Right Lobe Of Liver Research Articles

Correlation Between Hepatic Steatosis, Hepatic Volume, and Spleen Volume in Live Liver Donors

Introduction The purpose of this study was to evaluate the changes in liver fatty content and the volumes of liver and spleen after body weight reduction in potential living liver donors. Materials and methods Twenty-three potential living donors had fatty livers at pretransplantation sonography and computed tomography (CT). All were advised to undergo body weight reduction by exercise and diet control. A percutaneous core liver biopsy was performed in segment 5 of the liver in 22 donors to evaluate the hepatic fat content before and after body weight reduction. We compared the changes in the liver CT attenuation values and volume changes in the left and right lobes of the liver and the spleen before and after body weight reduction. Results The mean (SD) body weight, body mass index, and fatty content of the liver biopsy specimens were 73 (17) kg, 26.8 (4.4), and 16.9% (12.7%), respectively, before body weight reduction and 70 (15) kg, 25.3 (3.8), and 6.6% (3.7%), respectively, thereafter. These changes were significant. The CT attenuation values of the left and right lobes of the liver and spleen were 54 (11), 51 (11), and 52 (5) HU, respectively, before body weight reduction and 60 (8), 58 (6), and 53 (5) HU, respectively, thereafter. The mean CT attenuation value of the left lateral segment was greater than that of the right lobe both before and after body weight reduction. The volume of the left and right lobes and spleen changed from 497 (129) cm 3 to 452 (99) cm 3, 927 (237) cm 3 to 846 (173) cm 3, and 185 (65) cm 3 to 186 (63) cm 3, respectively, thereafter. The right and left lobe volume change ratios were 7.0% (10.6%) and 7.6% (11.1%), respectively, but showed no significant difference. Twenty of the 23 candidates were able to donate part of their liver. Conclusion Body weight reduction by exercise and diet control in potential living liver donors is effective to reduce the fatty content of the liver. Reversed percentage of the fatty content and volume of the liver was observed in these donors. The volumes of the right and left lobes of liver decreased significantly after body weight reduction. The volume changes were proportional.

High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins

Hepatocellular carcinoma (HCC) is an especially frequent malignancy in China. Radiofrequency ablation, percutaneous ethanol injection, transarterial chemoembolization, cryoablation, microwave coagulation, and laser-induced interstitial thermotherapy all offer potential local tumor control and occasionally achieve long-term disease-free survival. High-intensity focused ultrasound (HIFU), as a noninvasive therapy, can be applied to treat tumors that are difficult to treat with other techniques. The preliminary results of HIFU in clinical studies are encouraging. The aims of this investigation were to assess the efficacy of the system in obtaining necrosis of the target tissue and to determine whether HIFU ablation is hazardous to adjacent major blood vessels. Over 7 years, thirty-nine patients with HCC were enrolled in this investigation. The inferior vena cava (IVC), main hepatic vein branches, and the portal vein and its main branches were evaluated. The distance between tumor and main blood vessel was less than 1 cm in all these enrolled patients. Contrast-enhanced MRI was used to evaluate the perfusion of tumors and major blood vessels. We conducted HIFU ablation for the treatment of 39 patients with 42 tumors, with each tumor measuring 7.4+/-4.3 (1.5-22) cm in its greatest dimension. Among the 39 patients, 23 were males and 16 females. The average age was 53.2 years (range 25-77 years). Thirty-seven patients had a solitary lesion, one had two lesions, and the remaining one had three lesions. Nineteen lesions were located in the right lobe of liver, 18 in the left lobe, and 5 in both right and left lobes. Among the 42 tumors, 25 were adjacent to 1 blood vessel, 12 adjacent to 2 main vessels, 2 adjacent to 3 main vessels, and 1 adjacent to 4 main vessels. Twenty-one of the 42 tumors were completely ablated, while the rest of the tumors were ablated by more than 50% of lesion volume after one session of HIFU. No major blood vessel injury was observed in any subject after 23.8+/-17.2 months follow-up. HIFU can achieve complete tumor necrosis even when the lesion is located adjacent to the major hepatic blood vessels. Short-term and long-term follow-up results show that HIFU can be safely used to ablate the tumors adjacent to major vessels.

