No abstract

The results of the first 45 patients show that it is possible to safely perform outpatient LC with a low admission rate in fit, elective patients who live close to medical care. Provided a strict anaesthetic protocol is followed, the technique has good patient acceptance and provides some economic benefit to the hospital.

Parathyroid rests are common and potentially serve as a cause of recurrent disease in secondary hyperparathyroidism. Consideration should be given to performing thymectomy as part of the treatment of secondary hyperparathyroidism. A more detailed study is warranted.

SUMMARYEighty perfusions of the isolated pig liver were performed using diluted pig blood. Although a high proportion of these perfusions were successful, there was sporadic failure of perfusion, usually manifested by rising hepatic arterial blood-pressure and decreasing total hepatic blood-flow.The success rate of perfusion was improved by addition of low-molecular-weight dextran to the perfusate, the use of a less soluble siliconizing agent for the perfusion apparatus, and the use of new tubing for each perfusion. Preliminary flushing of the liver with Ringer-lactate reduced the success rate and, in unsuccessful perfusions, vaso-active drugs were ineffective in reducing raised vascular resistance.Changes in the perfusate electrolyte, glucose, and enzyme patterns were sometimes observed but could not be related to perfusion success.Perfused livers synthesized urea and bilirubin and incorporated 75Se-Iabelled methionine into protein.Perfused livers also conjugated bromsulphthalein (B.S.P.), but in unsuccessful perfusions the uptake of the dye from the perfusate was reduced and there was marked entry of conjugated B.S.P. into the perfusate.Careful attention to the details of perfusate composition and perfusion conditions does increase the number of successful perfusions. Suggestions for further improvements are discussed.The technical innovations suggested by these investigations are probably relevant to the preservation of the liver prior to clinical transplantation or to the preparation and perfusion of the porcine liver in the treatment of patients with acute liver failure.PERFUSION of the isolated pig liver has been used in the study of liver physiology (Drapanas, Zemel, and Vang, 1966;Hardison and Norman, 1968) and in the treatment of patients with acute liver failure (Eiseman, Liem, and Raffucci, 1965;Norman, Brown, Sararis, Ackroyd, and McDermott, 1966;Watts, Douglas, Dudley, Gurr, and Owen, 1967;Abouna, Garry, Kirkley, and Walder, 1969).In this paper we report the results and difficulties encountered in 80 perfusions of the isolated pig liver carried out in the course of studying the influence of gastroduodenal hormones on hepatic bile-flow (Gordon, Douglas, Jablonski, Owen, and Watts, 1971) and the metabolism of bromsulphthalein (Jablonski, Gordon, Owen, and Watts, 1970). MATERIALS AND METHODSWhole livers (500-650 g.) were taken from healthy pigs weighing 20-25 kg. The animal was anaesthetized with halothane and anaesthesia was maintained with intravenous pentothal. Ventilation with an oxygen/ nitrous oxide mixture was carried out through a tracheotomy. The liver was dissected free and the I 0 cystic duct ligated. The common bile-duct, hepatic artery, portal vein, and inferior vena cava were cannulated. The liver was then transferred to the perfusion circuit shown in Fig. I. During perfusion, the liver lay on a stainless-steel grid in a covered stainless-steel box. The liver was perfused with whole blood, diluted to yield a packedcell volume of 20-25 per cent. The perfusate was FIG. I.-Perfusion circuit...