ACG Clinical Guideline: disorders of the hepatic and mesenteric circulation

Disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries have important clinical consequences and may lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma. Although literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance and recommendations for management of these conditions. These guidelines represent the official practice recommendations of the American College of Gastroenterology. Key concept statements based on author expert opinion and review of literature and specific recommendations based on PICO/GRADE analysis have been developed to aid in the management of vascular liver disorders. These recommendations and guidelines should be tailored to individual patients and circumstances in routine clinical practice.

Repeatability of the "flash-replenishment" method in contrast-enhanced ultrasound for the quantitative assessment of hepatic microvascular perfusion

This study aimed to evaluate the feasibility and repeatability of the flash-replenishment method in contrast-enhanced ultrasound (CEUS) perfusion imaging and assess quantitatively microvascular perfusion in the liver. Twenty healthy New Zealand rabbits were submitted to CEUS perfusion imaging with continuous intravenous infusion. Using flash-replenishment kinetics, the dynamic process of depletion and refilling of microbubble contrast agent was recorded. The hepatic microvascular perfusion parameters were calculated, including region of interest, peak intensity (PI), area under the curve (AUC), and hepatic artery to vein transit time (HA-HVTT). A consistency test was performed for multiple measurements by the same operator and blind measurements by two different operators. The hepatic perfusion imaging of 3×108 bubbles/min had minimal error and the best imaging effect and repeatability. The variability of the perfusion parameter measured at 3 cm depth under the liver capsule was at a minimum with coefficient of variation of 3.9%. The interclass correlation coefficient (ICC) of measurements taken by the same operator was 0.985, (95% confidence interval, CI=0.927-0.998). Measurements taken by two operators had good consistency and reliability, with the ICC of 0.948 (95%CI=0.853-0.982). The PI and AUC of liver parenchyma after reperfusion were lower than before blocking; and HA-HVTT was significantly longer than before blocking (P<0.05). The flash-replenishment method in CEUS perfusion imaging showed good stability and repeatability, which provide a valuable experimental basis for the quantitative assessment of hepatic microvascular perfusion in clinical practice.

Portal Vein Dopplerflowmetry in healthy sheep according to age / Dopplerfluxometria da veia portal em ovinos hígidos de acordo com a idade

Pulsed Doppler ultrasound was used to evaluate portal blood flow, portal velocity and portal congestion index in 24 healthy sheep divided into groups (lambs, yearlings and ewes), according to age. Measurements were performed at the 11th right intercostal space using ideal insonation angle and uniform insonation method. Mean values obtained in each group were compared with one-way ANOVA, followed by Tukey post-hoc test. Portal velocity and portal blood flow were statistically similar between the groups (P>0.05). Mean portal velocity were 17.75; 17.13 and 16.75; while mean portal blood flow were 26.65; 31.04 and 24.32 for lambs, yearlings and ewes, respectively. Portal congestion index was statistically distinct between the groups and values for lambs, yearlings and ewes were 0.009; 0.058 and 0.09, respectively (P<0.01). Statistical differences were observed in portal vein diameter, portal vein area and portal congestion index between the groups, presumably due to influence of weight and not to age.(AU)

A ultrassonografia com Doppler pulsado foi utilizado para avaliar o fluxo sanguíneo portal, velocidade portal e índice de congestão portal em 24 ovinos saudáveis divididos em grupos (cordeiros, borregos e ovelhas), de acordo com a idade. As medições foram realizadas no 11o espaço intercostal direito utilizando ângulo de insonação ideal e método de inclusão uniforme. Os valores médios obtidos em cada grupo foram comparados com ANOVA, seguido pelo teste post-hoc de Tukey. A velocidade portal e o fluxo de sangue portal foram estatisticamente semelhantes entre os grupos (P>0,05). A velocidade portal média foram 17,75; 17,13 e 16,75; enquanto o fluxo de sangue portal médios foram 26,65; 31,04 e 24,32 para cordeiros, borregos e ovelhas, respectivamente. O índice de congestão portal foi estatisticamente diferente entre os grupos e os valores para cordeiros, novilhos e ovelhas foram 0,009; 0,058 e 0,09, respectivamente (P<0.01). Observaram-se diferenças estatísticas nos diâmetros da veia porta, na área da veia porta e nos índices de congestão portal entre os grupos, provavelmente devido à influência do peso e não pela idade.(AU)