Percutaneous cryosurgery for the treatment of hepatic colorectal metastases

To determine the safety and efficacy of efficacy of percutaneous cryosurgery for treatment of patients with hepatic colorectal metastases. Three hundred and twenty-six patients with non-resectable hepatic colorectal metastases underwent percutaneous cryosurgery under the guidance of ultrasound or CT. Follow-up was 1 mo after cryosurgery and then every 4 mo thereafter by assessment of tumor markers, liver ultrasonography, and abdominal CT. For lesions suspicious of recurrence, a liver biopsy was performed and subsequent repeat cryosurgery was given if histology was positive for cancer. All patients underwent a total of 526 procedures of cryosurgery. There were 151 patients who underwent repeat procedures of cryosurgery for recurrent tumors in the liver and extrahepatic places. At 3 mo after cryosurgery, carcinoembryonic antigen (CEA) levels in 197 (77.5%) patients who had elevated markers before cryosurgery decreased to normal range. Among 280 patients who received CT following-up, cryotreated lesions showed complete response (CR) in 41 patients (14.6%), partial response (PR) in 115 patients (41.1%), stable disease (SD) in 68 patients (24.3%) and progressive disease (PD) in 56 patients (20%). The recurrence rate was 47.2% during a median follow-up of 32 mo (range, 7-61). Sixty one percent of the recurrences were seen in liver only and 13.9% in liver and extrahepatic areas. The recurrence rate at cryotreated site was only 6.4% for all cases. During a median follow-up of 36 mo (7-62 mo), the median survival of all patient was 29 mo (range 3-62 mo). Overall survival was 78%, 62%, 41%, 34% and 23% at 1, 2, 3, 4 and 5 years, respectively, after the treatment. Patients with tumor size less than 3 cm, tumor in right lobe of liver, lower CEA levels (<100 ng/dL) and post-cryosurgery TACE had higher survival rate. There was no significant difference in terms of survival based on the number of tumors, pre-cryosurgery chemotherapy and the timing of the development of metastases (synchronous vs metachronous). Patients who underwent 2-3 procedures of cryosurgery had increased survival compared to patients who received cryosurgery once only. There was no intra-cryosurgery mortality. Main adverse effects, such as hepatic bleeding, cryoshock, biliary fistula, liver failure, renal insufficiency and liver abscess were only observed in 0.3%-1.5% of patients. Percutaneous cryosurgery was a safe modality for hepatic colorectal metastases. Rather than an alternative to resection, this technique should be regarded as a complement to hepatectomy and as an additional means of achieving tumor eradication when total excision is not possible.

Intraoperative use of recombinant activated factor VII in traumatic unpenetrating liver injury - case report

Uncontrolled massive bleeding is often the cause of death of polytraumatized patients. Massive haemorrhage in polytrauma is the consequence of severe tissue and blood vessel damage or the development of posttraumatic coagulopathy. Most often, it is the combination of the two causes. Coagulopathy arises in early stages of trauma and it is an independent predictor of mortality of polytraumatized patients, however, its timely correction can significantly result in the reduction of mortality rate in trauma. We present a 15-year old male patient who fell from 11 m height and sustained injuries of the right lobe of liver, with partial avulsion and lacerations on the diaphragmal and visceral side of the right lobe. He also sustained brain injuries with presence of blood content in the right lateral chamber, numerous haemorrhagic spots and contusions in frontoparietal region and diffuse brain oedema of the right side of the hemisphere. A partial right sided hepatectomy was performed using the surgical techniques of haemostasis (ligation, tamponade, compression, embolisation), circulatory volume resuscitation (crystalloids and colloids), resuscitation of blood and blood components and the application of antifibrynolitics, as well as oxigenotherapy (endotracheal intubation and mechanical ventilation, with high inspiratory fractions of oxygen). Considering massive transfusions, the type and character of injury and visible oozing, as well as the fact that conventional methods did not stop the bleeding, recombinant activated factor VII (rFVIIa) was given intraoperatively, which resulted in successful reduction and finally the cecession of bleeding. Until today, there are numerous references about successful application of rFVIIa in uncontrolled bleedings in trauma when previously applied conventional methods of haemostasis were not sufficient. We are presenting a case of successful use of rFVIIa in our hospital accompanied by usual surgical measures and reanimation of a severely injured patient with massive bleeding. Based on our experience and available references, in case of timely diagnosis and adequate therapy, such as conventional treatment methods and the use of rFVIIa, uncontrolled bleedings in polytrauma have better prognosis.

