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Int. j. morphol ; 38(6): 1662-1667, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134495


SUMMARY: The celiac trunk is the first major unpaired branch of the abdominal aorta found at the twelfth vertebral level (T12). It gives off branches supplying the spleen, liver and the stomach. However, the branching patterns of the celiac trunk tend to vary by population throughout the world. We sought to investigate the branching patterns of the celiac trunk in a South African Caucasian sample. The celiac trunk was assessed by visual observation in 66 dissected bodies comprised of both males (n= 30) and females (n=36). These samples were obtained at the School of Anatomical Sciences, University of the Witwatersrand, Johannesburg. The celiac trunk arose directly from the abdominal aorta in all cases, with none connected to the superior mesenteric artery. We observed celiac trunk trifurcation in 84.84 % of the sample, although a celiac trunk with four branches was observed in 10.61 %. Bifurcation into the common hepatic and splenic arteries forming a hepatosplenic trunk (2 females) or into the left gastric artery and splenic artery forming a splenogastric trunk (1 male) was also observed. The results are largely comparable with other studies in Caucasians, showing a high rate of celiac trunk trifurcation (above 75 %). Our sample exhibited fewer variations than reported in previous studies worldwide. Therefore, a larger study with more samples may be required in the future to ascertain all the existing celiac trunk branching patterns in the South African Caucasian population.

RESUMEN: El tronco celíaco es la primera rama principal de la parte abdominal de la aorta en el nivel de la duodécima vértebra torácica (T12), con ramas que irrigan el bazo, el hígado y el estómago. Sin embargo a nivel mundial, las ramificaciones del tronco celíaco tienden a variar según la población. En este estudio se investigaron los patrones de ramificación del tronco celíaco en una muestra caucásica sudafricana. El tronco celíaco se analizó mediante observación visual en 66 cuerpos disecados compuestos por hombres (n = 30) y mujeres (n = 36). Estas muestras se obtuvieron en la Facultad de Ciencias Anatómicas de la Universidad de Witwatersrand, Johannesburgo. El tronco celíaco surgió directamente de la parte abdominal de la aorta en todos los casos, sin que ninguno estuviera unido a la arteria mesentérica superior. Se observó trifurcación del tronco celíaco en el 84,84 % de la muestra, aunque en el 10,61 % se observó un tronco celíaco con cuatro ramas. También se observó bifurcación en las arterias hepática y esplénica común formando un tronco hepatoesplénico (2 mujeres) o en la arteria gástrica izquierda y la arteria esplénica formando un tronco esplenogástrico (1 hombre). Los resultados son comparables con otros estudios en caucásicos que muestran una alta tasa de trifurcación del tronco celíaco (mayor al 75%). Nuestra muestra presentó menos variaciones que las reportadas en estudios previos. Por lo tanto, es posible que se requieran estudios más amplios con más muestras en el futuro, para determinar todos los patrones de ramificación del tronco celíaco en la población caucásica sudafricana.

Humans , Male , Female , Celiac Artery/anatomy & histology , Anatomic Variation , Aorta, Abdominal , South Africa , Splenic Artery , Stomach/blood supply , Mesenteric Artery, Superior , Liver/blood supply
Int. j. morphol ; 38(1): 226-229, Feb. 2020. graf
Article in English | LILACS | ID: biblio-1056426


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.

Humans , Portal Vein/anatomy & histology , Liver/blood supply , Dissection
ABCD arq. bras. cir. dig ; 33(1): e1484, 2020. tab, graf
Article in English | LILACS | ID: biblio-1088501


ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice.

RESUMO Racional: As hepatectomias compreendem considerável perda sanguínea e utilização de hemoderivados, o que diretamente estão relacionados com maior morbimortalidade. A hepatectomia hemoconservadora (HH) é modificação da técnica de oclusão vascular seletiva em hepatectomia. Ela pode ser alternativa cirúrgica para evitar ou diminuir o uso de hemoderivados no perioperatório. Objetivo: Avaliar os efeitos da HH sobre o volume globular (VG), concentração de hemoglobina (HB) e sobre a regeneração hepática em ratos. Métodos: Dois grupos de ratos Wistar foram constituídos: controle (n=6) e intervenção (n=6). Os do grupo controle foram submetidos à hepatectomia parcial de Higgins e Anderson e os do grupo Intervenção à HH. VG e HB foram medidos nos dias D0, D1 e D7. A relação peso do fígado/peso do rato foi calculada em D0 e D7. A regeneração hepática foi analisada qualitativamente e quantitativamente. Resultados: Houve diminuição dos níveis de VG e HB nos ratos do grupo controle a partir de D1, atingindo decréscimo de 18% em D7 (p=0,01 e p=0,008 respectivamente); a HH permitiu a manutenção dos níveis de VG e HB nos ratos do grupo intervenção. A HH não alterou a regeneração hepática. Conclusão: HH resultou em níveis maiores de VG e HB pós-operatórios sem alterar a regeneração hepática. Pode-se considerar estes dados como a prova necessária para a translação à pesquisa clinicocirúrgica.

