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1.  Diffuse Abdominal Splenosis Mimicking Peritoneal Metastases in a 35-Year-Old Man with a Resectable Carcinoma of the Ampulla of Vater 
Case Reports in Oncology  2013;6(3):467-471.
A 35-year-old man with a history of blunt abdominal trauma and splenic rupture was diagnosed with an ampullary adenocarcinoma. At workup, a CT scan showed multiple intra-abdominal lesions similar to peritoneal carcinosis, and the patient was referred for palliative chemotherapy. On clinical suspicion, however, a biopsy was performed on an intra-abdominal lesion, establishing the diagnosis of abdominal splenosis. A radical pancreaticoduodenectomy ad modum Whipple was performed, followed by adjuvant chemotherapy with gemcitabine. At the 18-month follow-up, the patient was free from recurrent disease. We conclude that splenosis should be considered as a differential diagnosis of peritoneal metastases in cancer patients with a history of abdominal trauma and/or splenectomy. Other reports on splenosis in cancer patients and diagnostic workup are discussed.
doi:10.1159/000355233
PMCID: PMC3806701  PMID: 24163662
Ampullary carcinoma; Splenosis; Peritoneal metastasis
2.  Tracer input for kinetic modelling of liver physiology determined without sampling portal venous blood in pigs 
Purpose
Quantification of hepatic tracer kinetics by PET requires measurement of tracer input from the hepatic artery (HA) and portal vein (PV). We wished to develop a method for estimating dual tracer input without the necessity to sample PV blood.
Methods
Pigs weighing 40 kg were given bolus doses of C15O (CO), 2-[18F]fluoro-2-deoxy-d-glucose (FDG), [11C]-methylglucose (MG), 2-[18F]fluoro-2-deoxy-d-galactose (FDGal) or H2 15O (H2O). Tracer concentration 3-min time courses were measured in the femoral artery and PV by blood sampling. Blood flow was measured in the HA and PV using flow-meters. A model for transfer of tracer through the splanchnic circulation was used to estimate values of a tracer-specific model parameter β. Tracer-specific mean values of β were used to estimate tracer concentration time courses in the PV from the measured arterial concentration. A model-derived dual-input was calculated using the mean HA flow fraction (0.25) and validated by comparison of the use of the measured dual-input and a kinetic model with a fixed “true” K1true, i.e. clearance of tracer from blood to liver cells.
Results
The rank order of the means of β was CO
Conclusion
The hepatic dual tracer input, which is of great importance for the assessment of processes such as transfer across the plasma-hepatocyte membrane or hepatic blood perfusion, can be well approximated in pigs without the necessity to sample PV blood and measure hepatic blood flow; only arterial blood sampling is needed.
doi:10.1007/s00259-010-1620-0
PMCID: PMC3021702  PMID: 20882283
Splanchnic circulation; Liver kinetics; Molecular imaging; Pharmacokinetics; PET; Portal model; Radioactive tracers
There is an unmet clinical need for an imaging method for quantification of hepatic blood perfusion. The purpose of the present study was to develop and validate a PET method using blood-to-cell clearance (K1) of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG), 3-O-[11C]-methylglucose (11C-MG) or 2-[18F]fluoro-2-deoxy-D-galactose (18F-FDGal) as a measure of hepatic blood perfusion without the need of portal venous blood samples. We aimed to make the method as simple as possible with the perspective of future application to clinical studies. For this purpose, we examined the possibility of using 3-min data acquisition and a model-derived dual-input calculated from measurements of radioactivity concentrations in a peripheral artery.
Methods
Pigs (40 kg) underwent dynamic PET of the liver with 18F-FDG, 11C-MG or 18F-FDGal with simultaneous measurements of time-activity curves (TAC) in blood sampled from a femoral artery and the portal vein (PV); blood flow rates were measured in the hepatic artery (HA) and portal vein (PV) by transit-time flow-meters. Two input functions were compared: A measured dual-input and a model-derived dual-input, the latter with the PV TAC estimated from the measured arterial TAC and a previously validated one-parametric PV-model. K1 was estimated for each tracer by fitting compartmental models to the data comparing 3-min and 60-min data acquisitions and the two dual-input TACs.
