[The untellable patient's history].

An essay with personal touch on the interaction between patients and professionals seen from the perspective of an anonymous writer that is presumably preoccupied with midlife reflections.

Regenerative capacity of individual liver lobes in the microsurgical mouse model.

In the development of microsurgical mouse models of hepatic regeneration and repair, lobe-specific regenerative responses were observed. We therefore determined the hepatic regenerative capacity of individual mouse liver lobes. In mice, 26, 60, 75, and 83% of total liver mass was resected.

Analysis of stapling versus endoloops in appendiceal stump closure.

Background: The effectiveness of various appendiceal stump closure methods has not been evaluated systematically. The aim of this study was to compare the morbidity of stump closure by stapling or use of endoloops.

Methods: A non-concurrent cohort study of prospectively acquired data was performed.

Cellular differentiation determines the expression of the hypoxia-inducible protein NDRG1 in pancreatic cancer.

N-myc downstream-regulated gene-1 (NDRG1) is a recently described hypoxia-inducible protein that is upregulated in various human cancers. Pancreatic ductal adenocarcinoma, called pancreatic cancer, is a highly aggressive cancer that is characterised by its avascular structure, which results in a severe hypoxic environment. In this study, we investigated whether NDRG1 is upregulated in these tumours, thus providing a novel marker for malignant cells in the pancreas.

[Acute "difficult" gastrointestinal bleeding].

Gastrointestinal bleeding with its point of origin outside the reach of conventional gastro- and colonoscopy represents an extraordinary diagnostic and therapeutic challenge. Bleeding may originate from the small bowel distal to the duodenojejunal junction (middle gastrointestinal bleeding) or from the biliary tree (haemobilia) or from the pancreatic ductal system (haemosuccus pancreaticus). This particular type of gastrointestinal bleeding is often intermittend and caused by a variety of different pathologies.

[Acute lower gastrointestinal bleeding--an evidence-based algorithm for diagnosis and treatment].

Novel means to locate and treat lower gastrointestinal bleeding (lGB) allow to reduce the rate of required surgical interventions and help to limit the extend of resection. The risk stratification of patients with lGB is the primary step of our recommended treatment algorithm. Accordingly, risk stratifying instruments, which are only partly validated up to now, are gaining significance in lGB.

Interferon-inducible expression of APOBEC3 editing enzymes in human hepatocytes and inhibition of hepatitis B virus replication.

Hypermutations in hepatitis B virus (HBV) DNA by APOBEC3 cytidine deaminases have been detected in vitro and in vivo, and APOBEC3G (A3G) and APOBEC3F (A3F) have been shown to inhibit the replication of HBV in vitro, but the presumably low or even absent hepatic expression of these enzymes has raised the question as to their physiological impact on HBV replication. We show that normal human liver expresses the mRNAs of APOBEC3B (A3B), APOBEC3C (A3C), A3F, and A3G. In primary human hepatocytes, interferon alpha (IFN-alpha) stimulated the expression of these cytidine deaminases up to 14-fold, and the mRNAs of A3G, A3F, and A3B reached expression levels of 10%, 3%, and 3%, respectively, relative to GAPDH mRNA abundance.

Intraoperative three-dimensional fluoroscopic cholangiography.

Precise intraoperative assessment of the architecture of the biliary tree could reduce lesions to intra- or extrahepatic bile ducts. The aim of this study was to test feasibility of intraoperative three-dimensional imaging during liver resections. Isocentric C-arm fluoroscopy acquires three-dimensional images during a 190 degrees orbital rotation.

Kidney transplantation improves survival and is indicated in Fabry's disease.

Background: Fabry's disease (FD) is an inborn error of glycosphingolipid catabolism with progressive systemic deposition of globotriaosylceramide thereby leading to renal and cardiac failure. Current therapy involves symptomatic medical management, dialysis, enzyme replacement therapy, kidney transplantation (KTx), and more recently gene therapy. Case fatalities occur in the fourth decade of life resulting from uremia unless dialysis or KTx is undertaken.

Laparoscopic ventral hernia repair is safe and cost effective.

Background: Ventral hernia repair is increasingly performed by laparoscopic means since the introduction of dual-layer meshes. This study aimed to compare the early complications and cost effectiveness of open hernia repair with those associated with laparoscopic repair.

Methods: Open ventral hernia repair was performed for 92 consecutive patients using a Vypro mesh, followed by laparoscopic repair for 49 consecutive patients using a Parietene composite mesh.

Functional comparison of bone marrow-derived liver stem cells: selection strategy for cell-based therapy.

Several distinct subpopulations of bone marrow-derived liver progenitor cells were recently described. However, there is inadequate information comparing these subpopulations from a liver-function point of view. This study was undertaken to compare two subpopulations of liver progenitors: beta(2)-microglobulin (beta(2)m)-negative/Thy-1-positive cells, and liver progenitors obtained from the non-adherent cell fraction after a panning procedure.

Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients.

The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e.

Early renal failure after domino hepatic transplantation using the liver from a compound heterozygous patient with primary hyperoxaluria.

