Initial institutional experience of uncooled single-antenna microwave ablation for large hepatocellular carcinoma.

AIM: To evaluate the safety, efficacy, and feasibility of a novel microwave generator, designed to deliver automatically adjusted energy by tissue permittivity feedback control into the tumour via an uncooled antenna, in patients with larger hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fourteen patients with HCC >5 cm in diameter received surgical or percutaneous microwave ablation with more than 12 months of follow-up. Microwave ablation was performed using a 902-928 MHz generator at 28 W; a single 14 G antenna without water-cooled system was used. The patients were followed up with contrast-enhanced CT and serum alpha-foetoprotein to monitor for tumour recurrence at 1 month and then every 3 months after tumour ablation. RESULTS: The follow-up duration for the 11 male and three female patients (mean tumour size 5.77 cm, range 5-7 cm; mean age 63.8 years) was 15.8 months. The mean ablation time was 2025 s (range 900-3600 s), and the mean ablation session was 2.5 (range 1-4). The complete ablation rate was 85% (17 of 20). Local recurrence rate was 5.8% (1 of 17). All patients survived and the morbidity and mortality rate was 21.4% and 0%, respectively. CONCLUSIONS: Microwave tissue ablation using this novel system with tissue permittivity feedback control and a single uncooled antenna has a high complete ablation rate and lower morbidity. It proved to be a fast, easy, and effective option for ablation of large (>5 cm) tumours.

Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus.

BACKGROUND: The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus. METHODS: Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic decompression was successful, complete bowel preparation was performed, followed by elective laparoscopically assisted sigmoidectomy. The details of the laparoscopic procedures are shown in the video. Briefly, the redundant sigmoid colon is totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it is exteriorized, transected, and reconstructed by end-to-end anastomosis. In the authors' experience, the medial-to-lateral approach is highly efficient for the laparoscopic mobilization of the redundant sigmoid colon. We believe that the longer the lateral abdominal wall attachment of the sigmoid colon is preserved, the better the exposure and the easier the dissection. If the risk of anastomotic leakage is considered high in a specific case, protective ileostomy is selectively preformed. Before entering the current study, the patients were well informed about the advantages and disadvantages of laparoscopic surgery. The enrollment of patients was selective according to the appropriate eligibility criteria. This study was approved by the Institutional Review Board of the National Taiwan University Hospital. The patients' clinicopathologic data and surgical outcomes were prospectively evaluated. RESULTS: Between August 2001 and April, 2005, a total of 14 patients (10 men and 4 women) with sigmoid volvulus were treated with the described procedure. The age distribution of the patients was 68.4 +/- 12.2 years. The attack of sigmoid volvulus was the first episode for eight patients, the second episode for 4 patients, and the third episode (or more) for two patients. The body mass index (BMI) of the patients was 26.8 +/- 4.4 kg/m(2). The physical status (classification of American Society of Anesthesiology [ASA]) was 1 for five patients, 2 for eight patients, and 3 for 1 patient. During the laparoscopy, all the patients presented with the pathognomonic findings of sigmoid volvulus including redundant sigmoid colon, narrow sigmoid mesenteric pedicle, and mesosigmoiditis with mesenteric fibrosis and scarring, as shown in the video. The length of the resected colon was 32 +/- 6 cm. The operation time was 194.6 +/- 32.4 min, and the blood loss was 44.0 +/- 12.4 ml. The abdominal wound consisted of four 5 to 12 mm working ports and a 5 cm major wound for exteriorization of the sigmoid colon. Some surgeons have shown that a sigmoid volvulus can be resected through a 5-cm left lower quadrant incision with very little mobilization of the colon because of its redundancy. In this context, the laparoscopic approach competed with the minilaparotomy method in terms of adequate sigmoid resection, lysis of mesosigmoid adhesion, and tension-free colorectal anastomosis. Protective ileostomy was performed for the only patient with a physical status of ASA 3. There was no mortality in this case series. However, pneumonia developed postoperatively in one patient, acute myocardial infarction in one patient, and wound infection in two patients. Excluding the two patients who experienced postoperative pneumonia and acute myocardial infarction, the duration of the postoperative ileus was 48 +/- 12 h, the postoperative hospitalization was 7 +/- 1 days, and the degree of postoperative pain was 3.5 +/- 0.5 according to the visual analog scale. The return to partial activity required 18 +/- 2.5 days, and the return to full activity required 28.4 +/- 5.6 days. As compared with the overall costs for a conventional sigmoid colectomy, which are completely covered by the National Bureau of Health Insurance of Taiwan, the expenses for the patients undergoing laparoscopic procedures were significantly higher by approximately 24,000.0 NT dollars +/- 2,635.0 (1 U.S. dollar = 32 NT dollars). These higher expenses must be borne by the patients themselves. CONCLUSION: Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence.

