Thesis (M.D.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 109-124).

Thesis (M.D.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 109-124) Also available in print.

In the work reported here the author set out to investigate five aspects of albumin metabolism following partial hepatectomy in the rat. 1. The plasma albumin levels following partial hepatectomy. 2. The effect of partial hepatectomy on the albumin synthesis rate. 3. The effect of supplementary amino acids on the albumin synthesis rate following partial hepatectomy. 4. The effect of hydrocortisone on the albumin synthesis rate following partial hepatectomy. 5. The effect of partial hepatectomy on the albumin catabolic rate.

published_or_final_version / Medicine / Master / Doctor of Medicine

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Thesis (Ph. D.)--University of Hong Kong, 1998. / Includes bibliographical references.

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Based on figure from American Association for Cancer Research (2010) & Global Cancer Statistics (2011), Liver cancer (HCC) is the sixth most frequently diagnosed cancer globally and third leading cause of cancer death (Jemal, A. et al., 2011; Jemal, A., Center, M. M., DeSantis, C. et al., 2010). In Hong Kong, Liver Cancer caused 1488 deaths in 2009 in total; it is 2nd and 4th leading killer of cancer death among Hong Kong male and female respectively (Hong Kong Cancer Registry, 2010). However, surgical resection for HCC remains as mainstream treatment modality and extensive studies on post-operative surgical outcomes for different HCC treatment modalities have been published. Nevertheless, the influence of kidney function on surgical outcomes on HCC patient stays novel and it emerges a need to explore on the relation. This study aims to compare the surgical outcomes of post hepatectomy HCC patients between reduced kidney function and normal kidney function in terms of (1) Length of hospital stay, (2) Survival rate, (3) Hospital Mortality and (4) Overall post operative complications. The kidney function can be reflected by the glomerular filtration rate (Thomas, R., Stanley, B. & Datta, S., 2007; Daugirdas, J. T., 2011). The direct measurement of GFR is a complicated and expensive procedure, which is not clinical possible to screen every patient. Thus this study adopted modified Cockcroft- Gault (CG) Formula, one type of creatinine based glomerular filtration rate estimation formulas with normalization to body surface area. Modified CG formula calculate the estimated glomerular filtration rate (eGFR) based on age, body weight, body height, gender and serum creatinine level (Himmelfarb, J. & Sayegh, M. H., 2010; Daugirdas, J. T., 2011; Joanna, Q. H. & Heather A. N., 2011). The eGFR of 452 HCC patients with major hepatectomy was evaluated and categorized into different kidney function groups according to the chronic kidney disease staging system suggested by K/DOQI, National Kidney Foundation. Hence, the surgical outcomes from different kidney function groups are analyzed and compared. Length of hospital stay was analyzed by Kruskal-Wallis Test. Hospital mortality and incidences of post-op complication are analyzed by Chi-square test. Lastly, the survival rate is analyzed by Kaplan-Meier Log rank test; the result is presented in form of survival curve, then 5-year survival rate of different group of samples are obtained and compared. Result of the study shows no evidence that patients with chronic kidney disease will have a longer hospital stay and more prone to surgical complications post operatively. However, it is indicated that the hospital mortality is associated with the severity of kidney function reduction and suggested that patients with chronic kidney disease are at higher risk of post-operative death than those with normal kidney. Patient with severe reduction of kidney function should be aware of high foreseeable chance of death after the surgery and special caution need to be taken. Surprisingly, the result revealed that the overall survival improves with the severity of kidney function reduction and the patients with worse kidney function are more likely to have a better survival. Nevertheless, the result on survival rate suspected to be biased by possible confounders and underlying co-morbidities of samples. In conclusion, eGFR formula is recommended in clinical estimation of kidney function for the patients. Also, it is suggested that HCC patients with reduced kidney function are more susceptible to hospital death after hepatectomy than normal individuals. Thus, cautious consideration and risk analysis before operation is particularly crucial for HCC patient with chronic kidney disease. / published_or_final_version / Medicine / Master / Master of Medical Sciences

No description available.

