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The aim of the study is to define age and gender regularities of the linear morphometric parameters of the liver in children and adolescents on the basis of intravital imaging findings.Material and methods. The authors analyzed computed tomograms of the abdominal cavity in 75 children without visible pathology. All patients were divided into 4 groups depending on their age: early childhood, first childhood, second childhood, adolescence. The transverse, anteroposterior and vertical dimensions of the right and left hepatic lobes were investigated on 16-slice computed tomographs. The obtained findings were processed using variational statistical analysis, the mean value (M), standard error (m) and the statistical significance were defined using the Student's t-test.Results. There was a significant increase in the anteroposterior size of the right hepatic lobe in separate sections at different age periods. A statistical significance between the parameters of the anteroposterior size of the right hepatic lobe was registered in girls and boys within the following groups: on one section in the 2nd group of patients, on two sections in the 4th group of patients. A statistical significance between the parameters of the transverse size of the right hepatic lobe was registered on one section (ThXII) in the 2nd and 3rd groups, and on two (ThXI and LI) and three (ThXI, ThXII and LI) sections in the 3rd and 4th groups of girls and boys, respectively. A statistical significance between the parameters of the transverse size of the right hepatic lobe in girls and boys were recorded only in the 4th group on three sections (ThXI, ThXII and LI). The vertical size of the right hepatic lobe was significantly higher in the 2nd and 4th groups, and the differences in the parameters between girls and boys were noted only among adolescents. A significant increase in the anteroposterior size of the left hepatic lobe was registered only in girls of the 2nd and 3rd groups on two sections (ThXII and LI); a significant increase in the transverse size was only registered at the LI level in these groups of patients. A significant increase in the vertical size of the left hepatic lobe was only detected in girls of the first childhood compared with girls of the early childhood. No statistical significance was registered for any of the linear parameters of the left hepatic lobe between girls and boys of the same groups.Conclusion. Thus, there was a significant increase in the anteroposterior and transverse dimensions of the right hepatic lobe in separate sections and an increase in the vertical size between individual groups of the studied patients, as well as a statistical significance between girls and boys of the same group. A significant increase in the anteroposterior and transverse dimensions of the left hepatic lobe was detected only in girls of the 2nd and 3rd groups if compared with the girls of the 1st group. No significant differences were registered between girls and boys of the same groups for any of the linear parameters of the left hepatic lobe.

The liver is a fascinating organ that possesses many unusual features, both anatomical and functional. It is the largest and heaviest of the solid glandular organs in the body with a rich blood supply which is derived from an unusual combination of two sources: one arterial, the other venous. In its functions the liver is immensely versatile. Indeed no other single organ in the body comes close to matching the liver for sheer range and intensity of metabolic, synthetic, haemopoietic and immunological activities. The normal liver has an impressive capacity for regeneration. In the past 60 years, and particularly in the last three decades, there has been a progressive and very considerable expansion in our knowledge and understanding of the vascular and functional anatomy of the liver. These advances in anatomical knowledge along with numerous technical and technological developments have had a great impact on the current state of hepatic surgery and are the principal factors underlying the sophistication and precision that define modern hepatic surgery. In this article, a description of the gross external and topographical anatomy of the liver is followed by an account of hepatic functional anatomy and hepatic blood supply.

Introduction: Hydatid disease is a parasitic disease caused by and is commonly met in clinical practice. The most common location for hydatic cysts is the liver, while the lung is the second organ in terms of localization frequency. Case report: We present the case of a 40-year-old patient with pulmonary hydatid cysts (two hydatid cysts located in the upper and lower pulmonary left lobes), and multiple hepatic hydatid cysts (ten cysts located in both hepatic lobes). Initially, the patient underwent thoracic surgery and was subjected to atypical lung resection of the upper and lower left pulmonary lobes. The patient underwent surgical treatment of the hepatic hydatid cysts 6 months after the thoracic surgery. The patient underwent multiple partial cystectomies, cholecystectomy, Kehr drainage with two hepatic hydatid cysts showing biliary fistulas. The postoperative evolution was favorable with patient discharge 10 days following surgery. Conclusions: Although the hepatic hydatid cyst is a seemingly benign disease, there are complex cases of disseminated echinococcosis in clinical practice that may require complex treatment. Surgical treatment remains the best therapeutic option in these cases. Thus, for these patients, a careful postoperative follow-up is required to detect recurrence of hydatid disease.