Multimedia article. Laparoscopic abdominoperineal resection for lower rectal cancers: how do we do it?

BACKGROUND: The appropriateness of the laparoscopic approach for the resection of rectal cancer has been controversial, although it is well established in colon cancer. This is a phase II study of laparoscopic abdominoperineal resection (APR) in the treatment of lower rectal cancers. METHODS: Patients with lower rectal adenocarcinoma located within 6 cm above the anal verge were recruited and subjected to laparoscopic APR. The surgical principle included en bloc resection with high ligation of inferior mesenteric vessels by no-touch isolation and total mesorectal excision. Details of the surgical procedures are presented in the video. The technical efficiency and outcome of this surgical approach were evaluated prospectively. This study was approved by the institutional review board of National Taiwan University Hospital (NTUH). RESULTS: A total of 22 patients were enrolled in the study from January 2003 to December 2004 under the ethical guidelines of clinical trials in NTUH. There were 12 females and 10 males, with an age distribution of 62.5 +/- 10.4 years. The body mass index was 24.8 +/- 4.0 kg/m2. Physical status (American Society of Anesthesiology classification) was class I in 12, class II in eight, and class III in two patients. Tumor size was 44.0 +/- 12.0 mm in diameter. Two patients were in pathologic TNM stage I, 14 in stage II, and six in stage III. The operation time was 214.0 +/- 28.4 min. Blood loss was 54.0 +/- 14.0 ml. Because the tumor specimen was retrieved from a perineal wound, the five 5 to 12 mm working ports constituted the abdominal wound. There were no major complications. However, wound infection of port sites was detected in one patient. The patients had a quick convalescence, as evaluated by the length of postoperative ileus (48.0 +/- 12.0 h), length of hospitalization (8.0 +/- 2.0 days), and degree of postoperative pain (3.5 +/- 0.5 visual analogue scale). Return to partial activity, full activity, and work was 2.0 +/- 0.5, 4.0 +/- 0.8, and 6.0 +/- 0.5 weeks, respectively. The number of cleared lymph nodes was 14.0 +/- 2.0. During follow-up (median, 18 months; range, 6-30), lung metastasis and local pelvic recurrence developed in one and two patients, respectively. Besides the expenses covered by the National Bureau of Health Insurance of Taiwan, the additional payment by patients undergoing laparoscopic procedures was NTD 24,000 +/- 3000 (1 U.S. dollar = 32 NTD). CONCLUSIONS: In our clinical setting, laparoscopic APR can be performed with good technical efficiency, quick functional recovery, and mild disability. The short-term oncologic results of laparoscopic APR seem to be acceptable, but further long-term follow-up for these patients is mandatory to define the oncologic outcomes of this approach.

Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) program: A new standard of care for injured workers in Hong Kong.

BACKGROUND: The objective of this study is to evaluate the effects of the Multi-disciplinary Orthopaedics Rehabilitation Empowerment (MORE) Program on reducing chronic disability among injured workers and improving efficiency of work rehabilitation process. METHODS: A cohort of patients with workplace injuries in the lower back were recruited from orthopaedics clinics and assigned to either MORE group (n= 139) or control group (n= 106). Patients in MORE group received an early MRI screening and a coordinated multi-disciplinary management, while patients in the control group received conventional care. Outcome variables are time to return-to-work (RTW) from date of injury, waiting time for MRI screening and time to medical assessment board (MAB). RESULTS: Patients in the MORE Program had significantly shorter duration for RTW (MORE: 6.1 months, CONTROL: 12.8 months, p< 0.01), and more RTW cases (n= 64, 46.0%) compared to CONTROL group (n= 29, 27.4%). The MORE group also had much shorter waiting time for MRI scans (91.85 vs. 309.2 days, p< 0.001) and MAB referral after MRI scans (97.2 vs. 178.9 days, p= 0.001) compared to CONTROL group. CONCLUSIONS: The MORE Program which emphasizes early intervention and early MRI screening, is shown to be effective in shortening sick leave and improving RTW outcomes of injured workers.