A cirurgia do fígado apresentou extraordinário avanço desde a primeira ressecção planejada realizada por Langenbuch em 1888, e o primeiro transplante de fígado realizado por Starzl em 1963, até atualmente quando extensas ressecções e transplantes de partes do fígado são possíveis. Isso se deve graças, entre outros fatores, ao reconhecimento da grande capacidade regenerativa do fígado. A regeneração hepática tem sido objeto de estudo por quase 100 anos, no entanto, o mecanismo pelo qual o hepatócito é estimulado à replicação não foi completamente elucidado. As citocinas têm papel fundamental no mecanismo de regeneração do fígado, destacando-se entre elas o TNF- e a IL-6. Elas favorecem a indução de outras citocinas e estimulam a regeneração. Elas, no entanto, contribuem também no mecanismo de lesão do hepátocito em situações como a da isquemia e reperfusão. Alguns dados da literatura são conflitantes e mostram respostas diferentes na regeneração hepática provocadas pela inibição do TNF-. A pentoxifilina é um derivado da metilxantina que tem uma potente ação inibidora da síntese de TNF-. O presente estudo visa a avaliar o efeito da administração de pentoxifilina na regeneração hepática em ratos submetidos a ressecção de 70% do parênquima hepático. Os animais foram divididos em 4 grupos: Controle, grupo I (laparotomia), Grupo II (hepatectomia + salina) e grupo III (hepatectomia + pentoxifilina). Foram realizadas dosagens de transaminases (AST e ALT) 2, 6 e 48 horas após o procedimento, de citocinas (TNF- e IL-6) no soro e no tecido hepático 2 e 6 horas após a operação, e realizado estudo histológico para avaliação do índice mitótico e do PCNA com o intuito de quantificar a regeneração hepática 48 horas após o procedimento. Os resultados mostraram que a pentoxifilina foi efetiva no bloqueio do TNF- e da IL-6 no soro, mas não no tecido hepático dos animais, e que esse bloqueio melhorou a regeneração hepática documentada pelo índice mitótico e pelo PCNA. Pudemos então concluir que a pentoxifilina, nas condições do presente estudo, melhorou a regeneração do fígado após ressecção de 70% do parênquima hepático por mecanismo relacionado a redução das citocinas séricas e manutenção das citocinas do tecido hepático / Liver surgery has grown extraordinarily from the first planned ressection performed by Langenbuch in 1888, and the first successful orthotopic liver transplantation by Starzl in 1963 to the extended liver resections and living donors liver transplantations currently performed in many centers. It occurred, among others factors, because of the recognition of the great liver regenerative capacity. Liver regeneration has been object of study for almost 100 years. However the mechanism by which hepatocytes replication is stimulated is not completely elucidated. Cytokines, mainly TNF- and IL-6, play a pivotal role in liver regeneration mechanism. However they also contribute to hepatocytes damage mechanisms, like in ischemia-reperfusion injury. Indeed some studies are conflicting, and show different effects of TNF- inhibition in liver regeneration. Pentoxifylline is a methylxanthine compound known to inhibits TNF- production by monocytic cells. The present study aims to evaluate the effect of pentoxifylline in liver regeneration in rats submitted to 70% hepatectomy. The animals were randomized into 4 groups: Control, group I (sham), Group II (hepatectomy + saline) and group III (hepatectomy + pentoxifylline). AST and ALT serum levels were determined at 2, 6 and 48 hours after the procedure, TNF- and IL-6 serum levels and liver tissue levels were determined at 2 and 6 hours after the operation. Mitotic index and PCNA were performed to quantify liver regeneration 48 hours after the procedure. We found that pentoxifylline reduces TNF- and IL-6 serum levels, without changes in the liver tissue levels. These results were associated with an improvement liver regeneration evaluated by the mitotic index and the PCNA. We concluded that pentoxifylline improved liver regeneration after 70% hepatectomy by a mechanism that comprises blood but not hepatic cytokines reduction