Tuberculoma of the liver

We report an isolated giant solid macronodular tuberculoma in an 8-year-old boy. A large-space-occupying lesion in the right lobe with nodular surface and hard consistency mimicked liver malignancy. This case is unusual as the ultrasonography, computed tomography scan, and aspiration cytology were all suggestive of a malignant tumor. Laparotomy confirmed a 15 × 10 cm nodular tumor present in the right lobe of liver. The segments 5, 6, 7, and 8 were excised. The histopathology revealed tuberculosis.

Liver teratoma in an adult

BACKGROUND: Liver teratomas are rare neoplasms accounting for less than 1% of all teratomas. By definition, a teratoma must contain tissue derivates from at least two of three germ cell layers: ectoderm, mesoderm and endoderm. They can be classified as benign or malignant on the basis of their histopathologic features. METHODS: Case report. RESULTS: The authors report a case of an adult female with a benign mature teratoma arising from the right lobe of liver, presented as an incidental finding on a computed examination scan. She was submitted to surgery with resection of the tumor and is presently well with no evidence of recurrence. CONCLUSIONS: This case reports a very rare entity, usually asymptomatic, with characteristic findings on imaging examination. Resection is the treatment of choice.

False-Positive I-131 Accumulation in a Hepatic Hydatid Cyst

In this report, a case of differentiated thyroid carcinoma having false-positive I-131 accumulation due to a large hydatid cyst in the liver is presented. Abdominal sonographic examination of a 37-year-old patient with differentiated thyroid carcinoma demonstrated an ovoid, complex cystic mass containing cystic parts as well as solid-appearing components in the right lobe of liver, which is concordant with a type CE-3 hydatid cyst. The postablative whole-body scan obtained 10 days after 100 mCi I-131 therapy displayed intense and homogeneous uptake of radioiodine in the liver. Hepatic cystic mass was removed, and postoperative histologic evaluation confirmed hydatid disease. Some cystic lesions of the kidney and liver have been previously reported as causes of false-positive radioiodine accumulation.

Hepatic Splenosis Mimicking Hepatocellular Carcinoma

Purpose: Splenosis is heterotropic implantation of splenic tissue after splenectomy or traumatic rupture of spleen. We report patient with alcoholic liver disease, who was found to have enhancing hepatic lesion during surveillance for HCC but was diagnosed as splenosis based on characteristic imaging, nuclear scintigraphic findings and associated multiple splenules. A 39-year-old man with alcoholic cirrhosis on routine surveillance for HCC was found to have small hypoechoic lesion on ultrasound, follow up MRI revealed a mass in right lobe of liver measuring 4.5 × 5.3 cm with enhancement in early phase and an isodense lesion on late phase (white arrow in Fig. 1). These findings suggested a diagnosis of hepatocellular carcinoma. There were also multiple enhancing lesions in mesentery and splenic bud suggestive of splenules (black arrow in Fig. 1). A Tc-99m sulfur colloid scan showed uptake in the area of hepatic mass and splenules (marked with black and white arrow respectively in Fig. 2). Patient had splenectomy in past after abdominal trauma. Laboratory data revealed Alpha-fetoprotein 3.5, AST 58, and ALT 45. Six months later repeat imaging showed no increase in size of mass. In our case, the presence of concurrent mesenteric splenosis, normal alpha-fetoprotein, no growth on subsequent imaging and radio isotope uptake in liver and splenic bed on Tc-99m scan established the correct diagnosis of splenosis and averted the need for biopsy. Majority of the time splenosis is an incidental finding at surgery or autopsy, and at times discovered during computed tomography (CT) or magnetic resonance imaging (MRI). Splenosis being highly vascular mimics other vascular hepatic neoplasia and presents a dilemma in diagnosis of Hepatocellular carcinoma (HCC).[figure1][figure2]FigureFigure

