Hipertensión portal no cirrótica: presentación de cuatro casos y revisión breve de la literatura / Non-cirrhotic portal hypertension: presentation of four cases and a brief review of the literatura

La hipertensión portal es un síndrome hemodinámico de la circulación venosa portal que condiciona múltiples complicaciones potencialmente mortales, debido a las alteraciones generadas en la circulación esplácnica y sistémica. En las últimas décadas se ha identificado la presencia de hipertensión portal en ausencia de cirrosis con un fenómeno de vasculopatía característico. Esta entidad puede clasificarse como prehepática, hepática y posthepática, según la localización del compromiso, identificado mediante estudios hemodinámicos. Se presentan cuatro casos de pacientes con hipertensión portal no cirrótica secundaria a trombosis portal. Adicionalmente, se realiza una revisión breve de la literatura, haciendo énfasis en las dos causas más frecuentes de hipertensión portal no cirrótica; la trombosis venosa portal crónica y la enfermedad vascular porto-sinusoidal.

Portal hypertension is a hemodynamic syndrome of the portal venous circulation that causes multiple life-threatening complications due to the alterations generated in the splanchnic and systemic circulation. In recent decades, the presence of portal hypertension in the absence of cirrhosis has been identified with a characteristic vasculopathy phenomenon. This condition can be classified as pre-hepatic, hepatic and post-hepatic, according to the location of the involvement, identified by hemodynamic studies. Four case reports of patients with non-cirrhotic portal hypertension secondary to portal thrombosis are presented. Additionally, a brief review of the literature is included, with emphasis in the two most frequent causes of non-cirrhotic portal hypertension; chronic portal venous thrombosis and portosinusoidal vascular disease.

Trombosis porto-mesentérica aislada secundaria a trauma abdominal cerrado / Isolated porto-mesenteric thrombosis secondary to blunt abdominal trauma

En este artículo se revisan los aspectos más importantes de la epidemiología, fisiopatología, abordaje diagnóstico y terapéutico de la trombosis del sistema venoso portal y mesentérico, para finalizar discutiendo la experiencia clínica de un caso a la luz de la literatura relevante. Esta complicación es usualmente relacionada con afecciones sistémicas y hepáticas, pero rara vez se presenta aislada y relacionada con el trauma. En ausencia de tratamiento adecuado durante la etapa aguda, la trombosis puede evolucionar hacia el infarto intestinal y la muerte del paciente. En casos crónicos, se ha asociado con la degeneración del sistema venoso portal hacia cambios por hipertensión portal crónica

This article reviews the epidemiology, pathophysiology, diagnostic and therapeutic approach of the portal and mesenteric venous system thrombosis, with a clinical case discussion considering the relevant literature. This complication is usually related to systemic and hepatic conditions, but rarely occurs isolated and related to trauma. In the absence of adequate treatment during the acute stage, thrombosis can progress to intestinal infarction and death. In chronic cases, it has been associated with degeneration of the portal venous system into changes due to chronic portal hypertension

Pileflebitis asociada a apendicitis aguda complicada. A propósito de un caso / Pileflebitis associated with complicated acute appendicitis. About a case

The aim of this study was to analyse a patient dignosed in our hospital as having pylephlebitis. The patient is a 29 years old male, and we must consider that pylophlebitis refers to the septic thrombosis of the portal venous system, associated to some kind of infectious process. Can occur related to acute appendicitis, colonic diverticulitis and cholangitis, among others. Is a rare but close to a significant morbidity and mortality, since it can develop to an abdominal sepsis. The management review of the case reported, is presented (AU)

Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word "pneumatosis" were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

