title: Ultrastructural changes in cirrhotic and noncirrhotic patients due to hepatectomy.
abstract: OBJECTIVE
  Alterations at the ultrastructural level can be identified prior to histological change in the early phase of irreversible cell damage. The aim of this investigation was to compare the ultrastructural changes in cirrhotic and noncirrhotic liver in response to ischemic and reperfusion injury due to hepatectomy.
  
  
  METHODS
  Hepatic resections using the same technique were performed in cirrhotic and noncirrhotic patients. Three biopsy specimens (Tru cut) from each patient, in the unresected part of the liver, were studied by transmission electron microscopy: immediately after laparotomy, before releasing of the porta hepatis clamp (ischemic phase), and 30-45 min after reperfusion.
  
  
  RESULTS
  All patients did well after surgery, except for 1 cirrhotic patient who died of liver failure. There were no significant differences in operative time, blood loss, and inflow occlusion times in any of the 15 patients. We found that morphological changes were the same in the 10 non-cirrhotic and 4 cirrhotic patients. Changes during the ischemic phase included nuclear membrane deformity, focal chromatin condensation at the nuclear margin, and swelling of both mitochondria and endoplasmic reticulum. In the reperfusion phase, there were early irreversible changes in the nuclei of some hepatocytes and intramitochondrial particles and increased vacuolization in cytoplasm. Endothelial cells, Kupffer cells, bile canaliculi, and Ito cells were not affected in either the ischemic or the reperfusion phase. However, in the 1 cirrhotic patient who died of liver failure, there were marked swelling and dilated cristae in mitochondria during the ischemic phase and deformity of Ito cells during the reperfusion phase.
  
  
  CONCLUSIONS
  In this, the first report of ultrastructural changes due to hepatectomy in cirrhotic patients, we found that the changes were the same as those in non-cirrhotic patients, except for the one cirrhotic patient who had postoperative liver failure.
authors.affiliation: Department of Surgery, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
authors.forename: Chumpon
authors.initials: C
authors.lastname: Wilasrusmee
authors.forename: Somsak
authors.initials: S
authors.lastname: Siritheptawee
authors.forename: Siroj
authors.initials: S
authors.lastname: Kanchanapanjapon
authors.forename: Prasert
authors.initials: P
authors.lastname: Sopon
authors.forename: Chaithip
authors.initials: C
authors.lastname: Vanichanon
authors.forename: Wichai
authors.initials: W
authors.lastname: Limpthong
authors.forename: Paisal
authors.initials: P
authors.lastname: Pongchailerks
authors.forename: Panuwat
authors.initials: P
authors.lastname: Lertsithichai
authors.forename: Skuntala
authors.initials: S
authors.lastname: Wilasrusmee
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Kittur
mesh_terms: D000328:Adult; D001648:Bile Canaliculi / Q000648:ultrastructure; D005260:Female; D006498:Hepatectomy; D022781:Hepatocytes / Q000648:ultrastructure; D006801:Humans; D007728:Kupffer Cells / Q000648:ultrastructure; D008099:Liver / Q000648:ultrastructure*; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008930:Mitochondria, Liver / Q000473:pathology; D011184:Postoperative Period; D015427:Reperfusion Injury / Q000473:pathology*