Espectro de hallazgos por TC multidetector en el trauma esplénico y hepático / Multidetector CT Findings in Splenic and Liver Trauma

El trauma abdominal cerrado puede ser causa de lesiones en varios órganos sólidos, siendo el bazo y el hígado más frecuentemente afectados en ese tipo de situaciones. La tomografía computada multicorte (TCMC), es el método de imágenes de elección en la evaluación de pacientes que sufrieron un trauma cerrado abdominal gracias a que aporta un rápido y preciso diagnóstico y permite un eficaz tratamiento. El objetivo de este trabajo, es describir el espectro de las lesiones esplénicas y hepáticas encontradas en el trauma abdominal cerrado.

Blunt Abdominal Trauma can cause lesions in several abdominal solid organs. The spleen and liver are most frequently injured in such situations. Multi Slice Computed Tomography (MSCT) is the method of choice in the evaluation of patients who suffered a closed abdominal trauma to provide a quick and accurate diagnosis and allow faster and more effective treatment. This pictorial essay aims to describe the most frequent spleen and liver injuries in blunt abdominal trauma.

Aminotransferases analysis in patients with dengue serotype IV / Análise das aminotransferases em pacientes com dengue sorotipo IV

OBJECTIVE: To evaluate the aminotransferase levels inpatients with dengue serotype IV. METHODS: We conducteda cross-sectional analysis of 3,596 people with laboratory confirmed dengue. RESULTS: The analysis showed that 49.2%(1,768) had normal aminotransferase levels, 43.4% (1,559)had changes in levels by up to three times the upper limit ofnormal, 7.0% (253) had elevations three times the referencevalue and 0.4% (16) developed acute hepatitis. Patients withthrombocytopenia and hemoconcentration had major changesin the levels of enzymes (p<0.05). Women were more susceptibleto those changes than men (p<0,05). The average AST and ALTwere higher in dengue hemorrhagic type (147.51±137.74U/Land 111.54±81.27U/L) as compared to dengue fever(55.18±52.06U/L and 60.39±57.50U/L) (p<0.05). Leukopenicpatients had aminotransferases average lower compared toindividuals without any drop in overall white blood cellcount (p<0.05). A total of 224 patients were submitted tohospitalization, with the AST average of 88.18±100.47U/Land ALT 77.95±88.38U/L, which is higher than the average inambulatory patients (p<0.05). CONCLUSION: A significantnumber of patients was found with altered levels of enzymes,which requires clinical laboratory monitoring for an extendedperiod.

OBJETIVO: Avaliar os níveis de aminotransferases em pacientes com dengue sorotipo IV. MÉTODOS: Foi realizada uma análise transversal de 3.596 pessoas com dengue confirmada laboratorialmente. RESULTADOS: A análise mostrou que49,2% (1.768) tinham níveis normais de aminotransferases,43,4% (1.559) mostraram alterações nos níveis em até três vezes o limite superior da normalidade, 7,0% (253) apresentaram elevações três vezes o valor de referência e 0,4% (16) desenvolveram hepatite aguda. Os doentes com trombocitopenia e hemoconcentração tiveram grandes alterações nos níveis enzimáticos(p<0,05). As mulheres foram mais suscetíveis a essas alterações do que os homens (p<0,05). As médias de AST e ALT foram maiores na dengue do tipo hemorrágica (147,51±137,74U/Le 111,54±81,27U/L) em comparação com dengue clássica(55,18±52,06U/L e 60,39±57,50U/L) (p<0,05). Pacientes leucopênicos tiveram a média de aminotransferases menor em comparação com os indivíduos sem qualquer queda na contagem global de glóbulos brancos (p<0,05). Um total de 224pacientes foi submetido a hospitalização, com a média de AST88,18±100,47U/L e ALT 77,95±88,38U/L, o que é mais elevado do que a média em doentes ambulatórios (p<0,05). CONCLUSÃO:Um número significativo de pacientes foi identificado com níveis alterados de enzimas, o que exige acompanhamento clínico e laboratorial por um período prolongado.

