Objective: To find out whether intraoperative ultrasound (IOUS) of the liver should still be considered a routine procedure for patients having hepatic resections as their preoperative investigation ...has become so much better with the standard use of triphasic spiral computed tomograms (CT). Design: Retrospective study. Setting: University medical centre, Utrecht, The Netherlands. Patients: 26 consecutive patients undergoing liver resection. Main outcome measures: How much additional information was given by IOUS, and its influence on operative strategy; how IOUS facilitated the hepatic resection. Results: IOUS revealed additional information over triphasic CT in 13/26 patients, which led to a change in the surgical procedure in 4 (15%). For all 4 patients the change in surgical approach proved to be correct as judged by histology and clinical outcome. In 12 patients IOUS facilitated the resection by providing helpful three-dimensional anatomical insight. Conclusion: Despite recent improvements in preoperative investigation, IOUS should still be recommended as a routine procedure in patients having hepatic resections. In addition to aiding the ultimate decision about which part to resect, it also gives insight into the hepatic anatomy.
Loss of epithelial morphology and the acquisition of mesenchymal characteristics may contribute to metastasis formation during colorectal tumorigenesis. The Wnt, Notch and TGFbeta signaling pathways ...control tissue homeostasis and tumor development in the gut. The relationship between the activity of these pathways and the expression of epithelial and mesenchymal markers was investigated in a series of primary colorectal tumors and their corresponding metastases.
Tissue samples of primary colorectal tumors, normal colonic mucosa, and regional and systemic metastases were processed for immunohistochemistry in a tissue microarray format. The expression of mesenchymal (vimentin, fibronectin) and epithelial (E-cadherin) markers was related to markers of Wnt (beta-catenin), Notch (HES1) and TGFbeta (phospho-SMAD2) signalling. In addition, the KRAS mutation status was assessed.
When compared to normal mucosa, primary colorectal tumors showed a marked increase in the levels of cytoplasmic vimentin and nuclear beta-catenin, phospho-SMAD2 and HES1. Increased vimentin expression correlated with the presence of oncogenic KRAS and with nuclear beta-catenin. The corresponding liver, lymph node, brain and lung metastases did not express vimentin and displayed significantly lower levels of nuclear phospho-SMAD2 and HES1, while retaining nuclear beta-catenin.
Primary colorectal carcinomas display aberrant expression of vimentin, and have activated Notch and TGFbeta signaling pathways. Surprisingly, many regional and distant metastases have lost nuclear HES1 and pSMAD2, suggesting that the activity of the Notch and TGFbeta pathways is reduced in secondary colorectal tumors.
To describe the results of 100 endoscopic posterior retroperitoneal adrenalectomies performed in the University Medical Center Utrecht, the Netherlands.
Descriptive, retrospective.
In the period ...August 1997-March 2008 100 endoscopic posterior retroperitoneal adrenalectomies were performed in the University Medical Center Utrecht. Data were collected retrospectively on patients, operations, complications and course following the procedure.
In this period 88 unilateral and 6 bilateral EPRA procedures were performed in 94 patients. The most common indications for unilateral EPRA were pheochromocytoma (33), Cushing's syndrome (16) and Conn's syndrome (20). Preoperative diagnosis involved clinical examination, hormonal analysis and radiological imaging. Mean operative time was 110 min and showed a clear learning curve. The mean intraoperative blood loss was 30 ml. The median size of the lesions was 2.8 cm (range: 0.4-7.5). Conversion to open surgery was necessary in 2 patients. No major intraoperative complications occurred. Postoperative complications occurred in 7 patients, of which 2 were severe and 5 were mild. Surgical reintervention was required in 1 patient. Median postoperative stay was 3 days.
In experienced hands endoscopic posterior retroperitoneal adrenalectomy appears to be a safe and effective treatment for adrenal gland lesions.
: Background/Aims: Major liver resection results in a high morbidity and mortality, and endotoxin plays a role in post‐resection hepatic failure. Severe hepatic failure as seen in hepatitis and ...cirrhosis may be accompanied by hepatic encephalopathy and is characterized by a typical plasma amino acid pattern reflected by a decreased Fischer ratio. This study was performed to evaluate the plasma amino acid pattern in patients undergoing major liver surgery receiving placebo or the endotoxin‐neutralizing agent bactericidal/permeability‐increasing protein (rBPI21). Patients and methods: Forty‐eight patients were randomized in this phase II, dose escalation, multicenter trial. Plasma amino acid profiles were determined preoperatively, and on the first (day 1) and third (day 3) postoperative day. Results: In the placebo group the Fischer ratio decreased significantly on both postoperative days. Administration of rBPI21 also resulted in a decreased Fischer ratio on day 1, but not on day 3. Highly elevated alanine plasma levels were observed on day 1 in placebo‐treated patients, whereas rBPI21 prevented this elevation. Plasma alanine levels on day 1 correlated with the duration of post‐resection hepatic failure. Conclusions: Major liver resection results in a decreased Fischer ratio and a rise in plasma alanine levels. Plasma levels of alanine on the first postoperative day correlated with the duration of the post‐resection hepatic failure. rBPI21 improved the Fischer ratio and prevented the rise of plasma alanine levels.
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