Balloon-occluded retrograde transvenous obliteration of gastric varix draining via the left inferior phrenic vein into the left hepatic vein

International Nuclear Information System (INIS)

Ibukuro, Kenji; Mori, Koichi; Tsukiyama, Toshitaka; Inoue, Yoshihiro; Iwamoto, Yukako; Tagawa, Kazumi

1999-01-01

We encountered a patient with gastric varix draining not via the usual left suprarenal vein but via the left inferior phrenic vein joining the left hepatic vein. Transfemoral balloon-occluded retrograde transvenous obliteration (BRTO) of the varix was performed under balloon occlusion of the left inferior phrenic vein via the left hepatic vein and retrograde injection of the sclerosing agent (5% of ethanolamine oleate) into the gastric varix. Disappearance of the gastric varix was confirmed on endoscopic examination 2 months later.

Giant cavernous hemangioma coexistent with diffuse hepatic hemangiomatosis presenting as portal vein thrombosis and hepatic lobar atrophy

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Bo Reum Yoo

2014-01-01

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A combination of giant hepatic hemangioma and diffuse hemangiomatosis is extremely rare in adults. Even when they are large, hemangiomas are soft and rarely compress adjacent structures. A 78-year-old man presented with abdominal pain and distension. Ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a large expansile mass replacing the medial segment and caudate lobe with diffusely scattered nodules in the entire liver. The large hilar mass contained a central nonenhancing area and had a mass effect, leading to left portal vein occlusion. The image findings also revealed two unprecedented findings: left lateral segmental atrophy of the liver and recent portomesenteric vein thrombosis. The hepatic lesions were confirmed with hemangiomas by ultrasonography-guided biopsy. We diagnosed intrahepatic portal vein obstruction caused by a mass effect of giant hepatic hemangioma coexistent with diffuse hemangiomatosis, resulting in hepatic segmental atrophy and extrahepatic portal vein thrombosis.

Giant cavernous hemangioma coexistent with diffuse hepatic hemangiomatosis presenting as portal vein thrombosis and hepatic lobar atrophy

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Yoo, Bo Reum; Han, Hyun Young; Choi, So Young; Kim, Joo Heun [Eulji University Hospital, Daejeon(Korea, Republic of)

2014-03-15

A combination of giant hepatic hemangioma and diffuse hemangiomatosis is extremely rare in adults. Even when they are large, hemangiomas are soft and rarely compress adjacent structures. A 78-year-old man presented with abdominal pain and distension. Ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a large expansile mass replacing the medial segment and caudate lobe with diffusely scattered nodules in the entire liver. The large hilar mass contained a central nonenhancing area and had a mass effect, leading to left portal vein occlusion. The image findings also revealed two unprecedented findings: left lateral segmental atrophy of the liver and recent portomesenteric vein thrombosis. The hepatic lesions were confirmed with hemangiomas by ultrasonography-guided biopsy. We diagnosed intrahepatic portal vein obstruction caused by a mass effect of giant hepatic hemangioma coexistent with diffuse hemangiomatosis, resulting in hepatic segmental atrophy and extrahepatic portal vein thrombosis.

Veias do sistema porta-hepático em gansos domésticos Veins from hepatic portal vein system in domestic geese

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Tatiana C. Santos

2009-04-01

Full Text Available A distribuição intraparenquimal das veias porta-hepáticas foi estudada em 30 gansos domésticos. Latex Neoprene corado foi injetado pela veia isquiática e os animais forma fixados por imersão e injeção intramuscular com formol a 10% e dissecados. O fígado esteve composto por um grande lobo hepático direito e por um lobo hepático esquerdo menor, os quais estiveram conectados por uma ponte de parênquima. O lobo direito do fígado teve exclusivamente vasos do sistema porta-hepático formados pela distribuição intraparenquimal da veia porta-hepática direita, enquanto que no lobo esquerdo estes originaram-se da veia porta-hepática direita e de pequenas veias porta-hepáticas esquerdas. A veia porta-hepática direita emitiu o ramo caudal direito, que emitiu um pequeno ramo caudolateral direito e um grande ramo caudomedial direito. Cranialmente esta veia emitiu os ramos craniais direito e ramos lateral direito. A porção transversa da veia porta-hepática direita cruzou para o lobo hepático esquerdo, emitindo de 1 a 6 pequenos ramos craniais e caudais para a região média do fígado. No lobo esquerdo, o ramo esquerdo da veia porta-hepática direita emitiu o ramo cranial esquerdo, o ramo lateral esquerdo e o ramo medial. De 1 a 6 veias porta-hepáticas esquerdas foram identificadas desembocando ou no ramo esquerdo da veia porta-hepática direita ou em sua porção transversa, oriundos do ventrículo gástrico e do pró-ventrículo. Em 40% dos gansos uma veia porta-hepática própria oriunda da confluência de vasos venosos da face esquerda do ventrículo distribuiu-se na extremidade caudal do lobo esquerdo isoladamente.The intraparenchymal distribution of the hepatic portal veins in 30 domestic geese were studied. Stained Neoprene latex was injected into the isquiatic vessels, and the animals were fixed in 10% formaldehyde by immersion and intramuscular injection. The liver of geese was composed of a large right and a smaller left

An automatic virtual patient reconstruction from CT-scans for hepatic surgical planning.

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Soler, L; Delingette, H; Malandain, G; Ayache, N; Koehl, C; Clément, J M; Dourthe, O; Marescaux, J

2000-01-01

PROBLEM/BACKGROUND: In order to help hepatic surgical planning we perfected automatic 3D reconstruction of patients from conventional CT-scan, and interactive visualization and virtual resection tools. From a conventional abdominal CT-scan, we have developed several methods allowing the automatic 3D reconstruction of skin, bones, kidneys, lung, liver, hepatic lesions, and vessels. These methods are based on deformable modeling or thresholding algorithms followed by the application of mathematical morphological operators. From these anatomical and pathological models, we have developed a new framework for translating anatomical knowledge into geometrical and topological constraints. More precisely, our approach allows to automatically delineate the hepatic and portal veins but also to label the portal vein and finally to build an anatomical segmentation of the liver based on Couinaud definition which is currently used by surgeons all over the world. Finally, we have developed a user friendly interface for the 3D visualization of anatomical and pathological structures, the accurate evaluation of volumes and distances and for the virtual hepatic resection along a user-defined cutting plane. A validation study on a 30 patients database gives 2 mm of precision for liver delineation and less than 1 mm for all other anatomical and pathological structures delineation. An in vivo validation performed during surgery also showed that anatomical segmentation is more precise than the delineation performed by a surgeon based on external landmarks. This surgery planning system has been routinely used by our medical partner, and this has resulted in an improvement of the planning and performance of hepatic surgery procedures. We have developed new tools for hepatic surgical planning allowing a better surgery through an automatic delineation and visualization of anatomical and pathological structures. These tools represent a first step towards the development of an augmented

Comparative analysis of contrast between hepatic vein and hepatic parenchyma with controlled velocity of ultrasound in normal and fatty liver

International Nuclear Information System (INIS)

Yun, Eun Joo; Choi, Byung Jin; Han, Joon Koo; Cha, Joo Hee; Kim, Seung Hyup; Lee, Dong Hyuk

2000-01-01

To evaluate the contrast between hepatic vein and hepatic parenchyma with controlled velocities of ultrasound in normal and fatty liver. 31 patient with normal liver and 39 patients with moderate degree of fatty liver were studies with sonography with controlled velocities of ultrasound (1,580 m/sec, 1,540 m/sec, 1,500 m/sec, 1,460 m/sec). Sonographic images were captured with picture grabbing (Sono-PACS) and were recalled with visual C++(Microsoft Redmond. WA, USA). The contrast between hepatic vein and parenchyma was measured and analyzed on each sonographic image. The number of patients with the highest contrast between hepatic vein and hepatic parenchyma among the 31 patients with normal liver were 5 (16.1%) with 1,580 m/sec, 12 (38.8%) with 1,540 m/sec, 9 (29.0%) with 1,500 m/sec, and 5 (16.1%) with 1,460 m/sec. The number of patients with highest contrast between hepatic vein and hepatic parenchyma among the 39 patients with fatty liver were 3 (7.7%) with 1,580 m/sec, 7 (17.9%) with 1,540 m/sec, 12 (30.8%) with 1,500 m/sec and 17 (43.6%) with 1,460 m/sec. The velocity of ultrasound for the highest contrast between hepatic vein and hepatic parenchyma in normal liver was 1,540 m/sec, and 1,460 m/sec in fatty liver.

Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

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Wang Quan

2012-06-01

Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

Doppler waveform of hepatic vein in patients with chronic hepatitis B; Correlation with histologic grade and stage

International Nuclear Information System (INIS)

Eom, Kyeong Tae; Namkung, Sook; Bae, Sang Hoon; Choi, Young Hee

1999-01-01

To evaluate the relationship between the waveform of the right hepatic vein and the histological grade and stage in patients with chronic hepatitis B. Eighty-seven patients with chronic hepatitis B were examined prospectively by one sonographer. In each patient, Doppler waveform of the right hepatic vein was obtained. Doppler waveform was classified into 3 type, type 0; normal triphasic pattern, type 1; reduced amplitude of phasic oscillation and no reverse flow phase, and type 2; completely flat flow pattern. In the same session, an ultrasound guided liver biopsy was performed and submitted to one pathologist for grading and staging. Duplex doppler ultrasonography of the right hepatic vein was also performed in 12 control subjects with no evidence of liver or heart disease. The doppler waveform was compared with the histologic severity and a statistical analysis was performed. In the control group, all cases had type 0 waveform. In the hepatitis group, there were type 0 waveform in 61 cases (70.1%), type 1 waveform in 22 cases (25.3%) and type 2 waveform in 4 cases (4.6%). The frequency of abnormal waveform is significantly higher in patients with grade 3-4 and stage 3-4 than grade and stage 1-2 (p>0.005). In the hepatitis group, the venous pulsatility index (VPI) was 0.17-0.69 (mean 0.41), and decreased in the highest and mean values when increasing the histologic scores. However, it was nor significant statistically (p>0.05). The frequency of abnormal waveform was correlated with the histologic severity in patients with chronic hepatitis B. The highest and mean values of the VPI were also correlated. However 70.1% of the patients with chronic hepatitis B showed normal waveform. So doppler ultrasonogram of the hepatic vein may be useful for the diagnosis and the differential diagnosis from cirrhosis in patients with chronic hepatitis B by combination of doppler waveform and venous pulsatility index.

Nasolabial facial artery and vein as recipient vessels for midface microsurgical reconstruction.

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Oh, Suk Joon; Jeon, Man Kyung; Koh, Sung Hoon

2011-05-01

Although free flap transfer is commonly performed to reconstruct facial defects, the submandibular facial artery and vein have historically been considered as adequate recipient vessels for microsurgical reconstruction. If the vascular pedicles of the free flap are short, vein grafts are necessary. The purpose of this study was to determine the indications for and effectiveness of using the nasolabial facial vessels for midfacial reconstruction. A retrospective chart review of 6 patients undergoing microsurgical reconstruction for defects of the face revealed 6 free tissue transfers in which the nasolabial facial artery and vein were considered for use as recipient vessels. Flap success rates were evaluated. Six patients (5 men and 1 woman) underwent 6 free flap transfers. Five anterior helix free flaps were used for the reconstruction of defects in the lower third of the nose. Nasal defects were due to trauma in 4 patients and squamous cell carcinoma in 1 patient. In 1 neurofibromatosis type 1 case, a radial forearm flap was used for reconstruction of the left orbital defect. The facial artery and vein in the nasolabial fold were used as the recipient artery and vein in every case. The mean length of follow-up was 5.8 years. All flaps survived. All patients were satisfied with the degree of aesthetic improvement after surgery.Use of the facial artery and vein in the nasolabial fold for facial reconstruction is reliable and safe. The nasolabial facial artery and vein should be considered as primary recipient vessels in microsurgical reconstruction of the midface.

Doppler waveforms of the hepatic veins in children with diffuse fatty infiltration of the liver

International Nuclear Information System (INIS)

Uzun, Hakan; Yazici, Burhan; Erdogmus, Besir; Kocabay, Kenan; Buyukkaya, Ramazan; Buyukkaya, Ayla; Yazgan, Omer

2009-01-01

Objective: The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. Methods: In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. Results: There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p < 0.001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r = -0.479, p < 0.001). Conclusions: Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL.

Evaluation of the portal veins, hepatic veins and bile ducts using fat-suppressed segmented True FISP

International Nuclear Information System (INIS)

Ueda, Takashi; Uchikoshi, Masato; Imaoka, Izumi; Iwaya, Kazuo; Matsuo, Michimasa; Wada, Akihiko

2005-01-01

True FISP (fast imaging with steady-state free precession) is a fast imaging technique that provides high SNR (signal to noise ratio) and excellent delineation of parenchymal organs. The contrast of True FISP depends on the mixture of T 2 /T 1 . Vessels with slow flow are usually displayed as high signal intensity on True FISP images. The purpose of this study was to optimize fat-suppressed (FS) segmented True FISP imaging for portal veins, hepatic veins, and bile ducts. FS segmented True FISP images were applied to the phantoms of liver parenchyma, saline, and oil with various flip angles (every 10 degrees from 5-65 degrees) and k-space segmentations (3, 15, 25, 51, 75, 99). Five healthy volunteers were also examined to get optimized flip angle and k-space segmentation. The largest flip angle, 65 degrees, showed the best contrast between the liver parenchyma phantom, saline, and oil. The largest segmentations, 99, provided the best contrast between a liver parenchyma phantom and saline. However, the signal of the oil phantom exceeded that of the liver parenchyma phantom with 99 segmentations. As a result, the flip angle of 65 degrees and 75 segments is recommended to get the best contrast between the liver parenchyma phantom and saline, while suppressing the signal of oil. The volunteer studies also support the phantom studies and showed excellent anatomical delineation of portal veins, hepatic veins, and bile ducts when using these parameters. We conclude that True FISP is potentially suitable for the imaging of portal veins, hepatic veins, and bile ducts. The flip angle of 65 degrees with 75 segments is recommended to optimize FS segmented True FISP images. (author)

Saphenous vein grafts for perforator flap salvage in autologous breast reconstruction.

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Flores, Jaime I; Rad, Ariel N; Shridharani, Sachin M; Stapleton, Sahael M; Rosson, Gedge D

2009-01-01

Although the use of saphenous vein grafts in free-flap salvage and extremity replantation is relatively common, their use in breast reconstruction is rare. These two case reports represent extreme alternatives for breast reconstruction flap salvage. In our normal daily practice, the overwhelming majority of elective breast reconstructions proceed smoothly. However, the occasional patient may require saphenous vein graft flap rescue for completion of the reconstruction. (c) 2008 Wiley-Liss, Inc.

Hepatic VX2 tumor after portal vein occlusion in rabbits: evaluation with DSA

International Nuclear Information System (INIS)

Qi Yueyong; Zou Liguang; Dai Shuhua; Zhang Qichuan; Chen Lin; Huang Xiaobing; Huan Guangqiang

2006-01-01

Objective: To study the value of DSA for hepatic vascular anatomy, and to evaluate the efficacy of portal vein occlusion in rabbits with hepatic VX2 tumor. Methods: Twenty New Zealand white rabbits were randomly divided into two groups with 10 in each group, including test group A and positive control group B of ham operation. For the test group A, portal branch ligation (PBL) was performed for the left external branch after 3 weeks of the tumor implantation to the left external lobe. Two weeks later, the DSA of hepatic artery and portal vein were performed in all of the rabbits. Results: The total displaying effectiveness of the branches of hepatic artery by DSA was better than that by vascular perfusion. There was hypovascular blood supply to hepatic artery implantation of the tumor in the test group A, comparing with that of the group B. Conclusion: DSA can clearly display special details of the hepatic vascular anatomy in rabbits, and play an important role in post-procedural evaluation of the portal vein occlusion in rabbits. (authors)

Intrahepatic venous collaterals forming via the inferior right hepatic vein in 3 patients with obstruction of the inferior vena cava

International Nuclear Information System (INIS)

Takayasu, K.; Moriyama, N.; Muramatsu, Y.

1985-01-01

When the inferior vena cava is obstructed, collateral veins enlarge, connecting with the inferior (acessory) right hepatic vein (IRHV) and thence through various hepatic veins to the right atrium. Three such cases are described. In one patient, most contrast material flowed into the IRHV and from there to the left hepatic vein. The second patient had several large collaterals arising from the IRHV and flowing into the right and middle hepatic veins, while the third patient demonstrated anastomoses between the IRHV and the middle hepatic vein. All of these hepatic venous shunts eventually drained into the right atrium. There were no clinical manifestations such as ascites, edema, or dilatation of the abdominal veins. Cavography alone or combined with computed tomography proved to be diagnostic in the assessment of these intrahepatic collaterals

Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model.

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Jiang, Jun; Wei, Jishu; Wu, Junli; Gao, Wentao; Li, Qiang; Jiang, Kuirong; Miao, Yi

2016-01-01

Hepatic infarcts or abscesses occur after hepatic artery interruption. We explored the mechanisms of hepatic deprivation-induced acute liver injury and determine whether partial portal vein arterialization attenuated this injury in rats. Male Sprague-Dawley rats underwent either complete hepatic arterial deprivation or partial portal vein arterialization, or both. Hepatic ischemia was evaluated using biochemical analysis, light microscopy, and transmission electron microscopy. Hepatic ATP levels, the expression of hypoxia- and inflammation-associated genes and proteins, and the expression of bile transporter genes were assessed. Complete dearterialization of the liver induced acute liver injury, as evidenced by the histological changes, significantly increased serum biochemical markers, decreased ATP content, increased expression of hypoxia- and inflammation-associated genes and proteins, and decreased expression of bile transporter genes. These detrimental changes were extenuated but not fully reversed by partial portal vein arterialization, which also attenuated ductular reaction and fibrosis in completely dearterialized rat livers. Collectively, complete hepatic deprivation causes severe liver injury, including bile infarcts and biloma formation. Partial portal vein arterialization seems to protect against acute ischemia-hypoxia-induced liver injury.

Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model

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Jun Jiang

2016-01-01

Full Text Available Hepatic infarcts or abscesses occur after hepatic artery interruption. We explored the mechanisms of hepatic deprivation-induced acute liver injury and determine whether partial portal vein arterialization attenuated this injury in rats. Male Sprague-Dawley rats underwent either complete hepatic arterial deprivation or partial portal vein arterialization, or both. Hepatic ischemia was evaluated using biochemical analysis, light microscopy, and transmission electron microscopy. Hepatic ATP levels, the expression of hypoxia- and inflammation-associated genes and proteins, and the expression of bile transporter genes were assessed. Complete dearterialization of the liver induced acute liver injury, as evidenced by the histological changes, significantly increased serum biochemical markers, decreased ATP content, increased expression of hypoxia- and inflammation-associated genes and proteins, and decreased expression of bile transporter genes. These detrimental changes were extenuated but not fully reversed by partial portal vein arterialization, which also attenuated ductular reaction and fibrosis in completely dearterialized rat livers. Collectively, complete hepatic deprivation causes severe liver injury, including bile infarcts and biloma formation. Partial portal vein arterialization seems to protect against acute ischemia-hypoxia-induced liver injury.

The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

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Bae, Bong Kyung; Kim, Jae Chul [Dept. of Radiation Oncology, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

2016-09-15

The purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated. Forty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated. The median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients' prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively). RT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

Ultrasonographic Measurement of the Diameter of a Normal Bile Duct, Hepatic Artery and Portal Vein in Infants Younger Than 3 Months

International Nuclear Information System (INIS)

Kim, Sang Yoon; Lee, Young Seok

2009-01-01

This study focused on measuring the diameter of the normal bile duct, hepatic artery and portal vein with high resolution US in infants younger than 3 months, and we wanted to determine the relative ratio of these diameters. Fifty US examinations were performed on infants younger than 3 months and who did not have any clinical or laboratory abnormality associated with the hepatobiliary system. We measured the diameter of the bile duct, hepatic artery and portal vein at the level of the portal vein bifurcation with using 17-5 MHz US and we determined the relative ratios of these diameters. To evaluate the statistical difference in the diameter of the bile duct, hepatic artery and portal vein, we performed one-way ANOVA and Scheffe's multiple comparison test. To determine the relative ratio of these diameters, the ratio of the bile duct to the hepatic artery was defined as the hepatic artery/bile duct, the ratio of the hepatic artery to the portal vein was defined as the portal vein/hepatic artery and the ratio of the bile duct to the portal vein was defined as the portal vein/bile duct. We calculated the averages ± standard deviations of this data (minimum ∼ maximum). In all fifty infants, the bile duct, hepatic artery and portal vein were detectable and measurable. The average diameter of a bile duct was 0.85 ± 0.19 mm (0.56 ∼ 1.47 mm), it was 1.33 ± 0.31 mm (0.90 ∼ 2.37 mm) for the hepatic artery and 3.32 ± 0.68 mm (2.06 ∼ 5.08 mm) for the portal vein. The diameter of these structures was significantly different from each other according to one-way ANOVA (p < 0.001). The average diameter of the hepatic artery was significantly larger than that of the bile duct and the average diameter of the portal vein was significantly larger than that of bile duct and hepatic artery on Scheffe's multiple comparison test. The relative ratio of the bile duct to the hepatic artery was 1.60 ± 0.41 (0.77 ∼ 2.66), that of the hepatic artery to the portal vein was 2

Computed tomography arterial portography for assessment of portal vein injury after blunt hepatic trauma.

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Fu, Chen Ju; Wong, Yon Cheong; Tsang, Yuk Ming; Wang, Li Jen; Chen, Huan Wu; Ku, Yi Kang; Wu, Cheng Hsien; Chen, Huan Wen; Kang, Shih Ching

2015-01-01

Intrahepatic portal vein injuries secondary to blunt abdominal trauma are difficult to diagnose and can result in insidious bleeding. We aimed to compare computed tomography arterial portography (CTAP), reperfusion CTAP (rCTAP), and conventional computed tomography (CT) for diagnosing portal vein injuries after blunt hepatic trauma. Patients with blunt hepatic trauma, who were eligible for nonoperative management, underwent CTAP, rCTAP, and CT. The number and size of perfusion defects observed using the three methods were compared. A total of 13 patients (seven males/six females) with a mean age of 34.5±14.1 years were included in the study. A total of 36 hepatic segments had perfusion defects on rCTAP and CT, while there were 47 hepatic segments with perfusion defects on CTAP. The size of perfusion defects on CT (239 cm3; interquartile range [IQR]: 129.5, 309.5) and rCTAP (238 cm3; IQR: 129.5, 310.5) were significantly smaller compared with CTAP (291 cm3; IQR: 136, 371) (both, P = 0.002). Perfusion defects measured by CTAP were significantly greater than those determined by either rCTAP or CT in cases of blunt hepatic trauma. This finding suggests that CTAP is superior to rCTAP and CT in evaluating portal vein injuries after blunt liver trauma.

Fast magnetic reconstruction of the portal vein with allogeneic blood vessels in canines.

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Wang, Shan-Pei; Yan, Xiao-Peng; Xue, Fei; Dong, Ding-Hui; Zhang, Xu-Feng; Ma, Feng; Wang, Hao-Hua; Lv, Yi

2015-06-01

The resection and reconstruction of large vessels, including the portal vein, are frequently needed in tumor resection. Warm ischemia before reconstruction might have deleterious effects on the function of some vital organs and therefore, how to reconstruct the vessels quickly after resection is extremely important. The present study was to introduce a new type of magnetic compression anastomosis (MCA) device to establish a quick non-suture anastomosis of the portal vein after resection in canines. The new MCA device consists of a pair of titanium alloy and neodymium-ferrum-boron magnet (Ti-NdFeB) composite rings. The NdFeB magnetic ring as a core of the device was hermetically sealed inside the biomedical titanium alloy case. Twelve canines were divided into two groups: a MCA group in which the end-to-end anastomoses was made with a new device after resection in the portal vein and a traditional manual suture (TMS) group consisted of 6 canines. The anastomosis time, anastomotic patency and quality were investigated at week 24 postoperatively. The portal vein was reconstructed successfully in all of the animals and they all survived. The duration of portal vein anastomosis was significantly shorter in the MCA group than in the TMS group (8.16+/-1.25 vs 36.24+/-2.17 min, PNdFeB composite MCA device was applicable in reconstruction of large vessels after resection. This device was easy to use and the anastomosis was functionally better than the traditional sutured anastomosis.

Anatomical variation of the main and right portal vein on indirect portogram : correlated with CT and hepatic angiogram

International Nuclear Information System (INIS)

Park, Won Kyu; Chang, Jae Chun; Bae, Kyoung Kug; Cho, Jae Ho

1996-01-01

To describe variations of the main and right portal veins as visualized by indirect portograms and to examine the surgical implications of these findings. A retrospective review was conducted of 632 indirect portograms of 632 patients in whom third-order branches were visualized. All patients also underwent dynamic CT and AP and oblique hepatic angiography. Variations of the main portal vein were found in 165 patients(26.1%) and involned an immediate trifurcation of the main portal vein in 102 patients(16.1%), early division of the right posterior portal vein in 53(8.4%), simultaneous division into four branches in three (0.5%), five branches in two (0.3%), a replaced P4 originating from the right portal vein in two (0.3%), and an accessory P6 originating from the main portal vein, a replaced P6 originating from the main protal vein, or a replaced left lateral portal vein originating from the right portal vein in one (0.2%), respectively. Of 468 patients who had a common right portal vein, absence of the right posterior portal vein was seen in 26 patients(5.6%) and an accessory subsegmental branch originating from the right portal vein in 17 patients(3.6%). Recognition of such variations of the portal vein assists in the localization and apperciation of the hepatic segmental anatomy, in preoperative evaluations for hepatic resections, and in radiologic interventional procedures through the portal vein

Hepatic Vein Arrival Time for Diagnosis of Liver Cirrhosis: A 10-Year Single-Center Experience With Contrast-Enhanced Sonography.

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Abbattista, Teresa; Ridolfi, Francesco; Consalvo, Giovanni Traina; Brunelli, Eugenio

2016-10-01

To evaluate the performance of contrast-enhanced sonography with a second-generation contrast agent in assessing the severity of chronic diffuse liver disease and differentiating cirrhotic from noncirrhotic liver disease. Contrast-enhanced sonography was performed after intravenous bolus injection of a second-generation contrast agent in 14 healthy control participants and 160 consecutive patients with cirrhotic and noncirrhotic liver disease (n = 78 and 82, respectively) enrolled between March 2004 and April 2014. The intensity of enhancement in a main hepatic vein was used to determine hepatic vein arrival time, time to peak intensity, and peak contrast enhancement. The hepatic vein arrival time was lower in cirrhotic patients compared with both noncirrhotic patients and controls (mean ± SD, 15.0 ± 2.8, 21.5 ± 3.4, and 25.6 ± 4.7 seconds, respectively; P < .05). The hepatic vein arrival time in noncirrhotic patients was also significantly lower than that in controls (P < .05). The time to peak intensity was significantly lower in cirrhotic patients compared with noncirrhotic patients and controls (40.7 ± 13.7, 49.4 ± 12.8, and 51.2 ± 13.7 seconds; P < .05). A receiver operating characteristic curve analysis revealed that the hepatic vein arrival time more accurately excluded a diagnosis of liver cirrhosis than the time to peak intensity (area under the receiver operating characteristic curve, 0.953 versus 0.694). Specifically, a hepatic vein arrival time cutoff value of 17 seconds excluded liver cirrhosis with 91.1% sensitivity and 93.6% specificity. Contrast-enhanced sonography is a valid alternative method for noninvasive staging of liver diseases. The hepatic vein arrival time could be used to exclude liver cirrhosis in a clinical setting.

Hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver

International Nuclear Information System (INIS)

Oguzkurt, Levent; Yildirim, Tulin; Torun, Dilek; Tercan, Fahri; Kizilkilic, Osman; Niron, E. Alp

2005-01-01

Objective: To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL). Materials and methods: In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30-62 years (mean age ± S.D., 42 ± 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34-65 years (mean age ± S.D., 45 ± 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index > 25). Serum lipid profile was obtained from all the patients with FIL. Results: Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P 0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60). Conclusion: Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform

Study of a new method for the evaluation of portal vein pressure by hepatic perfusion imaging

International Nuclear Information System (INIS)

Cheng Muhua; Ling Yunbiao; Pan Zhiheng; Zhang Feng; Chen Weizhen

2002-01-01

To study a new method for predication of portal vein pressure (PVP) by hepatic perfusion imaging. 25 hepato-cirrhotic cases and 13 normal controls were performed the hepatic perfusion imaging. According to two compartmental model the values of portal vein indexes (PVI) was calculated using curve slope, area and hepatic heart perfusion ratio methods etc. The relationship of PVI with different method to PVP was also observed. All PVI by three methods in hepatocirrhosis were higher than those in normal controls (P<0.01), and also positively correlated with the PVP, their correlated coefficients was 0.79, 0.60, 0.68 respectively. Among them the slope method was most markedly significant than normal control and closely correlated with PVP. PVI can sensitively reflect the changes of portal vein blood flow. And it was an atraumatic, simple method for the evaluation of PVP

Treatment of surgical brain injury by immune tolerance induced by intrathymic and hepatic portal vein injection of brain antigens.

Science.gov (United States)

Yang, Weijian; Liu, Yong; Liu, Baolong; Tan, Huajun; Lu, Hao; Wang, Hong; Yan, Hua

2016-08-24

Surgical brain injury (SBI) defines complications induced by intracranial surgery, such as cerebral edema and other secondary injuries. In our study, intrathymic and hepatic portal vein injection of allogeneic myelin basic protein (MBP) or autogeneic brain cell suspensions were administered to a standard SBI model. Serum pro-inflammatory IL-2, anti-inflammatory IL-4 concentrations and the CD4(+)T/CD8(+)T ratio were measured at 1, 3, 7, 14 and 21 d after surgery to verify the establishment of immune tolerance. Furthermore, we confirmed neuroprotective effects by evaluating neurological scores at 1, 3, 7, 14 and 21 d after SBI. Anti-Fas ligand (FasL) immunohistochemistry and TUNEL assays of brain sections were tested at 21 d after surgery. Intrathymic injections of MBP or autogeneic brain cell suspensions functioned by both suppressing secondary inflammatory reactions and improving prognoses, whereas hepatic portal vein injections of autogeneic brain cell suspensions exerted a better effect than MBP. Intrathymic and hepatic portal vein injections of MBP had equal effects on reducing secondary inflammation and improving prognoses. Otherwise, hepatic portal vein injections of autogeneic brain cell suspensions had better outcomes than intrathymic injections of autogeneic brain cell suspensions. Moreover, the benefit of injecting antigens into the thymus was outweighed by hepatic portal vein injections.

Drainage of the Left Hepatic Vein into the Coronary Sinus, a Rare Intraoperative Finding.

Science.gov (United States)

Morshuis, Wouter G; de Lind van Wijngaarden, Robert A F; Kik, Charles; Bogers, Ad J J C

2015-11-01

In a 76-year-old female undergoing coronary artery bypass surgery, a persistent left hepatic vein was observed. Draining of this vein into the coronary sinus is an extremely rare embryological malformation and this is the first case to be reported as a solitary malformation in absence of other cardiac malformations. © 2015 Wiley Periodicals, Inc.

Spatial relationship between intrahepatic artery and portal vein based on the fusion image of CT-arterial portography (CTAP) and CT-angiography (CTA): New classification for hepatic artery at hepatic hilum and the segmentation of right anterior section of the liver

International Nuclear Information System (INIS)

Ibukuro, Kenji; Takeguchi, Takaya; Fukuda, Hozumi; Abe, Shoko; Tobe, Kimiko; Tanaka, Rei; Tagawa, Kazumi

2012-01-01

Purpose: To clarify the variations of the intrahepatic artery and portal vein and to verify the proper segmentation for the right anterior section of the liver. Materials and methods: CT during arterial portography and CT angiography were performed on 64-slice multi detector row CT in 147 patients. All images were transferred to a workstation for analysis using multi-image-fusion mode. We investigated the spatial relationship between hepatic artery and portal vein in the right hemiliver and the segmentation of the right anterior hepatic artery and portal vein. Results: The spatial anatomy of right hepatic arteries and portal vein was (1) anterior and posterior hepatic artery run superior and inferior to anterior portal vein, respectively (47.6%), (2) one anterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (15%), (3) anterior and posterior hepatic arteries run superior to anterior portal vein (11.6%), (4) anterior and posterior hepatic arteries run inferior to anterior portal vein (7.5%), and (5) one posterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (6.8%). The combined anatomy of right anterior artery and portal vein with regard to segmentation was classified as (1) dorso-ventral (26.5%), (2) dorso-ventral and inferior (10.9%), (3) multiple (18.4%), and (4) superior and inferior segments (1.4%). Conclusion: There are various types of spatial anatomy of intrahepatic artery and portal vein. The hepatic arteries as well as portal veins of right anterior section of the liver could be divided into dorsal and ventral, not superior and inferior.

Anatomy of the portal and hepatic veins of the dog: a basis for systematic evaluation of the liver by ultrasonography

International Nuclear Information System (INIS)

Carlisle, C.H.; Wu, J.X.; Heath, T.J.

1995-01-01

The objective of this study was to define, in detail, the anatomy of the portal and hepatic veins in the dog in order to establish a procedure for the systematic evaluation of the liver by ultrasonography. Anatomical details were obtained from the formalin fixed livers of ten dogs. The hepatic and portal veins were removed intact from these livers so that a detailed pattern of distribution could be established and the numbers of branches could be counted. Silastic casts were also made of the hepatic and portal veins of two livers, one in situ and one in which it had been removed. The former was to enable the relationship of the portal to the hepatic veins to be established as closely as possible within the animal and the other to provide a model of the distribution of each venous system within the liver. Contrast medium was infused into two other livers and radiographs taken to establish the relationship of each branch to each lobe. It was found that there was a consistent pattern of venous branching to each lobe of the liver in the dog with little variation between individual specimens. All liver lobes contained definite venous branches so that the left lateral and medial, quadrate, right medial and lateral, caudate and papillary veins could be distinguished in each venous system. We believe that an appreciation of this venous distribution will aid in the systematic evaluation of the liver during ultrasonography by enabling identification of each liver lobe. It should be of value for differentiating portal from hepatic veins and veins from dilated bile ducts

PTFE Graft as a "Bridge" to Communicating Veins Maturation in the Treatment of an Intrahepatic Cholangiocarcinoma Involving the 3 Hepatic Veins. The Minor-but-Complex Liver Resection.

Science.gov (United States)

Urbani, Lucio; Balestri, Riccardo; Sidoti, Francesco; Bernardini, Juri Riccardo; Arces, Francesco; Licitra, Gabriella; Leoni, Chiara; Forfori, Francesco; Colombatto, Piero; Boraschi, Piero; Castagna, Maura; Buccianti, Piero

2016-12-01

Parenchyma-sparing liver surgery allows resecting hepatic veins (HV) at the hepatocaval confluence with minor (PTFE graft can be used as a bridge to communicating-veins maturation to ensure the correct outflow of the spared liver. We present a video of an intrahepatic cholangiocarcinoma (IC) involving the three HV at the hepatocaval confluence treated with this approach. In a 50-year old obese (BMI 44.8) male a 6-cm IC involving the hepatocaval confluence was identified during the follow-up for a kidney malignancy. At the preoperative CT scan the left HV was not detectable, the middle HV was incorporated within the tumor, and right HV had a 3-cm contact with the tumor. No communicating veins were evident at preoperative imaging. After a J-shape thoracophrenolaparotomy, the resection of segments II-III-IVa was partially extended to segment VIII-VII and I. The right HV was detached from the tumor, and the middle HV was reconstructed with a 7-mm ringed-armed PTFE graft anastomosed to V8. Surgery lasted 20 h and 55 min with an estimated blood loss of 3500 ml, but the postoperative course was uneventful and the patient was discharged on the 14th postoperative day. One month later the CT scan showed a patent PTFE graft with the maturation of communicating-veins. One year later a complete thrombosis of the PTFE graft was observed with normal liver perfusion and function, and the patient was disease-free. PTFE-based parenchyma-sparing liver resection is a new tool to treat tumors located at the hepatocaval confluence exploiting the maturation of intrahepatic communicating-veins between main HV.

The Anatomy of the Facial Vein: Implications for Plastic, Reconstructive, and Aesthetic Procedures.

Science.gov (United States)

Cotofana, Sebastian; Steinke, Hanno; Schlattau, Alexander; Schlager, Markus; Sykes, Jonathan M; Roth, Malcolm Z; Gaggl, Alexander; Giunta, Riccardo E; Gotkin, Robert H; Schenck, Thilo L

2017-06-01

Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. Whereas the majority of previous investigations focused on facial arteries, the precise course, variability, and relationship with adjacent structures of the facial vein have been widely neglected. Seventy-two fresh frozen human cephalic cadavers (32 male and 40 female cadavers; mean age, 75.2 ± 10.9 years; mean body mass index, 24.2 ± 6.6 kg/m; 99 percent Caucasian ethnicity) were investigated by means of layer-by-layer anatomical dissection. In addition, 10 cephalic specimens were investigated using contrast agent-enhanced computed tomographic imaging. The facial vein displayed a constant course in relation to the adjacent anatomical structures. The vein was identified posterior to the facial artery, anterior to the parotid duct, and deep to the zygomaticus major muscle. The angular vein formed the lateral boundary of the deep medial cheek fat and the premaxillary space, and the medial boundary of the deep lateral cheek fat and the sub-orbicularis oculi fat. The mean distance of the inferior and superior labial veins, of the deep facial vein, and of the angular vein from the inferior orbital margin was 51.6 ± 3.1, 42.6 ± 2.3, 27.4 ± 3.0, and 4.2 ± 0.7 mm, respectively. This work provides detailed information on the course of the facial vein in relation to neighboring structures. The presented clinically relevant anatomical observations and descriptions of landmarks will serve as helpful information for plastic, reconstructive, and aesthetic surgeons.

Interventional therapy and complications after liver transplantation: the obstruction of the hepatic vein and inferior vena cava

International Nuclear Information System (INIS)

Li Linsun; Shi Haibing; Zhao Linbo

2009-01-01

The occurrence rate of the obstruction of the hepatic vein or the inferior vena cava is very low. Obstruction can develop acutely as a result of technical problems or can present itself much later after the transplantation due to intimal hyperplasia or perianastomotic fibrosis. Clinically, the common presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, etc. Percutaneous endovascular treatment with balloon dilation or stent placement is a safe and effective alternative treatment, which can keep the vessels open for a long period of time. Angioplasty can achieve technical success in restoring anastomotic patency almost to 100% of cases, but, unfortunately, restenosis occurs frequently. For, adult patients or pediatric patients with adult-sized hepatic veins, stenting seems to be the optimal choice. (authors)

Effects of respiratory manoeuvres on hepatic vein Doppler waveform and flow velocities in a healthy population

International Nuclear Information System (INIS)

Altinkaya, Naime; Koc, Zafer; Ulusan, Serife; Demir, Senay; Gurel, Kamil

2011-01-01

Objective: This study was performed to determine the variations in Doppler waveforms and flow velocity during respiratory manoeuvres in healthy individuals with no liver disease. Materials and methods: In total, 100 individuals (75 women and 25 men) without known cardiac or liver disease were examined prospectively with duplex Doppler ultrasonography (US). We recorded the Doppler waveforms and peak systolic velocities (V max ) of the middle hepatic vein during normal respiration, during breath-holding after quiet expiration and also during deep inspiration. Doppler waveforms are categorised as triphasic, biphasic or monophasic. Results: During normal respiration, hepatic venous waveforms were triphasic in 93% of subjects, monophasic in 6% and biphasic in 1%. During breath-holding after quiet expiration, the percentages were 91%, 6% and 3%, respectively. During deep inspiration, they were 80%, 18% and 2%, respectively. Although significant differences were noted between rates during deep inspiration and normal respiration, they were quite similar during normal respiration and breath-holding after quiet expiration (P max were significantly higher during normal respiration compared to quiet expiration and during quiet expiration compared to deep inspiration (P < 0.05). Conclusion: The velocities and waveforms of hepatic veins varied during respiratory manoeuvres. The status of respiration must be taken into consideration whilst examining the hepatic vein waveforms and velocities with duplex Doppler US.

Right hepatic vein injury after blunt abdominal trauma in a 12-year-old boy- case report

International Nuclear Information System (INIS)

Roik, D.; Konecka, A.; Brzewski, M.; Marcinski, A.; Kaminski, A.; Piotrowska, A.; Jasinska, A.

2008-01-01

Blunt abdominal trauma in children is one of the most frequent causes of hospitalization. We present a rare case of traumatic liver injury. A 12-year-old boy was admitted to the Surgery Department after a bicycle fall and handlebar impact injury to the right infracostal area. At admission he was stable, with no abnormalities except for a subcutaneous hepatoma found in the injured area. Abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography (CT) revealed irregular branching laceration of the right superior hepatic segments with extension into the hepatic veins. No active extravasation of contrast material was seen. On the next day, cause of the deterioration of the patient's condition, CT examination was repeated and revealed focal extravasation of contrast material in the portal hilum posterior to the gallbladder. An injury of the right hepatic vein was found on laparotomy. Hepatic vein injury is a rare but very serious complication after blunt liver trauma and it is an indication for surgical treatment. Diagnostic imaging is essential for therapeutic decisions, but its value is sometimes limited.The precise analysis of injury mechanism and localization may be very helpful.CT is currently the modality of choice for the evaluation of blunt liver trauma. If an active bleeding is suspected the delayed scans seem to be recommended. (author)

Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans.

Science.gov (United States)

Boas, F Edward; Kamaya, Aya; Do, Bao; Desser, Terry S; Beaulieu, Christopher F; Vasanawala, Shreyas S; Hwang, Gloria L; Sze, Daniel Y

2015-04-01

Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

The diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by hepatic arterioportal vein fistulas in hepatocellular carcinoma

International Nuclear Information System (INIS)

Luo Pengfei; Chen Xiaoming; Lu Ligong; Hu Baoshan; Li Yong

2007-01-01

Objective: To investigate the hemodynamics of increasing portal venous pressure(PVP) in hepatocellular carcinoma patients complicated with hepatic arterioportal vein fistulas (HAPVF) and the diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by HAPVF. Methods: One hundred and fifteen cases of hepatocellular carcinoma with upper gastrointestinal hemorrhage were checked by hepatic arteriography and were treated through orifices embolization in cases with severe HAPCF by coils and/or ethanol. Results: Twenty-six out of 31 patients suffering intractable upper gastrointestinal hemorrhage have severe HAPVF (the main stem of portal veins are visible). However, there are only 15 patients with light HAPVF among the 84 patients who have mild upper gastrointestinal hemorrhage (the main stem of portal veins are invisible). After the embolization, all of the 26 patients who have severe HAPVF stopped bleeding. Among them, the main stem of hepatic arteries are occluded in 2 patients. Conclusion: The existence of severe HAPVF should be taken into consideration when intractable upper gastrointestinal hemorrhage occurs in hepatocellular carcinoma patients, and it can be diagnosed through hepatic artery DSA. Orifice embolization is the most effective method for such kind of hemorrhage. (authors)

Interventional treatment of upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting

International Nuclear Information System (INIS)

Li Jijun; Shang Jianqiang; Liu Zuoqin; Tang Jun; Sun Zengtao; Chen Jie; Zhang Lei; Liu Hongjun; Zhou Zhaohai

2011-01-01

Objective: To explore the diagnostic and therapeutic efficacy of interventional procedure for upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting (HAPVS). Methods: Clinical data of 27 patients of hepatic carcinoma accompanied with HAPVS were retrospectively analyzed. All patients underwent hepatic arterial angiography and transcatheter arterial embolization. Shunts were embolized with coils, Gelfoam particles or PVA particles. Results: Of 27 patients with upper gastrointestinal bleeding, central type HAPVS was seen in 16 and peripheral type HAPVS in 11. Reversed portal venous flow was detected in 20 cases and ascites was found in 23 cases. The abnormal shunts were successfully occluded in all patients and the bleeding ceased within 2 days after embolization. No recurrent bleeding occurred in one month after the treatment. Ascites disappeared in 16 cases and subsided in 7 cases. Conclusion: HAPVS is an important cause for upper gastrointestinal bleeding in patients of hepatic carcinoma, and the arteriovenous fistula can be confirmed with hepatic artery DSA. Embolization of fistulous orifice is the most effective therapy for such patients. (authors)

[Transposition of the cephalic vein in free flap breast reconstruction: Technical note].

Science.gov (United States)

Silhol, T; Suffee, T; Hivelin, M; Lantieri, L

2018-02-01

Free flaps have become a reliable practice for breast reconstruction. However, the venous congestion is still the most frequent reason of flap failure. It is due to bad quality of the internal mammary veins, a preferential superficial venous outflow of the flap or due to venous thrombosis. The transposition of the cephalic vein could useful in some cases. We describe the surgical technique and suggest an intraoperative algorithm. Seventeen patients (15 DIEP and 2 PAP) were included. Twenty nine point four percent had an unusable internal mammary vein, 23.5% a preferential superficial venous outflow and 47.1% a venous thrombosis. The length of the cephalic vein dissected varied from 15 to 25cm. The mean time of dissection was 39min. There was no flap failure after cephalic vein transposition. The sequelae were one or two scars on the arm without any functional morbidity. The transposition of the cephalic vein is a reliable, less morbid alternative in case of bad quality internal mammary vein with a good quality internal mammary artery, in case of an additional venous outflow necessity or in case of venous thrombosis. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Morphological and biomechanical remodeling of the hepatic portal vein in a swine model of portal hypertension.

Science.gov (United States)

He, Xi-Ju; Huang, Tie-Zhu; Wang, Pei-Jun; Peng, Xing-Chun; Li, Wen-Chun; Wang, Jun; Tang, Jie; Feng, Na; Yu, Ming-Hua

2012-02-01

To obtain the morphological and biomechanical remodeling of portal veins in swine with portal hypertension (PHT), so as to provide some mechanical references and theoretical basis for clinical practice about PHT. Twenty white pigs were used in this study, 14 of them were subjected to both carbon tetrachloride- and pentobarbital-containing diet to induce experimental liver cirrhosis and PHT, and the remaining animals served as the normal controls. The morphological remodeling of portal veins was observed. Endothelial nitric oxide synthase expression profile in the vessel wall was assessed at both mRNA and protein level. The biomechanical changes of the hepatic portal veins were evaluated through assessing the following indicators: the incremental elastic modulus, pressure-strain elastic modulus, volume elastic modulus, and the incremental compliance. The swine PHT model was successfully established. The percentages for the microstructural components and the histological data significantly changed in the experimental group. Endothelial nitric oxide synthase expression was significantly downregulated in the portal veins of the experimental group. Three incremental elastic moduli (the incremental elastic modulus, pressure-strain elastic modulus, and volume elastic modulus) of the portal veins from PHT animals were significantly larger than those of the controls (P portal vein decreased. Our study suggests that the morphological and biomechanical properties of swine hepatic portal veins change significantly during the PHT process, which may play a critical role in the development of PHT and serve as potential therapeutic targets during clinical practice. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Variability of hydrostatic hepatic vein and ascitic fluid pressure, and of plasma and ascitic fluid colloid osmotic pressure in patients with liver cirrhosis

DEFF Research Database (Denmark)

Henriksen, Jens Henrik Sahl

1980-01-01

The variability of hydrostatic hepatic vein and ascitic fluid pressures and of plasma and ascitic fluid colloid osmotic (oncotic) pressures was assessed during hepatic venous catheterization by repeated measurements on different days and at different locations in patients with cirrhosis...... of the liver. Furthermore, calculation of oncotic pressure from protein determinations was compared to the directly measured value of plasma and ascitic fluid samples. Repeated measurements of hydrostatic pressure in the same hepatic vein within 15 min showed a standard deviation (SD) below 1 mm......Hg. The variation in hydrostatic hepatic vein pressures, pressure differences and ascitic fluid pressures (when measured at different locations within the liver and peritoneal space during a single examination) was 1.5, 1.0 and 1.0 mmHg (SD), respectively. When measured on different days, the variation...

Hepatic vein tumor thrombus as a risk factor for excessive pulmonary deposition of microspheres during TheraSphere therapy for unresectable hepatocellular carcinoma.

Science.gov (United States)

Fleming, Chad J; Andrews, James C; Wiseman, Gregory A; Gansen, Denise N; Roberts, Lewis R

2009-11-01

To evaluate the impact of identifiable hepatic vein tumor thrombus on the ability to safely deliver TheraSphere (yttrium 90-containing glass microspheres) for the treatment of hepatocellular carcinoma (HCC). A retrospective review was performed of 87 patients (71 men, 16 women; mean age, 64.5 years; age range, 25-83 y) referred for TheraSphere therapy for HCC during a 2-year period between April 2005 and May 2007. Evaluation included contrast-enhanced computed tomography or magnetic resonance imaging, selective mesenteric angiography, and radionuclide perfusion scintigraphy to measure the arteriovenous shunting through the tumor. Of the 87 patients, 83 underwent angiography and perfusion scintigraphy; 53 were ultimately treated with 65 glass microsphere infusions. Twelve of 83 were identified as having tumor thrombus in a hepatic vein or extending into the inferior vena cava. The mean lung shunt for the patients with hepatic vein tumor thrombus was 30% (range, 11%-60%), compared with 8.2% (range, 3%-23%) for patients without identifiable tumor thrombus. Two of the 12 patients were treated with reduced doses of glass microspheres, and the remaining 10 were offered alternative therapies. The presence of hepatic vein tumor thrombus is a risk factor for an increased lung shunt that may prohibit delivery of a therapeutic dose of TheraSphere to hepatic tumor.

Portal vein ligation is as effective as sequential portal vein and hepatic artery ligation in inducing contralateral liver hypertrophy in a rat model

NARCIS (Netherlands)

Veteläinen, Reeta; Dinant, Sander; van Vliet, Arlène; van Gulik, Thomas M.

2006-01-01

PURPOSE: Dual embolization of the hepatic artery and portal vein (PV) has been proposed to enhance contralateral liver regeneration before resection. The aim of this study was to evaluate the effect of PV ligation compared with simultaneous or sequential dual ligation on regeneration,

A relative study of hepatic perfusion and portal vein pressure in rats with liver cirrhosis

International Nuclear Information System (INIS)

Li Jiaping; Yang Jianyong; Chen Wei; Huang Yonghui

2006-01-01

Objective: To evaluate spiral CT perfusion in assessing portal vein pressure in rats with different stages of liver cirrhosis. Methods Seventeen rats with early stage of liver cirrhosis, 18 with intermediate stage, 12 with advanced stage, and 13 healthy rats as a control group were selected and recieved hepatic perfusion on a single-row spiral CT scanner. The parameters of hepatic perfusion were calculated using the deconvolution method. The portal vein pressure was measured by multi-physiographer. Results: (1) In study group, the PVP (portal venous perfusion) and THBP (total hepatic blood perfusion) were negatively correlated with FPP, while positively correlated with the HPI (hepatic perfusion index) and MTT (mean transit time). The FPP had a close relation with PVP. The equation, Y 20.671-3.195X, could be conducted with linear regression analysis. (2) According to the linear regression equation mentioned above, the FPP in 47 rats were 16.090±2.150 cmH 2 0, which was highly correlated with the observed valuel6.108±3.662 cmH 2 O (r=0.823 P<0.01). Conclusion: CT perfusion is a new non-invasive and efficient modality for assessment of the portal pressure in liver cirrhosis in various stages. (authors)

Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

Directory of Open Access Journals (Sweden)

Rishi Nayyar

2010-01-01

Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

Assessment of contrast-enhanced ultrasonography of the hepatic vein for detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs.

