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Dynamic liver scanning using 99mTc sulphur colloid has been used in assessing 41 patients with cirrhosis and the data compared with 33 control subjects. The mesenteric fraction (MF) was significantly reduced in cirrhotics (0.30 +/- 0.17) compared with controls (0.58 +/- 0.09), P less than 0.001. The liver: spleen ratio (L:S) was also significantly different (1.6 +/- 0.95 compared with 4.9 +/- 1.4), P less than 0.001. Those patients who had undergone a recent variceal bleed had values less than patients who had not bled. Dynamic scintigraphy may be of value in monitoring the progress of disease and response to treatment.

Summary Liver and tumour blood flow has been studied in 30 patients with multiple liver metastases and in 14 patients with solitary liver tumours by means of dynamic hepatic scintigraphy. Observations were compared with those of a group of 33 control subjects. Haemodynamic changes were also measured in 10 patients who underwent hepatic arterial embolization (HAE).The mesenteric fraction (MF) to tumour regions in 32 subjects showed a wide range compared with control subjects. In 9 patients the MF to the tumour region was within the normal range suggesting that some tumours may possess a portal venous supply. The MF to the uninvolved liver regions was below the normal range in 25% of patients, indicating that HAE could be hazardous in this group. Following HAE the MF rose in all 4 tumour regions and fell in 4 non-embolized uninvolved liver regions. No increase in colloid clearance rate (k) was seen though a significant decrease occurred in 4 patients. These changes may well represent increased portal venous flow into tumours.The treatment of malignant liver neoplasms, apart from those that are truly solitary and accordingly suitable for resection, has been unrewarding in terms of prolonging survival (Taylor, 1985). Since therapeutic ligation of the hepatic artery was first performed for a liver tumour (Reinhoff & Woods, 1953), various forms of hepatic arterial manipulation have been attempted because tumour neovascularization is predominantly arterial (Breedis & Young, 1954). The hope was that hepatic arterial occlusion might result in tumour regression and increased survival. Unfortunately, initial optimism has largely been unrealized. Morbidity and mortality associated with the procedures (Almersjo et al., 1972) as well as the development of arterial collaterals (Bengmark & Rosengren, 1970) has been responsible for the limited benefit in terms of survival.A recent and perhaps more rational method of dearterialization is by percutaneous radiological hepatic arterial embolization (HAE). Laparotomy is avoided and should the vessels recanalise or arterial collaterals develop, they can be embolized at a later date. Although there is good evidence that this procedure provides temporary palliation of symptoms from the carcinoid syndrome (Odurny & Birch, 1985), the effects on survival have not been marked, particularly in other types of liver metastases (Chuang & Wallace, 1981). However, pain due to stretching of the liver capsule by metastases can sometimes be relieved.In general, the contribution of the portal vein has largely been ignored as a potential source of significant tumour blood flow and nutrition, particularly following dearterialisation procedures, principally because of the difficulty of studying relative hepatic haemodynamics in vivo. Dynamic hepatic scanning The validity of dynamic liver scanning using 99mTc sulphur colloid has been established in animals (Fleming et al., 1981) and humans (Fleming et al., 1983). Each study is performed with the patient fasted overnight beforehand. A rapid intravenous in...

Background: The management of an open abdomen (OA) remains an evolving field because of its relative rarity. Many techniques to achieve temporary abdominal closure exist, but often require multiple returns to the operating theatre and usually do not address the issue of lateral fascial retraction and do not achieve primary fascial closure (PFC). The ensuing incisional hernias result in a significant surgical challenge affecting both the physical and mental health of the patient. We describe our experience with the Abdominal Reapproximation Anchor (ABRA) device, which addresses some of these issues. Methods: The records of patients with an OA managed by a single surgeon using the ABRA device at Princess Alexandra Hospital, Queensland, Australia, between December 2014 and April 2020 were analysed retrospectively. Results: Six patients with OA were managed with the ABRA. All patients required an OA for the ramification of intraabdominal sepsis. Three patients were managed with the ABRA device electively and three in the acute setting. 100% of patients achieved PFC. Average follow-up was 40 months with three developing incisional hernias that were subsequently repaired. Conclusion: The OA in critically ill surgical patients remains one of the most challenging problems in general surgery. The ABRA device is simple to use and has shown positive outcomes in both the acute and elective setting. Our use has resulted in 100% PFC, which demonstrates that the ABRA device is an important tool for the general surgeon in managing these complex cases.