further investigations. (HEPATOL-OGY 1999;29:879-882.)Despite several previous reports on the dissemination of tumorous cells during needle liver biopsy, 1-6 the issue of surgical and diagnostic iatrogenic speading of liver cells has never been addressed with appropriated molecular methods and study design.The possibility of detecting circulating tumorous cells in patients with solid tumors, through highly sensitive reversetranscription polymerase chain reaction (RT-PCR)-based assays, has raised major interest and hopes during the last 5 years. 7 We and others 8,9 have used ␣-fetoprotein (AFP)-specific primers to detect spontaneously circulating tumorous cells in patients with primary liver cancer (PLC) and found that a positive test directly correlates with the risk of developing extrahepatic metastases. 10 We have now applied this method, with a carefully defined specificity and sensitivity, to patients with and without PLC. The protocol used consisted in blood sampling before and at different time points during and after liver resection and needle liver biopsy.Our results show that hematogenous dissemination of liver cells is induced very early in surgically treated patients, after liver mobilization, and before hepatic parenchyma transection. It also occurs, albeit less frequently, during needle liver biopsy. These data, therefore, point out a potentially important mechanism of liver cancer spreading that deserves further investigations.

Outpatient unilateral thyroid lobectomy is feasible and safe in the setting of appropriate facilities and management protocol. Strict control of postoperative nausea is essential, and a preoperative education for ambulatory surgery is useful to minimize patient anxiety and increase acceptability.

No abstract

From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 52 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.

These data suggest that partial portal embolization of the recipient liver improves engraftment of transplanted hepatocytes in a primate preclinical model providing a new strategy for hepatocyte transplantation.