Tuberculosis of the liver

A fifty years old lady underwent elective extended right hemicolectomy for a mass of ascending and transverse colon along with incision and drainage of abscess in the right lobe of liver. Histopathology turned out to be tuberculous liver abscess and tuberculous colitis. Although tuberclosis is very common in our country, but tuberculosis of liver is rare this case is one of that, showing the decreased immunity of the patient and local spread of disease. The tuberculous liver abscess is rare[1], when present is associated with focus of infection in the lungs or the GIT.

Agenesis of Right Lobe of Liver: Role of Multislice Computed Tomography

Congenital anomalies of the liver are rare. Agenesis of the right lobe of liver is a rare anomaly with 43 cases reported so far in the English literature. Hypoplasia and agenesis occur more on left side. Agenesis of right lobe of liver is presented in this case report. Role of multislice computed tomography is highlighted in diagnosis. A brief literature review is made along with discussions on differential diagnosis.

Successful Management of Rhabdoid Tumor of the Liver

A 3-year-old male was referred because of fever, abdominal pain, and enlarged abdomen. Magnetic resonance imaging showed a very large lobulated mass involving predominantly the right lobe of liver. Tumor histology was consistent with rhabdoid tumor of the liver. The patient received 3 cycles of chemotherapy consisting of ifosfamide, carboplatin, and etoposide alternating with vincristine, adriamycin, and cyclophosphamide, at 3-week intervals. Follow-up magnetic resonance imaging revealed approximately 84% decrease in size of tumor after 2 cycles of chemotherapy. Patient underwent liver transplantation, as the tumor was unresectable. Six weeks posttransplant, the patient received 4 more cycles of chemotherapy. The patient is free of disease at evaluation 3 years posttransplant.

A case of recurrent biliptysis

A case of recurrent biliptysis

Delayed obstructive jaundice secondary to bullet in common hepatic duct.

A young male presented with obstructive jaundice and recurrent attacks of acute cholangitis. He had sustained gunshot wound in abdomen 9 years back. Laparotomy was done at that time and the bullet was found left within right lobe of liver, as it was inaccessible and possible benefit to take it out was considered less than leaving it in-situ. The patient recovered and did well for 7 years. After 7 years of latency, he developed recurrent attacks of acute cholangitis. The reason of this delayed presentation was probably the migration of the bullet from its original place to the biliary tree i.e. common hepatic duct.

Hepatic hydatid cyst presenting as anaphylaxis.

A young soldier was brought to the emergency of Combined Military Hospital (CMH), Multan in a collapsed state with two day's history of chest pain. He was resuscitated and placed on ventilator. While the rest of examinations were normal, ultrasound examination of the abdomen revealed a cystic mass in liver most likely to be hydatid. The patient was fully conscious the next day and was put on tab albendazole (200 mg BID). CT scan of the abdomen revealed a large cystic mass having inner undulating wall with watery content diagnosed as hydatid cyst in right lobe of liver. Since anaphylaxis was considered consequent to hydatid cyst perforation, surgery was carried out. Approximately 100 ml of haemorrhagic fluid was aspirated and 10% hypertonic saline instilled. After re-aspiration, cyst cavity was opened and endocyst completely removed. Portion of ectocyst projecting away from the liver edge was also excised. He made an uneventful postoperative recovery and was discharged with the advice to continue tab albendazole 200mg BID for four weeks and weekly follow-up in surgical OPD. He is doing well now.