An outbreak of acute poisoning of horses by Enterolobium contortisiliquum pods is reported in the state of Goiás, Brazil. Three horses presented apathy, hyporexia, prostration, jaundice, recumbency and died in 24-48 hours. The main pathological findings were a yellowish liver with an enhanced lobular pattern, multifocal hepatic necrosis mostly in the midzones of lobules and sometimes with a random distribution across the hepatic lobes and swelling of hepatocytes. E. contortisiliquum trees has a wide distribution in South America and cases of poisoning have not been reported in horses.

To systematically test the reproducibility of DKI technique in normal liver and report a complete set of DKI measurement data. Thirty-two healthy volunteers were examined with liver DKI twice on the GE 3.0 T MRI scanner and reviewed by three professional experts. DKI-derived parameters fractional anisotropy of kurtosis (FAk), mean diffusivity (Md), axial diffusivity (Da), radial diffusivity (Dr), mean kurtosis (Mk), axial kurtosis (Ka), and radial kurtosis (Kr) in eight segments divided by Couinaud octagonal method were collected. Inter-class correlation coefficient (ICC) was used to assess the agreement between three experts. For each expert, the reproducibility of twice scans was evaluated by Bland–Altman method. Multivariate analysis of variance was to explore the regional distribution characteristics of DKI-derived parameters, and showed with box-plot graph. Using ICC analysis, except for FAk (ICC 0.312, 0.307), other DKI metric values showed high reproducibility (0.716

To reveal the intraorganic arterial anastomoses we studied arterial lobar architectonics and the topography of true hepatic interlobar borders. 23 samples of cadaveric liver were studied with the use of preparating technique, separate injecting colouring solutions, microfocus angiography, and transparenchymal sections. When the arterial bed of the liver was injected with colouring solutions or radiocontrast agents, in 21 cases the agents were visualized only within the injected lobe. In 2 observations, an extraorgan arterial anastomosis was detected between the branches of the hepatic artery in the gates of the liver. The investigation revealed that the anatomical and surgical concepts of the inter-lobar hepatic border do not coincide according to the arterial sign; macroscopically visible inter-lobar intraorganic arterial anastomoses are normally absent, which indicates the relative isolation of hepatic lobes.

Congenital liver anomalies are uncommon. Symptomatic accessory hepatic lobes (AHL), either in continuity with the liver or ectopically located, are even less common. AHL have been reported in individuals spanning from neonates to octogenarians and are typically asymptomatic, however when symptomatic often require surgical intervention. We report three new cases of AHL in children (mean = 14.6 years). All three presented with sudden onset of abdominal pain and were diagnosed preoperatively by imaging findings. All three patients had symptom resolution following resection of the torsed accessory liver lobes. We report here the largest series of pediatric AHL torsion at a single institution to date, review the classification schemes, identify diagnostic imaging findings, and summarize associated congenital disorders that should raise suspicion for accessory hepatic lobes.

No worldwide consensus on the assessment tool for liver functional reserve is currently available. The aim of this study was to evaluate the correlation between liver elasticity of both hepatic lobes and liver functional reserve tests. This prospective observational study comprised 40 patients scheduled for hepatectomy. Liver elasticity was assessed by Virtual Touch Quantification (VTQ). The mean VTQ value for the right and left lobes was defined as the mVTQ. Liver functional reserve was measured with technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin scintigraphy as LHL15 and HH15 and the indocyanine green (ICG) excretion test as ICG-R15 and ICG-K. All examinations were measured after biliary decompression confirmed serum a total bilirubin level

The caudate lobe of the liver is anatomically distinct from left and right hepatic lobes. Kumon first divided it into three parts: Spiegel lobe, paracaval portion and caudate process. The present study was conducted to note the extra hepatic branching pattern of PV and its distribution to various parts of caudate lobe and to note its variations. Eighty six cadaveric livers were studied. Number of branches from extra hepatic part of portal vein supplying different parts of caudate lobe, their origin from right branch (RPV) or left branch of portal vein (LPV) or from hilar bifurcation (HB) was noted. Their distribution to the parts of caudate lobe and diameter at origin was noted. At least one separate branch to caudate lobe from extra hepatic part of PV was present in 93.02% livers. 62.11% branches were originating from LPV, 26.09% from hilar bifurcation and 11.8% were from the RPV. Spiegel lobe received 98.64% from LPV and 1.35% from HB. Paracaval portion was supplied by 43.54% branches from LPV, 48.39% from HB and 8.06% from RPV. The caudate process received 56% branches from RPV and 44% from HB. Knowledge of vascular anatomy of caudate lobe is important for hepatic surgeons and for anatomists.

