Brain metastasis of hepatocellular carcinoma detected after liver transplantation

OBJETIVO: Relatar o caso de paciente com carcinoma hepatocelular submetido a transplante de fígado, que subseqüentemente manifestou recurrência tumoral em cérebro após o transplante. DESCRIÇÃO DO CASO: Homem de 48 anos de idade, com cirrose hepática secundária à infecção pelo vírus da hepatite C, com duas lesões focais hepáticas diagnosticadas como carcinoma hepatocelular pela citologia e histologia. Antes do transplante, foi submetido a tratamento coadjuvante com embolização da artéria hepática e injeção intra-tumoral de etanol. No terceiro mês pós-transplante, o paciente apresentou cefaléia, náuseas e vômitos, sem déficit neurológico focal. Tomografia computadorizada e ressonância magnética de crânio identificaram lesão expansiva hipervascular com sangramento interno. Avaliação da peça cirúrgica do transplante de fígado evidenciou invasão tumoral macroscópica da veia porta. CONCLUSÃO: A metástase cerebral de carcinoma hepatocelular após transplante de fígado pode ocorrer antes ou logo após a cirurgia. Pacientes, em lista para transplante de fígado, devem ser investigados para presença de metástase cerebral. Invasão vascular pode indicar disseminação tumoral hematogênica.

Avaliaçäo do intumescimento osmótico mitocondrial do fígado submetido a isquemia parcial e ao pré-condicionamento isquêmico / Evaluation of mitochondrial osmotic intumesciment of the liver submitted to partial ischemia to the ischemic preconditioning

O objetivo deste trabalho foi avaliar a permeabilidade da membrana mitocondrial em animais submetidos a pré-condicionamento isquêmico, isquemia e reperfusão seguido de hepatectomia a 70 por cento. Foram utilizados 30 ratos Wistar divididos em 3 grupos de 10: Grupo Controle (fc), Grupo Isquêmico (fi) e Grupo Pré-condicionado (fp). Após o procedimento cirúrgico os animais foram sacrificados para a remoção do remanescente hepático (30 por cento) do qual foram isoladas as mitocôndrias para a realização dos estudos de permeabilidade da membrana mitocondrial interna através do intumescimento osmótico. Foi observado um aumento significativo do intumescimento osmótico mitocondrial do grupo fi em relação aos grupos fc e fp, sugerindo uma possível participação de espécies reativas do oxigênio no processo.

Surgical management of short bowel syndrome

Treatment of the short bowel syndrome (SBS) following massive resections of the small bowel, sometimes associated with colon resection, remains a difficult problem. The use of total parenteral nutrition has resulted in more patients surviving massive intestinal resection. Therefore, interest persists in surgical therapy for the SBS. The goals of surgical therapy in the SBS are to increase the area of absorption, and slow down intestinal transit. However, none of the current surgical alternatives to treat SBS are sufficiently safe and effective to be recommended as a routine procedure. To achieve specific results, surgical treatment should be considered only for selected patients. Thus, the surgical emphasis continues to be on the prevention of massive enterectomy, or on the conservation of a much of the intestine as possible when ressection is inevitable.

Regeneraçäo hepática: algumas definiçöes num universo de incertezas / Liver regeneration: some definitions in an universe of doubts

No presente estudo, os autores elaboraram uma extensa abordagem acêrca da regeneraçäo hepática. Aspectos básicos, tais como cinética da resposta regenerativa, fases do processo replicativo e fatores que interferem na magnitude da síntese hepatocelular de DNA foram considerados. Considerou-se ainda as principais alteraçöes na expressäo gênica relacionadas à regeneraçäo hepática e, por fim, um minucioso relato dos principais fatores de crescimento hepático, com suas interaçöes e possíveis mecanismos de açäo

Effect of hepatic artery ligation on liver metabolism in rats

The rats an experimental model of orthotopic liver transplant that does not need arterial revascularization of the transplanted liver. the objective of the present study was to investigate the effect of hepatic artery ligation on hepatic metabolism in rats. After 2, 3, or 24 h hepatic artery ligation, no significant differences in serum levels of alanine aminotransferase were observed. Bile flow decreased significantly 3 h after arterial ligation (P < 0.05) and returned to normal after 24 h (P < 0.05)

Heparin-induced increase in plasma and serum gama-glutamyl transpeptidase activity

Gama-Glutamyl transpeptidase (GGT) activity may be a sensitive index of hepatobiliary dysfunction. GGT activity, however, has been shown to be affected by several factors in different clinical situations. The present study was designed to determine the effect of heparin on serum and plasma GGT activity. Blood samples were collected from 15 normal male Wistar rats weighing 200-250 g for the determination of GGT activity in plasma prepared with heparin (group P(H),N = 10), in serum (group S,N = 15) and in serum with heparin added (group S + H,N = 10). GGT activity was 45.1 + or - 9.5 U/l (mean + or - SD) for serum compared with 161.2 + or - 46.1 U/l for serum plus heparin and 93.3 + or - 30.9 U/l for plasma prepared with heparin. The mean for each group was significantly different from the means for the other groups. These data demonstrate that GGT activity measurements should be made on serum in the absence of heparin, which produces elevated results

Lack of correlation between the sulfobromophthalein test and fatty liver in diabetic dogs

The present study was performed to evaluate the correlation between fatty liver and liver function in diabetic dogs. Experimental diabetes was induced in 14 dogs by total pancreatectomy or by alloxan administration, and partial (30%) hepatectomy was performed. Diabetic dogs were compared with control dogs (N = 7) subjected only to partial hepatectomy (30%). Control and diabetic dogs were submitted to the sulfobromophthalein (BSP) liver function test. Serum BSP retention was increased in diabetic dogs but there was no correlation with the extent of fatty infiltration of the liver

Effect of chlorpromazine and biliary drainage on portal blood flow and mitochondrial function during extrahepatic cholestasis

The present study examines the effect of chlorpromazine and biliary drainage in cholestatic rats. The time course of portal blood flow was studied 24,48, and 72 h and seven days after bile duct ligation. Portal blood flow decreased after 72 h. Chlorpromazine reduced biliary hydrostatic pressure in sham-operated control rats, but 24-h obstruction was sufficient to prevent this effect in cholestatic rats. The drug ameliorated the mitochondrial and cell membrane function of cholestatic rats before and after drainage. The data present further support for the role of ischemia in cholestasis