No abstract

SummaryExtracts from dog livers which had been regenerating for 24, 48, and 72 h after hepatectomy were infused for 6 h into the left portal vein of animals which had fresh portacaval shunts (Eck fistula) and which were killed 2 and 3 days later. The brief exposure to the 48-h and especially the 72-h regenerating liver extracts induced a delayed proliferative response predominantly in the left liver lobes, with a slight spillover effect to the right liver lobes but none to the kidney. The response reached its peak 3 days later. In the left but not the right liver lobes, both the 48-h and the 72-h regenerating liver extract reversed the atrophy ordinarily caused by Eck fistula in 3 days and partly prevented the ultrastructural hepatocyte deterioration characteristic of Eck fistula. The active liver extracts apparently contained a growth-control factor or factors which is (are) not insulin or glucagon.

On the basis of our experience, major pediatric surgery in many under-resourced areas of sub-Saharan Africa can be developed, taking care to adapt surgical options to local conditions. Late referral of many congenital abnormalities, the impact of local culture, difficulties to establish regular follow-up, and shortage of facilities and medical devices must always be kept in mind before transferring modern protocols of management. Strong efforts have been devoted to train local medical and nursing staff to establish pediatric surgical manpower to cope with a still largely unanswered demand of care in this area of Africa.

Scrotal hematoma is an uncommon presentation of neonatal adrenal hemorrhage. Nine previous cases of such an association have been reported in the literature, and unnecessary surgery was carried out in five of these cases. The authors report three new cases observed during a 3-year period and stress the critical role of scrotal and abdominal ultrasonography in order to avoid unnecessary surgical exploration.

Nine of 48 adult patients who underwent orthotopic liver transplantation developed significant clinical neurological abnormalities recognized shortly after operation. Decrease in consciousness Otturred with resultant coma, focal and generalized seizures and the Ottasional appearance of a state or akinetic mutism. Neuropathologiall abnormalities consisted of mulUfocal areas of inrarction in cerebral cortex and basal ganglia in five patients, «Htral pontine myelinolysis in five (often more extensive than usuaUy reported), Wernicke's encephalopathy in three, cfiaI nodules in two, and fungal abscesses in OM. Alzheimer II astrocytosis was round in aU brains available for retrospective study. There was direct evidence in two of the patients that air embolization rrom the homografts had occurred. Correlation or this with the brain inrarcts in these and other cases seems reasonable. The ease with wbk:b air passed to tbe systemic circulation is explicable by the right to left venousarterial shunts that are common in cbronic liver disease. With the delineation of this cause ror tbe neurologic complications, measures to prevent it in future cases have been described. A MONG ADULTRECIPIENTS of orthotopic liver homografts. a high incidence of acute and profound neurologic disability has been recognized shortly after operation. 21 We rePOrt here a brief clinical-neuropathological survey of these central nervous system complications. Particular emphasis will be placed on the possible etiologic role. in some instances, of air emboli originating from the hepatic homograft. and on the avoidance of such emboli in future cases,