Domestic pig head and neck arteries from the viewpoint of imaging methods and experimental surgery

The aim of this paper is to summarize the current knowledge of the anatomy of domestic pig head and neck arteries for the needs of experimental surgery and imaging methods in biomedical research and translational medicine. The potential of this large animal model seems to be valuable also for the xenotransplantation of certain organs. Demands for the knowledge of morphological differences between analogous human structures and particular breeds are growing also in connection with the need for more precise planning of experiments or interpretation of the results. Deepening anatomical knowledge is allowed also by the development of imaging methods. The search was performed using the keywords "domestic pig" and "arteries of the head and neck" in the MEDLINE database, PubMed interface.

Benign liver angiomyolipoma: a case study.

INTRODUCTION: Hepatic angiomyolipoma is a rare mesenchymal tumor. It consists of vessels, fatty tissue and muscle tissue. These can appear in various ratios. While the kidney is the most common localization of angiomyolipoma, only about 300 cases have been described in the liver so far. It is a tumor of uncertain behavior. Most of the patients suffering from the lesion is asymptomatic. It is often preoperatively misdiagnosed using various imaging methods given its similarity to other hepatic tumors. CASE REPORT: Our 64 years old female patient was being examined for dull abdominal pains with no other symptoms. Her close relatives suffered from no malignancies. Imaging exams showed a liver lesion highly suspicious for hepatocellular carcinoma. However, the patient showed no elevation of typical oncomarkers. We performed left lateral sectionectomy. A grey solid focal lesion was found in the resected tissue. Histological and immunohistochemical evaluation determined the diagnosis of angiomyolipoma. The postoperative period was uncomplicated. The patient has been followed at an office for hepato-pancreato-biliary diseases, with no signs of recurrence until the present. CONCLUSION: Hepatic angiomyolipoma is a rare disease. The diagnostic process can be challenging as illustrated by the presented case. Even though the working diagnosis proved false, the chosen treatment was appropriate and delivered good results. Long-term postoperative follow-up is required.

Hepatic pseudolymphoma: a surprising finding in a case with suspected generalisation of lung cancer.

INTRODUCTION: Pseudolymphoma is a rare focal lesion which occurs in different locations. Only about 50 cases of liver pseudolymphoma have been reported so far. The diagnostic process is challenging. The lesion can resemble different malignancies using various imaging methods. No typical laboratory markers are available. The right diagnosis is usually made on the basis of histological examination. CASE REPORT: A 67 years old female patient with lung fibrosis was undergoing assessments for a malignant-appearing focal lesion of the left lung and a focal liver lesion of unknown etiology. Upper lobectomy of the left lung proved lung carcinoma. The liver lesion was suspected for being metastatic, therefore a liver resection followed. The biopsy revealed hepatic pseudolymphoma. It took 150 days from the first positive CT scan until the liver resection. Currently, the patient shows no signs of recurrence. CONCLUSION: Hepatic pseudolymphoma is a rare disease and we have only little experience with it so far. The diagnostic process is challenging, which is clear from the presented case. Only histological and immunohistochemical examinations ruled out a malignancy. A long-term observation of the patient is indicated.

Injuries of the small and large intestine.

INTRODUCTION: Patients with abdominal trauma appear frequently. The most vulnerable organs in these patients are the liver and the spleen. Injuries of the small and large intestines are relatively less frequent. The diagnostic process of these injuries is complex and requires an analysis of all results. Therefore it is highly probable that the final diagnosis can be delayed and so can be delayed an indication of surgical exploration of the abdominal cavity, which can have serious consequences on the morbidity and mortality of these patients with intestinal trauma. METHODS: We collected our data using the WinMedicalc 2000 software. We searched for patients hospitalised in years 20082017 in the Department of Surgery, Faculty of Medicine in Pilsen subjected to surgical revision of the abdominal cavity for intestinal trauma. RESULTS: Our set comprised 41 patients, including 30 men and 11 women. The mean age of the patients was 41 years, 4 of the patients were children. Twenty-three of the patients suffered from polytrauma, while 9 of the patients had a relatively isolated injury of either the small intestine or the colon. Six of the patients died. The small intestine was injured in 17 patients, the colon was injured in 14 patients and both were injured in 10 patients. The intestinal injury was diagnosed in 17 cases based on CT imaging (performed 31 times in total); 23 cases were diagnosed in the peroperative period. CONCLUSIONS: We assessed a set of patients with an intestinal injury in terms of specific diagnosis, severity of trauma, diagnostic process and treatment. The results are similar to the results of studies in large sets of patients. Even though imaging methods can help to reach the right diagnosis, they are insufficient as a sole diagnostic method, and physical examination plays a major role.

