Kuo-Shyang JENG - Academia.edu (original) (raw)

Papers by Kuo-Shyang JENG

An Unusual Cause of Gastrointestinal Hemorrhage???Intestinal Neurofibromatosis

Journal of Clinical Gastroenterology, Oct 1, 1988

World Journal of Surgery, Jun 1, 1988

Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resect... more Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resectable and nonresectable hepatoma, which is very prevalent in Taiwan. Two hundred and twenty-five embolizations of TAE were performed in 137 patients in a 3-year period. Postembolization syndrome developed in the majority of patients. We analyzed these patients to study the nature and incidence of unusual complications and the surgical role in their managment. In our series, unusual complications, which were rarely reported in the literature, included 13 cases (5.8%) of gastroduodenal bleeding, 2 cases (0.9%) of duodenal perforation, 9 cases (4.0%) of acute pancreatitis with l case of gangrenous change, 24 cases (10.7%) of gallbladder infarction with 1 case of perforation, 4 cases (1.8%) of delayed formation of gallstones, 3 cases (1.3%) of hyperuricemia, and 2 cases (0.9%) of hepatoma rupture. Ischemic necrosis of the organs may be attributed to the inadvertent blockade of the gastroduodenal artery, gastric artery, cystic artery, and important collaterals. Inadequate superselectivity, the size of the tumor, regurgitation of embolus, anatomical variations, injury of vessel intima, or pseudoaneurysm formation resulting from previous embolization attempts made the avoidance of complications difficult with this technique. Most of the unusual complications could be managed by conservative treatment, but urgent operation was indicated in the cases of organ perforation. Elective operation was also needed for the delayed formation of gallstones with prominent symptoms. Awareness of the occurrence of these untoward sequelae makes us more careful in the evaluation and long-term follow-up of patients following TAE. Surgical intervention plays a selective but important role in the management of these unusual complications.

Tuberculous splenic abscess in a patient with acute myeloblastic leukemia

Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association, 1985

An Unusual Cause of Gastrointestinal Hemorrhage???Intestinal Neurofibromatosis

Journal of Clinical Gastroenterology, 1988

Gastrointestinal Endoscopy, 1991

Reappraisal of the Roles of the Sonic Hedgehog Signaling Pathway in Hepatocellular Carcinoma

Cancers, Apr 29, 2024

Choledochal cyst in adults: aetiological considerations to intrahepatic involvement

ANZ Journal of Surgery, 2004

Choledochal cysts are rare anomalies of the biliary tree and their presentation in adults is infr... more Choledochal cysts are rare anomalies of the biliary tree and their presentation in adults is infrequent. The high incidence of associated anomalous pancreaticobiliary duct junction (APBDJ) has been well documented. However, the prevalence of APBDJ in different anatomic distribution of cysts has yet to be clarified. A total 39 adult patients with choledochal cysts were consecutively enrolled: 22 patients had Todani type I cysts, 16 patients had type IVa cysts, and one patient had a type IVb cyst. No statistical differences were found in age, sex or manifestations. A higher frequency of associated APBDJ was identified in patients with type IVa cyst (100%) than those with type I cyst (P < 0.05). With a mean follow-up of 7.2 years after cyst excision, three patients with type I choledochal cyst and four with type IVa cyst have had episodes of recurrent cholangitis, all accompanied with preoperatively diagnosed APBDJ. Anomalous pancreaticobiliary duct junction has a close relationship with adult choledochal cysts, particularly type IVa. We propose the hypothesis that intrahepatic involvement results from progressive enzymatic destruction. Adult choledochal cysts in association with APBDJ, with or without intrahepatic component, should be carefully monitored.

Cells, Dec 6, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Scandinavian Journal of Gastroenterology, 2002