Total liver CT perfusion imaging for evaluation on rabbit liver VX2 tumor perfusion and comparative analysis through immunohistochemisty / 中南大学学报(医学版)

To investigate the correlations among total liver CT perfusion parameters, unpaired arteries (UAs) and microvessel area (MVA) in a rabbit liver VX2 tumor model, and to learn the tumoral angiogenesis condition and the mechanisms for perfusion imaging.
 Methods: Rabbits with or without the inoculated VX2 tumor in the liver underwent total liver CT perfusion imaging 2 weeks after the operation. Perfusion parameters included blood flow (BF), blood volume (BV), arterial liver perfusion (ALP), portal liver perfusion (PVP), hepatic perfusion index (HPI) for the tumor rim and the surrounding liver tissue. After the examination, the UAs and MVA of tumor tissues were obtained by immunohistochemical staining. The differences of perfusion parameters between the vital tumor rim and the surrounding liver tissue were compared. The correlations among perfusion parameters, UAs and MVA were analyzed.
 Results: There was significant difference between the CT perfusion parameters at the tumor rim and the surrounding liver tissue or liver tissue of the control group (P0.05). There was positive correlation between UAs and MVA. UAs and MVA were positively correlated with BF, ALP and BV at the tumor rim. UAs and MVA were negatively correlated with PVP. HPI positively correlated with UAs, but it was not correlated with MVA.
 Conclusion: Total liver CT perfusion can provide quantitative information to evaluate the artery and portal vein perfusion of liver VX2 tumor, and to assess the degree of tumor angiogenesis.

Computed tomography findings of hepatic veno-occlusive disease caused by Sedum aizoon with histopathological correlation

This study investigated the value of computed tomography (CT) in the diagnosis and treatment of hepatic veno-occlusive disease (HVOD) caused by Sedum aizoon (SA). The clinical manifestations, treatment results, imaging findings, and histological findings of the liver were analyzed in 39 patients with HVOD caused by SA. Hepatomegaly, liver dysfunction, abdominal effusion, and geographic density changes on liver CT scans were found in all 39 patients. The pathological findings of histological liver examination included swelling and point-like necrosis of liver cells, significant expansion and congestion of the sinuses, endothelial swelling, and wall thickening with incomplete lumen occlusion of small liver vessels. CT geographic density changes were confirmed by histological examination of the liver in 18 patients. Sixteen patients with small amounts of ascites that started within 4 weeks of treatment recovered completely or significantly improved after symptomatic and supportive treatment. However, only 43.75% of the patients with larger amounts of ascites improved following symptomatic and supportive treatment. In conclusion, liver CT examination is a valuable, safe, and noninvasive tool for the diagnosis of HVOD caused by SA. In selected cases, liver CT examination may replace liver biopsy and histological analysis.

Doppler hepático na pré-eclâmpsia e na síndrome HELLP / Doppler ultrasonography of the liver in pre-eclampsia and HELLP syndrome

O fígado está entre os múltiplos órgãos que podem ser afetados na pré-eclâmpsia, e a função hepática pode ser gravemente prejudicada na síndrome HELLP. A ultrassonografia com Doppler constitui um método não invasivo que pode ser usado para o estudo da circulação hepática durante a gravidez. Com o objetivo de apresentar as evidências científicas disponíveis sobre as alterações do fluxo hepático na gravidez, foi realizada pesquisa da literatura mundial por meio das bases de dados MEDLINE/PubMed e LILACS. Em estudos de Dopplerfluxometria e Dopplervelocimetria, isoladamente ou associados ao eletrocardiograma e cardiografia por impedância, foram observadas alterações na circulação hepática durante a gravidez complicada por pré?eclâmpsia e síndrome HELLP. Entre os desafios para a pesquisa nesse campo destacamos a necessidade de aperfeiçoamento da técnica de exame, o estabelecimento de curvas de normalidade para as gestantes brasileiras, de indicadores de agravamento da pré?eclâmpsia e a aplicação potencial do método para o estudo da hipertensão crônica na gravidez.(AU)

