Management of liver trauma by laparoscopy using infrahepatic inferior vena cava partial clamping: A case report.

Liver trauma with hemodynamic instability is extremely dangerous. Exploratory surgery after fluid resuscitation is a potentially effective method to save lives. Although there have been great advances in laparoscopic techniques for hepatectomy, laparoscopy is rarely used for liver trauma. According to our previous experience, laparoscopic infrahepatic inferior vena cava (IVC) clamping was a safe and effective technique to reduce central venous pressure (CVP) and control bleeding during hepatectomy. In this article, we described a case of grade V liver trauma that had been managed by an entirely laparoscopic approach using infrahepatic IVC partial clamping, outlining the technique of laparoscopy for liver trauma and the postoperative outcomes.

Hydrogen gas inhalation protects against liver ischemia/reperfusion injury by activating the NF-κB signaling pathway.

Hydrogen has been demonstrated to function as a novel antioxidant and exert therapeutic antioxidant activity in a number of diseases. The present study was designed to investigate the effect of hydrogen inhalation on liver ischemia/reperfusion (I/R) injury in rats. The portal triad to the left lobe and the left middle lobe of the liver were completely occluded for 90 min. This was followed by reperfusion for 180 min. The rats subsequently underwent syngeneic orthotopic liver transplantation. Inhalation of various concentrations (1, 2 and 3%) of hydrogen gas and its administration for different durations (1, 3 and 6 h) immediately prior to the I/R injury allowed the optimal dose and duration of administration to be determined. Liver injury was evaluated through biochemical and histopathological examinations. The expression levels of proinflammatory cytokines, including tumor necrosis factor (TNF)-α and interleukin (IL)-6, were measured by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction (qPCR). Liver nuclear factor κB (NF-κB) was detected by qPCR and western blot analysis. Inhalation of hydrogen gas at 2% concentration for 1 h significantly reduced the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, the expression of cytokines, including IL-6, TNF-α, early growth response protein 1 (Egr-1) and IL-1ß, and morphological damage. In addition, the mRNA and protein expression levels of NF-κB, heme oxygenase-1 (HO-1), B-cell lymphoma 2 (Bcl-2) and zinc finger protein A20 (A20) in rats where only the donors received hydrogen were significantly increased compared with those in rats where both the donor and recipient, or only the recipient received hydrogen. The results indicate that hydrogen inhalation at 2% concentration for 1 h prior to liver transplantation protected the rats from ischemia/reperfusion injury by activation of the NF-κB signaling pathway.

To assess the benefits of medical image three-dimensional visualization system assisted pancreaticoduodenctomy for patients with hepatic artery variance.

BACKGROUND: Our main aim was to evaluate the value of medical image three-dimensional visualization system (MI-3DVS) in pancreaticoduodenctomy patients with hepatic artery variance. METHODS: 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed. Clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional (3D) reconstruction. The findings were compared with those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery. RESULTS: The 3D model demonstrated the origination and bifurcations of blood vessels, and the relationships among neoplasms, organs and blood vessels efficiently. About (14/114 cases, 12.3%) had variant. The sensitivity, specificity and accuracy of MI-3DVS in variant hepatic artery diagnosis were 100%. It assisted in preoperative procedural planning that was consistent with intraoperative findings. CONCLUSIONS: MI-3DVS can be applied for accurate diagnosis of hepatic artery variance. It also provides detailed preoperative guidance for individualized procedural planning.

Apigenin potentiates the growth inhibitory effects by IKK-ß-mediated NF-κB activation in pancreatic cancer cells.

Apigenin is a potential chemopreventive agent for cancer prevention. Because of the central role of transcription factor nuclear factor-κB (NF-κB) in pancreatic cancer, we investigated the roles of NF-κB in apigenin-induced growth inhibition in pancreatic cancer cells. It showed that apigenin reduced cell growth and induced apoptosis in the cells. Apigenin treatment down-regulated not only basal but also TNF-α-induced NF-κB DNA binding activity, NF-κB transcription activity, inhibitor of κB (IκB)-α phosphorylation together with translocation of p65 and p50, and it accompanied with the blockade of IκB kinase (IKK)-ß activity. Moreover, IKK blockage potentiated the anticancer efficacy of apigenin and IKK-ß overexpression attenuated the apigenin-induced cell growth inhibition. Additionally, apigenin (30 mg/kg) administration suppressed pancreatic cancer growth and IKK-ß activation in nude mice xenograft. These results indicated that apigenin had a potential to inhibit IKK-ß-mediated NF-κB activation, and was a valuable agent for the pancreatic cancer treatment.

Primary leiomyosarcoma of the inferior vena cava: a case report.

Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor originating from the vein smooth muscle. We present one case of primary leiomyosarcoma of the IVC. The patient benefited of surgical exploration at seventh day after admission. Tumor located in the junction of the anterior wall of the IVC and the left and right renal vein. We carried out the tumor resection, vena cava artificial vascular patch prosthetics. The patient did not take anticoagulant drugs after surgery and was discharged at 12 days after surgery. Currently, the patient had survived for nearly six months, repeated abdominal computed tomography examinations showed no clear recurrence.

[Protective effects of affiliating portasystemic shunt on graft injury in small-for-size liver transplantation in miniature pigs].

