Enzyme and Function Changes after Extensive Liver Resection in Man

Almersjö, O; Bengmark, S; Hafström, Larsolof; Olsson, Rolf

doi:10.1097/00000658-196901000-00011

Cited by 41 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cyclic changes in basic liver function were similar to those described by others after major hepatic resection [8,9,[11][12][13][14]. Prompt resumption of a healthful diet was probably the most important factor in our patient's recovery.…”

Section: Commentssupporting

confidence: 84%

Alopecia, ascites, and incomplete regeneration after 85 to 90 per cent liver resection

Starzl¹,

Putnam²,

Groth³

et al. 1975

The American Journal of Surgery

View full text Add to dashboard Cite

The purpose of this report is to describe some unusual manifestations that followed a very extensive hepatectomy (85 to 90 per cent) and to comment about the less than complete degree of regeneration that occurred postoperatively. Case ReportA nineteen year old girl had undergone exploration one week prior to admission because of a huge mass that occupied all of the upper abdomen and which, as indicated by liver scan ( Figure 1, left), replaced much of the liver. Tissue diagnosis of a well differentiated hepatoma was made from the previous exploration. Measurement of alpha fetoprotein was negative. For some months she had had severe abdominal pain that was eventually demonstrated to be due to hemorrhage into the tumor. A selective celiac arteriogram demonstrated a single hepatic artery. (Figure 1, right.) Although the entire arterial blood supply appeared to be involved in tumor, an attempt at resection was decided on.The procedure was carried out May 10, 1972, through a bilateral subcostal incision. The right hepatic artery, portal vein, and hepatic duct were ligated and divided. Branches of the left main hilar structures passing to the medial segment of the left lobe were cut, leaving only the lateral segment connected. The right and middle hepatic veins and all the small hepatic veins entering the inferior vena cava from the caudate lobe were sacrificed so that only the left hepatic vein remained. The lateral segment of the left lobe was smaller than usual, constituting approximately 15 per cent of the normal liver mass. Part of this segment had to be excised to remove the tumor, which extended to the left of the falciform ligament. The remaining hepatic fragment was thought to represent between 10 and 15 per cent of a normal liver. The excised specimen weighed 2,100 gm and had areas of hemorrhage within the tumor. It was examined histologically in five university departments of pathology noted for their special interest in liver disease. All consultants described the well-differentiated features of the neoplasm. Two diagnoses of hepatocellular adenoma were made, but three of the consultants classified the lesion as a hepatoma (hepatocarcinoma).After resection was completed, the residual fragment felt tense, a condition that was aggravated by efforts to cover the raw liver edge with the falciform ligament or omentum. Consequently, the raw surface was left open. The large right subphrenic cavity was extensively drained. The operation required nine hours and 5,500 ml of blood. Postoperative ventilatory support was provided for the first five hours. The patient was completely disoriented for three days but then suddenly became lucid.Requests for reprints should be addressed to Thomas E. Starzl, MD. Department of Surgery, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, Colorado 80220. NIH Public Access Author ManuscriptAm J Surg. Author manuscript; available in PMC 2010 October 25. Serious abnormalities in liver function, including jaundice, did not clear until the third week. (Figure 2) A...

show abstract

Section: Commentssupporting

confidence: 84%

Alopecia, ascites, and incomplete regeneration after 85 to 90 per cent liver resection

Starzl¹,

Putnam²,

Groth³

et al. 1975

The American Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…24 We find it difficult to accept this since T-tube drainage did not influence the development of jaundice in any of our cases. We found that the serum alanine transferase rose after hepatectomy and fell to normal levels within 10 days (Fig.…”

Section: Postoperative Jaundicementioning

confidence: 55%

“…The tail of the pack was brought out through an incision in the right hypochondrium, the subhepatic space was drained, and the abdomen closed. Though some oozing continued bleeding appeared reasonably controlled for some three to four hours, but it began again and continued for 24 hours, when the patient died after a cardiac arrest.…”

Section: Major Injuriesmentioning

confidence: 97%

Injuries to the Liver: Analysis of 20 Cases

Blumgart¹,

Vajrabukka²

1972

BMJ

View full text Add to dashboard Cite

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.

show abstract

“…Resection beyond the critical amount of liver necessary for maintenance of function and postoperative regeneration may result in a decline in liver function and even death [111]. Accurate estimation of the residual hepatic functional capacity after resection is crucial for preventing post-operative hepatic failure.…”

Section: Extending the Use Of Gd-eob-dtpamentioning

confidence: 99%