Viral etiology of intussusception in Taiwanese childhood.

BACKGROUND: Adenovirus infection and lymphoid hyperplasia have been associated with childhood intussusception. However, the extent of other viruses involved in this condition remains unclear. This prospective study investigates the relationship between some lymphotropic viruses and current childhood intussusception. METHODS: Patients with intussusception encountered in a pediatric emergency department in a recent 3-year period were studied. Healthy infants and toddlers of comparable age served as controls. Throat and rectal viral cultures were performed in patients and controls. Viral antibodies against adenovirus, cytomegalovirus, human herpesvirus (HHV)-6, HHV-7 and Epstein-Barr virus (EBV) were tested in paired sera from the patients. Acute stage serum from each patient and mesenteric lymph nodes from patients requiring surgery were studied for the presence of adenovirus genome by PCR. RESULTS: Twenty-seven of 61 (44.3%) intussusception patients, but only 2 of 52 (3.8%) healthy controls shed nonenteric adenovirus in throat and rectal specimens (P < 0.001). Of the 27 (74.1%) patients who shed adenovirus, 20 were older than 1 year old, whereas only 1 of 15 (6.7%) similarly aged patients in a previous study from the same area three decades ago did so (P = 0.001). Among 43 patients with available paired sera, acute primary viral infection was found in 17 (39.5%) by adenovirus, 4 (9.3%) by HHV-6, 5 (11.6%) by HHV-7, 2 (4.7%) by EBV and none by cytomegalovirus. Multiple viral infections occurred in 6 patients. Adenovirus genome was detected in 4 of 9 mesenteric lymph nodes and in only 3 of 60 (5%) acute phase sera. CONCLUSIONS: Primary nonenteric adenovirus infection contributes to current childhood intussusception. Acute primary HHV-6, HHV-7 and EBV infections also play etiologic roles.

Changes in T-lymphocyte subpopulations and serum lymphokine concentrations after partial hepatectomy in rats.

The relationship between liver regeneration and immunological response does exist. Extrathymic T cells and serum lymphokines are believed to be changed after partial hepatectomy, but there is still much controversy. This study evaluates the changes of peripheral blood T-lymphocyte subpopulations, natural killer (NK) cells, serum lymphokines, and NK cells in the remnant liver after partial hepatectomy. Male Wistar rats weighing around 200 g were used as subjects. Partial hepatectomies (67%) were done. Counting T-lymphocyte subpopulations (includes T3, T4, T8, T-IL2R, and NK cells) by using fluorescin isothiocyanate or phycoerythrin was performed preoperatively and on 1,2,3,5,7, and 10 d postoperatively. Serum gamma-interferon (gamma-IFN), interleukin-2 and interleukin-2 receptor concentrations were measured. Absolute number of NK cells in the remnant liver was also counted. Rats with right-side nephrectomy, sham operation, and no operation were used as control groups. Comparing the difference between all groups, we found that all T-lymphocyte subpopulations in peripheral blood, serum gamma-IFN, peripheral blood NK cells, and the absolute number of NK cells in the remnant liver of hepatectomized rats increased markedly, and were significantly higher than control groups rats, on the fifth and seventh post-hepatectomy day. It is suggested that gamma-IFN and NK cells were activated markedly and might play important roles in the regulation of liver regeneration after partial hepatectomy.

Energy substrate for liver regeneration after partial hepatectomy in rats: effects of glucose vs fat.

This study evaluated the effects of glucose or fat on liver regeneration after partial hepatectomy in rats. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed on three rat groups. Two groups were infused with high-glucose (HG) or high-fat (HF) solutions intravenously 2 days before surgery. The control (C) group was allowed to eat instead of receiving intravenous infusions. Another group with sham operation only was also allowed to eat. Rats were killed 6, 24, 48, or 72 hours after the operation. Remnant liver weight, DNA synthetic rate, DNA content, and mitotic index were chosen as comparing indicators. Blood glucose, serum free fatty acid (FFA), total ketone bodies, and ketone body ratio were measured. Transmission electron microscopy was also used to observe the remnant liver. The results showed that the HG rat group had a better regenerative condition than did the HF rat group (p less than .01). Glucose is the predominant energy substrate when enough is offered during the immediate posthepatectomy phase. FFA utilization occurred only very early after partial hepatectomy, and it was remarkable in the control group, moderate in the HF group, and low in the HG group. Shifting of the energy substrate to FFA occurred only when glucose was not available for utilization. The disappearance and reappearance of glycogen, and accumulation of fat in cytoplasm as shown by transmission electron microscope pictures support this conclusion.

