Inflammatory pseudotumor of the liver in association with a gastrointestinal stromal tumor: A case report

Inflammatory pseudotumor of the liver is a rare benign lesion that can mimic a malignant liver nioplasm. A case of inflammatory pseudotumor of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) of the small bowel was reported. The inflammatory pseudotumor was misdiagnosed as a metastasis from the GIST by frozen section. A correct diagnosis was made only after histopathological examination of the paraffin section of the resescted specimen. This case is psrticularly interesting because of the association of the two rare pathological entities and the diagnostic dilemma that arose from the similarity of their histological appearances. To our knowledge，this association has not been reported in the literature.

Versatility and viability of hepatic venoplasty in live donor liver transplantation using the right lobe with the middle hepatic vein

Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile , and able to cope with variation of the configurations of the hepatic vein.

Protection of the liver during partial hepatectomy

BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces mas- sive bleeding and ischemic damage to the liver remnant. DATA RESOURCES: From author' s practice at Queen Mary Hospital, the University of Hong Kong. RESULTS: To avoid technical errors leading to liver ische- mia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved. CONCLUSION: Protection of the liver remnant is impor- tant to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.

Estimating liver weight of adults by body weight and gender

瞄准：为了为估计接枝的足够估计标准肝重量，为癌症在主要肝切除术在实时施主肝移植和残余肝缩放。方法：在这研究，体重和身高的人体测量的数据在 159 个实时的肝施主为与肝重量的关联被测试包括中间的肝的静脉经历了施主权利肝切除术。肝重量从在背表格获得的正确脑叶接枝重量被计算，在计算断层摄影术上由正确脑叶的比例划分了。结果：这些题目，所有汉语，有 35.8+/-10.5 年，和女性的吝啬的年龄到 118:41 的男比率。正确脑叶的吝啬的体积是 710.14+/-131.46 mL 并且在计算断层摄影术上占据了整个肝的 64.55%+/-4.47% 。正确脑叶称了 598.90+/-117.39 g，估计的肝重量是 927.54+/-168.78 g。当体重和身高受到多重逐步的线性回归分析时，身高被发现不足道。一样的体重的女性有稍微更低的肝重量。一个公式基于体重和性被导出：估计的标准肝重量(g)= 218 + BW (kg ) x 12.3 + 性 x 51 (R2 = 0.48 )( 女 = 0，男 = 1 ) 。基于这 159 个题目，的人体测量的数据肝重量用在白种人，日语，朝鲜语，和汉语上从研究导出的以前出版的公式被计算。所有公式与这个公式相比过高估计肝重量。日本公式为成年人过高估计估计的标准肝重量(ESLW ) 不到 60 kg。结论：对中国男性和女性适用的一个公式是可得到的。为单个赛跑的一个公式显得必要。

Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation

AIM: To evaluate the outcome of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) ＜5 cm in diameter eligible for radiofrequency ablation (RFA).METHODS: The treatment-related mortality, morbidity,long-term survival, and prognostic factors of HCC patients who had TACE and fulfilled the present inclusion criteria for RFA were evaluated.RESULTS: Of the 748 patients treated with TACE between January 1990 and December 2002, 114 patients were also eligible for RFA. The treatment-related mortality and morbidity were 1% and 19%, respectively. Survival at 1, 3, and 5 years was 80%, 43%, and 23%, respectively. Older age and a high albumin level were associated with a better survival, whereas a high α-fetoprotein level (AFP) and the size of the largest tumor ＞3 cm in diameter were adverse prognostic factors in multivariate analysis.CONCLUSION: The morbidity, mortality, and survival data after TACE for small HCCs eligible for RFA are comparable to those reported after RFA in the literature. Our data suggest the need for a randomized comparison of the two treatment modalities for small HCCs.

Adeno-associated virus-mediated heme oxygenase-1 gene transfer suppresses the progression of micronodular cirrhosis in rats

瞄准：测试假设这项活动的那改进他我有与周期性的肝损伤联系的纤维发生的过程的氧合酶罐头 interfere，我们调查了在表示上的治疗学的潜力他我在 CCl (4 ) 的 oxygense-1 劝诱了微榴状的肝硬化模型。方法：带老鼠 HO-1 或 GFP 基因的 Recombinant 联系 adeno 的病毒被产生。1x 10 (12 )联系 adeno 的病毒的 vg 在肝的正式就职的时候通过门注射被管理纤维变性。结果：有由 rAAV/HO-1 的 HO-1 的在表示上的老鼠肝显著地增加了的调节以一种稳定的方式的 HO 酶的活动。微榴状的肝硬化的开发显著地作为与控制相比在 rAAV/HO-1-transduced 动物被禁止。门静脉高血压显著地作为与控制相比在 rAAV/HO-1-transduced 动物被减少，而在收缩血压没有重要变化。这发现伴有激活的改进的肝生物化学，更少的渗透的巨噬细胞和更少在 rAAV/HO-1-transduced 肝的肝的星形细胞(HSC ) 。结论：改进惊讶在肝的活动压制肝硬化的发展。