Purpose After radiopharmaceutical injection, a heightened 123I-MIBG concentration is frequently observed in the left hepatic lobe compared to the right one, but the reason of this finding remains unknown. Our aim was to retrospectively analyze the different 123I-MIBG uptake pattern between the two hepatic lobes and correlate our results with some epidemiological/clinical features. Methods Ninety-four 123I-MIBG scintigraphies from 71 patients were selected. Regions of interest were drawn in the right and left lobes using transverse tomographic sections and left to right activity ratios (L/R ratio) were calculated at 6 and 24 h after radiotracer administration. Results Twenty-seven examinations were positive for hypermetabolic lesions while the remaining 67 were negative. In all cases mean early and delayed L/R ratios were greater than 1.00; average early L/R ratio was 1.37 and delayed L/R ratio 1.52. The delayed L/R ratio was significantly higher than the early one. There was no difference in the L/R ratios with regard to age, gender, primary disease and result of scintigraphy. Conclusions 123I-MIBG uptake was higher in left hepatic lobe compared to right and this ratio did not correlate with any epidemiological or clinical feature. The reason of this metabolic is not yet explained and some biomolecular hypotheses could be tested in 3D dynamic in vitro models.

The liver is one of the main organs in the body, performing several metabolic and immunological functions that are indispensable to the organism. The liver is strategically positioned in the abdominal cavity between the intestine and the systemic circulation. Due to its location, the liver is continually exposed to nutritional insults, microbiota products from the intestinal tract, and to toxic substances. Hepatocytes are the major functional constituents of the hepatic lobes, and perform most of the liver's secretory and synthesizing functions, although another important cell population sustains the vitality of the organ: the hepatic immune cells. Liver immune cells play a fundamental role in host immune responses and exquisite mechanisms are necessary to govern the density and the location of the different hepatic leukocytes. Here we discuss the location of these pivotal cells within the different liver compartments, and how their frequency and tissular location can dictate the fate of liver immune responses.

Accessory liver lobes are a rare condition and appear to be due to excessive development of the liver. The presence of an accessory hepatic lobe is often diagnosed incidentally and sometimes revealed if it develops torsion, especially in pedunculated forms. In most cases, the accessory lobe is located below the liver, i.e., infrahepatic. Riedel's lobe is the best-known example of an accessory lobe, corresponding to hypertrophy of segments V and VI. While accessories lobes can simulate tumors, there have also been reports of hepatocellular tumor(s) that developed in these accessory lobes. Based on a review of the literature, this update focuses on accessory hepatic lobes.

The porcine liver is frequently used as a large animal model for verification of surgical techniques, as well as experimental therapies. Often, a histological evaluation is required that include measurements of the size, nuclearity or density of hepatocytes. Our aims were to assess the mean number‐weighted volume of hepatocytes, the numerical density of hepatocytes, and the fraction of binuclear hepatocytes (BnHEP) in the porcine liver, and compare the distribution of these parameters among hepatic lobes and macroscopic regions of interest (ROIs) with different positions related to the liver vasculature. Using disector and nucleator as design‐based stereological methods, the morphometry of hepatocytes was quantified in seven healthy piglets. The samples were obtained from all six hepatic lobes and three ROIs (peripheral, paracaval and paraportal) within each lobe. Histological sections (thickness 16 μm) of formalin‐fixed paraffin‐embedded material were stained with the periodic acid‐Schiff reaction to indicate the cell outlines and were assessed in a series of 3‐μm‐thick optical sections. The mean number‐weighted volume of mononuclear hepatocytes (MnHEP) in all samples was 3670 ± 805 μm(3) (mean ± SD). The mean number‐weighted volume of BnHEP was 7050 ± 2550 μm(3). The fraction of BnHEP was 4 ± 2%. The numerical density of all hepatocytes was 146 997 ± 15 738 cells mm(−3) of liver parenchyma. The porcine hepatic lobes contained hepatocytes of a comparable size, nuclearity and density. No significant differences were identified between the lobes. The peripheral ROIs of the hepatic lobes contained the largest MnHEP with the smallest numerical density. The distribution of a larger MnHEP was correlated with a larger volume of BnHEP and a smaller numerical density of all hepatocytes. Practical recommendations for designing studies that involve stereological evaluations of the size, nuclearity and density of hepatocytes in porcine liver are provided.