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

World Journal of Gastroenterology, 2003

AIM: To investigate the correlation between gammaglutamyl transpeptidase (γ-GTP) expression in th... more AIM: To investigate the correlation between gammaglutamyl transpeptidase (γ-GTP) expression in the primary HCC and post-resection recurrence and its biological behaviors. METHODS: Forty consecutive patients having curative resection for HCC were included in this study. The primers for reverse-transcription polymerase chain reaction (RT-PCR) were corresponding to the 5'-noncoding human γ-GTP mRNA of fetal liver (type A), HepG2 cells (type B), and placenta (type C). Both the cancer and non-cancerous tissues of the resected liver were analyzed. The correlations between the expression of γ-GTP and the clinicopathological variables and outcomes (recurrence and survival) were studied. RESULTS: Those with type B γ-GTP mRNA in cancer had significant higher recurrence rate than those without it (63.6 % vs 14.3 %). Both those with type B in cancer and in non-cancer died significantly more than those without it (45.5 % vs 0 % and 53.6 % vs 0 %, respectively). By multivariate analysis, the significant predictors of recurrence included high serum AFP (P=0.0108), vascular permeation (P=0.0084), and type B γ-GTP mRNA in non-cancerous liver (P=0.0107). The significant predictors of postrecurrence death included high serum AFP (P=0.0141), vascular permeation (P=0.0130), and daughter nodules (P=0.0053). As to the manifestations (recurrent number RR RR R2, recurrent extent¨RRRR R2 segments, extra-hepatic metastasis, and death) in recurrent patients, there were no statistical significant differences between those with type B in the primary tumor and those without it. The difference between those with type B in non-cancerous liver and those without it also was not significant. CONCLUSION: Patients of HCC with type B γ-GTP mRNA both in cancer and in non-cancerous tissue had a worse outcome, earlier recurrence, and more post-recurrence death.

Roux-en-Y Choledochojejunostomy for Late Complications of Choledochoduodenostomy in a Hepatolithiasis Patient

Formosan Journal of Surgery, Aug 1, 2005

Choledochoduodenstomy (CD) has been performed for hepatolithiasis in the past. However, it is rar... more Choledochoduodenstomy (CD) has been performed for hepatolithiasis in the past. However, it is rarely performed recenthy because of the frequenthy postoperative infection. We present a 65-year-old male who developed repeated ascending cholangitis and liver abscess after CD. Surgical conversion to Roux-en-Y choledochojejunostomy relieved the infection. We suggest that CD should be avoided in hepatolithiasis. If complications develop after CD, early surgical conversion is recommended.

Transplantation Proceedings, Apr 1, 2014

Introduction. Loss of speech after living-related liver transplantation is uncommon. Either immun... more Introduction. Loss of speech after living-related liver transplantation is uncommon. Either immunosuppressive agents, related sequelae, or a neurological event may cause it. Case Report. A 46-year-old man developed dysarthria and dysphagia on the 10th day after living-related donor liver transplantation for alcoholic cirrhosis with Child-Pugh class C. Brain magnetic resonance images and electroencephalograms could not detect any lesion, but the diffusion tensor image showed a subacute lacunar infarction at right midbrain. The patient's speech improved 1 month after rehabilitation. Conclusions. Some unexpected neurological events, such as loss of speech, may occur after liver transplantation. The differential diagnosis becomes very important before active treatment. Magnetic resonance imaging supplemented with diffusion tensor imaging is an effective imaging study in establishing the diagnosis.

Cancers, May 2, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Transplantation Proceedings, Apr 1, 2014

Background. Intrahepatic segmental portal vein thrombosis after living-related liver transplantat... more Background. Intrahepatic segmental portal vein thrombosis after living-related liver transplantation (LRLT) is uncommon. The cause remains unclear. Methods. After providing written informed consent, 25 recipients receiving LRLT at our institution from January 2011 to September 2013 were enrolled in this study. We performed triphase computerized tomographic (CT) study of the liver graft of each recipient 1 month after LRLT. The patencies of hepatic artery, portal vein, and hepatic vein were evaluated in detail. The triphase CT scans of the liver of each donor before transplantation also were reviewed. Thrombosis of the intrahepatic segmental portal vein was defined as the occlusion site of the portal vein being intrahepatic. Extrahepatic portal vein thrombosis was excluded in this study. Results. Among the 25 patients, 2 (8%) developed thrombosis of intrahepatic segmental portal vein. One 47-year-old man received LRLT for hepatitis B viral infectionerelated liver cirrhosis (Child-Pugh class C) with 3 hepatocellular carcinomas (total tumor volume <8 cm). Another 53-year-old man received LRLT for alcoholic liver cirrhosis (Child-Pugh class C). Both had developed progressive jaundice and cholangitis 1 month after surgery. Intrahepatic biliary stricture was found on the follow-up magnetic resonance images. However, liver triphase CT study demonstrated occlusion of intrahepatic portal vein of segment 8 in each patient. Radiologic interventions and balloon dilatation therapy via percutaneous transhepatic biliary drainage route improved the symptoms and signs of cholangitis and obstructive jaundice for both. Conclusions. Thrombosis of intrahepatic segmental portal vein is not common but is usually associated with complications of intrahepatic bile duct. Early detection is important, and follow-up CT study of liver is suggested.

