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Reoperation for “failed” hepatic portoenterostomy
674
performed in 400 patients at several centers all over the world since then, with an average 1-yr survival rate of 40%. The most important indication for liver transplantation in childhood is liver cirrhosis following biliary atresia. The donor problem is particularly serious since there are so few donors and since removal of the donor liver must be performed under stable circulatory conditions. The frequency of rejection reactions is ca.10%. Rejection reactions seem to be less violent in a transplanted liver than in other transplanted organs. Criteria for histocompatibility are based on the HLA-antigen-system. Transplantation should be performed as long as the patient is in balanced liver insufficiency. Experimental research has to deal with organ preservation, immunoresponse, and the search for appropriate immunosuppressive agents. The authors developed standard animal models using the rat. Hypothermia required for organ preservation may damage the liver since individual metabolic pathways are unequally decelerated resulting in a disturbance of intermediary metabolism. Five hundred transplantation experiments were performed using orthotopic liver transplantation. The authors could demonstrate that the survival of transplanted livers is dependent on the individual antigen-combinations. They used cyclosporin A as an immunosuppressive agent that seems to be free of the adverse effects of conventional immunosuppressive agents (azothiaprin, cyclophosmamide, steroids). Rejections of allogenic transplants could be prevented by administration of cyclosporine A for 1 mo.--Thomas A. Angerpointner Choledochal Cyst With Bile Duct Dilatation: Sonography and Se'Tc IDA Cholescintigraphy. B. K. Ban, D. S. Babcock, and M. H. Gelfand. A JR 136:1075-1079, (June), 1981.
The authors present the sonographic and cholescintigraphic findings in 3 patients with choledochal cysts. In all 3 patients the choledochal cyst was easily seen at sonography as a cystic structure separate from the gallbladder with dilated common hepatic or common bile duct in communication with the cyst. In 2 patients scintigrams revealed filling of the cyst and delayed emptying. These 2 noninvasive tests should eliminate the need for more invasive studies such as retrograde cholangiography, transhepatic cholangiography, and arteriography in eliminating other entities in the differential diagnosis. These include hepatic cyst, pancreatic pseudocyst, enteric duplication, hepatic artery aneurysm, and spontaneous perforation of the extrahepatic bile duct.--Randall 14I. Powell Reoperation for "Failed" Hepatic Portoenterostomy. K. Suruga, T. Miyano, K. Kimura, et al. Jpn J Pediatr Surg
14:365-372, (March), 1982. Reoperation for "failed" hepatic portoenterostomy was carried out in 33 patients with biliary atresia. In 16 patients, bile flow was not observed after the initial hepatic portoenterostomy. Reoperative procedures for these 16 patients were exploration of the porta hepatis, dissection of the remnant of the extrahepatic bile duct, and hepatic portoenterostomy. These procedures were carried out under the control of magnifying glasses. Bile flow was observed in 10 of 16 patients and jaundice disappeared in 3 patients. All 3 patients who showed good excretion of bile and disappearance of jaundice, underwent reoperation within 4 me after birth. In
ABSTRACTS
the remaining 17 patients, bile flow was observed after the initial hepatic portoenterostomy, but stopped. Reoperative procedures for these 17 patients were exploration and curettage of the porta hepatis. Good excretion of bile was observed in 9 of 17 patients and jaundice disappeared in 4 patients,-H. Suzuki Torsion of the Gall Bladder. T. lwanaka, Y. Kohda, T. Beppu, et al. Jpn J Pediatr Surg 14:129-133, (January), 1982.
A case of torsion of the gall bladder seen in a 6-yr-old boy was reported. The patient presented with vomiting and abdominal pain. Diagnosis of torsion of the gall bladder was made by percutaneous cholecystography carried out under ultrasonography. Cholecystectomy was performed. The authors reviewed 8 cases of torsion of the gall bladder seen in pediatric age group from the Japanese literature.--H. Suzuki tntraportal Splenic Autotransplantation in Rats: Feasibility and Effectiveness. David D. Oakes, Judy P. Froehlich, and A. Crane Charters. J Surg Res 32:7-14, (January), 1982.