Liver abscesses are very rare complications of ulcerative colitis, with only nine cases described in the literature, to our knowledge. We report a case where a recurrence of liver abscess occurred in an ulcerative colitis patient, in two different hepatic lobes, which has not been previously described. The recurrence was in the caudate lobe having the cultures yielded Staphylococcus aureus . This is also the first case report of liver abscess in this location and caused by this microorganism in an ulcerative colitis patient. A review of the literature concerning liver abscesses involving ulcerative colitis patients is also provided.

Introduction To evaluate the uptake of the liver-specific magnetic resonance imaging (MRI) contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by functional liver parenchyma after radioembolisation (RE) of hepatic malignancies. Methods Uptake of Gd-EOB-DTPA prior to RE versus 60+/−24d and 126+/−32d after RE was compared in a group of 33 patients with primary or secondary hepatic malignancies. In patients who underwent single-lobe treatment, left and right lobes were compared 59+/−24 days after RE. Gd-EOB-DTPA uptake was determined as follows: ratio of mean signal intensity in liver parenchyma to muscle in Gd-EOB-DTPA-enhanced T1-weighted MRI was subtracted from ratio of mean intensity in liver parenchyma to muscle in unenhanced T1-weighted MRI. Results Gd-EOB-DTPA uptake in liver parenchyma was 0.845+/−0.29 before RE, 0.615+/−0.38 (P = 0.0022) at day 60+/−24, and 0.739+/−0.30 at day 126+/−32 after RE. In cases of single-lobe treatment, Gd-EOB-DTPA uptake was 0.581+/−0.256 for treated and 0.828+/−0.32 (P = 0.0164) for untreated hepatic lobes. Conclusions Uptake of Gd-EOB-DTPA by liver parenchyma is impaired after RE, indicating dysfunction of the local hepatic system. These findings suggest that Gd-EOB-DTPA-enhanced MRI has the potential to be used for monitoring liver damage after RE.

The ramification of the portal vein in the right hemiliver was studied by anatomic dissection in 36 formalin-fixed human livers. In 28/36 (77.8%) cases, the portal vein bifurcated into a right branch and a left branch and the right branch bifurcated into anterior and posterior segmental branches. The anterior segmental branch terminated in the anterosuperior subsegment (S8) in two types: bifurcated when it divided into anterior P8 and posterior P8 branches towards the respective regions of S8 (24/28 cases) and monopodal when it had a single pedicle (4/28 cases). The maximum anteroinferior subsegmental branch (P5 maximum) originated either from the anterior segmental branch (16/28 cases) or from the anterior P8 branch (12/28 cases). The posterior segmental branch vascularized the posteroinferior (S6) and the posterosuperior (S7) subsegments, and was terminated in three types: fan-shaped (16/28), bifurcated (9/28) and tripodal (3/28). In 4/36 (11.1%) cases the portal vein bifurcated into a right branch and a left branch but the posterior segmental branch was not present. In 4/36 (11.1%) the right branch of the portal vein was not present. These anatomical variations are explained separately and finally all cases are considered as a whole.

Bilateral Morgagni's hernia is rare in infants. We report a rare case of bilateral anterio-medial defect in the diaphragm in a 5-month-old infant presenting with recurrent respiratory tract infection. He had two adjacent accessory hepatic lobes which, presumably, had embryologically caused the defect. He also had secondary herniation of the transverse colon without any symptoms attributable to it. We describe the management of this condition and the concerned literature is reviewed.

Knowledge of the anomalies and anatomical variants of the liver is often of great importance because these may be misinterpreted as pathologic conditions. While congenital anomalies of the liver are rare, anatomic variants are relatively common. The congenital anomalies of the liver include agenesis or hypoplasia of the hepatic lobes or segments, Riedel’s lobe, and other accessory hepatic lobe. Anatomic variants contain accessory fissures and diaphragmatic slips, sliver of the liver, and variants related to papillary process of the caudate lobe.

The area and number of silver-nucleolar organizer regions (Ag-NORs) in the hepatic lobes were determined in 3 male Wistar rats. There was a statistically significant increase in the percentage of Ag-NORs per nucleus in the right lateral and caudate lobe in relation to the left lateral and middle lobes. The area and number of Ag-NORs are greater in the caudate and right lateral lobes in relation to the left lateral and middle lobes. Since the Ag-NOR is a parameter which indicates hepatocytic protein synthesis, the different activity which corresponds to each lobe of the rat's liver makes it possible to assume that there is a functional heterogeneity which should be considered in the study of the hepatic regeneration according to the type of partial hepatectomy carried out.