Effect of high power microwave radiation on liver injury and serum cytokine in rats / 第二军医大学学报

Objective: To investigate the effect of high power microwave (HPM) radiation on morphology of liver cells and serum cytokines in rats. Methods: Adult male Wistar rats were exposed to 100 mW/cm2 intensity microwave radiation as experimental group, and rats without radiation were designed as normal controls. The blood samples were obtained from the hearts to determine the levels of aspartate transaminase (AST), alanine aminotransferase (ALT), interleukin (IL)-6,IL-10 and IL-18 on 1d,7d and 14d after HPM radiation. Finally the rats were sacrificed and the right leaf tissues of liver were obtained immediately under ice bath, and the hepatic tissue changes were observed under routine light microscope. Results: There were inflammatory cell infiltration, scattered, and patched cell degradation, and necrosis in rat hepatic lobule on 1d and 7d after HPM radiation; the situation was improved on 14 d after radiation, but there were still cell degradation and dotted necrosis. Serum levels of AST and ALT in the experimental group were significantly higher than those in the control group on 1d and 7d after HPM radiation (P0.05). Serum levels of cytokines IL-6 and IL-18 in the experimental group were significantly higher than those in the control group on 1d and 7d after HPM radiation (P<0.01), and the changes recovered somewhat on 14d after radiation. Level of IL-10 was decreased after radiation compared with the control group, with significant difference found on 1d after radiation (P<0.05). Conclusion: HPM radiation can cause damage to liver structure and function, which might be associated with the changes of serum IL-6,IL-10 and IL-18 levels.

The levels of serum lactate, lactate clearance rate and transaminase in septic rats and their relationship with liver damage / 中国医师杂志

Objective To explore the serum lactic acid,transaminase and their relationship with liver pathological damage in sepsis rats,whether a correlation exists between serum lactate clearance rate and transaminase in sepsis rats,and whether they can be used as indicators for the prediction and evaluation of septic rats liver injury.Methods A total of 150 clean Sprague-Dawley (SD) rats was divided into normal group (n =50),sham operated group (n =50),and the cecal ligation and puncture (CLP) (n =50).Ten rats were killed after successful surgery at the 6th,12th,24th,48th,and 72nd hour in CLP group,respectively.At each time point,10 normal rats and 10 sham-operated rats were taken as a control in the corresponding time point.The liver tissue was obtained for pathological analysis.The levels of lactate and liver transaminase were detected and the lactate clearance rate was calculated.The levels of lactate and transaminase at each time point were statistically compared.The correlation analysis was performed among serum lactate,transaminase,and liver damage pathological changes.Results The rat hepatocytes in CLP group begin to appear at the 6th hour,and the damage was gradually enhanced at the 12th,24th,and 48th,and up to the worst damage at the 48th time point.The levels of lactate and alanine aminotransferase (ALT)in CLP group at the 12th and 24th hour were significantly elevated compared with the normal and sham operation groups (P ＜0.05); The level of aspartate aminotransferase (AST) in CLP group at the 6th,12th,24th,48th,and 72nd hour was significantly elevated compared with the normal and sham operation groups (P ＜ 0.05).A positive correlation was found between the levels of ALT and lactate (r =0.766,P ＜0.05),and a negative correlation was found between lactate clearance rate and ALT (r =-0.712,P ＜0.05).Conclusions In septic rats,both lactate and lactate clearance rate were correlated with ALT,and they were correlated with liver pathological damage.The level of lactate,lactate clearance rate,and ALT could be used as the key indicators to predict liver damage in septic rats.

