Extra hepatic portal vein obstruction due to combined protein ‘C’ and ‘S’ deficiency - A case report

Extra-hepatic portal vein obstruction (EHPVO) is an important cause of non-cirrhotic portal hypertension, in Third World countries like India. In this disorder, it results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intra-hepatic portal vein, splenic vein, or superior mesenteric vein resulting in portal hypertension and esophagogastric varices. Extensive collateral circulation develops, involving paracholecystic, paracholedochal and pancreaticoduodenal veins which results in formation of ectopic varices, and portal biliopathy. Besides variceal bleeding, patients may have symptoms of portal biliopathy, hypersplenism, and growth retardation. Although the liver may appear normal, functional compromise develops in the long term. Patients with extra-hepatic portal vein obstruction are usually young and belong to India and other Asian countries. The variceal bleeding in EHPVO can be managed by endoscopic obliteration of varices, or by portosystemic shunt surgery. In this case report, we present a case of 15 year old male, with extra-hepatic portal vein obstruction due to combined deficiency of Protein C and Protein S recanalized by short-term low molecular heparin plus oral Rivaroxaban therapy

The human liver: vascular anatomy to determine its segments and divisions / El hígado humano: anatomía vascular para determinar sus segmentos y divisiones

This study aims at understanding the vascularization of the human liver to determine the correct way to divide it into "divisions" (sectors) and segments, for which we dissected 250 livers using the acrylic resin injection method. The results showed the role of the "Porta hepatis" in the hepatic vascular distribution, the existence of seven vascular pedicles for seven portal segments, and the role of portal fissures in the parenchymal division of the liver. Our research provides the definition of a portal segment and demonstrates the role of the hepatic portal vein in originating any liver parenchymal division.

Quisimos estudiar la vascularización del hígado humano para determinar la forma correcta de dividirlo en "divisiones" y segmentos, para lo cual disecamos 250 hígados usando técnicas de inyección acrílica. Los resultados mostraron la función de la Porta hepatis en la distribución vascular del hígado, la existencia de siete pedículos vasculares para siete segmentos portales, y el rol de las fisuras portales en la división parenquimal del hígado. Ofrecemos la definición de lo que es un segmento portal y demostramos el rol de la vena porta hepática en originar cualquier división parenquimal del hígado.

Emphasis on the significance of "short hepatic portal vein" anatomy in perihepatic portal surgery / 中国实用外科杂志

Perihilar area is a clinically specific anatomical area centered on the confluence of the main portal vein with the left and right branches and bounded by the "H-shaped transverse sulcus" of the liver. Its anatomical structure is complex, involving the liver, gallbladder, regional lymph nodes and luminal systems such as portal vein, hepatic artery, bile duct and inferior vena cava. It is a difficult area in hepatobiliary surgery. Therefore, a reasonable surgical approach is of great importance. The anatomical approach strategy of "Glisson intrathecal dissociation" can clearly show the anatomical structure of various luminal systems in the perihilar area, reduce the risk of surgical error injury, and contribute to the rational individualized surgical plan decision and implementation. The short hepatic portal vein is a small branch of the main, right and left branches of the portal vein and their confluence, which distributes and travels in the transverse sulcus of the liver. The anatomical characteristics of the short hepatic portal vein should not be ignored in the implementation of "Glisson intrathecal dissociation" in the perihilar area.

Establishment of an animal model by placing one end of PICC in hepatic portal vein of a Beagle dog and leaving the other end out of its body / 军事医学

Objective To establish an animal model by placing one end of PICC in the hepatic portal vein of a beagle dog and leaving the other end out of its body.Methods Six Beagle dogs were given respiration anesthesia through orotracheal intubation.An incision was made through the right rectus abdominalis to locate the superior mesenteric vein (SMA) and the main hepatic portal vein.The left branch of SMA was separated and cut to put PICC into the main hepatic portal vein before being ligated and fixed.The other end of PICC was elicited through the right abdominal wall and passed beneath the skin to the back neck and fastened in case of movement.Results The anesthetic effect was good and all the operations were successful.The mean operation time was about an hour and the mean blood loss was about 15 ml.The incision healed 5-7 d after operation.Conclusion The establishment of the model can improve the effects of liver-targeting drugs,which can cut down the dosage,lower the cost of treatment and experiment and reduce the adverse effect of medicines.Through PICC,we can directly draw blood from the hepatic portal vein to measure the blood concentration before the first pass elimination.Then according to the concentration,we can calculate the absorption rate in the gastrointestinal tract,which can facilitate related experimental studies.