Results
Agreement between K1 estimated using the measured and the model-derived dual-input was good for all 3 tracers. For 18F-FDG and 11C-MG, K1 (3-min data acquisition, model-derived dual-input and one-tissue compartmental model) correlated to the measured blood perfusion (P = 0.01 and P = 0.07, respectively). For 18F-FDGal the correlation was not significant.
Conclusion
A simplified method for quantification of hepatic blood perfusion using 3-min dynamic 18F-FDG PET or 11C-MG PET with blood sampling from only a peripheral artery was developed. Parametric K1 images were constructed and showed homogeneous blood perfusion in these normal livers.
doi:10.2967/jnumed.111.088278
PMCID: PMC3129486  PMID: 21680685
PET kinetics; molecular imaging; pharmacokinetics; liver PET; liver hemodynamics
Purpose
Quantification of hepatic tracer kinetics by PET requires measurement of tracer input from the hepatic artery (HA) and portal vein (PV). We wished to develop a method for estimating dual tracer input without the necessity to sample PV blood.
Methods
Pigs weighing 40 kg were given bolus doses of C15O (CO), 2-[18F]fluoro-2-deoxy-D-glucose (FDG), [11C]-methylglucose (MG), 2-[18F]fluoro-2-deoxy-D-galactose (FDGal) or H215O (H2O). Tracer concentration 3-min time courses were measured in the femoral artery and PV by blood sampling. Blood flow was measured in the HA and PV using flow-meters. A model for transfer of tracer through the splanchnic circulation was used to estimate values of a tracer-specific model parameter β. Tracer-specific mean values of β were used to estimate tracer concentration time courses in the PV from the measured arterial concentration. A model-derived dual-input was calculated using the mean HA flow fraction (0.25) and validated by comparison of the use of the measured dual-input and a kinetic model with a fixed ”true” K1true, i.e. clearance of tracer from blood to liver cells.
Results
The rank order of the means of β was CO < FDG ≈ MG < FDGal < H2O, reflecting their different splanchnic mean transit times. Estimated K1est was not significantly different from “true” K1true.
Conclusion
The hepatic dual tracer input, which is of great importance for the assessment of processes such as transfer across the plasma-hepatocyte membrane or hepatic blood perfusion, can be well approximated in pigs without the necessity to sample PV blood and measure hepatic blood flow; only arterial blood sampling is needed.
doi:10.1007/s00259-010-1620-0
PMCID: PMC3021702  PMID: 20882283
Splanchnic circulation; Liver kinetics; Molecular imaging; Pharmacokinetics; PET; Portal model; Radioactive tracers
Background
The surgical strategy for the treatment of colorectal cancer and synchronous liver metastases remains controversial. The aim of the present study was to investigate the effects of colonic resection on liver function and regeneration in a rat model.
Methods
Ninety-six Sprague-Dawley rats were block-randomized into six groups: Group I had a laparotomy performed. Group II had 1 cm colon resected and anastomosed. Group III and V had 40% or 70% of the liver resected, respectively. Additionally Group IV and VI had 1 cm colon resected and anastomosed, respectively. Body weight was recorded on postoperative day 0, 3, 5 and 7. Rats were sacrificed on postoperative day 7 by rapid collection of blood from the inferior vena cava, and endotoxin levels were measured. Remnant liver function was evaluated by means of branched amino acids to tyrosine ratio. Liver regeneration was calculated by (liver weight per 100 g of the body weight at sacrifice/preoperative projected liver weight per 100 g of the body weight) × 100.
Results
The total number of complications was significantly higher in Group VI than Group I, III, IV, and V. Body weight and branched amino acids to tyrosine ratio were both significantly lower in rats that had simultaneous colonic and liver resection performed. Hepatic regeneration rate was significantly higher in the simultaneous colectomy group. Systemic endotoxin levels were unaffected by simultaneous colectomy on postoperative day 7.