Trauma hepático por heridas punzocortantes y por arma de fuego: Nuestra experiencia en Ciudad Juárez / Hepatic trauma due to stab and gunshot wounds: Our experience in Ciudad Juárez, México

Objetivo: Analizar el manejo de las lesiones hepáticas por trauma penetrante en un hospital de trauma sin tomografía computada. Diseño: Estudio de cohorte, comparativo analítico no aleatorio Sede: Hospital General de Ciudad Juárez (segundo nivel de atención). Análisis estadístico: Porcentajes como medida de resumen de variables cualitativas, prueba χ² de Pearson y prueba exacta de Fisher. Pacientes y métodos: Pacientes intervenidos quirúrgicamente por trauma abdominal penetrante con lesión hepática. Grupo I (heridos por arma blanca) y grupo II (heridos por arma de fuego). Se estudiaron variables dependientes: edad, sexo, mecanismo de lesión, estado hemodinámico, hemoperitoneo, grado de lesión, lesiones concomitantes, tratamiento, complicaciones y mortalidad. Resultados: Se incluyeron 86 pacientes con lesión hepática. 70% de laparotomías fueron terapéuticas, 17% fueron cirugías de control de daños y 13% laparotomías no-terapéuticas. Los grados de lesión más común fueron grado I y III. El tratamiento establecido fue ''quirúrgico-conservador'' en 44%, hepatorrafia en 33% y empaquetamiento 23%. 70% tuvieron lesiones intraabdominales concomitantes. La complicación más frecuente fue choque hipovolémico. La mortalidad para el grupo I fue 4% y en el grupo II de 32%. Discusión: No existe diferencia significativa entre los dos grupos y las variables estudiadas, excepto la mortalidad, que es mayor los heridos por arma de fuego. El manejo según los algoritmos de centros de trauma nivel I no se puede cumplir en nuestro hospital.

Objective: To analyze the management of liver injuries due to penetrating trauma in a trauma hospital without computed tomography. Design: Cohort, non randomized analytical comparative study. Setting: General Hospital of Ciudad Juárez, Mexico (second level health care center). Statistical analysis: Percentages as summary measure of qualitative variables, Pearson's χ² test and Fisher's exact test. Patients and methods: Patients subjected to surgery due to abdominal penetrating trauma with liver injury Group I (stab wounds) and Group II (gunshot wounds). We studied the following dependent variables: age, gender, injury mechanism, hemodynamic state, hemoperitoneum, degree of injury, concomitant injuries, treatment, complications, and mortality. Results: We included 86 patients with liver injury; 70% of laparaotomies were therapeutic, 17% were damage control surgeries, and 13% were non-therapeutic. The most common injury degrees were I and III. The established treatment was ''conservative-surgical'' in 44%, hepatorrhaphy in 33%, and packing in 23%. Intraabdominal concomitant injuries occurred in 70% The most frequent complication was hypovolemic shock. Mortality was of 4% for Group I and of 32% for Group II patients. Discussion: There was no significant difference between both groups and among the studied variables, except for mortality, which was higher in the gunshot group of patients. Management according to the algorithms of level I trauma centers cannot be followed at our hospital.

Traumatismo hepático / Liver trauma

El hígado es el órgano más voluminoso del abdomen, lo que lo expone a ser altamente vulnerable durante un traumatismo abdominal, tanto compresivo como penetrante. La evolución en el diagnóstico y tratamiento del traumatismo hepático ha conseguido en los últimos años un descenso de la mortalidad; lo que es atribuible a la mejoría en los métodos diagnósticos, al principio de la cirugía del control de daños y a que el número de pacientes intervenidos cada vez es menor. Actualmente el manejo tiende a ser cada vez más conservador, dejando la cirugía para casos específicos. El objetivo de este trabajo es realizar una actualización en el enfrentamiento de esta patología.

The liver is the largest organ in the abdomen, that makes it highly vulnerable in blunt and penetrating abdominal trauma. Development in the diagnosis and management of liver trauma was followed in recent years by decline in mortality, which is attributable to improved diagnostic methods, the principle of damage control surgery and the number of operated patients is shrinking. Currently, the treatment tends to be increasingly conservative, leaving surgery for specific cases. The aim of this study is describe and analize the current managment of this kind of trauma.