Science.gov (United States)

Morishita, Keitaro; Hiramoto, Akira; Michishita, Asuka; Takagi, Satoshi; Hoshino, Yuki; Itami, Takaharu; Lim, Sue Yee; Osuga, Tatsuyuki; Nakamura, Sayuri; Ochiai, Kenji; Nakamura, Kensuke; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

2017-04-01

OBJECTIVE To assess the use of contrast-enhanced ultrasonography (CEUS) of the hepatic vein for the detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs. ANIMALS 6 healthy Beagles. PROCEDURES A prospective study was conducted. A catheter was surgically placed in the portal vein of each dog. Hypertension was induced by intraportal injection of microspheres (10 to 15 mg/kg) at 5-day intervals via the catheter. Microsphere injections were continued until multiple acquired portosystemic shunts were created. Portal vein pressure (PVP) was measured through the catheter. Contrast-enhanced ultrasonography was performed before and after establishment of hypertension. Time-intensity curves were generated from the region of interest in the hepatic vein. Perfusion variables measured for statistical analysis were hepatic vein arrival time, time to peak, time to peak phase (TTPP), and washout ratio. The correlation between CEUS variables and PVP was assessed by use of simple regression analysis. RESULTS Time to peak and TTPP were significantly less after induction of portal hypertension. Simple regression analysis revealed a significant negative correlation between TTPP and PVP. CONCLUSIONS AND CLINICAL RELEVANCE CEUS was useful for detecting hemodynamic changes associated with experimentally induced portal hypertension in dogs, which was characterized by a rapid increase in the intensity of the hepatic vein. Furthermore, TTPP, a time-dependent variable, provided useful complementary information for predicting portal hypertension. IMPACT FOR HUMAN MEDICINE Because the method described here induced presinusoidal portal hypertension, these results can be applied to idiopathic portal hypertension in humans.

Wedged-shaped, segmental changes in the liver caused by occlusion of a single hepatic vein

International Nuclear Information System (INIS)

Kanazawa, Susumu; Akaki, Shiro; Yasui, Kotaro; Tanaka, Akio; Hiraki, Yoshio

1997-01-01

We evaluated wedged-shaped, segmental changes in the liver caused by occlusion of a single hepatic vein in seven patients. The causes of occlusion were due to liver tumors in three patients, metastasis of the right adrenal gland in one, and postoperative changes in three. Changes included low attenuating on unenhanced CT, high attenuation on enhanced CT, low signal intensity on T1-weighted MRI, high signal intensity on T2-weighted MRI, high signal intensity on enhanced MRI, dense hepatogram and retrograde arterioportal shunt on hepatic arteriography. MRI and hepatic arteriography are more sensitive than CT in demonstration of those changes. (author)

Transhepatic Hilar Approach for Perihilar Cholangiocarcinoma: Significance of Early Judgment of Resectability and Safe Vascular Reconstruction.

Science.gov (United States)

Kuriyama, Naohisa; Isaji, Shuji; Tanemura, Akihiro; Iizawa, Yusuke; Kato, Hiroyuki; Murata, Yasuhiro; Azumi, Yoshinori; Kishiwada, Masashi; Mizuno, Shugo; Usui, Masanobu; Sakurai, Hiroyuki

2017-03-01

In the most common surgical procedure for perihilar cholangiocarcinoma, the margin status of the proximal bile duct is determined at the final step. Our procedure, the transhepatic hilar approach, confirms a cancer-negative margin status of the proximal bile duct first. We first performed a partial hepatic parenchymal transection to expose the hilar plate, and then transected the proximal bile duct to confirm margin status. Then, divisions of the hepatic artery and portal vein of the future resected liver are performed, followed by the residual hepatic parenchymal transection. The transhepatic hilar approach offers a wide surgical field for safe resection and reconstruction of the portal vein in the middle of the hepatectomy. We reviewed 23 patients with perihilar cholangiocarcinoma who underwent major hepatectomy using our procedure from 2011 to 2015. A combined vascular resection and reconstruction was carried out in 14 patients (60.9%). R0 resection was achieved in 17 patients (73.9%), and the overall 3-year survival rate was 52.9% (median survival time 52.4 months). The transhepatic hilar approach is useful and practicable regardless of local tumor extension, enabling us to determine tumor resectability and perform safe resection and reconstruction of the portal vein early in the operation.

A Simplified Technique of Percutaneous Hepatic Artery Port-Catheter Insertion for the Treatment of Advanced Hepatocellular Carcinoma with Portal Vein Invasion

Energy Technology Data Exchange (ETDEWEB)

Choi, Sun Young [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of); Kim, Ah Hyun; Lee, Do Yun; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Severance Hospital, Seoul (Korea, Republic of); Kim, Kyung Ah [Inje University Ilsan Paik Hospital, Ilsan (Korea, Republic of)

2010-12-15

We assessed the outcomes of a simplified technique for the percutaneous placement of a hepatic artery port-catheter system for chemotherapy infusion in advanced hepatocellular carcinoma with portal vein invasion. From February 2003 to February 2008, percutaneous hepatic artery port-catheter insertion was performed in 122 patients who had hepatocellular carcinoma with portal vein invasion. The arterial access route was the common femoral artery. The tip of the catheter was wedged into the right gastroepiploic artery without an additional fixation device. A side hole was positioned at the distal common hepatic artery to allow the delivery of chemotherapeutic agents into the hepatic arteries. Coil embolization was performed only to redistribute to the hepatic arteries or to prevent the inadvertent delivery of chemotherapeutic agents into extrahepatic arteries. The port chamber was created at either the supra-inguinal or infra-inguinal region. Technical success was achieved in all patients. Proper positioning of the side hole was checked before each scheduled chemotherapy session by port angiography. Catheter-related complications occurred in 19 patients (16%). Revision was achieved in 15 of 18 patients (83%). This simplified method demonstrates excellent technical feasibility, an acceptable range of complications, and is hence recommended for the management of advanced hepatocellular carcinoma with portal vein thrombosis

Atypical leiomyoma arising in a hepatic vein with extension into the inferior vena cava and right atrium

International Nuclear Information System (INIS)

Dunlap, H.J.; Udjus, K.

1990-01-01

We report an atypical leiomyoma arising in a hepatic vein and extending into the inferior vena cava and right atrium in a fourteen year old boy. US, CT and MRI facilitated diagnosis and removal of this tumor. (orig.)

Sectional localization of a small hepatocellular carcinoma in the right hepatic lobe by computed tomography: Comparison between the conventional and portal vein tracing methods

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Zhou, Chun-Gao [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing (China); Chung, Jin Wook; Hur, Saebeom; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Yin, Yong-Hu; Kim, Young Il [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); Ahn, Sang-bu [Dongnam Institution of Radiological and Medical Sciences, Department of Radiology, Busan (Korea, Republic of); Cho, Baik Hwan [Chonbuk National University Hospital, Department of Radiology, Jeonju (Korea, Republic of)

2016-12-15

To compare the accuracy of the conventional and portal vein tracing methods in the right hepatic lobe in multidetector computed tomography (MDCT). This retrospective study included patients with hepatocellular carcinoma (HCC) lesions in the right hepatic lobe who underwent multiphasic MDCT and C-arm CT hepatic arteriography (C-arm CTHA) for chemoembolization. The accuracies of the conventional and portal vein tracing methods were evaluated using C-arm CTHA as the gold standard. A total of 147 patients with 205 HCC nodules were included. The C-arm CTHA could identify all the tumour-feeding arteries and consequently demonstrated that 120 lesions were located in the anterior section, 78 in the posterior section, and 7 in the border zone. The accuracy rates of conventional vs. portal vein tracing methods were 71.7 % vs. 98.3 % for the anterior section lesions, 67.9 % vs. 96.2 % for the posterior section, and 28.6 % vs. 57.1 % for the border zone. The portal vein tracing method was more accurate than the conventional method (P<0.001). The portal vein tracing method should be used for sectional localization of HCCs in the right lobe, because it predicts the location more accurately than the conventional method. (orig.)

Da Vinci robot-assisted anatomic left hemihepatectomy and biliary reconstruction.

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Wang, Zhifei; Liu, Quanda; Chen, Junzhou; Duan, Weihong; Zhou, Ningxin

2013-06-01

Since the introduction of Da Vinci robotic surgery, more and more complicated surgeries can now be performed robotically, yet there have been very few on robotic hepatectomy, especially when billiary reconstruction is involved. The video shows our initial experience with an anatomic hepatectomy using Da Vinci surgical robot. In this case, we also conducted billiary reconstruction due to the anatomic abnormality of bile duct, while applying the choledochoscopy. The preoperative diagnosis is primary liver carcinoma, tumor thrombi in bile duct, and hepatitis B. First, the gallbladder was resected, and cystic artery and duct were identified. After opening of the common bile duct above the junction, the choledochoscopy was performed. Tumor thrombi were found in common bile duct and left hepatic duct, and they were all removed. Left branches hepatic artery and portal vein were dissected, ligated, and divided. Thrombi in the left hepatic duct were removed also. After marking the cutting line along the ischemic boarder, liver parenchyma was transected using robotic harmonic scalpel. Branches of ducts were encountered and managed by either direct coagulating or dividing after clipping. The left hepatic vein was visualized, exposed, and divided during hepatectomy. Two T tubes were placed into common hepatic duct and the proximal cutting end of right anterior bile duct which was found to join the left hepatic duct, respectively. The operation went on successfully. The operation time was 410 minutes, the blood loss was 200 mL. The pathologic diagnosis was introductal papillary adenocarcinoma of left hepatic duct. The patient went on well postoperatively and was followed up for 22 months till now. Postoperative computed tomography examination showed no recurrence. Da Vinci-assisted robotic hepatectomy can be performed safely in the hands of experienced hepatobilliary surgeons, and choledochoscopy can be combined for bile duct exploration. With the advantages of Da Vinci robot

Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

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Sonia Tewani Orcutt

2016-03-01

Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

Reversal of flow in the inferior vena cava and hepatic veins on dynamic CT

International Nuclear Information System (INIS)

Lelij, H. van der; Mallens, W.M.C.

1988-01-01

A tricuspid insufficiency may not be clinically evident and may remain unknown to the clinician. The phenomenon of a reversal of inferior vena caval blood flow and hepatic veins is known to occur in tricuspid regurgitation from right ventricular angiography and duplex scanning. Demonstration of such a reversal flow on a dynamic CT scan, as in our case, has, to our knowledge, not as yet been reported

The sural artery and vein as recipient vessels in free flap reconstruction about the knee.

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Johnson, P E; Harris, G D; Nagle, D J; Lewis, V L

1987-04-01

The sural artery and vein were used successfully as recipient vessels in nine patients who required free flap reconstruction about the knee. The anatomy of the sural vessels and the potential advantages of their use as free flap recipients are reviewed and discussed. Indications include popliteal vessels that are absent or severely damaged, as determined by preoperative angiography. No anastomotic complications were encountered in this series, indicating that the sural artery and vein can be used successfully as recipient vessels.

Augmented reality based real-time subcutaneous vein imaging system.

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Ai, Danni; Yang, Jian; Fan, Jingfan; Zhao, Yitian; Song, Xianzheng; Shen, Jianbing; Shao, Ling; Wang, Yongtian

2016-07-01

A novel 3D reconstruction and fast imaging system for subcutaneous veins by augmented reality is presented. The study was performed to reduce the failure rate and time required in intravenous injection by providing augmented vein structures that back-project superimposed veins on the skin surface of the hand. Images of the subcutaneous vein are captured by two industrial cameras with extra reflective near-infrared lights. The veins are then segmented by a multiple-feature clustering method. Vein structures captured by the two cameras are matched and reconstructed based on the epipolar constraint and homographic property. The skin surface is reconstructed by active structured light with spatial encoding values and fusion displayed with the reconstructed vein. The vein and skin surface are both reconstructed in the 3D space. Results show that the structures can be precisely back-projected to the back of the hand for further augmented display and visualization. The overall system performance is evaluated in terms of vein segmentation, accuracy of vein matching, feature points distance error, duration times, accuracy of skin reconstruction, and augmented display. All experiments are validated with sets of real vein data. The imaging and augmented system produces good imaging and augmented reality results with high speed.

Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

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Hong, Suk Kyun; Suh, Kyung-Suk; Kim, Hyo-Sin; Yoon, Kyung Chul; Ahn, Sung-Woo; Oh, Dongkyu; Kim, Hyeyoung; Yi, Nam-Joon; Lee, Kwang-Woong

2017-11-01

Despite increases in the performance of pure laparoscopic living donor hepatectomy, variations in the bile duct or portal vein have been regarded as relative contraindications to this technique [1-3]. This report describes a donor with separate right posterior and right anterior hepatic ducts and portal veins who underwent pure laparoscopic living donor right hemihepatectomy, integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography [1, 4, 5]. A 50-year-old man offered to donate part of his liver to his older brother, who required a transplant for hepatitis B-associated liver cirrhosis and hepatocellular carcinoma. Donor height was 178.0 cm, body weight was 82.7 kg, and body mass index was 26.1 kg/m 2 . Preoperative computed tomography and magnetic resonance cholangiopancreatography showed that the donor had separate right posterior and right anterior hepatic ducts and portal veins. The entire procedure was performed under 3D laparoscopic view. Following intravenous injections of 0.05 mg/kg ICG, ICG near-infrared fluorescence camera was used to demarcate the exact transection line and determine the optimal bile duct division point. The total operation time was 443 min; the donor required no transfusions and experienced no intraoperative complications. The graft weighed 1146 g with a graft-to-recipient weight ratio of 1.88%. The optimal bile duct division point was identified using ICG fluorescence cholangiography, and the bile duct was divided with good patency without any stricture. The right anterior and posterior portal veins were transected with endostaplers without any torsion. The patient was discharged on postoperative day 8, with no complications. Using a 3D view and ICG fluorescence cholangiography, pure 3D laparoscopic living donor right hemihepatectomy is feasible in a donor with separate right posterior and right anterior hepatic ducts and portal veins.

Reconstruction of circulation in the fingertip without vein repair in zone I replantation.

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Zhang, Xu; Wen, Sumin; Wang, Baoshi; Wang, Qi; Li, Chenglin; Zhu, Hongwei

2008-11-01

In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery. We present a new technique for reconstructing circulation without vein anastomosis in zone I replantation and analyze the outcomes of this technique in terms of eliminating external bleeding and of a high survival rate of the replanted digits. Between 1997 and 2007, we performed 120 replantations in 112 patients (83 male and 29 female; mean age, 33 years; range, 3-54 years). All were zone I amputations, based on the Tamai classification. We surgically repaired both proper digital arteries, excluded the vein, and then ligated 1 of the arteries. Using this technique, circulation was restored. Included in the outcome evaluation were 91 digits in the 87 patients (mean age, 35 years; range, 14-54) who returned for outcome assessments 12 months after surgery. Of 120 digits replanted, 115 digits survived, corresponding to an overall success rate of 96%. No patients received alternative means to alleviate venous congestion, such as leeches or other means of external bleeding. Nearly all of the 87 patients (91 digits) were satisfied with the results of the replantations. Our technique reconstructs circulation without vein anastomosis in zone I replantation. This alternative to venous congestion involves a simple surgical procedure and straightforward postoperative care. Follow-up assessments of a series of 120 replantations show that the majority of zone I replantations led to satisfactory function. We therefore propose this technique as an effective method for zone I replantation. Therapeutic IV.

Occult Amebic Liver Abscess as Cause of Extensive Inferior Vena Cava and Hepatic Vein Thrombosis.

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Martin, Leslie; Burute, Nishigandha; Haider, Ehsan; Serrano, Pablo E; O'Shea, Timothy; Siegal, Deborah

2017-10-01

The most common extraintestinal complication of Entamoeba histolytica is amebic liver abscess (ALA). Hepatic vein and inferior vena cava (IVC) thrombosis are rare but well-documented complications of ALA, typically attributed to mechanical compression and inflammation associated with a large abscess. We present a case of a previously healthy 43-year-old Canadian man presenting with constitutional symptoms and right upper quadrant abdominal pain. He was found to have thrombophlebitis of the IVC, accessory right hepatic vein, and bilateral iliac veins. Extensive investigations for thrombophilia were negative. Magnetic resonance imaging of the liver demonstrated a 3.2-cm focal area of parenchymal abnormality that was reported as presumptive hepatocellular carcinoma, and a 1.9-cm lesion in the caudate lobe with diffusion restriction and peripheral rim enhancement. Despite multiple biopsy attempts, a histopathological diagnosis was not achieved. Abdominal pain and fever 4 months later prompted repeat ultrasound demonstrating a 10.4- × 12.0-cm rim-enhancing fluid attenuation lesion felt to represent a liver abscess. Thick dark "chocolate brown" drainage from the lesion and positive serology for E. histolytica confirmed the diagnosis of ALA acquired from a previous trip to Cuba. The patient was started on treatment with metronidazole and paromomycin and repeat abdominal ultrasound demonstrated resolution of the abscess. This case is the first to demonstrate extensive IVC thrombosis secondary to a relatively small occult ALA and emphasizes the thrombogenic potential of ALA. Amebic infection should be considered as a rare cause of IVC thrombosis in the correct clinical context.

Comparative Study of Compensatory Liver Regeneration in a Rat Model: Portal Vein Ligation Only versus Sequential Ligation of the Portal Vein and Hepatic Artery

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Chung, Soo Young [Dept. of Pathology, Dongnam Institute of Radiological and Medical Sciences, Busan (Korea, Republic of); Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Lee, Byung Mo [Dept. of Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2013-04-15

To compare the volume change and the regenerative capacity between portal vein ligation (embolization) (PVL) and heterochronous PVL with hepatic artery ligation (HAL) in a rodent model. The animals were separated into three groups: group I, ligation of the left lateral and median portal vein branches; group II, completion of PVL, followed by ligation of the same branches of the hepatic artery after 48 h; control group, laparotomy without ligation was performed. Five rats from each group were sacrificed on 1, 3, 5, and 7 days after the operation. Volume change measurement, liver function tests and immunohistochemical analysis were performed. The volume of the nonligated lobe between groups I and II was not significantly different by day 5 and day 7. Mean alanine aminotransferase and total bilirubin levels were significantly higher in group II, while the albumin level was higher in group I. Both c-kit- and MIB-5-positive cells used in the activity detection of regeneration were more prevalent in group I on day 1, 3, and 5, with statistical significance. There was no operation related mortality. PVL alone is safe and effective in compensatory liver regeneration. Performing both PVL and HAL does not confer any additional benefits.

[Hydatid cyst in the hepatic hilum causing a cavernous transformation in the portal vein].

Science.gov (United States)

Gil-Egea, M J; Alameda, F; Girvent, M; Riera, R; Sitges-Serra, A

1998-05-01

Portal cavernomatosis consists in the substitution of the portal vein by many fine, twisting venules leading to the liver. This phenomenon is produced as a consequence of anterior thrombosis of the portal vein and is associated with chronic pancreatitis, cancer of the pancreas, intraabdominal sepsis and cholelithiasis. The symptomatology may be nul or present as obstructive jaundice or portal hypertension. Diagnosis is made by Doppler echography. The treatment is portal shunt when symptomatology is produced. In patients with cholelithiasis requiring surgery, the shunt is advised prior to biliary surgery since perioperative hemorrhage, if present, may be incoercible as in the case herein described. We present a 84-year-old woman with portal cavernomatosis the etiology of which was a hydatidic cyst located in the hepatic bifurcation and treated with mebendazol 10 years previously. This etiology has not been previously reported.

Benign hepatic portal venous gas following caustic ingestion

International Nuclear Information System (INIS)

Lewin, Maite; Tubiana, Jean-Michel; Pocard, Marc; Caplin, Scott; Parc, Rolland; Blain, Antoine

2002-01-01

Hepatic portal vein gas has been documented in numerous conditions and is traditionally regarded as a poor prognostic sign. There are, however, several reports of portal vein gas with a benign course. We report the first case of transient hepatic portal vein gas secondary to the ingestion of a caustic substance. The literature of hepatic portal vein gas in benign disease is reviewed. (orig.)

Changes in waveform on hepatic venous doppler in patients with chronic hepatic B: Correlation with histologic findings

International Nuclear Information System (INIS)

Ko, Joon Seok; Kim, Hak Soo; Chung, Dong Hae

2001-01-01

To evaluate changes of the waveform of the hepatic vein on doppler ultrasound (US) in patients with chronic hepatic B and to correlate them with histologic findings. Thirty three patients with chronic hepatic B were prospectively examined with doppler US, and liver biopsy was done at the same time. The right hepatic vein was examined on doppler US, and a liver biopsy was performed in the right lobe of the liver. Doppler waveform was considered abnormal if it showed either reduction in the amplitude of phasic oscillation without the reversed flow phase or the presence of completely flow. Specimens obtained from the biopsy were classified according to the predetermined histologic scoring criteria. It was technically possible to performed Doppler US of the right hepatic vein and liver biopsy simultaneously in all thirty three patients. Waveforms of the right hepatic vein were abnormal in fourteen (42.4%), biphasic in 12 (36.4%) and flat in two (6.0%) patients. Only the steatosis exhibited statistically significant correlation between changes of doppler waveform (p,0.05) of the normal and abnormal groups. Doppler US patterns of the hepatic vein in chronic hepatitis B were different from those of the normal group. The abnormal flow pattern on hepatic venous doppler appeared to be mainly influenced by the intrahepatic fat deposition rather than the degree of fibrosis.

Evaluation of hepatic atrophy after transcatheter arterial embolization

International Nuclear Information System (INIS)

Chung, Hwan Hoon; Lee, Mee Ran; Oh, Min Cheol; Park, Chul Min; Seol, Hae Young; Cha, In Ho

1995-01-01

Hepatic atrophy has been recognized as a complication of hepatic and biliary disease but we have often found it in follow up CT after transcatheter arterial embolization (TACE). The purpose of this study is to evaluate the characteristics of hepatic atrophy after TACE. Of 53 patients who had TACE. We evaluated the relationship between the incidence of hepatic atrophy and the number of TACE, and also evaluated the average number of TACE in patients with hepatic atrophy. Of 20 patients who had received more than average number of TACE for development of hepatic atrophy (2 times with portal vein obstruction, 2.7 times without portal vein obstruction in this study), we evaluated the relationship between the lipiodol uptake pattern of tumor and the incidence of hepatic atrophy. There were 8 cases of hepatic atrophy (3 with portal vein obstruction, 5 without portal vein obstruction), average number for development of hepatic atrophy were 2.5 times. As the number of TACE were increased, the incidence of hepatic atrophy were also increased. Of 20 patients who received more than average number of TACE for development of hepatic atrophy, we noted 6 cases of hepatic atrophy in 11 patients with dense homogenous lipiodol uptake pattern of tumor and noted only 1 case of hepatic atrophy in 9 patient with inhomogenous lipiodol uptake pattern. Hepatic atrophy was one of the CT findings after TACE even without portal vein obstruction. Average number of TACE was 2.5 times and risk factors for development of hepatic atrophy were portal vein obstruction, increased number of TACE, and dense homogenous lipiodol uptake pattern of tumor

The feasible study of vasodilators in portal vein targeting infusion for treating portal hypertension

International Nuclear Information System (INIS)

Wu Hanping; Liang Huiming; Zheng Chuansheng; Feng Gansheng

2002-01-01

Objective: To find out the ideal portal vein tar getting injection routes for portal hypertension treatment. Methods: 28 cirrhotic rat models with portal hypertension induced by CCl 4 were divided into 4 groups: inferior caval vein injection group, portal vein injection group, hepatic artery injection group, spleen injection group. The changes in portal vein pressure (PVP), inferior caval vein pressure (ICVP), mean artery pressure (MAP) and heart rate (HR) were monitored before and after prazosin injection. Results: After intra-portal, intra-hepatic arterial or spleen injection of prazosin, larger decrease in PVP and lesser effects on MAP than intravenous injection had been induced. The effect on HR showed no difference among these four groups. Conclusions: Hepatic artery and spleen prazosin administration have the same advantages on treatment of portal hypertension as those of intra-portal infusion, that is the greater decrease on portal vein pressure, the lesser effects on systemic hemodynamics. Vasodilation drugs for hepatic artery infusion through percutaneous port catheter system by hepatic artery implantation would be an ideal method for portal hypertension treatment

Clinical application of hepatic vein percutaneous transluminal angioplasty and stent after stent placement in inferior vena cava

International Nuclear Information System (INIS)

Xu Hao; Zu Maoheng; Gu Yuming; Li Guojun; Zhang Qingqiao; Wei Ning; Xu Wei; Liu Hongtao

2005-01-01

Objective: To investigate the feasibility and effect of recanalization of hepatic vein with percutaneous transluminal angioplasty (PTA) and stent after stent placement in inferior vena cava (IVC). Methods: Eleven patients with Budd-Chiari syndrome (BCS)were once performed metal stent placement in IVC at other hospital, but ascites was not subsided in 9 patients after the stent placement and occurred again in 2 patients in 3 months after the procedure. PTA and metal stent placement were used to treat the occlusion of the hepatic vein (HV) via stent in IVC. Results: Recanalization of occlusive HV was successful in all 11 patients, and symptoms disappeared or were obviously improved. The mean blood pressure in HV dropped from pre-operation (45.12 ± 1.57) cm H 2 O (1 cm H 2 O=0.098 kPa) to post-operation (17.53 ± 0.68) cm H 2 O (P<0.01). In a period of 4-30 months (mean: 13.6 months) following-up, no patient reoccurred symptoms. Conclusion: Recanalization of HV via stent in IVC is a feasible and effective method for occlusive HV, but it is difficult. (authors)

Relationship between hemodynamic changes of portal vein and hepatic artery measured by color Doppler ultrasound and FibroScan value in patients with liver cirrhosis

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CHENG Xiaofei

2014-11-01

Full Text Available ObjectiveTo explore the relationship between hemodynamic changes of the portal vein and hepatic artery measured by color Doppler ultrasound and FibroScan value in patients with liver cirrhosis. MethodsA total of 192 patients with hepatitis B cirrhosis who were admitted to our hospital from March 2010 to December 2013, as well as 100 healthy persons, were recruited. The mean portal vein blood flow velocity (PVVmean, hepatic artery pulsatility index (HAPI, and hepatic artery resistance index (HARI were measured by color Doppler ultrasound. FibroScan was also carried out. All data were statistically analyzed using SPSS 13.0. Continuous data were expressed as mean±SD and compared between groups by t-test. ResultsThe HAPI, HARI, and FibroScan value of the patient group were 1.56±024, 0.73±0.05, and 25.38±7.73, respectively, significantly higher than those of the control group (1.36±0.14, 0.65±0.07, and 7.8±3.6 (P＜0.05; the PVVmean of the patient group was 14.43±1.86, significantly lower than that of the control group (17.35±0.56 (P＜0.05. FibroScan value was positively correlated with HAPI and HARI (r1=0.59, r2=0.66, P＜0.001, but negatively correlated with PVVmean (r=-0.64, P＜0.001. ConclusionThe liver stiffness assessed by FibroScan and the hemodynamic changes of the portal vein and hepatic artery measured by color Doppler ultrasound are vitally important for evaluating the severity of liver cirrhosis.

Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI?

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Vermeulen, Mechteld A.R., E-mail: mar.vermeulen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Ligthart-Melis, Gerdien C., E-mail: g.ligthart-melis@vumc.nl [Department of Internal Medicine, Dietetics and Nutritional Sciences, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Buijsman, René, E-mail: renebuysman@gmail.com [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Siroen, Michiel P.C., E-mail: m.siroen6@upcmail.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Poll, Marcel C.G. van de, E-mail: mcg.vandepoll@ah.unimaas.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Boelens, Petra G., E-mail: p.boelens@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Dejong, Cornelis H.C., E-mail: chc.dejong@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Schaik, Cors van, E-mail: c.vanschaik@vumc.nl [Department of Radiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Hofman, Mark B.M., E-mail: mbm.hofman@vumc.nl [Department of Physics and Medical Technology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Leeuwen, Paul A.M. van, E-mail: pam.vleeuwen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands)

2012-09-15

Background: Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose. Objective: To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach. Methods: In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared. Results: Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433 ± 200/423 ± 162/507 ± 96 ml/min (portal vein); 96 ± 70/74 ± 41/108 ± 91 ml/min (hepatic artery); 248 ± 139/201 ± 118/219 ± 69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent. Conclusions: Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.

A comparative study of 1D and 3D hemodynamics in patient-specific hepatic portal vein networks

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Jonášová A.

2014-12-01

Full Text Available The development of software for use in clinical practice is often associated with many requirements and restrictions set not only by the medical doctors, but also by the hospital’s budget. To meet the requirement of reliable software, which is able to provide results within a short time period and with minimal computational demand, a certain measure of modelling simplification is usually inevitable. In case of blood flow simulations carried out in large vascular networks such as the one created by the hepatic portal vein, simplifications are made by necessity. The most often employed simplification includes the approach in the form of dimensional reduction, when the 3D model of a large vascular network is substituted with its 1D counterpart. In this context, a question naturally arises, how this reduction can affect the simulation accuracy and its outcome. In this paper, we try to answer this question by performing a quantitative comparison of 3D and 1D flow models in two patient-specific hepatic portal vein networks. The numerical simulations are carried out under average flow conditions and with the application of the three-element Windkessel model, which is able to approximate the downstream flow resistance of real hepatic tissue. The obtained results show that, although the 1D model can never truly substitute the 3D model, its easy implementation, time-saving model preparation and almost no demands on computer technology dominate as advantages over obvious but moderate modelling errors arising from the performed dimensional reduction.

Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

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Jianlin Tang

2014-12-01

Conclusion: The lessons we learned are (1 Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2 Synthetic graft is an alternative for internal jugular vein graft. (3 Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4 It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

Effects of albendazole nanoparticles in mice with hepatic echinococosis: Portal vein cannulation versus intravenous administration.

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Zhu, Di-Wen; Zhang, Ming-Xing; Bao, Ying-Jun; Gu, Jun-Peng; Ji, Wei-Zheng; Zhang, Hai-Xiao; Ren, Wei-Xin

2015-07-01

To compare the ABZ and its metabolites concentration in cyst tissue of hepatic alveolar echinococcosis administered by different routes, forty male Wistar rats receiving albendazole nanoparticles from tail vein and portal vein were divided into two groups, the concentration of ABZ and its metabolites ABZSO, ABZSO2, in the cyst tissue, were analyzed by HPLC at 2, 4, 8, 24, 36 h after administration. The parent drug and its metabolites were detected in plasm and the cyst tissue after portal cannulation and intravenous administration. The last results were the concentration of ABZ in the portal cannulation group was higher than in the intravenous group at every time point (p < 0.05). Compared to the intravenous group, the portal cannulation administration of ABZ led to a lower plasm concentration of ABZ. The concentration of ABZ and the active ABZSO were significantly higher in the portal cannulation group than that of the intravenous group. Copyright © 2015 Elsevier Inc. All rights reserved.

Full paleostress tensor reconstruction using quartz veins of Panasqueira Mine, central Portugal; part I: Paleopressure determination

Science.gov (United States)

Jaques, Luís; Pascal, Christophe

2017-09-01

Paleostress tensor restoration methods are traditionally limited to reconstructing geometrical parameters and are unable to resolve stress magnitudes. Based on previous studies we further developed a methodology to restore full paleostress tensors. We concentrated on inversion of Mode I fractures and acquired data in Panasqueira Mine, Portugal, where optimal exposures of mineralized quartz veins can be found. To carry out full paleostress restoration we needed to determine (1) pore (paleo)pressure and (2) vein attitudes. The present contribution focuses specifically on the determination of pore pressure. To these aims we conducted an extensive fluid inclusion study to derive fluid isochores from the quartz of the studied veins. To constrain P-T conditions, we combined these isochores with crystallisation temperatures derived from geochemical analyses of coeval arsenopyrite. We also applied the sphalerite geobarometer and considered two other independent pressure indicators. Our results point to pore pressures of ∼300 MPa and formation depths of ∼10 km. Such formation depths are in good agreement with the regional geological evolution. The obtained pore pressure will be merged with vein inversion results, in order to achieve full paleostress tensor restoration, in a forthcoming companion paper.

Segmental hepatic artery at hepatic hilar area. Analysis by 3 dimensional integrated image of artery, portal vein and bile duct

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Sakai, Hisamune; Okuda, Kouji; Yoshida, Jun; Kinoshita, Hisafumi; Aoyagi, Shigeaki [Kurume Univ., School of Medicine, Kurume, Fukuoka (Japan)

2006-11-15

Multiple individual variations in running and bifurcation of the hepatic artery, biliary duct and portal vein are known in hepatic hilar area. This paper describes the examination of such arterial variations by integrating the 3D images of those vessels obtained by multidetector-row CT (MDCT). Subjects are findings from 64 patients with cholangiocarcinoma, hepatocarcinoma or cholelithiasis. MDCT dynamic scanning, and percutaneous transhepatic biliary drainage-CT and/or drip infusion cholangiography-CT with the intravenous iopamidol and/or iotroxate megulumin, were done with GE LightSpeed Ultra 16 slice type equipment to compose the 3D images. Arterial variants of the bifurcation in the right and left lobe were found to be 18 cases/62 (29%) and 13/64 (20%), respectively. The left artery running at right side of portal venous umbilical region was seen in 9/64 (14%) and right artery running ''northward'', in 9/62 (14%). Previous realization of such individual 3D arterial variations as above is necessary for the precise microsurgery of the hilar area to preserve the essential vessel. (T.I.)

Segmental hepatic artery at hepatic hilar area. Analysis by 3 dimensional integrated image of artery, portal vein and bile duct

International Nuclear Information System (INIS)

Sakai, Hisamune; Okuda, Kouji; Yoshida, Jun; Kinoshita, Hisafumi; Aoyagi, Shigeaki

2006-01-01

Multiple individual variations in running and bifurcation of the hepatic artery, biliary duct and portal vein are known in hepatic hilar area. This paper describes the examination of such arterial variations by integrating the 3D images of those vessels obtained by multidetector-row CT (MDCT). Subjects are findings from 64 patients with cholangiocarcinoma, hepatocarcinoma or cholelithiasis. MDCT dynamic scanning, and percutaneous transhepatic biliary drainage-CT and/or drip infusion cholangiography-CT with the intravenous iopamidol and/or iotroxate megulumin, were done with GE LightSpeed Ultra 16 slice type equipment to compose the 3D images. Arterial variants of the bifurcation in the right and left lobe were found to be 18 cases/62 (29%) and 13/64 (20%), respectively. The left artery running at right side of portal venous umbilical region was seen in 9/64 (14%) and right artery running ''northward'', in 9/62 (14%). Previous realization of such individual 3D arterial variations as above is necessary for the precise microsurgery of the hilar area to preserve the essential vessel. (T.I.)

Resection-Reconstruction of Aberrant Right Hepatic Artery During Whipple Procedure (Pancreaticoduodenectomy).

Science.gov (United States)

Sayyed, Raza; Rehman, Iffat; Niazi, Imran Khalid; Yusuf, Muhammed Aasim; Syed, Aamir Ali; V, Faisal

2016-06-01

Aberrant hepatic arterial anatomy poses a challenge for the surgeon during Whipple procedure. Intraoperative injury to the aberrant vasculature results in hemorrhagic or ischemic complications involving the liver and biliary tree. We report a case of replaced right hepatic artery arising from the superior mesenteric artery in a patient with periampullary carcinoma of the pancreas, undergoing pancreaticoduodenectomy. The aberrant artery was found to be coursing through the pancreatic parenchyma. This is a rare vascular anomaly. Resection of the arterial segment and end-to-end anastomosis was fashioned. Intrapancreatic course of the replaced right hepatic artery is a rare anomaly and is best managed by preoperative identification on radiology and meticulous intra-operative dissection and preservation. However, for an intrapancreatic course, resection and reconstruction may occasionally be required.

Hepatic Artery Resection for Bismuth Type III and IV Hilar Cholangiocarcinoma: Is Reconstruction Always Required?

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Hu, Hai-Jie; Jin, Yan-Wen; Zhou, Rong-Xing; Shrestha, Anuj; Ma, Wen-Jie; Yang, Qin; Wang, Jun-Ke; Liu, Fei; Cheng, Nan-Sheng; Li, Fu-Yu

2018-03-06

The objective of the study is to examine the feasibility of hepatic artery resection (HAR) without subsequent reconstruction (RCS) in specified patients of Bismuth type III and IV hilar cholangiocarcinoma. We retrospectively reviewed 63 patients who underwent hepatic artery resection for Bismuth type III and IV hilar cholangiocarcinoma. These patients were subsequently enrolled into two groups based on whether the artery reconstruction was conducted. Postoperative morbidity and mortality, and long-term survival outcome were compared between the two groups. There were 29 patients in HAR group and 34 patients in the HAR + RCS group. Patients with hepatic artery reconstruction tended to have longer operative time (545.6 ± 143.1 min vs. 656.3 ± 192.8 min; P = 0.013) and smaller tumor size (3.0 ± 1.1 cm vs. 2.5 ± 0.9 cm; P = 0.036). The R0 resection margin was comparable between the HAR group and HAR + RCS group (86.2 vs. 85.3%; P > 0.05). Twelve patients (41.4%) with 24 complications in HAR group and 13 patients (38.2%) with 25 complications in HAR + RCS group were recorded (P = 0.799). The postoperative hepatic failure rate (13.8 vs. 5.9%) and postoperative mortality rate (3.4% vs. 2.9%) were also comparable between the two groups. In the HAR group, the overall 1-, 3-, and 5-year survival rates were 72, 41, and 19%, respectively; while in the HAR + RCS group, the overall 1-, 3-, and 5-year survival rates were 79, 45, and 25%, respectively (P = 0.928). Hepatic artery resection without reconstruction is also a safe and feasible surgical procedure for highly selected cases of Bismuth type III and IV hilar cholangiocarcinoma.

Effect of obstructive jaundice on hepatic hemodynamics: use of Sonazoid-enhanced ultrasonography in a prospective study of the blood flow balance between the hepatic portal vein and hepatic artery.

Science.gov (United States)

Wakui, Noritaka; Takeda, Yuki; Nishinakagawa, Shuta; Ueki, Nobuo; Otsuka, Takafumi; Oba, Nobuyuki; Hashimoto, Hiroshi; Kamiyama, Naohisa; Sumino, Yasukiyo; Kojima, Tatsuya

2015-10-01

To prospectively clarify the effects of obstructive jaundice (OJ) on hepatic hemodynamics using contrast-enhanced ultrasonography (US). Subjects comprised 14 patients admitted to our hospital for OJ between April 2013 and March 2014. Contrast-enhanced US was performed using the LOGIQ E9 ultrasound device during the jaundice phase, before biliary drainage, and again after improvement of jaundice. After injecting the Sonazoid contrast agent, contrast dynamics were recorded in the right kidney and liver segments 5 or 6. Prototype software was used to calculate mean arrival time (AT) of the contrast agent in the liver parenchyma. Statistical analysis was performed to compare the mean AT in the jaundice and improved jaundice phases. We were unable to follow up three of the 14 patients after biliary drainage; thus, we included 11 patients for further analysis. The mean AT of the contrast agent was 2.0 ± 1.8 and 6.1 ± 2.3 s in the jaundice and improved jaundice phases, respectively, showing significantly shorter AT in the jaundice phase (p = 0.0033). Our findings indicate that OJ may influence the blood flow balance between the hepatic portal vein and hepatic artery.

Renal Vein Reconstruction for Harvesting Injury in Kidney Transplantation

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Birkan Bozkurt

2014-03-01

Full Text Available Kidney transplantation is the best treatment choice in the end-stage renal disease. In the renal transplantation, renal vein damage or shortness which occurs during cadaveric or living donor nephrectomy causes technical difficulties for surgeons. The lack of the donors already especially cadaveric, the acquirement of the graft, gets very much importance. In this report, it is aimed to share the clinical experiment by which it seen, how anastomosis can become appropriate by using the renal vein which is damaged in the way that anastomosis cannot be done anyway by using cadaveric vena cava graft. The renal vein brought to length for anostomosis which is repaired by using cadaveric vena cava graft, is anastomosed successfully by becoming an end-to-side of the external iliac vein of the recipient. Vascular anastomoses are applied easily in technique. The time of the warm ischemia was under 2 hours and the kidney was functional in the post-operative period. Renal vein trombosis was not observed. The renal vein damage occured during cadaveric or living donor nephrectomy, can be repaired by some methods. In the kidneys in which vein requirement is done, the success rates are rather high although acute tubular necrosis and delayed function can be seen more.

Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

International Nuclear Information System (INIS)

Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo

1997-01-01

To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion

A model to study intestinal and hepatic metabolism of propranolol in the dog.

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Mills, P C; Siebert, G A; Roberts, M S

2004-02-01

A model to investigate hepatic drug uptake and metabolism in the dog was developed for this study. Catheters were placed in the portal and hepatic veins during exploratory laparotomy to collect pre- and posthepatic blood samples at defined intervals. Drug concentrations in the portal vein were taken to reflect intestinal uptake and metabolism of an p.o. administered drug (propranolol), while differences in drug and metabolite concentrations between portal and hepatic veins reflected hepatic uptake and metabolism. A significant difference in propranolol concentration between hepatic and portal veins confirmed a high hepatic extraction of this therapeutic agent in the dog. This technically uncomplicated model may be used experimentally or clinically to determine hepatic function and metabolism of drugs that may be administered during anaesthesia and surgery.

Transvenous liver biopsy via the femoral vein

International Nuclear Information System (INIS)

Khosa, F.; McNulty, J.G.; Hickey, N.; O'Brien, P.; Tobin, A.; Noonan, N.; Ryan, B.; Keeling, P.W.N.; Kelleher, D.P.; McDonald, G.S.A.

2003-01-01

AIM: To study the safety, effectiveness and diagnostic value of transvenous forceps biopsy of the liver in 54 patients with coagulopathy, gross ascites or morbid obesity and suspected liver disease in whom percutaneous liver biopsy was contraindicated. MATERIAL AND METHODS: Forceps biopsy of the liver via the femoral vein was attempted in 54 adult patients with advanced liver disease of unknown aetiology who had coagulation disorders (41 cases), gross ascites (11 cases) or morbid obesity (two cases). In each patient two to six biopsies (average four) were taken using a radial jaw forceps inserted via the right or left femoral vein. RESULTS: The procedure was successful in 53 cases. Hepatic vein catheterization failed in one patient. Adequate liver tissue for diagnosis was obtained in 84% of cases. One patient developed delayed haemorrhage at 12 h from a capsular leak that was undetected during the biopsy procedure. This patient required blood transfusions and laparotomy to control bleeding. There were no deaths in the 53 patients studied. Transient minor chest and shoulder pain was encountered during sheath insertion into a hepatic vein in 23 patients. Three patients developed a femoral vein haematoma, which resolved with conservative treatment. CONCLUSION: Transvenous liver biopsy via the femoral vein is another safe, effective, simple alternative technique of biopsy when the percutaneous route is contraindicated

[Treatment of nontumoral portal vein thrombosis in cirrhosis].

Science.gov (United States)

Bañares, Rafael; Catalina, María-Vega

2014-07-01

Portal vein thrombosis in cirrhosis is a relatively common complication associated with the presence of an accompanying prothrombotic phenotype of advanced cirrhosis. The consequences of portal vein thrombosis are relevant because it can be associated with impaired hepatic function, might contraindicate hepatic transplantation and could increase morbidity in the surgical procedure. There is controversy concerning the most effective treatment of portal vein thrombosis, which is based on information that is seldom robust and whose primary objective is to achieve a return to vessel patency. Various studies have suggested that starting anticoagulation therapy early is associated with portal vein repatency more frequently than without treatment and has a low rate of complications. There are no proven data on the type of anticoagulant (low-molecular-weight heparins or dicoumarin agents) and the treatment duration. The implementation of TIPS is technically feasible in thrombosis without cavernous transformation and is associated with portal vein recanalization in a significant proportion of cases. Thrombolytic therapy does not appear to present an adequate balance between efficacy and safety; its use is therefore not supported for this indication. The proper definition of treatment for portal vein thrombosis requires properly designed studies to delimit the efficacy and safety of the various alternatives. Copyright © 2014 Elsevier España, S.L. All rights reserved.

More than a quarter of a century of liver transplantation in Kaohsiung Chang Gung Memorial Hospital.

Science.gov (United States)

Chen, Chao-Long; Concejero, Allan M; Cheng, Yu-Fan

2011-01-01

Liver transplantation has been an accepted treatment for end-stage liver disease since the 1980s. The development of living donor liver transplantation (LDLT) was driven by limited deceased donor organ donation and a response to the growing demand for the option of liver replacement. LDLT is now performed with high rates of success due to judicious donor and recipient selection, careful preoperative planning, excellent anesthesia management, and prompt detection and treatment of complications. The first successful liver transplantation in Asia was performed in 1984, in Chang Gung Memorial Hospital in a Taiwanese adolescent with Wilson's disease, complicated by end-stage liver cirrhosis. The longest Asian liver transplant survivor has now been living for 26 years and that patient's transplant was also performed in Chang Gung Memorial Hospital. Through December 31, 2011, a total of 924 (783 living donor, 141 deceased donor) liver transplants have been performed at the Kaohsiung Chang Gung Memorial Hospital, where both graft and patient survivals are excellent. For biliary atresia, hepatitis B virus cirrhosis, and hepatocellular carcinoma recipients, our 5-year LDLT survival rates are 98%, 94%, and 90%, respectively. Our overall (deceased and living donor) actuarial 3-year survival rate is 91%. Innovative techniques in LDLT represent technical refinements in hepatic vein, portal vein, hepatic artery, and biliary reconstruction approaches. Hepatic vein reconstruction is highlighted by venoplasty reconstructions in both graft hepatic vein orifices and recipient hepatic veins, to ensure adequate outflow and decrease ischemia times during implantation. Vascular interposition to reconstruct middle hepatic vein tributaries with either fresh or cryopreserved vessels is used when the middle hepatic vein is not routinely harvested with the graft. We have extended the routine use of microsurgical techniques, initially for hepatic artery reconstruction, to biliary reconstruction

Examination of hepatic contrast-enhanced CT monitored by Smart Prep

International Nuclear Information System (INIS)

Kakizaki, Dai; Saito, Kazuhiro; Sakurada, Toru; Abe, Kimihiko; Suzuki, Kenji

1999-01-01

The aim of the present study is to obtain the time density curves of the contrast-enhanced CT of hepatic portal vein, hepatic and splenic parenchyma, and to examine the relation with age, body weight, type of liver dysfunction. Subjects were 32 patients with liver tumors or liver diseases. For this purpose, the procedure of hepatic CT was monitored by Smart Prep and the images of whole liver was taken when the level of the contrast at the hepatic portal vein reached to the enhancement threshold. The contrast medium used was Iomeprol 300. The adverse reactions by Iomeprol 300 were mild and any treatment did not need. There was no correlation age and weight with enhancement threshold at the hepatic portal vein and peak time at the splenic parenchyma. The enhancement threshold at the hepatic portal vein was various in patients with chrrhosis and chronic hepatitis, and tended to be delayed in patients with chrrhosis. The peak time of the splenic parenchyma was up to 52 seconds in all patients with chronic hepatitis. The shortage of the enhancement threshold and the increase in blood flow at arterial early phase were observed in the patients with advanced acute hepatitis. This method should be examined more cases with various hepatic diseases. (K.H.)

Adaptive statistical iterative reconstruction for volume-rendered computed tomography portovenography. Improvement of image quality

International Nuclear Information System (INIS)

Matsuda, Izuru; Hanaoka, Shohei; Akahane, Masaaki

2010-01-01

Adaptive statistical iterative reconstruction (ASIR) is a reconstruction technique for computed tomography (CT) that reduces image noise. The purpose of our study was to investigate whether ASIR improves the quality of volume-rendered (VR) CT portovenography. Institutional review board approval, with waived consent, was obtained. A total of 19 patients (12 men, 7 women; mean age 69.0 years; range 25-82 years) suspected of having liver lesions underwent three-phase enhanced CT. VR image sets were prepared with both the conventional method and ASIR. The required time to make VR images was recorded. Two radiologists performed independent qualitative evaluations of the image sets. The Wilcoxon signed-rank test was used for statistical analysis. Contrast-noise ratios (CNRs) of the portal and hepatic vein were also evaluated. Overall image quality was significantly improved by ASIR (P<0.0001 and P=0.0155 for each radiologist). ASIR enhanced CNRs of the portal and hepatic vein significantly (P<0.0001). The time required to create VR images was significantly shorter with ASIR (84.7 vs. 117.1 s; P=0.014). ASIR enhances CNRs and improves image quality in VR CT portovenography. It also shortens the time required to create liver VR CT portovenographs. (author)

Regeneração do fígado de ratos após oclusão parcial da drenagem venosa hepática Hepatic regeneration after parcial oclusion of hepatic vein drainage in rats

Directory of Open Access Journals (Sweden)

Luiz Roberto Farion de Aguiar

2009-06-01

the loss of liver functional tissue. This process has been studied through different methods. AIM: To evaluate the effect of the partial occlusion of the hepatic venous drainage on the regeneration of the remainder livers in rats submitted to partial hepatectomy. METHOD: Liver biopsies from 30 male Wistar rats were collected, and after they were submitted two-third hepatectomy. The animals were divided in three groups: a control group and two study groups, which were submitted to different degrees of the right hepatic vein stenosis. After 96 hours of the stimulation for regeneration all rats were submitted to another hepatic biopsy. The analysis of the fragments was performed by immunohistochemistry for the Ki-67 and von Willebrand factor markers. The reading of the samples was done using the SAMBA 4000 system. Collagen deposition was evaluated by the trichromic Masson's staining. RESULT: The cellular proliferation of the animals submitted to partial hepatectomy and stenosis of the right hepatic vein persists higher when compared to control group. The Label Index for Ki-67 was significantly higher post-hepatectomy in groups submitted to hepatic vein partial occlusion. The expression of von Willebrand factor was strongly decreased after the hepatectomy in all groups. There was little deposit of collagen in the hepatic tissue of animals with hepatic vein stenosis. CONCLUSION: Partial occlusion of the hepatic venous drainage in rats submitted to partial hepatectomy prolongs the time of hepatic cells proliferation when compared to the animals with vein of normal caliber. Consequently, there will be also a delay in the restoration of the extracellular matrix and in the formation of new sinusoidal vessels.

The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways.

Science.gov (United States)

Sato, Akihiro; Yamada, Takayuki; Takase, Kei; Matsuhashi, Toshio; Higano, Shuichi; Kaneda, Tomohiro; Egawa, Shinichi; Takeda, Kazunori; Ishibashi, Tadashi; Takahashi, Shoki

2011-03-01

To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy. Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used. Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure (n = 8) and abscess (n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur (P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals (P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant (P > .61). HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

Preduodenal superior mesenteric vein and Whipple procedure with vascular reconstruction-A case report.

Science.gov (United States)

Höing, Kristina; Ringe, Kristina I; Bektas, Hüseyin; Klempnauer, Jürgen; Jäger, Mark D

2015-01-01

Portal vein (PV) disorders are various, but rare. Here, we report a preduodenal superior mesenteric vein (PDSMV) in a patient who underwent a pancreaticoduodenectomy. A 67-year old woman with familial adenomatosis polyposis was suspicious for cancer of the papilla of vater and scheduled for surgery. Pre-operative diagnostic revealed a PDSMV continuing into the left PV. The splenic vein (SV) continued directly into the right PV without forming ananatomic PV confluence. Eight centimetre of the PDSMV were resected during the pancreaticoduodenectomy and reconnected using a polytetrafluoroethylene prosthesis. On day 1, early graft thrombosis was treated by thrombectomy and change to a larger graft. Pathology confirmed a R0-resection of the adenocarcinoma of the papilla of vater (pTis pN0,G2). At three-month follow-up, the patient was cancer-free and clinically asymptomatic, although, a late graft thrombosis with accompanying newly build venous collaterals passing mesenteric blood to the SV were found. Rare PV disorders like a PDSMV do not contradict pancreatic surgery, but should be treated in experienced centres. Skills of SMV/PV reconstruction and its peri-operative management might be beneficial for successful outcome. Despite late graft thrombosis no clinical disadvantage occurred most likely due to preservation of the SV and of potential venous collateral pathways. Extended surgical procedures like a pancreaticoduodenectomy are realisable in patients with PV disorders, but require awareness, adequate radiological interpretation and specific surgical experience for secure treatment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Congestive index of portal vein

International Nuclear Information System (INIS)

Kim, Won Ho; Kim, H. K.; Lee, S. C.; Han, S. H.; Han, K. H.; Chung, J. B.; Choi, H. J.