Study on anatomic variation of the portal vein based on magnetic resonance angiography using THRIVE sequence / 实用放射学杂志

Objective To analyze the anatomic variation of the portal vein based on magnetic resonance angiography using THRIVE sequence in one-stop examination of the liver.Methods Reconstructed three-dimensional images of 648 cases of hepatic portal vein acquired by THRIVE sequence were analyzed.Anatomic variation of the hepatic portal vein was investigated and the diameters of main portal vein (MPV), splenic vein (SV), superior mesenteric vein (SMV) and inferior mesenteric vein (IMV) were measured.Results (1)Four types of different variations of intrahepatic portal vein were observed, with normal type accounting for 79.2% (514/648), type Ⅰ 8.3% (54/648), type Ⅱ 9.0% (58/648) and type Ⅲ 3.4% (22/648), respectively.(2)Four types of different variations of extrahepatic portal vein were also observed, with type Ⅰ accounting for 37.4% (167/447), type Ⅱ 20.4% (91/447), type Ⅲ 36.2% (162/447) and other 6.0% (27/447), respectively.(3)Diameter of MPV, SV, SMV and IMV were (14.03±2.44) mm, (9.51±2.40) mm, (11.14±1.99) mm and (6.01±0.78) mm, respectively.Conclusion It is feasible to analyze anatomic variation in the hepatic portal vein using reconstructed three-dimensional images acquired by THRIVE sequence in one-stop examination of the liver.

Research advances in non-cirrhotic portal hypertension / 临床肝胆病杂志

Although liver cirrhosis is the most common cause of portal hypertension (PH), about 20% of PH cases are caused by non-cirrhotic reasons, which are referred to as non-cirrhotic portal hypertension (NCPH), with a high incidence rate in developing countries. NCPH is a group of heterogeneous hepatic vascular diseases, including idiopathic portal hypertension (IPH) and extrahepatic portal vein obstruction (EHPVO), as well as the rare diseases in clinical practice such as Budd-Chiari syndrome, congenital hepatic fibrosis, and nodular regenerative hyperplasia. The patients with NCPH usually have the symptoms of portal hypertension, such as recurrent variceal bleeding and splenomegaly, but liver function is well preserved in these patients. At present, the diagnosis of NCPH lacks a universally accepted standard and remains a challenge. In clinical practice, the method of exclusion is usually applied for the diagnosis of HCPH, and liver biopsy is performed when necessary to make a confirmed diagnosis. This paper introduces the pathogenesis and pathological manifestations of IPH and EHPVO, as well as the selection of diagnostic methods and therapeutic strategies. If upper gastrointestinal bleeding can be effectively controlled, NCPH is considered to have a relatively good prognosis.

Simultaneous Determination of Pinoresinol Di-glucopyranoside and Pinoresinol Glucoside in Rat Plasma by HPLC-tandem MS/MS for Pharmacokinetic Study / 中草药·英文版

Objective Pinoresinol di-glucopyranoside (PDG) is one of the main active lignans of Eucommiae Cortex considered to be a high-quality antihypertensive drug. In this study the pharmacokinetic process of PDG and its primary in vivo metabolite pinoresinol glucoside (PG) in the portal and jugular vein were surveyed and evaluated simultaneously. Methods A sensitive high-performance liquid chromatography coupled with tandem quadruple mass spectrometry (HPLC-MS/MS) method and sample preparation protocol were developed and validated in method of selectivity, sensitivity, precision, stability, and extraction recovery for the simultaneous determination of PDG and its primary metabolite PG in rat plasma. The double intubation technique was used to simultaneously collect blood from common jugular vein and hepatic portal vein after single ig administration of PDG. Results Using this method, the quantification linearity ranges of PDG and PG in rat plasma were both 0.05-100 ng/mL. This method was successfully applied to the evaluation of the absolute oral bioavailability of PDG and determination of the pharmacokinetic properties of PDG and PG after ig administration of single dose in rats. The bioavailability of PDG at common jugular vein was 51.3% compared to that of 91.6% at hepatic portal vein. Conclusion We conclude that liver is the major conversion site of PDG to PG.

