Resected or Remnant Liver Volume and Standard Liver Volume Ratio in Patients with Major Hepatectomy

To clarify the relationship between resected (RSV) or remnant hepatic volume (RMV) in major hepatectomy, and standard liver volume (SLV) and its clinical significance, the RSV/SLV, RMV/SLV and the volume of regeneration (RGV)/RMV were examined in 41 patients including 19 with chronic hepatitis and 5 with obstructive jaundice who underwent lobectomy or extended lobectomy. The hepatic function was maintained in all patients. SLV was calculated by the body-surface area using Urata\u27s formula. RGV was calculated by subtracting the RMV from the remnant liver volume at day 28 after hemi-hepatectomy. Measurement of the hepatic volume was performed by computed tomography. The means of RSV, RMV, RGV and SLV were 591 ﾂｱ 173, 459 ﾂｱ 119, 667 ﾂｱ 129 and 1128 ﾂｱ 129cm3, respectively. The means of RSV/SLV, RMV/SLV and RGV/RMV were 0.52 ﾂｱ 0.14, 0.41 ﾂｱ 0.12 and 1.54 ﾂｱ 0.47, respectively. RGV was inversely correlated with RMV/SLV (p<0.001) but not with the other parameters. RSV/SLV and RMV/SLV were not associated with long-term ascites and hepatic failure. The tendency of these results was similar in each patient with a normal liver, obstructive jaundice and chronic viral hepatitis. If the hepatic functional reserve is maintained, a liver with lower hepatic volume has potentially sufficient regeneration even in patients with an injured liver

Changes of Branched Chain Amino Acids and Tyrosine Ratio (BTR) after Hepatectomy

To clarify the clinical usefulness of measuring branched chain amino acids and tyrosine ratio (BTR), which is correlated with Fischer\u27s ratio, we examined the serum BTR level in 33 patients with liver diseases. Serum levels of branched-chain amino acids (BCAAs) and tyrosine were measured by the new enzymatic method, which costs inexpensive and is immediate compared to measuring Fischer\u27s ratio. BTR was calculated as ratio of concentration of BCAA to tyrosine. BTR was correlated with levels of albumin, transaminase and cholinesterase and was lower in patients with chronic viral hepatitis, Child B cirrhosis and portal hypertension. In 19 patients who underwent hepatic resection included 8 for major hepatectomy, resected volume, blood loss, operation time and background of liver diseases were not associated with changes of BTR after hepatectomy. In patients with prolonged jaundice, postoperative BTR level was significantly lower between day I and 7 after hepatectomy. We concluded that serum BTR level was correlated with poor liver function and monitoring of BTR levels after hepatectomy may be useful to evaluate degree of hepatic damage after liver surgery

Anterior chest wall reconstruction with titanium plate sandwiched between two polypropylene sheets

Extensive sternal resection carries the risk of difficult reconstruction and surgical complications. A 79-year-old woman underwent sternal resection and reconstruction for sternal chondrosarcoma. However, 18 months after the first operation, she developed six metastatic tumors on the anterior chest wall. She underwent subtotal sternectomy and rib resection, leaving a defect measuring 17 × 14 cm. Reconstruction of the anterior chest wall using a titanium plate sandwiched between two polypropylene mesh sheets is described. This method is potentially applicable to extensive anterior chest resection, and its advantages compared with conventional prostheses are rigidity, flexibility, and usability

Resected or Remnant Liver Volume and Standard Liver Volume Ratio in Patients with Major Hepatectomy

To clarify the relationship between resected (RSV) or remnant hepatic volume (RMV) in major hepatectomy, and standard liver volume (SLV) and its clinical significance, the RSV/SLV, RMV/SLV and the volume of regeneration (RGV)/RMV were examined in 41 patients including 19 with chronic hepatitis and 5 with obstructive jaundice who underwent lobectomy or extended lobectomy. The hepatic function was maintained in all patients. SLV was calculated by the body-surface area using Urata's formula. RGV was calculated by subtracting the RMV from the remnant liver volume at day 28 after hemi-hepatectomy. Measurement of the hepatic volume was performed by computed tomography. The means of RSV, RMV, RGV and SLV were 591 ﾂｱ 173, 459 ﾂｱ 119, 667 ﾂｱ 129 and 1128 ﾂｱ 129cm3, respectively. The means of RSV/SLV, RMV/SLV and RGV/RMV were 0.52 ﾂｱ 0.14, 0.41 ﾂｱ 0.12 and 1.54 ﾂｱ 0.47, respectively. RGV was inversely correlated with RMV/SLV (p<0.001) but not with the other parameters. RSV/SLV and RMV/SLV were not associated with long-term ascites and hepatic failure. The tendency of these results was similar in each patient with a normal liver, obstructive jaundice and chronic viral hepatitis. If the hepatic functional reserve is maintained, a liver with lower hepatic volume has potentially sufficient regeneration even in patients with an injured liver

Pulmonary Scedosporium apiospermum Infection with Pulmonary Tumorlet in an Immunocompetent Patient

Scedosporium apiospermum is an opportunistic fungus that can cause various types of infections, including localized infections and life-threatening disseminated infections, particularly in immunocompromised patients. Treatment is especially challenging due to its multidrug resistance. We herein report the case of a 73-year-old woman who was non-immunocompromised but developed S. apiospermum lung infection and a pulmonary tumorlet. To our knowledge, this is the first report of the coexistence of pulmonary S. apiospermum infection and tumorlet. The lung lesion was successfully treated by surgical excision without any antifungal agents, and no recurrence of the tumorlet or S. apiospermum infection has occurred