OBJECTIVES: To evaluate the protective effects of affiliating portasystemic shunt on small-for-size graft in liver transplantation. METHODS: Fifteen Chinese Bama miniature pigs were divided into three groups: group A (small-for-size liver transplantation), group B (distal splenorenal shunt + small-for-size liver transplantation), and group C (mesocaval H-shape shunt + small-for-size liver transplantation). Animals were followed up for 7 days with survival, dynamical liver function biochemical parameters, liver biopsies, portal venous pressure (PVP) and portal blood flow (PBF). RESULTS: Animal survivals were as follows: group A, 1/5, group B, 3/5 and group C, 5/5.Group A resulted in abnormal liver function parameters that were significantly ameliorated in group B and C. The histological examination of graft in group A displayed severe pathologic changes including hepatocyte vacuolar change or necrosis, sinusoidal congestion, parenchymal hemorrhage. Affiliating portasystemic shunt significantly alleviated graft injuries in group B and C. PVP rose and peaked up to 28.6 mm Hg (1 mm Hg = 0.133 kPa), PBF fluctuated after reperfusion in group A, but group B and C with affiliating portasystemic shunt showed significantly lower PVP and maintained rather stable PBF after reperfusion. There were also statistical differences in PVP or PBF between group B and C. CONCLUSIONS: Affiliating portasystemic shunt effectively might protect small-for-size graft from injuries after reperfusion.

[Cyclosporine microemulsion C2 monitoring in Chinese adult liver transplant recipients: a preliminary randomized control trial].

OBJECTIVE: To evaluate the safety and reliability of cyclosporine microemulsion (CsA-ME) C(2) monitoring and to determine the target level of C(2) in Chinese adult liver transplant recipients. METHODS: 53 Chinese adult liver transplant recipients were randomly divided into three groups (group C(0), n = 17; group high level C(2), n = 18; group low level C(2), n = 18). Blood chemistry reflecting heart, liver and renal function and CsA level were examined at certain interval during follow-up. The change of immune status and episodes of rejection were also observed closely. RESULTS: The group low level C(2) had the lowest CsA oral dose (2.51 +/- 0.37 mg/kg/d), and had significant difference compared with the other groups (P < 0.01). The best liver, heart and renal function was observed in group low level C(2). The CD(4)(+)/CD(8)(+) ratio of group low level C(2) was 1.04 +/- 0.68, which had no significant difference with C(0) group. The rejection incidence of the three groups had no significant difference. group low level C(2) had highest clinical benefit ratio (72.22%), while the clinical benefit of group high level C(2) is the lowest (11.11%). CONCLUSIONS: With rational target level, C(2) monitoring can show us the proper oral dose of CsA which can decrease the side effects remarkably without rejection episodes increasing. The target level of C(2) in Chinese adult liver transplant recipients might be: 600-800 ng/ml 1 to 6 months posttransplant, 400-600 ng/ml 7-12 months posttransplant.

[Study of the correlation between drug exposure and blood concentration during cyclosporine microemulsion absorption phase in Chinese adult liver transplant recipients].

OBJECTIVE: To analyze the correlation between drug exposure (AUC0-4) and blood concentration of different sample points during Neoral absorption phase in Chinese adult liver transplant recipients, and to evaluate the possibility of using post-dose 2 hour level (C2) as a surrogate marker of AUC0-4 for the therapeutic drug monitoring (TDM) of Neoral. METHODS: Neoral levels at 0, 1, 2, 3, and 4 hours (C1, C2, C3, C4) after morning dose of 22 de novo Chinese adult liver transplant recipients were monitored during different posttransplant periods. Liner regression was used to analyze the correlation between CsA concentration at different time points and the AUC0-4. RESULTS: The best correlation was found at C2, while the correlation of C0 was the lowest. During following-up, the correlation between C2 and AUC0-4 was very stable. CONCLUSION: C2 had the best correlation with drug exposure. This correlation is very stable. C2 may be used as a good surrogate marker of AUC0-4 for the TDM of Neoral.

Modified hepatic outflow tract reconstruction in piggyback liver transplantation.

OBJECTIVE: To summarize the experience in modified reconstruction of the hepatic outflow tract during piggyback liver transplantation at our hospital. METHODS: The clinical data on 67 patients undergoing piggyback liver transplantation with modified hepatic outflow tract reconstruction from January 1999 to October 2002 were analyzed retrospectively. RESULTS: In this group, 7 patients (10.45%) died perioperatively. Complications included: pulmonary infection (38 patients); multiple organ system failure (10), intraperitoneal bleeding (6), acute respiratory distress syndrome (14), thrombosis of the hepatic artery (1), and bile leakage (1). No hepatic outflow occluded. Two recipients survived for over 3 years, 8 over 2 years, and 19 over a year. CONCLUSION: Modified hepatic outflow reconstruction in piggyback liver transplantation may increase the success rate of liver transplantation and decrease technical complications.

Effect of aging on cytoskeleton system of Kupffer cell and its phagocytic capacity.

AIM:To investigate the age-related alterations of cytoskeleton system in liver Kupffer cell and their relation to the changed phagocytic function.METHODS: The phagocytic function of Kupffer cells from rats of various ages (6mo, 12mo,18mo and 24mo) were quantitatively evaluated by phagocytosis of polystyrene beads. The actin distribution and measurement of Kupffer cell were determined by a phalloidin-TRITC method; and the myosin and vimentin distribution and measurement with indirect immunochemical staining.RESULTS: Aging resulted in significant alterations of actin, myosin and vimentin distributions and reductions in Kupffer cell; the 3 cytoskeleton components of 24-mo-old Kupffer cell were significantly decreased to 68.0%, 84.9% and 75.5%, respectively of these of 6-mo-old Kupffer cell(P < 0.01,0.01 and 0.01). And these decreases had significant positive relations with the damaged phagocytosis of the aged Kupffer cell.gammavalues were 0.96(P < 0.05), 0.99(P < 0.01) and 0.95 (P < 0.05) respectively.CONCLUSION: The cytos-keleton system of the aged Kupffer cell presents an evident state of senescence, which may be an important mechanism of decreased phagocytosis of the aged Kupffer cell.