Long-term survival after intraluminal brachytherapy for inoperable hilar cholangiocarcinoma: A case report

Surgical resection with a tumor-free margin is the onlycurative treatment for hilar cholangiocarcinoma (Klatskin tumor). However, over half of the patients present late with unresectable tumors. Radiotherapy using external beamirradiation or intraluminal brachytherapy (ILBT) has been used to treat unresectable hilar cholangiocarcinoma with satisfactory outcome. We reported a patient with unresectable hilar cholangiocarcinoma surviving more than 6 years after combined external beam irradiation and ILBT.

Live donor liver transplantation in adults: graft size, related anatomical anomaly and imaging evaluation of donor

The shortage of cadaveric livers has sparked aninterest in adult live donor liver transplantation. Rightlobe donor hepatectomy is frequently required to ob-tain a graft of adequate size for adult recipients. Thisprocedure requires not only a precise understanding ofliver anatomy and anatomic anomaly, but also themeans of assessing them. This review focuses on thekey points in adult live donor liver transplantation us-ing the right lobe combined with our own experiencein 81 cases including graft size, related anatomicalanomaly and imaging evaluation of donor.

Mechanism of metastasis by membrane type 1-matrix metalloproteinase in hepatocellular carcinoma

AIM: To investigate the precise role of membrane type1-matrix metalloproteinase (MT1-MMP) in hepatocellular carcinoma (HCC) metastasis.METHODS: Human HCC cells Hep3B with overexpression of MT1-MMP were established by stable transfection, and compared with control cells carrying the empty vector.Cells were examined in vivo for their differences in the metastatic ability of athymic nude mice, and analyzed in vitro for their differences in invasion ability by invasion chamber coated with Matrigel, adhesion towards collagen I and migration through culture chamber. Cell proliferation and apoptosis in adherent and suspension status were evaluated by MTT and flow cytometry analysis.RESULTS: We found that overexpression of MT1-MMP could increase intrahepatic metastasis in nude mice with orthotopic implantation of HCC cells (incidence of 100%[MT1-MMP transfectants] vs 40% [vector control transfectants], P＜0.05). MT1-MMP could also enhance cell invasion through Matrigel (107.7 vs 39.3 cells/field,P＜0.001), adhesion towards matrix (0.30 vs 0.12absorbance unit at 540 nm, P＜0.001), cell migration(89.3 vs 39.0 cells/field, P＜0.001), and cell proliferation(24.3 vs 40.5 h/doubling, P＜0.001). We also observed that MT1-MMP supported cell survival (71.4% vs 23.9%,P＜0.001) with reduced apoptosis (43.7% vs51.0%, P＜0.05)in an attachment-free environment.CONCLUSION: MT1-MMP overexpression could enhance metastasis. In addition to its active role in matrix degradation during tumor invasion, MT1-MMP enhances tumor cell survival upon challenge of detachment, which is important during metastasis when cells enter the circulation.

Biological impacts of "hot-spot" mutations of hepatitis B virus X proteins are genotype B and C differentiated

AIM: To investigate the biological impacts of 'hot-spot'mutations on genotype B and C HBV X proteins (HBx).METHODS: Five types of'hot-spot' mutations of genotype B or C HBV X genes, which sequentially lead to the amino acid substitutions of HBx as I127T, F132Y, K130M+V131I,I127T+K130M+V131I, or K130M+V131I+F132Y, respectively,were generated by means of site-directed mutagenesis.To evaluate the anti-proliferative effects, HBx or related mutants' expression vectors were transfected separately to the Chang cells by lipofectamine, and the cells were cultured in hygromycin selective medium for 14 d, drug-resistant colonies were fixed with cold methanol, stained with Giemsa dyes and scored (increase of the colonies indicated the reduction of the anti-proliferation activity,and vice versa). Different types of HBx expression vectors were co-transfected separately with the reporter plasmid pCMVβ to Chang cells, which were lysed 48 h post-transfection and the intra-cellular β-galactosidase activities were monitored (increase of the β-galactosidase activities indicated the reduction of the transactivation activity, and vice versa). All data obtained were calculated by paired-samples t-test.RESULTS: As compared to standard genotype B HBx,mutants of I127T and I127T+K130M+V131I showed higher transactivation and anti-proliferative activities, while the mutants of F132Y, K130M+V131I, and K130M+V131I+F132Y showed lower activities. As compared to standard genotype C HBx, I127T mutant showed higher transactivation activity, while the other four types of mutants showed no differences. With regard to anti-proliferative activity,compared to standard genotype C HBx, F132Y and K130M+V131I mutants showed lower activities, and K130M+V131I +F132Y mutant, on the other hand, showed higher activity,while the mutants of I127T and I127T+K130M+V131I showed no differences.CONCLUSION: 'Hot-spot' mutations affect the antiproliferation and transactivation activities of genotype B and/or C HBx, and the biological impacts of most 'hot-spot' mutations on HBx are genotype B and C differentiated.