Radiofrequency ablation of colorectal liver metastases.

INTRODUCTION: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20-30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. METHODS: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs.

Growth of colorectal liver metastases is not accelerated by intraportal administration of stem cells after portal vein embolization.

INTRODUCTION: Future liver remnant volume (FLRV) is a crucial factor impacting resectability of colorectal liver metastases (CLM). In case of low FLRV, augmentation can be done by performing portal vein embolization (PVE). However, there is a risk of progression of CLM between PVE and resection. Intraportal application of autologous hematopoietic stem cells (HSC) is a possibility to accelerate the growth of FLRV. The effect of thus applied SC on CLM progression still remains unclear, though. METHODS: 63 patients underwent PVE between 2003 and 2015. In 20 patients a product with HSC was applied intraportally on the first day after PVE (PVE HSC group). HSC were gained from peripheral blood (10 patients) or bone marrow (10 patients). FLRV and volume of liver metastases (VLM) were evaluated by CT volumetry. The gained data were statistically evaluated in relation to the disease free interval (DFI), overall survival (OS), achievement of CLM resectability and progression of extrahepatic metastases. We compared the PVE HSC group with the group of patient undergoing simple PVE. RESULTS: No significant difference in FLRV and VLM growth was observed between the study groups. The percentage of exploratory laparotomies was smaller in the group with PVE and HSC application. Patients with simple PVE had a significantly higher incidence of extrahepatic metastases during follow up. We did not observe any significant differences in DFI and OS between the groups. CONCLUSION: HSC application did not accelerate CLM growth in comparison with PVE alone. PVE and HSC application had a higher percentage of patients undergoing liver resection and a lower incidence of extrahepatic metastases.

[Experimental processing of corrosion casts of large animal organs]. / Experimentální príprava korozivních preparátu orgánu velkého zvírete.

INTRODUCTION: Corrosion casts (CCs) are used for the visualization and assessment of hollow structures. CCs with filled capillaries enable (with the help of imaging methods) to obtain data for mathematical organ perfusion modelling. As the processing is more difficult in case of organs with greater volume of the vasculature, mainly organs from small animals have been cast up to now. The aim of this study was to optimize the protocol of corrosion casting of different organs of pig. Porcine organs are relatively easily accessible and frequently used in experimental medicine. METHOD: Organs from 10 healthy Prestice Black-Pied pigs (6 females, body weight 35-45 kg), were used in this study (liver, spleen, kidneys and small intestine). The organs were dissected, heparin was administered into the systemic circulation and then the vascular bed of the organs was flushed with heparinized saline either in situ (liver) or after their removal (spleen, kidney, small intestine). All handling was done under the water surface to prevent air embolization. The next step was an intraarterial (in case of the liver also intraportal) administration of Biodur E20® (Heidelberg, Germany) resin. After hardening of the resin the organ tissue was dissolved by 15% KOH and the specimen was rinsed with tap water. Voluminous casts were stored in 70% denatured alcohol, the smaller ones were lyophilized. The casts were assessed with a stereomicroscope, computed and microcomputed tomography (CT and microCT), a scanning electron microscope (SEM) and high-resolution digital microscope (HRDM). RESULTS: High-quality CCs of the porcine liver, kidneys, spleen and small intestine were created owing to the sophisticated organ harvesting, the suitable resin and casting procedure. Macroscopic clarity was improved thanks to the possibility of resin dying. Scanning by CT was performed and showed to be a suitable method for the liver cast examination. MicroCT, SEM and HRDM produced images of the most detailed structures of vascular bed. Despite the fact that SEM seems to be an irreplaceable method for CCs quality control, it seems that this modality could be partly replaced by HRDM. MicroCT enabled to obtain data about three-dimensional layout of the vascular bed and data for mathematical modelling of organ perfusion. With regard to the quality of the CCs, they could also be used to teach human anatomy. CONCLUSIONS: The protocol of the corrosion casting of the porcine liver, kidneys, spleen and small intestine CCs was optimized. Thanks to different imaging methods, the CCs can be used as a source of data on three-dimensional architecture of the vascular bed. These data can be used for mathematical modeling of organ perfusion which can be helpful for example for optimization of organ resections.Key words: corrosion casts microvasculature Biodur E20® domestic pig animal model.