Transplantation Proceedings, Apr 1, 2015

Right diaphragmatic hernia after donor hepatectomy is extremely rare. The occurrence is usually l... more Right diaphragmatic hernia after donor hepatectomy is extremely rare. The occurrence is usually late. We present a case with early occurrence complicated with small bowel strangulation. Early detection and emergency surgical repair relieved the problem quickly. Predisposing factors are discussed. To avoid such a complication is very important.

OncoTargets and Therapy, Aug 1, 2013

Background: The important role of cancer stem cells in carcinogenesis has been emphasized in rese... more Background: The important role of cancer stem cells in carcinogenesis has been emphasized in research. CD133+ cells have been mentioned as liver cancer stem cells in hepatocellular carcinoma (HCC). Some researchers have proposed that the sonic hedgehog (Shh) pathway contributes to hepatocarcinogenesis and that the pathway activation occurs mainly in cancer stem cells. We investigated whether the activation of the Shh pathway occurs in CD133+ cells from liver cancer. Materials and methods: We used magnetic sorting to isolate CD133+ cells from mouse cancer Hepa 1-6 cells. To examine the clonogenicity, cell culture and soft agar colony formation assay were performed between CD133+ and CD133-cells. To study the activation of the Shh pathway, we examined the mRNA expressions of Shh, patched homolog 1 (Ptch-1), glioma-associated oncogene homolog 1 (Gli-1), and smoothened homolog (Smoh) by real-time polymerase chain reaction of both CD133+ and CD133-cells. Results: The number (mean ± standard deviation) of colonies of CD133+ cells and CD133-cells was 1,031.0 ± 104.7 and 119.7 ± 17.6 respectively. This difference was statistically significant (P , 0.001). Their clonogenicity was 13.7% ± 1.4% and 1.6% ± 0.2% respectively with a statistically significant difference found (P , 0.001). CD133+ cells and CD133-cells were found to have statistically significant differences in Shh mRNA and Smoh mRNA (P = 0.005 and P = 0.043 respectively). Conclusion: CD133+ Hepa 1-6 cells have a significantly higher colony proliferation and clonogenicity. The Shh pathway is activated in these cells that harbor stem cell features, with an underexpression of Shh mRNA and an overexpression of Smoh mRNA. Blockade of the Shh signaling pathway may be a potential therapeutic strategy for hepatocarcinogenesis.

World Journal of Gastroenterology, 2004

AIM: To investigate the prognostic value of vascular endothelial growth factor messenger RNA (VEG... more AIM: To investigate the prognostic value of vascular endothelial growth factor messenger RNA (VEGF mRNA) in the peripheral blood (PB) of patients with hepatocellular carcinoma (HCC) undergoing curative resection. METHODS: Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, VEGF mRNA in the PB was determined prospectively in 50 controls and in 50 consecutive patients undergoing curative resection for HCC. RESULTS: Among the isoforms of VEGF mRNA, VEGF 165 and VEGF 121 were expressed. By multivariate analysis, a higher level of VEGF 165 in preoperative PB correlated with a risk of HCC recurrence with borderline significance (P=0.050) and significantly with recurrence-related mortality (P=0.048); while VEGF 121 did not. Other significant predictors of HCC recurrence included cellular dedifferentiation (P=0.033), an absent or incomplete capsule (P=0.020), vascular permeation (P=0.018), and daughter nodules (P=0.006). The other significant parameter of recurrence related mortality was cellular dedifferentiation (P=0.053). The level of circulating VEGF mRNA, however, did not significantly correlate with tumor size, cellular differentiation, capsule, daughter nodules, vascular permeation, necrosis and hemorrhage of tumors. CONCLUSION: The preoperative level of circulating VEGF mRNA, especially isoform VEGF 165 , plays a significant role in the prediction of postoperative recurrence of HCC.

