Retrograde Jejuno-Jejunal Intussusception after Total Gastrectomy

An eighty-year-old female was transferred to the hospital after experiencing abdominal pain and nausea. She had had a history of total gastrectomy for gastric cancer 14 years previously. Abdominal X-ray revealed a localized expansion of the small bowel. Computed tomography revealed a mass with a lamellar structure in a concentric circle. With a tentative diagnosis of small bowel obstruction due to intussusception, she underwent emergency operation. Laparotomy revealed a retrograde jejuno-jejunal intussusception. Bowel resection was performed due to the severe ischemic damage. All reported intussusception cases after total gastrectomy displayed retrograde characteristics and could occur both during the early and late period after surgery. It is important to consider the possibility of intussusception for patients presenting with acute abdomen who have previously undergone gastric resection

Underlying Histological Activity of Hepatitis Plays an Important Role for Tumor Recurrence After Curative Resection of Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis. This situation is one of the reasons why intrahepatic recurrence frequently occurs even after curative resection. There are two different components of such recurrences, which occurs within 12 months (the early recurrence group) and at more than 12 months after resection (the late recurrence group). The present study was conducted to clarify the factors contributing to these different types of HCC recurrence. Methods: Ninety seven patients who underwent curative resection for HCCs were followed for initial recurrence, and predictive factors of recurrence were examined. Results: Early and late intrahepatic recurrences developed in 30 and 42 patients, respectively. In the former group, univariate analyses showed the serum AFP level (>100ng/ml, P=0.045), higher inflammatory activity (Grading) (p=0.048) and status of fibrosis (Staging) (p=0.027) in non-cancerous liver tissues to be significant risk factors, while the serum AFP level (>100ng/ml) was the only independent risk factor based on a multivariate analysis (RR: 2.78). In the latter group, only the presence of hyperplastic foci (HPF) was found to be a significant risk factor (p=0.005). Higher Grading tended to be linked to shorter disease-free survival time, although not significant. In the non-cancerous liver tissues with HPF, the level of Grading, Staging, and PCNA labeling index was significantly higher (p=0.033, 0.003, 0.040, respectively).Conclusion: Not only the tumor factors but also the underlying hepatic status including HPF, Grading, and Staging were significant risk factors for intrahepatic recurrence after curative resection for HCC

Regeneration of Graft Livers and Limited Contribution of Extrahepatic Cells After Partial Liver Transplantation in Humans

Background Liver regeneration is still not fully understood. Partial liver transplantation (LT) can provide the opportunity to investigate the mechanisms of liver regeneration, including the contribution of extrahepatic cells to liver regeneration. Methods Of 61 patients transplanted with partial liver graft between August 1997 and October 2006, 56 patients were studied, including 49 adults and 7 children. Sequential computed tomography volumetric analysis was performed for volume measurement, while proliferating cell nuclear antigen (PCNA) labeling index was investigated for liver cell proliferation in nonprotocol liver biopsy specimens. In addition, 15 male recipients who had female liver grafts were investigated in order to detect Y chromosomes as extrahepatic cells in nonprotocol liver biopsy specimens. Results Graft volume per standard liver volume was markedly increased after adult-to-adult living-donor (LD) LT. In pediatric transplants, there was no volume increase over time. PCNA labeling index was vigorous in adult-to-adult LDLT in the early period after LDLT. No Y chromosome was evident in hepatocytes from female-donor male-recipient grafts during or after liver regeneration. However, in the cases of failing grafts of this type, many Y-chromosome-positive cells were observed in the graft liver. The character of those cells was CD34(−), CK9(−), hepatocyte-specific antigen(−), and CD68(+/−). Conclusion In adult-to-adult LDLT, vigorous liver regeneration occurs in the graft liver, demonstrated by not only volumetric but cell kinetic analysis. Involvement of extrahepatic cells in normal liver regeneration seems limited

Diverse Effects of FK506 on the Apoptosis of Hepatocytes and Infiltrating Lymphocytes in an Allografted Rat Liver.

BACKGROUND: The current study investigated whether FK506 (FK) regulates the apoptotic systems in allografted rat liver and the contribution of Fas/Fas-ligand system and Bcl-2 family during acute rejection. MATERIALS AND METHODS: The recipients were divided into three groups, the allo, the allo-FK, and the syn group. Rats were euthanized 1, 3, 5, and 7 d after OLT. Apoptotic activity was explored using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. The expression of Fas/Fas-ligand and Bcl-2/Bax in the grafted livers was investigated by Western blotting and immunohistochemistry. RESULTS: The apoptotic index (AI) of hepatocytes in the allo-FK group was less than that in the allo group. Fas in the allo group was more intense than that in the allo-FK group in the periportal areas on day 1 and 3, while Bcl-2 in the allo group was less intense than that in the allo-FK group in the pericaval areas at all time-points after OLT. CONCLUSION: FK provides beneficial antiapoptotic effects on hepatocytes in the grafted rat livers through both the down-regulation of Fas expression in the periportal areas and the up-regulation of Bcl-2 expression in the pericaval areas

99mTc-Galactosyl Syalil Albumin (GSA) Scintigram Adjusts Hepatic Resection Range in ICG Based Estimation

Background/Aims: Indocyanin Green (ICG)-based diagnosis is widely accepted in determination of hepatic resection range, however, we frequently encounter scattered results of preoperative assessment. The aim of this study was to clarify the role of "Tc Galactosyl sialyl albumin (GSA) scintigram in the decision of the resection range. Methodology: One hundred and eighty patients who underwent liver resection were included in this study. The patients were divided according to ICGR15 value as follows; Group 1 (n=100): ICG R15 25%. Each group was divided into two subgroups by their GSA-LHL 0.9 levels and compared with regards to liver function, portal pressure and HAI score of background liver. The frequency of complications was also compared to previous cases without GSA-LHL estimation (n=64). Results: In Groups 2 and 3, the GSA-LHL >0.9 subgroup showed better platelet counts, portal pressure and lower HAI score. In groups of GSA-LHL>0.9, platelet counts showed higher value between below 20% of ICGR15 and above that, while GSA-LHL0.9 compared to previous cases without GSA-LHL estimation. Conclusions: Levels of GSA-LHL reflects severity of portal hypertension in moderately damaged liver preoperatively and could contribute to the decision of the range of resection with low morbidity

Management of fungal colonization and infection after living donor liver transplantation

Background/Aims: Control of infection is important in liver transplant patients under immunosuppressive conditions. In particular, invasive fungal infection is often fatal if diagnosis and therapy are delayed. The aim of this study was to analyze the incidence of fungal colonization and infection after living donor liver transplantation (LDLT). Methodology: Retrospective analysis was performed with 60 consecutive adult recipients of LDLT. Results: Fungi were isolated from specimens of 16 (26.7%) patients after LDLT. All the fungi were Candida species. One patient for whom Candida species were isolated in ascites and blood was complicated with systemic methicillin-resistant Staphylococcus aureus and cytomegalovirus infection. In the univariate analysis, fungal carriage before surgery (p=0.01) was associated with fungal isolation after LDLT. In the multivariate analysis, fungal carriage was found to be an independent predictor of fungal isolation (odds ratio: 15.7, p=0.03). Of the 60 recipients, 16 (26.7%) showed serum levels of β-D glucan above 60pg/ml after surgery. Among these, 4 died and were all complicated with severe bacterial infection. Conclusion: Preoperative fungal carriage was associated with fungal isolation after LDLT. If fungal infection was suspected after LDLT, along with treatment against fungi, control of complicated infections with other pathogens to be simultaneously considered