肝左葉および方形葉が増生細胆管に置き換わるという特異な像を呈した胆管癌症例(72歳,女)を経験した.左葉および方形葉の外形には著変なかったが,割面は灰白色・瘢痕様で,増生細胆管に置き換わっていた.癌は左肝管原発で左肝管を閉塞し,門脈左枝も癌の浸潤および内膜の線維性肥厚により閉塞していた.肝動脈は良く保たれていた.葉全体が細胆管増生によって置換されることは極めて稀である.その発生機序として,胆汁うっ滞による細胆管増生刺激,門脈血流減少による肝細胞の脱落,ならびに肝動脈血流の維持という3つの条件の複合が考えられた.

The authors report a 74-year-old man with chronic hepatitis C-related cirrhosis and end-stage renal disease undergoing maintenance haemodialysis who was diagnosed with hepatoma. The hepatoma spontaneously regressed with significantly decreased serum alpha-fetoprotein level without any treatment during the subsequent 4-year follow-up period. However, recurrent hepatomas over bilateral hepatic lobes were evident thereafter, and the patient died later due to hepatic failure. Hepatoma with ring calcification is extremely rare and considered poor differentiation with high risk for recurrence. Spontaneous regression of hepatoma is also rare, while spontaneous regression occurring in a hepatoma with ring calcification is never reported. The definite mechanisms causing spontaneous regression of hepatomas remain unclear, but an immune response toward hepatoma induced by alpha-fetoprotein might play an important role.

Partial hepatectomy in mice is a basic model for hepatic research work. Different complications, especially bleeding, bile leakage, and vena cava stenosis, have been observed with the classical technique, which features ligature en-bloc at the base of the hepatic lobes. In order to reduce complications and improve experimental outcome, a novel, rapid, and safe technique was developed, which was characterized by the ligation of the lobar portal triads before the lobes were resected. Compared with previous protocols, the new protocol was associated with much less complications and better survival rates, and can be easily and safely performed without microsurgical equipments and techniques.

Two closely related British Shorthair cats, which died after surgery performed in the dorsal position, were presented for dissection. In both, a thin, flaccid, enlarged transparent tendinous diaphragmatic portion protruded cranially into the thoracic cavity, forming a cupola in which left, right medial and quadrate hepatic lobes were encased in both cats and the stomach in one cat. Microscopically, no muscle fibres were observed in the membrane, but numerous hepatocytes and bile ducts were incorporated in its central part. The anomaly was diagnosed as a congenital diaphragmatic eventration.

Hepatic vessel trees are the key structures for hepatic disease diagnosis and liver surgery planning. They are especially useful in estimating the volumes of the left and right hepatic lobes, integral for maximizing the safety of the donor and the recipient during a Living Donors Liver Transplantation (LDLT). In this paper, we propose the following steps for the automated segmentation of hepatic vessel trees in contrast abdominal MDCT images: (1) canny edge detection for ascertaining the location of the hepatic vessel, (2) extraction of hepatic vessel candidates by threshold filtering around the detected edge, (3) addition of true negatives, defined as hepatic vessel pixels - except for the extracted vessels, as the brightness of these pixels is less than the threshold, according to the pre and post section connections, and (4) removal of false positives, defined as small connected regions smaller than 9 voxels without connections to pre or post sections. The proposed method correctly segments the hepatic vessel regions.

In order to support the diagnosis of hepatic diseases, understanding the anatomical structures of hepatic lobes and hepatic vessels is necessary. Although viewing and understanding the hepatic vessels in contrast media-enhanced CT images is easy, the observation of the hepatic vessels in non-contrast X-ray CT images that are widely used for the screening purpose is difficult. We are developing a computer-aided diagnosis (CAD) system to support the liver diagnosis based on non-contrast X-ray CT images. This paper proposes a new approach to segment the middle hepatic vein (MHV), a key structure (landmark) for separating the liver region into left and right lobes. Extraction and classification of hepatic vessels are difficult in non-contrast X-ray CT images because the contrast between hepatic vessels and other liver tissues is low. Our approach uses an atlas-driven method by the following three stages. (1) Construction of liver atlases of left and right hepatic lobes using a learning datasets. (2) Fully-automated enhancement and extraction of hepatic vessels in liver regions. (3) Extraction of MHV based on the results of (1) and (2). The proposed approach was applied to 22 normal liver cases of non-contrast X-ray CT images. The preliminary results show that the proposed approach achieves the success in 14 cases for MHV extraction.