Clinical significance of serum vascular cell adhesion molecule-1 levels in patients with hepatocellular carcinoma

AIM: To evaluate the correlation between serum vascular cellular adhesion molecule-1 (VCAM-1) levels and clinicopathological features in patients with hepatocellular carcinoma (HCC).METHODS: Ninety-six patients who underwent HCC resection were recruited in the study. Preoperative serum levels of soluble VCAM-1 were measured by enzyme-linked immunosorbent assay.RESULTS: Serum VCAM-1 level in HCC patients was inversely correlated with platelet count (r=-0.431,P＜0.001)and serum albumin level (r=-0.279, P＜0.001), and positively correlated with serum bilirubin level (r=-0.379, P＜0.001).Serum VCAM-1 level was not associated with tumor characteristics such as tumor size, venous invasion,presence of microsatellite nodules, tumor grade and tumor stage. Serum VCAM-1 level was significantly higher in HCC patients with cirrhosis compared with those without cirrhosis (median 704 vs 546 ng/mL, P＜0.001). Furthermore, a significantly better disease-free survival was observed in HCC patients with low VCAM-1 level (P=0.019).CONCLUSION: Serum VCAM-1 level appears to reflect the severity of underlying chronic liver disease rather than the tumor status in HCC patients, and low preoperative serum VCAM-1 level is predictive of better disease-free survival after surgery.

Rapid onset Chilaiditi's sign on top of fulminant hepatic failure

ABSTRACT: Fulminant hepatic failure is a medical emer-gency. When this condition declared itself irreversible, atimely liver transplantation is the only effective treatment.A 34-year-old Chinese with fulminant hepatic failure wasevaluated as a potential liver transplantation candidate. Onthe erect chest radiograph, Chilaiditi' s sign has developedover a very short period of a week due to rapid shrinkage ofthe liver. Awareness of Chilaiditi' s sign facilitated distin-guishing the condition of free gas under the diaphragm dueto bowel perforation and subphrenic abscess by gas formingmicro-organisms. Rapidity of onset of this sign parallels thedeterioration of liver function and reflects the urgency ofcondition.

Hepatic stress gene expression and ultrastructural features under intermittent Pringle manoeuvre

Background: Intermittent Pringle manoeuvre resul- ted in less blood loss and better preservation of liver function when it was applied for fewer than 120 mi- nutes. The mechanism of better preservation of liver function under intermittent Pringle manoeuvre at molecular level remains unclear. Furthermore, the ultrastructural features in the liver with chronic di- seases under intermittent Pringle manoeuvre have not been studied. The aim of the study is to investigate the expression of stress genes and ultrastructural change of the liver under intermittent Pringle ma- noeuvre. Methods: From July 1995 to February 1998, 131 pa- tients underwent hepatectomy for liver tumours (61 patients without Pringle manoeuvre and 70 patients with intermittent Pringle manoeuvre). Twenty-five patients (15 with Pringle manoeuvre and 10 without Pringle manoeuvre) were included in the study of he- patic stress gene expression during hepatectomy. Twenty-two patients (18 patients with intermittent Pringle manoeuvre and four patients without Pringle manoeuvre) were randomly assigned for electron mi- croscopic examination. Results: For the expression of stress genes, both the heat shock genes (HSP 70A and HSC 70) and acute phase genes (TNF-α and interleukin-6) were detec- ted simultaneously in the patients with or without in- termittent Pringle manoeuvre. The patients under in- termittent Pringle manoeuvre had relatively higher mRNA levels of heat shock gene 70 family, which is related to intracellular repair and protection. Induc- tion of TNF-α and interleukin-6 genes, which con- tributed to ischaemia-reperfusion injury and posto- perative complication, was not found in the patients under intermittent Pringle manoeuvre. Under the e- lectron microscopy, the hepatic ultrastructure was well maintained under intermittent Pringle manoeu- vre whatever the liver status, even when the accumu- lated ischaemic duration was extended to 120 min. Conclusion: Intermittent Pringle manoeuvre induced relatively higher expression of heat shock genes, which are related to intracellular homeostasis, and is consistent with the well maintenance of liver ultra- structure.