The liver is among multiple organs that may be affected in pre-eclampsia, and liver function can be impaired in HELLP syndrome. Doppler ultrasonography of the liver provides a noninvasive method to study liver circulation during pregnancy. This paper reviews scientific evidence available in MEDLINE/ Pubmed and LILACS databases. Doppler studies on hepatic blood flow, flow velocities and vascular resistance indices, isolated or combined with Doppler?electrocardiography and impedance cardiography, observed changes in pregnancies complicated by pre?eclampsia and HELLP syndrome. Challenges to this research topic include improvements in Doppler examination techniques, establishment of normal values for Brazilian pregnant women, predictors for severe pre?eclampsia and potential use of hepatic Doppler use in chronic hypertension as well.(AU)

Preliminary observation on hepatic arterial infusion under temporary hepatic circulation occlusion in rabbits / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the advantages, feasibility and limitations of hepatic arterial infusion under temporary hepatic circulation occlusion.</p><p><b>METHODS</b>Twelve rabbits were randomly divided into two groups: hepatic artery infusion group (HAI group) and hepatic artery infusion under temporary hepatic circulation occlusion group (HAI-THCO). Microcatheters were separately inserted into the proper hepatic artery and right hepatic vein. For the HAI group, 5-Fu (10 mg/ml and 100 mg/kg) was infused into the common hepatic artery with a high pressure injector for 10 minutes. For the HAI-THCO group, the common hepatic artery and hepatic portal vein were temporarily occluded for 15 minutes using artery clamp when 5-Fu was being infused. For the two groups, at 2, 5, 10, 15, 20 and 30 min after the start of infusion, blood samples of the hepatic flow were collected from the right hepatic vein and of the systemic blood flow from the inferior vena cava, 1 ml at each time point. The blood drug concentration of these blood samples was determined by high performance liquid chromatography (HPLC).</p><p><b>RESULTS</b>Except that at 20 and 30 min after infusion, in the HAI group, the blood drug concentration of hepatic circulation was significantly higher than that of systemic circulation (P < 0.05). But in the HAI-THCO group, the blood drug concentration of hepatic circulation was significantly higher than that of systemic circulation at all the time points (P < 0.05). The hepatic circulation blood drug level of the HAI-THCO group was always significantly higher than that of the HAI group (P < 0.05), but the systemic circulation blood drug concentration of the HAI-THCO group was always lower (P < 0.05). The hepatic circulation maximum concentration (Cmax) of blood drug concentration of the HAI-THCO and HAI groups was (23.057±3.270) µg/ml and (4.408±1.092) µg/ml, respectively, and the Cmax of HAI-THCO group was significantly higher (P < 0.001), being 5.23 times of that of HAI group. The systemic circulation Cmax of the two groups was (1.456±0.217) µg/ml and (2.335±0.669) µg/ml, respectively, and the Cmax of HAI group was 1.60 times higher than that of the HAI-THCO group (P = 0.022). The hepatic circulation AUC of HAI-THCO and HAI groups was (368.927±52.416) µg·min·ml(-1) and (65.630±14.928) µg·min·ml(-1), respectively. The AUC of HAI-THCO group was 5.62 times higher than that of the HAI group (P < 0.001). The systemic circulation AUC of the two groups was (27.193±3.948) µg·min·ml(-1) and (45.301±12.275) µg·min·ml(-1), respectively. The AUC of HAI group was 1.67 times higher than that of the HAI-THCO group (P = 0.014).</p><p><b>CONCLUSIONS</b>HAI-THCO is a simple and effective regional hepatic infusion chemotherapy technique. It can be performed through occluding the common hepatic artery and the hepatic portal vein by balloon catheter. HAI-THCO can not only increase the blood drug concentration in the hepatic circulation, but also decrease the blood drug concentration in the systemic circulation, therefore, distinctly lowering the systemic toxicity.</p>

Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Background: Spontaneous bacterial peritonitis [SBP] is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients: however, there is a lack of knowledge about this issue in ascitic infections

Aim of the study: The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous bacterial peritonitis which may help to understand the role of immune system in pathogenesis of SBP and consequently introduction of new therapeutic modalities

Subjects and methods: This case-control study included 50 decompensated cirrhotic patients [37 male. 13 female] from gastroenterology and hepatology unit of internal medicine department; Assiut university hospital with different etiologies. Patients with ascitic polymorphonuclear leukocyte count >/=250/mm[3] and/or positive ascitic bacterial cultures were classified as the 'patients group' [n=25, mean +/- SD of age was 57.84 +/- 6.66 years]. Patients with ascitic poly morphonuclear leukocyte count <250/mm[3] and/or negative ascitic bacterial cultures were classified as the controls group [n=25, mean +/- SD of age was 60.36 +/- 6.51years]. Comparison was made between the patients and controls groups for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of ascitic lymphocyte subsets [CD3, CD4. CD8, CD4/CD8 ratio. CD19, CD45] and ascitic cytokine TNF-alpha