Transplantation, Jul 1, 2014

death of the patient. It is proposed to divide SFSS into small-for-size dysfunction (SFSD) and sm... more death of the patient. It is proposed to divide SFSS into small-for-size dysfunction (SFSD) and small for size non function (SFSNF). Objectives: to defi ne SFSS, sub classifi cation, pathogenesis, clinical presentation, risk factors, possible specifi c management and outcome of this syndrome. Patients and methods: During the period from April 2003 to the end of 2013, 174 adult-to-adult LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufi ya University, Egypt. The records of these patients were retrospectively analyzed to study cases with SFSS. Results: twenty (11.5%) recipient had been diagnosed to have SFSS, of whom 16 patients (80%) had SFSD and 4 patients (20%) had SFSNF. Hyperbillirubinaemia was the fi xed presentation in 100% of cases followed by large volume of ascitis in 90%, then, coagulopathy in 85% of cases. While SFSG (> 0.8) was present in 9.7% (n=17/174), Graft size in SFSS cases were classifi ed to extra-small (GRWR <0.8) in 10 cases, small (GRWR ≥0.8 and < 1) in 5 cases and medium sized (GRWR ≥ 1) in 5 cases. The occurrence of the syndrome had been owed to transplantation of extra small graft in 10 cases, portal hyperperfusion in 3 cases, severe portal hypertension in 4 cases and outfl ow obstruction in 3 cases. While extra-small graft, Portal hypertension, steatosis and Lt lobe graft were signifi cant predictors of SFSS in univariate analysis,only graft size were independent predictor of SFSS on multivariate analysis. Splenectomy was tried in 7 patients at the time of transplantation of extra-small graft aiming to prevent its occurrence. The SFSS related mortalities were recorded in 13/20 patients (65%). Conclusion: SFSS is a major and diffi cult entity following LDLT with dreadful outcome. Small graft represents the main obvious causing factor. Splenectomy may be used in cases with extra-small grafts to avoid SFSS but of controversial value and should be further studied before being addressed as a benefi cial management for SFSS.

Transplantation Proceedings, May 1, 2013

Annals of Hepatology, 2017

The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a li... more The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a liver graft has seldom been reported. This report details a case which had torsion of the left hepatic vein on the seventh day after living-related donor liver transplantation. The torsion was reduced soon after re-exploration; however, congestion with partial necrosis of the graft occurred. On the follow-up imaging studies, some resolution of necrosis and graft regeneration were found, yet geographic calcification of the liver graft appeared. The patient died of pneumonia after 13 weeks, post-operation. The avoidance such torsion of vessels is necessary and important.

An Unusual Cause of Gastrointestinal Hemorrhage???Intestinal Neurofibromatosis

Journal of Clinical Gastroenterology, Oct 1, 1988

World Journal of Surgery, Jun 1, 1988

Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resect... more Transcatheter arterial embolization (TAE) is accepted to be an effective treatment in both resectable and nonresectable hepatoma, which is very prevalent in Taiwan. Two hundred and twenty-five embolizations of TAE were performed in 137 patients in a 3-year period. Postembolization syndrome developed in the majority of patients. We analyzed these patients to study the nature and incidence of unusual complications and the surgical role in their managment. In our series, unusual complications, which were rarely reported in the literature, included 13 cases (5.8%) of gastroduodenal bleeding, 2 cases (0.9%) of duodenal perforation, 9 cases (4.0%) of acute pancreatitis with l case of gangrenous change, 24 cases (10.7%) of gallbladder infarction with 1 case of perforation, 4 cases (1.8%) of delayed formation of gallstones, 3 cases (1.3%) of hyperuricemia, and 2 cases (0.9%) of hepatoma rupture. Ischemic necrosis of the organs may be attributed to the inadvertent blockade of the gastroduodenal artery, gastric artery, cystic artery, and important collaterals. Inadequate superselectivity, the size of the tumor, regurgitation of embolus, anatomical variations, injury of vessel intima, or pseudoaneurysm formation resulting from previous embolization attempts made the avoidance of complications difficult with this technique. Most of the unusual complications could be managed by conservative treatment, but urgent operation was indicated in the cases of organ perforation. Elective operation was also needed for the delayed formation of gallstones with prominent symptoms. Awareness of the occurrence of these untoward sequelae makes us more careful in the evaluation and long-term follow-up of patients following TAE. Surgical intervention plays a selective but important role in the management of these unusual complications.