Animals , Male , Rats , Veins/physiology , Hepatectomy/methods , Liver/surgery , Liver/blood supply , Liver Regeneration , Portal Vein/surgery , Postoperative Period , Blood Volume/physiology , Hepatic Veno-Occlusive Disease/physiopathology , Hemoglobins/analysis , Rats, Wistar , Hematocrit
Acta cir. bras ; 34(11): e201901103, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054680


Abstract Purpose: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.

Animals , Male , Portal Vein/surgery , Hepatic Artery/surgery , Liver/diagnostic imaging , Liver Regeneration/physiology , Organ Size/physiology , Immunohistochemistry , Random Allocation , Tomography, X-Ray Computed/methods , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Imaging, Three-Dimensional/methods , Hepatomegaly/physiopathology , Hepatomegaly/diagnostic imaging , Ligation , Liver/blood supply , Liver/pathology
Acta cir. bras ; 34(10): e201901003, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054672


Abstract Purpose: To evaluate that Connexin (Cx43) plays a role in lesions after hepatic ischemia/reperfusion (IR) injury. Methods: We use Cx43 deficient model (heterozygotes mice) and compared to a wild group. The groups underwent 1 hour ischemia and 24 hours reperfusion. The heterozygote genotype was confirmed by PCR. We analyzed the hepatic enzymes (AST, ALT, GGT) and histology. Results: The mice with Cx43 deficiency showed an ALT mean value of 4166 vs. 307 in the control group (p<0.001); AST mean value of 7231 vs. 471 in the control group (p<0.001); GGT mean value of 9.4 vs. 1.7 in the control group (p=0.001); histology showed necrosis and inflammation in the knockout group. Conclusions: This research demonstrated that the deficiency of Cx43 worses the prognosis for liver injury. The topic is a promising target for therapeutics advancements in liver diseases and procedures.

Animals , Reperfusion Injury/metabolism , Connexin 43/deficiency , Disease Models, Animal , Liver/blood supply , Aspartate Aminotransferases/analysis , Reference Values , Time Factors , Reperfusion Injury/pathology , Polymerase Chain Reaction , Mice, Knockout , Connexin 43/analysis , Alanine Transaminase/analysis , Genotyping Techniques , gamma-Glutamyltransferase/analysis , Liver/pathology , Necrosis
Int. j. morphol ; 37(3): 1179-1186, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1012414


Due to a lack of consensus on the description of the human liver anatomy, we decided to explore different researches worldwide. Studies are focused on the hepatic vascularization. The results obtained through serial dissections in embryos, fetuses and adults have contributed to new definitions. Researchers around the world have agreed on finding the bases to propose a liver segmentation with seven portal segments.

La confusión existente en la descripción de la anatomía del hígado humano nos llevó a realizar esta revisión a nivel mundial. Las investigaciones se centran en la vascularización del hígado, el conocimiento obtenido mediante disecciones seriadas en embriones, fetos y adultos han aportado nuevos conocimientos que fundamentan nuevas definiciones. Investigadores de países distantes han coincidido en encontrar las bases para proponer una segmentación del hígado con siete segmentos portales.

Humans , Liver/anatomy & histology , Hepatic Veins/anatomy & histology , Liver/embryology , Liver/blood supply
Acta cir. bras ; 34(7): e201900707, 2019. graf
Article in English | LILACS | ID: biblio-1038118


Abstract Purpose: To evaluate the effects of splenic ischemic preconditioning (sIPC) on oxidative stress induced by hepatic ischemia-reperfusion in rats. Methods: Fifteen male Wistar rats were equally divided into 3 groups: SHAM, IRI and sIPC. Animals from IRI group were subjected to 45 minutes of partial liver ischemia (70%). In the sIPC group, splenic artery was clamped in 2 cycles of 5 min of ischemia and 5 min of reperfusion (20 min total) prior to hepatic ischemia. SHAM group underwent the same surgical procedures as in the remaining groups, but no liver ischemia or sIPC were induced. After 1h, hepatic and splenic tissue samples were harvested for TBARS, CAT, GPx and GSH-Rd measurement. Results: sIPC treatment significantly decreased both hepatic and splenic levels of TBARS when compared to IRI group (p<0.01). Furthermore, the hepatic and splenic activities of CAT, GPx and GSH- Rd were significantly higher in sIPC group than in IRI group. Conclusion: sIPC was able to attenuate hepatic and splenic IRI-induced oxidative stress.