Role of hepatic stem cells in hepatic regeneration / 第二军医大学学报

Hepatic stem cells transplantation might be an important treatment strategy for patients with end stage liver diseases and related research has become a focus of recent studies. Hepatic stem cells of different sources have great therapeutic potential in clinical practice, but much research still need to be done before it can be used as a routine method in clinical practice. This review discusses the characteristics of hepatic stem cells and its role in liver regeneration after liver damage.

Role of cell apoptosis and oxidative stress in stressive liver injury after traumatic brain injury in rats / 中华创伤杂志

Objective To explore the effect of cell apoptosis and oxidative stress on stressive liv-er injury after traumatic brain injury (TBI) in rats. Methods The model of TBI was duplicated by u-sing modified Allen's mehtods. Forty male Wistar rats were randomly divided into control group and groups at 6,12,24,48 hours after TBI. The serum levels of ALT and AST as well as the levels of superox-ide dismutase (SOD) and malandialdehyde in liver tissue were measured. The index of hepatocyte apopto-sis was detected through flow cytometer. Pathological changes of liver tissues were observed under light and electron microscopes. Results After TBI, the serum levels of ALT and AST were significantly in-creased, while malondialdehyde was increased and SOD decreased in liver tissues. The electron micro-scope showed that the index of hepatocyte apoptosis reached a peak at 6 hours after TBi. Aggressive inju-ries of the liver tissues were observed after TBI, showed by pathological observations. Conclusion Cell apoptosis and oxidative stress may be involved in the pathogenesis of stressive liver injury after TBI.

Experiência do Hospital João XXIII no tratamento não-operatório de vísceras abdominais Maciças / Hospital John XXIII's experience in non-surgical treatment of solid abdminal visceras

O tratamento não-operatório (TNO) de pacientes traumatológicos hemodinamicamente estáveis passou a ser a conduta terapêutica mais adequada nos centros de trauma, com altos índices de sucesso e baixas taxas de complicações. Os fatores determinantes para essa conduta foram o uso de tomografia computadorizada e a organização de centros com infraestrutura adequada para o monitoramento desses pacientes. As falhas do TNO são poucas e o seu sucesso é a regra em mais de 90% das vezes. Outro fator responsável pelo sucesso do TNO é a adoção de medidas minimamente invasivas, como a angiografia e a colangiopancreatografia retrógrada endoscópica. Este artigo relata experiência do Hospital João XXIII, em Belo Horizonte, com o TNO entre novembro de 2004 e dezembro 2008.

The Non-surgical treatment (NST) of hemodynamically stable trauma patients has become the most appropriate therapeutic approach in trauma centers with high success rates and low complication rates. The determining factors for this behavior were the use of computed tomography and the organization of centers with adequate infrastructure for monitoring these patients. The NTS(TNO)failures are few and success is the rule in more than 90% of the cases. Another factor responsible for the NST success is the adoption of minimally invasive measures, such as angiography and endoscopic retrograde cholangiopancreatography. This article reports the experience with TNO/NST in Hospital João XXIII, in Belo Horizonte, between November 2004 and December 2008.

Percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound for grade Ⅲ-Ⅳ hepatic trauma / 中华超声影像学杂志

Objective To explore the value of percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound(CEUS)for grade Ⅲ-Ⅳ hepatic trauma patients.Methods Eleven patients with severe hepatic trauma were treated using percutaneous focal injection of hemostatic agents.Five of these patients were hepatic injury of grade Ⅲ,and others were grade Ⅳ according to AAST.Results Out of all patients with severe hepatic trauma,9 patients were cured by once percutaneous injection of hemostatic agents under the guidance of CEUS,and 1 patient was cured by twice injection,and 1 patient was switched to surgery because of complicated pancreatic injury and the increase of free intraperitoneal fluid.Conclusions CEUS can display the site and severity of liver injury.Combining with interventional technology,injection of hemostatic agents under the guidance of CEUS can save life and avoid to resect organ,and it can win time for treating other compound injury.