1989-01-01

In patients with portal hypertension, the blood flow volume is maintained despite decreased blood flow velocity due to enlargement of the vascular cross sectional area. Thus, the 'congestion index' of the portal vein, which is the ratio between the cross sectional area (cm2) and the blood flow velocity (cm/sec) determined by a Doppler ultrasonography, may be a sensitive index by which to assess portal hypertension. We performed Doppler ultrasonography on 24 normal subjects, 14 patients with biopsy proved chronic active hepatitis and 55 patients with liver cirrhosis in order to assess the diagnostic value of the congestion index. The cross sectional area of the portal vein was significantly enlarged and the mean blood flow velocity was significantly reduced in patients with liver cirrhosis compared with controls. However, the blood flow volume was no difference. The congestion index of the portal vein was significantly increased in patients with liver cirrhosis (0.113+0.035) compared with patients with chronic active hepatitis(0.078+0.029) (p<0.001) and controls (0.053+0.016) (p<0.001). The sensitivity, specificity and predictability of the congestion index for detection of patients with the cirrhosis of the liver were 76.4%, 100% and 100% respectively, when the normal range was set at mean+2SD. The results suggest that the congestion index of the portal vein may pla a significant role in diagnosis of portal hypertensive patients

Palliative treatment of TIPS to portal vein tumor thrombosis complicated with portal vein hypertension

International Nuclear Information System (INIS)

Jiang Zaibo; Shan Hong; Guan Shouhai; Zhu Kangshun; Huang Mingsheng; Li Zhengran; Guo Tiansheng; Liu Lang

2002-01-01

Objective: To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (PVTT) complicated with portal vein hypertension, and to discuss the technical skills. Methods: There were 14 cases of end-stage hepatocellular carcinoma complicated with PVTT and portal vein hypertension, the average age was 53.6 yr. There were 8 cases with complete occlusion of main portal vein, 6 eases with incomplete thrombosis, and 5 cases combined with portal vein cavernous transformation. One case had simple hemorrhage, 3 eases had intractable ascites, and 10 cases had hemorrhage accompanied by intractable ascites. Results: The procedure of TIPS was successful in 10 cases, the successful rate was about 71%. The mean portal vein pressure was reduced from 37.2 mm Hg to 18.2 mm Hg, with an average reduction of 19.0 mm Hg. After the procedure of TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared. The average survival period was 132.3 days. The procedure were failing in 4 cases. Conclusion: TIPS was an effective palliative therapeutic methods to control the hemorrhage and ascites aroused by hepatic carcinoma complicated with PVTT

Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

International Nuclear Information System (INIS)

Sarwar, Ammar; Brook, Olga R.; Weinstein, Jeffrey L.; Khwaja, Khalid; Ahmed, Muneeb

2016-01-01

Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients undergoing extensive hepatic resection. Portal vein access for PVE via the ipsilateral hepatic lobe (designated for resection) places veins targeted for embolization at acute angles to the access site requiring reverse curve catheters for access. This approach also involves access close to tumors in the ipsilateral lobe and requires care to avoid traversing tumor. Alternatively, a contralateral approach (through the FLR) risks damage to the FLR due to iatrogenic trauma or non-target embolization. Two patients successfully underwent PVE via trans-splenic portal vein access, allowing easy access to the ipsilateral portal veins and eliminating risk of damage to FLR. Technique and advantages of trans-splenic portal vein access to perform PVE are described.

Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

Energy Technology Data Exchange (ETDEWEB)

Sarwar, Ammar, E-mail: asarwar@bidmc.harvard.edu; Brook, Olga R.; Weinstein, Jeffrey L. [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Interventional Radiology, Department of Radiology (United States); Khwaja, Khalid [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Transplant Surgery, Department of Surgery (United States); Ahmed, Muneeb [Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Interventional Radiology, Department of Radiology (United States)

2016-10-15

Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients undergoing extensive hepatic resection. Portal vein access for PVE via the ipsilateral hepatic lobe (designated for resection) places veins targeted for embolization at acute angles to the access site requiring reverse curve catheters for access. This approach also involves access close to tumors in the ipsilateral lobe and requires care to avoid traversing tumor. Alternatively, a contralateral approach (through the FLR) risks damage to the FLR due to iatrogenic trauma or non-target embolization. Two patients successfully underwent PVE via trans-splenic portal vein access, allowing easy access to the ipsilateral portal veins and eliminating risk of damage to FLR. Technique and advantages of trans-splenic portal vein access to perform PVE are described.

Microcirculation of the liver and hepatic tumors: implication for intervention

International Nuclear Information System (INIS)

Matsui, O.

2012-01-01

Full text:To understand the microcirculation of the liver and hepatic tumors is important for the precise imaging diagnosis and intervention of hepatic diseases. In this presentation, blood flow imaging features of dynamic MDCT in various hepatic lesions or variations as described below will be discussed based on the angiography-assisted CT imaging and pathophysiologic correlations. (1) Portal venous obstruction (segmental staining) and microangioarchtecture of the liver; Because of compensatory blood flow from the hepatic artery to the distal portion of the portal vein through the peribiliary vascular plexus (PBP), the obstructed segment shows early enhancement on dynamic CT (segmental staining). In diffuse intrahepatic portal vein obstruction, peripheral (zone) enhancement can be seen, resulting in 'central hypertrophy' in chronic stage. (2) Pseudolesion and/or pseudotumor due to third inflow into the liver; According to CT during arterial portography (CTAP)-based analysis, the third inflow includes flow from an aberrant right gastric vein (or pancreatico-duodeno-gastric vein), cystic veins, veins of Sappey, and aberrant left gastric vein. These veins usually connect directly to the intrahepatic portal venules. The areas receiving the third inflow often show pseudolesions or pseudotumors. (3) Microcirculation of hepatocellular carcinoma (HCC) and dynamic MDCT features; By single level dynamic thin-section CT during the bolus injection of a small amount of contrast medium, we revealed in vivo hemodynamics in hypervascular classical HCC, namely, the arterial blood flow into the tumor drains into surrounding hepatic sinusoids (corona enhancement, wash out). Histological examination revealed continuity between a tumor sinusoid and a portal venule in the pseudocapsule (encapsulated HCC) or surrounding hepatic sinusoids (HCC without pseudocapsule). The drainage area is the first site of the intrahepatic metastasis of HCC, and daughter nodules are commonly seen in this

Modified sleeve anastomosis for reconstruction of the hepatic artery in rat liver transplantation.

Science.gov (United States)

Li, Jun; Dahmen, Uta; Dirsch, Olaf; Shen, Kai; Gu, Yanli; Broelsch, Christoph Erich

2002-01-01

End-to-end sleeve anastomosis between a donor common hepatic artery and a recipient proper hepatic artery was proven to be the most physiological and simple method for hepatic rearterialization in rat liver transplantation. Current technical variants of the sleeve technique, however, are hampered by the high rate of bleeding from the anastomotic site. This report deals with a technical modification which inhibits postoperative bleeding efficiently. The procedure consisted of a guiding suture, as previously described in other technical variants, and a modified fixing suture. Instead of using a single stitch to fix the feeding vessel with the receiving vessel, a running suture between the edge of the donor common hepatic artery and the adventitia of the recipient proper hepatic artery was performed to avoid a possible backflow. The patency rate of 91% was as high as reported by others using a sleeve technique, which was also reflected in the histomorphological picture, being indistinguishable from normal liver histology. This technical modification simplified the procedure of reconstructing the hepatic artery and could contribute to a wider use of the arterialized liver transplantation model in rats. Copyright 2002 Wiley-Liss, Inc.

CT findings of portal vein aneurysm

International Nuclear Information System (INIS)

Yang, Dal Mo; Chang, Mi Son; Yoon, Myung Hwan; Kim, Hak Soo; Kim, Hyung Sik; Chung, Hyo Sun; Chung, Jin Woo

1999-01-01

To describe the CT findings of portal vein aneurysm in eight patients. All patients included in this study (two men and six women) underwent CT examinations between October 1996 and June1998. Of these eight, three were suffering from hepatic disease and portal hypertension. We determined the location, shape, size, and characteristics of the lesions, and the presence or absence of portal vein anomaly. Seven patients had intrahepatic portal vein aneurysm (at the umbilical portion of the left portal vein in five patients, between the transverse and umbilical portion of the left portal vein in one, and at the bifurcation of the anterior and posterior branch of the right portal vein in one), while extrahepatic portal vein aneurysm, at the confluence of the superior mesenteric and splenic vein was found in only one. Lesions were cyst-shaped in seven cases and saccular in one, and showed well-circumscribed, markedly enhanced mass, which communicated with the portal vein and/or gives off major branches. Portal vein anomaly, in which the right anterior segmental portal vein originated from the umbilical portion of the left portal vein, was seen in three patients. In all three, intrahepatic portal vein aneurysm was present at the umbilical portion of the left portal vein, and in one, the umbilical protion of the left portal vein was located to the right of the Cantlic line. CT examination can help reveal portal vein aneurysm by detecting a well-circumscribed, markedly enhanced mass which communicates with the portal vein and/or gives off major branches

Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy - Case report.

Science.gov (United States)

Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B

2014-12-01

62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival.

Aneurysmal malformation of the extrahepatic portal vein: a case report

International Nuclear Information System (INIS)

Lee, Jeong Min; Kang, Sung Soo; Kim, Chong Soo; Han, Hyeun Young

1999-01-01

Aneurysmal malformation of the portal vein is a rare entity. To our knowledge, only scattered reports of portal vein aneurysms appear in the literature in English, and there is no previously published report in Korean. We describe a case exhibiting aneurysmal malformation of the extrahepatic portal vein at the hepatic hilum ; the findings demonstrated by ultrasound, CT and angiography are discussed, a review of previously described cases is included

Hepatic Scintigraphic Findings of Budd-Chiari Syndrome due to Inferior Vena Caval Obstruction

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Kim, Sung Hoon; Chung, Soo Kyo; Byun, Jae Young; Lee, Sung Yong; Shinn, Kyung Sub; Kim, Choon Yul; Bahk, Yong Whee [Catholic University College of Medicine, Seoul (Korea, Republic of)

1988-03-15

Budd-Chiari syndrome (BCS) is a rare clinical entity characterized by post-sinusoidal portal hypertension caused by the obstruction to the hepatic vein outflow. The diagnosis is suggested by hepatic scintigraphy and is usually confirmed by hepatic venography, inferior vena cavography and biopsy. The scintigraphic finding of BCS caused by the obstruction of main hepatic vein has been reported to consist typically of hypertrophy of the caudate lobe with increased radionuclide accumulation. Such a typical finding has been accounted for by the fact that the venous outflow from the caudate lobe is preserved when the main hepatic vein is obstructed. But usually, the hepatic venous outflow from the caudate lobe is also obstructed in BCS due to inferior vena caval obstruction. So hepatic scintigraphic findings of BCS due to inferior vena caval obstruction show different findings as compared with the BCS due to hepatic vein obstruction. We evaluate the hepatic scintigrams of the 13 cases of BCS due to inferior vena caval obstruction and review the literatures. The results are as follows: 1) We cannot observe the caudate lobe hypertrophy with increased uptake, which is known as a classic finding in BCS due to hepatic vein obstruction. 2) The most prominent hepatic scintigraphic findings of BCS are nonhomogenous uptake in the liver with extrahepatic uptake in the all cases. 3) We can see cold areas at the superior aspect of right hepatic lobe in 7 cases (54%). This is a useful finding suggesting BCS due to inferior vena caval obstruction.

Hepatic Scintigraphic Findings of Budd-Chiari Syndrome due to Inferior Vena Caval Obstruction

International Nuclear Information System (INIS)

Kim, Sung Hoon; Chung, Soo Kyo; Byun, Jae Young; Lee, Sung Yong; Shinn, Kyung Sub; Kim, Choon Yul; Bahk, Yong Whee

1988-01-01

Budd-Chiari syndrome (BCS) is a rare clinical entity characterized by post-sinusoidal portal hypertension caused by the obstruction to the hepatic vein outflow. The diagnosis is suggested by hepatic scintigraphy and is usually confirmed by hepatic venography, inferior vena cavography and biopsy. The scintigraphic finding of BCS caused by the obstruction of main hepatic vein has been reported to consist typically of hypertrophy of the caudate lobe with increased radionuclide accumulation. Such a typical finding has been accounted for by the fact that the venous outflow from the caudate lobe is preserved when the main hepatic vein is obstructed. But usually, the hepatic venous outflow from the caudate lobe is also obstructed in BCS due to inferior vena caval obstruction. So hepatic scintigraphic findings of BCS due to inferior vena caval obstruction show different findings as compared with the BCS due to hepatic vein obstruction. We evaluate the hepatic scintigrams of the 13 cases of BCS due to inferior vena caval obstruction and review the literatures. The results are as follows: 1) We cannot observe the caudate lobe hypertrophy with increased uptake, which is known as a classic finding in BCS due to hepatic vein obstruction. 2) The most prominent hepatic scintigraphic findings of BCS are nonhomogenous uptake in the liver with extrahepatic uptake in the all cases. 3) We can see cold areas at the superior aspect of right hepatic lobe in 7 cases (54%). This is a useful finding suggesting BCS due to inferior vena caval obstruction.

Selecting optimal monochromatic level with spectral CT imaging for improving imaging quality in hepatic venography

International Nuclear Information System (INIS)

Sun Jun; Luo Xianfu; Wang Shou'an; Wang Jun; Sun Jiquan; Wang Zhijun; Wu Jingtao

2013-01-01

Objective: To investigate the effect of spectral CT monochromatic images for improving imaging quality in hepatic venography. Methods: Thirty patients underwent spectral CT examination on a GE Discovery CT 750 HD scanner. During portal phase, 1.25 mm slice thickness polychromatic images and optimal monochromatic images were obtained, and volume rendering and maximum intensity projection were created to show the hepatic veins respectively. The overall imaging quality was evaluated on a five-point scale by two radiologists. Inter-observer agreement in subjective image quality grading was assessed by Kappa statistics. Paired-sample t test were used to compare hepatic vein attenuation, hepatic parenchyma attenuation, CT value difference between the hepatic vein and the liver parenchyma, image noise, vein-to-liver contrast-to-noise ratio (CNR), the image quality score of hepatic venography between the two image data sets. Results: The monochromatic images at 50 keV were found to demonstrate the best CNR for hepatic vein.The hepatic vein attenuation [(329 ± 47) HU], hepatic parenchyma attenuation [(178 ± 33) HU], CT value difference between the hepatic vein and the liver parenchyma [(151 ± 33) HU], image noise (17.33 ± 4.18), CNR (9.13 ± 2.65), the image quality score (4.2 ± 0.6) of optimal monochromatic images were significantly higher than those of polychromatic images [(149 ± 18) HU], [(107 ± 14) HU], [(43 ±11) HU], 12.55 ± 3.02, 3.53 ± 1.03, 3.1 ± 0.8 (t values were 24.79, 13.95, 18.85, 9.07, 13.25 and 12.04, respectively, P < 0.01). In the comparison of image quality, Kappa value was 0.81 with optimal monochromatic images and 0.69 with polychromatic images. Conclusion: Monochromatic images of spectral CT could improve CNR for displaying hepatic vein and improve the image quality compared to the conventional polychromatic images. (authors)

Intrahepatic portal-hepatic venous shunt diagnosed by ultrasonography and computed tomography

International Nuclear Information System (INIS)

Shinagawa, Takashi; Iino, Yasuo; Ukaji, Haruyasu; Ishizuka, Masaharu

1986-01-01

Two cases of intrahepatic portal-hepatic venous shunt found by ultrasonography and computed tomography are reported. The first case came to the hospital because of hematuria. A large shunt between the portal vein and the hepatic vein was demonstrated by ultrasonography done for screening, and confirmed by percutaneous transhepatic portography (PTP). The second case was admitted because of cholelithiasis. Computed tomography with contrast enhancement revealed a dilated portal vein in the upper portion of the right lobe. It was subsequently shown by PTP to be a portal-hepatic venous shunt. Portal vein pressure and histological finding of the liver were normal in both cases. The etiology of the shunt was thought to be congenital in these cases for lack of liver disease, portal hypertension and history of trauma. Both cases had no history of hepatic encephalopathy and did not show any symptom attributable to the shunt. (author)

Right trisectionectomy with principle en bloc portal vein resection for right-sided hilar cholangiocarcinoma: no-touch technique.

Science.gov (United States)

Machado, Marcel Autran; Makdissi, Fabio F; Surjan, Rodrigo C

2012-04-01

The most favorable long-term survival rate for hilar cholangiocarcinoma is achieved by a R0 resection. A surgical concept involving a no-touch technique, with extended right hepatic resections and principle en bloc portal vein resection was described by Neuhaus et al. According to Neuhaus et al., their technique may increase the chance of R0, because the right branch of the portal vein and hepatic artery is in close contact with the tumor and is frequently infiltrated. The left artery runs on the left margin of the hilum and often is free. The 5-year survival rate for their patients is 61% but 60-day mortality rate is 8%. Given the increased morbidity, some authors do not agree with routine resection of portal vein and may perform the resection of portal vein only on demand, after intraoperative assessment and confirmation of portal vein invasion. This video shows en bloc resection of extrahepatic bile ducts, portal vein bifurcation, and right hepatic artery, together with extended right trisectionectomy (removal of segments 1, 4, 5, 6, 7, and 8). A 75-year-old man with progressive jaundice due to right-sided hilar cholangiocarcinoma underwent percutaneous biliary drainage with metallic stents for palliation. The patient was referred for a second opinion. Serum bilirubin levels were normal, and CT scan showed a resectable tumor, but volumetry showed a small left liver remnant. Right portal vein embolization was then performed, and CT scan performed after 4 weeks showed adequate compensatory hypertrophy of the future liver remnant (segments 2 and 3). Surgical decision was to perform a right trisectionectomy with en bloc portal vein and bile duct resection using the no-touch technique. The operation began with hilar lymphadenectomy. The common bile duct is sectioned. Right hepatic artery is ligated. Left hepatic artery is encircled. Portal vein is dissected and encircled. Right liver is mobilized and detached from retrohepatic vena cava. Right and middle hepatic

Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy – Case report

Science.gov (United States)

Tang, Jianlin; Abbas, Jihad; Hoetzl, Katherine; Allison, David; Osman, Mahamed; Williams, Mallory; Zelenock, Gerald B.

2014-01-01

62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished. Pancreaticoduodenectomy (PD) and superior mesenteric portal vein (SMPV) confluence resection were performed; A saphenous vein interposition graft thrombosed immediately. The splenic vein remnant was distended and adjacent to the stump of the portal vein. Harvesting an internal jugular vein graft required extra time and using a synthetic graft posed a risk of graft thrombosis or infection. As a result, we chose to perform a direct anastomosis of the portal and splenic vein in a desperate situation. The anastomosis decompressed the mesenteric venous system, so we then ligated the SMV. The patient had an uneventful postoperative course, except transient ascites. She redeveloped ascites more than one year later. At that time a PET scan showed bilateral lung and right femur metastatic disease. She expired 15 months after PD. Conclusion The lessons we learned are (1) Before SMPV confluence resection, internal jugular vein graft should be ready for reconstruction. (2) Synthetic graft is an alternative for internal jugular vein graft. (3) Direct portal vein to SMV anastomosis can be achieved by mobilizing liver. (4) It is possible that venous collaterals secondary to SMV tumor obstruction may have allowed this patient's post-operative survival. PMID:25568802

The effect of partial portal decompression on portal blood flow and effective hepatic blood flow in man: a prospective study.

Science.gov (United States)

Rosemurgy, A S; McAllister, E W; Godellas, C V; Goode, S E; Albrink, M H; Fabri, P J

1995-12-01

With the advent of transjugular intrahepatic porta-systemic stent shunt and the wider application of the surgically placed small diameter prosthetic H-graft portacaval shunt (HGPCS), partial portal decompression in the treatment of portal hypertension has received increased attention. The clinical results supporting the use of partial portal decompression are its low incidence of variceal rehemorrhage due to decreased portal pressures and its low rate of hepatic failure, possibly due to maintenance of blood flow to the liver. Surprisingly, nothing is known about changes in portal hemodynamics and effective hepatic blood flow following partial portal decompression. To prospectively evaluate changes in portal hemodynamics and effective hepatic blood flow brought about by partial portal decompression, the following were determined in seven patients undergoing HGPCS: intraoperative pre- and postshunt portal vein pressures and portal vein-inferior vena cava pressure gradients, intraoperative pre- and postshunt portal vein flow, and pre- and postoperative effective hepatic blood flow. With HGPCS, portal vein pressures and portal vein-inferior vena cava pressure gradients decreased significantly, although portal pressures remained above normal. In contrast to the significant decreases in portal pressures, portal vein blood flow and effective hepatic blood flow do not decrease significantly. Changes in portal vein pressures and portal vein-inferior vena cava pressure gradients are great when compared to changes in portal vein flow and effective hepatic blood flow. Reduction of portal hypertension with concomitant maintenance of hepatic blood flow may explain why hepatic dysfunction is avoided following partial portal decompression.

Hereditary haemorrhagic telangiectasia: study of hepatic vascular alterations with multi-detector row helical CT and reconstruction programs

International Nuclear Information System (INIS)

Memeo, Maurizio; Stabile Ianora, Amato Antonio; Scaldapane, Arnaldo; Rotondo, Antonio; Angelelli, Giuseppe; Suppressa, Patrizia; Cirulli, Anna; Sabba', Carlo

2005-01-01

Purpose: To evaluate hepatic alterations in patients affected by Hereditary Haemorrhagic Telangiectasia (HHT) by using multidetector row helical CT (MDCT) and new reconstruction programs. Materials and methods: An MDCT multiphasic study of the liver was performed in 105 consecutive patients: 89 considered to be affected by HHT and 16 with suspicion of disease alone. The scan delay was determined by using a test bolus of contrast material. The CT examination was performed with a triphasic technique (double arterial phase and portal venous phase). multiplanar and angiographic reconstructions were then obtained, and the images checked for the presence of shunts, hepatic perfusion disorders, vascular lesions (telangiectasis and large confluent vascular masses), indirect signs of portal hypertension, and anatomical vascular variants. Results: Hepatic vascular alterations were found in 78/105 cases (67/89) patients affected by HHT and 11/16 patients with clinical suspicion alone). Therefore HHT diagnosis was excluded in 5 patients. 78/100 (78%) patients with HHT had intrahepatic vascular alterations: arterioportal shunts in 40/78 (51.2%) arteriosystemic shunts in 16/78 (20.5%) and both shunt types in 22/78 (28.3%). Intraparenchymal perfusion disorders were found in 46/78 (58.9%) patients. Telangiectasis were recognised in 50/78 (64.1%) patients. Large confluent vascular masses (LCVMs) were identified in 20/78 (25.6%) patients. indirect signs of portal hypertension were found in 46/78 (58.9%) cases. Variant hepatic arterial anatomy was present in 38/100 cases (38%). Conclusions: Multiphasic MDCT and the new reconstruction programs enable the identification and characterisation of the complex vascular alterations typical of HHT [it

Combination therapy using PSE and TIO ameliorates hepatic encephalopathy due to intrahepatic portosystemic venous shunt in idiopathic portal hypertension

International Nuclear Information System (INIS)

Kojima, Seiichiro; Ito, Hiroyuki; Takashimizu, Shinji; Ichikawa, Hitoshi; Matsumoto, Tomohiro; Hasebe, Terumitsu; Watanabe, Norihito

2016-01-01

A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT) showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS). Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH). To minimize the increase in portal vein pressure after shunt obliteration, partial splenic artery embolization (PSE) was first performed to reduce portal vein blood flow. Transileocolic venous obliteration (TIO) was then performed, and intrahepatic PSS was successfully obliterated using coils with n-butyl-2-cyanoacrylate (NBCA). In the present case, hepatic encephalopathy due to intrahepatic PSS in the patient with IPH was successfully treated by combination therapy using PSE and TIO

Teratoma arising from hepato duodenal ligament in the newborn with transection of portal vein, hepatic artery and common bile duct: A surgical challenge

Directory of Open Access Journals (Sweden)

V R Ravikumar

2018-01-01

Full Text Available A 7-day-old neonate presented with a large intra-abdominal mass adherent to the hilum of the liver encasing the portal triad. During excision, the portal vein, hepatic artery, and common bile duct were injured. The repair was done promptly and needed massive blood transfusion. Histopathology revealed immature teratoma Grade III. Survival in neonate following total transection of portal triad is rare and has not been reported.

Hepatic vena cava syndrome: New concept of pathogenesis.

Science.gov (United States)

Shrestha, Santosh Man; Kage, Masayoshi; Lee, Byung Boong

2017-06-01

Hepatic vena cava syndrome, also known as membranous obstruction of inferior vena cava (IVC), was considered a rare congenital disease and classified under Budd-Chiari syndrome. It is now recognized as a bacterial infection-induced disease related to poor hygiene. Localized thrombophlebitis of the IVC at the site close to hepatic vein outlets is the initial lesion which converts on resolution into stenosis or complete obstruction, the circulatory equilibrium being maintained by development of cavo-caval collateral anastomosis. These changes persist for the rest of the patient's life. The patient remains asymptomatic for a variable period until acute exacerbations occur, precipitated by bacterial infection, resulting in deposition of thrombi at the site of the lesion and endophlebitis in intrahepatic veins. Large thrombus close to hepatic vein outlets results in ascites from hepatic venous outflow obstruction, which is followed by development of venocentric cirrhosis. Endophlebitis of intrahepatic veins results in ischemic liver damage and development of segmental stenosis or membrane. Acute exacerbations are recognized clinically as intermittent jaundice and/or elevation of aminotransferase or ascites associated with neutrophil leukocytosis and elevation of C-reactive protein; sonologically, they are recognized as the presence of thrombi of different ages in IVC and thrombosis of intrahepatic veins. Development of liver cirrhosis and hepatocellular carcinoma is related to severity or frequency of acute exacerbations and not to duration or type of caval obstruction. Hepatic vena cava syndrome is a common co-morbid condition with other liver diseases in developing countries and it should be considered in differential diagnosis in patient with intermittent elevation serum bilirubin and or aminotransferase or development of ascites and cirrhosis. © 2017 The Japan Society of Hepatology.

A comparison of liver surface and hepatic vein wall ultrasound as markers for fibrosis or cirrhosis of the liver

International Nuclear Information System (INIS)

Allan, Richard B.; Thoirs, Kerry A.

2014-01-01

Objective: Clinical management of patients with suspected chronic liver disease (CLD) relies on liver biopsy which carries significant risks. This study aimed to compare the diagnostic accuracy of two previously described ultrasound techniques of liver assessment in patients who were clinically at risk of cirrhosis or fibrosis. Methods: We obtained approval from our institutional review board prior to commencement of this prospective, blinded, observational study. A sample of convenience (n = 65) was recruited from the Flinders Medical Centre endoscopy unit to compare the liver biopsy results and ultrasound assessments of the liver surface and the hepatic vein wall. The diagnostic accuracy of each ultrasound technique was measured by calculating the sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values and diagnostic accuracy. Comparisons between diagnostic performance of the two techniques was calculated with McNemar's χ 2 test. Results: Highest diagnostic accuracy (0.721) was demonstrated for assessment of the left lobe liver surface. Highest specificity was demonstrated for assessments of the left lobe liver (0.94) and right liver surfaces (0.98) and sensitivity was low for all ultrasound assessments (0–0.5). Conclusion: Compared to the hepatic vein wall image, the left surface image has higher specificity and diagnostic accuracy, a higher technical success rate, and has higher inter-reader agreement. The high specificity and low false positive rate for ultrasound assessment of liver surface indicates that a patient testing negative can potentially be ruled out of having CLD without the need for liver biopsy

The method to make the three dimensional anatomical pattern of hepatic vessels by stereo angiography

International Nuclear Information System (INIS)

Mutou, Haruomi; Kobayashi, Seiichiro; Yamada, Akiyoshi; Takasaki, Takeshi; Isobe, Yoshinori; Tanaka, Seiichi; Saeki, Shin; Yoshida, Masanori

1986-01-01

For the Past few years, there has been a big advance in the hepatic surgery. Now, small resection, such as segmentectomy or subsegmentectomy, is performed routinely. Based on this tendency, hepatic surgeons request more details, more stereographic findings of hepatic vessels to heaptic angiography. Especially three dimensional combined anatomical pattern of the hepatic artery, portal vein and hepatic vein is strongly needed. We have tried three dimensional computer graphic of hepatic vessels since few years ago, using the personal computer, digitizer with clear screen, commercially available 3D software and my own program. We use three groups of angiographic films, that is the hepatic artery, portal vein and hepatic vein with IVC, which were taken by stereoangiography. The depth of each poits of vessels are calculated by the way described in Fig 3. Using these points, the 3D software, '3DPROGATS', can make the anatomical pattern of combined hepatic vessels on TV display. And then we can also perform rotation, heading, bank, zooming, hidden line elimination freely for this picture. Out of necessity as hepatic surgeons, we make a simple system for 3D computer graphic of heptic vessels. At present, the image is somewhat rough, but clinically it is relatively effective. In this report we want to explain our method and to show the anatomical pattern of hepatic vessels of case of hepatoma. (author)

Hepatic blood perfusion estimated by dynamic contrast-enhanced computed tomography in pigs

DEFF Research Database (Denmark)

Winterdahl, Michael; Sørensen, Michael; Keiding, Inger Susanne

2012-01-01

The aim of this study was to determine whether dynamic contrast-enhanced computed tomography (DCE-CT) and the slope method can provide absolute measures of hepatic blood perfusion from the hepatic artery (HA) and portal vein (PV) at experimentally varied blood flow rates.......The aim of this study was to determine whether dynamic contrast-enhanced computed tomography (DCE-CT) and the slope method can provide absolute measures of hepatic blood perfusion from the hepatic artery (HA) and portal vein (PV) at experimentally varied blood flow rates....

Hepatic venography in noncirrhotic idiopathic portal hypertension: comparison with cirrhosis of the liver

International Nuclear Information System (INIS)

Futagawa, S.; Fukazawa, M.; Musha, H.

1981-01-01

Free and wedged hepatic venography were carried out in 37 patients with idiopathic portal hypertension (IPH) and the findings compared with those in 88 patients with cirrhosis of the liver. Characteristic changes in IPH included frequent vein-to-vein anastomoses, narrower angles between large veins and their tributaries, smooth and wavy middle-sized to large branches (giving a general ''weeping willow'' appearance), homogeneous sinusoidal filling, and minimal to absent filling of the portal venous system on wedged retrograde portography. In cirrhosis, by contrast, changes included rare vein-to-vein anastomoses, wide angles between veins and tributaries, irregular stenoses of large veins and branches at various levels, spotty sinusoidal filling, and frequent retrograde flow in the portal venous system. Hepatic venography is helpful in differentiating IPH from cirrhosis

Hepatic venous pressure gradients measured by duplex ultrasound

International Nuclear Information System (INIS)

Tasu, J.-P.; Rocher, L.; Peletier, G.; Kuoch, V.; Kulh, E.; Miquel, A.; Buffet, C.; Biery, M.

2002-01-01

AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient (r = 0.83, P -2 provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient > 12 mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity (r = 0.45,P = 0.01) and portal vein velocity (r = 0.40,P = 0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension. Tasu, J.-P. et al. (2002)

Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia

Directory of Open Access Journals (Sweden)

Nagpal Anish

2009-01-01

Full Text Available Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

Hepatitis B and A virus antibodies in alcoholic steatosis and cirrhosis

DEFF Research Database (Denmark)

Gluud, C; Aldershvile, J; Henriksen, J

1982-01-01

Sera from 74 alcoholics with cirrhosis and 63 alcoholics with steatosis were tested for antibody to hepatitis B surface antigen, to hepatitis B core antigen, and to hepatitis A virus by radioimmunoassay or enzyme-linked immunosorbent assay. No significant difference between the two groups...... of alcoholics could be found concerning the prevalence of these antibodies. The total group of patients had antibody to hepatitis B surface antigen or hepatitis B core antigen, or both, significantly (p less than 0.001) more often (26%) than sex- and age-matched controls (4%). No significant difference...... was found between patients and controls concerning the prevalence of antibody to hepatitis A virus (46% v 40%). In patients with cirrhosis, no correlation between wedged hepatic vein pressure or wedged-to-free hepatic vein pressure and any of the viral antibodies could be established. The present results...

Carbon dioxide hepatic arterial DSA and CT angiography in swine model

International Nuclear Information System (INIS)

Tan Huaqiao; Hu Hongjie; Huang Wenxin; Zhang Shizheng; Dong Yonghua; Zhou Dachun

2005-01-01

Objective: To evaluate the imaging findings of carbon dioxide hepatic arterial DSA and CT angiography in normal swine. Methods: In general anaesthesia, hepatic arterial DSA was performed with 10 ml iodinated contrast medium (5 ml/s, 10 ml) in 5 normal swine, and then repeated hepatic arterial CO 2 -DSA was performed with a total of 30-50 ml CO 2 injected by manually operated syringe at the velocity of 5-8 ml/s, followed by CO 2 -CT angiography. All the swine were sacrificed after the procedure, the selective hepatic segments were removed, and pathological examination was carried out. The radiological features of hepatic arterial DSA with iodinated contrast medium and CO 2 and CT angiography with CO 2 were analyzed. The ability of showing the arterio-venous shunt was compared. Results: Hepatic arterio-portal shunt was found in the advanced arterial phase of CO 2 -DSA in three of five swine, which was furthermore demonstrated by CO 2 -CT angiography, but iodinated contrast medium DSA showed no arterio-portal shunt in all swine. The gaseous CO 2 in portal vein was absorbed within 1-3 minutes. No CO 2 shunted into the hepatic vein during CO 2 -DSA and CO 2 -CTA. Histology didn't reveal any abnormal changes caused by CO 2 shunt in the swine liver. Conclusion: (1) Hepatic arterial CO 2 -DSA and CO 2 -CTA can reveal arterio-portal shunt that isn't seen with iodinated contrast medium, the gaseous CO 2 in portal vein was absorbed within 1-3 minutes. (2) The gaseous CO 2 can't shunt into hepatic vein when the hepatic artery is perfused with CO 2 in normal swine. (authors)

Magnetic Resonance Imaging of a Liver Hydatid Cyst Invading the Portal Vein and Causing Portal Cavernomatosis.

Science.gov (United States)

Herek, Duygu; Sungurtekin, Ugur

2015-01-01

Hepatic hydatid cysts rarely invade portal veins causing portal cavernomatosis as a secondary complication. We report the case of a patient with direct invasion of the right portal vein by hydatid cysts causing portal cavernomatosis diagnosed via magnetic resonance imaging (MRI). The presented case highlights the useful application of MRI with T2-weighted images and gadolinium-enhanced T1-weighted images in the diagnosis of hepatic hydatid lesions presenting with a rare complication of portal cavernomatosis.

Surgical disconnection of patent paraumbilical vein in refractory hepatic encephalopathy.

Science.gov (United States)

Ishikawa, Yoshinori; Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Bando, Koichi; Mizuguchi, Yoshiaki; Kakinuma, Daisuke; Kanda, Tomohiro; Akimaru, Koho; Tajiri, Takashi

2008-06-01

Refractory hepatic encephalopathy (HE) frequently develops in patients with cirrhosis and portal-systemic shunt. Recently, patients with refractory HE associated with portal-systemic shunt have been treated with interventional radiology. We describe a promising new treatment for portal-systemic shunt, ligation of the patent paraumbilical vein (PUV) after partial splenic embolization, in patients with refractory HE. Four patients with cirrhosis (3 women and 1 man; mean age, 56 years) and refractory HE due to a patent PUV were studied. Patency of the PUV had recurred in 1 patient after primary occlusion by interventional radiological procedures. The Child-Pugh class was B in 2 patients and C in 2. Before the present treatment, all patients had been hospitalized at least 3 times because of recurrent HE. Partial splenic embolization was performed in all patients to decrease portal venous pressure before surgery. Surgical ligation of the patent PUV was performed under epidural anesthesia. The patent PUV was carefully skeletonized and doubly ligated. Esophageal varices were evaluated with upper gastrointestinal endoscopy before and after surgery. The mean follow-up duration was 15.8 months. After ligation, there were no clinically significant complications. Esophageal varices were unchanged. The serum ammonia level was higher before surgery (162.3 +/- 56.4 mug/dL, mean +/- SD) than after surgery (41.8 +/- 20.2 mug/dL; p=0.0299). No patient had symptoms of HE. Ligation of the patent PUV is an effective treatment for patients with refractory HE.

Intrahepatic portal-hepatic venous shunt diagnosed by ultrasonography and computed tomography. Report of two cases

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Shinagawa, Takashi; Iino, Yasuo; Ukaji, Haruyasu; Ishizuka, Masaharu

1986-02-01

Two cases of intrahepatic portal-hepatic venous shunt found by ultrasonography and computed tomography are reported. The first case came to the hospital because of hematuria. A large shunt between the portal vein and the hepatic vein was demonstrated by ultrasonography done for screening, and confirmed by percutaneous transhepatic portography (PTP). The second case was admitted because of cholelithiasis. Computed tomography with contrast enhancement revealed a dilated portal vein in the upper portion of the right lobe. It was subsequently shown by PTP to be a portal-hepatic venous shunt. Portal vein pressure and histological finding of the liver were normal in both cases. The etiology of the shunt was thought to be congenital in these cases for lack of liver disease, portal hypertension and history of trauma. Both cases had no history of hepatic encephalopathy and did not show any symptom attributable to the shunt.

Thrombosis of the portal vein in a miniature schnauzer.

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Díaz Espiñeira, M M; Vink-Nooteboom, M; Van den Ingh, T S; Rothuizen, J

1999-11-01

A miniature schnauzer with a history of apathy, anorexia and jaundice was presented to the Utrecht University Clinic for Companion Animals. Abnormal laboratory findings included highly increased levels of total bile acids and alkaline phosphatase, and hyponatraemia. Abdominal ultrasonography revealed that the right side of the liver was enlarged and the left side was small, together with a thrombus in the portal vein. Biopsies from the right side of the liver demonstrated subacute to chronic active hepatitis, for which the dog was treated with prednisolone (1 mg/kg/day for four weeks). No improvement was observed and the owner requested euthanasia. At necropsy the left lobes of the liver were found to be small and firm, while the right lobes were large and soft. There were two thrombi in the portal vein. Microscopic examination revealed chronic active hepatitis and cirrhosis.

Hemodynamics of hepatocellular carcinoma with single-level dynamic computed tomography during hepatic arteriography

International Nuclear Information System (INIS)

Tanihata, Hirohiko

2002-01-01

The purpose of this study is to verify the hemodynamics of hepatocellular carcinoma (HCC) and to explore the draining pathway using single-level dynamic computed tomography during hepatic arteriography (single-level dynamic CTHA). One hundred one patients with 131 nodules of HCC underwent single level dynamic CTHA. Forty seven nodules were diagnosed by histological specimen and the other eighty four nodules by clinical findings of elevation in AFP and/or PIVKA II and hypervascular tumor in angiography. Single-level dynamic CTHA was performed under insertion of a catheter into proper hepatic artery or the more peripheral hepatic artery with a slice thickness of 3 mm at the same level. Each image of single level dynamic CTHA was continuously taken in a second for 40 seconds during injection of contrast medium at of 2 ml/sec for 10 seconds. The images of single-level dynamic CTHA were differentiated into three phases, as early phase 1 to 10 seconds, middle phase 11 to 20 seconds and late phase 21 to 40 seconds. After the analysis of the vascular pattern in each phase, the hemodynamics of HCC was classified into three patterns; hypovascular pattern in the 24 nodules whose average size was 13.4±4.2 mm, intermediate pattern in the 21 nodules whose average size was 20.8±7.8 mm and hypervascular pattern in 86 nodules whose average size was 31.6±16.3 mm. There were significant correlations between the tumor size and the vascular pattern. In the groups of hypovascular and intermediate pattern, the draining pathways were sinusoids. Of the 86 nodules of the group with hypervascular pattern, blood flow drained into portal vein including bright branch structure in 20 nodules, into portal vein and hepatic vein in 2 nodules, into portal vein and extrahepatic vein in 1 nodule, into hepatic vein in 11 nodules, into extrahepatic vein in 4 nodules and into sinusoids in 48 nodules. In conclusion, from a viewpoint of hemodynamics using single-level dynamic CTHA, I proposed the new

MRI diagnosis and preoperative evaluation for hepatic hilar tumor

International Nuclear Information System (INIS)

Liu Yulin; Kong xiangquan; Xu Haibo; Xiao Xuehong; Liu Dingxi; Peng Zhenjun

2004-01-01

Objective: To investigate the value of the all-in-one MR scanning in the diagnosis and preoperative evaluation of hepatic hilar tumor. Methods: Forty-two cases of hepatic hilar tumors were examined with a 1.5 T superconductive MR system, including hepatocellular carcinoma (HCC, n=12), hilar cholangiocarcinoma (HC, n=22), and hilar metastasis (n=8). Besides the precontrast MRI and MRCP, all cases underwent consecutive dynamic contrast-enhanced MR scanning. The whole liver dynamic contrast-enhanced MR was performed with the first bolus injection of Gd-DTPA (10 ml), and 15 minutes later, 3D DCE MRA was performed with additional injection of Gd-DTPA (15-20 ml) (0.15-0.20 mmol/kg). The contrast time-signal curve of liver and tumor was drawn, and arterial and portal venous phase images were reconstructed with MIP. MR appearances were compared with surgical findings and pathology. Results: Consecutive DCE scanning was successfully performed in all cases. The contrast time-signal curve of HCC showed type I and II (10/12, 83.3%), and the curve of HC showed type III and IV (21/22, 95.4%), whereas the curve of metastasis was various. The difference of tumor peak transit time (PT) between HCC group and HC group was significant (P<0.05). The vascular invasion in HCC group appeared as arterial-portal vein fistula (2/12, 16.7%), portal vein infiltration (3/24, 12.5%), and occlusion by tumor thrombosis (4/24, 16.7%). However, the vascular invasion in HC group showed spiral artery (5/22, 22.7%), portal vein infiltration (5/44, 11.4%), portal vein central narrowing (8/44, 18.2%) and occlusion (11/44, 25.0%). All metastasis had no vascular invasion expect one gall bladder carcinoma with right portal vein infiltration. The accuracy of preoperative evaluation with MRI in HCC group and HC group was 83.3% (10/12) and 86.4% (19/22), respectively. The accuracy of preoperative evaluation in all hilar tumors was 78.6% (33/42). Conclusion: Consecutive DCE was a safe and useful technique in MR

Treatment of hepatic encephalopathy by retrograde transcaval coil embolization of an ileal vein-to-right gonadal vein portosystemic shunt

International Nuclear Information System (INIS)

Nishie, Akihiro; Yoshimitsu, Kengo; Honda, Hiroshi; Kaneko, Kuniyuki; Kuroiwa, Toshiro; Fukuya, Tatsuro; Irie, Hiroyuki; Ninomiya, Toshiharu; Yoshimitsu, Takahiro; Hirakata, Hideki; Okuda, Seiya; Masuda, Kouji

1997-01-01

A 43-year-old non-cirrhotic woman suffered from encephalopathy caused by an extrahepatic portosystemic shunt between the ileal vein and inferior vena cava via the right gonadal vein. Percutaneous transcatheter embolization with stainless steel coils was performed by the retrograde systemic venous approach. Encephalopathy improved dramatically

Susceptibility-weighted angiography (SWAN) of cerebral veins and arteries compared to TOF-MRA

International Nuclear Information System (INIS)

Boeckh-Behrens, T.; Lutz, J.; Lummel, N.; Burke, M.; Wesemann, T.; Schöpf, V.; Brückmann, H.; Linn, J.

2012-01-01

Problem: High resolution, non-contrast imaging of both cerebral veins and arteries by use of gradient echo T2 star weighted angiography (SWAN) is a new method for susceptibility-weighted imaging with short acquisition times. We assessed the potential of this sequence for the depiction of both cerebral veins and arteries. Methods: 15 healthy volunteers were included in the study. MRI was performed on a 3 T MR scanner using the following sequences: (1) a 3D multi-echo gradient echo T2 star weighted angiography (SWAN), (2) an arterial 3D TOF MR angiography and (3) a venous 2D TOF. With regard to the SWAN sequence, both MinIP and MIP images were reconstructed and systematically compared to MIP reconstructions of the artTOF and the venTOF. To suggest possible clinical implications of our findings, we additionally included two illustrative cases. Results: With regard to the visualization of the cerebral veins, the MinIP reconstructions of the SWAN sequence were considerably superior compared to the venTOF. Concerning the depiction of the main segments of the big cerebral arteries the value of the MIP reconstructions of the SWAN was comparable to that of the artTOF with limitations in the homogenity and in the depiction of smaller arteries. Conclusions: SWAN allows for high-resolution visualization of both cerebral veins and arteries in one sequence without application of contrast agent and with significantly shortened scan time compared to the combined scan time of TOF-MRA and TOF-MRV. By use of either MinIP or MIP reconstructions, the arteries can be distinguished from the veins.

Diagnostic value of liver scintigraphy, computed tomography and ultrasonography of fatal hepatitis

International Nuclear Information System (INIS)

Komori, Hideshi; Hirasa, Masahiro; Ibuki, Yasuyoshi

1983-01-01

The purpose of this study was investigate the diagnostic value of liver scintigraphy, computed tomography (CT) and ultrasonography in acute hepatic failure, subacute hepatitis and acute hepatitis. By scintigraphy low uptake in the liver and high uptake in the spleen and bone marrow were observed in hepatic failure. However, uneven liver edge and heterogenous RI destribution were not corresponded to massive necrosis. In fulminant hepatitis, liver size and other findings were variable in patient by patient. But in subacute hepatitis, the findings were typical. The finding of left lobe swelling was observed in a half of patients with acute hepatic failure based on chronic hepatitis. Localized low density area by the CT was detected in most of the cases of subacute hepatitis, and acute hepatitis with submassive hepatic necrosis. But in fulminant hepatitis, that was rare. In these cases, irregular and strong lesion was also obsurved by ultrasonography. These findings by the CT and ultrasonography were corresponded to massive necrosis histrogically ultrasonography revealed narrowing of hepatic vein in fatal hepatitis. Localized low density area by the CT in subacute hepatitis was shown surrounding hepatic vein. We conclude that development of massine hepatic necrosis concern to secondary hepatic ischemia. (author)

Endovascular management for significant iatrogenic portal vein bleeding.

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Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

2017-11-01

Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

Transarterial chemoembolization combined with sorafenib for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus

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Zhang YF

2016-07-01

Full Text Available Yong-Fa Zhang,1–3,* Wei Wei,1–3,* Jia-Hong Wang,1–3,* Li Xu,1–3 Pei-En Jian,1–3 Cheng-Zuo Xiao,4 Xiao-Ping Zhong,1–3 Ming Shi,1–3 Rong-Ping Guo1–3 1Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 2State Key Laboratory of Oncology in South China, 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, 4Department of General Surgery, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, People’s Republic of China *These authors contributed equally to this work Objective: To compare the treatment outcomes of sorafenib plus transarterial chemoembolization (TACE vs TACE alone in patients with hepatocellular carcinoma (HCC and hepatic vein tumor thrombus (HVTT.Methods: Twenty patients who were initially diagnosed with HCC and HVTT and received TACE combined with sorafenib during February 2009 to October 2013 were included in the study. To minimize selection bias, these patients were compared with 60 case-matched controls selected from a pool of 81 patients (in a 1:3 ratio who received TACE alone during the same period. The primary end point was overall survival (OS. The secondary end points were time to progression, disease control rate, and adverse events.Results: After a median follow-up period of 12.5 months (range, 1.03–44.23 months, the OS of the combined group was found to be significantly higher compared with the monotherapy group (14.9 vs 6.1 months, P=0.010. The time to progression was found to be significantly longer in the combined group (4.9 vs 2.4 months, P=0.016. Univariate and multivariate analyses revealed that the treatment allocation was an independent predictor of OS.Conclusion: Sorafenib plus TACE was well tolerated and was more effective in treating patients with advanced HCC and HVTT. Future trials with prospective larger samples are required to validate these results. Keywords: hepatocellular carcinoma, hepatic vein tumor thrombus, prognosis

Hepatic venous pressure gradients measured by duplex ultrasound

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Tasu, J.-P.; Rocher, L.; Peletier, G.; Kuoch, V.; Kulh, E.; Miquel, A.; Buffet, C.; Biery, M

2002-08-01

AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient (r = 0.83, P < 0.0001) and with the Child-Pugh score (r = 0.63, P < 0.0001). An acceleration index cut-off value of 1 m.s{sup -2} provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient > 12 mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity (r = 0.45,P = 0.01) and portal vein velocity (r = 0.40,P = 0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension. Tasu, J.-P. et al. (2002)

Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

Science.gov (United States)

Anaya-Ayala, Javier E; Adams, Matthew K; Telich-Tarriba, Jose E; Dresser, Kelly L; Ismail, Nyla; Peden, Eric K

2013-01-01

Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins. Copyright © 2013 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Radiographical findings in patients with liver cirrhosis and hepatic encephalopathy.

Science.gov (United States)

Elwir, Saleh; Hal, Hassan; Veith, Joshua; Schreibman, Ian; Kadry, Zakiyah; Riley, Thomas

2016-08-01

Hepatic encephalopathy is a common complication encountered in patients with liver cirrhosis. Hepatic encephalopathy is not reflected in the current liver transplant allocation system. Correlation was sought between hepatic encephalopathy with findings detected on radiographic imaging studies and the patient's clinical profile. A retrospective analysis was conducted of patients with cirrhosis, who presented for liver transplant evaluation in 2009 and 2010. Patients with hepatocellular carcinoma, ejection fraction less than 60% and who had a TIPS (transjugular intrahepatic portosystemic shunting) procedure or who did not complete the evaluation were excluded. Statistical analysis was performed and variables found to be significant on univariate analysis (P encephalopathy group (n = 58) and a control group (n = 59). Univariate analysis found that a smaller portal vein diameter, smaller liver antero-posterior diameter, liver nodularity and use of diuretics or centrally acting medications showed significant correlation with hepatic encephalopathy. This association was confirmed for smaller portal vein, use of diuretics and centrally acting medications in the multivariate analysis. A decrease in portal vein diameter was associated with increased risk of encephalopathy. Identifying patients with smaller portal vein diameter may warrant screening for encephalopathy by more advanced psychometric testing, and more aggressive control of constipation and other factors that may precipitate encephalopathy. © The Author(s) 2015. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

Development of a New Technique for Reconstruction of Hepatic Artery during Liver Transplantation in Sprague-Dawley Rat.

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Xingmu Liu

Full Text Available Sleeve anastomosis is the most common technique used to rearterialize orthotopic liver transplants (OLT. However, this technique has a number of disadvantages, including difficulty of performance of the technique visually unaided. We herein describe a novel rearterialized OLT model in the rat.Forty-six male Sprague Dawley rats (300-400 g were used as donors and recipients. Based on Kamada's cuff technique, the new model involved performing a modified "sleeve" anastomosis between the celiac trunk of the donor and common hepatic artery of the recipient to reconstruct blood flow to the hepatic artery. An additional ten male Sprague Dawley rats underwent liver transplantation without artery reconstruction. Liver grafts were retrieved from the two groups and histological examination was performed following surgery.Total mean operating times were ~42 minutes for the donor liver extraction and 57 minutes for the recipient transplantation. Graft preparation took an additional 15 minutes and the time to fix the arterial bracket was ~3 minutes. During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes. The patency rate was 94.44% and the 4-week survival rate was 90%. Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.This new method allows for the surgical procedure to be performed visually unaided with good survival and patency rates and represents an alternative model investigating OLT in rats.

[Application of hepatic segment resection combined with rigid choledochoscope in the treatment of complex hepatolithiasis guided by three-dimensional visualization technology].

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Xiang, Nan; Fang, Chihua

2015-05-01

To study the value of hepatic segment resection combined with rigid choledochoscope by the three-dimensional (3D) visualization technology in the diagnosis and treatment of complex hepatolithiasis. Enhance computed tomography (CT) data of 46 patients with complex hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from July 2010 to June 2014 were collected.All of the CT data were imported into the medical image three-dimensional visualization system (MI-3DVS) for 3D reconstruction and individual 3D types. The optimal scope of liver resection and the remnant liver volume were determined according to the individualized liver segments which were made via the distribution and variation of hepatic vein and portal vein, the distribution of bile duct stones and stricture of the bile duct, which provided guidance for intraoperative hepatic lobectomy and rigid choledochoscope for the remnant calculus lithotripsy. Outcomes of individual 3D types: 10 cases of type I, 11 cases of IIa, 23 cases of IIb, 2 cases of IIc, 19 cases coexisted with history of biliary surgery. The variation of hepatic artery was appeared 6 cases. The variation of portal vein was appeared 8 cases. The remaining liver volume for virtual hepatic lobectomy controlled more than 50%. Eighteen cases underwent left lateral hepatectomy, 8 cases underwent left liver resection, 8 cases underwent right posterior lobe of liver resection, 4 cases underwent the right hepatic resection, 4 cases underwent IV segment liver resection, 2 cases underwent right anterior lobe of liver resection, 2 cases underwent left lateral hepatectomy combined with right posterior lobe of liver resection, 26 cases underwent targeting treatment of rapid choledochoscope and preumatic lithotripsy. The actual surgical procedure was consistent with the preoperative surgical planning. There was no postoperative residual liver ischemia,congestion, liver failure occurred in this study. The intraoperative

Fusion of the midplane with the left intersectional plane: a liver anatomical variation revisited with multidetector-row CT

International Nuclear Information System (INIS)

Lucidarme, Olivier; Taboury, Jacques; Savier, Eric; Hannoun, Laurent; Cadi, Mehdi; Grenier, Philippe A.