Mechanisms of the alleviation of islet graft injury in the gastric submucosa / 中华肝胆外科杂志

Objective To investigate the mechanisms of the alleviation of islet graft earlier injury in the gastric submucosa.Methods The recipients were divided into gastric submucosa group (n =8) and hepatic portal vein group (n =8).1200IEQ SD rat islets were transplanted into diabetic SD rats induced by the administration of streptozocin (STZ).Glucose tolerance test and pathological examination were performed 14 days post transplantation.30 min after the transplantation,the C-peptide of the two groups were detected.12 h after the transplantation,IL-1β and TNF-α of the two groups were examined.Results The mean survival time (MST) of grafts in gastric submucosa group was (25.9 ± 4.1) d and (16.0 ± 0.8) d (P ＜0.01) in portal vein group.The results of glucose tolerance test and immunofluorescent staining demonstrated that grafts in gastric submucosa group survived well and got excellent function 14 days post transplantation.Compared with the gastric submucosa group,after 30 min of the transplantation,C-peptide in portal vein group was significantly higher [(1.46 ± 0.28) ng/ml.vs.(3.84 ± 0.22) ng/ml,P ＜ 0.01].Additionally,the level of IL-1β [(29 ± 1.41) pg/ml.vs.(262.26 ± 53.37) pg/ml,P ＜ 0.01] and TNF-α [(23 ± 1.41) pg/ml.vs.(138.51 ± 39.5) pg/ml,P ＜ 0.01] in portal vein group,were also significantly higher than the gastric submucosa group,after 12 h of the transplantation.Conclusion Islet transplantation in gastric submucosa prolongs islet grafts survival by avoiding or alleviating IBMIR and the injuries induced by early inflammatory mediators.

A Case of Successful Treatment of Portal Venous Gas Caused by Acute Pancreatitis / 대한소화기학회지

Hepatic portal venous gas (HPVG) has been considered a rare entity associated with a poor prognosis. Portal vein gas is most commonly caused by mesenteric ischemia but may have a variety other causes. HPVG can be associated with ischemic bowel disease, inflammatory bowel disease, intra-abdominal abscess, small bowel obstruction, acute pancreatitis, and gastric ulcer. Because of high mortality rate, most HPVG requires emergent surgical interventions and intensive medical management. We experienced a case of hepatic portal venous gas caused by acute pancreatitis and successfully treated with medical management.

Studies on metabolism of Chinese materia medica of radix from Paeonia lactiflora Pall / 国际中医中药杂志

ObjectiveTo research the metabolism of components in the Radix of Paeonia lactiflora Pall. Methods(①) we established the HPLC fingerprint of water extract of Paeonia lactiflora Pall. and real-time monitored the chemical composition. (②) We established the HPLC fingerprint of rats' serum samples from hepatic portal vein, serum samples from aorta abdominalis and samples of intestinal absorption of Paeonia lactiflora Pall. (③) On this basis, using the established methods, I-IPLC fingerprint spectrum of serum samples,the sample of herb, the sample after intestinal metabolism, rats' serum samples from hepatic portal vein and rats'serum samples from aorta abdominalis were analyzed and compared in order to infer the metabolism of components in the Radix of Paeonia lactiflora Pall. Results24 compositions were detected, seven of which were metabolized by intestinal flora and could not be absorbed into blood; six of them could not be absorbed directedly into intestinal; eight new compounds were absorbed into blood after bowel metabolism while they were not detected in water extract in Paeonia lactiflora Pall. ConclusionWe could infer the metabolic processes of chemicals of Paeonia lactiflora Pall. in oral administration with this method.