Interventional treatment of hepatic or splenic trauma under the guidance of contrast-enhanced ultrasound:an animal experiment / 中华超声影像学杂志

Objective To determine whether hemostatic agents directly injected into injury sites under the guidance of contrast-enhanced ultrasound(CEUS)can effectively control hemorrhage from hepatic or splenic trauma. Methods Healthy adult dogs were impacted by a impactor to create hepatic or splenic trauma. Among 32 dogs,28 had hepatic or splenic injury of grade Ⅲ～Ⅳ according to Injury Scale of the American Association for the Surgery of Trauma(AAST),which were divided into two groups,the treatment group and the control. In the treatment group,hemocoagulase and α-cyanoacrylate were injected respectively into the injury site and transected micro-vessel tinder the guidance of CEUS,while in the control group,normal saline was injected. Results All animals of the two groups survived after the injection. CEUS demonstrated that active hemorrhage disappeared in treatment group but still existed in the control group.In the treatment group,laparotomy showed that hepatic or splenic injury had been covered and adhered with clot and glue membrane of hemostatic agents and free intraperitoneal blood volume was significantly less than that in the control group(P=0.000),while in the control group injury bleeding did not stop after injection. Conclusions Hemostatic agents injected under the guidance of CEUS can effectively control hemorrhage from hepatic or splenic trauma of grade Ⅲ～Ⅳ. This therapy was simple,convenient and effective. It may be performed immediately after hepatic or splenic injury was diagnosed.

Research of the therapeutic enhancement by high intensity focused ultrasound combined with SonoVue on goats livers in vivo / 中华超声影像学杂志

Objective To investigate the feasibility of enhancing therapeutic effects on goats' liver in vivo treated by high intensity focused ultrasound(HIFU)combined with microbubble contrast agent SonoVue.Methods Fifteen Nanjiang goats were adopted,own control was adopted in this study.One group received purely HIFU therapy(control group),another one was radiated with HIFU combined with SonoVue contrast agent(SonoVue group).The HIFU irradiating mode was dotted with 30 mm focal length and 150 W,250 W,350 W acoustic power respectively,and the exposure time was 15 s.Animals were sacrificed and dissected 24h later,and the sizes of necrotic region were measured.Specimens were collected for histological inspection.Results Under the same parameter of exposure,the maximum length,width,depth,and the mean volume of the tissue coagulated by HIFU in the SonoVue group were all significantly greater than those in control group(P＜0.05),the change of volume coagulated tissue was much more significant with the increase of the acoustic power.The energy effciency factor (EEF)of SonoVue group was significantly smaller than that of control group(P＜0.05).The demarcation line between the necrosis and normal region was clear and the necrosis was complete,no living cell.The boundary exist amount of bubbles.Conclusions The therapy of HIFU combined with microbubble eontrast agent can substantially enhance the biological effects of the treatment and improve the efficiency of HIFU therapy on goats liver.

Blunt liver injuries in children: the role of nonoperative management

Background: Nonoperative management (NOM) is presently considered the treatment modality of choice for hemodynamically stable patients sustaining blunt liver trauma, especially in children. Objective: To evaluate role of NOM of blunt liver injuries (BLI) in children at National Hospital of Pediatrics. Subjects and method: Therecords ofallthe patientstreatedin National HospitalofPediatricswithfinaldiagnosisBLI betweenJanuary2000 and December 2006 were reviewed. The clinical signs,investigations,imagingstudies, methods oftreatmentandresultswereanalysed.Theliverinjuriesweregradedaccordingtothe American AsociationfortheSurgeryofTrauma(AAST).Results: There were15patients from one dayto 12 years of age with average BLI grade 2.5; 14 patients with precise diagnosis BLI were atempted NOM, 1 neonate was operated with diagnosis intraabdominal haemorrhage (BLI grade II found intraoperatively). Two patients (BLI grade II and V) from the atempted NOM group were operated thereafter because of hemodynamical instability or continuing bleeding, the remained 12recovered well with average hospital stay of 7.5 days. The rate of succesful NOM for BLI in our series was 12/14 (85.7%). Conclusions: NOM can be applied safely for BLI in children with high successful rate. Patients\ufffd?hemodynamic status may be more important for treatment decision-making than the injury grade according to the AAST based on ultrasound or CT.