Hepatic Metastasis of Papillary Renal Carcinoma Preoperatively Diagnosed as Cystadenocarcinoma of the Liver: Report of a Case

The patient was a 48-year-old man who had been found to have a hepatic tumor 6.6 cm in diameter on a CT scan and was admitted to our hospital for further examination. His past medical history included left nephrectomy for papillary renal cell carcinoma in December 2003. An abdominal CT scan revealed a multilocular cystic mass showed 75 mm in diameter in S7 of the right lobe of liver. Abdominal ultrasonography showed a highly echoic mass 70 mm in diameter in the right lower abdomen. On abdominal MRI a multilocular cystic mass measuring 80 mm×65 mm was seen in S7 of the right lobe of liver, and it was depicted as mild high intensity on the T1-weighted images and very high intensity on the T2-weighted images. Celiac arteriography showed a hypervascular mass in the arterial phase and a tumor stain in the venous phase. Based on these findings, a diagnosis of cystadenocarcinoma of the liver was made, and surgery was performed. Intraoperative exploration revealed that the tumor was located in the right lobe of the liver. Right lobectomy was performed, and macroscopic examination of the surgical specimen showed that the tumor measured 70 mm×70 mm×50 mm. The cut surface was cavenous and brown. The histopathological diagnosis was papillary carcinoma, and the histological findings resembled those of the papillary renal cell carcinoma in the surgical specimen obtained previously. The multilocular cystic mass in the liver misdiagnosed as a cystadenocarcinoma of the liver was a metastasis from the papillary renal carcinoma in the previous surgical specimen.

Gene Expression Profiles in Living Donors Immediately After Partial Hepatectomy—The Initial Response of Liver Regeneration

Gene expression profiles of liver regeneration are well explored in rat models. However, there are limited relative data in humans. This study aimed to show that mRNA expression profiles change immediately after right hepatectomy in living-related donors and correlate with mechanisms of liver regeneration reported in the literature. Prospective study was conducted from March 2003 to August 2004. Living-related donors who donated right lobe of liver were included. Liver biopsies were performed at the beginning and, 5 hours later, at the end of liver resection. RNAs were isolated to synthesize cRNA. Oligo DNA microarray experiments were conducted and paired signal intensity ratios (Cy3/Cy5) were normalized with rank-invariant global Lowess regression analysis by taking base two logarithms. Genes whose average residuals more than 2.5-fold increased or less than -2.5-fold decreased were selected to get the most pronounced expression changes during this period. Five of 34 donors were included with qualified samples. The expression patterns of paired DNA microarray experiments were similar in five donors. A total of 28 upregulated and 14 downregulated genes were collected. Acute-phase proteins (serum amyloid A, complement-reactive protein, heme oxygenase-1) were upregulated. Genes related to growth signal transduction (G-protein coupled receptor-30) were downregulated. Gene expression profiles immediately after partial hepatectomy were reported first in humans with the techniques of oligo DNA microarray, which were compatible with the initial gene expression patterns of liver regeneration in rats.

Efficacy of Right Anterior Sector Drainage Reconstruction in Right-Lobe Live-Donor Transplantation

Background Without including the middle hepatic vein (MHV) into right-lobe grafts, venous drainage of the anterior segment (AS) has always been a concern. The efficacy and the necessity of additional venous reconstruction in the AS for graft viability and function are still controversial. Methods Since February 2002, 57 right-lobe grafts were implanted into adult recipients. The mean graft to ideal recipient weight ratio (GRWR) was 1.3% (minimum: 0.8%, maximum 2.1%). All minor venous tributaries to the MHV less than 5 mm in diameter were ligated. The management of MHV tributaries was categorized into three groups: (A) no major tributaries (n = 33); (B) major tributaries ligated (n = 11); and (C) major tributaries reconstructed (n = 13). Reconstructions were established using vascular grafts (PTF, n = 8; cadaveric, n = 2) or joining with right hepatic vein orifice (n = 6). The groups were homogenous in age, gender, MELD (17 ± 6, 16 ± 4, 18 ± 7), graft weight (817 ± 181, 838 ± 152, and 855 ± 159 g), and graft/ideal liver weight ratio (0.54 ± 0.12, 0.57 ± 0.13, and 0.57 ± 0.1, respectively). We investigated the volume of ascites, serum bilirubin, albumin, and liver enzyme levels and INR on postoperative day 4 (POD4) and POD21. Results Two patients died of MRSA sepsis on POD18 and POD23 (MELD: 24 and 28) after initial graft function. Their graft weights were 800 g and 980 g, and their volumes were 47% (group B) and 62% (group A) of the ideal liver mass of the recipients, respectively. One PTF and another cadaveric vascular graft were found occluded 4 and 7 days after implantation without any negative consequence. At 6-month follow-up, the remaining 55 patients were alive with primary liver grafts. Vascular reconstructions were patent except for 2 early occlusions. Among the 3 groups, no significant difference was found on POD4. Three weeks after transplantation, the mean AST level in the major ligation group (46.7 ± 8.14) was significantly higher than in the minor ligatation group (29.6 ± 8.6) but not in the major reconstruction group (33.7 ± 3.7; P = .03 and P = .29). The mean albumin level was highest after minor ligation (3.2 ± 0.18), which was significantly better than the major reconstruction (2.7 ± 0.1) but not the major ligation (3.1 ± 0.14) cohorts ( P = .02 and P = .13). Conclusions In this study of a limited number of cases, right-lobe liver grafts with GRWR of ≥1.1% displayed optimal graft function without additional venous reconstruction to the AS.