犬を用いて,肝の70%領域の胆管分枝を結紮し,結紮葉および非結紮葉の機能的ならびに形態的変化を検討し,さらに,これらに胆道再建を行うとともに,非結紮葉の門脈枝結紮や肝切除を行って,結紮葉の肝再生能やその限界を検討した.胆管結紮葉は12週以降に萎縮が著明となり,総織学的には,胆管結紮後4～6週で軽度の胆汁うっ滞を示し,8～12週では小葉改築傾向がみられたが,肝線維症の所見に留まっていた.これらに胆道再建と共に対側の肝切除を併施すると,胆管結紮後6週以内では手術に耐え,肝再生は良好であった.胆管結紮後8～12週目では対側肝切除に耐えなかったが,対側の門脈枝結紮には耐えて,胆管再建側肝葉は良好な再生を示した.すなわち,胆管結紮葉は,胆管結紮後6週以内であれば良好な肝再生能を有しており,12週目でも門脈血流を増加させることによって,良好な肝再生が得られた.

右季肋部痛を主訴に来院した39歳の女性に対し,肝両葉にわたる多発性かつ不整形の巨大海綿状血管腫と診断し,グリソン鞘処理により肝左葉・尾状葉・右葉後区域を系統的に切除した.切除後は,肝右葉前区域実質のみが前区域グリソンと中肝静脈に把持される状態となった.切除肝は,大きさ20×15×5cm重量720gで,組織所見では,典型的な海綿状血管腫であった.残肝の再生および術後経過は良好であった.肝海綿状血管腫は良性疾患であるが,稀に本例の様に進行性に血管腫が発育したと思われる症例が認められており,それに付随して自然破裂,Kasabach-Merritt症候群の合併などの問題もある.ゆえに我々は,本症には発見時から定期的な経過観察の必要性があり,特に自覚症状の発現,および血管腫の増大傾向を認めた場合には,悪怪疾患と同様に早期に積極的に外科的治療を行わなければならないものと考える.

The prognostic value of peritoneoscopy was examined in 372 patients with liver cirrhosis according to the degree of development and size of regenerating nodules, the development of reddish markings, the development of small lymphatic vesicles, the presence or absence of patchy markings, the size of the right and left hepatic lobes, and the degree of splenomegaly. The cumulative survival rate was compared with these peritoneoscopic parameters. The usefulness of peritoneoscopic and histological findings in the prognosis of liver cirrhosis was evaluated using the proportional hazard model of Cox. Significant differences were observed in the cumulative survival rate with respect to the degree of development of regenerating nodules, the size of the right hepatic lobe, the formation of small lymphatic vesicles, and the degree of splenomegaly. Analysis using Cox's proportional hazard model indicated that peritoneoscopic findings are of greater clinical use than histological findings in determining the prognosis of liver cirrhosis.

OBJECTIVE. The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis.CONCLUSION. CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with recurrent pyogenic cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein.

The asialoglycoprotein receptor (ASGPR) is abundantly expressed on the sinusoidal surfaces of hepatocytes. However, regional expression and clinical significance of the ASGPR in acute hepatic damage is presently unknown. Our aim was to clarify the clinical significance of the regional expression of ASGPR in human livers with acute hepatitis (AH) and fulminant hepatic failure (FHF). Eighteen volunteers, 42 patients with AH and 10 with FHF were studied using a newly developed, conventional 99mTc-GSA SPECT analysis. Using Cantlie's line as a guide, ASGPR expression was analyzed separately in the right and left hepatic lobes, as well as in the whole liver, using novel indices (the liver uptake ratio [LUR] and liver uptake density [LUD], which reflect the amount and density of ASGPRs in the liver, respectively). Mean LUR and LUD values for the whole liver and the right and left lobes decreased in accordance with the severity of acute hepatic damage. In the FHF group, the reduction in LUR and LUD values in the right lobes was more significant than in the left lobes. The LUR and LUD values for the whole liver correlated well with hepatic functional reserve and total bilirubin levels. The right LUR and LUD values in particular correlated well with these parameters. A time-course observation of 13 patients with either AH or FHF revealed that the expression of ASGPRs in the right lobe recovered faster than in the left. We first evaluated the regional expression of AGSPRs by 99mTc-GSA SPECT analysis in both AH and FHF patients, which is a clinically useful and reliable indicator for assessing the severity of regional hepatic damage and evaluating regional liver regeneration.

Four patients with anomalous lobes of the liver were observed at MR imaging. In one patient the anterior segment of the right hepatic lobe was absent and in 3 patients the left hepatic lobe was anomalous. The hepatic vasculature supporting the information of the anomalous hepatic lobes was well observed in all patients.