Results: Ascitic total protein and albumin levels were significantly decreased in patients group. The C4, CD19. CD45 and CD4/CD8 ratio were significantly decreased in the patients group. Furthermore, ascites CD3, CD8 and TNF-alpha levels were significantly elevated in this group. The incidence of renal impairment, gastrointestinal bleeding and hepatic encephalopathy was higher in patients group and there was a significant correlation between TNF-alpha and renal impairment in this group

Conclusion: These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might he involved in the pathogenesis of ascites infections

Derivaciones portosistemáticas congénitas: reporte de caso en un canino / Congenital portosystemics shunts: case report in a dog

Las derivaciones portocava extrahepáticas son anomalías vasculares donde la circulación portal se conecta con la circulación sistemática. En los caninos constituyen el 45% de las anomalías portovasculares, registrándose un predisposición racial. El objetivo de este trabajo es presentar los hallazgos ecográficos en un canino de raza Yorkshire. Se observó disminución del tamaño hepático, con la presencia de un vaso anómalo que comunicaba la vena porta con la vena cava, y donde el Doppler color registró turbulencia. Luego de la corrección quirúrgica, se observó un aumento del diámetro de la vena porta, con aumento del tamaño del órgano. En el diagnóstico de las derivaciones vasculares extra hepáticas, la ecografía tiene la ventaja de ser un método no invasivo que da información sobre el parénquima hepático y la vasculatura, sirviendo de guía para la selección de los procedimientos quirúrgicos.

Intrahepatic Portosystemic Venous Shunt: Successful Embolization Using the Amplatzer Vascular Plug II

A 67-year-old woman presented with memory impairment and behavioral changes. Brain MRI indicated hepatic encephalopathy. Abdominal CT scans revealed an intrahepatic portosystemic venous shunt that consisted of two shunt tracts to the aneurysmal sac that communicated directly with the right hepatic vein. The large tract was successfully occluded by embolization using the newly available AMPLATZERTM Vascular Plug II and the small tract was occluded by using coils. The patient's symptoms disappeared after shunt closure and she remained free of recurrence at the 3-month follow-up evaluation.

Establishment of an isolated porcine liver machine perfusion model for high-intensity focused ultrasound studies / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the feasibility of establishing an isolated porcine liver machine perfusion model and assess its value in high-intensity focused ultrasound studies.</p><p><b>METHODS</b>Twenty-one isolated porcine livers were perfused with autologous blood for 4 h through dual vessels (portal vein and hepatic artery) cannulation using an extracorporeal circulation machine under a sub-normothermic perfusion condition. The perfusion model was assessed by monitoring the liver color, texture, liver weight gain, hemodynamic parameters, color Doppler flow imaging, bile output and histopathology.</p><p><b>RESULTS</b>Nineteen isolated porcine livers were successfully cannulated with dual vessels, and failure of hepatic artery intubation occurred in two porcine livers. After machine perfusion for 4 h, the isolated livers maintained a soft texture with stable hemodynamic levels within relative normal physiological ranges. The bile output was more than 3 ml/h within the initial 3 h of perfusion. Histopathological examination demonstrated no morphological or structural changes of the liver tissues.</p><p><b>CONCLUSION</b>The isolated porcine liver perfusion model is stable and feasible, and can be used for high-intensity focused ultrasound studies.</p>

Resecciones hepáticas sin tecnología de punta: ocho años de experiencia / Liver resection without advanced technologies: eight years experience