Delayed diagnosis of traumatic rupture of hydatid cyst of the liver – A case report

We present a patient with slow rupture of hydatid cyst into the peritoneal cavity, presenting as massive abdominal distension and respiratory embarrassment. On paracentesis, no fluid could be drained. A small lateral incision was made under local anaesthesia to drain the ‘ascites’, but daughter cysts typical of hydatid came out. On laparotomy, there was a cyst in the right lobe of liver which had ruptured into the peritoneal cavity leading to secondary echinococcosis.

Preoperative Helical Computerized Tomography Estimation of Donor Liver Volume

Background The purpose of this study was to evaluate the accuracy of spiral computed tomography (CT) and 3-D imaging models in measuring total and segmental liver volume in potential living donors. Methods A prospective study was undertaken to assess the correlation between the volumes of potential donor livers determined via helical CT and the actual volumes measured during operation in 150 donor candidates. Left-lateral segment (S2,3) or left-lobe (S2,3,4) transplantation was performed in 36 cases with 96 right-lobe liver transplants (S5,6,7,8). Ten donor candidates were refused owing to inadequate liver volumes, and 8 for other reasons. Results The regression analysis model showed a significant correlation between the preoperative CT estimates of graft volume and intraoperative weight measurement of harvested grafts in living liver donors (F:5525.37; P < .05); 97.7% of changes in CT volume were explained by differences in graft mass (R 2:0.977). Conclusion Preoperative estimation of segmental volumes of the donor liver is necessary to avoid donor-recipient size disparity, thereby preventing hepatic failure of donors after harvesting. It has a major impact on donor selection and type of surgical management. The accuracy of helical CT was high to determine total and segmental liver volumes.

Impact of venous drainage on regeneration of the anterior segment of right living‐related liver grafts

The effect of additional venous reconstruction on morphologic and functional regeneration of the anterior segment of right-lobe liver grafts was compared among three groups according to graft type: right liver graft without the middle hepatic vein (MHV) or MHV tributaries (n=7), with MHV tributaries (n=25) and with the MHV (n=10). Whole graft volume (GV) and anterior segment volume (ASV) were estimated from CT scans and post-operative laboratory data and daily ascitic fluid volume were examined. Peak GV in each group was reached two or three wk after surgery. The ASV/GV ratios of the grafts with the MHV or MHV tributaries were higher than those of grafts without additional venous reconstruction. However, the asparate aminotransferase and ascitic fluid volume values in the group that received grafts with MHV tributaries were higher than in the group that received grafts with the MHV in the same period. Although rapid enlargement of the anterior segment of right-lobe grafts with MHV tributaries occurred in the early post-operative period, complete functional liver regeneration may not occur even after additional tributary reconstruction. These results suggest that the selection of right-lobe grafts with the MHV is more beneficial for recipients, as long as donor safety is protected and that as many MHV tributaries as possible should be reconstructed in right-lobe grafts without MHV.