Conclusions
In our model morbidity seems to be related to the extent of hepatic resection. In rats undergoing liver resection, simultaneous colectomy induced a higher degree of hepatic regeneration rate. Body weight changes and branched amino acids to tyrosine ratio were negatively affected by simultaneous colectomy.
doi:10.1186/1750-1164-3-16
PMCID: PMC2806264  PMID: 20034379
Background
Topical haemostatic agents are used to help achieve haemostasis during surgery when standard surgical techniques are insufficient. The objective of this study was to confirm the safety profile of an equine collagen patch coated with human fibrinogen and human thrombin with particular focus on the occurrence of thromboembolic events (TEEs), major bleeding and immunological events.
Methods
This was a non-interventional, multicentre, prospective, surveillance study in which a collagen fleece-bound fibrin sealant was prescribed in accordance with its marketing authorisation. The decision to use the sealant was based solely on current surgical practice. All patients that received the sealant and provided informed consent were included. TEEs (any coagula-based occlusion in a vessel or the heart identified by symptomatic clinical signs and/or verified by paraclinical examination), major bleeding (any bleeding that required intervention), and immunological events (hypersensitivity including anaphylaxis) that occurred during surgery, post-operative hospital stay or 6 months of follow-up were reported as adverse events. The primary endpoint was the proportion of patients experiencing a confirmed TEE.
Results
A total of 3098 patients were recruited at 227 centres in 12 European countries. The most frequent types of surgery were hepatic (33%), gastrointestinal (16%) and urological (14%) and the main indication for surgery was for primary (35%) or secondary (20%) malignancy. Forty-six patients (1.5%, 95% CI 1.1–2.0%) had at least one TEE during the study. The most commonly reported TEEs were pulmonary embolism or post-procedural pulmonary embolism (n = 18) and deep vein thrombosis (n = 9). There were 64 major bleedings in 62 patients and 9 immunological events in 8 patients.
Conclusion
Collagen fleece-bound fibrin sealant does not appear to be associated with an increased risk of TEEs, major bleeding or immunological events in patients undergoing surgery.
Trial registration
Clinicaltrials.gov number: NCT00285623
doi:10.1186/1754-9493-3-13
PMCID: PMC2711964  PMID: 19545437
Hepatology International  2008;3(1):310-315.
Purpose
Ischemia-reperfusion injury induced by the Pringle maneuver is a well-known problem after liver surgery. The aim of this study was to monitor metabolic changes in the pig liver during warm ischemia and the following reperfusion preceded by ischemic preconditioning (IPC).
Methods
Eight Landrace pigs underwent laparotomy. Two microdialysis catheters were inserted in the liver, one in the left lobe and another in the right lobe. A reference catheter was inserted in the right biceps femoris muscle. Microdialysis samples were collected every 30 min during the study. After 2 h of baseline measurement, IPC was performed by subjecting pigs to 10 min of ischemia, followed by 10 min of reperfusion. Total ischemia for 60 min was followed by 3 h of reperfusion. The samples were analyzed for glucose, lactate, pyruvate, and glycerol. Blood samples were drawn three times to determine standard liver parameters.
Results
All parameters remained stable during baseline. Glycerol and glucose levels increased significantly during ischemia, followed by a decrease from the start of reperfusion. During the ischemic period, lactate levels increased significantly and decreased during reperfusion. The lactate–pyruvate ratio increased significantly during ischemia and decreased rapidly during reperfusion. Only minor changes were observed in standard liver parameters.
Conclusions
The present study demonstrated profound metabolic changes before, during, and after warm liver ischemia under the influence of IPC. Compared with a similar study without IPC, the metabolic changes seem to be unaffected by preconditioning.
doi:10.1007/s12072-008-9104-z
PMCID: PMC2712317  PMID: 19669382
Warm liver ischemia; Portal triad clamping; Preconditioning; Metabolic changes; Microdialysis

Results 1-7 (7)