2006-01-01

This article updates the description of an anatomical variation of the liver, in which the gallbladder is adjacent to the ligamentum teres, that was described until now as ''right-sided ligamentum teres and right umbilical portion of the portal vein''. A study of eight patients showing this anatomical variation has led to a new archetypal anatomical description of the hepatic and portal veins, using multidetector-row computed tomography (MDCT) with three-dimensional (3D) volume-rendering (VR) reconstructions. While 2D axial imaging gave the same information, MDCT imaging with VR reconstructions provided a clear 3D visualization of this anatomical variation. Typical features can be described as follows: (1) juxtaposition of the ligamentum teres and the gallbladder; (2) typical portal vein branching with a right posterior branch, a left posterior branch and a main medial branch that terminates in the ligamentum teres; (3) two main hepatic veins and a hypotrophied medial hepatic vein. We think, based on the direct comparison of anatomical findings and knowledge of chronological embryological development, that this abnormality results from the defective development of the central part of the liver and not from the persistence of the right rather than the left umbilical vein. Because of the presence of only one medial plane, containing both the gallbladder and the ligamentum teres, we propose renaming it ''fusion of hepatic planes''. (orig.)

The Doppler Ultrasonographic Evaluation of Hemodynamic Changes in Hepatic Vascular Structures in Patients with Hepatosteatosis

International Nuclear Information System (INIS)

Karasin, Mehmet; Tokgoz, Ozlem; Serifoglu, İsmail; Oz, İlker; Erdem, Oktay

2014-01-01

The hemodynamic changes in hepatic vascular structures of hepatosteatosis patients were examined using Doppler ultrasonography. Ninety hepatosteatosis patients, classified as mild, moderate or severe, and 30 healthy volunteers were included in this 120-person study. The height, weight, liver size, blood lipids and blood liver function tests of the subjects were measured. Those values were compared in the patient and control groups. In the patient and control groups, color duplex Doppler ultrasonography was used to examine portal vein peak velocity, portal vein flow volume, hepatic artery resistive index (RI), hepatic artery pulsatility index (PI) and hepatic artery flow volume. Similarly to the degree of hepatosteatosis, increases in body mass index, liver size, liver enzyme levels and blood lipid levels were statistically significant (p<0.05). While the difference in portal vein peak velocity in the hepatosteatosis and control groups was not statistically significant, there was an increasing reduction in the degree of steatosis (p>0.05). As the degree of hepatosteatosis increased, there was a reduction in hepatic artery flow volume, portal vein flow volume and total flow volume that was not statistically significant. In the mild hepatosteatosis group, hepatic artery RI and PI values were statistically significantly lower than in the other groups (p<0.05). In the severe hepatosteatosis group, although the hepatic artery RI and PI values were not statistically significant, there was a minimal increase compared to the other groups. It is believed that those results were caused by a reduction in liver compliance and hepatic vascular compliance, in addition to resistance increase in vascular structures

Hepatic blood flow determination. A comparison of 99mTc-diethyl-IDA and indocyanine green as hepatic blood flow indicators in man

DEFF Research Database (Denmark)

Henriksen, Jens Henrik Sahl; Winkler, K

1987-01-01

99mTc-diethyl-acetanilide-iminodiacetic acid (IDA) was compared with indocyanine green (ICG) as an indicator of hepatic blood flow (HBF). Twelve subjects (8 with cirrhosis, 2 with fatty liver, one with pancreatitis, and one with intestinal angina) were studied during hepatic vein catheterization...

Interposition vein cuffs.

Science.gov (United States)

Harris, P; Da Silva, T; How, T

1996-01-01

A vein cuff interposed at the distal anastomosis between a prosthetic vascular graft and a recipient infrageniculate artery improves the chances of continued patency of the graft, at least in the short and medium term. The mode of effect appears to be suppression or modification of anastomotic myointimal hyperplasia (MIH). In the event of graft failure the recipient artery and run-off vessels remain free from MIH and their patency is preserved thereby improving the prospects for further vascular reconstruction and limb salvage. The mechanisms by which interposition vein cuffs might modulate MIH are reviewed. Experimental evidence is described to show that the geometry of a cuffed anastomosis promotes a characteristic haemodynamic flow structure with a stable vortex. It is suggested that this vortex exerts greater shear stress upon the wall of the artery than the normal laminar flow observed in conventional anastomoses. High shear stress is known to inhibit MIH.

An experimental study on combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization

International Nuclear Information System (INIS)

Wang Maoqiang; Zhang Jinshan; Xing Zhanhai

1997-01-01

The experimental study is aimed at achieving the effect of hepatic tumor and tumor-bearing lobar or segmental resection by using combined transcatheter hepatic arterial embolization and retrograde hepatic venous embolization (THAE-RHVE) in experimental study. THAE-RHVE was carried out in 8 mongrel dogs. Hepatic arterial embolization was performed by injecting lipiodol followed by gelatin sponge particles, following complete occlusion of the hepatic vein with balloon catheter. Retrograde hepatic venous embolization (RHVE) was then performed by injecting a mixture of absolute ethanol and meglumini diatrizoatis (MD) via the inflated balloon catheter. Ethanol and MD were combined with a ratio of 1:1. RHVE alone was performed in 4 dogs as control. The animals were followed up for 1∼8 weeks with liver function test, CT, gross and microscopic examinations. There was no technical failure or procedural complications. Transient elevation of AST and ALT levels was seen immediately in both groups after the procedure. Follow-up CT after 3 weeks showed dense lipiodol accumulation in the embolized lobe or segment and the corresponding portal branches in the THAE-RHVE animals. At 1 week after THAE-RHVE, complete coagulation necrosis was seen at histologic examination in the embolized lobe. The hepatic vein and portal branches of the embolized area had thickened walls and were filled with thrombus. At 2 weeks, granulomatous tissue and inflammatory cell infiltration surrounding the necrotic area could be seen. At 4∼8 weeks, marked atrophy of the embolized lobe was found, and the necrotic area was progressively reducing in size and being replaced by fibrosis. In the control group, incomplete segmental coagulated necrosis was seen and the necrosis area wa smaller than that of THAE-REVE. Hepatic lobectomy or segmentectomy can be achieved with THAE-RHVE. This new method is safe and easy, and may be useful in the treatment of HCC

Endovascular Treatment of Acute Portal Vein Thrombosis After Liver Transplantation in a Child

International Nuclear Information System (INIS)

Carnevale, Francisco Cesar; Borges, Marcus Vinicius; Moreira, Airton Mota; Cerri, Giovanni Guido; Maksoud, Joao Gilberto

2006-01-01

Although operative techniques in hepatic transplantation have reduced the time and mortality on waiting lists, the rate of vascular complications associated with these techniques has increased. Stenosis or thrombosis of the portal vein is an infrequent complication, and if present, surgical treatment is considered the traditional management. This article describes a case of acute portal vein thrombosis after liver transplantation from a living donor to a child managed by percutaneous techniques

Focused Transhepatic Electroporation Mediated by Hypersaline Infusion through the Portal Vein in Rat Model. Preliminary Results on Differential Conductivity.

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Pañella, Clara; Castellví, Quim; Moll, Xavier; Quesada, Rita; Villanueva, Alberto; Iglesias, Mar; Naranjo, Dolores; Sánchez-Velázquez, Patricia; Andaluz, Anna; Grande, Luís; Ivorra, Antoni; Burdío, Fernando

2017-12-01

Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed. HI was performed (NaCl 20%, 3.8 mL/Kg) by trans-splenic puncture. Deionized serum (40 mL/Kg) and furosemide (2 mL/Kg) were simultaneously infused through the jugular vein to compensate hypernatremia. Changes in conductivity were monitored in the hepatic and tumour tissue. The period in which hepatic conductivity was higher than tumour conductivity was defined as the therapeutic window (TW). Animals were monitored during 1-month follow-up. The animals were sacrificed and selective samples were used for histological analysis. The overall survival rate was 82.4% after the HI protocol. The mean maximum hepatic conductivity after HI was 2.7 and 3.5 times higher than the baseline value, in group A and B, respectively. The mean maximum hepatic conductivity after HI was 1.4 times higher than tumour tissue in group B creating a TW to implement selective IRE. HI through the portal vein is safe when the hypersaline overload is compensated with deionized serum and it may provide a TW for focused IRE treatment on tumour nodules.

Imaging and clinical significance of hepatic portal venous gas seen in adult patients

International Nuclear Information System (INIS)

Aikawa, Hisayuki; Mori, Hiromu; Miyake, Hidetoshi

1994-01-01

In 10 adult patients with hepatic portal venous gas (HPVG), the clinical significance of HPVG and the efficacy of X-ray computed tomography (CT) were evaluated. HPVC was associated with ischemic bowel disease (n=3), trauma (n=4), liver abscess (n=1), sepsis (n=1) and unknown etiology (n=1). The diagnostic ability of CT for the detection of HPVG was far superior to that of plain abnormal radiograph. Of 9 patients who underwent CT, HPVG located in the left hepatic lobe in all patients, and also in right hepatic lobe in 7 patients. Gas could be recognized in the left lobe and the anterior segment of the right lobe more clearly than in the posterior segment of the right lobe because of its larger amount of intravenous collection. The mortality rate of our cases was 100%. Gas was demonstrated simultaneously in the portal vein radicles and hepatic veins on CT in 4 patients with no clinical evidence of sepsis, which suggested the possibility of intraparenchymal shift of gas from the portal vein into the hepatic vein. In a single case with sepsis, gas was noted in various vessels, including arteries, in addition to the portal venous system. The authors conclude that HPVG is still a grave sign in Japan and prompt appropriate treatment is required. CT may be of great value in the early detection of HPVG and may indicate its etiology. (author)

Macronodular hepatic tuberculosis associated with portal vein thrombosis and portal hypertension

International Nuclear Information System (INIS)

Venkatesh, S.K.; Tan, L.K.A.; Siew, E.P.Y.; Putti, T.C.

2005-01-01

Tuberculosis (TB) of the liver is usually associated with miliary spread. Macronodular TB of the liver is rare. A case of macronodular TB of the liver in a 31-year-old woman causing portal vein thrombosis and portal hypertension is presented. Ultrasound and CT appearances are described. There was coexistent ileo-caecal TB with extensive mesenteric and retroperitoneal lymphadenopathy. Macronodular TB should be considered in the differential diagnosis when a patient presents with multiple calcified masses in the liver with portal vein thrombosis and portal hypertension. Copyright (2005) Blackwell Science Pty Ltd

Congenital absence of the portal vein in a child with Turner syndrome

International Nuclear Information System (INIS)

Noe, Jacob A.; Burton, Edward M.; Pittman, Heather C.

2006-01-01

Congenital absence of the portal vein (CAPV) is a rare malformation associated with hepatic encephalopathy and liver function abnormalities. We report a case of a 2-year-old with Turner syndrome, CAPV, and congenital heart malformations. (orig.)

Congenital absence of the portal vein in a child with Turner syndrome

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Noe, Jacob A.; Burton, Edward M. [Department of Radiology, University of Tennessee College of Medicine-Chattanooga Branch, Chattanooga, TN (United States); Pittman, Heather C. [Department of Pediatrics, University of Tennessee College of Medicine-Chattanooga Branch, Chattanooga, TN (United States)

2006-06-15

Congenital absence of the portal vein (CAPV) is a rare malformation associated with hepatic encephalopathy and liver function abnormalities. We report a case of a 2-year-old with Turner syndrome, CAPV, and congenital heart malformations. (orig.)

Segmentation of hepatic artery in multi-phase liver CT using directional dilation and connectivity analysis

Science.gov (United States)

Wang, Lei; Schnurr, Alena-Kathrin; Zidowitz, Stephan; Georgii, Joachim; Zhao, Yue; Razavi, Mohammad; Schwier, Michael; Hahn, Horst K.; Hansen, Christian

2016-03-01

Segmentation of hepatic arteries in multi-phase computed tomography (CT) images is indispensable in liver surgery planning. During image acquisition, the hepatic artery is enhanced by the injection of contrast agent. The enhanced signals are often not stably acquired due to non-optimal contrast timing. Other vascular structure, such as hepatic vein or portal vein, can be enhanced as well in the arterial phase, which can adversely affect the segmentation results. Furthermore, the arteries might suffer from partial volume effects due to their small diameter. To overcome these difficulties, we propose a framework for robust hepatic artery segmentation requiring a minimal amount of user interaction. First, an efficient multi-scale Hessian-based vesselness filter is applied on the artery phase CT image, aiming to enhance vessel structures with specified diameter range. Second, the vesselness response is processed using a Bayesian classifier to identify the most probable vessel structures. Considering the vesselness filter normally performs not ideally on the vessel bifurcations or the segments corrupted by noise, two vessel-reconnection techniques are proposed. The first technique uses a directional morphological operator to dilate vessel segments along their centerline directions, attempting to fill the gap between broken vascular segments. The second technique analyzes the connectivity of vessel segments and reconnects disconnected segments and branches. Finally, a 3D vessel tree is reconstructed. The algorithm has been evaluated using 18 CT images of the liver. To quantitatively measure the similarities between segmented and reference vessel trees, the skeleton coverage and mean symmetric distance are calculated to quantify the agreement between reference and segmented vessel skeletons, resulting in an average of 0:55+/-0:27 and 12:7+/-7:9 mm (mean standard deviation), respectively.

Evaluation of hepatic blood flow using 99mTc-GSA in rats with hepatic blood flow manipulation

International Nuclear Information System (INIS)

Hiraguchi, Etsuo

1995-01-01

Blood clearance and hepatic uptake parameters of 99m Tc-DTPA-galactosyl human serum albumin ( 99m Tc-GSA) were evaluated in two groups of rats, normal liver group and CCl 4 induced chronic liver injury group. In each group, four subgroups were classified as follows: simple laparotomy (LAP), hepatic artery ligation (HAL), portal vein ligation (PVL) and both hepatic artery and portal vein ligation (HAL+PVL). 99m Tc-GSA was intravenously injected (50 μg/100 g B.W.) to rats. Heart and liver were targetted as region of interest and time activity curves (TACs) were obtained. The blood clearance parameters (HH4 and Kd) and the hepatic uptake parameters (LHL4 and Ku) were calculated from these TACs. In normal liver group, the mean HH4 of LAP was significantly different from those of PVL and HAL+PVL. Similarly, the other three parameters (LHL4, Kd and Ku) of LAP were significantly different from those of PVL and HAL+PVL. CCl 4 induced chronic liver injury group showed significant difference on all four parameters in four subgroups. Hepatic tissue blood flow rates (HTBFR) calculated by Laser Doppler flowmeter correlated well with 99m Tc-GSA parameters in both groups. These results suggest that 99m Tc-GSA is useful to estimate hepatic blood flow not only in rats with normal liver, but also in rats with CCl 4 induced chronic liver injury. (author)

CT imaging of hepatic veno-occlusive disease (an analysis 14 cases)

International Nuclear Information System (INIS)

Zhang Guohua; Kong Azhao; Fang Junwei; Chen Yuejing; Zheng Weiliang; Dong Danjun; Zhang Shizheng

2006-01-01

Objective: To probe imaging characteristics of the hepatic veno-occlusive disease (VOD) based on clinical features and abdomen CT findings. Methods: Fourteen patients including 6 male and 8 female aged from 41 to 73 years were enrolled in this study. They all had previous trauma history and notoginseng was given as herbal remedy. Dynamic enhanced CT and color Dopplor ultrasound examinations were routinely used. Two of them received venous angiography and four cases were pathologically proved as VOD after CT guided needle biopsy. Results: Hepatic swelling and ascites were found on plain CT scan. Diffuse patchy areas without enhancement indicative of poorly hepatic perfusion were found. Hepatic veins were compressed and became thin, and inferior vena cava was flat and narrow without distal dilation or collateral circulation. No obstruction of hepatic veins and inferior vena cava was found on ultrasound and venography. Conclusion: Dynamic enhanced CT is highly valuable for early assessing VOD and imaging features of venous hepatic congestion found on CT was strongly suggestive of VOD if there's previous history of treatment of gynura segetum. (authors)

Portal Vein Embolization with Radiolabeled Polyvinyl Alcohol Particles in a Swine Model: Hepatic Distribution and Implications for Pancreatic Islet Cell Transplantation

International Nuclear Information System (INIS)

Owen, Richard J.; Mercer, John R.; Al-Saif, Faisal; Molinari, Michele; Ashforth, Robert A.; Rajotte, Ray V.; Conner-Spady, Barbara; Shapiro, A. M. James

2009-01-01

The distribution of radiolabeled polyvinyl alcohol microspheres (PVAMs) when infused into the portal vein of domestic swine was investigated, with the purpose of assessing implications for pancreatic islet cell transplantation. PVAMs measuring 100-300 μm (Contour SE) and labeled with 99m Tc were infused into the main portal vein of 12 swine, with intermittent portal venous pressure measurements. The infusion catheter was introduced antegradely via direct or indirect cannulation of the portal vein. The liver was subsequently divided into anatomical segments. Radioactivity (decay corrected) was measured for 99m Tc microsphere synthesis, dose preparation, gross organ activities, tissue samples, and blood. Particulate labeling, catheter positioning, and infusion were successful in all cases. The number of particles used was (185,000 ± 24,000) with a volume of 1 ml. Mean portal pressure at 5 min was significantly higher than baseline, but without a significant difference at 15 min. Extrahepatic tissue and serum radioactivity was negligible. A significant difference in number of radioactive particles per gram was detected between segments 6/7 and segments 5/8. Intrasegmental activity was analyzed, and for segments 2/3 a significant difference in the percentage dose per gram across samples was demonstrated (P = 0.001). Effective and stable radiolabeling of PVAMs with 99m Tc-sulfur colloid was demonstrated. Portal venous infusion of 100- to 300-μm particles showed entrapment in the sinusoidal hepatic system with transient portal pressure elevation. Preferential embolization into the right lateral and posterior segments occurs, suggesting that flow dynamics/catheter tip position plays a role in particle distribution.

Technical Considerations in Percutaneous Hepatic Perfusion—A Multi-Center Experience

Science.gov (United States)

Antoine, Radcliffe A.

2011-01-01

Abstract: Patients diagnosed with primary or metastatic liver cancer face a daunting future that is complicated by limited treatment options. Percutaneous hepatic perfusion is a novel approach to chemotherapy delivery that offers significant benefits over contemporary modalities. Percutaneous hepatic perfusion is a procedure in which a chemotherapeutic agent is administered at high doses via the hepatic artery where it perfuses the liver, is extracted and filtered using a veno-veno bypass circuit, a fenestrated multi-lumen double-balloon catheter, and two biocompatible hemoperfusion filters. Venous access is gained at the groin through the femoral vein after which the catheter is advanced and positioned in the inferior vena cava just below the right atrium. The catheter’s proximal and distal balloons are inflated to occlude the inferior vena cava above and below the hepatic veins. The occlusion isolated the chemo-rich venous outflow of the liver from the systemic venous circulation. This maneuver also diverts venous blood returning to the heart from lower extremities of the azygos vein. Once the patient is on bypass, the agent is infused through the hepatic artery where it saturates the liver. The chemorich venous outflow is extracted through the double-balloon catheter by the bypass circuit. The blood is continuously filtered and cleared of the agent as it passes through the filters and returned to the patient through a catheter placed in the right internal jugular vein. A phase I study demonstrated efficacy with an overall radiographic response rate of 30% observed in treated patients. In 10 patients with ocular melanoma, a 50% overall response rate was observed, including two complete responses. The technique is minimally invasive and can be performed safely by a well-trained multi-disciplinary team. It offers significant benefits including multiple procedures without risks commonly associated with open abdominal surgery. PMID:21449232

Cryo-electron microscopy and three-dimensional reconstructions of hepatitis C virus particles

International Nuclear Information System (INIS)

Yu Xuekui; Qiao Ming; Atanasov, Ivo; Hu Zongyi; Kato, Takanobu; Liang, T. Jake; Zhou, Z. Hong

2007-01-01

The structural details of hepatitis C virus (HCV) have been elusive because of the lack of a robust tissue culture system for producing an adequate amount of virions from infectious sources for in-depth three-dimensional (3D) structural analysis. Using both negative-stain and cryo-electron microscopy (cryoEM), we show that HCV virions isolated from cell culture have a rather uniform size of 500 A in diameter and that recombinantly expressed HCV-like particles (HCV-LPs) have similar morphologic, biophysical and antigenic features in spite of the varying sizes of the particles. 3D reconstructions were obtained from HCV-LPs with the same size as the HCV virions in the presence and absence of monoclonal antibodies bound to the E1 glycoprotein. The 3D reconstruction of HCV-LP reveals a multilayered architecture, with smooth outer-layer densities arranged in a 'fishbone' configuration. Reconstruction of the particles in complex with anti-E1 antibodies shows that sites of the E1 epitope are exposed and surround the 5-, 3- and 2-fold axes. The binding pattern of the anti-E1 antibody and the fitting of the structure of the dengue virus E glycoprotein into our 3D reconstructions further suggest that the HCV-LP E1 and E2 proteins form a tetramer (or dimer of heterodimers) that corresponds morphologically and functionally to the flavivirus E homodimer. This first 3D structural analysis of HCV particles offers important insights into the elusive mechanisms of HCV assembly and maturation

Limitations of nonoperative management of type IIIb blunt hepatic injuries in hemodynamically stable patients after fluid resuscitation

International Nuclear Information System (INIS)

Sekine, Kazuhiko; Kitano, Mitsuhide; Shimizu, Masayuki; Matsumoto, Shokei; Yoshii, Hiroshi; Yamazaki, Motoyasu; Aikawa, Naoki

2007-01-01

Nonoperative management (NOM) of hepatic injuries caused by blunt trauma in hemodynamically stable patients is widely accepted, but the feasibility of NOM for severe hepatic injuries has not been fully evaluated. Among all patients with blunt severe hepatic injury (type IIIb) admitted to Saiseikai Kanagawa-ken Hospital and Keio University Hospital from 1988 to 2004, those who had been hemodynamically stable after fluid resuscitation at the emergency department were initially managed nonoperatively. We reviewed demographic, physiological, and laboratory data; computed tomography (CT) findings; 80-day cumulative laparotomy rate; and complications. The anatomical severity of the hepatic injuries was evaluated based on the CT findings, such as hepatic vein injuries and area lacerated according to the Couinaud liver segment. In patients who underwent surgery after admission, the surgical indications and operative findings were reviewed. Overall, 34 consecutive patients were enrolled in this study. Five patients underwent surgery, and all of their surgical indications were attributable to liver-related complications after injury. The indication for surgery was hemodynamic instability in 3 patients with hepatic vein injures in the early phase (<15 hours after estrogen receptor (ER) arrival) and intra-abdominal septic complications in 2 patients in the late phase (hospital days 14 and 64). The cumulative 80-day laparotomy rate in the early phase was significantly higher (p<0.0001) in the patients suspected of having hepatic vein injury, and in the late phase it was higher (p=0.002) in those with injuries in 4 or more segments of hepatic injuries. For the successful NOM of blunt hepatic injury type IIIb in patients who are hemodynamically stable after fluid resuscitation, a strong suspicion of concurrent hepatic vein injury is critical in the early phase, and laceration in 4 or more segments should be noted in the late phase. (author)

Dose-reduced CT with model-based iterative reconstruction in evaluations of hepatic steatosis: How low can we go?

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Yasaka, Koichiro, E-mail: koyasaka@gmail.com [Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Katsura, Masaki [Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Akahane, Masaaki [NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 (Japan); Sato, Jiro [Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Matsuda, Izuru [Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8510 (Japan); Ohtomo, Kuni [Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan)

2014-07-15

Purpose: To determine whether dose-reduced CT with model-based iterative image reconstruction (MBIR) is a useful tool with which to diagnose hepatic steatosis. Materials and methods: This prospective clinical study approved by our Institutional Review Board included 103 (67 men and 36 women; mean age, 64.3 years) patients who provided written informed consent to undergo unenhanced CT. Images of reference-dose CT (RDCT) with filtered back projection (R-FBP) and low- and ultralow-dose CT (dose-length product; 24 and 9% of that of RDCT) with MBIR (L-MBIR and UL-MBIR) were reconstructed. Mean CT numbers of liver (CT[L]) and spleen (CT[S]), and quotient (CT[L/S]) of CT[L] and CT[S] were calculated from selected regions of interest. Bias and limits of agreement (LOA) of CT[L] and CT[L/S] in L-MBIR and UL-MBIR (vs. R-FBP) were assessed using Bland–Altman analyses. Diagnostic methods for hepatic steatosis of CT[L] < 48 Hounsfield units (HU) and CT[L/S] < 1.1 were applied to L-MBIR and UL-MBIR using R-FBP as the reference standard. Results: Bias was larger for CT[L] in UL-MBIR than in L-MBIR (−3.18 HU vs. −1.73 HU). The LOA of CT[L/S] was larger for UL-MBIR than for L-MBIR (±0.425 vs. ±0.245) and outliers were identified in CT[L/S] of UL-MBIR. Accuracy (0.92–0.95) and the area under the receiver operating characteristics curve (0.976–0.992) were high for each method, but some were slightly lower in UL-MBIR than L-MBIR. Conclusion: Dose-reduced CT reconstructed with MBIR is applicable to diagnose hepatic steatosis, however, a low dose of radiation might be preferable.

Computed tomographic evaluation of the portal vein in the hepatomas

Energy Technology Data Exchange (ETDEWEB)

Lee, Kee Hyung; Lee, Seung Chul; Bae, Man Gil; Seo, Heung Suk; Kim, Soon Yong; Lee, Min Ho; Kee, Choon Suhk; Park, Kyung Nam [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1986-10-15

Computed tomography and pornographic findings of 63 patients with hepatoma, undergone hepatic angiography and superior mesenteric pornography for evaluation of tumor and thrombosis of portal vein and determination of indication of transcatheter arterial embolization for palliative treatment of hepatoma from April, 85 to June, 86 in Hanyang university hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis was detected during photography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the liver showed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liver revealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2. Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence of portal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal vein thrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did not reveal contrast enhancement. 4. CT revealed well the evidence of obstructions in the cases of portal vein thrombosis and the findings were well-corresponded to the findings of the superior mesenteric photography. 5. Five of the cases of the portal vein thrombosis were missed in the CT and the causes were considered as due to partial volume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases with occlusion of main portal vein showed cavernous transformation and they were noted as multiple small enhanced vascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a useful modality to detect the changes of the portal veins in the patients of the hepatoma.

Computed tomographic evaluation of the portal vein in the hepatomas

International Nuclear Information System (INIS)

Lee, Kee Hyung; Lee, Seung Chul; Bae, Man Gil; Seo, Heung Suk; Kim, Soon Yong; Lee, Min Ho; Kee, Choon Suhk; Park, Kyung Nam

1986-01-01

Computed tomography and pornographic findings of 63 patients with hepatoma, undergone hepatic angiography and superior mesenteric pornography for evaluation of tumor and thrombosis of portal vein and determination of indication of transcatheter arterial embolization for palliative treatment of hepatoma from April, 85 to June, 86 in Hanyang university hospital, were reviewed. The results were as follows: 1. In 36 cases, portal vein thrombosis was detected during photography. Nineteen of 37 cases which revealed localized hepatoma in the right lobe of the liver showed portal vein thrombosis; 9 of 11 cases of the left lobe; 8 of 14 cases which were involved in entire liver revealed thrombosis. One case localized in the caudate lobe showed no evidence of invasion to portal vein. 2. Twenty-four of 34 cases with diffuse infiltrative hepatoma revealed portal vein thrombosis and the incidence of portal vein thrombosis in this type were higher than in the cases of the nodular type. 3. The portal vein thrombosis appeared as filling defects of low density in the lumen of the portal veins in CT and they did not reveal contrast enhancement. 4. CT revealed well the evidence of obstructions in the cases of portal vein thrombosis and the findings were well-corresponded to the findings of the superior mesenteric photography. 5. Five of the cases of the portal vein thrombosis were missed in the CT and the causes were considered as due to partial volume effect of enhanced portal vein with partial occlusion or arterioportal shunts. 6. Six of 13 cases with occlusion of main portal vein showed cavernous transformation and they were noted as multiple small enhanced vascularities around the porta hepatis in the CT. According to the results, we conclude that CT is a useful modality to detect the changes of the portal veins in the patients of the hepatoma.

Transection of the hepatic parenchyma associated or not with the contralateral portal vein branch ligature and its effect in liver regeneration.

Science.gov (United States)

Wiederkehr, Henrique de Aguiar; Wiederkehr, Julio Cesar; Collaço, Luiz Martins; Sousa, Eros Luiz de; Salvalaggio, Paolo; Carvalho, Caroline Aragão de; Wiederkehr, Barbara de Aguiar; Marques, Camila Aparecida Moraes; Rosa, Francielle França da; Nanni, Felipe de Negreiros; Fuchs, Taíse

2017-01-01

To analyze the influence of portal vein ligation in hepatic regeneration by immunohistochemical criteria. Ten pigs divided into two groups of five animals underwent hepatectomy in two stages, and the groups were differentiated by ligation or not of the left portal vein tributary, which is responsible for vascularization of the left lateral and medial lobes of the pig liver. Five days after the procedure, the animals underwent liver biopsies for further analysis of histological and immunohistochemical with marker Ki67. The group submitted to hepatectomy with vascular ligation showed an increase of approximately 4% of hepatocytes in regeneration status, as well as a greater presence of Kupffer and inflammatory cells as compared to control. As a result of positive cell replication observed through the Ki67 marker, we can suspect that the ligation of a tributary of the portal vein associated with liver resection promoted a greater stimulus of liver regeneration when compared to liver resection alone. Analisar a influência da ligadura da tributária da veia porta no estímulo regenerativo hepático por meio de critérios imuno-histoquímicos. Dez suínos, divididos em dois grupos de cinco animais, foram submetidos à hepatectomia em dois estágios, sendo que os grupos foram diferenciados pela ligadura ou não da tributária da veia porta, responsável pela vascularização dos lobos lateral e medial esquerdos do fígado do suíno. Cinco dias após o procedimento, os animais foram reabordados para retirada de amostras hepáticas para posterior análise de histológica e imunoistoquímica com o marcador Ki67. O grupo submetido à hepatectomia com ligadura vascular apresentou incremento de 4% aproximadamente de hepatócitos em processo de regeneração, bem como grande número de células de Kupffer e células inflamatórias, quando comparado ao controle. Em virtude da análise positiva da replicação celular observada por meio do marcador Ki67, pode-se observar que a

Are hepatic portal venous system components distributed equally to the liver? A MDCT study

International Nuclear Information System (INIS)

Incedayi, M.; Aribal, S.; Sivrioglu, A.; Sonmez, G.; Ozturk, E.; Yalcin, B.; Basekim, C.

2012-01-01

Full text: Objective: We aimed to evaluate the relationships between the splenic index, right and left hepatic lobe volumes, diameters of splenic vein (SV), superior mesenteric vein (SMV) and the portal vein (PV) by Multidetector Computerized Tomography (MDCT). We also investigated indirect signs of portal venous flow pattern using these parameters. Material and method: Following their contrast thoracoabdominal and abdominal 64-MDCT examinations, the images of 100 cases (61 males and 39 females) were evaluated retrospectively. The patients who were included in the study ranged from age 20 to 88 (mean age: 41,78). For each case, the splenic index, total hepatic volume, left and right hepatic volumes were calculated on the post-contrast portal venous phase (50th sec) images. Cases without any known liver and spleen diseases were included in the study. Spearman and Pearson's correlation tests were carried out with the purpose of determining the relationships between the variables. Results: A statistically significant relationship between the splenic index and left hepatic lobe volume and total volume was demonstrated (p=0.001). Positive correlations between the left hepatic lobe volume and splenic index (r=0.55) and between the right hepatic lobe volume and splenic index (r=0.32) were also exhibited. However, the correlation between the left hepatic lobe volume and the splenic index was relatively stronger compared to the correlation between the right hepatic lobe volume and the splenic index (r=0.55 versus r= 0.32). Between the diameter of the SMV and right hepatic lobe volume a statistically significant relation was demonstrated (p<0.0001), and according to Pearson's correlation analysis, a positive correlation of medium strength (r=0.36) was observed. Conclusion: In our study, the MDCT findings revealed statistically significant relations between the splenic index and the left lobe volume and between the diameter of the SMV and the right lobe volume. Information

Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion

International Nuclear Information System (INIS)

Kawamata, Hiroshi; Kumazaki, Tatsuo; Kanazawa, Hidenori; Takahashi, Shuji; Tajima, Hiroyuki; Hayashi, Hiromitsu

2000-01-01

A 23-year-old woman with liver cirrhosis secondary to primary sclerosing cholangitis was referred to us for the treatment of recurrent bleeding from esophageal varices that had been refractory to endoscopic sclerotherapy. Her portal vein was occluded, associated with cavernous transformation. A transjugular intrahepatic portosystemic shunt (TIPS) was performed after a preprocedural three-dimensional computed tomographic angiography evaluation to determine feasibility. The portal vein system was recanalized and portal blood flow increased markedly after TIPS. Esophageal varices disappeared 3 weeks after TIPS. Re-bleeding and hepatic encephalopathy were absent for 3 years after the procedure. We conclude that with adequate preprocedural evaluation, TIPS can be performed safely even in patients with portal vein occlusion associated with cavernous transformation.

High Incidence of Hepatitis B Infection-Associated Cirrhosis and Hepatocellular Carcinoma in the Southeast Asian Patients with Portal Vein Thrombosis

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Auewarakul Chirayu U

2011-06-01

Full Text Available Abstract Background Portal vein thrombosis (PVT is a rare condition associated with serious morbidity and mortality. The objective of this study was to determine the frequency, clinical presentations, and risk factors of PVT from the set of data firstly collected among the Southeast Asian population. Methods A retrospective study was undertaken to identify patients diagnosed with thrombosis of the portal system and other abdominal veins. The hospital medical records were retrieved based on the selected ICD-10 codes. Clinical presentations were collected and risk factors determined. Results From 2000-2009, 467 hospital charts with designated ICD-10 codes of I81, I82.2, I82.3, I82.8, I82.9, or K55.0 were identified. PVT (I81 was the most common thrombosis (194 cases, 41.54%. The majority of PVT patients were males (65%, older than 40 years (75%, and presented with abdominal distension/ascites (69%, splenomegaly (54.6%, and abdominal pain (50.5%. Overall, the predominant risk factor was hepatocellular carcinoma (HCC (52.5%, followed by liver cirrhosis without cancer (9.3%, abdominal infection/inflammation (9.3%, cholangiocarcinoma (8.2%, and abdominal intervention (7.7%. In young patients, abdominal interventions including umbilical catheterization (23.1% and hepatectomy (7.7% were the most frequent risks whereas in older cases, primary hepatobiliary cancer and cirrhosis (78% were the major risks. Liver metastases from other organs were infrequently found. Chronic hepatitis B virus (HBV infection was the main etiology associated with cirrhosis/HCC leading to PVT in this cohort. A third of the older PVT patients (age >40 had HBV and very few carried hepatitis C virus (HCV whereas none of the young PVT patients (age Conclusion HBV is the major risk of PVT in the Southeast Asian population. Several risk factors identified in this population have rarely been described and some are remarkably different from those reported in the West. Host and

Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

Directory of Open Access Journals (Sweden)

D. Henne-Bruns

1993-01-01

four or more organs. Additionally, in 11.8% of these cases (n = 8 a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1 was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68 and 0% for patients with additional portal venous injuries.

Anatomical variations of the thymus in relation to the left brachiocephalic vein, findings of necropsia.

Science.gov (United States)

Plaza, Oscar Alonso; Moreno, Freddy

2018-04-01

Two cases of anatomical variations of the thymus are presented with respect to the anatomical relations with the left brachiocephalic vein and found during the necropsy process. Less than 2 days after birth with Noonan Syndrome, when the left brachiocephalic vein was scanning behind the upper thymus horns, there were other adjacent lesions consisting of three supernumerary spleens and three hepatic veins. The second case was an 8-year-old infant with child malpractice who died from urinary sepsis due to obstructive uropathy, in which case the upper lobes of the thymus were fused and formed a ring through which the left brachiocephalic vein passed. Copyright © 2018 Elsevier B.V. All rights reserved.

Reinforced long saphenous vein bypass graft for infrainguinal reconstruction procedures: case series and literature review.

LENUS (Irish Health Repository)

Hynes, Niamh

2006-03-01

Poor rehabilitation rates and the high-cost of managing postamputation patients justify an aggressive revascularization policy in critical lower limb ischemia. Endovascular therapy is our first choice for limb salvage in these patients. However there are patients for whom endovascular therapy is not feasible. When bypass is necessary, autologous vein is a superior conduit to synthetic material. However, varicosities usually contraindicate autologous vein bypass because of the risk of aneurysm formation, rupture and increased intimal hyperplasia compared with nonvaricose venous grafts. We report the use of varicosed long saphenous vein (LSV) with external Dacron support in infrainguinal bypass procedures for limb salvage, where endovascular therapy was not feasible. The external Dacron tube was not brought close to the distal anastomotic area itself. With a mean follow-up of 18 months, duplex ultrasonography and computed tomography angiography showed no evidence of stenosis of the reinforced vein segments or aneurysmal degeneration of the residual vein. External reinforcement with Dacron prosthesis allows the use of autogenous greater saphenous veins with varicose dilatation without compromising graft patency and limb salvage.

Hepatic sinusoidal obstruction syndrome caused by herbal medicine: CT and MRI features

International Nuclear Information System (INIS)

Zhou, Hua; Lou, Hai Yan; Wang, Yi Xiang J.; Xu, Xiao Jun; Zhang, Min Ming

2014-01-01

To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

Hepatic sinusoidal obstruction syndrome caused by herbal medicine: CT and MRI features

Energy Technology Data Exchange (ETDEWEB)

Zhou, Hua; Lou, Hai Yan [Dept. of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China); Wang, Yi Xiang J. [Dept. of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China); Xu, Xiao Jun; Zhang, Min Ming [Dept. of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China)

2014-04-15

To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

Positron emission tomography of hepatic first-pass metabolism of ammonia in pig

DEFF Research Database (Denmark)

Keiding, S; Munk, O L; Roelsgaard, K

2001-01-01

Hepatic first-pass metabolism plays a key role in metabolic regulation and drug metabolism. Metabolic processes can be quantified in vivo by positron emission tomography scanning (PET). We wished to develop a PET technique to measure hepatic first-pass metabolism of ammonia. Seven anaesthetised...... pigs were given positron-labelled ammonia, (13)NH(3), into the portal vein and into the vena cava as successive 2-min infusions followed by 22-min dynamic liver scanning. Vena cava infusion data were used to account for recirculation of tracer and metabolites following the portal vein infusion...

Anatomic relationship of intrahepatic bile ducts to portal veins revisited

International Nuclear Information System (INIS)

Bret, P.M.; Stempel, J.; Atri, M.; Lough, J.O.; Illescas, F.F.

1987-01-01

It is well accepted that intrahepatic bile ducts lie in front of corresponding portal vein branches. Since the authors' clinical experience with US was different, they studied 18 normal necropsy cadaver livers. The common bile duct, main portal vein, and hepatic artery were cannulated and injected respectively with air, dilute contrast medium, and mineral oil. The livers were then examined in anatomic position with CT. In the left lobe of the liver, the bile ducts were anterior to the portal vein in seven cases, posterior in seven cases, and were tortuous both anterior and posterior in three cases. In the right lobe, the bile ducts were anterior in nine cases, posterior in five cases, tortuous in one case, and not seen in two cases. In the porta hepatis, the bile ducts were anterior in eight cases, posterior in one case, tortuous in five cases, and not seen in three cases. Histologic specimens confirmed the anterior and posterior location of the bile ducts relative to the portal veins. In conclusion, intrahepatic bile ducts can be either anterior or posterior to the corresponding portal vein branches

Transsinusoidal Portal Vein Embolization with Ethylene Vinyl Alcohol Copolymer (Onyx): A Feasibility Study in Pigs

Energy Technology Data Exchange (ETDEWEB)

Smits, Maarten L. J., E-mail: m.l.j.smits-3@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology (Netherlands); Vanlangenhove, Peter, E-mail: peter.vanlangenhove@uzgent.be; Sturm, Emiel J. C., E-mail: ejcsturm@gmail.com [Ghent University Hospital, Department of Vascular and Interventional Radiology (Belgium); Bosch, Maurice A. A. J. van den, E-mail: mbosch@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology (Netherlands); Hav, Monirath, E-mail: hav.monirath@gmail.com; Praet, Marleen, E-mail: marleen.praet@ugent.be [Ghent University Hospital, N. Goormaghtigh Institute of Pathology (Belgium); Vente, Maarten A. D., E-mail: m.vente@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology (Netherlands); Snaps, Frederic R., E-mail: fsnaps@ulg.ac.be [University of Liege, Department of Clinical Sciences, Faculty of Veterinary Medicine (Belgium); Defreyne, Luc, E-mail: luc.defreyne@ugent.be [Ghent University Hospital, Department of Vascular and Interventional Radiology (Belgium)

2012-10-15

Purpose: Portal vein embolization is performed to increase the future liver remnant before liver surgery in patients with liver malignancies. This study assesses the feasibility of a transsinusoidal approach for portal vein embolization (PVE) with the ethylene vinyl alcohol copolymer, Onyx. Methods: Indirect portography through contrast injection in the cranial mesenteric artery was performed in eight healthy pigs. Onyx was slowly injected through a microcatheter from a wedged position in the hepatic vein and advanced through the liver lobules into the portal system. The progression of Onyx was followed under fluoroscopy, and the extent of embolization was monitored by indirect portography. The pigs were euthanized immediately (n = 2), at 7 days (n = 4), or at 21 days postprocedure (n = 2). All pigs underwent necropsy and the ex vivo livers were grossly and histopathologically analyzed. Results: Transsinusoidal PVE was successfully performed in five of eight pigs (63%). In 14 of 21 injections (67%), a segmental portal vein could be filled completely. A mean of 1.6 liver lobes per pig was embolized (range 1-2 lobes). There were no periprocedural adverse events. Focal capsular scarring was visible on the surface of two resected livers, yet the capsules remained intact. Histopathological examination showed no signs of recanalization or abscess formation. Mild inflammatory reaction to Onyx was observed in the perivascular parenchyma. Conclusions: The porcine portal vein can be embolized through injection of Onyx from a wedged position in the hepatic vein. Possible complications of transsinusoidal PVE and the effect on contralateral hypertrophy need further study.

Basic anatomic study of transjugular intrahepatic portosystemic shunt by direct transcaval approach

International Nuclear Information System (INIS)

Wu Xia; Xu Ke

2007-01-01

Objective: To investigate the indications and related anatomic foundation of transjugular intrahepatic portosystemic shunt (TIPS) through direct transcaval approach, and to evaluate the safety, feasibility and clinical significance. Methods: Sixty four patients diagnosed as hepatocirrhosis clinically were involved, including the function of liver Child B (n=40), Child C (n=24). After 2 phrase of hepatic CT enhancement scanning and postprocessing through multiple planner reconstruction (MPR) and curve planner reconstruction (CPR), the data were conjugated statistically by ANOVA. Results: The length of the intrahepatic segment of the inferior cava in Child B is longer than that in Child C (P<0.05). Referring the points of hepatic vein entrance to vena cava as A1, 2 cm away from right hepatic vein as A2, the crotch of portal vein as B1, 2 cm away from right portal vein as B2. The length of A1B1 is shorter than that of A2B1(P<0.05). The angle between A1B2 and right portal vein is smaller than that of A2B2 and right portal vein (P<0.05). Conclusion: Transcaval TIPS creation is safe and feasible, providing the direct transcaval approach as a favorable fluent patency way and less influence on hemodynamics in comparison with traditional TIPS. (authors)

Hepatic parenchymal atrophy induction for intractable segmental bile duct injury after liver resection.

Science.gov (United States)

Hwang, Shin; Park, Gil-Chun; Ha, Tae-Yong; Ko, Gi-Young; Gwon, Dong-Il; Choi, Young-Il; Song, Gi-Won; Lee, Sung-Gyu

2012-05-01

Liver resection can result in various types of bile duct injuries but their treatment is usually difficult and often leads to intractable clinical course. We present an unusual case of hepatic segment III duct (B3) injury, which occurred after left medial sectionectomy for large hepatocellular carcinoma and was incidentally detected 1 week later due to bile leak. Since the pattern of this B3 injury was not adequate for operative biliary reconstruction, atrophy induction of the involved hepatic parenchyma was attempted. This treatment consisted of embolization of the segment III portal branch to inhibit bile production, induction of heavy adhesion at the bile leak site and clamping of the percutaneous transhepatic biliary drainage (PTBD) tube to accelerate segment III atrophy. This entire procedure, from liver resection to PTBD tube removal took 4 months. This patient has shown no other complication or tumor recurrence for 4 years to date. These findings suggest that percutaneous segmental portal vein embolization, followed by intentional clamping of external biliary drainage, can effectively control intractable bile leak from segmental bile duct injury.

A new venous conduit utilizing the recipient portal vein branches for segment V in adult partial liver transplantation.

Science.gov (United States)

Moon, I S; Kim, D G; Lee, M D; Hong, S K; Park, S C; Oh, D Y; Ahn, S T; Lee, Y J

2005-03-01

Right anterior-medial lobe congestion due to temporary clamping of segment V and/or VIII is common in the operative theater during adult donor right lobe liver transplantation, the most common procedure in our institute. We have used an autogenous saphenous vein conduit to recipient portal vein tributaries in 15 cases, as a "Y-to-I venoplasty" since January 2004. The recipient portal vein is transected 5 mm proximal to its bifurcation and extended to both sides with partial hepatic dissection. The "Y-to-I venoplasty" is made by suture closure of the portal vein transversely to form a tube. The average length is 7.5 cm with a 1.3 cm width. One end of "Y-to-I venoplasty" conduit is anastomosed to the donor segment V branch on the back table. And the other end is anastomosed directly to the IVC via a new window or the middle hepatic vein stump in recipient. The phase distension of the conduit with respiration is noted in the operative field. A 6/15 (40%) patency rate, was observed by CT angiography at the second postoperative week. All-patient conduits showed good flow on serial examinations at the 60th postoperative day. This new venous graft, made of recipient portal vein is a good conduit for segment V decongestion in adult right lobe partial liver transplantation.

Gd-DTPA-enhanced MR venography for varicose veins of the calf

International Nuclear Information System (INIS)

Kohata, Yoshiko; Naito, Akira; Ito, Katuhide.

1995-01-01

2D time-of-flight MR venography (2D TOF MRV) was performed in 16 patients (25 calves) with varicose veins and 2 volunteers (4 calves), and compared with venography. Sequential SPGR (TR/TE/FA=45 ms/7 ms/60deg) transverse images and/or GRASS (TR/TE/FA=100 ms/13 ms/60deg) transverse images were obtained for MRV. Superior presaturation pulse (S-SAT) was placed in 21 calves, and 0.05 mmol/kg Gd-DTPA was used in all calves. Projection MRVs were generated with maximum intensity projection (MIP) reconstruction. Regarding sequence parameter, S-SAT was useful to eliminate signal from artery that would obscure the signal of deep veins. The detectability of deep veins was improved with the use of S-SAT. In the comparison with venography, MRV could more clearly demonstrate varicose veins more than 5 mm in diameter and their drainage veins than venography. But it could not so clearly demonstrate deep veins as venography. It could not detect fine varicose veins less than 5 mm in diameter and connecting veins with valve insufficiency. In the examination of varicose veins, detection of deep veins, large varicose veins and their main drainage veins is clinically important, because diagnosis of patency of deep veins and dilatation of the drainage veins is necessary to choose the treatment, concluding conservative therapy, stripping and sclerotherapy. However, detection of fine varicose veins and connecting veins are not so important because those veins seldom need treatment. MRV was not so suitable for detection of deep veins, but very useful for detection of varicose veins more than 5 mm in diameter and their main drainage veins. In conclusion, MRV is non-invasive and effective method in varicose veins of calf, and it can take the place of venography with the improvement of deep vein detectability. (author)

Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry

NARCIS (Netherlands)

Hikspoors, Jill P. J. M.; Peeters, Mathijs M. J. P.; Kruepunga, Nutmethee; Mekonen, Hayelom K.; Mommen, Greet M. C.; Köhler, S. Eleonore; Lamers, Wouter H.

2017-01-01

Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular

Adopting wedge hepatic venography with CO2 during transjugular intrahepatic portosystemic shunt procedures

International Nuclear Information System (INIS)

Zhang Linpeng; Chen Songtao; Shi Xiulan

2012-01-01

Objective: To renovate angiography in identifying portal vein anatomy during transjugular intrahepatic portosystemic shunt (TIPS) procedures, saving the time of TIPS procedures, decreasing the risk of the complications of the post-procedure. Methods: The difference between the Wedge hepatic venography with Carbon Dioxide in 6 cases and Inferior Mesenteric artery angiography in 7 cases during TIPS procedures were compared in the identification of portal vein anatomy. The quality of images, their effects on the procedures, the complications and the recovery post-procedure were evaluated. Results: Using CO 2 , the portal veins were opacified in all 6 cases. TIPS procedures succeeded in all cases except 1 case because of poor coagulation function. Using Inferior Mesenteric artery angiography, the portal veins were opacified in all 7 cases. TIPS procedure succeeded in all cases except 1 case because of chronic portal occlusion. Puncture-site hematoma occurred in 1 case after TIPS procedure. Conclusion: Wedge hepatic venography with Carbon Dioxide is superior, safer and more convenient than Inferior Mesenteric Artery angiography in identifying portal vein anatomy during TIPS. (authors)

Computed tomographic and ultrasonographic diagnosis of portal vein tumor thrombus in hepatocellular carcinoma

Energy Technology Data Exchange (ETDEWEB)

Mori, H; Futagawa, S; Hayashi, K; Amagasaki, Y; Ochi, M [Nagasaki Univ. (Japan). School of Medicine

1982-04-01

Nine cases of hepatocellular carcinoma which have invaded the intra- and extrahepatic portal vein were evaluated by computed tomography (CT) and ultrasonography (US). The outstanding CT and sonographic features of the portal vein tumor thrombus were described. In CT, contrast opacification of normal portal vein and its major tributaries were not observed, and they were replaced by a soft tissue density mass representing the tumor thrombus. The thrombus measured 35 - 45 Hounsfield units (HU) in precontrast scans and 60 - 80 HU in postcontrast scans. The portal vein tumor thrombus showed a branched pattern of low density in porta hepatis and intrahepatic region due to differences in attenuation coefficients of the thrombus and adjacent noncancerous hepatic parenchyma on postcontrast scans. In ultrasound study, tumor thrombus was recognized as an echogenic solid mass in the porta hepatis obliterating the normal portal venous structures, or as an intraluminal solid mass in the dilated portal vein and its branches. Numerous collateral venous channels surrounding the thrombosed portal vein were also demonstrated on both CT and US. Particular emphasis was placed on the clinical implications of these non-invasive detection of the portal vein tumor thrombosis in patients with hepatocellular carcinoma.

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver.

