Despite numerous studies in the past it is not possible yet to predict postoperative liver failure and safe limits for hepatectomy. In this study the following liver function tests ICG-ER (indocyaninegreen elimination rate), GEC (galactose elimination capacity) and MEGX-F (monoethylglycinexylidid formation) are examined with regard to loss of liver tissue and prediction of operative risk. Liver function tests were assessed in 20 patients prior to liver resection and on the 10th. postoperative day. Liver and tumor volume were measured by ultrasound and pathologic specimen and the parenchymal resection rate was calculated. In patients without cirrhosis (n = 10) ICG-ER and MEGX-F remained unchanged after resection, GEC was reduced but did not correspond to the resection rate. Patients with cirrhosis (n = 10) had a significantly lower ICG-ER and GEC before resection than patients without cirrhosis. After resection these tests were unchanged. Patients with liver related complications and cirrhosis (n = 5) had lower ICG-ER and GEC than patients with cirrhosis and no complications. In the postoperative course all liver function tests in these patients were significantly lower compared to preoperative results. Comparing liver function tests ICG serves best to indicate postoperative liver failure. Liver function tests do not correspond with loss of liver tissue.

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comEosinophilic syndrome with life-threatening end-organ damage Shahd Ahmed, Erini V Kasfiki, John Smith ABSTRACT Introduction: Hypereosinophilic syndrome (HES) can be a multisystem disorder due to direct end-organ damage by eosinophilia, and can rarely present with life-threatening features. We present a case of multi-organ failure secondary to eosinophilia related to medications. Case report: A 66-year-old woman with a recent diagnosis of asthma on montelukast, presented with excruciating pains of sudden onset in her lower limbs, and on admission, she was found to be in multi-organ failure. After initial resuscitation, immunological investigations, including vasculitic screen were negative, and hematological investigations revealed severe eosinophilia. She was diagnosed to have systemic eosinophilic granulomatosis polyarteritis secondary to montelukast. The agent was withdrawn and the patient was started on prednisolone. The initial symptom of severe pains preventing her from mobilizing was reversed within days and the patient was cured and become steroid free after six weeks of steroid treatment with no further problems reported in subsequent follow-up. Conclusion: Eosinophilia may have a variety of causes, and montelukast is a recognized agent that can give rise to an eosinophilic syndrome. It can only be diagnosed once other systemic disorders have been excluded. The presentation can vary and can be multisystem, and rarely lifethreatening, but it potentially is completely reversible, depending on the underlying diagnosis. In case of medications causing the syndrome, stopping the agent and giving a course of steroids may reverse the condition as in this case, without the need of immunotherapy in the long-term.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Papillary thyroid carcinoma presenting as a lateral neck mass in the presence of a normal thyroid is extremely rare. Ectopic thyroid tissue can arise in the lateral aspect of the neck, and, therefore, PTC may arise at this site in ectopic tissue. Alternatively, cervical cystic lymph node metastasis may be a first presentation of occult PTC. Case Report: A case of a 28-year-old male was referred for investigation of a painless left-sided neck swelling. Excisional biopsy revealed PTC, and completion surgery revealed papillary microcarcinoma and a further lymph node metastasis in the definitive resection specimen. Conclusion:This case highlights that PTC always needs to be considered in the differential diagnosis of lateral neck swellings even in presence of a normal thyroid. Establishing the exact etiology of lateral cystic PTC can be challenging.

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