Animals , Male , Rats , Reperfusion Injury/prevention & control , Oxidative Stress/physiology , Ischemic Preconditioning/methods , Liver/blood supply , Liver Diseases/prevention & control , Reperfusion Injury/physiopathology , Random Allocation , Rats, Wistar , Disease Models, Animal , Liver/physiology , Liver Diseases/physiopathology
Acta cir. bras ; 34(8): e201900805, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038124


Abstract Purpose To investigate the effect of sevoflurane preconditioning on ischemia/reperfusion (I/R)-induced pulmonary/hepatic injury Methods Fifty-one Wistar rats were randomly grouped into sham, I/R, and sevoflurane groups. After reperfusion, the structural change of the lung was measured by Smith score, the wet and dry weights (W/D) were determined, malondialdehyde (MDA) myeloperoxidase (MPO) content was determined colorimetrically and by fluorescence, respectively, and matrix metalloprotein-9 (MMP-9) mRNA was quantified by RT-PCR. Biopsy and morphological analyses were performed on liver tissue, activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined, and tumor necrosis factor-alpha (TNF-α) level was determined. Results The sham group showed no changes in tissue structure. Structural lesions in the sevoflurane and I/R groups were mild and severe, respectively. Smith score, W/D, MDA, MPO, and MMP mRNA showed the same trend, and were increased in the I/R group and recovered in the sevoflurane group, compared with the sham group (both P<0.05). AST and ALT were significantly increased compared to the sham group (AST: 655±52.06 vs . 29±9.30 U/L; ALT: 693±75.56 vs . 37±6.71 U/L; P<0.05). In the sevoflurane group, AST and ALT levels were significantly decreased (464±47.71 and 516±78.84 U/L; P<0.001). TNF-α presented similar results. Conclusion The protection of lung and liver by sevoflurane may be mediated by inhibited leukocyte recruitment and MMP-9 secretion.

Animals , Male , Rats , Reperfusion Injury/prevention & control , Anesthetics, Inhalation/therapeutic use , Ischemic Preconditioning/methods , Liver/blood supply , Lung/blood supply , Aspartate Aminotransferases/blood , Reperfusion Injury/drug therapy , Tumor Necrosis Factor-alpha/blood , Peroxidase/analysis , Alanine Transaminase/blood , Disease Models, Animal , Sevoflurane/therapeutic use , Ischemia/prevention & control , Liver/drug effects , Liver/pathology , Lung/drug effects , Lung/pathology , Malondialdehyde/analysis
Acta cir. bras ; 34(4): e201900402, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001091


Abstract Purpose: To evaluate the effect of amniotic fluid in liver preservation in organ transplantation, and compare it with standard preservation solutions. Methods: The groups consisted of Group 1: Ringer Lactate (RL) group, Group 2: HTK group, Group 3: UW group, Group 4: AF group. The livers of rats from Group 1, 2, 3, and 4 were perfused and placed into falcon tubes containing RL, HTK, UW, and AF solutions at +4‎°C, respectively. The tubes were stored for 12 hours in the refrigerator at +4°C. Tissue samples were taken at the 6th and 12th hours for histopathological examinations of the perfused livers, and storage solutions for biochemical analyzes at 6th and 12th hours. Results: AF was shown to maintain organ viability by reducing the number of cells undergoing apoptosis. Histopathological changes such as sinusoidal dilatation, hydropic degeneration, and focal necrosis were found to be similar to the groups in which the standard organ preservation solutions were used. Additionally, the results of INOS, IL-10, and TNF-α,which were evaluated immunohistochemically, have been shown to be similar to the UW and HTK groups. Conclusions: AF provided conservation similar to UW and HTK in the 12-hour liver SCS process. The fact that apoptosis values are comparable to standard preservation solutions supports the success of AF in the cold storage of the liver.

Animals , Male , Cryopreservation/methods , Organ Preservation Solutions/pharmacology , Amniotic Fluid , Liver/blood supply , Liver/pathology , Organ Preservation/methods , Potassium Chloride/pharmacology , Procaine/pharmacology , Reference Values , Time Factors , Tissue Survival , Immunohistochemistry , Reperfusion Injury/prevention & control , Random Allocation , Reproducibility of Results , Tumor Necrosis Factor-alpha/analysis , Interleukin-10/analysis , Rats, Wistar , In Situ Nick-End Labeling , Nitric Oxide Synthase Type II/analysis , Ringer's Solution/pharmacology , Glucose/pharmacology , Mannitol/pharmacology
Acta cir. bras ; 33(12): 1043-1051, Dec. 2018. graf
Article in English | LILACS | ID: biblio-973484