This paper presents the feasibility of intraportal splenic autotransplantation and its effectiveness in preventing postsplenectomy sepsis. Eleven of 16 rats (68%) survived intraportal splenic autotransplantation in which autogenous splenic tissue was injected into the portal vein after having been passed through a 5-~m screen. Histologically, splenic tissue could be demonstrated within terminal portal venules. Unfortunately, this was not effective in preventing experimental post-splenectomy sepsis. One hundred three rats were challenged with intravenous boluses of pneumococci 8-12 me following splenectomy. Mortality was 91% for the splenectomized animals, 88% for animals bearing autotransplants, and 59% for controls. The spleen's ability to protect against overwhelming infection seems to be dependent upon at least 2 factors: the volume of splenic tissue restored and the adequacy of its access to the circulation. This experiment and others demonstrate that salvage of the spleen or partial splenectomy is the only effective way of protecting against overwhelming infection~ Subcutaneous transplants, retroperitoneal transplants, omental transplants, and now intraportal splenic transplants all fail to give effective protection.Richard R. Ricketts Partial Splenectomy and Overwhelming Infection in Rats. Peter H. Bradshaw and Co~in G. Thomas, Jr. J Surg Res 32:173-175, (February), 1982.
Sprague-Dawley rats were divided randomly into 5 groups: sham splenectomy; 25%, 50%, or 75% splenectomy; or total splenectomy. The rats were then injected with pneumococci in varying doses and the LDso was calculated for each group. The presence of a regenerated partial spleen resulted in a LDs0 intermediate between that following a sham operation and that following a total splenectomy. The critical mass of splenic tissue required to protect the animal against overwhelming infection could not be determined from this study. However, this study and others seemed to indicate that at least 25% of the spleen is necessary for normal phagocytic function in experimental animals.--Richard R. Ricketts
performed in 400 patients at several centers all over the world since then, with an average 1-yr survival rate of 40%. The most important indication for liver transplantation in childhood is liver cirrhosis following biliary atresia. The donor problem is particularly serious since there are so few donors and since removal of the donor liver must be performed under stable circulatory conditions. The frequency of rejection reactions is ca.10%. Rejection reactions seem to be less violent in a transplanted liver than in other transplanted organs. Criteria for histocompatibility are based on the HLA-antigen-system. Transplantation should be performed as long as the patient is in balanced liver insufficiency. Experimental research has to deal with organ preservation, immunoresponse, and the search for appropriate immunosuppressive agents. The authors developed standard animal models using the rat. Hypothermia required for organ preservation may damage the liver since individual metabolic pathways are unequally decelerated resulting in a disturbance of intermediary metabolism. Five hundred transplantation experiments were performed using orthotopic liver transplantation. The authors could demonstrate that the survival of transplanted livers is dependent on the individual antigen-combinations. They used cyclosporin A as an immunosuppressive agent that seems to be free of the adverse effects of conventional immunosuppressive agents (azothiaprin, cyclophosmamide, steroids). Rejections of allogenic transplants could be prevented by administration of cyclosporine A for 1 mo.--Thomas A. Angerpointner Choledochal Cyst With Bile Duct Dilatation: Sonography and Se'Tc IDA Cholescintigraphy. B. K. Ban, D. S. Babcock, and M. H. Gelfand. A JR 136:1075-1079, (June), 1981.