Tuberculous splenic abscess in a patient with acute myeloblastic leukemia

Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association, 1985

An Unusual Cause of Gastrointestinal Hemorrhage???Intestinal Neurofibromatosis

Journal of Clinical Gastroenterology, 1988

Gastrointestinal Endoscopy, 1991

Reappraisal of the Roles of the Sonic Hedgehog Signaling Pathway in Hepatocellular Carcinoma

Cancers, Apr 29, 2024

Choledochal cyst in adults: aetiological considerations to intrahepatic involvement

ANZ Journal of Surgery, 2004

Choledochal cysts are rare anomalies of the biliary tree and their presentation in adults is infr... more Choledochal cysts are rare anomalies of the biliary tree and their presentation in adults is infrequent. The high incidence of associated anomalous pancreaticobiliary duct junction (APBDJ) has been well documented. However, the prevalence of APBDJ in different anatomic distribution of cysts has yet to be clarified. A total 39 adult patients with choledochal cysts were consecutively enrolled: 22 patients had Todani type I cysts, 16 patients had type IVa cysts, and one patient had a type IVb cyst. No statistical differences were found in age, sex or manifestations. A higher frequency of associated APBDJ was identified in patients with type IVa cyst (100%) than those with type I cyst (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). With a mean follow-up of 7.2 years after cyst excision, three patients with type I choledochal cyst and four with type IVa cyst have had episodes of recurrent cholangitis, all accompanied with preoperatively diagnosed APBDJ. Anomalous pancreaticobiliary duct junction has a close relationship with adult choledochal cysts, particularly type IVa. We propose the hypothesis that intrahepatic involvement results from progressive enzymatic destruction. Adult choledochal cysts in association with APBDJ, with or without intrahepatic component, should be carefully monitored.

Cells, Dec 6, 2021

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Scandinavian Journal of Gastroenterology, 2002

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

World Journal of Gastroenterology, 2003

AIM: To investigate the correlation between gammaglutamyl transpeptidase (γ-GTP) expression in th... more AIM: To investigate the correlation between gammaglutamyl transpeptidase (γ-GTP) expression in the primary HCC and post-resection recurrence and its biological behaviors. METHODS: Forty consecutive patients having curative resection for HCC were included in this study. The primers for reverse-transcription polymerase chain reaction (RT-PCR) were corresponding to the 5'-noncoding human γ-GTP mRNA of fetal liver (type A), HepG2 cells (type B), and placenta (type C). Both the cancer and non-cancerous tissues of the resected liver were analyzed. The correlations between the expression of γ-GTP and the clinicopathological variables and outcomes (recurrence and survival) were studied. RESULTS: Those with type B γ-GTP mRNA in cancer had significant higher recurrence rate than those without it (63.6 % vs 14.3 %). Both those with type B in cancer and in non-cancer died significantly more than those without it (45.5 % vs 0 % and 53.6 % vs 0 %, respectively). By multivariate analysis, the significant predictors of recurrence included high serum AFP (P=0.0108), vascular permeation (P=0.0084), and type B γ-GTP mRNA in non-cancerous liver (P=0.0107). The significant predictors of postrecurrence death included high serum AFP (P=0.0141), vascular permeation (P=0.0130), and daughter nodules (P=0.0053). As to the manifestations (recurrent number RR RR R2, recurrent extent¨RRRR R2 segments, extra-hepatic metastasis, and death) in recurrent patients, there were no statistical significant differences between those with type B in the primary tumor and those without it. The difference between those with type B in non-cancerous liver and those without it also was not significant. CONCLUSION: Patients of HCC with type B γ-GTP mRNA both in cancer and in non-cancerous tissue had a worse outcome, earlier recurrence, and more post-recurrence death.

Roux-en-Y Choledochojejunostomy for Late Complications of Choledochoduodenostomy in a Hepatolithiasis Patient

Formosan Journal of Surgery, Aug 1, 2005

Choledochoduodenstomy (CD) has been performed for hepatolithiasis in the past. However, it is rar... more Choledochoduodenstomy (CD) has been performed for hepatolithiasis in the past. However, it is rarely performed recenthy because of the frequenthy postoperative infection. We present a 65-year-old male who developed repeated ascending cholangitis and liver abscess after CD. Surgical conversion to Roux-en-Y choledochojejunostomy relieved the infection. We suggest that CD should be avoided in hepatolithiasis. If complications develop after CD, early surgical conversion is recommended.