[Experimental promotion of liver regeneration after portal vein branch ligation]. / Moznosti experimentálního ovlivnení regenerace jaterního parenchymu v souvislosti s ligací vetví portální zíly.

INTRODUCTION: Portal vein embolization or ligation (PVE/PVL) is part of most multi-stage liver procedures in the case of low future liver remnant volume (FLRV). PVE initiates compensatory hypertrophy of non-occluded liver parenchyma. This hypertrophy is stimulated by an increased volume of portal blood in the non-occluded veins. PVE results in adequate FLRV growth necessary for resection only in 63-96% patients. The aim of this publication is to summarize the possibilities of influencing liver regeneration after PVE/PVL in an experiment using cytokines (TNF-α, IL-6), a monoclonal antibody against TGF-ß1 (MAB TGF-ß1) and mesenchymal stem cells (MSC). METHODS: The experimental model of PVE/PVL was chosen as best compatible for potential use in human medicine. 9 (control group), 9 (TNF-α group), 8 (IL-6 group), 6 (MSC group) and 7 piglets (MAB TGF-ß1 group) were enrolled in individual studies. We performed laparotomy with PVL of the right-sided liver lobes under general anaesthesia. The following amounts of substances were applied in the non-occluded portal vein branches immediately after PVL: physiological solution (control group), recombinant porcine TNF-α (5 µg/kg), recombinant porcine IL-6 (0.5 µg/kg) and MSC (8.75, 14.0, 17.0, 17.5, 43.0 and 61.0 x 106 MSC). MAB TGF-ß1 was applied 24 hours after PVL (40 µg/kg). Biochemical parameters were analysed repeatedly and FLRV ultrasound assessments were performed in the postoperative period. The experiments were ended on postoperative day 14 by sacryfiing the animals under general anaesthesia. Liver samples of hypertrophic and atrophic liver parenchyma were analysed. RESULTS: Repeated ultrasound assessments of the effects of MSC, TNF-α, IL-6 and MAB TGF-ß1 compared with the physiological solution in the control group demonstrated statistically significant acceleration of FLRV growth in the experimental groups. For MSC, maximum growth was observed between postoperative days 3 and 7, on day 7 for TNF-α, between days 3 and 7 for MAB TGF-ß1 and on day 7 for IL-6. Serum levels of AST and ALT increased after PVL and MSC whereas other biochemical parameters showed no statistically significant differences. We identified individual MSC using immunohistochemistry in the hypertrophic tissue of the MSC group. A statistically significant difference was observed in the number of binucleated hepatocytes, with their increased concentration in the IL-6 group. CONCLUSION: Application of IL-6, TNF-α, MAB TGF-ß1 and MSC seems to provide suitable stimulation for achieving faster FLRV growth. Nevertheless, many controversial questions still remain to be answered with respect to the mechanism of their respective effects.Key words: liver regeneration portal vein embolization large animal experiment mesenchymal stem cells cytokines.

Porcine liver vascular bed in Biodur E20 corrosion casts.