Diffuse hepatic hemangiomatosis without extrahepatic lesions is extremely rare in adults. A case of diffuse hepatic hemangiomatosis involving right lobe in a 50-year-old woman was presented. The hemangiomatosis was demonstrated by ultrasonography, computerized tomography (CT) and magnetic resonance image (MRI), and was confirmed histopathologically. Although diffuse hepatic hemangiomatosis is a rare disease in adults, its diagnosis should be considered in patients with diffuse tumor growth in one or both hepatic lobes and distinguished from malignant tumors. The present case is the first documented case of diffuse hepatic hemangiomatosis in an adult in Korea.

To compare the fundamental structure of the human liver, in relation to that of the rat a comparative study was performed, in which 20 rat livers and 78 human cadaver livers were examined. The rat livers had four lobes (left, middle, right, and caudate). The left and middle lobes formed a single lobe but the middle lobe had a deep notch to which the round ligament attached. The right lobe was split into two sub-lobes and the caudate lobe was divided into the paracaval portion and the Spiegel lobe, which was split into two sub-lobes. The left, right, and caudate lobes had one primary portal branch, whereas the middle lobe had two portal branches. The left and the right sub- and caudate lobes had one large hepatic vein each, whereas three large hepatic veins were observed in the middle lobe. Based on the ramifying patterns of the portal and hepatic veins, the rat middle lobe possessed left and right hepatic components and a main portal fissure. The following rat hepatic lobes were equivalent to the following human liver segments: the left lobe to segment II; the middle lobe to segments III, IV, V, and VIII; and the right lobe to segments VI and VII. The fundamental structures of rat and human livers were similar, and the findings demonstrated a new interpretation of the anatomy of the human liver.

Hepatic arteries of twelve mongrel dogs, different sex and ages, were studied. Takilon were injected to the hepatic artery in twelve dogs and corrosion were taken. Blood supply and anastomose were investigated in those animals. The hepatic artery varieties were determined in twelve animals. In seven dogs {% 58.33) the anastomose were observed between hepatic lobes., Çeştli yaş ve cinsiyette, sokak köpeği karaciğerinin arterleri üzerinde çalışıldı. On iki köpek piyesinde arteria hepatica'ya Takilon enjekte edilerek kastları Çıkarıldı. Kastlar damarlaşma ve daha önce hiç çalışılmamış anastomoz yönünden incelendi. Oniki piyeste oniki farklı damarlaşma tesbit edildi. Bu sonuçla arteria hepatica'nm oldukça fazla varyasyon gösterdiği gözlendi. Toplam piyeslerin yedisinde (%. 58.33) karaciğerin loblart arasında anastomoz belirlendi.

Os autores esquematizam as vias biliferas de 2 espécies de tatus (Dasypus novemcinctus e Euphractus sexcinctus) oriundos do Pantanal Matogrossense, Brasil. A dissecação foi efetuada após o preenchimento do sistema excretor do fígado com látex Neoprene 650 corado e da fixação das peças em solução aquosa de formol a 10%. O ductus choledocus, em ambas as espécies, provém da reunião do ductus cysticus com o ductus hepaticus. Este, por sua vez, resulta da convergência do ramus principalis dexter e do ramus principalis sinister. Na formação dos ramus principalis dexter e sinister participam vários ramos oriundos dos lobos hepáticos e seus processos. The biliary tree of armadillos (Dasypus novemcinctus e Euphractus sexcinctus), from the Pantanal Matogrossense, Brazil, was studied after latex injection, formaldehyde fixation and dissection. The ductus choledocus, in both species, results from the junction of the ductus hepaticus and the ductus cysticus. The ductus hepaticus is made up by the convergence of the ramus principalis dexter and the ramus principalis sinister, in turn formed by branches of hepatic lobes.

Carbonized polyethylene microspheres of 3.53 micron diameter were injected intravenously into splenectomized, laparotomized, and untreated rats. The number of Kupffer cells which phagocytosed microspheres and the number of microspheres phagocytosed by single Kupffer cells were counted. The number of Kupffer cells which phagocytosed microspheres was 1.51 times greater in splenectomized rats than in untreated rats, and 1.29 times greater in splenectomized rats than in laparotomized rats, both values being statistically significant. Although this same value was 1.18 times greater in laparotomized rats than in untreated rats, this was not statistically significant. The number of microspheres phagocytosed by single Kupffer cells also increased significantly in splenectomized rats. The intra-acinar distribution of the phagocytosing Kupffer cells showed the number in the periportal area to be 8-9 times greater than in the central area in all 3 groups. No significant difference in this intra-acinar distribution was observed between the groups. In addition, there was no difference in the phagocytic activity of Kupffer cells and the distribution of phagocytosing Kupffer cells between the hepatic lobes.