Transplantation Proceedings, Apr 1, 2014

Introduction. Loss of speech after living-related liver transplantation is uncommon. Either immun... more Introduction. Loss of speech after living-related liver transplantation is uncommon. Either immunosuppressive agents, related sequelae, or a neurological event may cause it. Case Report. A 46-year-old man developed dysarthria and dysphagia on the 10th day after living-related donor liver transplantation for alcoholic cirrhosis with Child-Pugh class C. Brain magnetic resonance images and electroencephalograms could not detect any lesion, but the diffusion tensor image showed a subacute lacunar infarction at right midbrain. The patient's speech improved 1 month after rehabilitation. Conclusions. Some unexpected neurological events, such as loss of speech, may occur after liver transplantation. The differential diagnosis becomes very important before active treatment. Magnetic resonance imaging supplemented with diffusion tensor imaging is an effective imaging study in establishing the diagnosis.

Cancers, May 2, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Transplantation Proceedings, Apr 1, 2014

Background. Intrahepatic segmental portal vein thrombosis after living-related liver transplantat... more Background. Intrahepatic segmental portal vein thrombosis after living-related liver transplantation (LRLT) is uncommon. The cause remains unclear. Methods. After providing written informed consent, 25 recipients receiving LRLT at our institution from January 2011 to September 2013 were enrolled in this study. We performed triphase computerized tomographic (CT) study of the liver graft of each recipient 1 month after LRLT. The patencies of hepatic artery, portal vein, and hepatic vein were evaluated in detail. The triphase CT scans of the liver of each donor before transplantation also were reviewed. Thrombosis of the intrahepatic segmental portal vein was defined as the occlusion site of the portal vein being intrahepatic. Extrahepatic portal vein thrombosis was excluded in this study. Results. Among the 25 patients, 2 (8%) developed thrombosis of intrahepatic segmental portal vein. One 47-year-old man received LRLT for hepatitis B viral infectionerelated liver cirrhosis (Child-Pugh class C) with 3 hepatocellular carcinomas (total tumor volume <8 cm). Another 53-year-old man received LRLT for alcoholic liver cirrhosis (Child-Pugh class C). Both had developed progressive jaundice and cholangitis 1 month after surgery. Intrahepatic biliary stricture was found on the follow-up magnetic resonance images. However, liver triphase CT study demonstrated occlusion of intrahepatic portal vein of segment 8 in each patient. Radiologic interventions and balloon dilatation therapy via percutaneous transhepatic biliary drainage route improved the symptoms and signs of cholangitis and obstructive jaundice for both. Conclusions. Thrombosis of intrahepatic segmental portal vein is not common but is usually associated with complications of intrahepatic bile duct. Early detection is important, and follow-up CT study of liver is suggested.

Transplantation Proceedings, Apr 1, 2015

Right diaphragmatic hernia after donor hepatectomy is extremely rare. The occurrence is usually l... more Right diaphragmatic hernia after donor hepatectomy is extremely rare. The occurrence is usually late. We present a case with early occurrence complicated with small bowel strangulation. Early detection and emergency surgical repair relieved the problem quickly. Predisposing factors are discussed. To avoid such a complication is very important.

OncoTargets and Therapy, Aug 1, 2013

Background: The important role of cancer stem cells in carcinogenesis has been emphasized in rese... more Background: The important role of cancer stem cells in carcinogenesis has been emphasized in research. CD133+ cells have been mentioned as liver cancer stem cells in hepatocellular carcinoma (HCC). Some researchers have proposed that the sonic hedgehog (Shh) pathway contributes to hepatocarcinogenesis and that the pathway activation occurs mainly in cancer stem cells. We investigated whether the activation of the Shh pathway occurs in CD133+ cells from liver cancer. Materials and methods: We used magnetic sorting to isolate CD133+ cells from mouse cancer Hepa 1-6 cells. To examine the clonogenicity, cell culture and soft agar colony formation assay were performed between CD133+ and CD133-cells. To study the activation of the Shh pathway, we examined the mRNA expressions of Shh, patched homolog 1 (Ptch-1), glioma-associated oncogene homolog 1 (Gli-1), and smoothened homolog (Smoh) by real-time polymerase chain reaction of both CD133+ and CD133-cells. Results: The number (mean ± standard deviation) of colonies of CD133+ cells and CD133-cells was 1,031.0 ± 104.7 and 119.7 ± 17.6 respectively. This difference was statistically significant (P , 0.001). Their clonogenicity was 13.7% ± 1.4% and 1.6% ± 0.2% respectively with a statistically significant difference found (P , 0.001). CD133+ cells and CD133-cells were found to have statistically significant differences in Shh mRNA and Smoh mRNA (P = 0.005 and P = 0.043 respectively). Conclusion: CD133+ Hepa 1-6 cells have a significantly higher colony proliferation and clonogenicity. The Shh pathway is activated in these cells that harbor stem cell features, with an underexpression of Shh mRNA and an overexpression of Smoh mRNA. Blockade of the Shh signaling pathway may be a potential therapeutic strategy for hepatocarcinogenesis.