BACKGROUND: Pigs are frequently used as animal models in experimental medicine. To identify processes of vascular development or regression, vascular elements must be recognised and quantified in a three-dimensional (3D) arrangement. Vascular corrosion casts enable the creation of 3D replicas of vascular trees. The aim of our study was to identify suitable casting media and optimise the protocol for porcine liver vascular corrosion casting. MATERIALS AND METHODS: Mercox II® (Ladd Research, Williston, Vermont, USA) and Biodur E20® Plus (Biodur Products, Heidelberg, Germany) were tested in 4 porcine livers. The resins (volume approximately 700 mL) were injected via the portal vein. Corrosion casts were examined by macro-computed tomography, micro-computed tomography and scanning electron microscopy. RESULTS: For hepatectomies, the operating protocol was optimised to avoid gas or blood clot embolisation. We present a protocol for porcine liver vascular bed casting based on corrosion specimens prepared using Biodur E20® epoxy resin. CONCLUSIONS: Only Biodur E20®Plus appeared to be suitable for high-volume vascular corrosion casting due to its optimal permeability, sufficient processing time and minimum fragility. Biodur E20® Plus is slightly elastic, radio-opaque and alcohol-resistant. These properties make this acrylic resin suitable for not only vascular research but also teaching purposes.

Alveolar echinococcosis - a rare disease with differential diagnostic problems.

INTRODUCTION: Alveolar echinococcosis is a life-threatening zoonotic parasitic disease. Its incidence is rare. In some cases, the correct and timely diagnosis can be difficult. CASE REPORT: The authors present the case of a young patient with liver, diaphragm and lung involvement. The suspicion of echinococcus infection was made on the basis of medical history, clinical symptoms, and a combination of ultrasonography, computed tomography, magnetic resonance imaging tests and serological methods. The patient underwent multimodal treatment with albendazole and en-bloc resection of the liver, lung and diaphragm. The definitive diagnosis of alveolar echinococcosis was determined from samples of the resected tissues using histopathology and polymerase chain reaction methods. The patient has been followed regularly and is on life-long treatment with albendazole. CONCLUSION: The precise diagnosis and multimodal therapy of alveolar echinococcosis is fundamental from the point of view of patient long-term survival. KEY WORDS: alveolar echinococcosis - diagnosis - multimodal treatment - follow-up.

[Comparison of percutaneous and open approach to radiofrequency ablation of colorectal liver metastases in Teaching Hospital Pilsen in 20012015]. / Porovnání perkutánní a otevrené radiofrekvencní ablace metastáz kolorektálního karcinomu ve FN Plzen v letech 20012015.

INTRODUCTION: Radiofrequency ablation (RFA) is a well-established method for palliative therapy of unresectable liver tumors. We use an open or percutaneous approach for the treatment of colorectal liver metastases (CLM). METHOD: Clinical data of patients undergoing percutaneous or open RFA for CLM between January 2001 and January 2015 were included in the retrospective study. We evaluated clinical factors for overall survival (OS), no evidence of disease (NED) and non-ablation in relation to tumor sizes and numbers, type of approach and type of used probes. RESULTS: 147 patients underwent RFA for CLM in this time period. Mean age was 65 years. 168 RFAs were performed in total. OS was influenced by a high number of censors. OS for the first and third years was 93.6% and 61% with no statistical differences between the percutaneous and open approach. NED was significantly shorter in patients with the percutaneous approach. NED was not influenced neither by size nor number of the lesions. A higher risk of non-ablation was observed as statistically significant in patients with percutaneous RFA. A higher, although not statistically significant, risk of non-ablation was also observed for larger metastases. Patients with percutaneous RFA showed a shorter stay in the hospital and fewer complications. CONCLUSION: RFA is an alternative approach to the treatment of unresectable CLM. In our study the open approach was associated with a lower risk of non-ablation. Percutaneous RFA showed a lower risk of complications and a shorter stay in the hospital. KEY WORDS: radiofrequency ablation percutaneous RFA colorectal liver metastases CLM palliative therapy.