Hepatopulmonary Syndrome Induced by Common Bile Duct Ligation in a Rabbit Model: Correlation between Pulmonary Vascular Dilatation on Thin-Section CT and Angiography and Serum Nitrite Concentration or Endothelial Nitric Oxide Synthase (eNOS) 1 Expression

OBJECTIVE: To investigate the correlation between radiologic vascular dilatation and serum nitrite concentration and eNOS expression in the endothelial cell and pneumocyte in a rabbit model of hepatopulmonary syndrome induced by common bile duct ligation (CBDL). MATERIALS AND METHODS: Thin-section CT scans of the lung and pulmonary angiography were obtained 3 weeks after CBDL (n=6), or a sham operation (n=4), and intrapulmonary vasodilatation was assessed. The diameter and tortuosity of peripheral vessels in the right lower lobe by thin-section CT and angiography at the same level of the right lower lobe in all subjects were correlated to serum nitrite concentration and eNOS (endothelial nitric oxide synthase) expression as determined by immunostaining. RESULTS: The diameters of pulmonary vessels on thin-section CT were well correlated with nitrite concentrations in serum (r = 0.92, p < 0.001). Dilated pulmonary vessels were significantly correlated with an increased eNOS expression (r = 0.94, p < 0.0001), and the severity of pulmonary vessel tortuosity was found to be well correlated with serum nitrite concentration (r = 0.90, p < 0.001). CONCLUSION: The peripheral pulmonary vasculature in hepatopulmonary syndrome induced by CBLD was dilated on thin-section CT and on angiographs. Our findings suggest that peripheral pulmonary vascular dilatations are correlated with serum nitrite concentrations and pulmonary eNOS expression.

The Protective Effects of Garlic against Carbon tetrachloride-induced Hepatotoxicity / 예방의학회지

OBJECTIVES: The purpose of this study was to find the protective effects of garlic on the halogenated hydrocarbon induced hepatotoxicities, and the possible protection mechanisms involved. METHODS: Male Sprague-Dawley rats received garlic (0.5 %) or regular diet, for 4 weeks. This was followed by a single dose of corn oil (the controls), carbon tetrachloride (400mg/kg body weight) and trichloroethylene (2,000mg/kg body weight) being administered to each diet group. Blood samples were collected 24 hours following the administration, and the serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities measured. The liver samples were studied for their cytochrome P450 and CYP2E1 contents, lipid peroxidation and histopathology. RESULTS: The results for the group receiving the 0.5 % garlic diet showed a slight decrease of CYP2E1 expression compared with the regular diet group. Carbon tetrachloride was significantly decreased the CYP2E1 contents in both the regular and garlic diet groups, but the trichloroethylene remained unchanged. Garlic did not decrease the lipid peroxidation of the liver in the control group, but attenuated the increase of lipid peroxidation caused by carbon tetrachloride. Garlic attenuated the increase of both the serum AST and ALT activities caused by carbon tetrachloride. The histopathological observations also showed that garlic attenuated centrilobular necrosis and vacuolar degenerative changes significantly in the carbon tetrachloride treated group. Conclusions : The results indicate that garlic attenuates the carbon tetrachloride-induced hepatotoxicity, through the prevention of the metabolic activation and lipid peroxidation.

Protective effect of wortmannin against pancreas and liver injuries induced by severe acute pancreatitis in rats / 中国普通外科杂志

Objective To observe the protective effect of pretreatment with wortmannin against pancreas and liver injuries indued by severe acute pancreatitis(SAP) in rats and investigate its mechanism.Methods Fifty-four SD rats were randomly divided into 3 groups: control group(C group),SAP group(P group) and SAP+wortmannin group(PW group)(n=18 per group). SAP model was induced by retrograde infusion of 50g/L sodium taurocholate into the biliopancreatic duct of rats,except C group in which sodium taurocholate was replaced by normal saline. Serum level of tumor necrosis factor-alpha(TNF-?)、 alanine aminotransferase(ALT)、aspartate aminotransferase(AST)、and nuclear factor-kappa B(NF-?B)in liver were detected. Histopathology of liver and pancreas was studied.Results In P group, serum levels of TNF-?、ALT、AST and NF-?B in liver were significantly elevated(P

