Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation-assisted liver surgery.

BACKGROUND: Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25-30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. PURPOSE: The aim of this review is to depict the various interventions for liver parenchyma augmentation-assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. CONCLUSIONS: To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly "palliative" disease into a curative and sometimes in a "chronic" disease.

Communications of the median nerve in foetuses.

BACKGROUND: Communications between the median, ulnar and musculocutaneous nerves in the arm, forearm and hand were reported in adult cadaveric and electrophysiological studies. These communicant branches may lead conflicting clinical and electrodiagnostic outcomes. While there are many studies on adult patients or cadavers, there is poor regarding foetuses. The present study was conducted to examine the frequencies of these communications and their coexistences in human foetuses. MATERIALS AND METHODS: Anterior aspect of the forearms of 50 foetuses (29 females, 20 males, and 1 unknown) were dissected bilaterally (totally 100 sides) for this purpose. RESULTS: Communications between the median and the musculocutaneous nerves in the arm were found unilaterally in 4%. Communications from the median to the ulnar nerve in the forearm were encountered unilaterally in 22%, and bilaterally in 12%; from the ulnar to the median nerve in the hand unilaterally in 28%, and bilaterally in 12%. Coexistence of all these variations was not encountered in any foetus. But coexistence of two different types of communicant branch was encountered in 4%. CONCLUSIONS: Precise knowledge of nerve communications, variations and rate of coexistences in foetuses may have significance for clinicians and researchers dealing with subjects in foetal period.