Effect of partial portal vein ligation on hepatic regeneration.

To evaluate the effect of portal hypertension and diminished portal venous blood flow to the liver on hepatic regeneration, male rats were subjected to partial portal vein ligation and subsequently to a two-thirds partial hepatectomy. The levels of ornithine decarboxylase activity at 6 h after partial hepatectomy were greater (p less than 0.001) in the rats with prior partial portal vein ligation than in those without portal hypertension. The rats with prior partial portal vein ligation also had greater (p less than 0.005) levels of thymidine kinase activity at 48 h after partial hepatectomy than did those without portal hypertension. Hepatic sex hormone receptor activity was not affected by prior partial portal vein ligation either before or after partial hepatectomy. The reductions in both estrogen and androgen receptor activity observed in the hepatic cytosol after partial hepatectomy were similar to those observed in control animals. These data indicate that animals with portal hypertension having a diminished hepatic portal blood flow have a normal capacity to regenerate hepatic mass following a hepatic resection.

Heterotopic heart transplantation in the rat receiving FK-506 alone or with cyclosporine.

In rats, FK significantly prolonged heterotopic heart graft survival over a wide dose range when given for 2 weeks starting on the day of the operation. Brief courses of FK for one to four days preoperatively, and especially beginning four days postoperatively, allowed long subsequent survival of heart grafts in otherwise untreated recipients. The seeming acceptance of the grafts with postoperative FK treatment was largely but not exclusively donor specific when tested eight days after the last FK dose by second grafts from the same donor v third-party donor grafts. FK in minimally therapeutic doses was synergistic with suboptimal doses of CyA.

Extrarenal Wilms' tumor--a case report.

Extrarenal Wilms' tumor is extremely rare. To our knowledge, only 22 cases had been reported up to 1984. We treated a 5-year-old girl with an extrarenal Wilms' tumor arising in the right inguinal region. Total excision was performed. Abdominal sonogram, computed tomography (CT) scan, and intravenous pyelogram (IVP) showed normal kidneys, no other mass, and no evidence of metastasis. Postoperative chemotherapy was administered. The patient has been disease-free since first diagnosis 19 months ago.

Colon perforation in a patient with hyperimmunoglobulin E (Job's) syndrome.

A Taiwanese boy was diagnosed as having hyperimmunoglobulin E syndrome at the age of 4 years. At age 18 he was admitted to the hospital because of pneumonia in the left lower lobe. Abdominal pain developed 9 days later, and his condition progressed to peritonitis. Colon perforation, 10 cm distal to the ileocecal valve, was found. Double-barrel ileostomy was performed, and reanastomosis was done 1 1/2 months later. Afterward, he was fine, and he had no significant gastrointestinal problems after being discharged. To the author's knowledge, this is the first reported case of hyperimmunoglobulin E syndrome complicated by colon perforation.

Separation of ischiopagus tripus conjoined twins.

The authors report on their second experience of a successful separation of ischiopagus tripus conjoined twins. Particular emphasis is placed on the painful decision of sacrificing the only available leg to cover the infected wound after an unexpected complication in twin A. The twins' preoperative evaluation, separation surgery, and subsequent 16-month course are described.

Hepatocellular carcinoma in children: clinical review and comparison with adult cases.