Background: To cover the shortage of cadaveric organs, new approaches to expand the donor pool are needed. Here we report on a case of domino liver transplantation (DLT) using an organ harvested from a compound heterozygous patient with primary hyperoxaluria (PHO), who underwent combined liver and kidney transplantation. The DLT recipient developed early renal failure with oxaluria.

[Practical aspects and current perspectives of liver transplantation for the general practitioner].

Orthotopic liver transplantation (OLT) has become the method of choice for many forms of endstage liver disease and is generally associated with a good long-term outcome. Morbidity and mortality for this routine procedure have become acceptable provided the procedure is carried out with a correct and timely indication. It is important for the general practitioner to recognize the various early clinical signs of liver failure and portal hypertension in due course in order to reach a comprehensive planning of all necessary medical steps ahead.

Use of a mechanical thrombectomy device to recanalize a subacutely occluded aortohepatic bypass after orthotopic liver transplantation.

Purpose: To report the use of a rotational thrombectomy device for recanalization of a thrombosed hepatic artery bypass graft in an orthotopic liver transplant (OLT).

Case Report: Six months after a second OLT in a 52-year-old man, an iliac conduit used for an aortohepatic bypass became occluded, interrupting arterial supply to the liver transplant. The 8-F Straub Rotarex system was used to successfully remove clot from the bypass graft, avoiding embolization to the hepatic arteries.

Severe acute pancreatitis: case-oriented discussion of interdisciplinary management.

The clinical course of an episode of acute pancreatitis varies from a mild, transitory illness to a severe often necrotizing form with distant organ failure and a mortality rate of 20-40%. Patients with severe pancreatitis, representing about 15-20% of all patients with acute pancreatitis, need to be identified as early as possible after onset of symptoms allowing starting intensive care treatment early in the disease process. An episode of severe acute pancreatitis progresses in two phases.

Interleukin-3 induces hepatocyte-specific metabolic activity in bone marrow-derived liver stem cells.

Bone marrow-derived adult liver stem cells (BALSC) are a promising target for the development of future cell-based therapies for a variety of liver disorders. However, the ability of stem cells to fully function, as hepatocytes, is limited and differentiation is time dependent. Therefore, it will be conducive to find a growth factor that is able to enhance liver-specific metabolic activity in freshly isolated liver stem cells.

[Consensus-recommendations for sirolimus in liver transplantation].

Sirolimus is an m-TOR inhibitor without renal side effects and potentially protects against the development of malignancy. Due to a higher incidence of complications in two trials and an official warning in the drug information, the use of Sirolimus in liver transplantation is limited. The participants of this consensus meeting had to analyse and evaluate the literature with respect to the potential role of Sirolimus in liver transplantation.

Magnetic resonance imaging provides accurate and precise volume determination of the regenerating mouse liver.

Direct and repetitive noninvasive determination of the time course and the strain-specific hepatic regenerative capacity after partial hepatectomy can extend our knowledge about the basic mechanisms of liver regeneration and repair. The aim of this study was to develop a magnetic resonance (MR)-based volumetric procedure to measure the hepatic volume in the regenerating mouse liver. In Balb-C mice (n = 14), varying amounts of liver tissue were resected and MR imaging was performed 24 hours later in a 1.

Local and remote ischemia-reperfusion injury is mitigated in mice overexpressing human C1 inhibitor.

Activation of the classical complement pathway is crucially involved in complement-mediated endothelial cell damage in ischemia-reperfusion injury. C1 inhibitor is the only known physiological inhibitor of classical complement pathway activation. Transgenic mice overexpressing human C1 inhibitor were used in a surgical lower torso and a liver ischemia-reperfusion model.

The Met kinase inhibitor SU11274 exhibits a selective inhibition pattern toward different receptor mutated variants.

Point mutations constitute a major mode of oncogenic activation of the Met receptor tyrosine kinase. Met is aberrantly activated in many types of human malignancies and its deregulated activity is correlated with aggressive tumor traits such as abnormal proliferation and survival, leading to tumor growth, local invasion and metastasis. Here we report that the Met kinase inhibitor SU11274 differentially affects the kinase activity and subsequent signaling of various mutant forms of Met.

Effect of vascular endothelial growth factor on functional recovery after hepatectomy in lean and obese mice.

Background/aims: Liver regeneration is dependent upon coordinated proliferation of hepatocytes and endothelial cells. Vascular endothelial growth factor (VEGF) promotes angiogenesis. Hepatic steatosis delays regeneration and increases liver resection morbidity.

Liver resection for colorectal metastases.

Background: Colorectal cancer is the second commonest malignancy in the UK. Metastases to the liver occur in greater than 50% of patients and remain the biggest determinant of outcome in these patients. Liver resection is a safe procedure that achieves good long-term survival, but surgery has traditionally been limited to select groups of patients.

[A new method of orthotopic liver transplantation from the guinea pig to the rat].

Guinea pig to rat orthotopic liver transplantation is associated with serious technical problems contributing to impaired graft reperfusion and a high incidence of primary non function. In order to reduce the operation time and thereby organ damage during procurement a simplified technique for reconstruction of the infrahepatic vena cava was developed and is described in detail. Reduced operation time was associated with markedly improved lobular graft perfusion and significantly better graft survival.