Science.gov (United States)

de Leede, Eleonora M; Burgmans, Mark C; Martini, Christian H; Tijl, Fred G J; van Erkel, Arian R; Vuyk, Jaap; Kapiteijn, Ellen; Verhoef, Cornelis; van de Velde, Cornelis J H; Vahrmeijer, Alexander L

2016-07-31

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Resolution of Large Azygos Vein Aneurysm Following Stent-Graft Shunt Placement in a Patient with Ehlers-Danlos Syndrome Type IV

International Nuclear Information System (INIS)

D'Souza, Estelle S.; Williams, David M.; Deeb, G.M.; Cwikiel, Wojciech

2006-01-01

Ehlers-Danlos syndrome (EDS) type IV is a rare connective tissue disorder associated with thin-walled, friable arteries and veins predisposing patients to aneurysm formation, dissection, fistula formation, and vessel rupture. Azygos vein aneurysm is an extremely rare condition which has not been reported in association with EDS in the literature. We present a patient with EDS type IV and interrupted inferior vena cava (IVC) with azygos continuation who developed an azygos vein aneurysm. In order to decrease flow through the azygos vein and reduce the risk of aneurysm rupture, a stent-graft shunt was created from the right hepatic vein to the azygos vein via a transhepatic, retroperitoneal route. At 6 month follow-up the shunt was open and the azygos vein aneurysm had resolved

Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

International Nuclear Information System (INIS)

Cao Wei; Li Jing; Wu Zhiqun; Zhou Changxi; Liu Xi; Wan Yi; Duan Yunyou

2013-01-01

Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 °C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 °C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

Energy Technology Data Exchange (ETDEWEB)

Cao Wei, E-mail: cawe-001@163.com [Tangdu Hospital, The Fourth Military Medical University, Department of Interventional Radiology (China); Li Jing, E-mail: lijing02@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Burn and Plastic Surgery (China); Wu Zhiqun, E-mail: zhiqunwu@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Interventional Radiology (China); Zhou Changxi, E-mail: changxizhou@163.com [Chinese PLA General Hospital, Department of Respiratory Disease (China); Liu Xi, E-mail: xiliu@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Ultrasound Diagnostics (China); Wan Yi, E-mail: yiwan@163.com [The Fourth Military Medical University, Department of Health Statistics, Institute for Health Informatics (China); Duan Yunyou, E-mail: yunyouduan@fmmu.edu.cn [Tangdu Hospital, The Fourth Military Medical University, Department of Ultrasound Diagnostics (China)

2013-06-15

Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 Degree-Sign C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 Degree-Sign C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

Circulating Elastin Fragments Are Not Affected by Hepatic, Renal and Hemodynamic Changes, But Reflect Survival in Cirrhosis with TIPS.

Science.gov (United States)

Nielsen, M J; Lehmann, J; Leeming, D J; Schierwagen, R; Klein, S; Jansen, C; Strassburg, C P; Bendtsen, F; Møller, S; Sauerbruch, T; Karsdal, M A; Krag, A; Trebicka, J

2015-11-01

Progressive fibrosis increases hepatic resistance and causes portal hypertension with complications. During progressive fibrosis remodeling and deposition of collagens and elastin occur. Elastin remodeling is crucially involved in fibrosis progression in animal models and human data. This study investigated the association of circulating elastin with the clinical outcome in cirrhotic patients with severe portal hypertension receiving transjugular intrahepatic porto-systemic shunt (TIPS). We analyzed portal and hepatic venous samples of 110 cirrhotic patients obtained at TIPS insertion and 2 weeks later. The circulating levels of elastin fragments (ELM) were determined using specific monoclonal ELISA. The relationship of ELM with clinical short-time follow-up and long-term outcome was investigated. Circulating levels of ELM showed a gradient across the liver before TIPS with higher levels in the hepatic vein. Interestingly, the circulating ELM levels remained unchanged after TIPS. The circulating levels of ELM in portal and hepatic veins correlated with platelet counts and inversely with serum sodium. Hepatic venous levels of ELM were higher in CHILD C compared to CHILD A and B and were associated with the presence of ascites. Patients with high levels of ELM in the hepatic veins before TIPS showed poorer survival. In multivariate analysis ELM levels in the hepatic veins and MELD were independent predictors of mortality in these patients. This study demonstrated that circulating levels of ELM are not associated with hemodynamic changes, but might reflect fibrosis remodeling and predict survival in patients with severe portal hypertension receiving TIPS independently of MELD.

Interferon-induced central retinal vein thrombosis

International Nuclear Information System (INIS)

Nazir, L.; Husain, A.; Haroon, W.; Shaikh, M.I.; Mirza, S.A.; Khan, Z.

2012-01-01

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy. (author)

Interferon-induced central retinal vein thrombosis

Energy Technology Data Exchange (ETDEWEB)

Nazir, L; Husain, A; Haroon, W; Shaikh, M I; Mirza, S A; Khan, Z

2012-11-15

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy. (author)

Two cases of esophageal cancer with portal hypertension: esophagectomy with venous shunt procedure.

Science.gov (United States)

Kato, T; Motohara, T; Kaneko, Y; Shikishima, H; Okushiba, S; Kondo, S; Kato, H

2001-01-01

We performed venous shunt procedure in the reconstruction of the esophagus after esophagectomy using the gastric tube in two cases of esophageal cancer with portal hypertension due to liver cirrhosis. In both cases, the short-term postoperative course was uneventful, without congestion in the gastric tube. In Case 1 where the short gastric vein had been used as the shunt vein, the long-term postoperative course was also uneventful, without hepatic encephalopathy or hemorrhage from deterioration of the varices of the gastric tube. However, in Case 2 where the left gastroepiploic vein had been used, hepatic encephalopathy developed due to excessive shunt flow. These results suggested that appropriate shunt flow could be expected by using short gastric vein.

Surgical outcomes of hepatocellular carcinoma invading hepatocaval confluence.

Science.gov (United States)

Li, Wei; Wu, Hong; Han, Jun

2016-12-01

Combined liver and inferior vena cava (IVC) resection followed by IVC and/or hepatic vein reconstruction (HVR) is a curative operation for selected patients with hepatocellular carcinoma (HCC) invading the hepatocaval confluence. The present study aimed to elucidate the prognostic factors for patients with HCC invading the hepatocaval confluence. Forty-two consecutive patients underwent hepatectomy, combined with IVC replacement and/or HVR for HCC between January 2009 and December 2014 were included in this study. The cases were divided into three groups based on the surgical approaches of HVR: group 1 (n=13), tumor invaded the hepatocaval confluence but with one or two hepatic veins intact in the residual liver, thus only the replacement of IVC, not HVR; group 2 (n=23), the hepatic vein of the residual liver was also partially invaded, and the hepatic vein defect was repaired with patches locally; group 3 (n=6), three hepatic veins at the hepatocaval confluence were infiltrated, and the hepatic vein remnant was re-implanted onto the side of the tube graft. The patient characteristics, intra- and postoperative results, and long-term overall survival were compared among the three groups. The survival-related factors were analyzed by univariate and multivariate analysis. The group 1 had higher preoperative alpha-fetoprotein level (PHVR (PHVR (group 1). HVR was one of the unfavorable prognostic factors of overall survival.

Laparoscopic approach of hepatic hydatid double cyst in pediatric patient: difficulties, indications and limitations

Directory of Open Access Journals (Sweden)

Isabela M. Drăghici

2016-05-01

Full Text Available Purpose: Laparoscopic management analysis of a rare condition having potentially severe evolution, seen in pediatric surgical pathology. Aims: Outlining the optimal surgical approach method of hepatic hydatid double cyst and the laparoscopic method’s limitations. Materials and Methods: The patient is a 6 years old girl that presented with two simultaneous giant hepatic hydatid cysts (segments VII-VIII, having close vicinity to the right branch of portal vein and to hepatic veins; she benefited from a single stage partial pericystectomy Lagrot performed by laparoscopy. Results: The procedure had no intraoperative accidents or incidents. Had good postoperative evolution without immediate or late complications. Trocars positioning had been adapted to the patient’s size and cysts topography. Conclusions: The laparoscopic treatment is feasible and safe, but is not yet the gold standard for a hepatic hydatid disease due to certain inconveniences.

Sclerotherapy of Varicose Veins and Spider Veins

Science.gov (United States)

... Index A-Z Sclerotherapy of Varicose Veins and Spider Veins Sclerotherapy uses injections from a very fine, ... Sclerotherapy? What is Sclerotherapy of Varicose Veins and Spider Veins? Sclerotherapy is a minimally invasive treatment used ...

Metabolic profiles and bile acid extraction rate in the liver of cows with fasting-induced hepatic lipidosis.

Science.gov (United States)

Mohamed, T; Oikawa, S; Iwasaki, Y; Mizunuma, Y; Takehana, K; Endoh, D; Kurosawa, T; Sato, H

2004-04-01

This study was designed to monitor lipid profile in the portal and hepatic blood of cows with fasting-induced hepatic lipidosis, and to compare the results with those in the jugular blood. The work was also carried out to investigate bile acid (BA) in these vessels, and further to investigate BA extraction rate in the liver. Five cows were equipped with catheters in the portal, hepatic and jugular veins (day 0), fasted for 4 days (day 1-day 4) and then refed (day 5-day 11). Before morning feeding, blood was sampled before, during and after fasting from the catheterized vessels. In the portal blood, the concentration of non-esterified fatty acids (NEFA) showed a progressive increase and at day 5 there was an approximate twofold rise. Increased NEFA concentrations were also found similarly in the other two veins. At day 5, beta-hydroxybutyrate (BHBA) in the portal, hepatic and jugular blood rose to 197, 190 and 186% of the pre-fasting value, respectively. However, the concentrations of NEFA and BHBA in the three veins gradually returned to pre-fasting concentration during the refeeding period. Compared with the pre-fasting value at day 0, the content of liver triglyceride (TG) increased significantly at day 5 (P hepatic extraction rate of BA dropped from 3.1 times pre-fasting to 2.2 times during fasting. There were no significant differences in the concentrations of glucose, TG, total cholesterol, cholesterol esters, free cholesterol and phospholipids. The results of the current study show that metabolic alterations occur in the portal, hepatic and jugular veins during induction of hepatic lipidosis in cows, and mostly metabolites, with exception of BA concentration, run parallel. The decreased BA extraction rate in the liver of fasted cows was considered to reflect hepatic cell impairment caused by TG accumulation. Hopefully, the findings, at least in part, contribute to the explanation of the pathophysiology of hepatic lipidosis in dairy cows.

Embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy

International Nuclear Information System (INIS)

Sakurabayashi, Shin; Sezai, Shuichi; Yamamoto, Yoshihiro; Hirano, Masanori; Oka, Hiroshi

1997-01-01

Purpose. To evaluate the efficacy of embolization of portal-systemic shunts in cirrhotic patients with chronic recurrent hepatic encephalopathy (CRHE). Methods. Seven cirrhotic patients with CRHE refractory to medical treatment (3 men and 4 women, mean age 66 years) were studied. Five patients had splenorenal shunts, 1 had a gastrorenal shunt, and 1 had an intrahepatic portal vein-hepatic vein shunt. Shunt embolization was performed using stainless steel coils, with a percutaneous transhepatic portal vein approach in 4 patients and a transrenal vein approach in 3 patients. Results. After embolization, the shunt disappeared in 4 patients on either ultrasound pulsed Doppler monitoring or portography. Complications observed in the 7 patients were fever, transient pleural effusion, ascites, and mild esophageal varices. For 3-6 months after embolization, the 4 patients whose shunts disappeared showed minimal or no reappearance of a shunt, and had no recurrence of encephalopathy. The serum ammonia levels decreased and electroencephalograms also improved. One of the 4 patients, who developed mild esophageal varices, required no treatment. Treatment was effective in 3 of the 4 patients (75%) who underwent embolization via a transhepatic portal vein. Conclusion. Transvascular embolization of shunts improved the outcome in 4 of 7 patients. The most effective embolization was achieved via the percutaneous transhepatic portal vein approach

Full paleostress tensor reconstruction: case study of the Panasqueira Mine, Portugal.

Science.gov (United States)

Pascal, C.; Jaques Ribeiro, L. M.

2017-12-01

Paleostress tensor restoration methods are traditionally limited to reconstructing geometrical parameters and are unable to resolve stress magnitudes. Based on previous studies we further developed a methodology to restore full paleostress tensors. We concentrated on inversion of Mode I fractures and acquired data in Panasqueira Mine, Portugal, where optimal 3D exposures of mineralised quartz veins can be found. To carry out full paleostress restoration we needed to determine (1) pore (paleo)pressure and (2) vein attitudes. To these aims we conducted an extensive fluid inclusion study to derive fluid isochores from the quartz of the studied veins. To further constrain P-T conditions, we combined these isochores with crystallisation temperatures derived from geochemical analyses of coeval arsenopyrite. We also applied the sphalerite geobarometer and considered two other independent pressure indicators. Our results point to pore pressures of 300 MPa and formation depths of 10 km. As a second step, we measured 600 subhorizontal quartz veins in all the levels of the mine. The inversion of the attitudes of the veins allowed for reconstructing the orientations of the principal axes of stress, the unscaled Mohr circle and the relative pore pressure. After merging these results with the previously obtained absolute pore pressure we reconstructed the six parameters of the paleostress tensor.

Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

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Pekindil, Goekhan [Department of Radiology, Trakya University School of Medicine, 22030 Edirne (Turkey); Varol, Fuesun G. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Ali Yuece, M. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Yardim, Turgut [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey)

1999-03-01

Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period.

Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

International Nuclear Information System (INIS)

Pekindil, Goekhan; Varol, Fuesun G.; Ali Yuece, M.; Yardim, Turgut

1999-01-01

Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period

The effect of TACE with endostatin on hemodynamics in hepatic implantation tumor using Doppler ultrasonography

International Nuclear Information System (INIS)

Zhou Guangli; Wu Yuanyuan; Wang Bin; Liu Yan; Zheng Chuanli; Sang Li; Liu Feng

2009-01-01

Objective: To investigate the hemodynamic changes in the rabbit liver and VX2 hepatic implantation tumor after treatment by transcatheter arterial chemoembolization (TACE)/endostatin using Doppler ultrasonography. Methods: Twenty rabbits with VX2 hepatic tumor were randomly distributed into the control group (n=10) and the anti- angiogenesis group (n=10). The rabbits were administered with endostatin and adriamycin-lipiodol in the anti-angiogenesis group and with 37℃ saline in the control group via hepatic artery. The hemodynamic changes of the tumors, hepatic artery, and portal vein were recorded with Doppler ultrasonography 1 week after the treatment. The results before and after the treatment were compared. Results: In the control group, the maximal hepatic artery blood flow velocity was significantly higher than that before the treatment (P<0.05). However, the resistance index and the portal vein blood flow velocities had no significantly change compared with those before the treatment (P>0.05). In the anti-angiogenesis group, the hepatic artery blood flow velocity was significantly lower than that before the treatment (P<0.05), and the resistance index was increased (P<0.05). However, the portal vein blood flow velocity had no significantly change (P>0.05). The blood flow signal in all tumors was rich before embolization. After TACE, the blood flow signal was significantly decreased, even partly disappeared in the anti-angiogenesis group. Conclusion: TACE with endostatin can effectively block the blood supplement of VX2 hepatic implantation tumor. Doppler ultrasonography can detected the blood flow changes and can be used in evaluating the therapeutic effect in hepatic implantation tumor. (authors)

A preliminary discussion of angiographic anatomy and variations of rabbit hepatic vessels and catheterization methods of hepatic artery

International Nuclear Information System (INIS)

Wang Diaodong; Yang Renjie; Zhang Hongzhi; Sun Hongliang

2006-01-01

Objective: To study the normal angiographic anatomy and variations of rabbit hepatic vessels, and explore the optimal method for hepatic artery catheterization. Methods: 30 rabbits were divided into two groups randomly. Modified surgical method and interventional method were used to catheterize hepatic artery respectively, and followed by angiography to demonstrate the normal anatomy and variations of rabbit celiac artery, hepatic artery and portal vein. Results: The route and distribution of rabbit celiac artery and hepatic artery were very different from human's. The commonly seen variation showed the differences in branching bifurcation of hepatic-gastric artery, with the incidence of 13.3%. The rates of successfully hepatic artery catheterization with surgical and interventional methods were 86.6%(13/15) and 80%(12/15) respectively (P>0.05). The surgical method will not be successful, whenever there's variation. Conclusion: The normal anatomy and variation of rabbit celiac artery and hepatic artery are quite different from human's. Both surgical and interventional catheterizations could be rather successful but possessing advantages and disadvantages of each its own. (authors)

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

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Lim, Jae Hoon; Lee, Won Jae [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Dong Ho [Kyunghee University Hospital, Seoul (Korea, Republic of); Nam, Kyung Jin [Donga University College of Medicine, Pusan (Korea, Republic of)

2000-06-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

International Nuclear Information System (INIS)

Lim, Jae Hoon; Lee, Won Jae; Lee, Dong Ho; Nam, Kyung Jin

2000-01-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis

Increase in left liver lobe function after preoperative right portal vein embolisation assessed with gadolinium-EOB-DTPA MRI.

Science.gov (United States)

Geisel, Dominik; Lüdemann, Lutz; Keuchel, Thomas; Malinowski, Maciej; Seehofer, Daniel; Stockmann, Martin; Hamm, Bernd; Gebauer, Bernhard; Denecke, Timm

2013-09-01

To prospectively evaluate the early development of regional liver function after right portal vein embolisation (PVE) with Gd-EOB-DTPA-enhanced MRI in patients scheduled for extended right hemihepatectomy. Ten patients who received a PVE before an extended hemihepatectomy were examined before and 14 days after PVE using Gd-EOB-DTPA-enhanced MRI of the liver. In these sequences representative region of interest measurements were performed in the embolised right (RLL) and the non-embolised left liver lobe (LLL). The volume as well as hepatic uptake index (HUI) was calculated independently for each lobe. Relative enhancement 14 days after PVE decreased in the RLL and increased significantly in the LLL (P DTPA-enhanced MRI, which could reflect the redirected portal venous blood flow and the rapid utilisation of a hepatic functional reserve. • Preoperative portal vein embolisation (PVE) is widely performed before right-sided hepatic resection. • PVE increases intravenous contrast medium uptake in the left lobe of liver. • The hepatic uptake index for the left liver lobe increases rapidly after PVE. • Left liver lobe function increase may be visualised by Gd-EOB-DTPA-enhanced MRI.

Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

International Nuclear Information System (INIS)

Bercu, Zachary L.; Sheth, Sachin B.; Noor, Amir; Lookstein, Robert A.; Fischman, Aaron M.; Nowakowski, F. Scott; Kim, Edward; Patel, Rahul S.

2015-01-01

The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation

Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

Energy Technology Data Exchange (ETDEWEB)

Bercu, Zachary L., E-mail: zachary.bercu@mountsinai.org; Sheth, Sachin B., E-mail: sachinsheth@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Noor, Amir, E-mail: amir.noor@gmail.com [The George Washington University School of Medicine and Health Sciences (United States); Lookstein, Robert A., E-mail: robert.lookstein@mountsinai.org; Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org; Nowakowski, F. Scott, E-mail: scott.nowakowski@mountsinai.org; Kim, Edward, E-mail: edward.kim@mountsinai.org; Patel, Rahul S., E-mail: rahul.patel@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

2015-10-15

The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

Comparison of the image qualities of filtered back-projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction for CT venography at 80 kVp

International Nuclear Information System (INIS)

Kim, Jin Hyeok; Choo, Ki Seok; Moon, Tae Yong; Lee, Jun Woo; Jeon, Ung Bae; Kim, Tae Un; Hwang, Jae Yeon; Yun, Myeong-Ja; Jeong, Dong Wook; Lim, Soo Jin

2016-01-01

To evaluate the subjective and objective qualities of computed tomography (CT) venography images at 80 kVp using model-based iterative reconstruction (MBIR) and to compare these with those of filtered back projection (FBP) and adaptive statistical iterative reconstruction (ASIR) using the same CT data sets. Forty-four patients (mean age: 56.1 ± 18.1) who underwent 80 kVp CT venography (CTV) for the evaluation of deep vein thrombosis (DVT) during 4 months were enrolled in this retrospective study. The same raw data were reconstructed using FBP, ASIR, and MBIR. Objective and subjective image analysis were performed at the inferior vena cava (IVC), femoral vein, and popliteal vein. The mean CNR of MBIR was significantly greater than those of FBP and ASIR and images reconstructed using MBIR had significantly lower objective image noise (p <.001). Subjective image quality and confidence of detecting DVT by MBIR group were significantly greater than those of FBP and ASIR (p <.005), and MBIR had the lowest score for subjective image noise (p <.001). CTV at 80 kVp with MBIR was superior to FBP and ASIR regarding subjective and objective image qualities. (orig.)

Studies on blood supply of liver metastasis with DSA, CT and portal vein perfusion CT during superior mesenteric arterial portography

International Nuclear Information System (INIS)

Li Zhigang; Shi Gaofeng; Huang Jingxiang; Li Shunzong; Liang Guoqing; Wang Hongguang; Han Pengyin; Wang Qi; Gu Tieshu

2008-01-01

Objective: To probe the blood supply of liver metastasis by celiac artery, proper hepatic artery DSA, portal vein perfusion CT during superior mesenteric arterial portography (PCTAP). Methods: One hundred patients with liver metastases were examined prospectively by plain CT scan, multiphase enhanced CT scan, celiac arteriography and proper hepatic arteriography. Of them, 56 patients were examined by PCTAP. All primary lesions were confirmed by operation and (or) pathology examination. In order to investigate the blood supply of metastasis lesions, the software of Photoshop was used to obtain the time-attenuation curves (TDC) of tumor center, tumor edge, portal vein and normal liver parenchyma adjacent to the tumor to calculate liver perfusion for DSA image analysis, while a deconvolution model from CT perfusion software was designed for the dual blood supply. Results: DSA findings: TDC of proper hepatic arteriography showed: the mean peak concentration (K value) in tumor centers was (67 ± 12)%, and it was (76 ± 15)% for peritumor tissue, (51 ± 10)% in normal liver parenchyma. TDC of celiac arteriogaphy showed that the contrast concentration of tumor centers and tumor edge increased fast in early stage, then maintained a slight upward plateau, in the meanwhile, the contrast concentration of normal liver parenchyma kept increasing slowly. PCTAP findings: tumors exhibited no enhancement during 30 s continued scans. Conclusion: The blood supply of liver metastasis mainly comes from hepatic artery, but barely from portal vein. (authors)

Abnormal positioning of multiple abdominal organs with anomalous direct drainage of hepatic vein into the right atrium in a post operative omphalocele patient: A case report

International Nuclear Information System (INIS)

Hyun, Su Jeong; Cho, Bum Sang; Kim, Sung Jin; Lee, Seung Young; Kang, Min Ho; Yi, Kyung Sik

2012-01-01

An omphalocele is a rare congenital anomaly in which the infant's intestines protrude through the navel. Additional anomalies that are associated with omphalocele remain present in as many as 50% of cases, and these anomalies vary greatly from patient to patient. However, the persistent anomalies or abnormal position of the abdominal organs in post operative omphalocele patients have not reported previously. Herein, we report the case of an omphalocele patient with abnormal positioning of the liver, spleen and both kidneys, as well as abnormal drainage of the hepatic vein into the right atrium, which was found during a routine, postoperative follow-up computed tomography scan

Evaluation of portal circulation through the superior mesenteric vein with an enteric capsule of [123I]iodoamphetamine

International Nuclear Information System (INIS)

Shiomi, Susumu; Kuroki, Tetsuo; Miyazawa, Yuko; Ueda, Tadashi; Takeda, Tadashi; Nishiguchi, Shuhei; Nakajima, Shinya; Kobayashi, Kenzo; Ochi, Hironobu

1995-01-01

We report a method by which the contribution of the superior mesenteric vein to the portal blood flow can be evaluated noninvasively. An enteric-coated capsule containing [ 123 I]iodoamphetamine is given by mouth 3h before the examination. The data obtained are treated by computer to calculate the portal shunt index (SI) through the superior mesenteric vein. The SI was higher for more severe liver disorders, increasing in the order of chronic persistent hepatitis, chronic aggressive hepatitis, and cirrhosis. The SI was higher in cirrhotic patients than in chronic hepatitis patients or healthy volunteers (both, P<0.001). The SI was higher in cirrhotic patients with esophageal varices than in such patients without varices (P<0.05). The SI was higher in cirrhotic patients with ascites than in such patients without ascites (P<0.001). The SI was higher in cirrhotic patients with encephalopathy than in those without encephalopathy (P<0.01). Correlation was significant between the SI and classical indicators of functional reserve. This method is clinically useful. (author)

Case Report: Supernumerary right renal vein draining inferior to the ...

African Journals Online (AJOL)

With recent increase in renal transplantations, renovascular reconstructions and imaging advances, meticulous knowledge of the normal and variant anatomy of the renal vasculature is important to avoid potential pitfalls. We report a case of an accessory renal vein arising from the right kidney, and draining into the inferior ...

Microsurgical reconstruction of extensive oncological scalp defects

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Ole eGoertz

2015-09-01

Full Text Available While most small to medium defects of the scalp can be covered by local flaps, large defects or complicating factors like a history of radiotherapy often require a microsurgical reconstruction.Several factors need to be considered in such procedures. A sufficient preoperative planning is based on adequate imaging of the malignancy and a multi-disciplinary concept. Several flaps are available for such reconstructions, of which the latissimus dorsi and anterior lateral thigh flaps are the most commonly used ones.In very large defects, combined flaps such as a parascapular / latissimus dorsi flaps can be highly useful or necessary. The most commonly used recipient vessels for microsurgical scalp reconstructions are the superficial temporal vessels, but various other feasible choices exist. If the concomitant veins are not sufficient, the jugular veins represent a safe backup alternative but require a vessel interposition or long pedicle. Postoperative care and patient positioning can be difficult in these patients but can be facilitated by various devices. Overall, microsurgical reconstruction of large scalp defects is a feasible undertaking if the mentioned key factors are taken into account.

Association between portal vein pressure drop gradient after transjugular intrahepatic portosystemic shunt and clinical prognosis

Directory of Open Access Journals (Sweden)

XU Zhengguo

2016-12-01

Full Text Available ObjectiveTo investigate the association between portal vein pressure drop gradient in patients with cirrhotic portal hypertension treated by transjugular intrahepatic portosystemic shunt (TIPS and clinical prognosis, as well as the ideal range of portal vein pressure drop. MethodsA total of 58 patients who underwent TIPS in Xinqiao Hospital of Third Military Medical University from November 2013 to December 2015 were enrolled. All the patients underwent TIPS and embolization of the gastric coronary vein and the short gastric veins, and the change intervals of portal vein pressure gradient were monitored. The follow-up time ranged from 3 days to 2 years, and the association of portal vein pressure drop gradient with postoperative liver function, splenic function, rebleeding rate, hepatic encephalopathy, and portal hypertensive gastrointestinal diseases was analyzed. The paired t-test was used for comparison of parameters before and after treatment. ResultsThe patients had a significant reduction in liver function on day 3 after surgery. At 2 month after surgery, the levels of TBil was rised and had significant changes［(49.81±27.82μmol/L vs (31.64±17.67 μmol/L,t=5.372,P＜0.001］. At 6 months after surgery, red blood cell count and platelet count had no significant changes，but，white blood cell count was reduced［(3.79±1.37）×109/L vs (4.57±2.24×109/L，t=2.835，P=0.006］. There was a 23% reduction in portal vein pressure after surgery (from 30.62±3.56 mmHg before surgery to 21.21±2.90 mmHg after surgery, t=23.318，P＜0.001. All the patients had varying degrees of relief of gastrointestinal symptoms associated with portal vein hypertension, such as abdominal distension, poor appetite, and diarrhea. Of all patients, none experienced in-stent restenosis or occlusion and 13 experienced hepatic encephalopathy after surgery, which tended to occur at the time when postoperative portal vein pressure was reduced to 14.7-25.7 mmHg, i

Quantitative Assessment of Hepatic Fibrosis by Contrast-enhanced Ultrasonography

Institute of Scientific and Technical Information of China (English)

Ming-bo Zhang; En-ze Qu; Ji-Bin Liu; Jin-rui Wang

2011-01-01

Objective To explore the contrast-enhanced ultrasonographic features for quantitative assessment of hepatic fibrosis.Methods 86 patients with chronic viral hepatitis B were enrolled in this study from March 2007 to August 2009.The patients were classified into 5 groups (S0-S4) according to fibrosis stage evaluated with ultrasound guided liver biopsy.New contrast-enhanced ultrasonography (CEUS) features including area under the time-intensity curve (TIC) of portal venous phase/hepatic arterial phase (Qp/Qa) and intensity of portal venons phase/hepatic arterial phase (Ip/Ia) were used to detect the blood supply ratio (portal vein/hepatic artery) in each group.Arrival time of portal vein trunk (Tp) and decreasing rate of TIC (β) were also analyzed.Results Qp/Qa and Ip/Ia decreased from So to S4,while Tp and β increased These 4 features were significantly correlated with the degree of fibrosis (P＜0.001) and were significantly different among the five groups (P＜0.001).Sensitivity and specificity of Ip/Ia were 80% and 86% for groups ≥S1,75% and 86% for groups ≥ S2,71% and 84% for groups ≥ S3,and 76% and 80% for group S4,respectively.Sensitivity and specificity of Qp/Qa were 70% and 88% for groups ≥ S1,80% and 76% for groups ≥ S2,74% and 70% for groups ≥ S3,and 81% and 95% for group S4,respectively.Conclusion Ip/Ia and Qp/Qa could be adopted as reliable,non-invasive features for quantitative assessment of hepatic fibrosis.

Evaluation of the anomalous retroesophageal left brachiocephalic vein in Chinese children using multidetector CT

Energy Technology Data Exchange (ETDEWEB)

Ming, Zhu; Aimin, Sun; Rui, He [Shanghai Children' s Medical Center, Department of Radiology, Shanghai (China)

2009-04-15

Anomalous retroesophageal left brachiocephalic vein is a very rare anomaly of the brachiocephalic vein. At the time of writing only one case had been reported worldwide. The purpose of this study was to report four cases of anomalous retroesophageal left brachiocephalic vein and to evaluate the utility of multidetector computed tomography (MDCT) for investigation of the anomaly. From June 2005 to May 2008, we examined 2,146 children with congenital heart disease and 4,082 children without congenital heart disease using MDCT. The patients ranged in age from 1 day to 12 years. Maximum intensity projection reconstruction was performed to show the brachiocephalic vein. A retroesophageal left brachiocephalic vein was found in 4 of the 2,146 patients (0.19%) with congenital heart disease and in 0 of the 4,082 patients without congenital heart disease. In all four patients, the condition was confirmed during surgery for the congenital heart disease. MDCT is a good modality for evaluating the anomalous retroesophageal left brachiocephalic vein. An anomalous retroesophageal left brachiocephalic vein was more common in patients with congenital heart disease. (orig.)

Evaluation of the anomalous retroesophageal left brachiocephalic vein in Chinese children using multidetector CT

International Nuclear Information System (INIS)

Ming, Zhu; Aimin, Sun; Rui, He

2009-01-01

Anomalous retroesophageal left brachiocephalic vein is a very rare anomaly of the brachiocephalic vein. At the time of writing only one case had been reported worldwide. The purpose of this study was to report four cases of anomalous retroesophageal left brachiocephalic vein and to evaluate the utility of multidetector computed tomography (MDCT) for investigation of the anomaly. From June 2005 to May 2008, we examined 2,146 children with congenital heart disease and 4,082 children without congenital heart disease using MDCT. The patients ranged in age from 1 day to 12 years. Maximum intensity projection reconstruction was performed to show the brachiocephalic vein. A retroesophageal left brachiocephalic vein was found in 4 of the 2,146 patients (0.19%) with congenital heart disease and in 0 of the 4,082 patients without congenital heart disease. In all four patients, the condition was confirmed during surgery for the congenital heart disease. MDCT is a good modality for evaluating the anomalous retroesophageal left brachiocephalic vein. An anomalous retroesophageal left brachiocephalic vein was more common in patients with congenital heart disease. (orig.)

Pattern of venous collateral development after splenic vein occlusion in an extended Whipple procedure : comparison with collateral vein pattern in cases of sinistral portal hypertension.

Science.gov (United States)

Strasberg, Steven M; Bhalla, Sanjeev; Sanchez, Luis A; Linehan, David C

2011-11-01

The risks of developing sinistral portal hypertension as a result of occlusion of the splenic vein close to its termination during a Whipple procedure are unclear. Our purpose was to compare the pattern of venous collateral development after splenic vein ligation in an extended Whipple procedure with the pattern of collateral development in cases of sinistral portal hypertension. Five patients underwent an extended Whipple procedure in which the splenic vein was divided and not reconstructed. Six to eight months later detailed mapping of venous return from the spleen was determined by contrast-enhanced multidetector computed tomography or in one case by 3D contrast-enhanced MRI. Spleen size and length of residual patent splenic vein were also measured. The literature on sinistral portal hypertension was evaluated to ascertain whether the venous collateral pattern in cases of left-sided portal hypertension was similar to the pattern that developed when the splenic vein was ligated at its termination in the Whipple procedure. A length of splenic vein remained patent in all five patients, measuring 4.5 to 11.5 cm from the spleen. Splenomegaly did not develop. Blood returned from the spleen by multiple collaterals including collaterals in the omentum and mesocolon. These types of collaterals do not develop in sinistral portal hypertension, nor is residual patent splenic vein seen. Ligation of the splenic vein close to its termination in five patients resulted in a pattern of venous return different from patients that have developed left-sided portal hypertension.

[Logistic regression model of noninvasive prediction for portal hypertensive gastropathy in patients with hepatitis B associated cirrhosis].

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Wang, Qingliang; Li, Xiaojie; Hu, Kunpeng; Zhao, Kun; Yang, Peisheng; Liu, Bo

2015-05-12

To explore the risk factors of portal hypertensive gastropathy (PHG) in patients with hepatitis B associated cirrhosis and establish a Logistic regression model of noninvasive prediction. The clinical data of 234 hospitalized patients with hepatitis B associated cirrhosis from March 2012 to March 2014 were analyzed retrospectively. The dependent variable was the occurrence of PHG while the independent variables were screened by binary Logistic analysis. Multivariate Logistic regression was used for further analysis of significant noninvasive independent variables. Logistic regression model was established and odds ratio was calculated for each factor. The accuracy, sensitivity and specificity of model were evaluated by the curve of receiver operating characteristic (ROC). According to univariate Logistic regression, the risk factors included hepatic dysfunction, albumin (ALB), bilirubin (TB), prothrombin time (PT), platelet (PLT), white blood cell (WBC), portal vein diameter, spleen index, splenic vein diameter, diameter ratio, PLT to spleen volume ratio, esophageal varices (EV) and gastric varices (GV). Multivariate analysis showed that hepatic dysfunction (X1), TB (X2), PLT (X3) and splenic vein diameter (X4) were the major occurring factors for PHG. The established regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4. The accuracy of model for PHG was 79.1% with a sensitivity of 77.2% and a specificity of 80.8%. Hepatic dysfunction, TB, PLT and splenic vein diameter are risk factors for PHG and the noninvasive predicted Logistic regression model was Logit P=-2.667+2.186X1-2.167X2+0.725X3+0.976X4.

Focused transhepatic electroporation mediated by hypersaline infusion through the portal vein in rat model. Preliminary results on differential conductivity

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Pañella Clara

2017-11-01

Full Text Available Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE when applied in a transhepatic fashion.

Pelvic Vein Embolisation in the Management of Varicose Veins

International Nuclear Information System (INIS)

Ratnam, Lakshmi A.; Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S.; Hussain, Fuad F.; Whiteley, Mark S.; Lopez, Anthony

2008-01-01

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center

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Priscila Menezes Ferri

2012-03-01

Full Text Available CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5% were male. In 29 patients (52.7%, none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%. In 20 patients (36.4%, the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9% showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an

Post-TIPS Hepatic Encephalopathy Treated by Occlusion Balloon-Assisted Retrograde Embolization of a Coexisting Spontaneous Splenorenal Shunt

International Nuclear Information System (INIS)

Shioyama, Yasukazu; Matsueda, Kiyoshi; Horihata, Koushi; Kimura, Masashi; Nishida, Norifumi; Kishi, Kazushi; Terada, Masaki; Sato, Morio; Yamada, Ryusaku

1996-01-01

A 51-year-old man with posthepatitis cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for bleeding of recurrent esophageal varices. The patient had a coexisting, spontaneous, splenorenal shunt. He subsequently developed hepatic encephalopathy, presumably due to excessive portosystemic shunting. Since medical management resulted in no significant improvement, the splenorenal shunt was embolized from the jugular vein approach via renal vein access during temporary balloon occlusion. Within a few days, the patient's hepatic encephalopathy resolved. Twelve months later the patient showed no recurrence of encephalopathy and had maintained a patent TIPS

Pictorial essay: trans-jugular intra-hepatic porto-systemic shunt (TIPS)

International Nuclear Information System (INIS)

Rao Anuradha, T.N.; Rastogi, H.; Pandey, U.C.

2001-01-01

TIPS is an interventional radiologic method of creating a portosystemic shunt by percutaneous means. It is a relatively new weapon in the armamentarium of the management of portal hypertension with variceal bleeding or intractable ascites. Using needles, angioplasty balloon catheters and expandable metallic stents, a shunt is established directly inside the liver parenchyma connecting a large hepatic vein with a main portal vein branch. Depending on the diameter of the expandable stent used, the created TIPS diverts various amounts of portal blood into the systemic circulation and results in significant portal decompression, cessation of hemorrhage from esophageal varices and resolution of ascites. TIPS is not only an effective and safe alternative to shunt surgery but is life saving in cases of variceal hemorrhage. The use of TIPS seems to be a valid alternative to surgery and has several advantages over either esophageal transection or surgical shunts. TIPS avoids a general anesthetic, laparotomy, and disruption of the hepatic venous system that may adversely affect subsequent hepatic transplantation. TIPS has been performed on patients without interfering with successful transplantation

Evaluation of portal circulation through the superior mesenteric vein with an enteric capsule of [{sup 123}I]iodoamphetamine

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Shiomi, Susumu; Kuroki, Tetsuo; Miyazawa, Yuko; Ueda, Tadashi; Takeda, Tadashi; Nishiguchi, Shuhei; Nakajima, Shinya; Kobayashi, Kenzo; Ochi, Hironobu [Osaka City Univ. (Japan). Medical School

1995-02-01

We report a method by which the contribution of the superior mesenteric vein to the portal blood flow can be evaluated noninvasively. An enteric-coated capsule containing [{sup 123}I]iodoamphetamine is given by mouth 3h before the examination. The data obtained are treated by computer to calculate the portal shunt index (SI) through the superior mesenteric vein. The SI was higher for more severe liver disorders, increasing in the order of chronic persistent hepatitis, chronic aggressive hepatitis, and cirrhosis. The SI was higher in cirrhotic patients than in chronic hepatitis patients or healthy volunteers (both, P<0.001). The SI was higher in cirrhotic patients with esophageal varices than in such patients without varices (P<0.05). The SI was higher in cirrhotic patients with ascites than in such patients without ascites (P<0.001). The SI was higher in cirrhotic patients with encephalopathy than in those without encephalopathy (P<0.01). Correlation was significant between the SI and classical indicators of functional reserve. This method is clinically useful. (author).

A Meta-Analysis of Outcomes After In Situ Reconstructions for Aortic Graft Infection.

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Batt, Michel; Feugier, Patrick; Camou, Fabrice; Coffy, Amandine; Senneville, Eric; Caillon, Jocelyne; Calvet, Brigitte; Chidiac, Christian; Laurent, Frederic; Revest, Matthieu; Daures, Jean Pierre

2018-05-01

To confirm the advantage of in situ reconstruction (ISR) over extra-anatomic reconstruction (EAR) for aortic graft infection and determine the most appropriate conduit including autogenous veins, cryopreserved allografts, and synthetic prosthesis (standard, rifampicin of silver polyesters). A meta-analysis was conducted with rate of mortality, graft occlusion, amputation, and reinfection. A meta-regression was performed with 4 factors: patients' age, presence of prosthetic-duodenal fistula (PDF), virulent organisms, or nonvirulent organisms. In situ reconstruction over EAR seems to favor all events. For the 5 conduits used for ISR, according to operative mortality, age of the patients looks to have a positive correlation only for silver polyester and no conduit present any advantage in the presence of PDF. Reinfection seems to be not significantly different for the 5 conduits, and only autogenous veins appear to have a positive correlation with infecting organisms. In situ reconstruction may be considered as first-line treatment. Our results suggest that silver polyesters appear to be most appropriate for older patients, and in order to limit reinfection, autogenous veins are probably the most suitable conduit.

Uneven acute non-alcoholic fatty change of the liver after percutaneous transhepatic portal vein embolization in a patient with hilar cholangiocarcinoma - a case report.

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Tsai, Chun-Yi; Nojiri, Motoi; Yokoyama, Yukihiro; Ebata, Tomoki; Mizuno, Takashi; Nagino, Masato

2017-12-06

Portal vein embolization is essential for patients with biliary cancer who undergo extended hepatectomy to induce hypertrophy of the future remnant liver. Over 830 patients have undergone the portal vein embolization at our institution since 1990. Non-alcoholic fatty liver disease is an entity of hepatic disease characterized by fat deposition in hepatocytes. It has a higher prevalence among persons with morbid obesity, type 2 diabetes, and hyperlipidemia. Neither the mechanism of hepatic hypertrophy after portal vein embolization nor the pathophysiology of non-alcoholic fatty liver disease has been fully elucidated. Some researchers integrated the evident insults leading to progression of fatty liver disease into the multiple-hit hypothesis. Among these recognized insults, the change of hemodynamic status of the liver was never mentioned. We present the case of a woman with perihilar cholangiocarcinoma who received endoscopic biliary drainage and presented to our institute for surgical consultation. A left trisectionectomy with caudate lobectomy and extrahepatic bile duct resection was indicated for curative treatment. To safely undergo left trisectionectomy, she underwent selective portal vein embolization of the liver, in which uneven acute fatty change subsequently developed. The undrained left medial sector of the liver with dilated biliary tracts was spared the fatty change. The patient underwent planned surgery without any major complications 6 weeks after the event and has since resumed a normal life. The discrepancies in fatty deposition in the different sectors of the liver were confirmed by pathologic interpretations. This is the first report of acute fatty change of the liver after portal vein embolization. The sparing of the undrained medial sector is unique and extraordinary. The images and pathologic interpretations presented in this report may inspire further research on how the change of hepatic total inflow after portal vein embolization can be

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

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Hyunyoung G. Kim

2017-04-01

Full Text Available A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In

Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

International Nuclear Information System (INIS)

Carnevale, Francisco Cesar; Santos, Aline Cristine Barbosa; Tannuri, Uenis; Cerri, Giovanni Guido

2010-01-01

We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

Hepatic encephalopathy in a liver transplant recipient with stable liver function.

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Arab, Juan Pablo; Meneses, Luis; Pérez, Rosa M; Arrese, Marco; Benítez, Carlos

2013-04-01

Postshunt hepatic encephalopathy after liver transplantation (LT) is an infrequent condition and is commonly associated with portal occlusion or stenosis and the presence of a patent portosystemic shunt. Portal vein stenosis (PVS) or thrombosis (PVT) are uncommon complications after LT. The overall frequency of both complications is reported to be less than 3%. When PVS or PVT develop early after LT, the occlusion of the portal vein can have catastrophic consequences to the graft including acute liver failure and graft loss. Late PVT/PVS are asymptomatic in approximately 50% of the cases and mainly diagnosed by a routine ultrasound. Symptomatic postshunt hepatic encephalopathy (HE) is a very infrequent condition after LT that has been scarcely reported in the literature. We present here the case of a liver recipient with normal graft function who presented with hepatic encephalopathy 3 months after LT with stable liver function but a severe portal stenosis and the presence of a spontaneous portosystemic shunt whose successful endovascular treatment was followed by the complete resolution of the HE.

A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow.

Science.gov (United States)

Martino, Rodrigo B; Júnior, Eserval Rocha; Manuel, Valdano; Rocha-Santos, Vinicius; D'Albuquerque, Luis Augusto C; Andraus, Wellington

2017-10-11

BACKGROUND Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow 'steal' by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, ligation of the left renal vein has been recommended to improve portal venous blood flow. CASE REPORT A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other comorbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal antibody to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchyma in the liver transplant. CONCLUSIONS This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of postoperative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be important in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.

Vascular Reconstruction Technique Using a Tubular Graft for Leiomyosarcoma of the Inferior Vena Cava: A Case Report

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C. Higutchi

Full Text Available Objective/background: This study is a case report that addresses the key aspects of vascular reconstruction, as well as the intraoperative complications, postoperative morbidity, and possibility of adjunctive therapy. Methods: This article reports the case of a 46 year old female patient with a leiomyosarcoma located in the middle segment of the inferior vena cava (between the renal and hepatic veins who underwent surgical resection with vena cava reconstruction and insertion of a tubular graft made of a synthetic material. Results: This case report reveals that surgical resection of the tumor with the insertion of a smaller-caliber tubular graft provide better patency of the vena cava reconstruction, which was maintained for a year after surgery. In addition, the patient was asymptomatic for lower limb edema, despite having a local recurrence after one year. Surgical resection is the treatment of choice for leiomyosarcoma of the inferior vena cava (LIVC and is the only therapy that offers a chance of cure. Several surgical techniques are used for this condition, especially, reconstruction with a vascular graft using natural or synthetic materials. Conclusion: Due to the aggressiveness of the disease, this study suggests that surgical intervention used may have no influence on a patient's survival outcome. However, vascular reconstruction with a smaller-caliber tubular graft may yield a better prognosis for patients in terms of postoperative symptoms, such as edema and thrombosis. Keywords: Inferior vena cava, Leiomyosarcoma, Synthetic vascular grafting

Matrix metalloproteinase-14 mediates formation of bile ducts and hepatic maturation of fetal hepatic progenitor cells

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Otani, Satoshi [Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo (Japan); Kakinuma, Sei, E-mail: skakinuma.gast@tmd.ac.jp [Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo (Japan); Department for Liver Disease Control, Tokyo Medical and Dental University, Tokyo (Japan); Kamiya, Akihide [Institute of Innovative Science and Technology, Tokai University, Isehara (Japan); Goto, Fumio; Kaneko, Shun; Miyoshi, Masato; Tsunoda, Tomoyuki; Asano, Yu; Kawai-Kitahata, Fukiko; Nitta, Sayuri; Nakata, Toru; Okamoto, Ryuichi; Itsui, Yasuhiro; Nakagawa, Mina; Azuma, Seishin [Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo (Japan); Asahina, Yasuhiro [Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo (Japan); Department for Liver Disease Control, Tokyo Medical and Dental University, Tokyo (Japan); Yamaguchi, Tomoyuki [Division of Stem Cell Therapy, Institute of Medical Science, The University of Tokyo, Tokyo (Japan); Koshikawa, Naohiko [Division of Cancer Cell Research, Institute of Medical Science, The University of Tokyo, Tokyo (Japan); Seiki, Motoharu [Medical School, Kanazawa University, Kanazawa (Japan); Nakauchi, Hiromitsu [Division of Stem Cell Therapy, Institute of Medical Science, The University of Tokyo, Tokyo (Japan); and others

2016-01-22

Fetal hepatic stem/progenitor cells, called hepatoblasts, play central roles in liver development; however, the molecular mechanisms regulating the phenotype of these cells have not been completely elucidated. Matrix metalloproteinase (MMP)-14 is a type I transmembrane proteinase regulating pericellular proteolysis of the extracellular matrix and is essential for the activation of several MMPs and cytokines. However, the physiological functions of MMP-14 in liver development are unknown. Here we describe a functional role for MMP-14 in hepatic and biliary differentiation of mouse hepatoblasts. MMP-14 was upregulated in cells around the portal vein in perinatal stage liver. Formation of bile duct-like structures in MMP-14–deficient livers was significantly delayed compared with wild-type livers in vivo. In vitro biliary differentiation assays showed that formation of cholangiocytic cysts derived from MMP-14–deficient hepatoblasts was completely impaired, and that overexpression of MMP-14 in hepatoblasts promoted the formation of bile duct-like cysts. In contrast, the expression of molecules associated with metabolic functions in hepatocytes, including hepatic nuclear factor 4α and tryptophan 2,3-dioxygenase, were significantly increased in MMP-14–deficient livers. Expression of the epidermal growth factor receptor and phosphorylation of mitogen-activated protein kinases were significantly upregulated in MMP-14–deficient livers. We demonstrate that MMP-14–mediated signaling in fetal hepatic progenitor cells promotes biliary luminal formation around the portal vein and negatively controls the maturation of hepatocytes. - Highlights: • Loss of MMP-14 delayed formation of bile duct-like structures in perinatal liver. • Overexpression of MMP-14 in hepatobalsts promoted the biliary formation in vitro. • Loss of MMP-14 promoted hepatocyte maturation of hepatoblasts in vivo. • MMP-14–mediated signaling regulates terminal differentiation of

Non-invasive assessment of fibrosis using color Doppler ultrasound in patients with hepatitis C virus in the Amazon rainforest, Brazil.

Science.gov (United States)

Leão, Jorge; Brock, Marianna; Castilho, Márcia; Scariot, André; Scariot, Ana; Braga, Wornei

2012-02-01

The purpose of this study was to correlate morphologic and hemodynamic Doppler ultrasound findings as indicators of the degree of inflammation and fibrosis and to diagnose chronic vital hepatitis complications and progression. A prospective, descriptive study of a case series was conducted that analyzed Doppler ultrasound images of the liver and portal system and used the portal vein congestion index, hepatic and splenic artery impedance indices, and the liver vascular index. Of 50 patients positive for antibodies against hepatitis C virus, morphologic changes highlighted increased hepatic parenchyma echogenicity in 24%, and increased gall blander echogenicity and wall thickness in 4%. The most common hemodynamic changes observed were reduced flow velocity in the portal vein trunk in 26%, congestion index changes in 12%, liver vascular index changes in 16%, and splenic and hepatic artery impedance index changes in 14%. These indices were shown to be associated with alanine aminotransferase levels, which suggested that they are important liver damage indicators in the early phase of infection with hepatitis C virus.

Hepatic extraction of the aminoterminal propeptide of type III procollagen before and after bile duct ligation in pigs

DEFF Research Database (Denmark)

Bentsen, K D; Henriksen, Jens Henrik Sahl; Boesby, S

1991-01-01

before and during a 4-h period after ligation of the common bile duct was assessed from serum PIIINP concentrations in a systemic artery, the portal vein and a hepatic vein of seven healthy anaesthetized pigs. Seven sham-operated anaesthetized pigs served as controls. Ligation of the bile duct did...

Concurrent Hepatic Artery and Portal Vein Thrombosis after Orthotopic Liver Transplantation with Preserved Allografts

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Arshad Khan

2014-01-01

Full Text Available In contrast to early HAT, late HAT has an insidious clinical presentation. Nevertheless, biliary and vascular reconstructions in this late setting are unlikely to improve outcome. Patent portal flow makes an important contribution to the viability of liver in case of late HAT while the allograft reconstitutes intrahepatic arterial flow through neovascularization. Concurrent HAT with PVT without immediate graft necrosis is extremely rare, and allograft and patient survival are seemingly impossible without retransplantation. In fact, hepatopetal arterial and portal venous neovascularization are known albeit obscure phenomena that can preserve posttransplant hepatic function under the extenuating circumstances of complete interruption of blood flow to the graft. We describe two such cases that developed combined HAT and PVT more than six months after OLT with perfect preservation of graft function. The survival of allografts in our cases was due to extensive hepatopetal arterial and portal venous collateralization. Simultaneous HAT and PVT after OLT are rare events and almost uniformly fatal, if they occur early. Due to paucity of such cases, however, underlying mechanisms and etiology remain elusive, and despite radiological diagnosis of these complications, there is no way to predict these events in the wake of stable graft function.

Hepatic metabolism of anaesthetized growing pigs during acute portal infusion of volatile fatty acids and hydroxy-methyl butyrate

DEFF Research Database (Denmark)

Theil, Peter Kappel; Larsen, Uffe Krogh; Bjerre-Harpøth, Vibeke

2016-01-01

ABSTRACT: The objective of the experiment was to study hepatic metabolism during infusion of volatile fatty acids (VFA) differing in amounts and composition or infusion of HMB. Three fasted (20 h) pigs (mean BW ± SE; 58 kg ± 1) were fitted with indwelling catheters in the portal vein, hepatic vein......, respectively, for Inf2 and Inf3, or 65%, 20%, and 10% of acetate, propionate, and butyrate, respectively, for Inf4 and Inf5. In addition, for Inf5, HMB was infused at 2 mmol/h. Statistical analysis included fixed effects of infusion and interaction between infusion and samplings within infusion while...

Lower limb edema after arterial reconstruction, a comparison with lymph, reconstruction and DVT edema by RI scintigram

International Nuclear Information System (INIS)

Ojiro, M.; Takenosita, M.; Toshinaga, R.; Shimazu, H.; Nakajo, M.; Iwasita, S.