BACKGROUND: Hepatocellular carcinoma (HCC) in children was rarely reported and usually included with hepatoblastoma in most studies of pediatric liver malignancies despite different clinical behaviors. The authors report their experience in pediatric HCC and discuss its differences from adult HCC. METHODS: A retrospective review of radiographic, laboratory, pathological, and therapeutic data in 55 children with HCC was performed. The liver function was graded by modified Child's classification. Kaplan-Meier survival curves in various therapeutic and Child's groups were plotted, and log-rank test was used to detect differences among survival curves. RESULTS: Although children with HCC mostly presented with advanced disease at diagnosis, disturbances of liver function were unremarkable. Sixty-eight percent of cases concurred with liver cirrhosis. The median survivals for resectable, chemotherapeutic, and untreated HCCs were 23, 3, and 2 months, respectively. Resectable HCC significantly posed a much better prognosis. However, the resectability was unsatisfactory (18.2%). Resection was limited because of anatomic unfeasibility including bilateral involvement (62.5%), portal vein thrombi (41.7%), distant metastasis (29.1%), para-aortic lymphadenopathy (18.8%), inferior vena cava thrombi (16.7%), and hilar invasion (6.3%). Distant metastasis was the most ominous for survival in children with unresectable HCC. CONCLUSIONS: HCC behaved somewhat differently between children and adults. Surgical resection represented the best hope of long-term survival. The outcome in children could not keep up with that in adults because of a diagnostic delay. Hence, alpha-fetoprotein and sonography screening in carrier children should be worthwhile.

Separation of thoracopagus conjoined twins. A case report.

A pair of thoracopagus conjoined twins with a connection at the atrioventricular groove of both hearts and a huge conjoined liver were surgically separated. An aortopulmonary shunt was created for Twin B, a victim of complex congenital heart disease with hypoplastic right heart syndrome, who died 5 hours later. However, Twin A survived after prolonged endotracheal intubation and parenteral nutrition. He survived for 7 months, and went home, but finally died of sepsis. In reviewing 47 pairs of surgically separated thoracopagus conjoined twins, in 30 pairs of type A (Leachman's classification, completely separate hearts), 42 patients survived (70%); in 5 pairs of type B (atrial connection only), one patient survived (10%); in 9 pairs of type C (both atrial and ventricular interconnections), none survived; in 3 pairs of unknown type, 2 survived. Total survival rate of surgically separated thoracopagus conjoined twins was 47.9%. The survival rate was 38.2% in those operated in the neonatal period (n = 34) and 63.6% in those operated over 1 month of age (n = 44) (p = 0.016). In conclusion, thoracopagus conjoined twins are rare. Although its separation carries a high risk, especially in those with cardiac connection, this report confirmed that separation is still feasible under proper preparation and planning.

The effect of different electro-motor stimulation training intensities on strength improvement.

The effect of different training intensities of electro-motor stimulation (EMS) on strength gains produced in the quadriceps femoris muscle group was investigated. Twenty-four subjects were randomly assigned to one of three groups: Control (C), Low Intensity (LI) trained at 25% of their maximum voluntary isometric contraction (MVIC), and High Intensity (HI) trained at 50% of MVIC. Results indicated a significant strength improvement in both training groups (p<0.01) following a three-week EMS training program. The HI group showed significantly greater strength gains (48.5%) than the LI group (24.2%) (p<0.01). A significant carry-over effect was also demonstrated in a three-week follow-up period, specifically in the HI group. Positive isokinetic strength changes in the concentric mode were observed in both training groups. In addition, a significant cross transfer effect was demonstrated in the contralateral homologous muscle group (p<0.01) for both HI and LI groups.

The effect of training intensity on voluntary isometric strength improvement.

The effect of different training intensities on maximum voluntary isometric contraction (MVIC) strength was examined in a three week voluntary isometric exercise programme. Eighteen healthy university students were randomly assigned to one of three training groups: Low Intensity (LI), High Intensity (HI) and Maximal Effort (ME) groups. The LI and HI groups trained by producing voluntary isometric knee extension torques equivalent to 25% and 50% of MVIC strength, respectively. The ME group produced maximal effort contractions during training. Only the HI and ME groups demonstrated significant (p <.05) isometric strength gains. The HI group produced the greatest strength gain (45.8% of MVIC), followed by the ME group (31.3%) and the LI group (22.3%). No significant strength retention, cross transfer or isokinetic strength improvement were seen in any group. The strength improvements were of the same magnitude as those previously obtained using electro-motor stimulation at equivalent training intensities.

Focal nodular hyperplasia of the liver in a child.

We present a case of focal nodular hyperplasia (FNH) of the liver in a 7-year-old girl. The hepatic tumor was found incidentally on physical examination at school. During surgery, a hypervascular mass with a nodular surface was found to be confined to the right lobe of the liver (mainly in segments 5 and 6). The brownish tumor and the gallbladder were completely removed. Pathologic examination revealed a 10 x 9 x 5-cm mass with a central scar and radiating septa, consistent with the diagnosis of FNH. The postoperative course was complicated by subhepatic effusion, which was resolved by percutaneous computed tomography-guided drainage. She remained well 2 years after surgery.

