Nazli Erbay

Liver regeneration and surgical outcome in donors of right-lobe liver grafts.

Introduction. Previous studies of healthy live‐liver donors have suggested that complete liver regeneration occurs within a matter of weeks; however, there have been no long‐term studies evaluating liver regeneration and few studies documenting long‐term donor outcome. Materials and Methods. Fifty‐one donors who provided right‐lobe grafts underwent volumetric spiral computed tomography scans preoperatively and postoperatively at time intervals of 1 week and 1, 3, 6, and 12 months. Patient demographics, surgical data, and postoperative outcome were correlated with liver regeneration data. Donor surgical outcome was followed prospectively and recorded in a comprehensive database. Results. Thirty‐three males and 18 females (mean age 36.0±9.6 years) provided 51 right‐lobe grafts. Mean follow‐up was 9.8±3.4 months. No donor operation was aborted, and surgical morbidity and mortality rates were 39% and 0%, respectively. Donor remnant liver volume was 49.4±5.7% of the original total liver volume (TLV). Overall liver regeneration was 83.3±9.0% of the TLV by 1 year. Female donors had significantly slower liver regrowth when compared with males at 12 months (79.8±9.3% vs. 85.6±8.2%, P<0.01). There was no effect of age, body mass index, operative time, estimated blood loss, postoperative complications, or perioperative liver function tests on liver regeneration. Discussion. Liver regeneration continues throughout the first postoperative year. Only one donor achieved complete liver regeneration during this time period; however, all donors have maintained normal liver function without long‐term complications. Longer follow‐up is needed to determine whether donors ever achieve original TLV.

Liver regeneration after living adult right lobe transplantation

AbstractBackground: The purpose of this study was to describe liver regeneration in patients undergoing living-adult liver transplantation. Methods: This prospective study included 10 donors and eight recipients who had a total of 65 computed tomographic (CT) scans. All patients had preoperative CT (n = 18), and follow-up CT scans (n = 47) were obtained for up to 14 months after transplantation. Liver and spleen volumes were measured by hand tracing each organ on the axial portal venous phase images. Results: Both donors and recipients showed immediate increases in liver volume. However, liver regeneration was significantly faster and reached a higher peak in recipients than in donors. Splenic volume in donors demonstrated an initial increase followed by a decline, reaching the preoperative volume after 1 year. Splenic volume in recipients demonstrated immediate decline postoperatively. Conclusion: Restoration of liver volume occurred rapidly after transplantation, but followed different patterns in donors and recipients. Deviation from these patterns warrants further investigation.

Tc-99m pertechnetate thyroid images in hyperthyroidism : Size, distribution, and presence of a pyramidal lobe

One hundred consecutive thyroid images obtained by use of Tc-99m pertechnetate, in authenticated cases of hyperthyroidism, were reviewed. Calibrated images showed that only 42 of the 200 thyroid lobes (21%) were greater than 5 cm in length. The enlarged lobes occurred in 29 patients. Of these, only 4 had a multinodular appearance (and 7 patients with smaller lobes also had multinodular glands). Neither thyromegaly (by length) nor multinodular appearance are common features of hyperthyroidism in this area. There were 12 instances of pyramidal lobes in the hyperthyroid men (12 of 26 = 46%) and 24 cases in women (24 of 74 = 32%). The site of origin of the pyramidal lobe was from the left in 17, from right in 16, and from the midline in 3 cases. During the period of review of all thyroid images, only one other case of a pyramidal lobe was found (a case of multinodular goiter).

Bone imaging in congenital perforation of the sternum.

A case is described of a lower sternal cold central defect on a Tc-99m-MDP bone scan. There was no history of sternal trauma, infection, radiation, or surgery in this man. The appearance was consistent with a defect described as congenital perforation of the sternum. Radiographic correlation was available and confirmed the sternal central defect.

Late effects of postradiation cystitis noted on renal dynamic study.

A dynamic renal study revealed an immediate blush in the bladder region. This was not uterine related (previous hysterectomy). The outline of the site did not change with time as bladder filling progressed. The effect was due to a bladder relatively fixed in shape from the late effects of radiation, with probable continued vascular abnormalities within its walls.

Hydrocele mimicking testicular torsion on radionuclide and ultrasound studies

A 24-year-old man with a swollen right testis was noted, by ultrasound (US), to have a hydrocele on that side, and homogenous echogenicity. Clear demonstration of blood flow was not possible. A Tc-99m RBC radionuclide study also did not show perfusion of the right testis. At operation, massive hydrocele was noted to have reduced vascular pulsations to the testis. Reported difficulties with diagnosing testicular torsion with use of US or radionulcide angiograms were reviewed.