ABSTRACT
Objective Budd-Chiari syndrome is apt to be misdiagnosed,so we explore its diagnosis and treatment by liver transplantation.Methods We retrospectively analyzed the clinical data of two patients who underwent liver transplantation for Budd-Chiari syndrome.One patient was misdiagnosed before the transplantation and another was diagnosed correctly.Results Both patients were grouped to Child C category with decompensated liver cirrhosis.Patient 1 was diagnosed as recurrent hepatocellular carcinoma,but the etiology of liver disease was first unknown then suspected to be schistosomiasis.This patient underwent piggyback liver transplantation.Because there was significant swelling in the perineum and lower extremities after liver transplantation,we re-reviewed the preoperative imaging data and found communicant veins between hepatic veins,which proved that the patient was actually suffered from Budd-Chiari syndrome with hepatic vein and suprahepatic vena cava occlusion before the transplantation.After conservative treatment,the swelling of the lower body was alleviated,however,the long-term survival of the patient would be compromised.Learning from the first case,we found communicant veins between hepatic veins in imaging data of patient 2,resulting in correct diagnosis of Budd-Chiari syndrome with hepatic vein and retrohepatic vena cava diseases before the transplantation,so the patient underwent orthotopic liver transplantation,in which the liver and retrohepatic vena cava were resected,and recovered uneventfully.Liver function was normal during the follow up period of 7 months.Conclusion We should consider the possibility of Budd-Chiari syndrome in patients with unexplained end-stage liver diseases.Communicant veins between the hepatic veins shown in thin CT or MRI image are the characteristic sign for diagnosing Budd-Chiari syndrome.Simultaneously hepatic vein or cava vena disease determines the choice of various technique of liver transplantation.
ABSTRACT
Objective To investigate anatomic feature of variant right hepatic artery originating from the gastroduodenal artery.Methods We studied the anatomy of hepatic artery in 70 patients by 64-slice CT scans.If the right hepatic artery originated from the gastroduodenal artery,its relation to duodenum,common bile duct and portal vein was further investigated.Results Normal hepatic artery was found in 40 patients (57.1％).Variant hepatic artery can't be categorized to classic types in 8 patients (11.4％),among them 6 patients (8.6％) were with replaced (5 patients) or accessory (one patient) right hepatic artery arising from gastroduodenal artery.With the distance between original point of the right hepatic artery and that of the gastroduodenal artery growing further anatomic course of the variant right hepatic artery is more similar to that of the right hepatic artery originating from the superior mesenteric artery.Conclusions The variation of right hepatic artery originating from the gastroduodenal artery was not uncommon.This specific variant hepatic artery can exert impact on biliary blood supply,avoiding injury decreases the incidence of serious biliary complications in general surgery.
ABSTRACT
The therapeutic potential of soluble TRAIL (sTRAIL) in hepatocellular carcinoma(HCC) was studied. The expression of TRAIL receptors was detected in 60 HCC tissues, 20 normal liver samples and 2 HCC cell lines (HepG2 and SMMC-7721) by in situ hybridization. Before and after HepG2 and SMMC-7721 were treated with sTRAIL protein with various concentrations,the apoptosis rate was observed by using flow cytometry and in situ terminal deoxynucleotidyl tranferase (TdT) labeling. The results showed death receptor 4 (DR4) and DR5 were expressed in 60 HCC tissues and 20 normal liver samples, while the expression intensity of DR in HCC tissues was stronger than in normal liver samples. DcR1and DcR2 were not detectable in 54 (90 %) and 25 (41.7 %)HCC tissues, while in 20 normalliver samples, DcR was detectable. The high expressionof DR and low expression of DcR in HCC tissues were significantly differed from the low expression and high expression in normal liver samples. The expression of DR5, DR4 and DcR2 in both HCC cell lines was detectable, but the expression of DcR1 was not detectable. The expression of DR in HCC tissues was related to the differentiation and grades of HCC. In the poor differentiated HCC, the expression of DR was decreased (P＜0.01). The expression of DR in Ⅲ/Ⅳ grades was significantly lower than that in Ⅰ / Ⅱ grades (P＜0.05). The expression of DR was not related to gender, age, HBsAg, AFP, tumor sizeand metastasis. The expression of DR in the HCC drugresistant lines was decreased. After treatment with TRAIL (100 ng/ml) for 24 h, the apoptosis rate of HCC cells, Jurkat cells and human cholangiocarcinoma cell line QBC939 was 10 %, 70 %,50 % respectively. It was suggested that the TRAILR expression is prevalent in HCC with different expression patterns of different receptor types. HCC is resistant to TRAIL-mediated apoptosis.The treatment of TRAIL alone has a limited effect on inducing apoptosis of HepG2 and SMMC-7721.