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Background: Low temperature has been utilised as the basic method for extension of organ preservation time. From the enzymological and energetic viewpoints, the lower the temperature is in cold storage, the longer the organs could be preserved. However, in the past organ preservation experiments at subzero temperatures have all ended in failure for various reasons. We took note of the existence of unfrozen state of water at subzero temperatures under high pressure, and came to the idea that livers could be stored in the preservation solution maintained in the supercooling (non-freezing) state under certain conditions.

Aim: Intrahepatic cholangiocarcinoma (IHC) is associated with an extremely poor prognosis. Locoregional extension is usually advanced at the time of diagnosis, accounting for low resectability rates. As IHC is currently considered a contraindication for liver transplantation, surgical resection remains the only chance for cure.

Methods: 30 liver resections were enrolled in group A, while 107 liver resections represented group B. All patients had hepatic neoplasm except four living donors for transplant (group A). Mean age was 49.29 years in group A and 52.2 years in group B. The male:female ratio was 1:1 in both group A and B. In group A, 39.29% of resections involved3 3 segments and 60.71% involved 2 segments; in Group B, 36.40% involved 3 3 segments and 63.6% consisted of 2 segments. Statistical analysis utilised independent T square (Pearson χ2).

Methods: From 1981 to 2002, 308 curative hepatectomies for HCC on cirrhosis (group 1) and 135 for HCC without cirrhosis (group 2) were performed. Clinicopathological data, operative parameters, early results, overall and disease-free survival, and prognostic factors for survival and tumour recurrence were analysed and compared.

Aim: Freezing is not assumed to achieve total cell destruction within the iceball. Repeated freezing and thawing (cryocycling) improves cryonecrosis. The present study investigated the effect of 'pulse' cryocycling (repeated very short cycles of freezing and thawing) on normal liver tissue.

Conclusion: Liver tolerates irradiation injury suprisingly well, preconditioning promotes restitution of liver circulation after ischaemic lesion. Low dose irradiation (25 Gy) with normothermic, short-term ischaemia (30 min) seems to be tolerable for the tumour-free liver.

Conclusion: Patient and disease-free survival following liver resection for colorectal metastases has improved significantly in recent years, and our experience is consistent with evolving international standards. Although the reasons for improved survival are not clear, contributing factors may include better selection with newer preoperative and intraoperative imaging and increased use of chemotherapy.

Methods and Results: Between 1982 and 2002, a total of 204 patients were admitted to Akdeniz University Medical School, Department of General Surgery, Antalya, Turkey, with the diagnosis of pancreatic and periampullary cancer. Only 60 (29.4%) of those patients with periampullary cancer have undergone pancreaticoduodenal resection. 39 (65%) were male and 21 (35%) were female. The youngest patient was 22 and the oldest was 86 years old. The average age of the patients was 57 years old.

Conclusion: Injury of the common bile duct presents a dangerous and potentially lethal complication of laparoscopic cholecystectomy, particularly in cases with concomitant vascular injuries. Early recognition of the lesion is extremely important. It is advisable to treat these patients in specialized centers, as their management frequently requires advanced knowledge of hepatobiliary surgery.

Results and Conclusion: The incidence of bile duct injury was higher in female patients. There was no difference in the average postoperative stay in hospital. Common hepatic duct injury was more frequently diagnosed in both groups. However, vascular injury was seen more frequently in the laparascopic group than the open surgery group. According to Olsen's classification, type III A was the major injury type in groups 1 and 2. Hepaticojejunostomy with stent, choledococholedocostomy, choledoco-duodenostomy, choledocojejunostomy, or T-tube were used to repair bile duct injury. There was no difference in morbidity and mortality in the two groups.

Results: 37 patients with benign hepatocellular tumours (adenoma, 17; FNH, 18; others, 2) were managed during this period. 8 females and 2 males presented with spontaneous rupture of tumours. 6 females were on oral contraceptives (OCP) when they bled. 6 were operated on during the same admission. 3 who remained haemodynamically stable later underwent elective resection. Surgical resection varied from segmental resection to extended hemi-hepatectomy. There was no postoperative mortality. Surgical resection was facilitated following resolution of subcapsular haematoma in elective resections. One patient who had multiple lesions in both lobes of liver was considered inoperable and advised to avoid the OCP and has remained well. Histology of the resected lesions showed: adenoma (7), nodular regenerative hyperplasia(l) and FNH(l).

