BackgroundThe safety of living liver donors is the paramount priority of liver transplantation surgeons. The liver has an effective regeneration capacity. The regeneration rate of the liver remnant in living liver donors provides much information useful in liver surgery. The outcome of the remnant liver after hepatectomy can be affected by many different perioperative factors.Material/MethodsA total of 46 patients were enrolled in the study. Retrospective clinical data, including preoperative and postoperative early and late computed tomography liver volumetry measurements, estimated resection volumes, resected liver weights, and postoperative laboratory values, were statistically evaluated according to the liver resection type.ResultsNo significant difference was detected in age, sex, calculated and computed tomography estimated total liver volume, intraoperative Hb decrease, postoperative complications, or postoperative portal vein flow rate. Postoperative liver enlargement rates were significant higher in the right hemihepatectomy (RHH) group than in the left lateral sectionectomy (LLS) group. The size of the liver remnant or graft has a major effect on regeneration rate. Postoperative biliary leakage did not have any significant effect on liver regeneration. No post-hepatectomy liver failure was detected among the liver donors.ConclusionsLiver hypertrophy depends on the extent of liver resection. The cause of volume decrease in the LLS group after hepatectomy in our series appears to be the gradual atrophy of liver segment 4. RHH and LLS surgeries differ from each other in terms of resected liver volume, as well as inflammatory activity, and the latter appears to affect liver regeneration.
Background: Desmoid tumors, also known as aggressive fibromatosis, are extremely rare, accounting for less than 3% of soft-tissue sarcomas and less than 0,03% of all neoplasms. The diagnosis is usually delayed because of the lack of specific symptoms, and can sometimes lead to serious and, even fatal complications. Case presentation: We report the case of a 27-year-old male patient presenting with the clinical picture of acute appendicitis. During the operation, we found a tumor in the jejunum with a necrotic zone and perforation on its surface, causing hemorrhagic effusion into the abdominal cavity and subsequent peritonitis. The tumor was removed with negative margins via resection of the small bowel. The final histological result showed aggressive fibromatosis. Conclusions: Aggressive fibromatosis remains a serious problem with the possibility of locally aggressive behavior with high rates of recurrence. Sometimes, its clinical and macroscopic recognition can be immensely tricky. As shown by our patient, on rare occasions, desmoid tumors can lead to acute surgical abdomen requiring an emergency operation.
Obiectiv: Evidenţierea rolului hepatotoxicităţii cauzată de Albendazol în alegerea între drenaj sau rezecţie în cazul hidatiozei. Metode: Fişele medicale a patru pacienţi au fost analizate retrospectiv. În cazul a trei pacienţi, albendazol a cauzat o creştere de 10 ori a transaminazelor şi a fost întrerupt. Unul din pacienţi a prezentat concomitent o hepatită autoimună. Rezultate: În primul caz, au fost identificate două chisturi hidatice mari care cuprind vena hepatică stângă şi dreaptă. Mai întâi, au fost efectuate o secţionectomie laterală stângă şi o ligatură a venei porte posterioare drepte. Hipertrofia ficatului rămas a permis o secţionectomie dreaptă posterioară sigură două luni mai târziu. În cazul celui deal doilea pacient, un chist de 9 cm în segmentele 6 şi 7 a fost tratat prin perichistectomie. Cel deal treilea pacient a prezentat un chist de 6 cm localizat central. Au fost efectuate o perichistectomie, îndepărarea unor vezicule mici din secţiunea anterioară a coledocului şi explorarea coledocului prin plasarea unui tub în formă de T. În cazul pacientului cu hepatită autoimună, s-a optat pentru perichistectomie cu scopul: 1) de a elimina cavitatea predispusă la recidivă în cazul pacientului cu tratament imunosupresiv, 2) de a evita administrarea de albendazol, care poate complica interpretarea testelor de funcţionare a ficatului. Perioada postoperatorie şi începutul perioadei de urmărire s-a desfăşurat fără evenimente deosebite. Cel deal doilea şi cel deal patrulea pacient au fost urmăriţi timp de 56, respectiv 17 luni, fără detectarea nici unei recidive.
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