The types of connections between the portal sinus and main portal vein in foetuses / Tipos de conexiones entre el seno portal y la vena porta principal en fetos

In the prenatal period, the three types of connections between the portal sinus and main portal vein have been published in the literature: T, X and H-shaped. The T type is the most frequent in the literature, and the aim of our study is to define the percentage of the connection types during the prenatal period in our population. In this prospective study, 237 women between 20 and 38 weeks of pregnancy without a foetal anomaly or pregnancy-related complications were included, and the precordial veins of the foetuses were examined using a wide-band color Doppler technique. The types of connections were determined by two specialists according to the shape of the colour coded vessels in Doppler examinations. The criteria of Czubalski & Aleksandrowicz (2000) were used. All of the connection types in patients were confirmed using video clips and were stored in the picture archiving and communication system. In 237 patients, the types of connection were determined by the first specialist as 189 foetuses (79.7 %) with the X-shaped or side-to-side connection, 16 foetuses (6.8 %) with the T-shaped or end-to-side type and 32 foetuses (13.5 %) with the H-shaped or parallel-coursed vessels connected with a short segment. The most common types of connections between the portal sinus and main portal vein in foetuses are X shaped or side-to-side, which is contrary to previous studies.

En el período prenatal, se han publicado en la literatura los tres tipos de conexiones entre el seno portal y la vena porta principal: en forma de T, X y H. El tipo T es el más frecuente, y el objetivo de nuestro estudio fue definir el porcentaje de tipos de conexión durante el período prenatal en nuestra población. En este estudio prospectivo, se incluyeron 237 mujeres entre 20 y 38 semanas de embarazo, sin anomalías fetales o complicaciones relacionadas con el embarazo, y se examinaron las venas precordiales de los fetos utilizando una técnica Doppler de banda ancha. Los tipos de conexiones fueron determinados por dos especialistas según la forma de los vasos codificados por color en los exámenes Doppler. Se utilizaron los criterios del estudio de Czubalski & Aleksandrowicz. Todos los tipos de conexión en los pacientes se confirmaron mediante videoclips y se almacenaron en el sistema de comunicación y en archivo de imágenes. En 237 pacientes, el primer especialista determinó en 189 fetos (79,7 %) la conexión en forma de X o de lado a lado; en 16 fetos (6,8 %) la forma de T o Tipo de extremo a lado; y en 32 fetos (13,5 %) los vasos en forma de H o paralelos, conectados con un segmento corto. Los tipos más comunes de conexiones entre el seno portal y la vena porta principal en los fetos son en forma de X o de lado a lado, lo que es contrario a estudios anteriores.

Serum vitamin D expression in advanced schistosomiasis patients with hepatic fibrosis and its association with disease progression / 中国血吸虫病防治杂志

Objective To compare the expression of serum vitamin D in advanced schistosomiasis patients with grade I and II hepatic fibrosis, and to preliminarily examine its associations with the internal diameter of the main portal vein and progression of hepatic fibrosis. Methods The medical records of 126 advanced schistosomiasis patients with grade I and II hepatic fibrosis referred to Jiaxing First Hospital from March 2012 to September 2015 were retrospectively analyzed. The internal diameter of the main portal vein and serum 25-hydroxyvitamin D3 [25(OH)D3] level were measured. The progression of hepatic fibrosis was followed up, and the serum vitamin D level was compared between patient with disease progression and stable disease. Results The 126 advanced schistosomiasis patients included 72 men and 54 women, and had ages of 62 to 80 years. There were 58 cases with grade I hepatic fibrosis and 68 cases with grade II hepatic fibrosis. There were significant differences between patients with grade I and II hepatic fibrosis in terms of hemoglobin, white blood cell count, prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen or 25(OH)D3 level (all P > 0.05), and significant differences were seen in alanine aminotransferase, aspartate aminotransferase, blood calcium, blood phosphorus levels and the internal diameter of the main portal vein (all P values < 0.05). In addition, a lower serum 25(OH)D3 level was detected in patients with broadened internal diameter of the main portal vein than in those with normal internal diameter of the main portal vein [(19.08 ± 1.36) nmol/L vs. (25.61 ± 6.69) nmol/L, P < 0.05]. Following 3-year follow-up, there were 73 cases with progression of hepatic fibrosis, and a significantly lower serum vitamin D level was found in patients with disease progression than in those with stable disease [(20.00 ± 0.81) nmol/L vs. (25.47 ± 5.91) nmol/L, P < 0.05]. Conclusions Vitamin D deficiency is common in advanced schistosomiasis patients with hepatic fibrosis, and it may be associated with the internal diameter of the main portal vein and the progression of hepatic fibrosis disease.

