Liver Failure

Liver
Failure

    

• Henricus BAC Stockmann, Coen A
  Hiemstra, et al  (The
  Department of Surgery, University Hospital Dijkzigt
  and Erasmus University, Rotterdam, The Netherlands)
  
  
  Extracorporeal
  Perfusion for the Treatment of Acute Liver Failure
  
  Annals of Surgery 231(4), 460-470.
  
     
  
  Because
  of the life-threatening complications of Acute Liver
  Failure, 75% die within a few days of onset. 
  At present there is no satisfactory treatment
  for this condition except liver transplantation.
  Though this operation has a 70-80%, 5 year
  survival rate, there is a shortage of donor organs. Therefore several temporary liver assisting therapies have been
  developed. This
  article reviews the various forms of temporary liver
  support as well as the immunologic and metabolic
  developments toward a solution for this problem.
  
    
  
  The
  authors conclude that renewed interest has developed
  in the various methods of temporary liver support from
  the early haemodialysis, haemofiltration, exchange
  transfusion, plasma exchange, resin haemoperfusion and
  charcoal perfusion to the bioartificial liver, extra
  corporeal liver assist device and extracorporeal whole
  liver perfusion. The
  immunologic implications and metabolic developments
  have also been discussed.
  
      
  
  The
  clinical improvement though temporary, allows life to
  be prolonged. New
  developments in the field of genetic modification and
  tissue engineering await clinical application in the
  near future.
  
        

• Bjorg
  Tilde Fevang, Jonas Fevang, Lodve Stangeland, et al
  (The Department of Surgery, Haukeland University
  Hospital, University of Bergen, Bergen, Norway)
  
  Complications
  and Death After Surgical Treatment of 
  Small Bowel Obstruction
  
  A 35-Year Institutional Experience
  
  Annals of Surgery, April 2000, 231(4), 529-537.
  
      
  
  This
  study was conducted to determine the factors
  influencing  complications
  and mortality after surgery for small bowel
  obstruction using multifactorial statistical methods.
  
      
  
  877
  patients who underwent 1007 operations for small bowel
  obstruction (SBO) between 1961 and 1995 were studied
  retrospectively. 
  Patients with paralytic ileus, intussusception
  and abdominal cancer were excluded.
  
      
  
  43%
  were caused by adhesions and 41% were due to
  incarcerated hernias. Whereas
  the incidence of adhesions has increased with time but
  the incidence of hernias has dropped.
  The proportion of women has increased over the
  years. The
  overall incidence of viable strangulation was 26% and
  non-viable strangulation was 16%.
  62% had a previous laparotomy like
  gynecological surgery, appendectomies and a small
  percentage had GI surgery done on them.
  
        
  
  30%
  of patients had co-morbidity in the form of
  cardiovascular disease, lung disease, diabetes and
  central nervous system disease.
  
        
  
  The
  results showed that old age co-morbidity, non-viable
  strangulation, and a delay in treatment for more than
  24 hours were associated with an increased mortality.
  The rate of non-viable strangulation increased
  with age. The
  need for repeat surgery also increased morbidity and
  mortality. The
  overall death and complication rates decreased from
  1961 to 1995.
  
       

• Ronnie
  Tung-Ping Poon, Sheung-Tat Fan, et al (The Centre of
  Liver Diseases, Department of Surgery and Pathology,
  The University of Hong Kong Medical Centre, Queen Mary
  Hospital, Hong Kong, China).
  
  Significance
  of Resection Margin in Hepatectomy for Hepatocellular
  Carcinoma.
  
  A Critical Reappraisal
  
  Annals of Surgery, April 2000, 231(4), 544-551.
  
        
  
  This study evaluates the influence of the width
  and the histologic involvement of the resection margin
  on postoperative recurrence after resection of
  hepatocellular carcinoma (HCC).
  
       
  
  288
  patients with macroscopically complete resection of
  HCC were divided into 2 groups with narrow (< 1cm)
  or wide (³
  1cm) resection margins, and compared.
  
       
  
  The
  recurrence rates were similar between the two groups
  and they were similar in other clinicopathologic
  variables.
  
       
  
  Most
  recurrences occurred away from the resection margin or
  at multiple sites. Those
  who had histologically involved resection margin or
  venous tumour emboli or multisatellites had higher
  recurrence rates then those without.
  
       
  
  However,
  a positive histologic margin was not a significant
  risk factor for recurrence by multivariate analysis.
  The tumour stage and the perioperative
  transfusion were the only independent risk factor.
  
        
  
  They
  conclude that the width of the resection margin did
  not influence the post-operative recurrence rate after
  hepatectomy for HCC. Most
  recurrences were considered to arise from venous
  dissemination.