Veias do sistema porta-hepático em gansos domésticos / Veins from hepatic portal vein system in domestic geese

A distribuição intraparenquimal das veias porta-hepáticas foi estudada em 30 gansos domésticos. Latex Neoprene corado foi injetado pela veia isquiática e os animais forma fixados por imersão e injeção intramuscular com formol a 10 por cento e dissecados. O fígado esteve composto por um grande lobo hepático direito e por um lobo hepático esquerdo menor, os quais estiveram conectados por uma ponte de parênquima. O lobo direito do fígado teve exclusivamente vasos do sistema porta-hepático formados pela distribuição intraparenquimal da veia porta-hepática direita, enquanto que no lobo esquerdo estes originaram-se da veia porta-hepática direita e de pequenas veias porta-hepáticas esquerdas. A veia porta-hepática direita emitiu o ramo caudal direito, que emitiu um pequeno ramo caudolateral direito e um grande ramo caudomedial direito. Cranialmente esta veia emitiu os ramos craniais direito e ramos lateral direito. A porção transversa da veia porta-hepática direita cruzou para o lobo hepático esquerdo, emitindo de 1 a 6 pequenos ramos craniais e caudais para a região média do fígado. No lobo esquerdo, o ramo esquerdo da veia porta-hepática direita emitiu o ramo cranial esquerdo, o ramo lateral esquerdo e o ramo medial. De 1 a 6 veias porta-hepáticas esquerdas foram identificadas desembocando ou no ramo esquerdo da veia porta-hepática direita ou em sua porção transversa, oriundos do ventrículo gástrico e do pró-ventrículo. Em 40 por cento dos gansos uma veia porta-hepática própria oriunda da confluência de vasos venosos da face esquerda do ventrículo distribuiu-se na extremidade caudal do lobo esquerdo isoladamente.

The intraparenchymal distribution of the hepatic portal veins in 30 domestic geese were studied. Stained Neoprene latex was injected into the isquiatic vessels, and the animals were fixed in 10 percent formaldehyde by immersion and intramuscular injection. The liver of geese was composed of a large right and a smaller left hepatic lobe, connected by a parenchyma bridge. The right hepatic lobe had vessels exclusively from the hepatic portal system composed by intraparenchymal distribution of the right hepatic portal vein, while the vessels of the left hepatic lobe came from the right hepatic portal vein and from small left hepatic portal veins. The right hepatic portal vein emitted the right caudal branch, which emitted a small right caudolateral branch and a large right caudomedial branch. Cranially this vein emitted right cranial and right lateral branches. The tranverse portion of the right hepatic portal vein crossed to the left hepatic lobe, emitting 1 to 6 small cranial and caudal branches to the medial area of the liver. In the left hepatic lobe, the left branch from the right hepatic vein emitted the left cranial, left lateral and left median branches. One to six left hepatic portal veins were identified arising from the left branch or from the transverse portion of the right hepatic portal vein. These vessels arose from the gizzard and pro-ventricle. In 40 percent of geese one proper hepatic portal vein originated from venous vessels of the gizzard and was distributed into the caudal extremity of the left hepatic isolated lobe.

Comparison of Morphology and Microstructural Components of Hepatic Portal Vein between Human and Pig / 华中科技大学学报（医学）（英德文版）

In order to provide morphological data and theoretical basis for pig-to-human hepatic xenotransplantation, the difference in morphological parameters and vessel wall structural factors between human and porcine hepatic portal vein was studied. From human subjects and pigs of varying ages, hepatic portal veins were collected, paraffin-embedded and cut into sections. The histological structures were stained with HE, and elastin, collagen and smooth muscles were stained with Weigert, Aniline blue and orange G, respectively. Morphological parameters and relative contents of structural components were determined under microscopy and by computer image analysis system, respectively. The results showed that histological structures of human and porcine hepatic portal vein wall were similar. Caliber, wall thickness, lumen and wall area in pigs increased with age, all in linear correlation to months. Morphological parameters of 6- month-old pigs were similar to those of human. In pigs, collagen content increased gradually with months, elastin content remained relatively stable, smooth muscle content reached the peak at the 3rd month, and collagen/elastin (C/E) rose gradually. The contents of collagen and elastin in porcine hepatic portal vein wall were lower, while the content of smooth muscle was higher than in human, and C/E at the 5th and 6th month was similar to that in human. It is concluded that morphological parameters and contents of structural components of porcine hepatic portal vein vary with age. At the 6 month, its caliber, wall thickness, lumen and wall area are similar to those of human. There are differences in contents of structural components between human and pigs. However, in terms of C/E, mechanic properties of pigs at the 5th and 6th month mimic those of human, hence inosculation is viable in xenotransplantation between pigs and human.