The authors present the sonographic and cholescintigraphic findings in 3 patients with choledochal cysts. In all 3 patients the choledochal cyst was easily seen at sonography as a cystic structure separate from the gallbladder with dilated common hepatic or common bile duct in communication with the cyst. In 2 patients scintigrams revealed filling of the cyst and delayed emptying. These 2 noninvasive tests should eliminate the need for more invasive studies such as retrograde cholangiography, transhepatic cholangiography, and arteriography in eliminating other entities in the differential diagnosis. These include hepatic cyst, pancreatic pseudocyst, enteric duplication, hepatic artery aneurysm, and spontaneous perforation of the extrahepatic bile duct.--Randall 14I. Powell Reoperation for "Failed" Hepatic Portoenterostomy. K. Suruga, T. Miyano, K. Kimura, et al. Jpn J Pediatr Surg
14:365-372, (March), 1982. Reoperation for "failed" hepatic portoenterostomy was carried out in 33 patients with biliary atresia. In 16 patients, bile flow was not observed after the initial hepatic portoenterostomy. Reoperative procedures for these 16 patients were exploration of the porta hepatis, dissection of the remnant of the extrahepatic bile duct, and hepatic portoenterostomy. These procedures were carried out under the control of magnifying glasses. Bile flow was observed in 10 of 16 patients and jaundice disappeared in 3 patients. All 3 patients who showed good excretion of bile and disappearance of jaundice, underwent reoperation within 4 me after birth. In
ABSTRACTS
the remaining 17 patients, bile flow was observed after the initial hepatic portoenterostomy, but stopped. Reoperative procedures for these 17 patients were exploration and curettage of the porta hepatis. Good excretion of bile was observed in 9 of 17 patients and jaundice disappeared in 4 patients,-H. Suzuki Torsion of the Gall Bladder. T. lwanaka, Y. Kohda, T. Beppu, et al. Jpn J Pediatr Surg 14:129-133, (January), 1982.
A case of torsion of the gall bladder seen in a 6-yr-old boy was reported. The patient presented with vomiting and abdominal pain. Diagnosis of torsion of the gall bladder was made by percutaneous cholecystography carried out under ultrasonography. Cholecystectomy was performed. The authors reviewed 8 cases of torsion of the gall bladder seen in pediatric age group from the Japanese literature.--H. Suzuki tntraportal Splenic Autotransplantation in Rats: Feasibility and Effectiveness. David D. Oakes, Judy P. Froehlich, and A. Crane Charters. J Surg Res 32:7-14, (January), 1982.
This paper presents the feasibility of intraportal splenic autotransplantation and its effectiveness in preventing postsplenectomy sepsis. Eleven of 16 rats (68%) survived intraportal splenic autotransplantation in which autogenous splenic tissue was injected into the portal vein after having been passed through a 5-~m screen. Histologically, splenic tissue could be demonstrated within terminal portal venules. Unfortunately, this was not effective in preventing experimental post-splenectomy sepsis. One hundred three rats were challenged with intravenous boluses of pneumococci 8-12 me following splenectomy. Mortality was 91% for the splenectomized animals, 88% for animals bearing autotransplants, and 59% for controls. The spleen's ability to protect against overwhelming infection seems to be dependent upon at least 2 factors: the volume of splenic tissue restored and the adequacy of its access to the circulation. This experiment and others demonstrate that salvage of the spleen or partial splenectomy is the only effective way of protecting against overwhelming infection~ Subcutaneous transplants, retroperitoneal transplants, omental transplants, and now intraportal splenic transplants all fail to give effective protection.Richard R. Ricketts Partial Splenectomy and Overwhelming Infection in Rats. Peter H. Bradshaw and Co~in G. Thomas, Jr. J Surg Res 32:173-175, (February), 1982.
Sprague-Dawley rats were divided randomly into 5 groups: sham splenectomy; 25%, 50%, or 75% splenectomy; or total splenectomy. The rats were then injected with pneumococci in varying doses and the LDso was calculated for each group. The presence of a regenerated partial spleen resulted in a LDs0 intermediate between that following a sham operation and that following a total splenectomy. The critical mass of splenic tissue required to protect the animal against overwhelming infection could not be determined from this study. However, this study and others seemed to indicate that at least 25% of the spleen is necessary for normal phagocytic function in experimental animals.--Richard R. Ricketts