World Journal of Gastroenterology, 2004

AIM: To investigate the prognostic value of vascular endothelial growth factor messenger RNA (VEG... more AIM: To investigate the prognostic value of vascular endothelial growth factor messenger RNA (VEGF mRNA) in the peripheral blood (PB) of patients with hepatocellular carcinoma (HCC) undergoing curative resection. METHODS: Using a reverse-transcription polymerase chain reaction (RT-PCR)-based assay, VEGF mRNA in the PB was determined prospectively in 50 controls and in 50 consecutive patients undergoing curative resection for HCC. RESULTS: Among the isoforms of VEGF mRNA, VEGF 165 and VEGF 121 were expressed. By multivariate analysis, a higher level of VEGF 165 in preoperative PB correlated with a risk of HCC recurrence with borderline significance (P=0.050) and significantly with recurrence-related mortality (P=0.048); while VEGF 121 did not. Other significant predictors of HCC recurrence included cellular dedifferentiation (P=0.033), an absent or incomplete capsule (P=0.020), vascular permeation (P=0.018), and daughter nodules (P=0.006). The other significant parameter of recurrence related mortality was cellular dedifferentiation (P=0.053). The level of circulating VEGF mRNA, however, did not significantly correlate with tumor size, cellular differentiation, capsule, daughter nodules, vascular permeation, necrosis and hemorrhage of tumors. CONCLUSION: The preoperative level of circulating VEGF mRNA, especially isoform VEGF 165 , plays a significant role in the prediction of postoperative recurrence of HCC.

Transplantation, Jul 1, 2014

death of the patient. It is proposed to divide SFSS into small-for-size dysfunction (SFSD) and sm... more death of the patient. It is proposed to divide SFSS into small-for-size dysfunction (SFSD) and small for size non function (SFSNF). Objectives: to defi ne SFSS, sub classifi cation, pathogenesis, clinical presentation, risk factors, possible specifi c management and outcome of this syndrome. Patients and methods: During the period from April 2003 to the end of 2013, 174 adult-to-adult LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufi ya University, Egypt. The records of these patients were retrospectively analyzed to study cases with SFSS. Results: twenty (11.5%) recipient had been diagnosed to have SFSS, of whom 16 patients (80%) had SFSD and 4 patients (20%) had SFSNF. Hyperbillirubinaemia was the fi xed presentation in 100% of cases followed by large volume of ascitis in 90%, then, coagulopathy in 85% of cases. While SFSG (> 0.8) was present in 9.7% (n=17/174), Graft size in SFSS cases were classifi ed to extra-small (GRWR <0.8) in 10 cases, small (GRWR ≥0.8 and < 1) in 5 cases and medium sized (GRWR ≥ 1) in 5 cases. The occurrence of the syndrome had been owed to transplantation of extra small graft in 10 cases, portal hyperperfusion in 3 cases, severe portal hypertension in 4 cases and outfl ow obstruction in 3 cases. While extra-small graft, Portal hypertension, steatosis and Lt lobe graft were signifi cant predictors of SFSS in univariate analysis,only graft size were independent predictor of SFSS on multivariate analysis. Splenectomy was tried in 7 patients at the time of transplantation of extra-small graft aiming to prevent its occurrence. The SFSS related mortalities were recorded in 13/20 patients (65%). Conclusion: SFSS is a major and diffi cult entity following LDLT with dreadful outcome. Small graft represents the main obvious causing factor. Splenectomy may be used in cases with extra-small grafts to avoid SFSS but of controversial value and should be further studied before being addressed as a benefi cial management for SFSS.

Transplantation Proceedings, May 1, 2013

Annals of Hepatology, 2017

The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a li... more The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a liver graft has seldom been reported. This report details a case which had torsion of the left hepatic vein on the seventh day after living-related donor liver transplantation. The torsion was reduced soon after re-exploration; however, congestion with partial necrosis of the graft occurred. On the follow-up imaging studies, some resolution of necrosis and graft regeneration were found, yet geographic calcification of the liver graft appeared. The patient died of pneumonia after 13 weeks, post-operation. The avoidance such torsion of vessels is necessary and important.