Analysis of the association between periportal low attenuation, as seen on CT, after blunt abdominal trauma,and elevated central venous pressure1

PURPOSE: To assess the causes of periportal low attenuation, as seen on CT, in patients with blunt abdominaltrauma. MATERIALS AND METHODS: From among 812 patients who underwent abdominal CT after blunt abdominal trauma,we retrospectively analysed the findings in 124 with evidence of periportal low attenvation. Among these, hepaticinjury was noted in only 87. The presence or absence, and extent of hepatic injury, and of periportal lowattenuation, as seen on CT, were carefully evaluated. In each case, the ratio of the transverse diameter of theinferior vena cava(IVC) to the aorta at the level of the right adrenal gland provided an indirect measurement ofcentral venous pressure; for control purposes, the ratio was also obtained in 21 non-traumatic patients with noabnormal abdominal CT findings. RESULTS: Of the 87 patients with hepatic injury, 46 showed no periportal lowattenuation, and the average value of the ratio between the IVC and aorta was 1.16+/-0.12, while the remaining 41patients showed periportal low attenuation with a ratio of 1.51+/-0.21(p<0.05). In the 37 patients with periportallow attenuation but no evidence of concomitant hepatic injury, the average ratio was 1.52+/-0.25, while in 21non-traumatic patients it was 1.15+/-0.16. For resustication, all patients had received 0.5-5.0l of IV fluidtherapy before CT, and at the time of CT, were normotensive. CONCLUSION: Rapidly elevated central venous pressurefollowing massive IV infusion therapy in patients with blunt abdominal trauma can be one of the causes ofperiportal low attenuation, as seen on CT.

Liver injuries and falciform ligament reinforcement for haemostasis.

Clinical data of 78 patients with liver injury treated at the Pranungklao Hospital, Nonthaburi, Thailand, from February 1986 to June 1994, were described in details with reference to severity of injury and surgical treatment modality. Patients were 71 males and 7 females ranging in age from 1.8/12 to 78 years (mean 27.4 years). Of the 78 injured, 43 patients sustained blunt liver injury, and 35 sustained penetrating injury. The severity of injury was graded into mild injury (grade 1-2) in 13 patients; moderate injury (grade 3-4) in 48 patients; and severe injury (grade 5-6) in 17 patients. Treatment included drainage alone, electric cautery or haemostatic agent, simple suture, suture ligation of bleeding points, hepatic artery ligation, resectional debridement, segmental resection, hepatectomy and perihepatic packing. In addition, calceiform ligament was used with the purpose to stop bleeding in 6 patients together with other techniques such as simple suture, traction, compression tourniquet and patch graft. Overall rate of complications and mortality were 21.79% and 8.97%, respectively.

THE PROTECTIVE ACTION OF HYDROLYSATE OF ARCA SUB-CRENATA ON LIVER INJURIES IN MICE / 中国海洋药物

Hydrolysate of Area subcrenata (HA) was found to be effective in lowering the elevated SGPT level induced by carbon tetrachloride, thioacetamide (TAA) and pred-nisolone. In addition, HA was shown to shorten sodium pentobarbital sleeping time in both normal and carbon tetrachloride intoxicated mice. The results indicated that HA possessesa significantl protective action on liver injuries in mice.

Role of hepatic stem cells in hepatic regeneration / 第二军医大学学报

Hepatic stem cells transplantation might be an important treatment strategy for patients with end stage liver diseases and related research has become a focus of recent studies.Hepatic stem cells of different sources have great therapeutic potential in clinical practice,but much research still need to be done before it can be used as a routine method in clinical practice. This review discusses the characteristics of hepatic stem cells and its role in liver regeneration after liver damage.