RESUMO OBJETIVO: Avaliar o desempenho diagnóstico dos achados CT em causas diferenciadoras da pneumatose intestinal (PI), incluindo causas benignas e que ameaçam a vida. MÉTODOS: Todos os relatórios CT contendo a palavra "pneumatose" foram questionados de 10 de junho de 2006 a 31 de maio de 2015. Um total de 42 pacientes com PI foi matriculado (idade média 63,4 anos, 23 do sexo masculino e 19 do sexo feminino) e divididos em dois grupos na base de registros médicos elétricos: grupo benigno, n = 24 e grupo com risco de vida, n = 18. Dois radiologistas analisaram as imagens da CT e avaliaram seus achados, incluindo distensão intestinal, padrão de realce da parede intestinal, defeito da parede intestinal, gás venoso portal (PVG), gás venoso mesentérico (MVG), ar extraluminal e ascite. RESULTADOS: Achados CT, incluindo distensão intestinal, diminuição do realce da parede intestinal. PVG e ascite foram mais comumente identificados em grupo com risco de vida (todos p < 0,05, respectivamente). Todos os casos com PVG foram incluídos em grupo com risco de vida (8/18 pacientes, 44,4%). Defeito da parede do intestino, ar livre extraluminal e gás venoso mesentérico não mostraram significância estatística entre dois grupos. CONCLUSÃO: PI e PVG concorrente, distensão intestinal, diminuição do aumento da parede do intestino ou ascites foram significativamente associados com causas que ameaçaram a vida e prognóstico desfavorável. Portanto, avaliar os recursos de CT auxiliares quando encontramos PI nos ajudaria a caracterizar as causas de PI e determinar a opção de tratamento apropriada.

Hígado: siete segmentos hepáticos / Liver: seven hepatic segments

Estudiamos la estructura intrahepática en 200 hígados (A05.8.01.001)* humanos: Las ramas portales, arteriales y biliares formaron siete pedículos segmentarios antes de penetrar en su parénquima correspondiente. Los cuatro primeros pertenecen, generalmente, al lóbulo izquierdo (A05.8.01.027) y los segmentos V, VI y VII al lóbulo derecho (A05.8.01.026). En un 80 % la rama portal V es derecha y en 20 % izquierda; por su parte, en un 80 % la fisura portal principal (A05.8.01.035) divide el lóbulo derecho del izquierdo, extendiéndose desde la fosa de la vesícula biliar (A05.8.01.013) al margen izquierdo de la vena cava inferior (A12.3.09.001); en un 20 % la fisura portal derecha (A05.8.01.036) divide el lóbulo derecho del izquierdo, ella se extiende desde un punto equidistante entre el margen vesicular derecho y el ángulo anterior derecho del hígado, describiendo una curva de convexidad externa y alcanza el margen derecho de la vena cava inferior. En un 70 % el hígado estuvo irrigado por la arteria hepática propia (A12.2.12.029), en un 30 % ésta se anastomosaba con arterias hepáticas accesorias. Observamos anastomosis entre la arteria hepática derecha (A12.2.12.030) y la izquierda (A12.2.12.035) en un 55 % de los casos en el hilio inferior y no en el espesor del parénquima. Las arterias segmentarias al penetrar a su correspondiente segmento se vuelven terminales. Los conductos biliares aberrantes son conductos biliares segmentarios que no han confluido para constituir el conducto hepático derecho (A05.8.01.062), drenan en el conducto hepático común (A05.8.01.061) o en el conducto cístico (A05.8.02.011). El tronco común biliar de los segmentos VI y VII drena en el conducto hepático izquierdo (A05.8.01.065) en el 21 % de los casos, no más allá de un cm del punto de formación del conducto hepático común. En relación al grupo venoso superior, conformado por la vena hepática izquierda (A12.3.09.008), vena hepática intermedia (A12.3.09.007) y vena hepática derecha (A12.3.09.006), observamos venas del lóbulo caudado+ en el 100 % de los casos y la vena hepática inferior derecha+ en el 61 %. Estas tenían un diámetro entre 5 y 20 mm, habiendo 5 % de casos con vena hepática media derecha+. En un 40 % existe un puente parenquimal que une los segmentos III y IV. En un 25 % apreciamos lóbulos hepáticos accesorios que se desprenden de la cara visceral del hígado. El objetivo de este trabajo consistió en aportar una clasificación sencilla de la segmentación hepática desde un punto de vista quirúrgico.

Intrahepatic structure study in 200 human livers: The Portal, arterial and biliary branches form seven segmental pedicles before entering the corresponding parenchyma. The first four belong, generally to the left lobe and the number V, VI and VII to the right. In 80 % portal branch V is right and 20 % is left, so in 80 % the line dividing both hemi livers ranges from biliary cystic fossa to the left edge of the inferior cava vein; in 20 % said line running from a equidistant point between biliary cystic fossa right margin and the right anterior angle edge of the liver, describes a convex outer curve and reaches the right edge of the inferior cava vein. 70 % of the livers were supplied by the hepatic artery, in 30 % there were anastomosis with accessory hepatic arteries. We observed anastomosis between the left and right hepatic artery in 55 % of cases in the hilum plate and not in the thickness of the parenchyma. Segmental arteries while penetrating their segments, become terminal. Aberrant bile ducts are segmental bile, they have not come together to form the right hepatic duct, draining into the common hepatic or cystic. Biliary common duct segments VI and VII drains into the left hepatic duct in 21 % of cases, no more than 1 cm from the point of formation of the common hepatic. Besides in (left hepatic, intermediate and and right hepatic) upper venous system we observed veins in the caudate lobe in 100 % of cases, and right lower hepatic in 61 % of cases, these had a diameter between 5 and 20 mm, and 5 % with right middle hepatic. At 40 % there is a parenchymal bridge linking segments III and IV. In 25 % we appreciate accessory lobes arising from the underside of the liver. The aim of this study was to provide a simple classification of the hepatic segmentation from a surgical point of view.