Abstract Purpose: To analyze the effect of methylene blue (MB) therapy during the liver ischemia-reperfusion injury (I/R) process. Methods: Thirty-five male Wistar rats were used, (70%) submitted to partial ischemia (IR) or not (NIR) (30%) were obtained from the same animal. These animals were divided into six groups: 1) Sham (SH), 2) Sham with MB (SH-MB); 3) I/R, submitted to 60 minutes of partial ischemia and 15 minutes of reperfusion; 4) NI/R, without I/R obtained from the same animal of group I/R; 5) I/R-MB submitted to I/R and MB and 6) NI/R-MB, without I/R. Mitochondrial function was evaluated. Osmotic swelling of mitochondria as well as the determination of malondialdehyde (MDA) was evaluated. Serum (ALT/AST) dosages were also performed. MB was used at the concentration of 15mg/kg, 15 minutes before hepatic reperfusion. Statistical analysis was done by the Mann Whitney test at 5%. Results: State 3 shows inhibition in all ischemic groups. State 4 was increased in all groups, except the I/R-MB and NI/R-MB groups. RCR showed a decrease in all I/R and NI/R groups. Mitochondrial osmotic swelling showed an increase in all I/R NI/R groups in the presence or absence of MB. About MDA, there was a decrease in SH values in the presence of MB and this decrease was maintained in the I/R group. AST levels were increased in all ischemic with or without MB. Conclusions: The methylene blue was not able to restore the mitochondrial parameters studied. Also, it was able to decrease lipid peroxidation, preventing the formation of reactive oxygen species.

Humans , Animals , Male , Reperfusion Injury/prevention & control , Enzyme Inhibitors/therapeutic use , Liver/blood supply , Methylene Blue/therapeutic use , Oxygen Consumption , Aspartate Aminotransferases/blood , Reference Values , Time Factors , Mitochondria, Liver/drug effects , Mitochondria, Liver/metabolism , Lipid Peroxidation/drug effects , Reperfusion Injury/metabolism , Reproducibility of Results , Reactive Oxygen Species/analysis , Reactive Oxygen Species/metabolism , Rats, Wistar , Cell Respiration , Alanine Transaminase/blood , Enzyme Inhibitors/pharmacology , Mitochondrial Membranes/drug effects , Mitochondrial Membranes/metabolism , Liver/metabolism , Malondialdehyde/analysis , Methylene Blue/pharmacology , Mitochondrial Swelling/drug effects
Acta cir. bras ; 33(11): 964-974, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973473


Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Animals , Male , Rabbits , Stomach/blood supply , Stomach/pathology , Ischemia/complications , Liver/pathology , Aspartate Aminotransferases , Reference Values , Time Factors , Bilirubin/blood , Serum Albumin/analysis , Reperfusion Injury/pathology , Random Allocation , Alanine Transaminase , Alkaline Phosphatase , gamma-Glutamyltransferase , Ischemia/pathology , Liver/blood supply , Liver Diseases/etiology , Liver Diseases/pathology , Necrosis
Rev. bras. anestesiol ; 68(6): 591-596, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977407


Abstract Introduction: Hepatic ischemia-reperfusion injury is a common pathophysiological process in liver surgery. Whether Propofol can reduce myocardial ischemia-reperfusion injury induced by hepatic ischemia-reperfusion injury in rats, together with related mechanisms, still needs further studies. Objective: To investigate if propofol would protect the myocardial cells from apoptosis with hepatic ischemia-reperfusion injury. Methods: Male Sprague-Dawley rats (n = 18) were randomly allocated into three groups: Sham Group (Group S, n = 6), Hepatic Ischemia-reperfusion Injury Group (Group IR, n = 6) and Propofol Group (Group P, n = 6). Group S was only subjected to laparotomy. Group IR was attained by ischemia for 30 min and reperfusion for 4 h. Group P was subjected identical insult as in Group IR with the administration of propofol started 10 min before ischemia with 120−1, following by continuous infusion at 20−1.h−1. Cell apoptosis was examined by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay. Endoplasmic reticulum Ca2+-ATPase2 (SERCA2) and cysteine-containing aspartic acid cleaved-caspase3 (cleaved-caspase3) were assayed by western blot and Altimeter polymerase chain reaction. Results: Apoptosis rate was increased, with mRNA and protein of SERCA2 down-regulated and cleaved-caspase3 up-regulated in Group IR compared with Group S (p < 0.01). Apoptosis rate was decreased, with mRNA and protein of SERCA2 up-regulated and cleaved-caspase3 down-regulated in Group P compared with Group IR (p < 0.01). Conclusions: Propofol can reduce hepatic ischemia-reperfusion injury-induced myocardial cell apoptosis, meanwhile, can up-regulate mRNA and protein of SERCA2 in rats.