1991-01-01

Postoperative lower limb edema after arterial-reconstruction is common complication. However the precise mechanism of this process is not fully understood. In order to investigate this pathogenesis, it was studied whether the postoperative edema was affected by the various types of reconstruction, the materials, the degree of preoperative ischemia and the grade of improvement of ankle pressure index (API) after reconstruction retrospectively. Furthermore, by pertechnetate anion the difference of scintigraph pattern was studied in the lower limb and was compared with postoperative edema, lymph edema and acute deep vein thrombosis (DVT) with swelling limb. (author). 4 refs.; 2 figs

Hepatocellular carcinoma with cavernous transformation of the protal vein

Energy Technology Data Exchange (ETDEWEB)

Seo, Heung Suk; Lee, Seung Ro; Hahm, Chang Kok [Hanyang University College of Medicine, Seoul (Korea, Republic of)

1985-10-15

Twenty cases of hepatocellular carcinoma were examined by selective celiac and superior mesenteric arteriography. Obstruction of the main portal vein due to tumor thrombus was revealed in 7 cases and 3 of these cases had cavernous transformation of the portal vein (CTPV). The authors intended in this study to evaluate CTPV group and non-CTPV group clinically and radiologically. The results obtained are as follows: 1. The duration of illness was shorter in CTPV group than non- CTPV group. 2. There was no significant difference in tumor size between two groups ,and main portion of tumor was located in the right lobe in both groups. 3. Arterio portal shunt was present in 2 of 4 cases in non-CTPV group, but was no present at all in CRPV groups. 5. There wa no significant difference in blood chemistry between two groups. 6. CTPV may play an important role maintain the hepatic blood flow.

Drenagem anômala de veia pulmonar inferior direita em veia cava inferior associada a apêndice hepático intracardíaco Anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to intrathoracic hepatic appendix

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Carlos R Moraes

1988-08-01

Full Text Available Descreve-se o caso de uma paciente de 61 anos de idade, com drenagem anômala de veia pulmonar inferior direita em veia cava inferior, associada a apêndice hepático intratorácico, herniado através de fenda no diafragma. A correção cirúrgica foi realizada por anastomose direta da veia anômala com o átrio esquerdo, pela redução do apêndice hepático para a cavidade abdominal e, finalmente, pelo fechamento do defeito diafragmático. O pós-operatório decorreu sem qualquer complicação. Os autores chamam a atenção para a raridade do caso.The authors present a case of a 61-year-old woman with anomalous drainage of the right inferior pulmonary vein into the inferior vena cava associated to an intrathoracic hepatic appendix herniated through a diaphragmatic defect. Surgical correction was obtained by direct anastomosis of the anomalous vein to the left atrium, reduction of the hepatic appendix to the abdominal cavity and closure of the diphragmatic defect. The postoperative course was unevenftul. The rarity of this condition is stressed.

Diagnostic value of Doppler assessment of the hepatic and portal vessels and ultrasound of the spleen in liver disease.

Science.gov (United States)

O'Donohue, John; Ng, Chaan; Catnach, Susan; Farrant, Patricia; Williams, Roger

2004-02-01

To investigate the clinical utility and the intra-observer and inter-observer variability of Doppler ultrasound assessment of the hepatic and portal vessels along with measurement of spleen size in the diagnosis of chronic liver disease and cirrhosis. Ultrasound measurements of portal vein diameter (PVD), portal vein velocity (PVV), hepatic arterial resistance index (HARI), hepatic vein profile (HVP), and spleen size were obtained in 49 controls and 45 patients with liver disease (23 with primary biliary cirrhosis, 22 with hepatitis C) by two experienced observers, who each performed three blinded measurements of each variable. Control values were derived from normal hospital workers. Percutaneous liver biopsies in 41 of the patients showed cirrhosis (14 patients), moderate/severe fibrosis (13 patients), and early disease (14 patients). Seventy-one percent of cirrhotic patients had splenomegaly (> 13.6 cm). The spleen size was significantly larger in cirrhotics (16.0 cm) than in non-cirrhotics (13.0 cm, P HVP was abnormal in 76.9% of cirrhotics, 57.7% of non-cirrhotics and 2.1% of controls (P HVP are useful predictors of chronic liver disease and cirrhosis, and both can be measured reliably and reproducibly. However, Doppler measurements of PVV, PVD and HARI are not useful in distinguishing patients with chronic liver disease from normal controls.

Vein networks in hydrothermal systems provide constraints for the monitoring of active volcanoes.

Science.gov (United States)

Cucci, Luigi; Di Luccio, Francesca; Esposito, Alessandra; Ventura, Guido

2017-03-10

Vein networks affect the hydrothermal systems of many volcanoes, and variations in their arrangement may precede hydrothermal and volcanic eruptions. However, the long-term evolution of vein networks is often unknown because data are lacking. We analyze two gypsum-filled vein networks affecting the hydrothermal field of the active Lipari volcanic Island (Italy) to reconstruct the dynamics of the hydrothermal processes. The older network (E1) consists of sub-vertical, N-S striking veins; the younger network (E2) consists of veins without a preferred strike and dip. E2 veins have larger aperture/length, fracture density, dilatancy, and finite extension than E1. The fluid overpressure of E2 is larger than that of E1 veins, whereas the hydraulic conductance is lower. The larger number of fracture intersections in E2 slows down the fluid movement, and favors fluid interference effects and pressurization. Depths of the E1 and E2 hydrothermal sources are 0.8 km and 4.6 km, respectively. The decrease in the fluid flux, depth of the hydrothermal source, and the pressurization increase in E2 are likely associated to a magma reservoir. The decrease of fluid discharge in hydrothermal fields may reflect pressurization at depth potentially preceding hydrothermal explosions. This has significant implications for the long-term monitoring strategy of volcanoes.

Positron emission tomography of hepatic first-pass metabolism of ammonia in pig

International Nuclear Information System (INIS)

Keiding, S.; Munk, O.L.; Roelsgaard, K.; Bender, D.; Bass, L.

2001-01-01

Hepatic first-pass metabolism plays a key role in metabolic regulation and drug metabolism. Metabolic processes can be quantified in vivo by positron emission tomography scanning (PET). We wished to develop a PET technique to measure hepatic first-pass metabolism of ammonia. Seven anaesthetised pigs were given positron-labelled ammonia, 13 NH 3 , into the portal vein and into the vena cava as successive 2-min infusions followed by 22-min dynamic liver scanning. Vena cava infusion data were used to account for recirculation of tracer and metabolites following the portal vein infusion. The scan data were analysed by a model of sinusoidal zonation of ammonia metabolism with periportal urea formation and perivenous formation of glutamine. The hepatic extraction fraction of 13 NH 3 was 0.73±0.16 (mean±SD, n=7 pigs). Values of clearance of ammonia to urea and to glutamine were obtained, as were rate constants for washout of these two metabolites. Overall, the modelling showed half of the ammonia uptake to be converted to urea and half to glutamine. The washout rate constant for glutamine was about one-tenth of that for urea. We conclude that hepatic first-pass metabolism of ammonia was successfully assessed by PET. (orig.)

The change of volume of each hepatic segment in liver cirrhosis

International Nuclear Information System (INIS)

Arai, Kazunori; Takashima, Tsutomu; Matsui, Osamu; Kadoya, Masumi; Kameyama, Tomiaki; Nishijima, Hiroshi; Takanaka, Tsuyoshi; Gabata, Toshifumi

1986-01-01

We studied morphological changes of liver due to liver cirrhosis by evaluating the volume of liver and each hepatic segments (left lateral, left medial, right anterior, right posterior, and caudate lobe) divided using dynamic sequential CT during arterial portography. In liver cirrhosis, left lateral segment and caudate lobe were relatively enlarged, while right lobe and left medial segment showed significant shrinkage. But when posterior inferior right hepatic vein was evident on CT, right posterior segment did not shrink. (author)

Varicose vein stripping

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... stripping; Venous reflux - vein stripping; Venous ulcer - veins Patient Instructions Surgical wound care - open Varicose veins - what to ask your doctor Images Circulatory system References American Family Physician. Management of varicose veins. www.aafp.org/afp/2008/ ...

Hepatic iron overload is associated with hepatocyte apoptosis during Clonorchis sinensis infection.

Science.gov (United States)

Han, Su; Tang, Qiaoran; Chen, Rui; Li, Yihong; Shu, Jing; Zhang, Xiaoli

2017-08-01

Hepatic iron overload has been implicated in many liver diseases; however, whether it is involved in clonorchiasis remains unknown. The purpose of this study is to investigate whether Clonorchis sinensis (C. sinensis) infection causes hepatic iron overload, analyze the relationship between the iron overload and associated cell apoptosis, so as to determine the role of excess iron plays in C. sinensis-induced liver injury. The Perls' Prussian staining and atomic absorption spectrometry methods were used to investigate the iron overload in hepatic sections of wistar rats and patients infected with C. sinensis. The hepatic apoptosis was detected by transferase uridyl nick end labeling (TUNEL) methods. Spearman analysis was used for determining the correlation of the histological hepatic iron index and the apoptotic index. Blue iron particles were deposited mainly in the hepatocytes, Kupffer cells and endothelial cells, around the liver portal and central vein area of both patients and rats. The total iron score was found to be higher in the infected groups than the respective control from 8 weeks. The hepatic iron concentration was also significantly higher in treatment groups than in control rats from 8 weeks. The hepatocyte apoptosis was found to be significantly higher in the portal area of the liver tissue and around the central vein. However, spearman's rank correlation coefficient revealed that there was a mildly negative correlation between the iron index and hepatocyte apoptosis. This present study confirmed that hepatic iron overload was found during C. sinensis infection. This suggests that iron overload may be associated with hepatocyte apoptosis and involved in liver injury during C. sinensis infection. Further studies are needed to investigate the molecular mechanism involved here.

Pulmonary sequestration: diagnosis with three dimensional reconstruction using spiral CT

International Nuclear Information System (INIS)

Nie Yongkang; Zhao Shaohong; Cai Zulong; Yang Li; Zhao Hong; Zhang Ailian; Huang Hui

2003-01-01

Objective: To evaluate the role of three dimensional (3D) reconstruction using spiral CT in the diagnosis of pulmonary sequestration. Methods: Ten patients with pulmonary sequestration were analyzed. The diagnoses were confirmed by angiography in 2 patients, by operation in 2 patients, and by CT angiography in 6 patients. All patients were examined with Philips SR 7000 or GE Lightspeed Plus scanner. CT images were transferred to a workstation and 3D reconstruction was performed. All images were reviewed and analyzed by two radiologists. Results: Among 10 patients, the pulmonary sequestration was in the right lower lobe in 1 patient and in the left lower lobe in 9 patients. Anomalous systemic arteries originated from thoracic aorta in 8 patients and from celiac artery in 2 patients. On plain CT scan, there were 4 patients with patchy opacities, 3 patients with hilar mass accompanying vascular engorgement and profusion in adjacent parenchyma, 2 patients with finger-like appendage surrounded by hyper-inflated lung, and 1 patient with lung mass-like lesion. Enhanced CT revealed anomalous systemic arteries in 9 patients and drainage vein in 7 patients. Maximum intensity projection (MIP) and curvilinear reconstruction could depict the abnormal systemic artery and drainage vein in sequestration. Surface shadow display (SSD) and volume rendering (VR) could delineate the anomalous systemic artery. Conclusion: 3D reconstruction with enhanced spiral CT can depict anomalous systemic artery and drainage vein and it is the first method of choice in diagnosing pulmonary sequestration

Injuries of the Portal Vein in Patients With Blunt Abdominal Trauma

Science.gov (United States)

Kremer, B.; Lloyd, D. M.; Meyer-Pannwitt, U.

1993-01-01

Between January 1987 and September 1991, 68 severely traumatized patients underwent emergency laparotomy because of blunt abdominal trauma. Intraoperatively, 54.4% of the patients had a major injury to one organ, 23.5% had injuries to two organs, 16.2% had injuries to three organs and 5.9% to four or more organs. Additionally, in 11.8% of these cases (n = 8) a major vascular injury (portal vein n = 5, vena cava n = 2, mesenteric root n = 1) was found. Injuries to the portal vein were always associated with complete rupture of the pancreas, requiring distal pancreatic resection in four cases and a duodenum preserving resection of the head of the pancreas in one. In two of these patients the portal vein had to be reconstructed with a Goretex prosthetic graft. Mortality was 14.7% for the whole group (n = 68) and 0% for patients with additional portal venous injuries. PMID:8489966

Hemodynamic evaluation of the right portal vein in healthy dogs of different body weights

Directory of Open Access Journals (Sweden)

de Almeida Mariana F

2010-05-01

Full Text Available Abstract Background Doppler ultrasonography is an important tool for evaluating hepatic portal hemodynamics. However, no study in dogs of different body weights, in the range encountered in routine clinical veterinary practice, has been reported. It can be difficult to obtain an ideal insonation angle when evaluating the main portal vein, so evaluation of the right portal vein branch has been described in humans as an alternative. The aim of this study was to analyze, through Doppler ultrasonography, the hemodynamics in the right portal vein branch in dogs of different body weights. Methods Thirty normal dogs were divided in three groups by weight, in order to establish normal values for mean velocity, flow volume and portal congestion index of the right portal vein branch by means of Doppler ultrasonography. Results In all dogs ideal insonation angles were obtained for the right portal vein branch. The average velocity was similar in the three groups, but the portal congestion index and the flow volume differed, showing that the weight of the dog can influence these values. Conclusion Doppler ultrasonography for the evaluation of flow in the right branch of the portal vein could be a viable alternative, or complement, to examining the main vessel segment. This is especially so in those animals in which an ideal insonation angle for examination of the main portal vein is hard to obtain. In addition, the weight of the dog must be considered for the correct evaluation of the portal system hemodynamics, particularly for portal blood flow and the congestion index.

Abnormal portal vein waveform as an indicator of constrictive pericarditis – a case report

Directory of Open Access Journals (Sweden)

Joanna Ścieszka

2015-06-01

Full Text Available We report a case of a 17-year-old patient referred to our outpatient Doppler Department due to clinical suspicion of liver cirrhosis. The patient presented with non-specifi c symptoms, such as malaise, pain in the right subcostal region, peripheral oedema. Until then, diagnostic imaging, including echocardiography was inconclusive. We performed the Doppler sonography of the portal system, which revealed normal diameter of the portal vein with abnormal, phasic and markedly pulsatile waveform. Hepatic veins distention with pathological reverse fl ow during systole was reported. Additionally, inferior vena cava was dilated and remained unchanged through the respiratory cycle. Basing on the above image a heart disease, which had not been taken into differential diagnosis before, was suggested. The following echocardiography, together with computed tomography, enabled a diagnosis of constrictive pericarditis. Successful pericardiotomy was performed. Such a complicated diagnostics happened to demonstrate an uncommon example of the use of portal vein waveform in making the proper cardiologic diagnosis.

Hepatic perfusion disorders: a pictorial review of CT and MR imaging

International Nuclear Information System (INIS)

Yim, Nam Yeol; Jeong, Yong Yeon; Shin, Sang Soo; Song, Sang Gook; Lim, Hyo Soon; Heo, Suk Hee; Chang, Nam Kyu; Yoon, Woong; Kang, Heoung Keun; Lan, Shen Yu

2005-01-01

The liver has a unique dual blood supply through the portal vein and the hepatic artery. There are several communications between these two vessels under various conditions such as in hepatic tumors, trauma and liver cirrhosis, vascular compromise, among others. When vascular compromise occurs, this dual blood supply system can cause changes in the volume of blood flow in individual vessels or even in the direction of blood flow. With rapid image acquisition and increased resolution available in multislice CT and MR imaging, hepatic perfusion disorders are now more frequently encountered than in the past. Familiarity with imaging findings of these perfusion disorders will be helpful in characterizing focal hepatic lesions and will also help to avoid false positive diagnoses

Hepatic perfusion disorders: a pictorial review of CT and MR imaging

Energy Technology Data Exchange (ETDEWEB)

Yim, Nam Yeol; Jeong, Yong Yeon; Shin, Sang Soo; Song, Sang Gook; Lim, Hyo Soon; Heo, Suk Hee; Chang, Nam Kyu; Yoon, Woong; Kang, Heoung Keun [Chonnam National University, Gwangju (Korea, Republic of); Lan, Shen Yu [Yan Bian Cancer Hospital, Peijing (China)

2005-09-15

The liver has a unique dual blood supply through the portal vein and the hepatic artery. There are several communications between these two vessels under various conditions such as in hepatic tumors, trauma and liver cirrhosis, vascular compromise, among others. When vascular compromise occurs, this dual blood supply system can cause changes in the volume of blood flow in individual vessels or even in the direction of blood flow. With rapid image acquisition and increased resolution available in multislice CT and MR imaging, hepatic perfusion disorders are now more frequently encountered than in the past. Familiarity with imaging findings of these perfusion disorders will be helpful in characterizing focal hepatic lesions and will also help to avoid false positive diagnoses.

Computed tomography research about the artery and vein of separated pig lung

International Nuclear Information System (INIS)

Ji Jiansong; Gong Jianping; Qian Minghui

2003-01-01

Objective: To evaluate the artery and vein of the separated lung of pig, and analyse the value of routine CT in differentiating the arteries from veins, and to prove the results by anatomizing, making vessel cast specimens, 3-D reconstruction techniques and so on. Method: Thirty normal fresh pig lungs, GE spiral CT Hispeed/I and workstation, anatomic tools, red and blue dyestuff 100 ml and so on were used. Result: Pig lungs are divided into left, lingua and right lung. 85.7% left lungs have three lobes coded as superior, middle and inferior; 93.75% right have the three lobes coded in the same way. Segments and subsegments can be analysed through thin thickness scanning and MIP of spiral CT; arteries and veins of separated pig lung can be resolved to order of 6-7, by Kassab improved Strahler ordering system, but can only be measured to order 5-6; their angles of going out and going positions of those arteries and veins above segments and below subsegments were statistically different (P<0.05). Conclusion: CT can discriminate the arteries well from the veins to order 11-12 in separated pig lung which demonstrates that CT can differentiate the arterial grain and venous grain

Dynamic MRI of the liver with parallel acquisition technique. Characterization of focal liver lesions and analysis of the hepatic vasculature in a single MRI session

International Nuclear Information System (INIS)

Heilmaier, C.; Sutter, R.; Lutz, A.M.; Willmann, J.K.; Seifert, B.

2008-01-01

Purpose: to retrospectively evaluate the performance of breath-hold contrast-enhanced 3D dynamic parallel gradient echo MRI (pMRT) for the characterization of focal liver lesions (standard of reference: histology) and for the analysis of hepatic vasculature (standard of reference: contrast-enhanced 64-detector row computed tomography; MSCT) in a single MRI session. Materials and method: two blinded readers independently analyzed preoperative pMRT data sets (1.5T-MRT) of 45 patients (23 men, 22 women; 28 - 77 years, average age, 48 years) with a total of 68 focal liver lesions with regard to image quality of hepatic arteries, portal and hepatic veins, presence of variant anatomy of the hepatic vasculature, as well as presence of portal vein thrombosis and hemodynamically significant arterial stenosis. In addition, both readers were asked to identify and characterize focal liver lesions. Imaging parameters of pMRT were: TR/TE/matrix/slice thickness/acquisition time: 3.1 ms/1.4 ms/384 x 224/4 mm/15 - 17 s. MSCT was performed with a pitch of 1.2, an effective slice thickness of 1 mm and a matrix of 512 x 512. Results: based on histology, the 68 liver lesions were found to be 42 hepatocellular carcinomas (HCC), 20 metastases, 3 cholangiocellular carcinomas (CCC) as well as 1 dysplastic nodule, 1 focal nodular hyperplasia (FNH) and 1 atypical hemangioma. Overall, the diagnostic accuracy was high for both readers (91 - 100%) in the characterization of these focal liver lesions with an excellent interobserver agreement (κ-values of 0.89 [metastases], 0.97 [HCC] and 1 [CCC]). On average, the image quality of all vessels under consideration was rated good or excellent in 89% (reader 1) and 90% (reader 2). Anatomical variants of the hepatic arteries, hepatic veins and portal vein as well as thrombosis of the portal vein were reliably detected by pMRT. Significant arterial stenosis was found with a sensitivity between 86% and 100% and an excellent interobserver agreement (κ

Hepatic portal vein cannulation for infusion and blood sampling in freely moving rats

NARCIS (Netherlands)

Strubbe, J.H.; Bruggink, J.E; Steffens, A.B

1999-01-01

Chronic portal vein cannulation in the rat is an important technique to study secretory rates of hormones from the endocrine pancreas. Moreover, it can be used for studying the effects of enteric hormones and pharmaca on behavioral and physiological processes. This article contains an extensive

Portal Vein Thrombosis

Directory of Open Access Journals (Sweden)

Hakan Demirci

2016-01-01

Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

Collateral veins in left renal vein stenosis demonstrated via CT

Energy Technology Data Exchange (ETDEWEB)

Lien, H.H.; Lund, G.; Talle, K.

1983-02-01

Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development.

Collateral veins in left renal vein stenosis demonstrated via CT

International Nuclear Information System (INIS)

Lien, H.H.; Lund, G.; Talle, K.

1983-01-01

Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development. (orig.)

Effect of oral propranolol administration on azygos, renal and hepatic uptake and output of catecholamines in cirrhosis

DEFF Research Database (Denmark)

Bendtsen, F; Christensen, N J; Sørensen, T I

1991-01-01

Circulating catecholamines are increased in cirrhosis with portal hypertension, and increase further after propranolol. In 23 cirrhotic patients, plasma norepinephrine and epinephrine were determined in an artery, the azygos vein, the right renal vein and a hepatic vein before and after an oral 80...... to the circulation) and clearance of epinephrine remained unaltered. Hepatointestinal clearance showed no significant change for norepinephrine, but showed a borderline-significant decrease for epinephrine (-23%, p = 0.08). Our results show a net production of norepinephrine in the prehepatic splanchnic area drained...

Angiohepatogram in diffuse hepatic disease

International Nuclear Information System (INIS)

Aburano, Tamio; Suzuki, Yutaka; Hisada, Kinichi; Matsudaira, Masamichi.

1975-01-01

A region of interest angiohepatogram was obtained with intravenous injection of 10mCi of sup(99m)Tc-Sn-colloid and a data processing system. Furthermore, the ratio of hepatic arterial blood flow volume to total hepatic blood flow volume was calculated according to Ueda's method, and the correlation of this calculated ratio and the degree of extrahepatic distribution of sup(99m)Tc-Sn-colloid (spleen to liver, and bone marrow to liver activity ratio) was examined. Most cases of liver cirrhosis and Banti's syndrome showed the increased hepatic arterial blood flow ratio (liver cirrhosis: 43.5+-9.5%, Banti's syndrome 48.8+-4.9%) in contrast with 18.1+-4.6% in normal cases, and its ratio showed much higher values in the presence of portal hypertension manifestations (esophageal varix and ascites). The hepatic arterial blood flow ratio showed increased values in the case of markedly increased extrahepatic activity, e.g. liver cirrhosis, and the correlation of the ratio and extrahepatic activity degree of sup(99m)Tc-Sn-colloid was significant statistically. From these results, a region of interest angiohepatogram was supposed to be useful for the prediction of the hemodynamic change, as well as, the improvement of diagnostic accuracy with radioisotope in diffuse hepatic disease, especially liver cirrhosis. Moreover, the hemodynamic change of liver, especially the reduction of the effective hepatic blood flow volume via the portal vein was considered to be closely concerned in the mechanism of increased extrahepatic activity of RI colloid in diffuse hepatic disease. (auth.)

Preservation for future use of the autologous saphenous vein during femoro-popliteal bypass surgery is inexpedient.

NARCIS (Netherlands)

Dirven, M.; Scharn, D.M.; Blankensteijn, J.D.; Vliet, J.A. van der

2008-01-01

PURPOSE: To investigate the usefulness of greater saphenous vein preservation for future vascular reconstructions during femoro-popliteal bypass surgery. DESIGN: Post-hoc analysis of data acquired in a randomized multi-centre clinical trial comparing two different vascular prostheses

Focus on Varicose Veins

Science.gov (United States)

... because the valves of the veins no longer work. Under the pressure of gravity these veins can continue to expand and, in ... and to determine whether the vein valves are work- ing properly or have ... painless. How are varicose veins treated? Varicose veins are always ...

Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

International Nuclear Information System (INIS)

Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun

2002-01-01

To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (2 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month.Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external irradiation

Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

International Nuclear Information System (INIS)

Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun; Lee, Do Yun; Park, Sung Il; Lee, Jong Tae; Moon, Young Myoung; Chon, Chae Yoon; Han, Kwang Hyup; Seoung, Jin Sil

2002-01-01

To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (12 males and 3 females; mean age = 47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a Chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month. Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external

Combined therapy involving hepatic arterial chemoinfusion through a percutaneously implanted port, and external irradiation for advanced hepatocellular carcinoma

Energy Technology Data Exchange (ETDEWEB)

Kim, Jong Won; Suh, Sang Hyun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)] [and others

2002-12-01

To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. Fifteen patients (2 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a chemoport was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month.Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a chemoport and external irradiation

On free jejunal and colon transfer for pharyngo-esophageal reconstruction

International Nuclear Information System (INIS)

Fukui, Kiyoko; Annraku, Kuniaki; Ikenoya, Shintaro; Makino, Sachio; Ito, Kazuyuki; Takubo, Kenji; Kaji, Shogo

2013-01-01

Free jejunal transfer is a common procedure for hypopharyngo-esophageal reconstruction. We reviewed our experience with patients who underwent free jejunal and colon transfer surgery for hypopharyngo-esophageal reconstruction in the last 20 years in our institute. A retrospective review was conducted for 31 cases of reconstruction with free jejunal and colon transfer performed at Japanese Red Cross Matsue Hospital during the period of 20 years from January 1992 to December 2011. The mean age of the patients was 66 years. There were 30 patients with hypopharynx cancer and one patient with larynx cancer. Thirty patients had received preoperative radiotherapy and chemotherapy. The average time of surgery for free jejunal transfer reconstruction was 8.8 hours, including extraction of the hypopharynx, pharynx and cervical esophagus, debridment of pars hemi-cervicalis, and grafting procedure of free jejunum. The most common recipient vessels were the transverse cervical artery and external jugular vein, but recently, vessels of free flaps are often chosen to be anastomosed with the superior thyroid artery and internal jugular vein. The free jejunal and colon grafts for reconstruction took successfully in all patients. The complication rate was 52% (16/31 cases). Complications often occurred in cases of total esophagectomy, recurrence after full-dose chemoradiotherapy, and radiation therapy administered postoperatively. (author)

Percutaneous Liver Biopsy after Living Donor Liver Transplantation Resulting in Fulminant Hepatic Failure: The First Reported Case of Hepatic Compartment Syndrome

Directory of Open Access Journals (Sweden)

Nicholas N. Nissen

2010-01-01

Full Text Available A 28-year-old female who underwent live donor liver transplantation 3 years prior presented after percutaneous liver biopsy with abdominal and shoulder pain, nausea, vomiting, and elevated liver enzymes. Computed tomography (CT showed an intrahepatic and subcapsular hematoma. There was a progressive increase in liver enzymes, bilirubin, and INR and a decline in hemoglobin. Subsequent CT imaging revealed flattening of the portal vein consistent with compression by the enlarging hematoma. Liver failure ensued and the patient required urgent retransplantation. The explant demonstrated ischemic necrosis of greater than 90% of the liver parenchyma. We report this case of “Hepatic Compartment Syndrome” leading to fulminant hepatic failure.

Spider Vein Removal

Science.gov (United States)

Spider veins: How are they removed? I have spider veins on my legs. What options are available ... M.D. Several options are available to remove spider veins — thin red lines or weblike networks of ...

Hepatic veno-occlusive disease associated with comfrey ingestion.

Science.gov (United States)

Yeong, M L; Swinburn, B; Kennedy, M; Nicholson, G

1990-01-01

A 23 year old man presented with hepatic veno-occlusive disease and severe portal hypertension and subsequently died from liver failure. Light microscopy and hepatic angiography showed occlusion of sublobular veins and small venous radicles of the liver, associated with widespread haemorrhagic necrosis of hepatocytes. The patient had been on a predominantly vegetarian diet and, prior to his illness, took comfrey leaves which are known to contain hepatotoxic pyrrolizidine alkaloids. Comfrey is widely used as a herbal remedy, but so far has only been implicated in two other documented cases of human hepatic veno-occlusive disease. A possible causal association of comfrey and this patient's veno-occlusive disease is suggested by the temporal relationship of the ingestion of comfrey to his presentation, the histological changes in the liver and the exclusion of other known causes of the disease.

Evaluation of portal hypertension: a comparison of the use of liver perfusion CT with wedge hepatic venous pressure and hepatic

International Nuclear Information System (INIS)

Chung, Dong Jin; Kim, Young Joong; Park, Yong Sung; Lee, Tae Hee; Kim, Chong Soo; Kang, Heung Keun

2008-01-01

We compared the hepatic perfusion indices obtained using hepatic perfusion CT with the wedge hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) to determine the efficacy of the use of liver perfusion CT for the evaluation of portal hypertension. Thirty-five patients with liver cirrhosis underwent hepatic vein catheterization to measure WHVP and HVPG and underwent a liver perfusion CT examination. Arterial perfusion, portal perfusion, total perfusion and the hepatic perfusion index (HPI) were calculated by the methods described by Miles and Blomlely. The overall correlation coefficients (r) between the perfusion indices and WHVP and HVPG were calculated. An additional correlation coefficient of 23 alcoholic cirrhosis patients was calculated. Using Blomley's equation, HPI had a positive correlation with WHVP (r = .471; ρ < .05) and HVPG (r = .482; ρ < .05). For the alcoholic liver cirrhosis patients, HPI had a higher positive correlation with WHVP (r = .500; ρ < .05) and HVPG (r = .539; ρ < .05) than for the non-alcoholic cirrhosis patients. There was no statistical difference between the use of Miles' equation and Blomley's equation for the evaluation of portal hypertension. This preliminary study showed that HPI positively correlated with WHVP and HVPG, especially in alcoholic cirrhosis patients. Liver perfusion CT may be useful in the evaluation of portal hypertension

What Are Varicose Veins?

Science.gov (United States)

... Leer en español What Is Varicose (VAR-i-kos) veins are swollen, twisted veins that you can ... TA-ze-uhs), spider veins, varicoceles (VAR-i-ko-seals), and other vein problems. Telangiectasias Telangiectasias are ...

O papel da oxigenação hiperbárica na estrutura do fígado e baço após ligadura das veias hepáticas: estudo em ratos The role of hyperbaric oxygenation in the liver and spleen structure after hepatic vein ligation: study in rats

Directory of Open Access Journals (Sweden)

Ricardo Costa-Val

2006-03-01

Full Text Available OBJETIVO: Avaliação morfológica do fígado e baço de ratos submetidos à oxigenoterapia hiperbárica após a ligadura das veias hepáticas. MÉTODO: Foram utilizados 30 animais machos adultos da espécie Holtzman, distribuídos aleatoriamente em dois grupos de 15 animais cada, assim designados: grupo 1 - ligadura das veias hepáticas; grupo 2 - ligadura das veias hepáticas associada à oxigenoterapia hiperbárica. Todos os animais foram submetidos à anestesia geral por meio de solução contendo cloridrato de cetamina (40 mg/ml e cloridrato de meperidina (10 mg/ml na dose de 50 mg/kg/peso, laparotomia mediana e ligadura das veias hepáticas. A oxigenoterapia hiperbárica foi aplicada nos animais do grupo 2, a partir da oitava hora do pós-operatório, por 120 minutos, sendo 90 minutos sob pressão de 2,5 atmosferas e 15 minutos no início e final da terapêutica, para promover a compressão e descompressão gradativa no período de 20 dias consecutivos. No 21° dia de pós-operatório, os animais foram mortos por inalação de éter e submetidos à laparotomia e extirpação dos fígados e baços para exame histológico. Foram comparados os resultados da histologia hepática e esplênica aplicando-se o teste exato de Fisher, considerando-se a diferença significante de P OBJECTIVE: Liver and spleen morphologic evaluation of rats submitted to hyperbaric oxygen therapy after hepatic vein ligation. METHOD: Thirty Holtzman adult male rats were used, distributed into two groups of 15 animals: group 1 - hepatic vein ligation; group 2 - hepatic vein ligation associated with hyperbaric oxygen therapy. All animals received general anesthesia by a solution composed of ketamine chloride (40 mg/ml and meperidine chloride (10 mg/ml in a dose of 50/mg/weight, and were submitted to median laparotomy and hepatic vein ligation. Group 2 animals were submitted to hyperbaric oxygen therapy, 8 hours after the operation, 90 minutes at 2.5 atmosphere pressure

Non invasive cardiac vein mapping: Role of multislice CT coronary angiography

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Malago, Roberto, E-mail: robertomalag@yahoo.it [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Pezzato, Andrea; Barbiani, Camilla; Sala, Giuseppe; Zamboni, Giulia A. [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Tavella, Domenico [Cardiology Service, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy); Mucelli, Roberto Pozzi [Radiology Department, University Hospital Policlinico G.B.Rossi, P.le L.A. Scuro 10, 37134 Verona (Italy)

2012-11-15

Purpose: Coronary venous anatomy is of primary importance when implanting a cardiac resynchronization therapy device, besides, the coronary sinus can be differently enlarged depending on chronic heart failure. The aim of this study is to evaluate the usefulness of Coronary CTA in describing the coronary venous tree and in particular the coronary sinus and detecting main venous system variants. Materials and methods: 301 consecutive patients (196 Male-Sign , mean age 63.74 years) studied for coronary artery disease with 64 slice Coronary CTA were retrospectively examined. The acquisition protocol was the standard acquisition one used for coronary artery evaluation but the cardiac venous system were visualized. The cardiac venous system was depicted using 3D, MPR, cMPR and MIP post-processing reconstructions on an off-line workstation. For each patient image quality, presence and caliber of the coronary sinus (CS), great cardiac vein (GCV), middle vein (MV), anterior interventricular vein (AIV), lateral cardiac vein (LCV), posterior cardiac vein (PCV), small cardiac vein (SCV) and presence of variant of the normal anatomy were examined and recorded. Results: CS, GCV, MV and AIV were visualized in 100% of the cases. The LCV was visualized in 255/301 (84%) patients, the PCV in 248/301 (83%) patients and the SCV in 69/301 (23%) patients. Mean diameter of the CS was 8.7 mm in 276/301 (91.7%) patients without chronic heart failure and 9.93 mm in 25/301 (8.3%) patients with chronic heart failure. Conclusions: Coronary CTA allows non invasive mapping of the cardiac venous system and may represent a useful presurgical tool for biventricular pacemaker devices implantation.

Radical antegrade modular pancreatosplenectomy for adenocarcinomaof the body of the pancreas in a patient with portal annular pancreas, aberrant hepatic artery, and absence of the celiac trunk: A case report.

Science.gov (United States)

Yuan, Hao; Wu, Pengfei; Chen, Jianmin; Lu, Zipeng; Chen, Lei; Wei, Jishu; Guo, Feng; Cai, Baobao; Yin, Jie; Xu, Dong; Jiang, Kuirong; Miao, Yi

2017-12-01

Portal annular pancreas is a rare anatomic variation, where the uncinated process of the pancreas connects with the dorsal pancreas and the pancreas tissue encases the portal vein (PV), superior mesenteric vein (SMV) or splenic vein (SV). Malignancies are quite uncommon in the patients, who have an annular pancreas especially portal annular pancreas. Ectopic common hepatic artery and absence of the celiac trunk (CT) are the other infrequent abnormalities. A 74-year-old man suffered from upper abdominal and back pain. Contrast enhanced computed tomography indicated a low-density mass in the body of the pancreas. Pathological report showed adenocarcinoma of the body of pancreas after radical antegrade modular pancreatosplenectomy (RAMPS). In the operation, we found the superior vein and portal vein was surrounded by the pancreatic tissue. The left gastric artery and splenic artery originated respectively from abdominal aorta, and celiac trunk was not viewed. In addition, the common hepatic artery was a branch from the superior mesenteric artery. In general, this is a novel clinical case of pancreatic carcinoma happening in the portal annular pancreas which was accompanied with aberrant hepatic artery and absence of the celiac trunk at the same time. Confronted with the pancreatic neoplasms, the possibility of coexistent annular pancreas and arterial variations should be considered.

Varicose vein - noninvasive treatment

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... spider veins. These are small varicose veins. Salt water (saline) or a chemical solution is injected into the varicose vein. The vein will harden and then disappear. Laser treatment can be used on the surface of the skin. Small bursts ...

Angiohepatogram in diffuse hepatic disease

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Aburano, T; Suzuki, Y; Hisada, K [Kanazawa Univ. (Japan). School of Medicine; Matsudaira, M

1975-10-01

A region of interest angiohepatogram was obtained with intravenous injection of 10mCi of sup(99m)Tc-Sn-colloid and a data processing system. Furthermore, the ratio of hepatic arterial blood flow volume to total hepatic blood flow volume was calculated according to Ueda's method, and the correlation of this calculated ratio and the degree of extrahepatic distribution of sup(99m)Tc-Sn-colloid (spleen to liver, and bone marrow to liver activity ratio) was examined. Most cases of liver cirrhosis and Banti's syndrome showed the increased hepatic arterial blood flow ratio (liver cirrhosis: 43.5+-9.5%, Banti's syndrome 48.8+-4.9%) in contrast with 18.1+-4.6% in normal cases, and its ratio showed much higher values in the presence of portal hypertension manifestations (esophageal varix and ascites). The hepatic arterial blood flow ratio showed increased values in the case of markedly increased extrahepatic activity, e.g. liver cirrhosis, and the correlation of the ratio and extrahepatic activity degree of sup(99m)Tc-Sn-colloid was significant statistically. From these results, a region of interest angiohepatogram was supposed to be useful for the prediction of the hemodynamic change, as well as, the improvement of diagnostic accuracy with radioisotope in diffuse hepatic disease, especially liver cirrhosis. Moreover, the hemodynamic change of liver, especially the reduction of the effectivehepatic blood flow volume via the portal vein was considered to be closely concerned in the mechanism of increased extrahepatic activity of RI colloid in diffuse hepatic disease.

Effect of a venotonic agent on the main arteries and veins during a 5 day HDT

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Roumy, Jerome; Herault, Stephane; Tobal, Nathalie; Besnard, Stephane; Arbeille, Philippe

2001-08-01

Objective: To evaluate the cardiac, arterial and venous effect of a venotonic drug (Cirkan « Ck å) administrated orally daily to 6 subjects in HDT position during 5 days. These subjects underwent a second 5d HDT without Ck treatment one month later. Pre and post HDT the subjects were submitted to a stand test. Method: The cardiovascular parameters were measured by echography and Doppler. Results and discussion: The Cirkan treatment contributed to reduce the increase in cerebral resistance, and to maintain the lower limb resistance at a higher level than on controls. It reduces the vein section at the extremities (Jugular, femoral) and in the central vein system connected to the right heart (sub hepatics). On the other hand it increases the portal vein section which means that the blood stagnation at the splanchnic level is increased. Despite these arterial and venous significant modifications the clinical and ECG and Blood pressure response to the Stand test was similar in both groups.

Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report.

Science.gov (United States)

Nanashima, Atsushi; Imamura, Naoya; Tsuchimochi, Yuki; Hiyoshi, Masahide; Fujii, Yoshiro

2016-01-01

This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. A 63-year-old woman was admitted to our institute's Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient's postoperative course was uneventful. In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Treatment of caval vein thrombosis associated with renal tumors.

Science.gov (United States)

Jiménez-Romero, Carlos; Conde, María; de la Rosa, Federico; Manrique, Alejandro; Calvo, Jorge; Caso, Óscar; Muñoz, Carlos; Marcacuzco, Alberto; Justo, Iago

2017-03-01

Renal carcinoma represents 3% of all solid tumors and is associated with renal or inferior caval vein (IVC) thrombosis between 2-10% of patients, extending to right atrial in 1% of cases. This is a retrospective study that comprises 5 patients who underwent nephrectomy and thrombectomy by laparotomy because of renal tumor with IVC thrombosis level iii. Four patients were males and one was female, and the mean age was 57,2 years (range: 32-72). Most important clinical findings were hematuria, weight loss, weakness, anorexia, and pulmonary embolism. Diagnostic confirmation was performed by CT scanner. Metastatic disease was diagnosed before surgery in 3 patients. Suprahepatic caval vein and hepatic hilium (Pringle's maneouver) were clamped in 4 patients, and ligation of infrarrenal caval vein was carry out in one patient. Five patients developed mild complications (Clavien I/II). No patient died and the mean hospital stay was 8,6 days. All patients were treated with chemotherapy, and 3 died because distant metastasis, but 2 are alive, without recurrence, at 5 and 60 months, respectively. Nephrectomy and thrombectomy in renal tumors with caval thrombosis can be curative in absence of metastasis or, at less, can increase survival or quality of live. Then these patients must be treated in liver transplant units because major surgical and anesthesiologic expertise. Adjuvant treatment with tyrosin kinase inhibitors must be validate in the future with wider experiences. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Transient hepatic attenuation difference of lobar or segmental distribution detected by dynamic computed tomography

International Nuclear Information System (INIS)

Itai, Y.; Moss, A.A.; Goldberg, H.I.

1982-01-01

Dynamic computed tomography of hepatic tumors revealed a transient attenuation difference of the liver in a lobar or segmental distribution in three cases. The difference was most prominent during the hepatogram phase. It was attributed to siphonage of arterial blood by hepatic tumors in two cases, while an increase of arterial flow induced by portal vein occlusion was inferred in the other case. Results indicate dynamic computed tomography will be usful in analysis of geometrical hemodynamics

Improving the Outcome of Vein Grafts: Should Vascular Surgeons Turn Veins into Arteries?

OpenAIRE

Isaji, Toshihiko; Hashimoto, Takuya; Yamamoto, Kota; Santana, Jeans M.; Yatsula, Bogdan; Hu, Haidi; Bai, Hualong; Jianming, Guo; Kudze, Tambudzai; Nishibe, Toshiya; Dardik, Alan

2017-01-01

Autogenous vein grafts remain the gold standard conduit for arterial bypass, particularly for the treatment of critical limb ischemia. Vein graft adaptation to the arterial environment, i.e., adequate dilation and wall thickening, contributes to the superior performance of vein grafts. However, abnormal venous wall remodeling with excessive neointimal hyperplasia commonly causes vein graft failure. Since the PREVENT trials failed to improve vein graft outcomes, new strategies focus on the ada...

Post-traumatic arteriovenous fistula of the hepatic pedicle.

Science.gov (United States)

Ibn Majdoub Hassani, K; Mohsine, R; Belkouchi, A; Bensaid, Y

2010-10-01

Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion. Copyright © 2010. Published by Elsevier Masson SAS.

Clinical quantitative study of therapeutic effect of partial splenic embolization (PSE) on portal vein hemodynamics

International Nuclear Information System (INIS)

Li Zhengran; Shan Hong; Zhu Kangshun; Jiang Zaibo; Guan Shouhai; Huang Mingsheng

2002-01-01

Objective: To research the changes of blood flow and pressure of the portal vein at both pre-and post-PSE. Methods: The blood flows of the portal vein (PV), splenic vein (SV), and superior mesentery vein (SMV) were measured by using color Doppler in 31 cases with clinically proved hepatic cirrhosis and hypersplenism at both pre- and post-PSE. The pressure of the portal vein and its branches was measured by percutaneous and trans-spleen portal venous catheterization, respectively both pre- and post-embolization in 11 cases of them. Results: The blood flow of PV, SV and SMV decreased significantly in all 31 cases after PSE (P < 0.05). The decreased degrees of blood flow of both PV and SV after PSE were positively related to the embolization degree (r = 0.589, P = 0.002 for PV; r= 0.862, P < 0.001 for SV). In 11 cases whose embolization degrees were more than 60%, the pressure of PV, SV and SMV decreased significantly after embolization (P<0.001). The decrease degree was (22.2 +- 5.8)%, (28.5 +- 1.7)% and (19.5 +- 8.1)%, respectively. The decreased degrees of pressure of both PV and SV after PSE were also positively related to the embolization degree (r = 0.645, P = 0.032 for PV; r = 0.687, P = 0.020 for SV). Conclusion: The embolization degree ranged from 60% to 80% may ameliorate peripheral blood WBC and PLT count, significantly decrease the blood flow and depress the pressure of portal vein, and relieve esophageal and gastric varices

Budd-Chiari Syndrome in a Patient with Hepatitis C

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Joseph Frankl

2016-01-01

Full Text Available Chronic Budd-Chiari syndrome can present with cirrhosis and signs and symptoms similar to those of other chronic liver diseases. We present a case of Budd-Chiari syndrome discovered during attempted transjugular intrahepatic portosystemic shunting in a patient with decompensated cirrhosis believed to be secondary to hepatitis C. Although the patient had hepatocellular carcinoma, the Budd-Chiari syndrome was a primary disease due to hepatic venous webs. Angioplasty was performed in this case, which resolved the patient’s symptoms related to portal hypertension. Follow-up venography 5 months after angioplasty demonstrated continued patency of the hepatic veins. A biopsy was obtained in the same setting, which showed centrilobular fibrosis indicating that venous occlusion was indeed the cause of cirrhosis. It is important to consider a second disease when treating a patient with difficult to manage portal hypertension.

Extrahepatic portal vein obstruction with parkinsonism and symmetric hyperintense basal ganglia on T1 weighted MRI

Directory of Open Access Journals (Sweden)

Jayalakshmi Sita

2006-01-01

Full Text Available Abnormal high signal in the globus pallidus on T1 weighted magnetic resonance imaging (MRI of the brain has been well described in patients with chronic liver disease. It may be related to liver dysfunction or portal-systemic shunting. We report a case of extra hepatic portal vein obstruction with portal hypertension and esophageal varices that presented with extra pyramidal features. T1 weighted MRI brain scans showed increased symmetrical signal intensities in the basal ganglia. Normal hepatic function in this patient emphasizes the role of portal- systemic communications in the development of these hyperintensities, which may be due to deposition of paramagnetic substances like manganese in the basal ganglia.

Evaluation of portal hypertension: a comparison of the use of liver perfusion CT with wedge hepatic venous pressure and hepatic

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Chung, Dong Jin; Kim, Young Joong; Park, Yong Sung; Lee, Tae Hee [University of Konyang College of Medicine, Daejeon (Korea, Republic of); Kim, Chong Soo; Kang, Heung Keun [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

2008-09-15

We compared the hepatic perfusion indices obtained using hepatic perfusion CT with the wedge hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) to determine the efficacy of the use of liver perfusion CT for the evaluation of portal hypertension. Thirty-five patients with liver cirrhosis underwent hepatic vein catheterization to measure WHVP and HVPG and underwent a liver perfusion CT examination. Arterial perfusion, portal perfusion, total perfusion and the hepatic perfusion index (HPI) were calculated by the methods described by Miles and Blomlely. The overall correlation coefficients (r) between the perfusion indices and WHVP and HVPG were calculated. An additional correlation coefficient of 23 alcoholic cirrhosis patients was calculated. Using Blomley's equation, HPI had a positive correlation with WHVP (r = .471; {rho} < .05) and HVPG (r = .482; {rho} < .05). For the alcoholic liver cirrhosis patients, HPI had a higher positive correlation with WHVP (r = .500; {rho} < .05) and HVPG (r = .539; {rho} < .05) than for the non-alcoholic cirrhosis patients. There was no statistical difference between the use of Miles' equation and Blomley's equation for the evaluation of portal hypertension. This preliminary study showed that HPI positively correlated with WHVP and HVPG, especially in alcoholic cirrhosis patients. Liver perfusion CT may be useful in the evaluation of portal hypertension.

Further substantial improvement of interventional diagnosis and treatment via portal vein system

International Nuclear Information System (INIS)

Yang Weizhu; Chen Yongde

2006-01-01

Along with the development of interventional appliances and proficiency of operational skills, the interventional diagnosis and treatment via hepatic portal vein system have achieved great progress and improvement. However, in order to further exploit the advantages of interventional diagnosis and treatment, the review of the anatomical structures, normal aberrance of portal venous system were needed. Getting familiar with pathologic condition to discover the new interventional appliances and embolic agents, and then in term of conduct the research on a very tough substantial base in a down-to-earth manner were important. (authors)

Quantitative hepatic CT perfusion measurement: Comparison of Couinaud's hepatic segments with dual-source 128-slice CT

Energy Technology Data Exchange (ETDEWEB)

Wang, Xuan [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Xue, Hua-dan, E-mail: bjdanna95@hotmail.com [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Jin, Zheng-yu, E-mail: jin_zhengyu@163.com [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China); Su, Bai-yan; Li, Zhuo; Sun, Hao; Chen, Yu; Liu, Wei [The Department of Radiology, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730 (China)

2013-02-15

Purpose: To compare the quantitative liver computed tomography perfusion (CTP) differences among eight hepatic segments. Materials and methods: This retrospective study was based on 72 acquired upper abdomen CTP scans for detecting suspected pancreas tumor. Patients with primary or metastatic liver tumor, any focal liver lesions except simple cyst (<3 cm in diameter), history of liver operation or splenectomy, evidence of liver cirrhosis or invasion of portal vein were excluded. The final analysis included 50 patients (M:F = 21:29, mean age = 43.2 years, 15–76 years). Arterial liver perfusion (ALP), portal-venous perfusion (PVP), total hepatic perfusion (THP = ALP + PVP), and hepatic perfusion index (HPI) of each hepatic segment were calculated and compared by means of one-way analysis of variance (ANOVA) and the Bonferonni correction method. Results: Compared to hepatic segments 5, 6, 7 and 8, segments 2 and 3 showed a tendency of higher ALPs, lower PVPs, and higher HPIs, most of which were statistically significant (p < 0.05). Hepatic segments 1 and 4 had higher mean values of ALP and HPI and lower mean values of PVP than segments 5, 6, 7 and 8 as well, although no significant differences were detected except for ALP and HPI for liver segments 1 and 7 (p = 0.001 and 0.035 respectively), and ALP for liver segments 1 and 5 (p = 0.039). Higher ALP and HPI were showed in hepatic segment 3 compared to segment 4 (p = 0.000 and 0.000 respectively). No significant differences were found for THP among eight segments. Conclusions: Intra-hepatic perfusion differences exist in normal hepatic parenchyma especially between lateral sector (segments 2 and 3) and right lobe (segments 5, 6, 7 and 8). This might have potential clinical significance in liver-perfusion-related protocol design and result analysis.

Ultrasound based evaluation of hepatic steatosis and fibrosis in hepatitis c non-responders

International Nuclear Information System (INIS)

Sohail, S.; Aziz, S.

2013-01-01

To determine the accuracy of ultrasound in the diagnosis and grading of steatosis and fibrosis in Hepatitis C (HCV) patients not responding to ribavarin-interferon therapy. Study Design: A cross-sectional, analytical study. Place and Duration of Study: Radiology Department, Civil Hospital, Karachi, from March 2008 to August 2010. Methodology: Patients with positive HCV RNA despite 24 weeks ribavarin-interferon therapy (non-responders) were subjected to ultrasound and biopsy prior to institution of pegylated interferon therapy for detection and grading of steatosis and fibrosis. Using histopathology as the gold standard, sensitivity, specificity, negative and positive predictive values for ultrasound were determined. Results: The sensitivity of ultrasound for hepatic steatosis was 90.9% for no steatosis (NS), 100% for moderate and gross steatosis and 84.4% for mild steatosis with 100% specificity. The senitivity for fibrosis was 25% for no fibrosis, 100% for mild fibrosis, 89.74% for moderate fibrosis and 100% for gross fibrosis. The overall accuracy for detection of steatosis was 95.39% and that for fibrosis was 98.02%. Hepatic vein showed increased dampening of flow with advancing grades of steatosis and fibrosis. Conclusion: Ultrasound has a high accuracy in the diagnosis and grading of steatosis and fibrosis in HCV nonresponders. Mild fibrosis may confound the diagnosis of mild steatosis. (author)

Hepatic and pancreatic involvement in hereditary hemorrhagic telangiectasia: quantitative and qualitative evaluation with 64-section CT in asymptomatic adult patients

Energy Technology Data Exchange (ETDEWEB)

Barral, Matthias; Sirol, Marc; Hamzi, Lounis; Gayat, Etienne; Boudiaf, Mourad [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Place, Vinciane [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Universite Diderot-Paris 7, UFR de Medecine, Paris (France); Borsik, Michel [Hopital Lariboisiere-APHP, Deparment of Ear, Nose and Throat, Paris (France); Soyer, Philippe [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Universite Diderot-Paris 7, UFR de Medecine, Paris (France); Unite 965 INSERM/Paris7, Hopital Lariboisiere-APHP, Paris (France)

2012-01-15

To analyse quantitatively and qualitatively asymptomatic hepatic and pancreatic involvement in hereditary haemorrhagic telangiectasia (HHT) using 64-section helical CT. The 64-section helical CT examinations of 19 patients with HHT (8 men, 11 women; mean age, 58.6 years) were quantitatively and qualitatively analysed and compared to those of 19 control subjects who were matched for age and sex. Comparisons were made using univariate analysis. Dilated and tortuous intrahepatic arterial branches was the most discriminating independent variable (P < 0.0001) and had the highest specificity (100%; 19/19; 95%CI: 82%-100%) and accuracy (97%; 37/38; 95%CI: 86%-100%) for the diagnosis of HHT. Heterogeneous enhancement of hepatic parenchyma, intrahepatic telangiectases, hepatic artery to hepatic vein shunting, hepatic artery enlargement (i.e. diameter > 6.5 mm) and portal vein enlargement (i.e. diameter > 13 mm) were other variables that strongly correlated with the presence of HHT. Intrapancreatic telangiectases and arteriovenous malformations were found in 42% and 16% of patients with HHT, respectively. Liver and pancreatic involvement in asymptomatic HHT patients is associated with myriad suggestive findings on 64-section helical CT. It can be anticipated that familiarity with these findings would result in more confident diagnosis of HHT. (orig.)

