Post hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality after major liver resection. Although the etiology of PHLF is multifactorial, an inadequate functional liver remnant (FLR) is felt to be the most important modifiable predictor of PHLF. Pre-operative evaluation of FLR function and volume is of paramount importance before proceeding with any major liver resection. Patients with inadequate or borderline FLR volume must be considered for volume optimization strategies such as portal vein embolization (PVE), two stage hepatectomy with portal vein ligation (PVL), Yttrium-90 radioembolization, and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This paper provides an overview of assessing FLR volume and function, and discusses indications and outcomes of commonly used volume optimization strategies.

Snake bites are increasing amongst those who unlawfully keep snakes as petsworldwide. The rural population active in agricultural works, laborers, herders, professionalsnake handlers, trekkers, snake charmers and fishermen are at risk for snake bites. Objectives:To determine the frequency and pattern of vasculotoxic effects in patients with snake bite.Design: Case Study. Period: Six Months Setting: Liaquat University Hospital Hyderabad.Patients and methods: All the patients who initially present in casualty department of hospitalwith the history of snake bite were enrolled in the study. The vasculotoxic effects were evaluatedby whole blood clotting time (WBCT) test, bleeding time, PT/APTT, hypofibrinogemia, DIC andthrombocytopenia. Relevant information would be entered in specifically designed proformafor this study. The data was entered, saved and analyzed in SPSS. So no test of significancewould be applied. Results: Out of 140 patients 112(80%) had vasculotoxic effects, of which80(72%) were males and 32(28%) were females. The mean age ±SD of the overall patients was37.53±8.72 whereas the mean age ±SD of male and female population was 38.98±7.44 and34.88±4.32 respectively. The systemic bleeding was observed in 99% patients, the fang marksin 94 patients, the prolonged bleeding time, WBCT and PT/APTT in 103, 96 and 101 patients,thrombocytopenia in 93 patients, hypofibrinogemia in 81 patients and DIC in 76 patients.The hamaturia (22%), hamoptysis(16%) and hametemesis (11%) was predominant features.The gangrene was observed in 02 patients, vomiting was observed in 60% of patients hadhaematemesis in 11%, bleeding gums in 03 cases and haemoptysis in 16%. Renal failure wasobserved in 12 cases. Conclusions: The coagulation tests disturbed as venom increases theclotting time. Proteins digesting enzymes or thrombin like activity of venom may be one of thecauses for prolongation coagulation tests (vasculotoxic effects)