[Chemoembolization with Drug Eluting Beads (TACE DEB) in patients with primary unresectable hepatocellular carcinoma (HCC)]. / Transarteriální chemoembolizace pomocí "drug eluting beads" (TACE DEB) u nemocných s radikálne neodstranitelným hepatocelulárním karcinomem (HCC).

INTRODUCTION: The incidence of HCC is growing all over the word. Liver resection and transplantation are the methods of choice in only 25% of patients, representing radical treatment approaches. TACE is a method of palliative treatment in patients with primary unresectable disease. MATERIAL AND METHODS: 35 patients (27 men and 8 women) of an average age of 73.4 ± 7.2 years with HCC of average cumulative diameter 83.8 ± 36.3 mm were treated by TACE DEB with Doxorubicin. Solitary and multiple lesions were presented in 28 and 7 patients, respectively. 31 patients were classified as Child A, and 4 as Child B. One year overall survival, disease-specific, disease-free interval and their correlation with patients age, gender, as well as the number and cumulative diameter of tumours and complications after procedure were evaluated. RESULTS: 30-day mortality and morbidity rate was 0 and 8.6%, respectively. The so-called postembolization syndrome developed in 25.7% of patients. Repeated TACE was performed in 14 (40%) patients due to tumour progression. In two patients (5.7%) we performed liver resection after TACE. According to the RECIST criteria there was no complete response, partial response was presented in 17.1, stable disease in 37.1 and progression of disease in 25.7% of patients. One year overall survival, tumour-specific survival and disease-free survival was 69.7%, 88.9 and 49.3%, respectively. Better overall survival (p < 0.02) was achieved in patients < 75 years old. Worse disease-free interval was observed in patients with complication after TACE (p < 0.01). No significant differences were found in the other evaluated parameters. CONCLUSION: TACE is the method of palliative treatment in patients with unresectable HCC. There is no progression of HCC in one-half of patients after TACE. Better results are achieved in younger patients and in patients with no complications of procedure.

Portal vein embolization and application of autologous stem cells in patients with primary unresectable liver tumours.

BACKGROUND: Only 15-20 % of patients with liver tumours can undergo radical surgery. Insufficient future liver remnant volume (FLRV) is one of the main causes of tumours unresectability. Portal vein embolization (PVE) together with administration of haematopoietic stem cells (HSC) may expand the operability of primary unresectable liver tumours. METHODS: In this pilot study, the authors reported on five patients (1 hepatocellular carcinoma, 4 colorectal cancer metastases) with FLRV <30 %, who underwent PVE on the side of the tumour with a subsequent application of HSC to the non-embolized branch of portal vein. RESULTS: PVE with HSC application was without any complications. In three patients, a sufficient increase of FLRV occurred within 2-4 weeks followed by a liver resection. All patients were between 5-12 months after the surgery in good condition; one of them was diagnosed with pulmonary metastasis after nine months that was successfully treated with laser metastasectomy. In one patient with hepatocellular carcinoma, an increase of FLRV and progression of the tumour in the liver occurred following the PVE with administration of HSC and the patient was treated only symptomatically. Despite an adequate increase of FLRV, severe intraabdominal adhesions hampered liver resection in one patient. CONCLUSIONS: Combination of PVE with HSC administration appeared to be a promising method that stimulated growth of FLRV with a subsequent possibility of an early radical liver resection. The issue is a danger of tumour progression in the liver parenchyma following the PVE with HSC. The current randomized study should answer these questions (Tab. 1, Fig. 4, Ref. 38).

Liver abscess in human toxocariasis.

BACKGROUND: Toxocariasis is a parasitic infection caused by Toxocara canis or Toxocara cati. It is distributed worldwide. Liver is the main organ affected by Toxocara infection, typically with multiple eosinophilic infiltrates. Liver abscess formation is a very rare condition. METHOD: The authors report on a case of Toxocariasis infection with abscess formation in the right liver lobe. The diagnosis was made upon patient's history, clinical examination, use of ultrasonography, computed tomography and especially upon positive serologic test and hypereosinophilia. After unsuccessful conservative treatment (Mebendazole, antibiotics and corticoids), right hepatectomy was performed. RESULTS: The postoperative course was complicated by biliary fistula in the resection area. The complication was successfully managed by temporary stent implantation to the left hepatic duct. Six months after the operation, the patient is with no complications. CONCLUSION: Liver abscess formation is a rare condition associated with Toxocara infection. It is still a matter of debate whether liver abscess results from severe parasitic infection or whether human toxocariasis is a predisposing cause of pyogenic liver abscess formation. Liver resection is the only treatment option when sepsis fails to respond to conservative treatment (Fig. 5, Ref. 22).