Resumo Introdução: A lesão hepática por isquemia-reperfusão é um processo fisiopatológico comum em cirurgias hepáticas. Mais estudos ainda são necessários para avaliar se o propofol pode reduzir a lesão de isquemia-reperfusão miocárdica induzida pela lesão de isquemia-reperfusão hepática em ratos, juntamente com os mecanismos que estão relacionados. Objetivo: Investigar se propofol protege as células do miocárdio da apoptose com a lesão hepática por isquemia-reperfusão. Métodos: Ratos machos da raça Sprague-Dawley (n = 18) foram alocados aleatoriamente em três grupos: Grupo Sham (Grupo S, n = 6), Grupo Lesão Hepática por Isquemia-reperfusão (Grupo IR, n = 6) e Grupo Propofol (Grupo P, n = 6). O Grupo S foi submetido apenas à laparotomia. O grupo IR foi submetido à isquemia por 30 min e reperfusão por 4 h. O grupo P foi submetido à mesma isquemia do grupo IR, com a administração de 120 de propofol iniciada 10min antes da isquemia, seguida de infusão contínua a 20 A apoptose celular foi examinada por meio do ensaio de marcação de terminações dUTP pela deoxinucleotidil transferase. Retículo endoplasmático Ca2+-ATPase2 (SERCA2) e caspase-3 do ácido aspártico contendo cisteína (caspase-3 clivada) foram avaliados com o ensaio western blot e reação em cadeia da polimerase. Resultados: A taxa de apoptose foi maior com mRNA e proteína de SERCA2 regulados para baixo e caspase-3 clivada suprarregulada no Grupo IR, em comparação com o Grupo S (p < 0,01). A taxa de apoptose foi menor com mRNA e proteína de SERCA2 suprarregulada e caspase-3 clivada sub-regulada no Grupo P, em comparação com o Grupo IR (p < 0,01). Conclusões: O propofol pode reduzir a apoptose de células miocárdicas induzida por lesão hepática por isquemia-reperfusão. Entretanto, pode suprarregular o mRNA e a proteína de SERCA2 em ratos.

Animals , Male , Rats , Reperfusion Injury/prevention & control , Propofol/administration & dosage , Apoptosis/drug effects , Anesthetics, Intravenous/administration & dosage , Myocytes, Cardiac/drug effects , Myocytes, Cardiac/physiology , Sarcoplasmic Reticulum Calcium-Transporting ATPases/biosynthesis , Sarcoplasmic Reticulum Calcium-Transporting ATPases/drug effects , Liver/blood supply , Random Allocation , Propofol/pharmacology , Rats, Sprague-Dawley , Anesthetics, Intravenous/pharmacology
Acta cir. bras ; 33(10): 924-934, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973470


Abstract Purpose: To develop a new 24 hour extended liver ischemia and reperfusion (LIR) model analyzing the late biochemical and histopathological results of the isolated and combined application of recognized hepatoprotective mechanisms. In addition, we used a new stratification with zoning to classify the histological lesion. Methods: A modified animal model of severe hepatic damage produced through 90 minutes of segmental ischemia (70% of the organ) and posterior observation for 24 hours of reperfusion, submitted to ischemic preconditioning (IPC) and topical hypothermia (TH) at 26ºC, in isolation or in combination, during the procedure. Data from intraoperative biometric parameters, besides of late biochemical markers and histopathological findings, both at 24 hours evolution time, were compared with control (C) and normothermic ischemia (NI) groups. Results: All groups were homogeneous with respect to intraoperative physiological parameters. There were no losses once the model was stablished. Animals subjected to NI and IPC had worse biochemical (gamma-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, direct bilirubin, and total bilirubin) and histopathological scores (modified Suzuki score) compared to those of control groups and groups with isolated or associated TH (p < 0.05). Conclusion: The new extended model demonstrates liver ischemia and reperfusion at 24 hour of evolution and, in this extreme scenario, only the groups subjected to topical hypothermia, combined with ischemic preconditioning or alone, had better outcomes than those subjected to only ischemic preconditioning and normothermic ischemia, reaching similar biochemical and histopathological scores to those of the control group.

Animals , Male , Rats , Reperfusion Injury/pathology , Ischemic Preconditioning , Ischemia/pathology , Time Factors , Reperfusion Injury/etiology , Rats, Wistar , Disease Models, Animal , Hypothermia, Induced , Ischemia/etiology , Liver/physiopathology , Liver/blood supply , Liver/pathology
Int. j. morphol ; 36(3): 931-936, Sept. 2018. graf
Article in English | LILACS | ID: biblio-954210


SUMMARY: We wanted to know how many segmental portal branches were born from the primary branches of the hepatic portal vein in the porta hepatis, in order to determine the number of portal segments in human liver. We studied 286 human livers, age groups ranging from fetuses to octogenarians, both sexes and all races, using dissection, colored acrylic injection and reconstituted tomographic images. We found the porta hepatis channel formed by each and every portal segment; we found seven segmental terminal pedicles for seven portal segments, three planes of vertical and three planes of horizontal portal fissures. There are seven terminal portal pedicles that are formed in the porta hepatis from the right and left branches of the hepatic portal vein. The only variation was portal branch V emerging from the right branch in 79 % of cases or from the left branch in 21 %. The definition of hepatic portal segment is: Portion of parenchyma irrigated by terminal branches of the portal vein and the hepatic artery proper, isolated from the other segments by planes of portal fissures and forms the parenchymal channel of the porta hepatis where it receives its vascularization. We propose a new and simple portal segmentation based on the previous definition.

