Six cases of primary hepatic carcinoid tumors were studied with combined immunocytochemical and electron microscopic techniques. Positive tumor immunostaining with PHE5, LK2H10, neuron-specific enolase (NSE), serotonin, gastrin, and insulin antibodies was observed. At the ultrastructural level, cytoplasmic dense granules were seen in all the cases tested. This finding supports a putative origin of these carcinoids found in the liver from a pluripotential stem cell. The clinical course and follow-up of these cases suggests that this unusual hepatic neoplasm has a more favorable prognosis than other forms of hepatic cancer.

Summary4 days after portacaval shunt, the livers of normal dogs had pronounced atrophv and other structural abnormalities. These changes were greatly reduced in the left liver lobes, but not in the right, by a constant infusion to the left portal vein of insulin in non-hypoglyczmic doses. These experimental findings should have implications in clinical medicine.ISTRODl:CTIOS DURING the past ten years we have developed evidence that substances, termed hepatotrophic factors, in the portal venous blood of dogs can profoundly influence liver function as well as the size, internal structure, chemical composition, and dividing capability of the hepatocytes. 1 -' In most of these experiments, techniques were exploited that permitted comparative study of two portions of the same liver which were given different kinds of portal venous inflow under diabetic or non-diabetic conditions. The concept emerged that manifold hepatic processes are controlled or influenced by hormones that are generated by splanchnic organs and delivered straight to the liver, with a presumably augmented significance because of the episodically high concentrations of nutrient substrate in the same blood. 2 -' Insulin has' been identified as the most important of these undoubtedly multiple portal hepatotrophic constituents. 2·~ If the foregoing conclusions were correct, the ztiology METHODSEight normal mongrel dogs averaging about 19 kg had large side-ta-side portacaval shunts (group I)_ The shunts were made completely diverting by ligating the right and left portal branches at their origin. Thirteen more dogs of approximately the same weight had the same procedure except that the tip of a fine infusion catheter was placed into the tied-off left portal branch and led outside to a small finger pump that was incorporated into a light body cast. A pump infusion of regular insulin diluted in heparinised physiological saline was started, using volumes that never exceeded 21 ml/day. The thirteen test dogs were divided into two subgroups of nine (group 2) and four (group 3) on the basis of the insulin dose that was given (see accompanying table). Ten normal dogs in our laboratory had morning blood-sugars of 61·1-!9·2 (S.D.) mg/dl. The nine test dogs receiving the larger dose of insulin for 4 days had 30 morning blood-sugar concentrations that were 64·8± 13·0 (S.D.) mg/dl. The four dogs treated with low insulin doses had 13 sugar determinations of 71·2,:8·4 (S_D.) mg/dl. All dogs were on an ad-libitum diet from the 1st postoperative day onward.The experiments lasted 4 days_ Their design permitted an evaluation of any direct protective effect of insulin upon the left lobar hepatic tissues as well as a judgment whether insulin which passed through the left lobes without being consumed or degraded had a spillover effect upon the right side after recirculation. Histopathological end-points were used. The size of the hepatocytes was determined on hzmatoxylin-and-eosin-stained sections by a method previously described. l In essence, the technique cORsists in ...

For hepatic homotransplantation, two general types of operative procedures are available. One, which would be applicable for the treatment of malignant disease of the liver, consists of removal of the recipient's own organ and replacement with a hepatic homograft. The other variety of operation, which was first described in principle by Welch and Goodrich and their associates (Fig. 1A), is designed for the treatment of patients with hepatic failure due to benign disease, such as cirrhosis, and does not involve recipient hepatectomy.

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