Varicose Veins - Multiple Languages

Science.gov (United States)

... Concerns and Discomforts of Pregnancy: Varicose Veins - English MP3 Concerns and Discomforts of Pregnancy: Varicose Veins - 简体中文 (Chinese, Simplified (Mandarin dialect)) MP3 Concerns and Discomforts of Pregnancy: Varicose Veins - English ...

Valsalva and gravitational variability of the internal jugular vein and common femoral vein: Ultrasound assessment

Energy Technology Data Exchange (ETDEWEB)

Beddy, P. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: pbeddy@eircom.net; Geoghegan, T. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ramesh, N. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Buckley, O. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); O' Brien, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colville, J. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)

2006-05-15

Purpose: Central venous cannulation via the common femoral vein is an important starting point for many interventions. The purpose of this study was to determine the optimum conditions for cannulation of the femoral vein and to compare these with the relative changes in the internal jugular vein. Methods: High-resolution 2D ultrasound was utilised to determine variability of the calibre of the femoral and internal jugular veins in 10 healthy subjects. Venous diameter was assessed during the Valsalva manoeuvre and in different degrees of the Trendelenburg position. Results: The Valsalva manoeuvre significantly increased the size of the femoral and internal jugular veins. There was a relatively greater increase in femoral vein diameter when compared with the internal jugular vein of 40 and 29%, respectively. Changes in body inclination (Trendelenburg position) did not significantly alter the luminal diameter of the femoral vein. However, it significantly increased internal jugular vein diameter. Conclusions: Femoral vein cannulation is augmented by the Valsalva manoeuvre but not significantly altered by the gravitational position of the subject.

Early aneurysmal degeneration of femoral vein conduit used for aortoiliac reconstruction in a child

Directory of Open Access Journals (Sweden)

Zakariyae Bouziane, MD

2016-09-01

Full Text Available We report the case of a 14-year-old boy who underwent an aortobi-iliac bypass with a femoral vein graft. The patient presented with early aneurysmal degeneration of the entire venous graft only 11 months later. He was treated successfully with redo abdominal aortic surgery and a bifurcated Dacron graft.

Reconstruction of the midface and maxilla.

Science.gov (United States)

Dalgorf, Dustin; Higgins, Kevin

2008-08-01

To review the current classification systems and reconstructive options available for restoration of maxillectomy defects. Defects involving the midface can have a great functional and aesthetic impact on the patient. Adequate restoration of the complex three-dimensional maxillary structure is required to replace form and function of the native tissue. An in-depth discussion of appropriate recipient vessel selection and reconstructive options are included in this article. The superficial temporal vessel system is presented as a reliable anastomosis site for restoration of midfacial defects. In addition, the complications of vein grafting, arteriovenous fistula loops and alternative recipient vessels sites are addressed to manage the challenge of the vessel-depleted neck. The current indications, advantages and disadvantages of local, regional and free-flap reconstructive options available for maxillectomy defects are highlighted in order to aid the surgeon in appropriate flap selection. A myriad of reconstructive options are available to restore maxillectomy defects. The surgeon must consider each defect and the needs of the individual patient when choosing the best suited reconstructive technique.

Aspectos ultra-sonográficos da trombose da veia porta Ultrasonographic features of portal vein thrombosis

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Márcio Martins Machado

2006-04-01

Full Text Available A trombose da veia porta pode estar associada a várias alterações, como a presença de tumores (por exemplo: hepatocarcinoma, doença metastática hepática e carcinoma do pâncreas, pancreatite, hepatite, septicemia, trauma, esplenectomia, derivações porto-cava, estados de hipercoagulabilidade (por exemplo: gravidez, em neonatos (por exemplo: onfalite e cateterização da veia umbilical e desidratação aguda. Os autores discutem, neste artigo, os aspectos ultra-sonográficos da trombose de veia porta e alguns aspectos de relevância clínica.Portal vein thrombosis may be associated with many alterations, such as the presence of tumors (for example, hepatocellular carcinoma, metastatic liver disease and carcinoma of the pancreas as well as pancreatitis, hepatitis, septicemia, trauma, splenectomy, portacaval shunts, hypercoagulable conditions (for example, pregnancy, in neonates (for example, omphalitis and umbilical vein catheterization and in acute dehydration. The authors discuss herein the sonographic features of portal vein thrombosis as well as some aspects of clinical relevance.

Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

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Wen-jin JIANG

2015-03-01

Full Text Available Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE induced by transcatheter arterial chemoembolization (TACE so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up.Results: Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inflammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3-15 d. The re-examined chest X-ray showed normal after 20-60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein fistula and 7 with lipiodol dosage ≥20 mL.Conclusion: PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein fistula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

Case report of a modified Meso-Rex bypass as a treatment technique for late-onset portal vein cavernous transformation with portal hypertension after adult deceased-donor liver transplantation.

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Han, Dongdong; Tang, Rui; Wang, Liang; Li, Ang; Huang, Xin; Shen, Shan; Dong, Jiahong

2017-06-01

Portal vein thrombosis is a complication after liver transplantation and cavernous transformation of the portal vein (CTPV) is a result of portal vein thrombosis, with symptoms of portal hypertension revealed by an enhanced CT scan. Meso-Rex bypass is an artificial shunt connecting the left portal vein to the superior mesenteric vein and is mainly used for idiopathic cavernomas. This technique is also used for post-transplant portal vein thrombosis in pediatric patients thereby bypassing obstructed sites of the extrahepatic portal vein. Here we report about an adult patient who was treated by connecting the cystic part of the portal vein to the splenic vein instead of the superior mesenteric vein. An adult male patient with post-liver transplantation portal vein cavernous transformation suffered from hypersplenism and elevated hepatic enzymes. The last follow up revealed irregular and obvious hypersplenism, and splenomegaly had occurred, while an enhanced CT scan revealed serious esophagogastric varices and CTPV in addition to occluded right and common PV trunks. The patient was treated by connecting the cystic part of the portal vein to the splenic vein instead of the superior mesenteric vein. After the operation, a satisfactory velocity was confirmed 1 month postoperatively and the shunt still remained patent at the 6-month postoperation follow-up. A Meso-Rex bypass intervention connecting the left portal vein to the splenic vein instead of the superior mesenteric vein after liver transplantation in an adult patient with right and common portal vein occlusions has been successfully performed as an alternative approach.

Analysis of hepatoportal hemodynamics by hepatic radionuclide angiography on patients with portal hypertension

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Mitarai, Y; Yoshida, T; Yoshimura, T; Nagamine, K; Kanashima, R; Kobayashi, M; Nakashima, A; Kato, Y; Maeda, H

1987-04-01

Hepatoportal circulation was measured using radionuclide angiography with /sup 99m/Tc-fibrinogen in 40 patients with or without portal hypertension ; 20 cirrhotics with esophageal varices(LC with varices), 5 cirrhotics without esophageal varices(LC without varices), 5 patients with idiopathic portal hypertension(IPH) and 10 controls. In 8 cases among LC with varices, the hemodynamics was determined before and after left gastric vena caval shunt(LGCS). The radioactivity count and PA ratio(blood flow proportion of the portal vein to the hepatic artery) at the hepatic hilus were lower in the patients with liver cirrhosis(LC with and without varices) than those of the cases without liver cirrhosis(IPH and control). The comparison of hemodynamics before and during 6 weeks after LGCS demonstrated the radioactivity count well-preserved but on the contrary the PA ratio reduced at the hepatic hilus after surgery. The present results could indicate that the total hepatic inflow was maintained following LGCS, by compensatory increase of hepatic arterial flow in response to reduced portal flow. The implication of hepatic radionuclide angiography is discussed on patients with portal hypertension.

Analysis of hepatoportal hemodynamics by hepatic radionuclide angiography on patients with portal hypertension

International Nuclear Information System (INIS)

Mitarai, Yoshinobu; Yoshida, Takanori; Yoshimura, Takahisa; Nagamine, Kenji; Kanashima, Ryoichi; Kobayashi, Michio; Nakashima, Akihisa; Kato, Yukio; Maeda, Hirofumi

1987-01-01

Hepatoportal circulation was measured using radionuclide angiography with 99m Tc-fibrinogen in 40 patients with or without portal hypertension ; 20 cirrhotics with esophageal varices(LC with varices), 5 cirrhotics without esophageal varices(LC without varices), 5 patients with idiopathic portal hypertension(IPH) and 10 controls. In 8 cases among LC with varices, the hemodynamics was determined before and after left gastric vena caval shunt(LGCS). The radioactivity count and PA ratio(blood flow proportion of the portal vein to the hepatic artery) at the hepatic hilus were lower in the patients with liver cirrhosis(LC with and without varices) than those of the cases without liver cirrhosis(IPH and control). The comparison of hemodynamics before and during 6 weeks after LGCS demonstrated the radioactivity count well-preserved but on the contrary the PA ratio reduced at the hepatic hilus after surgery. The present results could indicate that the total hepatic inflow was maintained following LGCS, by compensatory increase of hepatic arterial flow in response to reduced portal flow. The implication of hepatic radionuclide angiography is discussed on patients with portal hypertension. (author)

Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

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Kang, Ung Rae; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University Medical Center, Catholic of Daegu University School of Medicine, Daegu (Korea, Republic of); Ahn, Eun Joung; Kim, See Hyung; Kim, Young Hwan [Dept. of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

2012-03-15

To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD). Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures. Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up. Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

Is the absence of Right Hepatic Vein opening into Inferior Vena Cava a contraindication for right lobe liver donation in Living Donor Liver Transplantation? Common hepatic venous trunk—A rare hepatic vein anomaly: A case report and review

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Samrat Ray

2017-01-01

Conclusion: This type of a rare anomaly poses challenge to the donor operation and requires a sound expertise on the knowledge of hepatic venous anatomy to perform the donor hepatectomy with the appropriate maneuvering.

Pathological mechanisms of alcohol-induced hepatic portal hypertension in early stage fibrosis rat model.

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Li, Jian; Niu, Jian-Zhao; Wang, Ji-Feng; Li, Yu; Tao, Xiao-Hua

2005-11-07

To study the role of hepatic sinusoidal capillarization and perisinusoidal fibrosis in rats with alcohol-induced portal hypertension and to discuss the pathological mechanisms of alcohol-induced hepatic portal hypertension. Fifty SD rats were divided into control group (n=20) and model group (n=30). Alcoholic liver fibrosis rat model was induced by intragastric infusion of a mixture containing alcohol, corn oil and pyrazole (1 000:250:3). Fifteen rats in each group were killed at wk 16. The diameter and pressure of portal vein were measured. Plasma hyaluronic acid (HA), type IV collagen (CoIV) and laminin (LN) were determined by radioimmunoassay. Liver tissue was fixed in formalin (10%) and 6-mum thick sections were routinely stained with Mallory and Sirius Red. Liver tissue was treated with rabbit polyclonal antibody against LN and ColIV. Hepatic non-parenchymal cells were isolated, total protein was extracted and separated by SDS-PAGE. MMP-2 and TIMP-1 protein expression was estimated by Western blotting. The diameter (2.207+/-0.096 vs 1.528+/-0.054 mm, Pportal vein were significantly higher in model group than those in the control group. Plasma HA (129.97+/-16.10 vs 73.09+/-2.38 ng/mL, Pmodel group. Abundant collagen deposited around the central vein of lobules, hepatic sinusoids and hepatocytes in model group. ColI and ColIII increased remarkably and perisinusoids were almost surrounded by ColIII. Immunohistochemical staining showed that ColIV protein level (0.130+/-0.007 vs 0.032+/-0.004, Pprotein level (0.152+/-0.005 vs 0.029+/-0.005, Pmodel group. MMP-2 protein expression (2.306+/-1.089 vs 0.612+/-0.081, Pprotein expression (3.015+/-1.364 vs 0.446+/-0.009, Pmodel group and TIMP-1 protein expression was evidently higher than MMP-2 protein expression (2.669+/-0.170 vs 1.695+/-0.008, Pportal hypertension in rats.

Comparison between mechanical properties of human saphenous vein and umbilical vein

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Hamedani Borhan

2012-08-01

Full Text Available Abstract Background As a main cause of mortality in developed countries, Coronary Artery Disease (CAD is known as silent killer with a considerable cost to be dedicated for its treatment. Coronary Artery Bypass Graft (CABG is a common remedy for CAD for which different blood vessels are used as a detour. There is a lack of knowledge about mechanical properties of human blood vessels used for CABG, and while these properties have a great impact on long-term patency of a CABG. Thus, studying these properties, especially those of human umbilical veins which have not been considered yet, looks utterly necessary. Methods Umbilical vein, as well as human Saphenous vein, are respectively obtained after cesarean and CABG. First, histological tests were performed to investigate different fiber contents of the samples. Having prepared samples carefully, force-displacement results of samples were rendered to real stress–strain measurements and then a fourth-order polynomial was used to prove the non-linear behavior of these two vessels. Results Results were analyzed in two directions, i.e. circumferentially and longitudinally, which then were compared with each other. The comparison between stiffness and elasticity of these veins showed that Saphenous vein’s stiffness is much higher than that of umbilical vein and also, it is less stretchable. Furthermore, for both vessels, longitudinal stiffness was higher than that of circumferential and in stark contrast, stretch ratio in circumferential direction came much higher than longitudinal orientation. Conclusion Blood pressure is very high in the region of aorta, so there should be a stiff blood vessel in this area and previous investigations showed that stiffer vessels would have a better influence on the flow of bypass. To this end, the current study has made an attempt to compare these two blood vessels’ stiffness, finding that Saphenous vein is stiffer than umbilical vein which is somehow as stiff as

Vein grafting in fingertip replantations.

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Yan, Hede; Jackson, William D; Songcharoen, Somjade; Akdemir, Ovunc; Li, Zhijie; Chen, Xinglong; Jiang, Liangfu; Gao, Weiyang

2009-01-01

In this retrospective study, the survival rates of fingertip replantation with and without vein grafting were evaluated along with their postoperative functional and cosmetic results. One hundred twenty-one-fingertip amputations were performed in 103 patients between September 2002 and July 2007. Thirty-four amputated fingertips were replanted without vein grafting, while 87 amputated fingertips were replanted with vein grafting for arterial and/or venous repairs. The overall survival rates of the replantations with and without vein grafting were 90% (78/87) and 85% (29/34), respectively. The survival rates were 88% (36/41) with venous repair, 93% (25/27) with arterial repair, and 89% (17/19) with both. Nineteen patients without vein grafting and 48 patients with vein grafting had a follow-up period of more than one year. Good cosmetic and functional outcomes were observed in both groups of patients. The results show that vein grafting is a reliable technique in fingertip replantations, showing no significant difference (P > 0.05) in survival between those with and without vein grafting. Furthermore, no significant difference (P > 0.05) in survival was found between cases with vein grafts for arterial and/or venous repairs. In fingertip replantations with vein grafting, favorable functional and esthetic results can be achieved without sacrificing replantation survival. (c) 2009 Wiley-Liss, Inc.

Perforator based rectus free tissue transfer for head and neck reconstruction: New reconstructive advantages from an old friend.

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Kang, Stephen Y; Spector, Matthew E; Chepeha, Douglas B

2017-11-01

To demonstrate three reconstructive advantages of the perforator based rectus free tissue transfer: long pedicle, customizable adipose tissue, and volume reconstruction without muscle atrophy within a contained space. Thirty patients with defects of the head and neck were reconstructed with the perforator based rectus free tissue transfer. Transplant success was 93%. Mean pedicle length was 13.4cm. Eleven patients (37%) had vessel-poor necks and the long pedicle provided by this transplant avoided the need for vein grafts in these patients. Adipose tissue was molded in 17 patients (57%). Twenty-five patients (83%) had defects within a contained space, such as the orbit, where it was critical to have a transplant that avoided muscle atrophy. The perforator based rectus free tissue transfer provides a long pedicle, moldable fat for flap customization, and is useful in reconstruction of defects within a contained space where volume loss due to muscle atrophy is prevented. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dsa examination and diagnosis of arteriovenous shunts in hepatic cavernous hemangiomas of adults

International Nuclear Information System (INIS)

Ouyang Yong; Ouyang Xuehui; Gu Subin; Zhou Qunhui

2000-01-01

Objective: To correct the misunderstanding that arteriovenous shunts (AVS) are rarely found in adult cavernous hemangiomas of the liver (CHL) and to increase its diagnosis rate by DSA. Methods: DSA examination and DSA images of thirty adults with definitely diagnostic CHL and without evidence of other hepatic diseases and hepatic injury were analyzed retrospectively. X-ray films of 21 cases with AVS taken immediately after transcatheter arterial embolization using lipiodol (L-TAE) were compared with the corresponding DSA images to check up those AVS opacified in DSA by observing sediment and distribution of iodized oil injected. Results: Definite diagnosis of AVS by DSA were obtained in 22 cases of this series (73%). All the AVS were located in the peritumoral parenchyma and appeared as parallel track sign, and early opacification of small draining veins, etc. during arterial phase of DSA. X-ray films taken immediately after L-TAE in 21 of 22 cases with AVS showed that few portal radicles or draining veins were refilled by iodized oil through incompletely occluded shunts in 11 cases, and no any vein was refilled by iodized oil resulted from complete occlusion of the present AVS in 10. No definite AVS was found in the other 8 cases of this series, and in 6 of them improper imaging factors of DSA were used. Conclusion: This study serves to emphasize that AVS is not a diagnosis of hepatic malignancy, but is frequently seen in the commonly benign CHL of adults. Proper imaging factors of DSA and superior images can be helpful to opacify small AVS of CHL. The formation of AVS in CHL may be closely related to the pathological changes of peritumoral parenchyma, however, its mechanism must be further studied

Random Pattern Vertically Oriented, Partial Thickness Buccinator Myomucosal Flap for Intraoral Reconstruction: A Report of Two Cases

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Amin Rahpeyma

2016-05-01

Full Text Available Introduction: Reconstruction of the oral cavity witha flap design containing the buccal mucosa and buccinator muscle but excluding the facial artery and vein is the topic of these case reports. Case Reports: This article uses random pattern vertically oriented partial thickness buccinator myomucosal flap for intraoral reconstruction in two cases. The first was for lining the mandibular anterior vestibule in a trauma patient. The second was for oral side coverage of bone graft in special cleft patient. In both patients, this flap survived and good bone coverage with non-keratinized mucosa was obtained. Conclusion:  Thin long buccal myomucosal flap not including facial artery and vein can survive.

[Mesenteric-cava shunt's results with autologous jugular vein graft in children with pre-sinusoidal portal hypertension].

Science.gov (United States)

Leal, N; López Santamaría, M; Gámez, M; Murcia, J; Andolfi, G; Berrocal, T; Frauca, E; Jara, P; Tovar, J

2002-07-01

Presinusoidal portal hypertension (PPH) in children evaluates without functional hepatic damage, and with the time, trends to compensate through the creation of spontaneous portosystemic shunts. Nevertheless, some patients suffer episodes of gastrointestinal bleeding (GIB) that because of its frequency or severity, force to propose the change of surgical treatment. To evaluate the results of the mesocaval shunt (MCS) with autologous jugular vein in children with PPH. Among the 32 children with PPH treated in our Hospital in the last 7 years, 10 had episodes of GIB that forced to perform a surgical shunt. The types of shunt were distal splenorenal in 3 patients and mesocaval in 7. These 7 cases are the material of this study. The origin of the PPH was a cavernomatosis transformation of the portal vein in 6 cases and a congenital hepatic fibrosis in 1. Before the surgery the average number of episodes of GIB was 9 (range 2-15); all the patients needed transfusion of blood products and variceal sclerosis. In 2 cases a tamponade with the Sengtaken balloon was required and 5 patients were treated with somatostatin and propranolol. The Doppler ultrasounds revealed and intense hepatofugal collateral circulation in all the cases. The initial flow through the shunt was adequate in all the patients except one who required a percutaneous balloon dilatation. Only this patient has suffered an episode of GIB. The hyperesplenism signs disappeared or improved in all the seven cases and the collateral circulation was significantly reduced. The pressure in the splenic territory decreased around 50% in the 4 patients that was measured. There were no cases of encephalopasty and only one child with congenital hepatic fibrosis shows signs of mild hepatic disfunction. The medium follow up post-shunt is 32 months (range 8 m-6 years). The MCS prevents the GIB in the PPH not responsive to the conservative treatment; its effectiveness is related with an adequate permeability though the graft

Percutaneous transsplenic catheterization of portal vein: technique and clinical application

International Nuclear Information System (INIS)

Zhu Kangshun; Huang Mingsheng; Pang Pengfei; Zhou Bin; Xu Changmo; Qian Jiesheng; Li Zhengran; Jiang Zaibo; Shan Hong

2010-01-01

(range: one to forty-two months), 14 patients died of hepatocellular carcinoma 1 to 12 months after procedure, and 2 patients died of hepatic failure caused by liver cirrhosis at fourteen months and twenty-three months after procedure, respectively. Variceal rebleeding was observed in 4 patients, the cumulative rebleeding rate at 1 year was 14.3%. Conclusion: PTSPC is a feasible procedure, which provides a useful route for endovascular treatment of portal vein. However, hemorrhage at the puncture site after procedure should be noticed. (authors)

Rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases following combined loco-regional therapy

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Pua, Uei [Dept. of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore (Singapore)

2013-08-15

This manuscript describes an unusual case of rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases occurring 1 month after combined chemoembolization and radiofrequency ablation. Inferior vena cava and portal vein invasion tumor thrombus was also detected, possibly accounting for the mechanism of disease dissemination route of disease.

Rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases following combined loco-regional therapy

International Nuclear Information System (INIS)

Pua, Uei

2013-01-01

This manuscript describes an unusual case of rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases occurring 1 month after combined chemoembolization and radiofrequency ablation. Inferior vena cava and portal vein invasion tumor thrombus was also detected, possibly accounting for the mechanism of disease dissemination route of disease.

A comparison of dobutamine and levosimendan on hepatic blood flow in patients with a low cardiac output state after cardiac surgery: a randomised controlled study.

Science.gov (United States)

Alvarez, J; Baluja, A; Selas, S; Otero, P; Rial, M; Veiras, S; Caruezo, V; Taboada, M; Rodriguez, I; Castroagudin, J; Tome, S; Rodriguez, A; Rodriguez, J

2013-11-01

Liver dysfunction due to a low cardiac output state after cardiac surgery is associated with a poor prognosis, but whether one inotrope is superior to another in improving hepatic perfusion remains uncertain. This study compared the systemic and hepatic haemodynamic effects of levosimendan to dobutamine in patients with a low cardiac output state (cardiac index flow (ml/min): 614.0±124.7, 585.9±144.8; pulsatility index: 2.02±0,28, 2.98±0.27 versus the levosimendan group: cardiac index: 3.02± 0.27, 2.98± 0.30; portal vein flow: 723.0± 143.5, 702.9±117.8; pulsatility index: 1.71±0.26, 1.73±0.27). The improvement in portal vein blood flow at 48 hours was significantly better after levosimendan than dobutamine (41% vs. 11% increment from baseline, Pflow through both the hepatic artery and portal venous system, whereas dobutamine can only improve the portal venous blood flow without vasodilating the hepatic artery.

Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2* correction and estimation

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Ge, Mingmei; Wu, Bing; Liu, Zhiqin; Song, Hai; Meng, Xiangfeng; Wu, Xinhuai [The Military General Hospital of Beijing PLA, Department of Radiology, Beijing (China); Zhang, Jing [The 309th Hospital of Chinese People' s Liberation Army, Department of Radiology, Beijing (China)

2016-06-15

To determine whether hepatic fat quantification is affected by administration of gadolinium using a multiecho reconstruction technique with T2* correction and estimation. Forty-eight patients underwent the investigational sequence for hepatic fat quantification at 3.0T MRI once before and twice after administration of gadopentetate dimeglumine (0.1 mmol/kg). A one-way repeated-measures analysis of variance with pairwise comparisons was conducted to evaluate the systematic bias of fat fraction (FF) and R2* measurements between three acquisitions. Bland-Altman plots were used to assess the agreements between pre- and post-contrast FF measurements in the liver. A P value <0.05 indicated statistically significant difference. FF measurements of liver, spleen and spine revealed no significant systematic bias between the three measurements (P > 0.05 for all). Good agreements (95 % confidence interval) of FF measurements were demonstrated between pre-contrast and post-contrast1 (-0.49 %, 0.52 %) and post-contrast2 (-0.83 %, 0.77 %). R2* increased in liver and spleen (P = 0.039, P = 0.01) after administration of gadolinium. Although under the impact of an increased R2* in liver and spleen post-contrast, the investigational sequence can still obtain stable fat quantification. Therefore, it could be applied post-contrast to substantially increase the efficiency of MR examination and also provide a backup for the occasional failure of FF measurements pre-contrast. (orig.)

Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2* correction and estimation

International Nuclear Information System (INIS)

Ge, Mingmei; Wu, Bing; Liu, Zhiqin; Song, Hai; Meng, Xiangfeng; Wu, Xinhuai; Zhang, Jing

2016-01-01

To determine whether hepatic fat quantification is affected by administration of gadolinium using a multiecho reconstruction technique with T2* correction and estimation. Forty-eight patients underwent the investigational sequence for hepatic fat quantification at 3.0T MRI once before and twice after administration of gadopentetate dimeglumine (0.1 mmol/kg). A one-way repeated-measures analysis of variance with pairwise comparisons was conducted to evaluate the systematic bias of fat fraction (FF) and R2* measurements between three acquisitions. Bland-Altman plots were used to assess the agreements between pre- and post-contrast FF measurements in the liver. A P value <0.05 indicated statistically significant difference. FF measurements of liver, spleen and spine revealed no significant systematic bias between the three measurements (P > 0.05 for all). Good agreements (95 % confidence interval) of FF measurements were demonstrated between pre-contrast and post-contrast1 (-0.49 %, 0.52 %) and post-contrast2 (-0.83 %, 0.77 %). R2* increased in liver and spleen (P = 0.039, P = 0.01) after administration of gadolinium. Although under the impact of an increased R2* in liver and spleen post-contrast, the investigational sequence can still obtain stable fat quantification. Therefore, it could be applied post-contrast to substantially increase the efficiency of MR examination and also provide a backup for the occasional failure of FF measurements pre-contrast. (orig.)

Vein matching using artificial neural network in vein authentication systems

Science.gov (United States)

Noori Hoshyar, Azadeh; Sulaiman, Riza

2011-10-01

Personal identification technology as security systems is developing rapidly. Traditional authentication modes like key; password; card are not safe enough because they could be stolen or easily forgotten. Biometric as developed technology has been applied to a wide range of systems. According to different researchers, vein biometric is a good candidate among other biometric traits such as fingerprint, hand geometry, voice, DNA and etc for authentication systems. Vein authentication systems can be designed by different methodologies. All the methodologies consist of matching stage which is too important for final verification of the system. Neural Network is an effective methodology for matching and recognizing individuals in authentication systems. Therefore, this paper explains and implements the Neural Network methodology for finger vein authentication system. Neural Network is trained in Matlab to match the vein features of authentication system. The Network simulation shows the quality of matching as 95% which is a good performance for authentication system matching.

Adipose derived mesenchymal stem cells transplantation via portal vein improves microcirculation and ameliorates liver fibrosis induced by CCl4 in rats

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Wang Yu

2012-06-01

Full Text Available Abstract Introduction Adipose derived mesenchymal stem cells (ADMSCs, carrying the similar characteristics to bone marrow mesenchymal stem cells, only much more abundant and easier to obtain, may be a promising treatment for liver fibrosis. We aim to investigate the therapeutic potential of ADMSCs transplantation in liver fibrosis caused by carbon tetrachloride (CCl4 in rats as well as its underlying mechanism, and to further explore the appropriate infusion pathway. Methods ADMSCs were isolated, cultured and identified. Placebo and ADMSCs were transplanted via portal vein and tail vein respectively into carbon tetrachloride (CCl4-induced liver fibrosis rats. Computed tomography (CT perfusion scan and microvessel counts were performed to measure the alteration of liver microcirculation after therapy. Liver function tests and histological findings were estimated. Results CT perfusion scan shown significant decrease of hepatic arterial perfusion index, significant increased portal vein perfusion, total liver perfusion in rats receiving ADMSCs from portal vein, and Factor VIII (FVIII immunohistochemical staining shown significant decrease of microvessels in rats receiving ADMSCs from portal vein, indicating microcirculation improvement in portal vein group. Vascular endothelial growth Factor (VEGF was significantly up-regulated in fibrosis models, and decreased after ADMSCs intraportal transplantation. A significant improvement of liver functional test and histological findings in portal vein group were observed. No significance was found in rats receiving ADMSCs from tail vein. Conclusions ADMSCs have a therapeutic effect against CCl4-mediated liver fibrosis. ADMSCs may benefit the fibrotic liver through alteration of microcirculation, evidenced by CT perfusion scan and down-regulation of VEGF. Intraportal transplantation is a better pathway than tail vein transplantation.

The optimal monochromatic spectral computed tomographic imaging plus adaptive statistical iterative reconstruction algorithm can improve the superior mesenteric vessel image quality

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Yin, Xiao-Ping; Zuo, Zi-Wei; Xu, Ying-Jin; Wang, Jia-Ning [CT/MRI room, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000 (China); Liu, Huai-Jun, E-mail: hebeiliu@outlook.com [Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000 (China); Liang, Guang-Lu [CT/MRI room, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000 (China); Gao, Bu-Lang, E-mail: browngao@163.com [Department of Medical Research, Shijiazhuang First Hospital, Shijiazhuang, Hebei, 050011 (China)

2017-04-15

Objective: To investigate the effect of the optimal monochromatic spectral computed tomography (CT) plus adaptive statistical iterative reconstruction on the improvement of the image quality of the superior mesenteric artery and vein. Materials and methods: The gemstone spectral CT angiographic data of 25 patients were reconstructed in the following three groups: 70 KeV, the optimal monochromatic imaging, and the optimal monochromatic plus 40%iterative reconstruction mode. The CT value, image noises (IN), background CT value and noises, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and image scores of the vessels and surrounding tissues were analyzed. Results: In the 70 KeV, the optimal monochromatic and the optimal monochromatic images plus 40% iterative reconstruction group, the mean scores of image quality were 3.86, 4.24 and 4.25 for the superior mesenteric artery and 3.46, 3.78 and 3.81 for the superior mesenteric vein, respectively. The image quality scores for the optimal monochromatic and the optimal monochromatic plus 40% iterative reconstruction groups were significantly greater than for the 70 KeV group (P < 0.05). The vascular CT value, image noise, background noise, CNR and SNR were significantly (P < 0.001) greater in the optimal monochromatic and the optimal monochromatic images plus 40% iterative reconstruction group than in the 70 KeV group. The optimal monochromatic plus 40% iterative reconstruction group had significantly (P < 0.05) lower image and background noise but higher CNR and SNR than the other two groups. Conclusion: The optimal monochromatic imaging combined with 40% iterative reconstruction using low-contrast agent dosage and low injection rate can significantly improve the image quality of the superior mesenteric artery and vein.

Dual compression is not an uncommon type of iliac vein compression syndrome.

Science.gov (United States)

Shi, Wan-Yin; Gu, Jian-Ping; Liu, Chang-Jian; Lou, Wen-Sheng; He, Xu

2017-09-01

Typical iliac vein compression syndrome (IVCS) is characterized by compression of left common iliac vein (LCIV) by the overlying right common iliac artery (RCIA). We described an underestimated type of IVCS with dual compression by right and left common iliac arteries (LCIA) simultaneously. Thirty-one patients with IVCS were retrospectively included. All patients received trans-catheter venography and computed tomography (CT) examinations for diagnosing and evaluating IVCS. Late venography and reconstructed CT were used for evaluating the anatomical relationship among LCIV, RCIA and LCIA. Imaging manifestations as well as demographic data were collected and evaluated by two experienced radiologists. Sole and dual compression were found in 32.3% (n = 10) and 67.7% (n = 21) of 31 patients respectively. No statistical differences existed between them in terms of age, gender, LCIV diameter at the maximum compression point, pressure gradient across stenosis, and the percentage of compression level. On CT and venography, sole compression was commonly presented with a longitudinal compression at the orifice of LCIV while dual compression was usually presented as two types: one had a lengthy stenosis along the upper side of LCIV and the other was manifested by a longitudinal compression near to the orifice of external iliac vein. The presence of dual compression seemed significantly correlated with the tortuous LCIA (p = 0.006). Left common iliac vein can be presented by dual compression. This type of compression has typical manifestations on late venography and CT.

Surgical Access to Jejunal Veins for Local Thrombolysis and Stent Placement in Portal Vein Thrombosis

International Nuclear Information System (INIS)

Schellhammer, Frank; Esch, Jan Schulte am; Hammerschlag, Sascha; Knoefel, Wolfram Trudo; Fuerst, Guenter

2008-01-01

Portal vein thrombosis is an infrequent entity, which may cause high morbidity and mortality. We report a case of portal vein thrombosis due to benign stenosis following partial pancreatoduodenectomy with segmental replacement of the portal vein by a Gore-tex graft. Using a surgical access to jenunal veins, local thrombolysis, mechanical fragmentation of thrombus, and stent placement were successfully performed.

Comparison of four embolic materials for portal vein embolization: experimental study in pigs

Energy Technology Data Exchange (ETDEWEB)

Baere, Thierry de [Institut de Cancerologie Gustave Roussy, Department of Interventional Radiology, Villejuif (France); Denys, Alban [Centre Hospitalier Universitaire Vaudois, Department of Radiology and Interventional Radiology, Lausanne (Switzerland); Paradis, Valerie [Hopital Beaujon-Inserm U773, Department of Anatomie Pathologique, Clichy (France)

2009-06-15

Different embolic materials for portal vein embolization (PVE) were evaluated. Twenty pigs received left and median PVE. Hydrophilic phosphorylcholine, N-butyl cyanoacrylate, hydrophilic gel, and polyvinyl alcohol (PVA) particles measuring either 50-150 {mu}m or 700-900 {mu}m were used in five pigs each. Portography and portal vein pressure measurement were performed before, immediately after PVE, and before being euthanized at day 7. Tissue wedges from embolized, and non-embolized liver were obtained for pathology. After complete embolization, recanalization occurred at 7 days in one gel and one 700-900 PVA embolization. Post-PVE increase in portal pressure was found in all groups (p = 0.01). The area of the hepatic lobules in non-embolized liver was larger than in the embolized liver in all groups (p = 0.001). The ratios of the areas between non-embolized/embolized livers were 1.65, 2.19, 1.57, and 1.32 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively; the ratios of fibrosis between the embolized and non-embolized livers were 1.37, 3.01, 3.49, and 2.11 for gel, NBCA, 50-150 PVA and 700-900 PVA, respectively. Hepatic lobules in non-embolized liver were significantly larger with NBCA than in other groups (p = 0.01). Fibrosis in embolized liver was significantly higher for NBCA and 50-150 PVA (p = 0.002). The most severe changes in embolized and non-embolized liver were induced by 50-150 PVA and NCBA PVE. (orig.)

Hepatic Involvement of Histiocytic Sarcoma: CT and MRI Findings

International Nuclear Information System (INIS)

Kubo, Takatoshi; Kiryu, Shigeru; Akai, Hiroyuki; Ota, Yasunori; Tojo, Arinobu; Yoshida, Hideo; Kato, Naoya; Nakano, Yoshiyasu; Ohtomo, Kuni

2016-01-01

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically

Hepatic involvement of histiocytic sarcoma: CT and MRI findings

Energy Technology Data Exchange (ETDEWEB)

Kubo, Takatosh; Ohtomo, Kuni [Graduate School of Medicine, University of Tokyo, Tokyo (Japan); Kiryu, Shigeru; Akai, Hiroyuki; Ora, Yasunori; Tojo, Arinobu; Yoshida, Hideo; Kato, Naoya; Nakano, Yoshiyasu [Institute of Medical Science, University of Tokyo, Tokyo (Japan)

2016-09-15

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically.

Hepatic Involvement of Histiocytic Sarcoma: CT and MRI Findings

Energy Technology Data Exchange (ETDEWEB)

Kubo, Takatoshi [Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8654 (Japan); Kiryu, Shigeru; Akai, Hiroyuki [Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639 (Japan); Ota, Yasunori [Department of Pathology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639 (Japan); Tojo, Arinobu [Department of Hematology and Oncology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639 (Japan); Yoshida, Hideo [Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo 150-8935 (Japan); Kato, Naoya [Advanced Medical Science, Institute of Medical Science, University of Tokyo, Tokyo 108-8639 (Japan); Nakano, Yoshiyasu [Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639 (Japan); Ohtomo, Kuni [Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8654 (Japan)

2016-11-01

Histiocytic sarcoma in the liver is an extremely rare hematological malignancy. Herein, we reported the case of a 68-year-old woman who presented with characteristic wedge-shaped abnormality bounded by hepatic veins on computed tomography and magnetic resonance imaging of the liver. In the wedge-shaped area, decreased portal flow and the deposition of iron were observed. These imaging findings are consistent with intrasinusoidal tumor cell infiltration. A liver biopsy was performed, and histiocytic sarcoma was confirmed histopathologically.

Use of deuterium labelled glucose in evaluating the pathway of hepatic glycogen synthesis

International Nuclear Information System (INIS)

Goodman, M.N.; Masuoka, L.K.; deRopp, J.S.; Jones, A.D.

1989-01-01

Deuterium labelled glucose has been used to study the pathway of hepatic glycogen synthesis during the fasted-refed transition in rats. Deuterium enrichment of liver glycogen was determined using nuclear magnetic resonance as well as mass spectroscopy. Sixty minutes after oral administration of deuterated glucose to fasted rats, the portal vein blood was fully enriched with deuterated glucose. Despite this, less than half of the glucose molecules incorporated into liver glycogen contained deuterium. The loss of deuterium label from glucose is consistent with hepatic glycogen synthesis by an indirect pathway requiring prior metabolism of glucose. The use of deuterium labelled glucose may prove to be a useful probe to study hepatic glycogen metabolism. Its use may also find application in the study of liver glycogen metabolism in humans by a noninvasive means

Evaluation of the therapeutic effect of hepatic arterial chemoembolization combined with portal chemoembolization for advanced hepatic carcinomas

International Nuclear Information System (INIS)

He Hongde; He Jing; Luo Zhonghua; Xu Jian; Sun Lijun; Li Jingbang; Zhang Xuexin

2010-01-01

Objective: To evaluate the effect of transcatheter arterial chemoembolization (TACE) together with portal vein chemoembolization (PVCE) for the treatment of advanced liver carcinomas. Methods: Forty-eight patients with liver carcinoma were randomly divided into two groups. Patients in study group (n = 22) were treated with TACE together with PVCE, and patients in control group (n = 26) were treated with TACE alone. Results: Based on the postoperative CT findings and AFP levels, the effective rate of the study group was markedly higher than that of control group and the difference between two groups was statistically significant (P < 0.05). The volume of un-embolized liver tissue in the patients of study group was obviously increased after treatment. Conclusion: TACE together with PVCE is superior to TACE alone in treating advanced hepatic carcinomas. The combination of TACE and PVCE can effectively increase the successful rate of surgical resection for the advanced hepatic carcinomas. (authors)

The value of multislice spiral CT in transcatheter arterial chemoembolization of the hepatocellular carcinoma

International Nuclear Information System (INIS)

Li Zhigang; Zhao Junjing; Shi Gaofeng; Li Shunzong; Han Pengyin; Yang Guang; Liang Guoqing; Wang Hongguang; Huang Jingxiang

2006-01-01

Objective: To evaluate the value of multislice spiral CT (MSCT) in transcatheter arterial chemoembolization of the hepatocellular carcinoma. Methods: MSCT were performed in 54 cases of HCC before interventional procedure. CT findings of hepatic artery phase, portal venous phase and hepatic venous phase were observed respectively. CTA were done in 12 cases, the anatomy of celiac artery and its branches were observed. The schemes of interventional therapy were worked out according to the findings of MSCT. The demonstration of lesions and its complications were compared between CT and DSA. Reconstruction of celiac artery branches used the technique of VRT, MIP or MPR. Results: MSCT showed 225 lesions, 10 cases tumor thrombosis of portal vein, 1 case hepatic arteriovenous shunt, and 13 cases hepatic arterioportal shunt. Positive rate of MSCT in showing number of tumor lesions, tumor thrombosis in portal vein was slightly higher than that of DSA, but there was no significant difference (P>0.05). Showing of 3D reconstruction of celiac artery branches in CTA is better than that in DSA, Showing of angles between celiac artery and abdominal aorta in MSCT is more convenient than that in DSA. MSCT showed 5 cases hepatic artery original abnormality. The results were in accord with that in DSA. Five cases were demonstrated of multiple supply blood vessels of tumor in MSCT, It was slightly lower than that of DSA. Conclusion: MSCT is of importance for guidance of transcatheter arterial chemoembolization of the hepatocellular carcinoma, delay time of CT scan is the key to the showing of lesions and blood vessels. (authors)

The economics of vein disease.

Science.gov (United States)

Sales, Clifford M; Podnos, Joan; Levison, Jonathan

2007-09-01

The management of cosmetic vein problems requires a very different approach than that for the majority of most other vascular disorders that occur in a vascular surgery practice. This article focuses on the business aspects of a cosmetic vein practice, with particular attention to the uniqueness of these issues. Managing patient expectations is critical to the success of a cosmetic vein practice. Maneuvering within the insurance can be difficult and frustrating for both the patient and the practice. Practices should use cost accounting principles to evaluate the success of their vein work. Vein surgery--especially if performed within the office--can undergo an accurate break-even analysis to determine its profitability.

Pathological Predictors of Shunt Stenosis and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt

Directory of Open Access Journals (Sweden)

Fuliang He

2016-01-01

Full Text Available Background. Transjugular intrahepatic portosystemic shunt (TIPS is an artificial channel from the portal vein to the hepatic vein or vena cava for controlling portal vein hypertension. The major drawbacks of TIPS are shunt stenosis and hepatic encephalopathy (HE; previous studies showed that post-TIPS shunt stenosis and HE might be correlated with the pathological features of the liver tissues. Therefore, we analyzed the pathological predictors for clinical outcome, to determine the risk factors for shunt stenosis and HE after TIPS. Methods. We recruited 361 patients who suffered from portal hypertension symptoms and were treated with TIPS from January 2009 to December 2012. Results. Multivariate logistic regression analysis showed that the risk of shunt stenosis was increased with more severe inflammation in the liver tissue (OR, 2.864; 95% CI: 1.466–5.592; P=0.002, HE comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001, or higher MELD score (95% CI, 1.298–1.731; P<0.001. Higher risk of HE was associated with shunt stenosis comorbidity (OR, 6.266; 95% CI, 3.141–12.501; P<0.001, higher stage of the liver fibrosis (OR, 2.431; 95% CI, 1.355–4.359; P=0.003, and higher MELD score (95% CI, 1.711–2.406; P<0.001. Conclusion. The pathological features can predict individual susceptibility to shunt stenosis and HE.

TRIPLE PHASE SPIRAL C.T. IN THE EVALUATION OF HEPATIC MASSES

Directory of Open Access Journals (Sweden)

Prasad

2015-10-01

Full Text Available BACKGROUND AND OBJECTIVE : The goal of the study is to determine the value of various phases of Triple, Helical CT, Hepatic arterial Phase (HAP, Portal venous phase (PVP and Equilibrium Phase (EP, is the detection and characterization of Hepatic Lesions and to evaluate whether u nenhanced and hepatic arterial phases when used in conjunction with porto venous phase would lead to detection of greater number of lesions or better characterization of lesion. METHODOLOGY : The study population consists of 50 Patients aged between 30 Years and 80 Years were examined with multiphase (plain, hepatic arterial, portal venous and equilibrium phases. Spiral CT of liver. Patients were referred for CT scan when liver diseases were suspected clinically, if ultrasound and other previous investi gations revealed lesions which had to be further evaluated by spiral CT and to detect liver metastases in known cases of primary extra hepatic malignancy. CT TECHNIQUE: Helical scanning of liver with Toshiba astein s4, continuous spiral run and the images were reconstructed at 5mm intervals. Contrast material 100ml was injected through 18 or 20G catheter at the rate of 3ml per second using automatic medrad power injector. Non - ionic contrast [IOHEXOl – 300mg perml was used in all the patients]. After obtaine d unenhanced CT scan HAP scanning was initiated 25 seconds after initiation of contrast injection. Portal venous phase scanning was initiated 60 - 65 seconds after start of contrast injection. Equilibrium phase scanning was initiated after 180 seconds after the start of contrast injection. IMAGE EVALUATION: All the images of 4 phases were reviewed. First Step : The presence, appearance and enhancement of each Lesion were noted in all phases and lesion were described Isodense, Hypodense Hyperdense based on thei r attenuation relative to liver parenchyma during that phase of scanning. Based on enhancement pattern of the lesion during various phases they were

Hepatitis virus protein X-Phenylalanine Hydroxylase fusion proteins identified in PKU mice treated with AAV-WPRE vectors

Science.gov (United States)

Utilizing the Pahenu2 mouse model for phenylketonuria (PKU), we developed an improved expression vector containing the Woodchuck Hepatitis Virus post-transcriptional regulatory element inserted into a rAAV-mPAH construct (rAAV-mPAH-WPRE) for treatment of PKU. Following portal vein delivery of these ...

Deep Vein Thrombosis

African Journals Online (AJOL)

OWNER

Deep Vein Thrombosis: Risk Factors and Prevention in Surgical Patients. Deep Vein ... preventable morbidity and mortality in hospitalized surgical patients. ... the elderly.3,4 It is very rare before the age ... depends on the risk level; therefore an .... but also in the post-operative period. ... is continuing uncertainty regarding.

Automatic Identification and Reconstruction of the Right Phrenic Nerve on Computed Tomography

OpenAIRE

Bamps, Kobe; Cuypers, Céline; Polmans, Pieter; Claesen, Luc; Koopman, Pieter

2016-01-01

An automatic computer algorithm was successfully constructed, enabling identification and reconstruction of the right phrenic nerve on high resolution coronary computed tomography scans. This could lead to a substantial reduction in the incidence of phrenic nerve paralysis during pulmonary vein isolation using ballon techniques.

Arabidopsis thaliana Ei-5: Minor Vein Architecture Adjustment Compensates for Low Vein Density in Support of Photosynthesis.

Science.gov (United States)

Stewart, Jared J; Polutchko, Stephanie K; Demmig-Adams, Barbara; Adams, William W

2018-01-01

An Arabidopsis thaliana accession with naturally low vein density, Eifel-5 (Ei-5), was compared to Columbia-0 (Col-0) with respect to rosette growth, foliar vein architecture, photosynthesis, and transpiration. In addition to having to a lower vein density, Ei-5 grew more slowly, with significantly lower rates of rosette expansion, but had similar capacities for photosynthetic oxygen evolution on a leaf area basis compared to Col-0. The individual foliar minor veins were larger in Ei-5, with a greater number of vascular cells per vein, compared to Col-0. This compensation for low vein density resulted in similar values for the product of vein density × phloem cell number per minor vein in Ei-5 and Col-0, which suggests a similar capacity for foliar sugar export to support similar photosynthetic capacities per unit leaf area. In contrast, the product of vein density × xylem cell number per minor vein was significantly greater in Ei-5 compared to Col-0, and was associated not only with a higher ratio of water-transporting tracheary elements versus sugar-transporting sieve elements but also significantly higher foliar transpiration rates per leaf area in Ei-5. In contrast, previous studies in other systems had reported higher ratios of tracheary to sieve elements and higher transpiration rate to be associated with higher - rather than lower - vein densities. The Ei-5 accession thus further underscores the plasticity of the foliar vasculature by illustrating an example where a higher ratio of tracheary to sieve elements is associated with a lower vein density. Establishment of the Ei-5 accession, with a low vein density but an apparent overcapacity for water flux through the foliar xylem network, may have been facilitated by a higher level of precipitation in its habitat of origin compared to that of the Col-0 accession.

Intracellular mechanism of action of sympathetic hepatic nerves on glucose and lactate balance in perfused rat liver

NARCIS (Netherlands)

Ballé, C.; Beuers, U.; ENGELHARDT, R.; JUNGERMANN, K.

1987-01-01

In rat liver perfused in situ stimulation of the nerve plexus around the hepatic artery and the portal vein caused an increase in glucose output and a shift from lactate uptake to output. The effects of nerve stimulation on some key enzymes, metabolites and effectors of carbohydrate metabolism were

Runinal and Intermediary Metabolism of Propylene Glycol in Lactating Holstein Cows

DEFF Research Database (Denmark)

Kristensen, Niels Bastian; Raun, Birgitte Marie Løvendahl

2007-01-01

Four lactating Holstein cows fitted with ruminal cannulas and permanent indwelling catheters in the mesenteric artery, mesenteric vein, hepatic portal vein, and hepatic vein were used in a cross-over design to study the metabolism of propylene glycol (PG).......Four lactating Holstein cows fitted with ruminal cannulas and permanent indwelling catheters in the mesenteric artery, mesenteric vein, hepatic portal vein, and hepatic vein were used in a cross-over design to study the metabolism of propylene glycol (PG)....

Development and molecular composition of the hepatic progenitor cell niche.

Science.gov (United States)

Vestentoft, Peter Siig

2013-05-01

, we examined several genes upregulated in a global gene expression array conducted on one of these models, in which progenitor cells are activated. The protein expression patterns were evaluated in our collections of human embryonic and fetal livers, human liver diseases, and rodent hepatic injury models. When analyzing standard histological liver sections underlying connections and tissue architecture are not immediately evident. We therefore developed models for digitally reconstructing not only protein expression in serially cut tissue sections, but also vessels of the portal area. Article I constituted our earliest attempts to create 3D reconstructions of biological material. Human embryonic stem cell cultures were previously thought to consist of homogenously undifferentiated cells. The protocols for 3D reconstructions developed in this study demonstrated micro heterogeneity in expression of differentiation markers and provided the basis for later reconstructions of hepatic tissues. In article II we examined the expression patterns of chosen proteins seen upregulated in the gene array as well as classical hepatocytic and cholangiocytic markers in human liver disease and during prenatal development. Previous studies had indicated direct connections between activated progenitor cells apparently isolated in the parenchyma and the intrahepatic biliary tree. Our developed protocols for 3D reconstructions visually demonstrated direct connections between these entities. Analysis of protein expression in prenatal liver revealed the formation of the intrahepatic tree to occur through a special form of asymmetric tubulogenesis, only recently described in mice. In order to describe the composition of the hepatic progenitor cell niche and the localization of cell surface proteins in article III, the expression patterns of certain genes upregulated in the gene array analysis were analyzed in different models of rodent liver regeneration. We observed that the extracellular

Vein visualization: patient characteristic factors and efficacy of a new infrared vein finder technology.

