Extreme liver resections with preservation of segment 4 only

To evaluate safety and outcomes of a new technique for extreme hepatic resections with preservation of segment 4 only. METHODSThe new method of extreme liver resection consists of a two-stage hepatectomy. The first stage involves a right hepatectomy with middle hepatic vein preservation and induction of left lobe congestion; the second stage involves a left lobectomy. Thus, the remnant liver is represented by the segment 4 only (with or without segment 1, ± S1). Five patients underwent the new two-stage hepatectomy (congestion group). Data from volumetric assessment made before the second stage was compared with that of 10 matched patients (comparison group) that underwent a single-stage right hepatectomy with middle hepatic vein preservation. RESULTSThe two stages of the procedure were successfully carried out on all 5 patients. For the congestion group, the overall volume of the left hemiliver had increased 103% (mean increase from 438 mL to 890 mL) at 4 wk after the first stage of the procedure. Hypertrophy of the future liver remnant (i.e., segment 4 ± S1) was higher than that of segments 2 and 3 (144% vs 54%, respectively, P < 0.05). The median remnant liver volume-to-body weight ratio was 0.3 (range, 0.28-0.40) before the first stage and 0.8 (range, 0.45-0.97) before the second stage. For the comparison group, the rate of hypertrophy of the left liver after right hepatectomy with middle hepatic vein preservation was 116% ± 34%. Hypertrophy rates of segments 2 and 3 (123% ± 47%) and of segment 4 (108% ± 60%, P > 0.05) were proportional. The mean preoperative volume of segments 2 and 3 was 256 ± 64 cc and increased to 572 ± 257 cc after right hepatectomy. Mean preoperative volume of segment 4 increased from 211 ± 75 cc to 439 ± 180 cc after surgery. CONCLUSIONThe proposed method for extreme hepatectomy with preservation of segment 4 only represents a technique that could allow complete resection of multiple bilateral liver metastases.

Antioxidant and anti-caspase 3 effect of chitosan-Pinus merkusii extract nanoparticle against lead acetate-induced testicular toxicity in rat

Objective: To investigate the antioxidant and anti-caspase 3 effect of chitosan-Pinus merkusii extract nanoparticle on lead acetate-induced toxicity in rat testis. Methods: Chitosan-Pinus merkusii nanoparticles were identified by dynamic light scattering and scanning electron microscope. The male rats were divided into control group (rats were given with distilled water);lead acetate group [rats were injected with lead acetate 20 mg/kg body weight (BW) i.p.], and the treatment group (rats were given the chitosan-Pinus merkusii nanoparticle 150 mg;300 mg;600 mg/kg BW orally and were injected with lead acetate 20 mg/kg BW). The testis tissues were collected to evaluate the malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), histological evaluations of testis damage, and the caspase 3 mRNA expression was measured by reverse transcription-polymerase chain reaction. Results: The dynamic light scattering showed that the size of chitosan-Pinus merkusii nanoparticle was (530.2±38.2) nm. The scanning electron microscope images of the chitosan-Pinus merkusii nanoparticles showed an irregular shape, and the morphology surface showed the rough surface. The treatment with lead acetate resulted in significantly increasing MDA level and caspase 3 mRNA expression, and significantly decreasing level of SOD and GPx when compared with control group. The treatment with the chitosan-Pinus merkusii nanoparticle 600 mg/kg BW but not 150 and 300 mg/kg BW significantly decreased the MDA levels, caspase 3 mRNA expression, and also increased level of SOD and GPx when compared with lead acetate group. The lead acetate induced loss of the normal structure of testicular cells and necrosis, whereas treatment with chitosan-Pinus merkusii nanoparticle inhibited testicular cell necrosis. Conclusions: It can be concluded that chitosan-Pinus merkusii nanoparticle protects rat testis from oxidative damage and apoptosis caused by lead acetate, through increasing antioxidant and inhibiting caspase 3 expression.