Introducción. Las hepatectomías son intervenciones quirúrgicas de gran envergadura. En la mayoría de los centros que las realizan, la tecnología es un importante soporte para su ejecución. El objetivo del estudio fue comparar los resultados obtenidos sin tecnología de última generación con los logrados en centros donde sí se utiliza. Diseño. Es un estudio retrospectivo, observacional y transversal. Se llevó a cabo en la Clínica Sucre, centro privado de tercer nivel. Material y métodos. Se analizaron 72 resecciones hepáticas en 68 pacientes. Los datos recolectados fueron: sexo, edad, enfermedad, tipo de resección practicada, procedimientos quirúrgicos asociados, volumen de sangre transfundida, estadía hospitalaria, morbilidad y mortalidad. La sección parenquimatosa se hizo con una técnica denominada “kellyclasia”. En la superficie de corte se colocó una compresa embebida en solución fisiológica caliente durante unos minutos. Resultados. De las 72 resecciones, 21 fueron mayores; en 19 ocasiones se asoció otro procedimiento quirúrgico. Catorce pacientes tenían cirrosis hepática. Se requirió transfusión de sangre en 26 pacientes, con una media de 807,6 ml, en 6 de los cuales se utilizó la técnica de autotransfusión por hemodilución normovolémica. El tiempo operatorio tuvo una media de 112 minutos. La morbilidad fue de 34,72 % y la mortalidad, de 5,5 %. Conclusión. Los resultados obtenidos son similares a los presentados en diferentes series. La ausencia de tecnología de última generación no es indispensable a la hora de obtener buenos resultados.

Background: Liver resection is a major type of surgery. Advanced technology as used in different centers constitutes an important support for its adequate performance. Aim: To compare our results without the use of advanced technologies with those of centers that have them available. Hypothesis: Technology is not indispensable in liver resection. Setting: Clínica Sucre, a tertiary level of care private Center. Design: Observational retrospective and transverse analysis. Material and methods: 72 hepatectomies performed in 68 patients were analyzed. Sex, age, pathology, type of liver resection, associated procedures, blood transfusion, hospital stay, morbidity and mortality rates were evaluated. Parenchymal section was made with “kellyclasie”. In the transection surface a warm water soaked-up compress was placed for a few minutes. Results: there were 21 major hepatectomies. In 19 opportunities an associate procedure was required. Cirrothic liver was present in 14 patients. Blood transfusion was used in 26 cases (transfusional media 807.6 ml), 6 of them with normovolemic hemodilution. Surgical time showed a media of 112 minutes. Morbidity rate was 34.72 % and mortality rate 5.5 %. Conclusion: Our results are similar to those published by centers that use advanced technology for liver resection.

Malformación de abernethy tipo 1: presentación de un caso clínico y revisión de la literatura / Abernethy Malformation type 1: report of a case and review of the literature

Se presenta caso de preescolar masculino de 5 años con antecedente de hepatoesplenomegalia desde el año de vida, quien consultó con clínica de hematuria, se realizó ecografía abdominal con hallazgos: de imágenes hipoecoicas difusas en el parénquima hepático, dificultad para valorar el sistema porta, esplenomegalia. Eco Doppler del sistema venoso portal presencia de anomalía vascular portal, no se observo porta principal, se realizó Angiotac multicorte del sistema arterial venoso portal y mesenterico que confirmo Agenesia de la vena Porta. Se diagnóstico malformación de Abernethy tipo I. Las malformaciones del sistema venoso abdominal son alteraciones vasculares raras. El primer acontecimiento de la ausencia congénita de la vena porta viene dado por un shunt cava mesenterico, los shunts portocava (SPC), son malformaciones infrecuentes descritas por Abernethy en 1973, se clasifican en dos grupos según la presencia tipo (II) o ausencia de la vena porta tipo (I). La malformación de Abernethy tipo I usualmente se relaciona a otras anomalías congénitas tales como: defectos cardiacos, atresia de vías biliares y poliesplenia, más frecuentes en el sexo femenino; en varones puede no encontrarse anomalías congénitas asociadas.

A case report of male preschool 5 years old with a history of hepatosplenomegaly since life, who consulted with clinical hematuria, abdominal ultrasonography was performed with fi ndings: hypoechoic image in the liver parenchyma diffuse, diffi cult to assess the portal system, splenomegaly. Echo Doppler of the portal venous system, presence of portal vascular anomaly, there was no main portal was ANGIOTAC multislice system portal and mesenteric venous blood confirmed that agenesis of the portal vein. Abernethy malformation is diagnosed type I Malformations of the abdominal venous system are rare vascular abnormalities. The first event of the congenital absence of the portal vein is given by a mesenteric caval shunt, shunts the Portocava (SPC) are rare malformations described by Abernethy in 1973, are classified into two groups according to the present type (II) or absence of portal vein type(I). The Abernethy malformation type I is usually associated with other abnormalities such as heart defects, atresia of bile ducts and poliesplenia more frequent in females, males May be associated congenital anomalies.