[Caroli disease--dilatation of intrahepatic bile ducts]. / Caroliho nemoc--dilatace intrahepatálních zlucových cest.

Caroli disease is a rare congenital condition characterized by a non-obstructive saccular or fusiform multi-focal segmental dilatation of the intrahepatic bile ducts and the frequent formation of the intrahepatic calculi. It can affect the entire liver with manifestations in the childhood, or only some segments, which may be an asymptomatic condition found accidentally in the adulthood. In other cases, the condition is manifested primarily with tract infections. The authors of the three case reports describe pitafalls of the diagnosis and treatment of the segmental Caroli disease, which is manifested in the adulthood. The treatment was a resection of the affected liver segments.

[Portal vein branch embolization in patients with primary inoperable liver tumors]. / Problematika embolizace vetve portální zíly u nemocných s primárne neoperabilními nádory jater.

INTRODUCTION: Portal vein embolization (PVE) is indicated in patients with insufficient liver remnants following liver resections for tumor disorders. Therefore, due to PVE, the number of primary operable patients is higher. Insufficient growth of the liver parenchyma or malignant progression remain the PVE cons. AIM OF THE STUDY: To date outcomes of PVE are assessed based on the authors' own experience and literature data. In particular, the authors focus on difficulties with PVE, i.e. its failures. METHODS: 40 patients (35 with colorectal carcinoma metastases, 2 with breast carcinoma metastases and one with ovarian carcinoma metastases, 2 with hepatocellular carcinoma) were indicated for PVE due to insufficient liver reserve following planned liver resection. RESULTS: Liver resections were completed in 22 subjects, 42.6 days (mean value) after PVE. In 14 (35%) subjects, the liver resection could not be performed (11x tumor progression, 3x insufficient liver tissue growth). In four subjects, only radiofrequency ablation was performed. At year one, two and three after the procedure, the survival rate is 83.7, 69.7 and 52.3% (resp.) of the subjects, while the survival rate following exploration and in unoperated subjects was 22.2% (25 subjects) (p < 0.001). A one-year, resp. two-year relapse--free survival rate was 30.3, resp. 7%. CONCLUSION: PVE has become an established procedure in stage liver procedures, due to its potential to facilitate operability of primary and secondary liver tumors. In order to improve the outcomes, attention must be paid to the post- PVE growth of the liver parenchyma and further assessment of oncological treatment approaches during the pre- and post- PVE period, with the aim to reduce liver and extra-liver malignant progression rates prior to the liver resection procedure.

Bony canal and grooves of the middle meningeal artery: mythic structures in anatomy and neurosurgery?

BACKGROUND: It has been previously published that the frontal branch of the middle meningeal artery (MMA) is usually embedded in a bony canal (BC). Although the incidence of the BC was over 70%, this structure is currently omitted both in anatomical nomenclature and in most of the literature. We found the same gap pertaining to the grooves for the MMA on the skull base. The aims of our study were to assess the incidence and morphometry of the MMA BC and grooves on the skull base. MATERIALS AND METHODS: Computed tomography (CT) scans of 378 patients, 172 skull bases as well as 120 sphenoidal bones and 168 temporal bones, and 12 histological specimens from 3 men and 3 women and 3 different regions of the MMA course were assessed. RESULTS: Based on CT scans, the incidence of the BC was 85.44% and was significantly higher in females than in males. Most of the canals and grooves were bilateral. The mean canal length was 17.67 mm, the mean transverse diameter 1.33 mm, and the mean distance from the superior orbital fissure (dFOS) was 26.7 mm. In the skull bases, the BC incidence was 70.07%, the mean canal length 10.74 mm, and the mean dFOS was 19.16 mm. The groove for the MMA on the temporal and sphenoidal bones was present in 99.42% and 95.35%, respectively. Histological specimens confirmed the presence of the MMA and accompanying vein/s. CONCLUSIONS: Based on our results, we suggest the addition of the BC and grooves for the middle meningeal vessels to the upcoming version of the Terminologia Anatomica.