Management of portal hypertension derived from uncommon causes

Portal hypertension can arise from any condition interfering with normal blood flow at any level within the portal system. Herein, we presented two uncommon cases of the portal hypertension and its treatment with brief literature review. A 71-year-old man who underwent right hemihepatectomy revealed a tumor recurrence adjacent to the inferior vena cava (IVC). After radiofrequency ablation (RFA) with lymph node dissection, he was referred for abdominal distension. The abdomen computed tomography scan showed severe ascites with a narrowing middle hepatic vein (MHV) and IVC around the RFA site. After insertion of two stents at the IVC and MHV, the ascites disappeared. Another 73-year-old man underwent right trisectionectomy of liver and segmental resection of the portal vein (PV). After operation, he underwent conservative management due to continuous abdominal ascites. The abdomen computed tomography scan showed severe ascites with obliteration of the left PV. After insertion of stent, the ascites disappeared. A decrease of the pressure gradient between the PV and IVC is one of the important treatment strategies for portal hypertension. Vascular stent is useful in the reduction of pressure gradient and thus, can be a treatment option for portal hypertension.

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.

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)

Validação das diretrizes gerais de comunicação do enfermeiro com o cego / Validation of the general guidelines of communication between the nurse and the blind / Validación de las directrices generales de la comunicación entre la enfermera y el ciego

Objetivou-se validar as diretrizes gerais da comunicação do enfermeiro com o cego. Estudo quantitativo, realizado entre abril de 2008 e março de 2009 em Fortaleza-CE. Participaram 30 enfermeiros e 30 cegos divididos em grupo controle e experimental. Realizaram-se 30 consultas de enfermagem filmadas e analisadas por especialistas. O grupo experimental apresentou desempenho bom e excelente em todas as diretrizes para a comunicação verbal e não verbal com o cego, contrariamente ao grupo controle. Os resultados do estudo apontam para a urgência da adoção do ensino destas diretrizes gerais de comunicação com cegos nos cursos de enfermagem, além de capacitar enfermeiros no cuidado a pessoas cegas.

This quantitative study, conducted between 2008 April and 2009 March in Fortaleza-CE, Brazil, aimed to validate the general guidelines of the communication of the nurse with the blind. Thirty nurses and 30 blinds, divided into control and experimental groups, participated in the study. Thirty nursing consultations were videotaped and analyzed by experts. In contrast to the control group, the experimental group showed good and excellent performance in all guidelines for verbal and non-verbal communication with the blinds. The study results point to the urgency of adopting the teaching of these general guidelines for communicating with the blind in nursing courses, in addition to training nurses in caring for the blind people.

Estudio cuantitativo, realizado entre abril de 2008 y marzo de 2009, en Fortaleza-CE, Brasil, que tuvo como objetivo validar los lineamientos generales de la comunicación del enfermero con los ciegos. Los participantes fueron 30 enfermeros y 30 ciegos, divididos en grupos control y experimental. Fueran realizadas 30 consultas de enfermería, registradas y analizadas por expertos. El grupo experimental mostró un buen y excelente rendimiento en todas las directrices para comunicación verbal y no verbal con los ciegos, en contraste con el grupo de control. Los resultados del estudio apuntan a la urgencia de la adopción de la enseñanza de estas directrices generales para la comunicación con los ciegos en los cursos de enfermería, además de la formación de enfermeras en el cuidado de las personas ciegas.

