differences are thought to depend mainly on the effective Technetium-99m-diethylenetriaminepentaacetic acidhepatic blood flow and the intra-, extrahepatic shunt. galactosyl human serum albumin (Tc-GSA) is a new liverAshwell and Morell demonstrated the existence of a hepatic scintigraphy agent which binds to the asialoglycoprobinding receptor for asialoglycoproteins (ASGP) with the intein receptors. We evaluated the preoperative assessvestigation of ceruloplasmin metabolism. 6 They found that ment for hepatectomy using Tc-GSA liver scintigraphy.ceruloplasmin molecules, which lack a sialic acid residue, Ninety patients with hepatocellular carcinoma were adrapidly disappeared from the circulation and were taken up mitted for elective hepatectomy. Tc-GSA scintigraphy by hepatocytes. 7 This activity was found to be exclusively was conducted after the intravenous injection of Tcassociated with a protein termed ASGP receptors (ASGPR) GSA, and maximal removal rate of Tc-GSA (GSA-Rmax)in the sinusoidal membrane of hepatocytes. 8 Sawamura et was calculated using a radiopharmacokinetic model. al. 9 reported that a decrease in the number of ASGPRs led Measurement of GSA-Rmax, conventional liver function, to the accumulation of ASGP in the sera of galactosamineand 15-minute retention rate of indocyanine green treated rats. In addition, this receptor decreases in patients (ICGR15) was carried out preoperatively. The relationwith chronic liver disease. 10ships between liver functions, histological activity index Technetium-99m-diethylenetriaminepentaacetic acid-ga-(HAI), ICGR15, and GSA-Rmax values were estimated. A lactosyl, human serum albumin (Tc-GSA), is a new liver scinsignificant correlation was obtained between GSA-Rmax tigraphy agent which binds to the ASGPR on hepatocytes. and ICGR15 (r Å .534, P õ .0001). Preoperative discrepanMaximal removal rate of Tc-GSA (GSA-Rmax) using a radiocies between GSA-Rmax and ICGR15 values were seen pharmacokinetic model decreased with the severity of liver in 15 patients. In these cases, the GSA-Rmax values cordisease, and there was also a significant difference in the related well with the total HAI scores (r Å .595, P õ .02), GSA-Rmax between the chronic hepatitis and normal liver but no significant correlation was seen between the groups. 11 The purpose of this study was to evaluate the clini-ICGR15 and HAI scores. Two patients died of postoperacal utility of the GSA-Rmax for the preoperative assessment tive liver failure within 2 months of the operation. These of hepatectomy in patients with hepatocellular carcinoma. 1992 and December 1995. The mean age of all patients was 61 years, with a range of 43 to 77 years. There were 72 (80%) male and 18 (20%) female patients, yielding a male:female ratio of 4:1; 59 patients It is well known that patients with a normal liver tolerate (65.6%) had cirrhosis. Surgical resections were performed according a 70% to 80% hepatectomy and that regeneration of the liver to the liver anatomy of Couinaud.12 Surgical procedures were mainly determined usi...

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Ischemia/reperfusion contributes to the hepatic injury in resection and transplantation of the liver. However, the precise mechanisms involved in hypoxia stress remain to be clarified. Pro-inflammatory cytokines including interleukin 1␤ (IL-1␤) induce a gene expression of inducible nitric oxide synthase (iNOS) and produce nitric oxide, which exerts either a cytoprotective or toxic effect. In this report, we found that hypoxia and heat markedly inhibited the induction of nitric oxide production stimulated by IL-1␤ in rat cultured hepatocytes. Both treatments also abolished the induction of iNOS protein and mRNA. However, hypoxia could not prevent either degradation of an inhibitory protein (I B␣)

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Spiral computed tomography (SCT) is a recently introduced technique which enables scanning of one large volume with no interscan intervals. Three-dimensional reconstruction using this technique is emerging as an effective means of identifying complex anatomical relationships. Ninety-two patients with cholecystolithiasis including ten with choledocholithiasis were investigated. All underwent SCT after oral and intravenous infusion cholangiography (IVC-SCT) and 22 were also examined by endoscopic retrograde cholangiography (ERC). IVC-SCT showed significantly more anatomical detail than conventional intravenous infusion cholangiography (IVC). The junction between the cystic duct and the common bile duct could be identified before surgery in 19 of 22 patients undergoing ERC, in 18 of 22 receiving IVC-SCT and in five of 22 undergoing IVC. Significant differences were noted between IVC-SCT, ERC and conventional IVC. Three-dimensional surface reconstruction of the biliary tract is useful in the evaluation of anatomical relationships between the cystic duct and the common bile duct (clearly seen in 86 per cent of cases). Three-dimensional reconstruction using SCT scanning is useful for anatomical assessment before laparoscopic cholecystectomy.

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