Cytokines and liver regeneration after partial portal vein ligation in porcine experimental model.

THE AIM OF STUDY: The limits of liver surgery are restricted today by the functional reserves of remnant parenchyma. The aim of this article was to acquaint the general surgical and medical public with the results of experimental liver regeneration stimulated by cytokines and thus to enhance their effort to carry on with implementing the research results in clinical practice. METHODS: Authors present their experimental model of liver regeneration after ligation of portal branches for caudate and right lateral, and right medial liver lobes. The regeneration was induced by application of TNF-alpha and IL-6 into the non-occluded portal branches, and compared with the results of other experimental teams. RESULTS AND CONCLUSION: The absolute volume of hypertrophic lobes increases after application of TNF-alpha more rapidly, whereas in the control group, practically no changes were recorded in hypertrophic liver lobes volumes in first three days. The achieved acceleration of growth of hypertrophic liver lobes after application of TNF-alpha and IL-6 confirmed the key role of studied pleiotropic cytokines in the priming of liver parenchyma regeneration after portal vein ligation (Fig. 3, Ref. 26).

[Liver cystadenoma]. / Cystadenom jater.

THE INTRODUCTION: Biliary cystadenomas of the liver are less often complicated cystic lesions of the liver with a malignant potential. THE AIM: The aim of the work was to assess the results of the set of an own working place emphasising new findings in the diagnostics and the treatment of benign tumours of the liver. THE SET OF THE PATIENTS AND THE METHOD: From 2004 till 2009 three patients were operated on biliary cystadenomas of the liver at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzen. In all cases these patients were women with the average age 42 years of the age category 36-58 years. In all cases the formation was located centrally close to the branching of the big biliary ducts. The diagnosis was established preoperativelly in 66% of cases. An enucleation was performed two times and the right hepatectomy once. Mortality was 0% and morbidity was 33%. THE CONCLUSION: Regarding to the fact that cystadenomas of the liver as benign tumours have a malignant potential for rising the cystadenocarcinoma, it is always necessary to perform their surgical removing--resection or the enucleation. With respect to their central location their surgical treatment belongs to more difficult performances carried out on the liver parenchyma. Long-term results after the surgical treatment are very good.

[Treatment strategy in non-parasitic benign cysts of the liver]. / Strategie lécby neparazitárních benigních cyst jater.

The authors present the problems of treatment of benign non-parasitic cystic liver diseases. Recent diagnostic and treatment strategy is demonstrated at the cohort of 25 patients (16 women and 9 men), who were operated on Department of Surgery, Medical School and Teaching Hospital Pilsen, Charles University Prague between years 2002-2007. The average age was 59.9 years (38-86 years). We performed 15 laparoscopic fenestrations, 5 opened fenestrations, three enucleations of cysts and one left lobectomy and one central liver resection. The resections were performed because of diagnostic uncertainty to verify histological character of leasions at patients after previous operation of gastrointestinal tract for malignancy. Histological diagnosis was proved in 16 cases solitary liver cyst, in 7 cases of polycystic liver disease, one biliary cystadenoma and one retentive cyst. The reoperation of symptomatic solitary liver cyst was performed in one patient after 12 months from primary operation. The average follow-up of patients after surgical treatment was 41 months (5-96 months). Solitary liver cysts are indication to laparoscopic fenestration with biopsy in case of evidence of symptoms. Polycystic liver diseases are treated conservative and surgical treatment is indicated at outstanding and apparent symptomatology of this disease, where is possible to demonstrate preoperatively one or more dominant cysts.