RESUMEN: El objetivo de este trabajo consistió en conocer el número de ramas portales segmentarias que nacen de las ramas primarias de la vena porta hepática en la Porta hepatis, con la finalidad de determinar el número de segmentos portales en el hígado humano. Estudiamos 286 hígados, los grupos etarios fueron desde fetos hasta octogenarios, ambos sexos y todas las razas, usamos la disección en fresco, inyección de acrílico coloreado e imágenes tomográficas reconstituidas. El canal de la Porta hepatis estuvo formado por todos y cada uno de los segmentos portales, encontramos siete pedículos terminales segmentarios para siete segmentos portales, el pedículo portal para el segmento V nació de la porta derecha en 79 % de casos y de la porta izquierda en 21 %, encontramos tres planos de fisuras portales verticales y tres horizontales. Existen siete pedículos segmentarios portales terminales que se forman en la Porta hepatis a partir de las ramas derecha e izquierda de la vena porta hepática. La única variación fue que la rama portal para el segmento V nació de la rama derecha en 79 % de casos y de la rama izquierda en 21 %. Concluimos que la definición de segmento portal hepático es: Porción de parénquima irrigado por ramas terminales de la vena porta y la arteria hepática propia, aislada de los otros segmentos por planos de fisuras y que llega a conformar el canal parenquimal de la Porta hepatis donde recibe su vascularización. Proponemos una nueva y sencilla segmentación portal basada en la definición previa.

Humans , Portal Vein/anatomy & histology , Hepatic Veins/anatomy & histology , Liver/blood supply
Acta cir. bras ; 33(9): 775-784, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973506


Abstract Purpose: To evaluate whether pre-treatment with rivastigmine is able to attenuate the I/R induced lesions in rat liver. Methods: SHAM animals or those submitted to I/R, non-treated or pre-treated with rivastigminine (2mg/kg) either 50 or 15 minutes before ischemia, were used. After I/R protocol, these animals were killed and their livers were harvested to measurement of the mitochondrial swelling as well as the malondialdehyde (MDA), nitrite and nitrate tissue concentration. Blood was also harvested for serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) determinations. Results: I/R promoted a significant increase of mitochondrial swelling in the studied animals. This increase of mitochondrial swelling was partially prevented by rivastigmine, but only if administered 50 minutes before ischemia. No significant modification of MDA, nitrite or nitrate tissue concentrations was observed in consequence of I/R, followed or not by rivastigmine treatments. In addition, I/R elevated both AST and ALT. These elevations of serum enzymes were not reversed by the different rivastigmine treatments. Conclusions: Rivastigmine administered 50 minutes before ischemia attenuates I/R-induced mitochondrial swelling, that indicates liver injury. This protective effect may be related to a greater stimulation of α7nAChR present in the Kupffer cells by the non-methabolized ACh, leading to an attenuation of I/R-induced inflammation.

Animals , Male , Rats , Reperfusion Injury/prevention & control , Rivastigmine/administration & dosage , Ischemia/complications , Liver/blood supply , Aspartate Aminotransferases/blood , Mitochondria, Liver , Reperfusion Injury/pathology , Rats, Wistar , Mitochondrial Myopathies/prevention & control , Alanine Transaminase/blood , Disease Models, Animal , Ischemia/blood , Liver/drug effects
Acta cir. bras ; 33(8): 723-735, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-949372


Abstract It is well known that during hepatic operative procedures, it is often critical that the irrigation is interrupted to avoid possible bleeding, blood transfusions, variable intensities, and their short and long-term consequences. It was believed in the past that the flow interruption should not exceed 20 minutes, which limited the use of this maneuver. However, it has been postulated that ischemia could be maintained for more than 60 minutes in healthy livers. The present paper review includes: 1) A brief introduction to justify the rationale of the review design; 2) Aspects of the pathophysiology of the three stages of the liver ischemia-reperfusion injury; 3) The innate and acquired immunity; 4) Oxidative stress; 5) Apoptosis and autophagy, Some essential biomarkers (Tumor Necrosis Factor-α, nitric oxide, metalloproteinases); and, finally; 6) Preventive ("cheating") strategies, non-pharmacological and pharmacological options to treat the liver IR injury.