Prediction of the outcome of pull-through surgery for Hirschsprung's disease using acetylcholinesterase activity.

BACKGROUND AND PURPOSE: Advances in surgical procedures for the treatment of Hirschsprung's disease have afforded the majority of patients a satisfactory outcome after definitive corrective surgery. However, some patients continue to have signs of persistent bowel dysfunction despite adequate resection of the aganglionic bowel segment. The definite etiology of persistent bowel dysfunction in these patients remains controversial. MATERIALS AND METHODS: The acetylcholinesterase activity in the proximal resection margin of pull-through surgical specimens collected from September 1992 to June 1998 was evaluated and correlated with clinical outcome. RESULTS: A total of 24 patients were studied, 15 males and 9 females. The follow-up period ranged from 1 year 7 months to 7 years 6 months. The Soave procedure was performed in 17 cases and the Duhamel in 7. Twenty cases had a good or fair clinical outcome and four (16.7%) had a poor outcome. There was no mortality. Among the 20 patients with a good or fair outcome, the acetylcholinesterase activity in the proximal section margins was not increased in 12, mildly increased in seven, and moderately increased in one. The four cases with poor outcome all had moderately increased acetylcholinesterase activity in at least one specimen. The association between moderately increased acetylcholinesterase activity and poor surgical outcome was significant (p = 0.0005). In contrast, there was no association between the surgical method (Soave or Duhamel) used and clinical outcome (p = 0.55). CONCLUSION: Acetylcholinesterase activity in the proximal resection margins of pull-through surgical specimens is a useful indicator for predicting the postoperative outcome in Hirschsprung's disease.

Liver regeneration after partial hepatectomy: effects of glucose and branched-chain amino acid.

The phenomenon of liver regeneration has been observed within several days after partial hepatectomy, though there is still much controversy as to its initiation, regulation, and the control factors behind it. Male Wistar rats weighing around 200 g were used as subjects in this study. Partial hepatectomy with resection of the median and left lateral lobes (67.31%) was performed. High glucose, low glucose, or high or low branched-chain amino acid (BCAA) solutions were given intravenously 2 days prior to the partial hepatectomy. The rats were sacrificed at 6, 24, 48, and 72 hours after the operation. Remnant liver weight, Deoxyribonucleic acid (DNA) content, DNA synthesis rate, and mitotic index were chosen as markers for comparing the effects of the glucose and branched-chain amino acid solutions on liver regeneration. The results were as follows: (1) following removal of two-thirds of a rat's liver, DNA synthesis increased abruptly, peaking at 24 hours, the mitotic index reached a maximum at 48 hours, and the remaining lobes had doubled in size by 48 hours and had attained around 90% of the normal liver weight at 72 hours; (2) judging by the results of the remnant liver weight, DNA content, and DNA synthesis rate, the low glucose infusion rates showed the worst regenerative condition; and (3) the only effect of BCAA on liver regeneration observed was that low BCAA infusion rates resulted in a lower DNA content in the remnant liver.

Alterations of high-energy phosphate, serum energy substrate and their metabolites after partial hepatectomy in rats.

Partial hepatectomy with resection of the median and left lateral lobes was performed on our experimental rat group. Another group undergoing a sham operation only was compared. The rats from both groups were allowed to eat freely after their operation. Rats were sacrificed at 6, 24, 48, and 72 hours post-operatively. Remnant liver weight, deoxyribonucleic acid (DNA) synthetic rate, DNA content, and mitotic index were chosen for monitoring regeneration. Adenosine triphosphate (ATP) and creatine phosphate (CP) in liver tissue, blood glucose, serum free fatty acid (FFA), total ketone bodies, and ketone body ratio (KBR) were measured. The results showed that: (1) the high-energy phosphate (ATP and CP) in liver tissue decreased sharply in the early phase after partial hepatectomy and recovered gradually; (2) the decrease in creatine phosphate was more marked than ATP; (3) the blood glucose level decreased, while the serum metabolites of FFA markedly increased in the early posthepatectomized phase; and (4) the KBR was markedly depressed in this early postoperative period.