ABSTRACT
Objective To investigate the effect of selective bowel decontamination (SBD) on prognosis of 90％ hepatectomy in rats.Methods We adopted rat model of subtotal hepatectomy(90％,SHx),gentamicin + polymyxin + nystatinor saline of the same amount was administrated preoperatively.Liver damage makers,portal and systemic lipopolysaccharide(LPS),mucosal damage,signaling pathways and liver regeneration were investigated.Results We found that SHx resulted in significantly enhancedsystemic LPS.Inhibition of gastrointestinal gram-negative bacteria by SBD significantly reduced LPS levels and improved survival after SHx.SBD protected intestinal mucosa barrier,alleviated liver parenchymal damage and inflammation and promoted liver regeneration.Conclusion SBD is beneficial and necessary for extended heptactomy.
ABSTRACT
Objective To study the clinicopathological features and prognosis of Gastric hepatoid adenocarcinoma (GHA) and aims to guide future clinical practice.Method We retrospectively studied the clinical data of 25 patients with pathologically confirmed GHA who were admitted to our hospital from January 2003 to December 2015.Results There were 19 males and 6 females.The average age was 61.2 years.The clinical manifestations were non-specific.Pathologically,majority of GHA presented with ulcerative type,poor differentiation and extensive vascular cancerous embolus.Preoperative liver metastases were found in 12 patients,and postoperative liver metastases in 15 patients.Conclusions GHA is a special primary gastric adenocarcinoma which possesses both hepatocellular carcinoma-like and adenocarcinoma-like histology.GHA is characterized by a significantly elevated serum AFP and early hepatic metastasis.GHA is therefore often misdiagnosed as primary hepatocellular carcinoma.The main treatment option remains to be surgical resection,and the prognosis is poor.
ABSTRACT
Objective To study the role of mesenchymal stem cells (MSC) in an animal model combining ischemia-reperfusion with 85％ liver resection.Methods Eight-week-old male SD rats received BM-MSC by tail vein and then underwent 30-min ischemia followed by 85％ liver resection.The survival rate was monitored for 7 days after surgery.Liver regeneration was assessed on day 2 after hepatectomy.Liver damage,liver cell apoptosis,and cytokine expression in the first 24 h after hepatectomy were also assessed.Results BM-MSC mostly homed to the spleen.Transplantation significantly inhibited myeloperoxidase [(19.9 ± 6.0) mg/g vs.(41.4 ± 10.2) mg/g] and downregulated proinflammatory cytokines.BM-MSC significantly reduced the ALT and AST levels [AST (1 475 ± 275) IU/L vs.(2 550 ± 441) IU/L,P ＜ 0.05;ALT (738 ± 101) IU/L vs.(1 113 ± 268) IU/L,P ＜ 0.05].The attenuation of liver injury was also verified histologically 24 h after surgery.Liver cell apoptosis was markedly reduced.Moreover,BM-MSC infusion significantly promoted remnant liver regeneration.As a result,the survival rate was improved by BM-MSC treatment in this model (95％ vs 70％,P ＜ 0.05).Conclusion In an animal model combining ischemia-reperfusion with 85％ liver resection,BM-MSC infusion attenuated liver injury and promoted hepatocyte regeneration,resulting in improved survival rate.
ABSTRACT
Gastric hepatoid adenocarcinoma (GHA) is a rare but important sub-type of gastric adenocarcinoma characterized by high serum α-fetoprotein,early lymphatic and hepatic metastasis,and poor prognosis.Clinically,the presentation could be atypical,liver neoplasm could be the initial finding.With similar clinicopathological presentation as hepatocellular carcinoma (HCC),prompt and correct diagnosis can be a challenge,especially in endemic areas with a high incidence of HCC.Once diagnosed,surgical removal remains the treatment of choice.This review focus on advancement on the biological,histological and immunohistological features,and the clinicopathological presentation of GHA.
ABSTRACT
Objective To investigate the diagnosis and treatment of traumatic pancreatic injury.Method The clinical data of 35 patients with traumatic pancreatic injury treated between January 1998and July 2010 at the General Hospital of Chinese PLA were retrospectively analyzed.Results There were 9 patients with Grade Ⅰ injury,7 with Grade Ⅱ injury,7 with Grade Ⅲ,7 with Grade Ⅳ,and 5 with Grade V injury,respectively.The diagnostic rate using CT before operation was 75.8％.8 patients with mild traumatic pancreatic injury received nonoperative treatment. 27 patients underwent open operation which included 15 simple external drainage of the pancreas area,2 distal pancreatectomy,5 Roux-en-Y pancraticojejunostomy,3 duodenal diverticulisation procedure,and 2 pancreaticoduodenectomy.After operation,there were 14 patients with pancreatic leakage,9 with intraabdominal infection,and 6 with intrabdominal bleeding.There were 3 patients with Grade Ⅳ and Grade V injuries who died of multiple organ failure or uncontrolled massive intraabdominal bleeding.Conclusions It was difficult to diagnose pancreatic injury before operation.CT was a suitable method to accurately diagnose severe traumatic pancreatic injury.Most minor pancreatic injury could be treated nonoperatively or by external drainage.The appropriate operation should be selected according to the extent and degree of the injuries basing on the principle of damage control in patients with major injuries.Pancreatic fistula,intraabdominal infection and bleeding were conrmon complications after operation.Multiple organ failure and massive bleeding were the main causes for mortality.
ABSTRACT
OBJECTIVE To discuss the preventive methods of hepatitis B virus reinfection after liver transplantation. METHODS Eighty eight liver transplantation recipients with HBV-related end-stage liver diseases including chronic fulminant hepatitis B,end-stage liver cirrhosis and liver carcinoma were analyzed retrospectively,and were given lamivudine pre-transplantation to prevent hepatitis B virus reinfection.Post-transplantation medicines of lamivudine were administered in 3 cases;lamivudine and hepatitis B immunoglobulin(HBIg) in 85 cases.The follow-up criteria included serum HBV,HBV-DNA,liver biopsy,immunohistochemical study of liver biopsy specimens and clinical manifestations.All of patients were followed-up 6 months at least.RESULTS Two of the three cases who taken lamivudine developed reinfection,the little time is 6 months following liver transplantation.There were three of eighty five cases taken lamicudine and HBIg(small dosage) developed reinfection.CONCLUSIONS Liver transplantation is an effective treatment for HBV-related end-stage liver diseases.Given lamivudine at the pre-transplantation could reduce the levels of the HBV virus copies.Lamivudine and HBIg post-transplantation offer effective prevention against hepatitis B virus reinfection.
ABSTRACT
OBJECTIVE To explore the treatment measure of pulmonary infection after liver transplantation.METHODS The clinical data of 78 cases of pulmonary infection after liver transplantation in our hospital were analyzed retrospectively.RESULTS The incidence of pulmonary infection in this group of patients was 48.8%.The mean onset time of the first pulmonary infection after operation was(9.56?5.53)days after surgery.Forty four patients were diagnosed as right pneumonia,14 as left pneumonia,and 20 bilateral pneumonia.Long operation time,mechanical ventilatory time,abdominal bleeding,intraoperative total fluid perfusion and renal dysfunction after liver transplantation were risk factors of pulmonary infection.87.2% Of these patients improved,and 12.8% died.CONCLUSIONS The mortality of pulmonary infection after liver transplantation is high.Bacteria and fungi are the major pathogens.The key of prevention and cure of pulmonary infection after liver transplantation wis included of cutting down operation time,lessening abdominal bleeding,controlling intraoperative fluid perfusion,extubating as soon as possible,protecting renal dysfunction and raising pathogeny to check.