Humans , Reperfusion Injury/physiopathology , Reperfusion Injury/therapy , Ischemic Preconditioning/methods , Ischemia/physiopathology , Ischemia/therapy , Liver/blood supply , Time Factors , Mitochondria, Liver/metabolism , Reperfusion Injury/metabolism , Tumor Necrosis Factor-alpha/metabolism , Cell Death/physiology , Oxidative Stress/physiology , Matrix Metalloproteinases/metabolism , Ischemia/metabolism , Nitric Oxide/metabolism
Acta cir. bras ; 33(7): 597-608, July 2018. graf
Article in English | LILACS | ID: biblio-949363


Abstract Purpose: To compare early- and late-effect remote ischemic preconditioning (RIPC) by analysing the microcirculatory, hemodynamic and histological changes in partial liver ischemia-reperfusion of rats. Methods: 60-minute partial liver ischemia followed by 120-minute reperfusion was performed without (Control group, n=7) or with preconditioning. In RIPC groups a tourniquet was applied around the left thigh using 3 cycles of 10-minute ischemia/10-minute reperfusion, one (RIPC-1, n=7) or twenty-four hours (RIPC-24, n=7) before I/R. Hemodynamic and microcirculatory measurements were performed before and after ischemia and in 30th, 60th and 120th minute of reperfusion and histological examination at the end of reperfusion. Results: Blood pressure decreased in all groups followed by biphasic changes in Control group. In RIPC groups R120 values returned almost to normal. Heart rate increased in Control and RIPC-1 groups at R120, while RIPC-24 did not show significant changes. Microcirculation of non-ischemic liver stayed constant in Control and showed significant changes in RIPC-24 group, while in ischemic liver elevated by R120 in all groups. RIPC didn't reduce histological alterations. Conclusion: Considering the survival and the results, both remote ischemic preconditioning protocols had beneficial effect in hepatic ischemia-reperfusion, however the histopathological findings were controversial.

Animals , Rats , Reperfusion Injury/prevention & control , Ischemic Preconditioning/methods , Ischemia/prevention & control , Liver/blood supply , Microcirculation/physiology , Temperature , Time Factors , Blood Pressure/physiology , Random Allocation , Reproducibility of Results , Treatment Outcome , Laser-Doppler Flowmetry , Disease Models, Animal , Respiratory Rate/physiology , Liver/pathology
Int. j. morphol ; 36(2): 402-406, jun. 2018. tab, graf
Article in English | LILACS | ID: biblio-954128


SUMMARY: The liver dimensional (3D) models, consists of eight segments including portal triad (portal vein, hepatic artery, and bile duct), are necessary because it is difficult to dissect a liver and its inner structures. But it is difficult to produce 3D models from high resolution and color sectioned-images. This study presents automatic and accurate methods for producing liver 3D models from the sectionedimages. Based on the sectioned-images and color-filled-images of the liver, a 3D model including both the portal triad and hepatic vein was made. Referring to the 3D model, 3D models of liver's eight segments including the segmental branches of the portal triad and hepatic vein were completed and saved as STL format. All STL files were combined and saved as Liver-3D in PDF format for the common user. By functional subdivision of liver, the Liver-3D was divided into left (segments II, III, and, IV) and right (segments V, VI, VII, and VIII) liver in bookmark window of the PDF file. In addition, in Liver-3D, the primary to tertiary segmental branches of the portal triad could be shown in different colors. Owing to the difficulty of 3D modeling of liver including eight segments and segmental branches of the portal triad and hepatic, we started this research to find automatic methods for producing 3D models. The methods for producing liver 3D models will assist in 2D selection and 3D modeling of other complicated structures.

RESUMEN: Los modelos hepáticos dimensionales (3D) consisten en ocho segmentos que incluyen la tríada portal (vena porta, arteria hepática y conducto biliar), y son necesarios ya que es difícil disecar un hígado y sus estructuras internas. Sin embargo, es difícil producir modelos 3D a partir de imágenes en alta resolución e imágenes seccionadas en color. Este estudio presenta métodos automáticos y precisos para producir modelos 3D de hígado a partir de las imágenes seccionadas. Sobre la base de las imágenes seccionadas y las imágenes del hígado llenas de color, se realizó un modelo 3D que incluía tanto la tríada portal como la vena hepática. En referencia al modelo 3D, se completaron modelos 3D de los ocho segmentos del hígado que incluían las ramas segmentarias de la tríada portal y la vena hepática y se guardaron como formato STL. Todos los archivos STL fueron combinados y guardados como Liver-3D en formato PDF para el usuario común. Por subdivisión funcional del hígado, el hígado-3D se dividió en hígado izquierdo (segmentos II, III y IV) y derecho (segmentos V, VI, VII y VIII) en la ventana de marcador del archivo PDF. Además, en Liver-3D, las ramas segmentarias primarias a terciarias de la tríada portal podrían mostrarse en diferentes colores. Debido a la dificultad del modelado 3D del hígado, incluidos ocho segmentos y ramas segmentarias de la tríada portal y hepática, comenzamos esta investigación para encontrar métodos automáticos para producir modelos 3D. Los métodos para producir modelos 3D de hígado ayudarán en la selección 2D y el modelado 3D de otras estructuras complicadas.

