Evaluation of the New ISGLS Definitions of Typical Posthepatectomy Complications.

BACKGROUND AND OBJECTIVES: The International Study Group of Liver Surgery established the first internationally standardized definitions and grading for posthepatectomy hemorrhage, posthepatectomy liver failure, and bile leakage. We aimed to correlate these definitions and grades of complications with objective parameters of the postoperative course, namely, mortality and length of stay, to assess the usefulness in clinical routine. METHODS: A total of 415 patients underwent hepatic surgery between 2004 and 2014. Uni- and multivariate analyses were made for correlations of posthepatectomy hemorrhage, posthepatectomy liver failure, and bile leakage with perioperative parameters and mortality. RESULTS: Of the total, 25 (6.1%) patients developed a posthepatectomy hemorrhage Grade A, 3 (0.7%) patients a posthepatectomy hemorrhage Grade B, and 1 (0.2%) patient a posthepatectomy hemorrhage Grade C; 23 (5.5%) patients had a posthepatectomy liver failure Grade A, 24 (5.8%) patients a posthepatectomy liver failure Grade B, and 7 patients (1.6%) a posthepatectomy liver failure Grade C. Bile leakage Grade A occurred in 10 (2.4%) patients, bile leakage Grade B in 24 (5.8%) patients, and bile leakage Grade C in 7 (1.6%) patients. Mortality was significantly increased in patients with posthepatectomy hemorrhage Grades B and C and in patients with posthepatectomy liver failure Grades A, B, and C. Three (42.9%) patients with bile leakage Grade C died. CONCLUSION: Our data indicate that the new definitions correlate well with mortality and duration of hospital stay.

The effect of hyperosmotic and sodium chloride hyperosmotic environments on the secretion and synthesis of prolactin from human decidua in vitro.

Using a paired design as well as a cross-over design both with 16 h incubation periods, we have incubated human decidua in hyposmotic, isosmotic, and sodium chloride hyperosmotic media. In the cross-over design each tissue aliquot was subjected to 3 media with different osmolalities, one of which was isosmotic. Thus, intensive utilization of the tissue was possible. The results of the cross-over study were identical with the result of the paired design. We found a decreased secretion of prolactin in hyposmotic environments, whereas hyperosmotic environments up to an osmolality about 400 mmol/kg gave a dose related increase in the prolactin secretion into the medium as well as in the total content of prolactin in the tissue and the medium. Excessive hyperosmotic medium decreased the secretion. The enhanced secretion was an effect of increased production, which could be blocked by cycloheximide. We found no feedback of prolactin on its own secretion.

The anal transitional zone: a scanning and transmission electron microscopic investigation of the surface epithelium.

The ultrastructure of the anal transitional zone (ATZ) is described by means of scanning and transmission electron microscopy. The technique used permits histologic reexamination of the scanning electron microscopic biopsies. The surface of the ATZ shows, in addition to areas of normal colorectal mucosa and squamous epithelium, a characteristic picture: there are cells of varying size, arranged in a cobblestone pattern, and a surface covered with short microvilli that tend to form rows, indicating beginning microridge formation. This corresponds histologically to the so-called ATZ epithelium, and it is suggested that this might be metaplastic squamous epithelium rather than urothelium. The deepest part of the epithelium contains endocrinelike cells with granules of at least two types.

Scanning electron microscopy of the responses of postmenopausal endometrium to treatment with estriol and estriolprogesterone.

Seven postmenopausal women are given estriol orally in a daily dose of 1 mg x 2 or 5 mg x 2 for 14 or 28 days and 2 women were sequentially treated with 5 mg x 2 of estriol orally for 21 days, with the addition of 0.2 g x 2 of progesterone rectally in the last 7 days. Three women served as controls. Scanning electron microscopy revealed that the former treatment with estriol was sufficient to produce an estrogen response in the non-ciliated uterine epithelial cells, which developed many long microvilli, sometimes arranged in tufts. The sequential treatment with initial estriol priming followed by estriol and progesterone combined resulted in a slight secretory transformation of the uterine epithelium, observed as an increase in size and number of the apical protrusions of the cells.

Treatment of hyperprolactinemic luteal insufficiency with bromocriptine.

Twelve patients with infertility and insufficent luteal function were studied during a control cycle, and during a cycle when 2.5 mg of bromocriptine was given twice daily. Serum levels of prolactin, progesterone, estradiol-17-beta, FSH and LH were determined during both cycles. Endometrial biopsies were taken from most patients during the late luteal phase. Two patients had persistent hyperprolactinemia, approximately 35-45 ng/ml, and both had repeated insufficient luteal function, which completely reverted to normal during treatment. Five of the 10 normoprolactinemic patients achieved a normal luteal function during bromocriptine therapy. No pregnancies were achieved during the study but one patient later conceived during bromocriptine therapy.

Chorioangioma with hydramnios and intra-uterine fetal death.

Chorioangiomas are benign placental tumours derived from fetal vessels, that occur with a frequency of approximately 1%. Often they are associated with hydramnios and intra-uterine fetal death. Based on a case of multiple chorioangiomas with a fatal course for the baby, aspects of the pathogenesis of hydramnios are discussed. Future development in ultrasounc technology may facilitate antenatal diagnosis.