Computed tomography and angiography following transcatheter arterial embolization (TAE) was performed for 29 patients with hepatomas. In three cases crescent-shaped isodense regions were observed posterior to the necrotic tumor after TAE. They were located in the superior posterior segments of the right hepatic lobes and were consistent with residual tumor supplied by the right inferior phrenic artery. Recognition of this CT finding after TAE is important for evaluating the extent of embolization of the tumor.

We undertook a study to evaluate the correlation between morphometric evaluation and colorimetric determination of hepatic collagen content, and to analyze the variation among animals as well as among lobes of the same liver in hepatic collagen content after CCl4-induced micronodular cirrhosis. The results revealed a significant correlation (r = 0.9458; p less than 0.001) between the morphometric and colorimetric methods of collagen evaluation of liver specimens; both methods also significantly distinguished data obtained from controls and from cirrhotic rats (p less than 0.0005). After induction of micronodular cirrhosis by chronic CCl4 administration, a highly significant variation in hepatic collagen content was observed among animals (p less than 0.0001). By contrast, no significant difference in collagen content was observed (p less than 0.05) among hepatic lobes of a given animal. These results indicate that in this animal model of liver cirrhosis, interpretation of biochemical data would benefit by being related to the severity of the hepatic collagen infiltration of each animal. Our data also show that representative values for total hepatic collagen infiltration can be obtained from a single liver specimen; we suggest, however, that the specimen be taken from a major lobe of the liver and that a sufficiently large number of animals be used to avoid occasional sampling errors.

Experience with unilateral hepatic duct obstruction is limited. We reviewed 33 cases of unilateral hepatic duct obstruction from a total of 500 patients with biliary reconstruction treated between 1965 and 1984. The median age of the patients reviewed was 56 years. The most common cause of unilateral hepatic duct obstruction was operative injury (73 percent of patients). Including operations for unilateral obstruction, patients in the series underwent 131 operations related to biliary tract problems. The most common presentation (73 percent of patients) was fever and pain. Obstruction was more common in the right duct than in the left duct by a ratio of 2:1 (22 patients versus 11 patients). The three types of surgical procedures used were hepaticojejunostomy (17 patients), dilatation and drainage (13 patients), and primary hepatic resection (3 patients). Atrophic hepatic lobes resulting in rotational deformity of the portal structures were resected in six patients with combined hepatic duct and arterial injury. No operative deaths occurred, although 51.5 percent of the patients had postoperative complications. Follow-up studies ranging from 1 to 16 years demonstrated that patients who had hepaticojejunostomy required less frequent reoperation compared with those who had dilatation (36 percent versus 64 percent) and had a lower postoperative mortality rate related to biliary tract problems (7 percent versus 18 percent). We conclude that unilateral hepatic duct obstruction continues to occur most commonly because of operative injury and is best treated by hepaticojejunostomy or by resection of chronically obstructed lobes when possible.

A case of intrahepatic bile duct carcinoma is presented to illustrate the clinical features that suggest the possible usefulness of an aggressive surgical attack on this uncommon and highly lethal lesion. Utilizing percutaneous cholangiography and intrahepatic palpation and inspection by dividing the left and right hepatic lobes, a rational surgical approach to this disease is possible. Wide incontinuity resection of such operable lesions, including the left hepatic lobe, distal right hepatic duct, gallbladder, and proximal common bile duct, is possible and may be successful.

Solitary nonparasitic hepatic cysts are rare. Geist 4 collected 193 cases from the world literature up to 1954. Subsequently, 36 additional articles have appeared, making the total well over 200 cases. Others 1-3,5-9 have presented extensive reviews of the pathogenesis, diagnosis, and natural history, as well as treatment utilized in various forms of hepatic cystic disease. The present case of a solitary multilocular cyst is worthy of report, because the main cavity involved the whole of the left hepatic lobe, as well as the entire superior surface of the right lobe. The extent of involvement presented a difficult therapeutic problem at the time of surgery. In contrast to polycystic disease of the liver, which is commonly associated with cystic changes in other organs and frequently terminates fatally at an early age, solitary cysts often produce little or no disability. Characteristically, symptoms first appear in the fourth or fifth decade, with