Humans , Anatomy, Cross-Sectional , Imaging, Three-Dimensional , Hepatic Veins/diagnostic imaging , Liver/diagnostic imaging , Visible Human Projects , Hepatic Veins/anatomy & histology , Liver/blood supply , Models, Anatomic
Int. j. morphol ; 36(1): 113-120, Mar. 2018. graf
Article in Spanish | LILACS | ID: biblio-893197


RESUMEN: El conocimiento anatómico es necesario para la cirugía hepática. Los conocimientos acerca de la porción izquierda del hígado que aparecen en los textos de anatomía, cirugía y en la Internet deben ser mejorados y enriquecidos, proponemos hacerlo con este trabajo. Se estudiaron 286 hígados humanos que nos permitieron determinar entre otros conocimientos los siguientes: La porción izquierda del hígado fue más grande que la derecha en 21 % de casos. 2) La porción izquierda del hígado estuvo formada por los cuatro primeros segmentos portales (79 %) o por los cinco primeros (21 %). 3) La fisura umbilical se inclinó 50 grados hacia la izquierda en relación al plano sagital del hígado y no contuvo a la vena hepática izquierda en 100 % de casos. 4) La vena hepática izquierda tuvo un trayecto intrasegmentario y presentó tres modalidades de drenaje. 5) La irrigación arterial de los segmentos izquierdos I y IV nació de la rama derecha en 16 % y de ambas ramas en 24 %. 6) El drenaje biliar de los segmentos derechos VI-VII llegó al conducto hepático izquierdo en 21 % de casos. Estos resultados fueron diferentes de los conocimientos que figuran en los textos de anatomía humana usados en las Escuelas de Medicina a nivel general.

SUMMARY: Accurate anatomical knowledge is necessary for liver surgery. Much of the knowledge about the left portion of the liver in the anatomy, surgery and internet texts must be improved and enriched; we propose to do this with this work. We studied 286 human livers that allowed us to determine further knowledge, along with the following information: 1) The left liver portion was larger than the right liver in 21 % of cases. 2) The left portion of the liver was formed by the first four portal segments (79 %) or by the first five (21 %). 3) The umbilical fissure tilted 50 degrees to the left relative to the sagittal plane of the liver and did not contain the left hepatic vein in 100 % of cases. 4) The left hepatic vein had an intrasegmental path and presented three drainage modalities. 5) Arterial irrigation of the left segments I and IV were born from the right branch in 16 % and from both branches in 24 %. 6) Bile drainage of right segments VI-VII reached the left hepatic canal in 21 % of cases. These results were different from the knowledge contained in the human anatomy texts used in medical schools at the general level.

Humans , Liver/anatomy & histology , Hepatic Veins/anatomy & histology , Liver/blood supply
Clinics ; 73: e113, 2018. tab, graf
Article in English | LILACS | ID: biblio-952803


OBJECTIVES: The objective of the present study was to evaluate the protective effect of pre-conditioning treatment with laser light on hepatic injury in rats submitted to partial ischemia using mitochondrial function and liver fatty acid binding protein as markers. METHODS: Rats were divided into four groups (n=5): 1) Control, 2) Control + Laser, 3) Partial Ischemia and 4) Partial Ischemia + Laser. Ischemia was induced by clamping the hepatic pedicle of the left and middle lobes of the liver for 60 minutes. Laser light at 660 nm was applied to the liver immediately prior to the induction of ischemia at 22.5 J/cm2, with 30 seconds of illumination at five individual points. The animals were sacrificed after 30 minutes of reperfusion. Blood and liver tissues were collected for analysis of mitochondrial function, determination of malondialdehyde and analysis of fatty acid binding protein expression by Western blot. RESULTS: Mitochondrial function decreased in the Partial Ischemia group, especially during adenosine diphosphate-activated respiration (state 3), and the expression of fatty acid binding protein was also reduced. The application of laser light prevented bioenergetic changes and restored the expression of fatty acid binding protein. CONCLUSION: Prophylactic application of laser light to the livers of rats submitted to partial ischemia was found to have a protective effect in the liver, with normalization of both mitochondrial function and fatty acid binding protein tissue expression.

Animals , Reperfusion Injury/prevention & control , Ischemic Preconditioning/methods , Low-Level Light Therapy/methods , Fatty Acid-Binding Proteins/metabolism , Liver/radiation effects , Liver/blood supply , Aspartate Aminotransferases/blood , Blotting, Western , Reproducibility of Results , Rats, Wistar , Alanine Transaminase/blood , Mitochondrial Membranes/drug effects , Fatty Acid-Binding Proteins/analysis , Liver/metabolism , Malondialdehyde/analysis , Malondialdehyde/radiation effects , Mitochondrial Swelling/radiation effects