Comparison of putative circulating cancer stem cell detection between the hepatic portal system and peripheral blood in colorectal cancer patients

PURPOSE: The present pilot study was conducted to detect putative cancer stem cell (CSC) from the hepatic portal system and peripheral blood in the colorectal cancer patients and to compare them to healthy donor and diverticulitis patients. METHODS: Laboratory study was performed to identify the expression of cell surface markers, epithelial cell adhesion molecule (EpCAM), cytokeratin (CK) 18, CK20, CD44, and CD133, on several colon cancer cell lines. Clinical pilot study was conducted to detect putative circulating CSC as EpCAM+CD133+ cell in colorectal cancer (n = 10), diverticulitis (n = 5), and four healthy donors, by using flow cytometry. Blood was drawn from the hepatic portal system and peripheral vein. RESULTS: On laboratory study, EpCAM was expressed in whole colon cancer cell lines, and CD44 and CD133 were simultaneously expressed in 50% of the cell lines with stemness phenotype, but CK18 and CK20 were not expressed in most of the cell lines. On clinical study, the mean EpCAM+CD133+ cell counts of 11.6/105 in the hepatic portal system were somewhat lower than 15.4/105 in peripheral vein (P = 0.241). As for diverticulitis patients, EpCAM+CD133+ cells were also detected to have steeper dropped to near zero, after the surgery. CONCLUSION: The numbers of putative CSC were not statistically different between the detection sites of the portal vein and peripheral vein in the colon cancer patients. Therefore, we may not have benefitted by getting the cells from the hepatic portal system. In addition, the CD133+EpCAM+ cells in the colon cancer patients might contain normal stem cells from cancer inflammation similar to diverticulitis.

Immediate graft histological assay, post pig's liver transplantation

PURPOSE: To describe the vascular and tissue histopathological changes in seven sequential experimental liver transplantations in pigs. METHODS: Fourteen female pigs, Sus domesticus species, with body mass between 5 and 8 kg were utilized. After the end of all anastomoses of the graft implantation in the receptor, the animal was monitored for 30 minutes, and at its end one of the biopsies was collected for histological analysis. The histological criteria utilized were: lytic hepatocyte necrosis, density of septal and portal inflammatory infiltrated, sinusoidal congestion and hemorrhage. The analysis was performed separately for the portal region in zone 1, 2 and 3. RESULTS: Among the structural changes undergone by the graft, those with greater frequency and intensity were vascular congestion and steatosis, which stood out in transplantations 5, 6 and 7. CONCLUSIONS: The technique demonstrated vascular alterations represented by vasocongestion, edema and minimum inflammatory reaction. In relation to the parenchyma, was observed macrovacuolar pan-acinar steatosis, focal lytic and occasional hemorrhages, beyond the accumulation of hemosiderin in Kuppfer's cells.

Cavernous transformation of portal vein - a rare cause of massive hepatomegaly

There are very few reported cases of Cavernous Transformation of Portal Vein [CTPV] in adults. We present a case of 79 years old male who was found to have this complication due to portal vein thrombosis [PVT]. A 79 year old male with background history of JAK2 positive Myeloproliferative disorder [MPD] was referred with abnormal liver function tests. Patient was clinically well and asymptomatic. During initial workup for his abnormal LFTs, patient was noted to have enlarged caudate lobe of liver. Further abdominal imaging studies showed massively enlarged caudate lobe of liver with Cavernous Transformation of Portal Vein [CTPV], a very rare complication of portal venous thrombosis. Cavernous transformation of portal vein is a very rare cause of enlarged caudate lobe of liver. The management of CTPV is mainly symptomatic. Most of the patients are asymptomatic at presentation. Complications mostly occur due to portal hypertension which can be life threatening. There is no consensus on the management of Cavernous Transformation of portal vein itself. Patients with cavernous transformation of portal vein should be kept under regular follow up

A Case of Non-Immune Hydrops Fetalis due to Umbilical Venous Malformation and Noonan Syndrome / 대한주산의학회잡지

Anomalies of the fetal venous system are rare. Major portion of fetal venous anomalies are malformation of umbilical vein and ductus venosus. Abnormal umbilico-systemic shunt, bypassing the ductus venosus makes direct connection between the high-pressure umbilical system and the low-pressure systemic system. And it makes adverse to the fetal hemodynamics. Fetal hemodynamic distress may induce fetal growth retardation, hepatomegaly, cardiomegaly, hydrops fetalis and fetal death. We report a case of non-immune hydrops fetalis which was associated with abnormal umbilical vein pathway. Our patient had bifurcated umbilical veins. Main branch of umbilical vein was drained directly to the left internal iliac vein and another branch was drained to the portal vein. After birth, extrahepatic shunt through main branch of umbilical vein that bypassed the portal system was persisted and thrombocytopenia was combined due to consumption in thrombus of a dilated anomalous umbilical vein. Later this case was diagnosed as Noonan syndrome with a genetic testing.

