Liver transplantation: MR angiography with surgical validation

Article Abstract:

Liver transplantation is becoming increasingly available for the treatment of severe liver disease. A surgeon performing the transplantation needs detailed information regarding the anatomy of the patient's vessels, particularly the portal vein, to which the donor liver will be attached, as well as information about blood flow characteristics. Conventional angiography (X-ray imaging of blood vessels) for these purposes is invasive, not completely effective, and can be risky in some patients. Magnetic resonance (MR) angiography, a noninvasive technique for imaging blood vessels, has been reported to provide accurate information about portal vein anatomy and blood flow characteristics. This study examined the use of this technique to obtain data needed in the clinical setting for liver transplantation surgery. MR angiography was performed on 30 patients who were to have liver transplants. Surgical correlation of the MR findings was performed prior to transplantation. In addition, duplex ultrasound (US, which uses sound waves to examine blood flow) was performed in 28 patients and compared with MR findings regarding blood flow characteristics. Results of MR angiography revealed 26 patent (open) portal veins of 27 actual patent vessels. MR showed the other three patients to have blocked portal veins; this was confirmed by surgery. MR was also able to clearly define dilated and twisted vessels (varices) and branches (collaterals) of the major vessels. These findings were also confirmed by surgical examination. Duplex US was able to diagnose 2 of the 3 blocked portal veins as well as patent vessels in 24 of 25 patients, all agreeing with MR results as to blood flow direction. These results demonstrate that MR angiography is highly effective in visualizing the portal vein and associated vessels and their characteristics. The procedure has the added advantage of being noninvasive, making it a very useful tool in planning liver transplant surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Medical examination, Liver transplantation, Examinations, Test validity, Magnetic resonance imaging, Diagnostic imaging, Portal vein

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Long-term results of pancreatic resection and segmental pancreatic autotransplantation for chronic pancreatitis

Article Abstract:

Pancreatitis is an inflammation of the pancreas. Surgery for chronic pancreatitis is performed because of severe, disabling pain or complications of the pancreatitis. Removal of an extensive portion of the pancreas can lead to insufficient glandular secretions, particularly secretion of insulin, and serious delayed complications may result. The authors report their experience with 13 patients who underwent extensive pancreatic resection and segmental autotransplantation. The procedure involves removal of from 60 to 100 percent of the pancreas, with reimplantation of about 50 percent of the gland elsewhere in the body. There were 11 patients who had successful surgery; the other two patients required removal of the autotransplanted tissue within nine days of the operation. Six patients had the entire pancreas removed, and three of these patients require daily insulin injections. Of the five patients who had near total pancreas removal, three require insulin. In all cases, the amount of insulin required is small, and the diabetes is stable. The patients were followed for an average of 62 months. Pain has recurred in 7 of the 11 patients who had successful surgery, and five required further surgery. This second procedure involved removal of any remaining pancreas and a pancreato-duodenectomy. The authors recommend the use of pancreato-duodenectomy as the initial procedure. Because of the high rate of pain recurrence, total or near total pancreatectomy should be a last resort procedure for use only in selected patients. When used, however, the addition of autotransplantation may provide benefits of glucose balance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pancreas, Pancreatitis, Pancreas transplantation

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Surgical management of nonparasitic cystic liver disease

Article Abstract:

Simple cysts of the liver occur in about 5 percent of the population, are usually without symptoms, and are an incidental finding. Patients who develop symptoms are often middle-aged women. A study was undertaken to determine the role of surgery in treating symptomatic cysts of the liver. A review of 42 patients who underwent surgery for cystic liver disease (nonparasitic) between January 1964 and October 1989 was undertaken. The average age at the time of surgery was 48; there were 37 women (88 percent) and five men. The most common complaint was abdominal pain and tenderness in the upper right abdomen. Twelve patients had simple cysts, 11 had polycystic liver disease, and there were 19 patients with cystadenoma (an epithelial tumor, usually benign, with a gland-like appearance and multiple cystic structures). Five of the 11 patients with polycystic liver disease also had polycystic kidney disease. Computed tomographic scans and ultrasound were the most helpful diagnostic tools. There were 66 operations performed. Aspiration failed in all cases in which it was used. The failure rate for partial excision was 61 percent. Total excision of the cyst and liver resection was the most successful technique, with a 100 percent success rate. Three liver transplants were performed; two of these patients died. It is concluded that the best treatment for these conditions is complete excision, enucleation, or resection of the liver. Aspiration can be used as a temporary measure to relieve symptoms prior to surgery, and partial excision may relieve symptoms in a significant number of patients with polycystic liver disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Liver diseases, Cysts

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