Endovascular brachytherapy vs.sequential three-dimensional conformal radiotherapy for the treatment of main portal vein tumor thrombus: a comparative study / 介入放射学杂志

Objective To compare the safety and efficacy of endovascular brachytherapy (EVBT)with those of sequential three-dimensional conformal radiotherapy (3-D CRT) in treating main portal vein tumor thrombus (MPVTT).Methods The clinical data of a total of 176 hepatocellular carcinoma (HCC)patients complicated by MPVTT,who were treated with portal vein stenting and TACE during the period from May 2012 to June 2014,were retrospectively analyzed.Of the 176 patients,additional EVBT by using 125I seeds strand was carried out in 123 patients (group A) at the same time,and in the remaining 53 patients (group B) sequential 3-D CRT was conducted.The overall survival,progression free survival,stent patency period and the incidence of treatment-related complications were compared between the two groups.Results No serious treatment-related complications occurred after therapy.During a mean of (11.7±8.3) months followup period,the mean survival was (11.7±1.2) months in group A and (9.5±1.8) months in group B (P=0.002).The mean progression free survival in group A and in group B was (5.3±0.7) months and (4.4±0.4)months respectively (P=0.010).The mean stent patency period in group A and in group B was (10.3±1.1)months and (8.7±0.7) months respectively (P=0.003).Conclusion Compared to sequential 3-D CRT,EVBT combined with portal vein stenting and TACE can significantly improve the overall survival of patients with HCC complicated by MPVTT.

Brachytherapy with 125I seed strand for the treatment of implanted main portal vein tumor thrombus:an experimental study in rabbits / 介入放射学杂志

Objective To evaluate the safety and efficacy of brachytherapy with 125I seed strand in treating implanted main portal vein tumor thrombus (MPVTT) in experimental rabbits.Methods VX2 tumor cell line was implanted in the main portal vein (MPV) of 32 New Zealand white rabbits to establish MPVTT models.The rabbits were randomly divided into the treatment group (group T,n=16) and the control group (group C,n=16).125I seed strand was implanted in the MPVTT of the rabbits of group T,while blank seed strand was implanted in the MPVTT of the rabbits of group C.After the implantation,the changes in general condition,body weight and laboratory testing results were recorded.Two weeks after the treatment,every 8 rabbits from each group were sacrificed,and the specimens were collected and sent for pathological examination.The remaining rabbits were fed till they died,and then autopsy was conducted.Multi-slice spiral CT manifestations,histopathological findings,Ki-67 labeling index and apoptosis index were used to assess the curative effect,and the results were compared between the two groups.Results At each observation time point after brachytherapy,the weight loss of the experimental rabbits was more obvious in group C than in group T.No statistically significant differences in liver functions and white blood cell count existed between the two groups (P＞0.05).The mean MPVTT volume of group T and group C were (565.40±220.90) mm3 and (2 269.90±437.00) mm3 respectively (P＜0.001);the Ki-67 labeling indexes were (4.14±1.84)％ and (33.82± 6.07)％ respectively (P=0.001);the median survival days were (39.50±2.37) d and (27.38±1.22) d respectively (P=0.001).Conclusion For the treatment of implanted MPVTT in experimental rabbits,brachytherapy with 125I seed strand is safe and effective.

Embolization of hepatic arterio-portal shunt in patients with HCC complicated by portal vein tumor ;thrombus treated with TACE combined with portal vein stenting：its clinical significance / 介入放射学杂志

Objective To evaluated the clinical significance of embolization of arterio-portal venous shunt (APVS) in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) treated by transcatheter arterial chemoembolization (TACE) and portal vein stenting. Methods Twenty-six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases. Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was (50.1±6.3) cmH2O,(43.5± 7.5) cmH2O and (36.9 ±8.2) cmH2O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant (P<0.05); after APVS embolization the portal vein pressure was further decreased (P<0.05). Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce the portal vein pressure; and embolization of APVS can further reduce the pressure of portal vein, thus the bidirectional portal flow or hepatofugal portal flow will return to normal hepatopetal flow.

Establishment of a new model of secondary intra-abdominal hypertension in rats / 中华创伤杂志

Objective To create a stable,reliable and cheap rat model of intra-abdominal hypertension(IAH)by simulating the development of secondary IAH after overdose resuscitation for severe hemorrhagic shock.Methods Sixteen adult male SD rats were randomly divided into sham group and portal vein stenosis group,with eight rats in each group.Portal vein stenosis group had transabdominal separation of portal vein with constant stenosis,while sham group underwent simple laparotomy and dissection of portal vein.Abdominal binding and hemorrhagic shock by drawing blood through the femoral artery cannulation with mean arterial pressure(MAP)of 40 mm Hg(1 mm Hg=0.133 kPa)for two hours were performed in two groups.Then,reinfusion of all autologous blood and continuous infusion of sodium lactate Ringer's solution were performed to induce IAH.Results In the portal vein stenosis group,IAH models were successfully built in all the rats except that one rat died after ligation of portal vein.The success rate of modeling was 87.5％,with total time of(4.68±0.53)hours and total solution infusion of(597.33±75.03)ml/kg.No successful modeling was obtained in the sham group.Conclusion High success rate and good reproducibility of IAH models can be achieved by fluid resuscitation after constant portal vein stenosis,abdominal binding and hemorrhagic shock with mean MAP of 40 mm Hg for two hours.