Methods: The study included 15 patients who underwent CBD exploration for stone removal between March 2002 and December 2002. CBD exploration was performed laparoscopically in 7 cases, and by open surgery in 8 cases. There were 7 males and 8 females. Median age was 68 years. Basal pressure of the sphincter of Oddi and the frequency of phasic contraction were measured intraoperatively using a manometer via a working channel of the choledochoscope.

Aim: It has been shown that oestrogen causes less inflammation and fibrosis in women by means of effects on macrophages and fibroblasts. However, there are no studies dealing with gallbladder inflammation in males or in females. To investigate this, adhesions around the gallbladder and the gallbladder wall itself that had been removed laparoscopically were examined for macrophage infiltration and collagen (hydroxyproline-HP) deposition.

Methods: 28 children (18 girls and 10 boys) with hepatobiliary disorders (range 25 days to 12 years) were treated in our clinics between 1986 and 2002. 20 suffered from biliary atresia (female:male ratio 0.81) and 8 from choledochal cyst (female:male ratio 0.14). All the patients underwent surgery after the diagnosis. The operative approach in biliary atresia was excision of the bile duct remnants followed by Roux-en-Y portoenterostomy (Kasai's procedure) (average 1.1 months) and in choledochal cyst, cyst cholocystectomy followed by Roux-en-Y hepaticojejunostomy (average 7.2 years). The mean length of follow-up was 9.3 years.

Methods: Tissue samples were obtained from 27 individuals (8 female, 19 male) undergoing pancreatic resection for pancreatic cancer. Tissue samples from 13 previously healthy organ donors (5 female, 8 male) served as controls. The expression of CTGF was studied by Northern blot analysis. In situ hybridization and immunohistochemistry localized the respective mRNA moieties and proteins in the tissue samples.

Methods: 120 of 130 patients (71 female, 59 male) who had been diagnosed with pancreaticobiliary pathology were included in this study. Intravenous administration of 100 mg octreotide was begun 30 min before the procedure and continued during the procedure until 10 min after the procedure. Placebo was given in 87 patients. Serum amylase level was assessed before and during the procedure. These results were compared with placebo groups.

Results: Papilla of Vater was catheterized in 33 patients who were administered octreotide and pancreatic duct could be visualised by radioopac solution. Hyperamylasemia was assessed in 14 of 33 (42.4%). Clinical findings of pancreatitis were observed in 5 of these 14 (11.5%) patients but they were free from these findings on the 5th day after the procedure. Hyperamylasemia was also assessed in 41 of 87 (47.1%) patients who received placebo. Clinical findings of pancreatitis were observed in 10 of these 41 (11.5%) patients but their amylase levels were in the normal range on the 5th day after the procedure and they were free from these findings. There were no statistically significant differences between the groups.

In this report we present a radical resection of icteric-type hepatocellular carcinoma (HCC) by right anterior segmentectomy with bile duct resection. A 72-year-old male with HCV antibody was referred to our department due to liver dysfunction and icterus. CT showed a tumor in segment 8. ERCP demonstrated a tumor thrombus in the bile duct. The left hepatic duct and the bile duct of the posterior segment were drained by ENBD. As the patient had liver cirrhosis, we decided to perform anterior segmentectomy with bile duct resection. First, abdomino-thoracotomy was accomplished by J-shaped incision. After cholecystectomy, the right hepatic artery, the anterior and posterior branches were exposed. Then, the portal vein, the anterior and posterior branches were exposed. The respective anterior branches were divided. Hemihepatic clamping was employed for liver dissection. The liver dissection between the anterior segment and medial segment was performed and subsequently the left hepatic duct was divided. The common bile duct was divided at the entrance to the pancreas. Finally, the liver dissection between the anterior segment and posterior segment was performed and the bile duct to the posterior segment was divided. Thus the operation was accomplished without exposing the main tumor and the tumor thrombus in the bile duct. The bile ducts to segments 2 and 3 and the posterior segment were reconstructed by bilio-jejunostomy. The bleeding amount was 1106 ml and the operation time was 11 h and 23 min. His postoperative course was uneventful. 041b061a72


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