Usefulness of measuring hepatic functional volume using Technetium-99m galactosyl serum albumin scintigraphy in bile duct carcinoma: report of two cases.

We report the usefulness of measuring functional liver volume in two patients undergoing hepatectomy. Case 1 involved a 47-year-old man with hepatitis B virus infection. The indocyanine green test retention rate at 15 min (ICGR15) was 14%. Liver uptake ratio (LHL15) by technetium-99 m galactosyl human serum albumin ((99m)Tc-GSA) liver scintigraphy was 0.91. The patient displayed hilar bile duct carcinoma necessitating right hepatectomy. After preoperative portal vein embolization (PVE), future remnant liver volume became 54% and functional volume by (99m)Tc-GSA became 79%. Although the permitted resected liver volume was lower than the liver volume, scheduled hepatectomy was performed following the results of functional liver volume. Case 2 involved a 75-year-old man with diabetes. ICGR15 was 27.4% and LHL15 was 0.87. The patient displayed bile duct carcinoma located in the upper bile duct with biliary obstruction in the right lateral sector. The right hepatectomy was scheduled. After PVE, future remnant volume became 68% and functional volume became 88%. Although ICGR15 was worse as 31%, planned hepatectomy was performed due to the results of functional volume. In the liver with biliary obstruction or portal embolization, functional liver volume is decreased more than morphological volume. Measurement of functional volume provides useful information for deciding operative indication

Electrocardiographic Changes before and after Surgical Correction of Isolated pulmonic Stenosis

Electrocardiographic, vectorcardiographic and phonocardiographic changes were studied before and after surgical correction of isolated pulmonic stenosis. 1. Before operation, the maximal right ventricular systolic pressure were correlated well with the T wave changes, such as mean electrie T axis, direction of maximal T vector in each plane, spatial maximal QRS-T angle, ratio of spatial magnitude of T to QRS vector, and the QRS wave changes, such as height of Rv(1), sum of Rv(1) and Sv(5), direction of maximal QRS vector in frontal plane, rotation of QRS loop in horizontal plane, configuration of QRSv(1). After operation, in addition to those above, R/Sv(1), Rv(1)+Sv(5)/Sv(1)+Rv(5) and mean electric QRS axis tended to improve much more within the first one year after operation than thereafter. 2. The appearance of RBBB type were found more frequent after operation than before, and thought to be due to the decreasing right ventricular systolic overloading, or its combination with operative invasion to peripheral network of right bundle branch. 3. The more or less abnormal findings were revealed in twenty one cases, the remaining one was appreciated to be normal one hundred and twenty five months after operation