Amplio espectro de la enfermedad vascular hepática en imágenes / Ample spectrum of vascular hepatic disease

La enfermedad vascular hepática (EVH)constituye un amplio espectro de entidades de baja prevalencia, pero con manifestaciones clínicas diversas que pueden llevar a la muerte. Una detección temprana y un tratamiento oportuno cambian el pronóstico. De ahí que las imágenes diagnósticas desempeñen un papel fundamental; sin embargo, hay que tener en cuenta el amplio diagnóstico diferencial. La tomografía computarizada de abdomen es una de las herramientas más útiles para el diagnóstico, sin olvidar otros métodos de imagen, como el ultrasonido Doppler y la resonancia magnética. La EVH puede clasificarse según la repercusión que se pueda derivar de ella, por lo que en términos prácticos puede dividirse en alteraciones venosas, portales, arteriales, sinusoidales y otras. El objetivo de esta revisión es describir la presentación más frecuente de la EVH y sus principales hallazgos y diagnósticos diferenciales, al tiempo que se reconoce su correlación con los mecanismos fisiopatológicos.

Hepatic vascular diseases (HVD) are a broad spectrum of entities of low prevalence but with different clinical manifestations that may even lead to death. Its early detection and timely treatment may change the prognosis. Diagnostic imaging plays a key role and imaging findings may be typical.However, in most cases, radiologists must take into account a wide range of differential diagnosis. Computed tomography (CT) of the abdomen is one of the most useful tools for the diagnosis of HVD taking also into account the value of other imaging methods such as Doppler Ultrasound andMagnetic Resonance Imaging (MRI).HVD can be classified according to the compromised vascular structure and can be divided into venous, portal, arterial, sinusoidal and others disorders. The objective of this review is to describe the most common presentation HVD . The major imaging findings and differential diagnosis recognizingits correlation with the pathophysiological mechanisms.

Pathophysiology of Portal Hypertension, What's New? / 대한소화기학회지

Portal hypertension (PHT) is associated with changes in the intrahepatic, systemic and portosystemic collateral circulations. Alteration in vasoreactivity (vasodilation and vasoconstriction) plays a central role in the pathogenesis of PHT by contributing to increased intrahepatic resistance, hyperdynamic circulation and the expansion of the collateral circulation. PHT is also importantly characterized by changes in vascular structure; termed vascular remodeling, which is an adaptive response of the vessel wall that occurs in response to chronic changes in the environment such as shear stress. Angiogenesis, the sprouting of new blood vessels, also occurs in PHT, especially in the expansion of the portosystemic collateral circulation. These complementary processes of vasoreactivity, vascular remodeling and angiogenesis represent important targets in the research for the treatment of portal hypertension.

Hemodynamic alterations in cirrhosis and portal hypertension / 대한간학회지

Portal hypertension (PHT) is associated with hemodynamic changes in intrahepatic, systemic, and portosystemic collateral circulation. Increased intrahepatic resistance and hyperdynamic circulatory alterations with expansion of collateral circulation play a central role in the pathogenesis of PHT. PHT is also characterized by changes in vascular structure, termed vascular remodeling, which is an adaptive response of the vessel wall that occurs in response to chronic changes in the environment such as shear stress. Angiogenesis, the formation of new blood vessels, also occurs with PHT related in particular to the expansion of portosystemic collateral circulation. The complementary processes of vasoreactivity, vascular remodeling, and angiogenesis represent important targets for the treatment of portal hypertension. Systemic and splanchnic vasodilatation can induce hyperdynamic circulation which is related with multi-organ failure such as hepatorenal syndrome and cirrhotic cadiomyopathy.

Artéria hepática acessória: incidência e distribuição / Accessory hepatic artery: incidence and distribution

As variações anatômicas das artérias hepáticas são comuns. A identificação pré-operatória dessas variações é importante para prevenir lesão inadvertida e complicações potencialmente letais durante procedimentos abertos e endovasculares. Objetivo: Avaliar a incidência, o trajeto extra-hepático e a presença de ramos laterais das artérias hepáticas acessórias definidas como um suprimento arterial adicional para o fígado na presença de artéria hepática normal. Métodos: Oitenta e quatro cadáveres humanos masculinos foram dissecados através de laparotomia mediana transperitoneal. A aorta supracelíaca, o eixo celíaco e as artérias hepáticas foram dissecados, e suas trajetórias foram identificadas para descrever os padrões dos ramos arteriais...