Interobserver variability of ultrasound parameters in portal hypertension

The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (ê = 0.714-0.795) for portal vein thrombosis and perfect (ê = 1) for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869) and splenic index (r = 0.816-0.905) and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675), splenic (r = 0.573-0.913) and superior mesenteric (r = 0.525-0.607) veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.

comparison study of radiation dose received during cone beam computerized tomography and portal imaging techniques

Although widely varied in modality and method, all radiographic guidance techniques have one thing in common; they can give a significant radiation dose to the patient; which may have a late radiation stochastic effect on normal body tissues. To quantify and compare radiation doses to the tumour and the surrounding critical organs resulting from the orthogonal pair portal and megavoltage cone beam computarized tomography [MV CBCT] imaging techniques. The dose to the patient resulting from the orthogonal pair and the MV CBCT imaging techniques, has been calculated based on a 6 MV Oncor linear accelerator equipped with an amorphous silicon flat panel. All calculations were done on Eclipse 3D treatment planning system. 18 patients representing three different treatment sites [head and neck, thorax, and pelvis] were analysed. Data from 6 patients for each treatment site were used to calculate the mean doses. Calculations were done for: The integral dose, maximum dose to the patient, dose at the isocenter, and mean dose to the tumour and each critical organ. The absolute dose measured as integral dose, maximum dose to the patient, dose at the isocenter, and mean dose to the tumour and each critical organ was higher for MV CBCT as compared to orthogonal pair technique for all treatment sites. For both techniques, the absolute dose was higher for head and neck and thorax as compared to pelvis. The difference of maximum dose to the patient showed greater variation for head and neck, but not for thorax and pelvis. There are relatively high dose regions generated by MV CBCT that occur inside critical organs as well treatment area and tend to be larger than those generated by the orthogonal pair technique

Immunohistochemical studies of stellate cells in experimental cholestasis in newborn and adult rats

BACKGROUND AND AIMS: Although there is much known about liver diseases, some aspects remain unclear, such as the nature of the differences between the diseases observed in newborn infants and those in adults. For example, how do newborns respond to duct epithelial cell injury? Do the stellate cells in newborns respond similarly to those in adults during biliary obstruction? METHODS: Ninety newborn Wistar rats aged six days, weighing 8.0 - 13.9 g each, and 90 adult rats weighing 199.7 - 357.0 g each, were submitted to bile duct ligation. After surgery, they were randomly divided and sacrificed on the 3rd, 5th, 7th, 14th, 21st or 28th day post-bile duct ligation. Hepatic biopsies were obtained and immunohistochemical semi-quantification of desmin and á-SMA expression was performed in hepatic stellate cells and in myofibroblasts in the portal space, and between the portal space and the liver lobule. RESULTS: Desmin expression in the myofibroblast cells post-bile duct ligation was higher in young rats, reaching its peak level in a shorter time when compared to the adult animals. The differences between the groups for á-SMA expression were less significant than for desmin. CONCLUSIONS: These findings indicate that there is an increase in the number of collagen-producing myofibroblast cells in young animals, suggesting that there is more intense fibrosis in this population. This finding may explain why young animals with bile duct obstruction experience more intense portal fibrosis that is similar to the pathology observed in the livers of newborns with biliary atresia.

Hepatic encephalomyelopathy in a calf with congenital portosystemic shunt (CPSS)

A 4-month-old female Holstein Friesian calf was referred to the Veterinary Teaching Hospital, University of Berne, Switzerland for evaluation of ataxia, weakness, apathy and stunted growth. Clinical examination revealed generalized ataxia, propioceptive deficits, decreased menace response and sensibility. Postmortem examination did not reveal macroscopic changes of major organs. Histologically, the brain and the spinal cord lesions were characterized by polymicrocavitation, preferentially affecting the white matter fibers at the junction of grey and white matter and by the presence of Alzheimer type II cells. The liver revealed lesions consistent with a congenital portosystemic shunt, characterized by increased numbers of arteriolar profiles and hypoplasia to absence of portal veins. The pathological investigations along with the animal history and clinical signs indicated a hepatic encephalomyelopathy due to a congenital portosystemic shunt.

Acute Appendicitis with Superior Mesenteric Vein Thrombosis and Portal Vein Thrombosis

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.