Anatomic variations of the hepatic arteries are common. Preoperative identification of these variations is important to prevent inadvertent injury and potentially lethal complications during open and endovascular procedures. Objective: To evaluate the incidence, extra-hepatic course, and presence of side branches of accessory hepatic arteries, defined as an additional arterial supply to the liver in the presence of normal hepatic artery. Methods: Eighty-four human male cadavers were dissected using a transperitoneal midline laparotomy. The supra-celiac aorta, celiac axis, and hepatic arteries were dissected, and their trajectories were identified to describe arterial branching...

Effects of electroacupuncture on hepatic blood flow and lipid peroxidation in septic rats / 中国针灸

<p><b>OBJECTIVE</b>To investigate the protection effects of electroacupuncture on injury of lipid peroxidation induced by liver ischemia in septic rats.</p><p><b>METHODS</b>Forty-eight male SD rats were subjected to sepsis induced by cecal ligation and puncture (CLP), and were randomly divided into a Sham operation group (group A), a CLP model group (group B), a CLP model plus electroacupuncture at "Zusanli" (ST 36) group (group C), a CLP model plus electroacupuncture at the shame acupoint (group D), a vagotomy plus CLP model group (group E) and CLP model plus electroacupuncture group after vagotomy (group F), 8 rats in each group. CLP was performed in group E and group F after the abdominal vagotomy. Bilateral "Zusanli"(ST 36) points and the shame acupoint were electroacupunctured (2 mA, 2/100 Hz) for 1 hour in group C, group F and group D, respectively. The hepatic blood flow (HBF) was detected by a laser-Doppler flowmetry at 6 h after CLP. The plasma activity of alanine aminotransferase (ALT) was also determined and specimens of liver were harvested for evaluation of malondialdehyde (MDA), xanthine oxidase (XOD) and assessment of the rate of water content.</p><p><b>RESULTS</b>The blood flow of the liver was (56.97 +/- 11.95) U in group C which was significantly lower than (80.12 +/- 19.57) U in group A but higher than (42.61 +/- 10.97) U in group B, (44.53 +/- 9.23) U in group D, (30.05 +/- 4.46) U in group E and (30.46 +/- 6.38) U in group F (all P < 0.05) 6 h after CLP. Meanwhile, the levels of MDA, XOD, ALT and the rates of water content in liver in group C were all significantly higher than those in group A, but lower than those in the other four groups (all P < 0.05). The levels of MDA, XOD, ALT and the rates of water content in liver in group E and group F were all significantly higher than those in group D (all P < 0.05), while the blood flow of the liver lower than that in group D (P < 0.05), and with no significant differences in all above measurements between group E and group F (all P > 0. 05).</p><p><b>CONCLUSION</b>Electroacupuncture at "Zusanli" (ST 36) can promote hepatic blood flow, inhibit lipid peroxidation and alleviate hepatic edema and dysfunction in septic rats, which might be related with the completeness of cranial nerve.</p>

Plasma levels of D-dimer and von Willebrand factor and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus hepatitis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the significance of plasma D-dimer and von Willebrand factor (vWF) and the therapeutic effect of compound glycyrrhizin in children with cytomegalovirus (CMV) hepatitis.</p><p><b>METHODS</b>Twenty healthy children, 16 asymptomatic cases with CMV infection and 52 cases of CMV hepatitis (21 cholestatic and 31 non-cholestatic) were enrolled. The 52 children with CMV hepatitis were randomly administered with conventional treatment alone or conventional treatment plus compound glycyrrhizin treatment. Plasma D-dimer and vWF levels were measured before and after treatment.</p><p><b>RESULTS</b>Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly higher than those in the healthy control and asymptomatic CMV infection groups (P<0.01). The cholestatic hepatitis group had more increased plasma D-dimer and vWF levels compared with the non-cholestatic hepatitis group (P<0.01). Plasma D-dimer and vWF levels in the CMV hepatitis group were markedly reduced after conventional or compound glycyrrhizin treatment (P<0.01). Compound glycyrrhizin treatment decreased more significantly plasma D-dimer and vWF levels compared with the conventional treatment in children with CMV hepatitis (P<0.01).</p><p><b>CONCLUSIONS</b>The detection of plasma D-dimer and vWF is useful in the early assessment of liver damage in children with CMV hepatitis. Compound glycyrrhizin can decrease obviously plasma D-dimer and vWF levels and might thus provide protective effects against liver damage.</p>