Science.gov (United States)

Chiao, F B; Resta-Flarer, F; Lesser, J; Ng, J; Ganz, A; Pino-Luey, D; Bennett, H; Perkins, C; Witek, B

2013-06-01

We investigated the patient characteristic factors that correlate with identification of i.v. cannulation sites with normal eyesight. We evaluated a new infrared vein finding (VF) technology device in identifying i.v. cannulation sites. Each subject underwent two observations: one using the conventional method (CM) of normal, unassisted eyesight and the other with the infrared VF device, VueTek's Veinsite™ (VF). A power analysis for moderate effect size (β=0.95) required 54 samples for within-subject differences. Patient characteristic profiles were obtained from 384 subjects (768 observations). Our sample population exhibited an overall average of 5.8 [95% confidence interval (CI) 5.4-6.2] veins using CM. As a whole, CM vein visualization were less effective among obese [4.5 (95% CI 3.8-5.3)], African-American [4.6 (95% CI 3.6-5.5 veins)], and Asian [5.1 (95% CI 4.1-6.0)] subjects. Next, the VF technology identified an average of 9.1 (95% CI 8.6-9.5) possible cannulation sites compared with CM [average of 5.8 (95% CI 5.4-6.2)]. Seventy-six obese subjects had an average of 4.5 (95% CI 3.8-5.3) and 8.2 (95% CI 7.4-9.1) veins viewable by CM and VF, respectively. In dark skin subjects, 9.1 (95% CI 8.3-9.9) veins were visible by VF compared with 5.4 (95% CI 4.8-6.0) with CM. African-American or Asian ethnicity, and obesity were associated with decreased vein visibility. The visibility of veins eligible for cannulation increased for all subgroups using a new infrared device.

Correct diagnosis of vascular encasement and longitudinal extension of hilar cholangiocarcinoma by four-channel multidetector-row computed tomography

International Nuclear Information System (INIS)

Okumoto, Tadayuki; Yamada, Takayuki; Sato, Akihiro

2009-01-01

Accurate diagnosis of local invasion of hilar cholangiocarcinomas is challenging due to their small size and the anatomic complexity of the hepatic hilar region. On the other hand, the correct diagnosis of local invasion is essential for assuring the possibility of curative surgery. The purpose of this study was to evaluate the feasibility of four-channel multidetector-row computed tomography (MDCT) in the assessment of vascular and bile duct involvement, by which we could obtain useful information for the surgical management of hilar cholangiocarcinoma. The subjects were 18 patients for whom the extent of tumor invasion was surgically and pathologically confirmed. All patients underwent preoperative multiphasic CT scanning by MDCT. Arterial and portal dominant phases were acquired using a detector configuration of 1.25 mm x 4 mm, and both axial and multiplanar reconstructed images were interpreted. Longitudinal extension was evaluated up to second-order branches. Vascular invasion is considered to be the degree of tumor contiguity to the hepatic arteries and portal vein and was graded by CT. The longitudinal extension was correctly diagnosed in 14 patients (77.8%). Hepatic artery invasion was correctly diagnosed in 17 patients with sensitivity of 100% and specificity of 90%, respectively. Portal vein invasion was correctly diagnosed in 47 of 51 branches with sensitivity and specificity of 92.3% and 90.2%, respectively. Multiplanar reconstructed images contributed to the correct diagnosis for both vascular encasement and longitudinal tumor extension. In conclusion, MDCT is useful in preoperative evaluation of hilar cholangiocarcinoma, especially when combined with multiplanar reconstructed images. (author)

Effect of abomasal glucose infusion on splanchnic and whole-body glucose metabolism in periparturient dairy cows

DEFF Research Database (Denmark)

Larsen, Mogens; Kristensen, Niels Bastian

2009-01-01

Six periparturient Holstein cows fitted with ruminal cannulas and permanent indwelling catheters in the hepatic portal vein, hepatic vein, mesenteric vein, and an artery were used to study the effects of abomasal glucose infusion on splanchnic and whole-body glucose metabolism.......Six periparturient Holstein cows fitted with ruminal cannulas and permanent indwelling catheters in the hepatic portal vein, hepatic vein, mesenteric vein, and an artery were used to study the effects of abomasal glucose infusion on splanchnic and whole-body glucose metabolism....

Concerns and Discomforts of Pregnancy - Varicose Veins

Science.gov (United States)

Concerns and Discomforts of Pregnancy - Varicose Veins Varicose veins are enlarged veins you may see on your ... Healthy Roads Media project www. healthyroadsmedia. org English - Concerns and Discomforts of Pregnancy (Varicose Veins) Last reviewed ...

Image Quality Enhancement Using the Direction and Thickness of Vein Lines for Finger-Vein Recognition

Directory of Open Access Journals (Sweden)

Young Ho Park

2012-10-01

Full Text Available On the basis of the increased emphasis placed on the protection of privacy, biometric recognition systems using physical or behavioural characteristics such as fingerprints, facial characteristics, iris and finger-vein patterns or the voice have been introduced in applications including door access control, personal certification, Internet banking and ATM machines. Among these, finger-vein recognition is advantageous in that it involves the use of inexpensive and small devices that are difficult to counterfeit. In general, finger-vein recognition systems capture images by using near infrared (NIR illumination in conjunction with a camera. However, such systems can face operational difficulties, since the scattering of light from the skin can make capturing a clear image difficult. To solve this problem, we proposed new image quality enhancement method that measures the direction and thickness of vein lines. This effort represents novel research in four respects. First, since vein lines are detected in input images based on eight directional profiles of a grey image instead of binarized images, the detection error owing to the non-uniform illumination of the finger area can be reduced. Second, our method adaptively determines a Gabor filter for the optimal direction and width on the basis of the estimated direction and thickness of a detected vein line. Third, by applying this optimized Gabor filter, a clear vein image can be obtained. Finally, the further processing of the morphological operation is applied in the Gabor filtered image and the resulting image is combined with the original one, through which finger-vein image of a higher quality is obtained. Experimental results from application of our proposed image enhancement method show that the equal error rate (EER of finger-vein recognition decreases to approximately 0.4% in the case of a local binary pattern-based recognition and to approximately 0.3% in the case of a wavelet transform

Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma

International Nuclear Information System (INIS)

Ascenti, G.; Sofia, C.; Mazziotti, S.; Silipigni, S.; D'Angelo, T.; Pergolizzi, S.; Scribano, E.

2016-01-01

Aim: To investigate the diagnostic accuracy of dual-energy multidetector computed tomography (MDCT) with iodine quantification compared to conventional enhancement measurements in distinguishing bland from neoplastic portal vein thrombosis in patients with hepatocellular carcinoma. Material and methods: Thirty-four patients (26 men, eight women; mean age, 62 years) with hepatocellular carcinoma and portal vein thrombosis underwent contrast-enhanced dual-energy MDCT during the late hepatic arterial phase for the assessment of portal thrombosis (bland, n=21; neoplastic, n=13). Datasets were analysed separately by two different readers. Interobserver correlation and variability were calculated and compared with the Bland–Altman method. Diagnostic accuracy of conventional enhancement measurements and iodine quantification was calculated by setting either histopathology (n=7) or a reference standard based on MDCT imaging criteria and thrombus evolutionary characteristics compared to a previous MDCT examination (n=27). For iodine quantification threshold determination receiver operating characteristic (ROC) curves were drawn. p-Values <0.05 were considered significant. Results: For conventional enhancement measurements and iodine quantification interobserver correlation was 98% and 96%. Enhancement measurement resulted in a sensitivity of 92.3%, specificity of 85.7%, positive predictive value (PPV) of 80%, and negative predictive value (NPV) of 94.7%. An iodine concentration of 0.9 mg/ml optimised discrimination between neoplastic and bland thrombi (area under the ROC [AUC] 0.993) resulting in a sensitivity of 100%, specificity of 95.2%, PPV of 92.9%, and NPV of 100%. The overall diagnostic accuracy of iodine quantification (97%) was significantly better than conventional enhancement measurements (88.2%; p<0.001). Conclusion: Compared to conventional enhancement measurements, iodine quantification improves the characterisation of portal vein thrombi during the late

[Extrinsic compression of the hepatocholedocus caused by cavernomatosis of the portal vein. Report of a case].

Science.gov (United States)

Carpani, M; Guma, C I; Casal, M A

1982-01-01

The extrinsic compression of the hepatocholedochus by a cavernomatosis of the portal vein, is an unusual pathology. The present case begun clinically as an obstructive jaundice, assuming that the vascular origin of the compression increased the litiasic biliary disease. The percutaneous transhepatic cholangiography was the diagnostic method that suggested a double illness of the biliary system. The surgery and the pathology certificated the diagnosis. The correct treatment once confirmed the obstructive trial, must be: the extraction of the biliary gallstones and the bile-digestive derivation (preferently the hepatic-jejunum anastomosis in Y of Roux).

Gold nanoparticles administration induced prominent inflammatory, central vein intima disruption, fatty change and Kupffer cells hyperplasia

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Abdelhalim Mohamed

2011-08-01

Full Text Available Abstract Background Advances in nanotechnology have identified promising candidates for many biological, biomedical and biomedicine applications. They are being increasingly exploited for medical uses and other industrial applications. The aim of the present study was to investigate the effects of administration of gold nanoparticles (GNPs on inflammatory cells infiltration, central vein intima disruption, fatty change, and Kupffer cells hyperplasia in the hepatic tissue in an attempt to cover and understand the toxicity and the potential threat of their therapeutic and diagnostic use. Methods A total of 70 healthy male Wistar-Kyoto rats were exposed to GNPs received 50 or 100 μl of GNPs infusion of 10, 20 and 50 nm GNPs for 3 or 7 days. Animals were randomly divided into groups, 12 GNPs-treated rats groups and one control group (NG. Groups 1, 2 and 3 received infusion of 50 μl GNPs of size 10 nm (3 or 7 days, size 20 nm (3 or 7 days and 50 nm (3 or 7 days, respectively; while groups 4, 5 and 6 received infusion of 100 μl GNPs of size 10 nm, size 20 nm and 50 nm, respectively. Results In comparison with respective control rats, exposure to GNPs doses has produced alterations in the hepatocytes, portal triads and sinusoids. The alterations in the hepatocytes were mainly vacuolar to hydropic degeneration, cytopasmic hyaline vacuolation, polymorphism, binucleation, karyopyknosis, karyolysis, karyorrhexis and necrosis. In addition, inflammatory cell infiltration, Kupffer cells hyperplasia, central veins intima disruption, hepatic strands dilatation and occasional fatty change together with a loss of normal architechiture of hepatic strands were also seen. Conclusions The alterations induced by the administration of GNPs were size-dependent with smaller ones induced more affects and related with time exposure of GNPs. These alterations might be an indication of injured hepatocytes due to GNPs toxicity that became unable to deal with the

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

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Rodrigo da Fonseca Monjardim

2013-06-01

Full Text Available Objective To evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and Methods In the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results The simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity.

Diagnosis of hepatic steatosis by contrast-enhanced abdominal computed tomography

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Monjardim, Rodrigo da Fonseca; Costa, Danilo Manuel Cerqueira; Romano, Ricardo Francisco Tavares; Salvadori, Priscila Silveira; Santos, Jaime de Vargas Conde dos; Atzingen, Augusto Castelli Von; Shigueoka, David Carlos; D'Ippolito, Giuseppe

2013-01-01

Objective: to evaluate the diagnostic capacity of abdominal computed tomography in the assessment of hepatic steatosis using the portal phase with a simplified calculation method as compared with the non-contrast-enhanced phase. Materials and methods: in the present study, 150 patients were retrospectively evaluated by means of non-contrast-enhanced and contrast-enhanced computed tomography. One hundred patients had hepatic steatosis and 50 were control subjects. For the diagnosis of hepatic steatosis in the portal phase, the authors considered a result of < 104 HU calculated by the formula [L - 0.3 × (0.75 × P + 0.25 × A)] / 0.7, where L, P and A represent the attenuation of the liver, of the main portal vein and abdominal aorta, respectively. Sensitivity, specificity, positive and negative predictive values were calculated, using non-contrast-enhanced computed tomography as the reference standard. Results: the simplified calculation method with portal phase for the diagnosis of hepatic steatosis showed 100% sensitivity, 36% specificity, negative predictive value of 100% and positive predictive value of 75.8%. The rate of false positive results was 64%. False negative results were not observed. Conclusion: The portal phase presents an excellent sensitivity in the diagnosis of hepatic steatosis, as compared with the non-contrast-enhanced phase of abdominal computed tomography. However, the method has low specificity. (author)

The protective effect of huperzine A against hepatic ischemia reperfusion injury in mice.

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Yang, Y; Yang, J; Jiang, Q

2014-06-01

Nowadays, hepatic ischemia reperfusion (HI/R) injury is regarded as a serious concern in clinical practices. Huperzine A (HupA) is an alkaloid isolated from the Chinese folk medicine huperzia serrate, which has possessed diverse pharmacological actions. A mouse model of HI/R was caused by clamping the hepatic artery, the hepatoportal vein, and the bile duct with a vascular clamp for 30 minutes followed by reperfusion for 6 hours under anesthesia. The sham group experienced the identical procedure without hepatic ischemia. The HupA group received an injection into the tail vein 5 minutes prior to HI/R at the doses of 167 and 500 μg/kg. The vehicle group was injected with physiological saline instead of HupA. The liver function was assessed by determinations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities. Tissue levels of superoxide dismutase (SOD), catalase (CAT), malondiadehyde (MDA), and glutathione (GSH) were also measured spectrophotometrically. In addition, the activities of hepatic inflammatory mediators such as nuclear factor kappa B (NF-κB) p65, tumor necrosis factors-α (TNF-α, interleukin-1β (IL-1β) and IL-6 were also measured. Furthermore, the apoptotic damage was evaluated by measuring caspase-3 activity in hepatic tissues. Treatment with HupA in mice at the doses of 167 and 500 μg/kg remarkably reduced serum ALT and AST activities in HupA-treated ischemic mice. Furthermore, HupA treatment could enhance the activities of hepatic tissue SOD, CAT, and GSH but decrease MDA tissue content. The activities of inflammatory cytokines including NF-κB p65, TNF-α, IL-1β and IL-6 were all decreased in ischemic mice treated with HupA. Colorimetric test results illustrated that a marked reduction of caspase-3 activity was found in the HupA-treated group compared with the vehicle group. Our present data suggest that HupA has a protective role against HI/R injury of mice and antioxidative, anti-inflammatory, and antiapoptotic

The umbilical and paraumbilical veins of man.

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Martin, B F; Tudor, R G

1980-03-01

During its transit through the umbilicus structural changes occur in the thick wall of the extra-abdominal segment of the umbilical vein whereby the components of the intra-abdominal segment acquire an essentially longitudinal direction and become arranged in fibro-elastic and fibro-muscular zones. The vein lumen becomes largely obliterated by asymmetrical proliferation of loose subendothelial conective tissue. The latter forms a new inner zone within which a small segment of the lumen persists in an eccentric position. This residual lumen transmits blood to the portal system from paraumbilical and systemic sources, and is retained in the upper part of the vein, even in old age. A similar process of lumen closure is observed in the ductus venosus. In early childhood the lower third of the vein undergoes breakdown, with fatty infiltration, resulting in its complete division into vascular fibro-elastic strands, and in old age some breakdown occurs in the outermost part of the wall of the upper two thirds. The paraumbilical veins are thick-walled and of similar structure to the umbilical vein. Together they constitute an accessory portal system which is confined between the layers of the falciform ligament and is in communication with the veins of the ventral abdominal wall. The constituents form an ascending series, namely, Burow's veins, the umbilical vein, and Sappey's inferior and superior veins. The main channel of Sappey's inferior veins may be the remnant of the right umbilical vein since it communicates with the right rectus sheath and often communicates directly with the portal system within the right lobe of the liver. The results are of significance in relation to clinical usage of the umbilical vein.

Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

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Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

2006-01-01

A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

Idiopathic Bilateral External Jugular Vein Thrombosis.

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Hindi, Zakaria; Fadhel, Ehab

2015-08-20

Vein thrombosis is mainly determined by 3 factors, which constitute a triad called Virchow's triad: hypercoagulability, stasis, and endothelial injury. Venous thrombosis commonly occurs in the lower extremities since most of the blood resides there and flows against gravity. The veins of the lower extremities are dependent on intact valves and fully functional leg muscles. However, in case of valvular incompetency or muscular weakness, thrombosis and blood stasis will occur as a result. In contrast, the veins of the neck, specially the jugulars, have distensible walls which allow flexibility during respiration. In addition, the blood directly flows downward towards the heart. Nevertheless, many case reports mentioned the thrombosis of internal jugular veins and external jugular veins with identified risk factors. Jugular vein thrombosis has previously been associated in the literature with a variety of medical conditions, including malignancy. This report is of a case of idiopathic bilateral external jugular vein thrombosis in a 21 year-old male construction worker of Southeast Asian origin with no previous medical history who presented with bilateral facial puffiness of gradual onset over 1 month. Doppler ultrasound and computed tomography were used in the diagnosis. Further work-up showed no evidence of infection or neoplasia. The patient was eventually discharged on warfarin. The patient was assessed after 6 months and his symptoms had resolved completely. Bilateral idiopathic external jugular veins thrombosis is extremely rare and can be an indicator of early malignancy or hidden infection. While previous reports in the literature have associated jugular vein thrombosis with malignancy, the present case shows that external jugular vein thrombosis can also be found in persons without malignancy.

Microvascular Architecture of Hepatic Metastases in a Mouse Model

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Darshini Kuruppu

1997-01-01

Full Text Available Development of effective treatment for hepatic metastases can be initiated by a better understanding of tumour vasculature and blood supply. This study was designed to characterise the microvascular architecture of hepatic metastases and observe the source of contributory blood supply from the host. Metastases were induced in mice by an intrasplenic injection of colon carcinoma cells (106 cells/ml. Vascularization of tumours was studied over a three week period by scanning electron microscopy of microvascular corrosion casts. Metastatic liver involvement was observed initially within a week post induction, as areas approximately 100 μm in diameter not perfused by the casting resin. On histology these spaces corresponded to tumour cell aggregates. The following weeks highlighted the angiogenesis phase of these tumours as they received a vascular supply from adjacent hepatic sinusoids. Direct sinusoidal supply of metastases was maintained throughout tumour growth. At the tumour periphery most sinusoids were compressed to form a sheath demarcating the tumour from the hepatic vasculature. No direct supply from the hepatic artery or the portal vein was observed. Dilated vessels termed vascular lakes dominated the complex microvascular architecture of the tumours, most tapering as they traversed towards the periphery. Four vascular branching patterns could be identified as true loops, bifurcations and trifurcations, spirals and capillary networks. The most significant observation in this study was the direct sinusoidal supply of metastases, together with the vascular lakes and the peripheral sinusoidal sheaths of the tumour microculature.

Blood sampling from adrenal gland vein

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Sun Yong; Ni Caifang

2009-01-01

Adrenal gland vein sampling is an interventional method to get the blood samples from the adrenal gland vein. The blood is obtained via a catheter which is selectively inserted in the adrenal gland vein. This technique is mainly used to be diagnostic for primary hyperaldosteronism. A full knowledge of the anatomy and variations of the adrenal gland vein, serious preoperative preparation and skilled catheterization manipulation are necessary for obtaining sufficient blood sample and for reducing the occurrence of complications. Providing the physicians with definite diagnostic evidence and being technically feasible, adrenal gland vein sampling should become one of the routine examinations for clarifying the cause of primary hyperaldosteronism. (authors)

The diagnostic imaging and interventional therapy of hepatic angiomyolipoma associated with tuberous sclerosis

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You Jian; Xu Wei; Zhu Jiehui

2001-01-01

Objective: To evaluate imaging diagnosis, differential diagnosis, surgery and interventional therapy of hepatic angiomyolipoma associated with tuberous sclerosis. Methods: Clinical features, imaging appearances and interventional therapy for 2 cases of HAML in TS were retrospectively analyzed. Results: The features of HAML in TS are as following: (1) Two cases were female with no history of hepatitis and hepatocirrhosis, liver function test and alpha fetoprotein were normal: (2) the tumor was shown as a multiple hyper-echoic mass with sharp margin on ultrasonography; well defined, fat density and intensity mass on computerized tomography (CT); hypervascular mass with early drainage of hepatic vein and tumor staining on angiography. (3) One case underwent interventional therapy. After 42 month follow up, the tumor was found to be diminished in size. Another case was under monitored with only the enucleating of left renal mass. The hepatic tumor showed no change after 10 months. Conclusions: The imaging appearances of HAML in TS are relatively characteristic. Super selective arterial embolization is an effective treatment for HAML in TS

Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

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G Raghavendra Prasad

2013-01-01

Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

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Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

2017-01-01

Abstract Rationale: Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. Patient concerns: We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. Diagnoses: She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. Interventions: This patient was treated successfully with surgery. Outcomes: This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. Lessons: The pitfall of misdiagnosing this tumor as DVT is a useful reminder. PMID:29145269

Duplex sonography of the near-surface leg veins

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Mendoza, E.

2007-01-01

The book contains the following contributions: The ultrasonograph, selection of the ultrasonic transducer, anatomy of the near-surface vein system, physiology of the near-surface vein system, varicose status classification, systematics of the duplex sonography of near-surface leg veins, provocational maneuver for the duplex sonographic varicose diagnostics, exploration of vena saphena parva, perforans veins, side branches, phlebitis, sonography for varicose therapy, postsurgical sonography, deep leg veins, examination of near-surface leg veins for the pathology of the deep vein system, differential diagnostic clarification of leg oedema from the phlebologic-lymphological view, diagnostic side features along the near-surface leg veins

Rotational Angiography Based Three-Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture.

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Koektuerk, Buelent; Yorgun, Hikmet; Koektuerk, Oezlem; Turan, Cem H; Gorr, Eduard; Horlitz, Marc; Turan, Ramazan G

2016-02-01

Rotational angiography is a well-known method for the three-dimensional (3-D) reconstruction of left atrium and pulmonary veins during left-sided atrial arrhythmia ablation procedures. In our study, we aimed to review our experience in transseptal puncture (TSP) using 3-D rotational angiography. We included a total of 271 patients who underwent atrial fibrillation ablation using cryoballoon. Rotational angiography was performed to get the three-dimensional left atrial and pulmonary vein reconstructions using cardiac C-arm computed tomography. The image reconstruction was made using the DynaCT Cardiac software (Siemens, Erlangen, Germany). The mean age of the study population was 61 ± 10 years. The indications for left atrial arrhythmia ablation were paroxysmal AF in 140 patients (52%) and persistent AF patients in 131 (48%) patients. The success rate of TSP using only rotational guidance was (264/271 patients, 97.4%). In the remaining seven patients, transesophageal guidance was used after the initial attempt due to thick interatrial septum in five patients and difficult TSP due to abnormal anatomy and mild pericardial effusion in the remaining two patients. Mean fluoroscopy dosage of the rotational angiography was 4896.4 ± 825.3 μGym(2). The mean time beginning from femoral vein puncture to TSP was 12.3 ± 5.5 min. TSP guided by rotational angiography is a safe and effective method. Our results indicate that integration of rotational angiographic images into the real-time fluoroscopy can guide the TSP during the procedure. © 2015 John Wiley & Sons Ltd.

Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.

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Squara, Fabien; Tomi, Julien; Scarlatti, Didier; Theodore, Guillaume; Moceri, Pamela; Ferrari, Emile

2017-12-01

Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture. Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator. Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

A “Train-Track” Technique in Anatomic Reconstruction of SVC Bifurcation Complicated by Cardiac Tamponade: An Introspection

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Karuppasamy, Karunakaravel, E-mail: karuppk@ccf.org; Al-Natour, Mohammed, E-mail: mnatour85@msn.com; Gurajala, Ram Kishore, E-mail: gurajar@ccf.org [L10, Cleveland Clinic, Section of Vascular and Interventional Radiology, Imaging Institute (United States)

2017-04-15

This report describes a stenting technique used to anatomically reconstruct superior vena cava (SVC) bifurcation in a patient with benign SVC syndrome. After recanalizing the SVC bifurcation, we exchanged two 0.035-in. wires for two 0.018-in. wires, deployed the SVC stent over these two wires (“train-track” technique), and stented each innominate vein over one wire. However, our decisions to recanalize both innominate veins, use the “buddy-wire” technique for SVC dilation, and dilate the SVC to 16 mm before stent deployment likely contributed to SVC tear, which was managed by resuscitation, SVC stent placement, and pericardial drainage. Here, we describe the steps of the train-track technique, which can be adopted to reconstruct other bifurcations; we also discuss the controversial aspects of this case.

[THE STATE OF HEPATIC AND SPLANCHNIC BLOOD FLOW IN VARIOUS TYPES OF COMPLICATED PANCREATIC PSEUDOCYSTS].

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Kryvoruchko, I A; Goncharova, N M; Andreyeshchev, S A; Yavorska, T P

2015-05-01

Investigations were conducted in 37 patients, suffering complicated pancreatic pseudocysts. In accordance to data of ultrasound Doppler flowmetry for the blood flow along portal vein, a. hepatis communis, a. mesenterica superior in complicated pancreatic pseudocysts compensatory--adaptive reactions on level of hepatic--spanchnic blood flow are directed towards restriction of the blood inflow through the portal vein system. This is accompanied by the common peripheral vascular resistence raising in basin of a. mesenterica superior, which have depended upon the patients' state severity, caused by reduction of the volume blood flow in a certan vascular collector. The oxygen debt of the liver in these patients is compensated by the volume blood flow enhancement along a. hepatis communis.

Venous coupler use for free-flap breast reconstructions: specific analyses of TMG and DIEP flaps.

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Bodin, Frédéric; Brunetti, Stefania; Dissaux, Caroline; Erik, A Sauleau; Facca, Sybille; Bruant-Rodier, Catherine; Liverneaux, Philippe

2015-05-01

The purpose of this report was to present the results of comparisons of anastomotic data and flap complications in the use of venous coupler in breast reconstruction with the transverse musculocutaneous gracilis (TMG) flap and the deep inferior epigastric perforator (DIEP) flap. Over a three-year period, 95 patients suffering from breast cancer were treated with mastectomy and breast reconstruction using free flaps. We performed 121 mechanical venous anastomoses for 105 flap procedures (80 DIEP and 25 TMG). The coupler size, anastomotic duration, number of anastomoses and postoperative complications were assessed for the entire series. The coupling device was perfectly suitable for all end-to-end anastomoses between the vein(s) of the flap and the internal mammary vein(s). No venous thrombosis occurred. The mean anastomotic time did not significantly differ between the DIEP (330 seconds) and TMG flap procedures (352 seconds) (P = 0.069). Additionally, there were no differences in coupling time observed following a comparison of seven coupler sizes (P = 0.066). The mean coupler size used during the TMG flap procedure was smaller than that used with the DIEP (2.4 mm versus 2.8 mm) (P TMG flap (28%) than with the DIEP flap (11%). The coupler size used was smaller for the TMG procedure and when double venous anastomosis was performed. Additionally, anastomotic time was not affected by the flap type or coupler size used or by anastomosis number. © 2014 Wiley Periodicals, Inc.

Calcite veining and feeding conduits in a hydrothermal system: Insights from a natural section across the Pleistocene Gölemezli travertine depositional system (western Anatolia, Turkey)

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Capezzuoli, Enrico; Ruggieri, Giovanni; Rimondi, Valentina; Brogi, Andrea; Liotta, Domenico; Alçiçek, Mehmet Cihat; Alçiçek, Hülya; Bülbül, Ali; Gandin, Anna; Meccheri, Marco; Shen, Chuan-Chou; Baykara, Mehmet Oruç

2018-02-01

Linking the architecture of structural conduits with the hydrothermal fluids migrating from the reservoir up to the surface is a key-factor in geothermal research. A contribution to this achievement derives from the study of spring-related travertine deposits, but although travertine depositional systems occur widely, their feeding conduits are only rarely exposed. The integrated study carried out in the geothermal Gölemezli area, nearby the well-known Pamukkale area (Denizli Basin, western Anatolia, Turkey), focused on onyx-like calcite veins (banded travertine) and bedded travertine well exposed in a natural cross-section allowing the reconstruction of the shallower part of a geothermal system. The onyx-like veins represent the thickest vein network (> 150 m) so far known. New field mapping and structural/kinematic analyses allowed to document a partially dismantled travertine complex (bedded travertine) formed by proximal fissure ridges and distal terraced/pools depositional systems. The banded calcite veins, WNW-trending and up to 12 m thick, developed within a > 200 m thick damaged rock volume produced by parallel fault zones. Th/U dating indicates a long lasting (middle-late Pleistocene) fluids circulation in a palaeo-geothermal system that, due to its location and chemical characteristics, can be considered the analogue of the nearby, still active, Pamukkale system. The isotopic characteristics of the calcite veins together with data from fluid inclusions analyses, allow the reconstruction of some properties (i.e. temperature, salinity and isotopic composition) and processes (i.e. temperature variation and intensity of degassing) that characterized the parent fluids and the relation between degassing intensity and specific microfabric of calcite crystals (elongated/microsparite-micrite bands), controlled by changes/fluctuations of the physico-chemical fluid characteristics.

Portal vein thrombosis.

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Chawla, Yogesh K; Bodh, Vijay

2015-03-01

Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion.

Bile acid flux through portal but not peripheral veins inhibits CYP7A1 expression without involvement of ileal FGF19 in rabbits.

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Shang, Quan; Guo, Grace L; Honda, Akira; Shi, Daniel; Saumoy, Monica; Salen, Gerald; Xu, Guorong

2014-08-15

It was proposed that CYP7A1 expression is suppressed through the gut-hepatic signaling pathway fibroblast growth factor (FGF) 15/19-fibroblast growth factor receptor 4, which is initiated by activation of farnesoid X receptor in the intestine rather than in the liver. The present study tested whether portal bile acid flux alone without ileal FGF19 could downregulate CYP7A1 expression in rabbits. A rabbit model was developed by infusing glycodeoxycholic acid (GDCA) through the splenic vein to bypass ileal FGF19. Study was conducted in four groups of rabbits: control; bile fistula + bovine serum albumin solution perfusion (BF); BF + GDCA (by portal perfusion); and BF + GDCA-f (by femoral perfusion). Compared with only BF, BF + GDCA (6 h portal perfusion) suppressed CYP7A1 mRNA, whereas BF + GDCA-f (via femoral vein) with the same perfusion rate of GDCA did not show inhibitory effects. Meanwhile, there was a decrease in ileal FGF19 expression and portal FGF19 protein levels, but an equivalent increase in biliary bile acid outputs in both GDCA perfusion groups. This study demonstrated that portal bile acid flux alone downregulated CYP7A1 expression with diminished FGF19 expression and protein levels, whereas the same bile acid flux reaching the liver through the hepatic artery via femoral vein had no inhibitory effect on CYP7A1. We propose that bile acid flux through the portal venous system may be a kind of "intestinal factor" that suppresses CYP7A1 expression. Copyright © 2014 the American Physiological Society.

Surgical rationalization of living donor liver transplantation by abolition of hepatic artery reconstruction under a fixed microscope.

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Yagi, Takahito; Shinoura, Susumu; Umeda, Yuzo; Sato, Daisuke; Yoshida, Ryuichi; Yoshida, Kazuhiro; Utsumi, Masashi; Nobuoka, Daisuke; Sadamori, Hiroshi; Fujiwara, Toshiyoshi

2012-01-01

The small diameter of the hepatic artery is one of the complexities of living donor liver transplantation (LDLT). We analyzed whether the direct suture technique using surgical loupes can simplify the operative process for LDLT compared with fixed microscopic reconstruction. We applied the direct technique to rationalize the operative process and abolished routine microsurgery from 2004. Two hundred and nine LDLT with a postoperative period over 34 months were carried out from 1996 to 2008. The patients were divided into two groups: the micro group (children: 20, adults: 72) and the non-micro group (children: 12, adults: 97). Running anastomosis was undertaken in the non-micro group. The anastomotic size of the children was significantly smaller than that of the adults, but larger than 2 mm (2.38±0.4 vs. 2.7±0.47 mm, p=0.0005). By appropriate choice of the proximal artery, direct anastomosis is possible even in children. Early complications occurred in seven cases in the micro group, but none occurred in the non-micro group (prationalization of LDLT. © 2012 John Wiley & Sons A/S.

Trombose de veia porta em crianças e adolescentes Portal vein thrombosis in children and adolescents

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Graziela C. M. Schettino

2006-06-01

Full Text Available OBJETIVO: Apresentar uma revisão atualizada de trombose de veia porta na infância e adolescência, enfatizando o diagnóstico, suas complicações e tratamento. FONTE DOS DADOS: Foi realizada revisão da literatura, dos últimos 10 anos, através de pesquisa bibliográfica na Internet nos principais sites de busca médica, como o PubMed e MEDLINE, com enfoque na doença trombose de veia porta e suas repercussões clínicas. As principais palavras-chave e expressões pesquisadas foram: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Além disso, foram consultados os artigos citados nas referências dos trabalhos selecionados na pesquisa inicial e dos livros textos. SÍNTESE DOS DADOS: A trombose de veia porta é uma das causas mais comuns de hipertensão porta na infância. A apresentação clínica inicial pode ser através de episódios de hemorragia digestiva ou da presença de esplenomegalia em exame clínico de rotina. As principais complicações são a hemorragia digestiva, hiperesplenismo secundário à esplenomegalia, retardo de crescimento e biliopatia portal. O diagnóstico é realizado através da ultra-sonografia abdominal com Doppler. O tratamento é direcionado para as complicações, incluindo profilaxia primária e secundária de hemorragia digestiva, conseqüente à ruptura de varizes esofágicas, e derivações porto-sistêmicas, em casos selecionados. CONCLUSÕES:A trombose de veia porta é uma das causas mais importantes de hemorragia digestiva em crianças. Esses episódios acarretam impacto importante na qualidade de vida dos pacientes acometidos. Dessa forma, uma abordagem diagnóstica e terapêutica adequada é desejável na tentativa de se reduzir a morbimortalidade.OBJECTIVE: To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. SOURCE OF DATA: The medical

Huperzine A attenuates hepatic ischemia reperfusion injury via anti-oxidative and anti-apoptotic pathways.

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Xu, Zhe; Wang, Yang

2014-08-01

Hepatic ischemia reperfusion (HI/R) injury may occur during liver transplantation and remains a serious concern in clinical practice. Huperzine A (HupA), an alkaloid isolated from the Chinese traditional medicine Huperzia serrata, has been demonstrated to possess anti‑oxidative and anti‑apoptotic properties. In the present study, a rat model of HI/R was established by clamping the hepatic artery, the hepatoportal vein and the bile duct with a vascular clamp for 30 min followed by reperfusion for 6 h under anesthesia. HupA was injected into the tail vein 5 min prior to the induction of HI/R at doses of 167 and 500 µg/kg. The histopathological assessment of the liver was performed using hematoxylin and eosin staining. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were assayed in the serum samples. The tissue levels of superoxide dismutase (SOD), catalase (CAT), malondiadehyde (MDA) and glutathione (GSH) were also measured spectrophotometrically. Furthermore, the protein expression of caspase‑3, Bcl‑2 and Bax in hepatic tissues was detected via western blot analysis. Treatment of Wistar rats with HupA at doses of 167 and 500 µg/kg markedly attenuated HI/R injury as observed histologically. In addition, the significant reductions of serum ALT and AST were observed in HupA‑treated ischemic rats. Furthermore, HupA treatment enhanced the activity of hepatic tissue SOD, CAT and GSH, but decreased the MDA tissue content. Western blot analysis revealed elevated levels of Bcl‑2 expression but decreased Bax and caspase‑3 tissue expression at the protein level in the HupA‑treated group. The present data suggest that HupA attenuates the HI/R injury of rats through its anti‑oxidative and anti‑apoptotic signaling pathways.

Effects of partial portal vein arterialization on the hilar bile duct in a rat model.

Science.gov (United States)

Guo, Shao-Hua; Li, Chong-Hui; Chen, Yong-Liang; Song, Jian-Ning; Zhang, Ai-Qun; Zhou, Cheng

2011-10-01

Liver revascularization is frequently required during the enlarged radical operation for hilar cholangiocarcinoma involving the hepatic artery. Researchers have carried out a number of experiments applying partial portal vein arterialization (PVA) in clinical practice. In this study we aimed to establish a theoretical basis for clinical application of partial PVA and to investigate the effects of partial PVA on rat hilar bile duct and hepatic functions. Thirty rats were randomly and equally assigned into 3 groups: control (group A), hepatic artery ligation+bile duct recanalization (group B), and partial PVA+bile duct recanalization (group C). Proliferation and apoptosis of rat hilar bile duct epithelial cells, arteriolar counts of the peribiliary plexus (PBP) of the bile duct wall, changes in serum biochemistry, and pathologic changes in the bile duct were assessed 1 month after operation. The proliferation of hilar bile duct epithelial cells in group B was greater than in groups A and C (Philar bile duct epithelial cells were detected in any of the groups. The PBP arteriolar counts of the hilar bile duct wall were similar in groups A and C (P>0.05), but the count was lower in group B than in group A (Philar bile duct walls were observed only in group B. Partial PVA can restore the arterial blood supply of the hilar bile duct and significantly extenuate the injury to hilar bile duct epithelial cells resulting from hepatic artery ligation.

Obstruction of hepatic vein or inferior vena cava after liver transplantation: the diagnosis and interventional treatment

International Nuclear Information System (INIS)

Zhu Kangshun; Qian Jiesheng; Meng Xiaochun; Yi Shuhong; Pang Pengfei; He Keke; Jiang Zaibo; Lu Minqiang; Shan Hong

2010-01-01

Objective: To investigate the diagnosis and interventional therapeutic technology for the obstruction of hepatic vein (HV) or inferior vena cava (IVC) after liver transplantation. Methods: In the 831 patients who received orthotopic liver transplantation (OLT) and 26 patients who received living donor liver transplantation (LDLT), 11 cases were confirmed with HV or IVC obstruction by venography and received interventional treatment from 2 to 111 days after liver transplantation. Of the 11 patients, five had the obstruction of HV anastomosis, five had the obstruction of IVC anastomosis, and one had the obstruction of HV and IVC anastomosis. In the eleven patients, five patients underwent OLT, four patients underwent LDLT, and two pediatric patients underwent reduced-size OLT. Before interventional treatment, 9 patients function tests, clinical sympatom, and monitoring of HV or IVC flow. Pressure gradients before and after therapeutic technology of 11 cases were retrospectively analyzed. Results: In all 11 patients, CT or MRI could clearly show congested areas of the liver, and the location and degree of HV or IVC obstruction. Of the 11 patients, four with HV obstruction and five with IVC obstruction were treated with stent placement, one with HV obstruction was treated with percutaneous transluminal angioplasty (PTA), one with HV and IVC obstruction was treated with HV PTA and IVC stent placement. Interventional technical success was achieved in all patients. The venous pressure gradient across obstruction was significantly reduced from (16.5 ± 4.1) mm Hg (1 mm Hg =0.133 kPa) before the procedure to (2.9 ± 1.7) mm Hg after the procedure (t=11.5, P<0.01). Clinical improvement was noted in 10 patients except one pediatric patient who died of multiple-organs failure at the 9 th day after the treatment. During the follow-up period of 9 to 672 days, two patients with PTA treatment had recurrent HV stenosis within one month after treatment, no patient with stent

Renal Infarction during Anticoagulant Therapy after Living Donor Liver Transplantation

Directory of Open Access Journals (Sweden)

Shinji Onda

2018-04-01

Full Text Available Introduction: Liver transplant recipients are at risk for complications of vascular thrombosis. The reconstructed hepatic artery and portal vein thrombosis potentially result in hepatic failure and graft loss. Renal infarction is a rare clinical condition, but in severe cases, it may lead to renal failure. We herein report a case of renal infarction after living donor liver transplantation (LDLT during anticoagulant therapy. Case Presentation: A 60-year-old woman with end-stage liver disease due to primary biliary cholangitis underwent LDLT with splenectomy. Postoperatively, tacrolimus, mycophenolate mofetil, and steroid were used for initial immunosuppression therapy. On postoperative day (POD 5, enhanced computed tomography (CT revealed splenic vein thrombosis, and anticoagulant therapy with heparin followed by warfarin was given. Follow-up enhanced CT on POD 20 incidentally demonstrated right renal infarction. The patient’s renal function was unchanged and the arterial flow was good, and the splenic vein thrombosis resolved. At 4 months postoperatively, warfarin was discontinued, but she developed recurrent splenic vein thrombosis 11 months later, and warfarin was resumed. As of 40 months after transplantation, she discontinued warfarin and remains well without recurrence of splenic vein thrombosis or renal infarction. Conclusion: Renal infarction is a rare complication of LDLT. In this case, renal infarction was incidentally diagnosed during anticoagulant therapy and was successfully treated.

Case report: Varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: Report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain

Directory of Open Access Journals (Sweden)

Sandeep G Jakhere

2011-01-01

Full Text Available A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during surgery or cause life-threatening retroperitoneal hemorrhage. Varicosity of this venous channel may be mistaken for paraaortic lymphadenopathy, adrenal pseudo-mass, or renal artery aneurysm. We report a case of a patient with varicosity of this communicating vein, which mimicked a left renal artery aneurysm. A novel hypothesis is also proposed to explain the relationship with abdominal pain.

Interventional treatment of iliac vein compression syndrome

International Nuclear Information System (INIS)

Li Xiaoqiang; Zhou Weiming; Nie Zhonglin; Yu Chaowen

2002-01-01

Objective: To explore the clinical significance of interventional treatment of iliac vein compression syndrome (IVCS). Methods: Percutaneous transluminal angioplasty (PTA) was performed in 40 cases. Thirty-three cases underwent endovascular stent implantation and 27 cases underwent second-stage left saphenous vein ligation and stripping and the valves of left femoral veins narrowing. Thirty-one cases were followed-up postoperatively and the duration was 6-66 months (mean 28 months). Results: The dilation of iliac veins was successful in 36 cases and there were god efficacy in all patients when they discharged from hospital. Followed-up during post-operation, all the limbs ulcers were cured and varicose veins disappeared. The skin pigmentation disappeared in 17 of 19 cases and markedly relieved in 2 cases. Left lower limb swelling disappeared in 15 of 17 cases and relieved in 2 cases. Conclusion: There is good efficacy in the interventional treatment of left iliac vein lesions, but second-stage procedures should be performed in secondary lesions of saphenous veins and valves of femoral veins

A fundamental study of dynamic CT for hemodynamics in experimental hepatic tumors

International Nuclear Information System (INIS)

Yamakawa, Fumiko

1991-01-01

Dynamic CT was performed using iodamide meglumine (2 ml/kg) to investigate hemodynamics in experimental hepatic tumors, tumor margins and in normal hepatic tissue as well in rabbits with VX 2 -induced hepatic tumors. Peak time (PT) and first moment (M1) were calculated from a time density curve prepared by eight consecutive 3-second scans over a period of 55 seconds. PT and M1 in tumors were significantly shorter than those in tumor margins and normal tissue, but were not influenced by tumor size. PT and M1 in tumor margins and normal tissue became longer with enlargement of the tumor. Ligation of the hepatic artery caused (1) no change in PT or M1 in normal tissue and tumor margins and (2) difficulty in measuring PT and M1 in tumors. Ligation of the portal vein caused (1) difficulty in measuring PT and M1 in normal tissue and tumor margins and (2) no change in PT or M1 in tumors. Pathological studies of specimens taken from each region of interest (ROI) showed that hemodynamics in the tumors reflected tumor-specific vascular structures. (author)

Gastric Tube Reconstruction with Superdrainage Using Indocyanine Green Fluorescence During Esophagectomy.

Science.gov (United States)

Kitagawa, Hiroyuki; Namikawa, Tsutomu; Iwabu, Jun; Hanazaki, Kazuhiro

2017-01-01

We report a case of gastric tube reconstruction with superdrainage using indocyanine green fluorescence during esophagectomy for esophageal cancer. A 53-year-old man with a history of early esophageal cancer treated with endoscopic mucosal dissection experienced esophageal cancer recurrence. There was no evidence of lymph node involvement or distant metastasis on computed tomography; therefore, we performed thoracoscopic esophagectomy. After thoracoscopic esophagectomy, we created a gastric tube. When pulling up the gastric tube through the post-mediastinum route, a root of the right gastroepiploic vein was injured. We subsequently performed superdrainage to avoid congestion of the gastric tube with omental vein and pre-tracheal vein anastomosis at the neck, and confirmed venous flow using the indocyanine green fluorescence method. No postoperative anastomotic leakage was observed, and the patient was discharged 22 days after surgery. Thus, we recommend the indocyanine green fluorescence method in cases involving superdrainage during esophagectomy. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Dihydroartemisinin counteracts fibrotic portal hypertension via farnesoid X receptor-dependent inhibition of hepatic stellate cell contraction.

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Xu, Wenxuan; Lu, Chunfeng; Zhang, Feng; Shao, Jiangjuan; Yao, Shunyu; Zheng, Shizhong

2017-01-01

Portal hypertension is a frequent pathological symptom occurring especially in hepatic fibrosis and cirrhosis. Current paradigms indicate that inhibition of hepatic stellate cell (HSC) activation and contraction is anticipated to be an attractive therapeutic strategy, because activated HSC dominantly facilitates an increase in intrahepatic vein pressure through secreting extracellular matrix and contracting. Our previous in vitro study indicated that dihydroartemisinin (DHA) inhibited contractility of cultured HSC by activating intracellular farnesoid X receptor (FXR). However, the effect of DHA on fibrosis-related portal hypertension still requires clarification. In this study, gain- and loss-of-function models of FXR in HSC were established to investigate the mechanisms underlying DHA protection against chronic CCl 4 -caused hepatic fibrosis and portal hypertension. Immunofluorescence staining visually showed a decrease in FXR expression in CCl 4 -administrated rat HSC but an increase in that in DHA-treated rat HSC. Serum diagnostics and morphological analyses consistently indicated that DHA exhibited hepatoprotective effects on CCl 4 -induced liver injury. DHA also reduced CCl 4 -caused inflammatory mediator expression and inflammatory cell infiltration. These improvements were further enhanced by INT-747 but weakened by Z-guggulsterone. Noteworthily, DHA, analogous to INT-747, significantly lowered portal vein pressure and suppressed fibrogenesis. Experiments on mice using FXR shRNA lentivirus consolidated the results above. Mechanistically, inhibition of HSC activation and contraction was found as a cellular basis for DHA to relieve portal hypertension. These findings demonstrated that DHA attenuated portal hypertension in fibrotic rodents possibly by targeting HSC contraction via a FXR activation-dependent mechanism. FXR could be a target molecule for reducing portal hypertension during hepatic fibrosis. © 2016 Federation of European Biochemical Societies.

Usefulness of B-mode and doppler sonography for the diagnosis of severe acute viral hepatitis A.

Science.gov (United States)

Shin, Sang Wook; Kim, Tae Yeob; Jeong, Woo Kyoung; Kim, Yongsoo; Kim, Jinoo; Kim, Young Hwan; Park, Hwan Cheol; Sohn, Joo Hyun

2015-01-01

To investigate B-mode and Doppler ultrasonography (US) features correlating with laboratory findings for the diagnosis of severe acute hepatitis (SAH) in patients with hepatitis A virus infection. Thirty-nine consecutive serologically proven patients were enrolled. Decreased parenchymal echotexture, periportal tracking, gallbladder wall change, and splenomegaly were assessed on B-mode images. Blood flow velocities were measured in the main portal (V(PORTAL)) and in the hepatic veins, and the hepatic venous pulsatility index was calculated. SAH was defined as high model for end-stage liver disease (MELD) score ≥ 15 with or without coagulopathy. The relationship between US features and laboratory findings was assessed, and SAH diagnosis was evaluated. Serum alanine transaminase and prothrombin time were significantly different depending on the presence of gallbladder wall change and splenomegaly (p hepatic venous waveform and hepatic venous pulsatility index were significantly correlated with MELD score. For the diagnosis of SAH, the area under the receiver operating characteristic curve of V(PORTAL) was 0.798. It reached 0.869 in the patients with typical GB change. Both B-mode and Doppler US correlated well with several laboratory variables and may be helpful to diagnose SAH in patients with hepatitis A virus infection. © 2014 Wiley Periodicals, Inc.

Venous variants and anomalies on routine abdominal multi-detector row CT

International Nuclear Information System (INIS)

Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent; Tokmak, Naime

2007-01-01

Objective: This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). Materials and methods: One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. Results: In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. Conclusion: The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation

Venous variants and anomalies on routine abdominal multi-detector row CT

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Koc, Zafer [Baskent University, School of Medicine, Department of Radiology, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent University, School of Medicine, Department of Radiology, Adana (Turkey); Oguzkurt, Levent [Baskent University, School of Medicine, Department of Radiology, Adana (Turkey); Tokmak, Naime [Baskent University, School of Medicine, Department of Radiology, Adana (Turkey)

2007-02-15

Objective: This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). Materials and methods: One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. Results: In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. Conclusion: The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation.

Dual-energy CT with iodine quantification in distinguishing between bland and neoplastic portal vein thrombosis in patients with hepatocellular carcinoma.

Science.gov (United States)

Ascenti, G; Sofia, C; Mazziotti, S; Silipigni, S; D'Angelo, T; Pergolizzi, S; Scribano, E

2016-09-01

To investigate the diagnostic accuracy of dual-energy multidetector computed tomography (MDCT) with iodine quantification compared to conventional enhancement measurements in distinguishing bland from neoplastic portal vein thrombosis in patients with hepatocellular carcinoma. Thirty-four patients (26 men, eight women; mean age, 62 years) with hepatocellular carcinoma and portal vein thrombosis underwent contrast-enhanced dual-energy MDCT during the late hepatic arterial phase for the assessment of portal thrombosis (bland, n=21; neoplastic, n=13). Datasets were analysed separately by two different readers. Interobserver correlation and variability were calculated and compared with the Bland-Altman method. Diagnostic accuracy of conventional enhancement measurements and iodine quantification was calculated by setting either histopathology (n=7) or a reference standard based on MDCT imaging criteria and thrombus evolutionary characteristics compared to a previous MDCT examination (n=27). For iodine quantification threshold determination receiver operating characteristic (ROC) curves were drawn. p-Values <0.05 were considered significant. For conventional enhancement measurements and iodine quantification interobserver correlation was 98% and 96%. Enhancement measurement resulted in a sensitivity of 92.3%, specificity of 85.7%, positive predictive value (PPV) of 80%, and negative predictive value (NPV) of 94.7%. An iodine concentration of 0.9 mg/ml optimised discrimination between neoplastic and bland thrombi (area under the ROC [AUC] 0.993) resulting in a sensitivity of 100%, specificity of 95.2%, PPV of 92.9%, and NPV of 100%. The overall diagnostic accuracy of iodine quantification (97%) was significantly better than conventional enhancement measurements (88.2%; p<0.001). Compared to conventional enhancement measurements, iodine quantification improves the characterisation of portal vein thrombi during the late hepatic arterial phase in patients with

Effect of severity of steatosis as assessed ultrasonographically on hepatic vascular indices in non-alcoholic fatty liver disease.

Science.gov (United States)

Mohammadi, Afshin; Ghasemi-rad, Mohammad; Zahedi, Hengameh; Toldi, Gergely; Alinia, Tahereh

2011-09-01

Early monitoring of non-alcoholic fatty liver disease (NAFLD) progression in obese patients is important to avoid the development of complications associated with fatty infiltration. of this study was to investigate the relationship between the degrees of fatty infiltration and reduced vascular compliance in NAFLD patients in the three main hepatic vessels. Two hundred and fourty subjects were enrolled in the study. They were divided into 4 groups: 60 controls, 60 grade 1 NAFLD patients, 60 grade 2 NAFLD patients and 60 grade 3 NAFLD patients. After US confirmation of the presence and grade of NAFLD, the peak and mean portal vein velocity (PPVV and MPVV, respectively), the hepatic artery resistance index (HARI), and the phasicity of the hepatic vein were measured. The PPVV was 19.6 +/- 2.4 cm/sec in patients with grade 1 fatty liver, 17.6 +/- 1.2 cm/sec in grade 2 and 15.4 +/- 1.1 cm/sec in grade 3. The MPVV was 16.6 +/- 2.4 cm/sec in patients with grade 1 fatty liver, 16.6 +/- 2.9 cm/sec in grade 2 and 12.7 +/- 0.7 cm/sec in grade 3. The HARI was 0.75 in patients with grade 1 fatty liver, 0.68 in grade 2 and 0.64 in grade 3. There was an inverse relationship between PPVV, MPVV and HARI and different grades of fatty liver in patients (p = 0.001 for PPVV (Figure 7) and HARI, p = 0.006 for MPVV. The values of the investigated liver blood flow parameters were inversely correlated with the fatty infiltration grading. Fatty infiltration can severely influence hepatic blood flow, pointing attention to the importance of early diagnosis and the need for hepatic vessel flow abnormalities characterization in the NAFLD population.

Percutaneous unilateral biliary metallic stent placement in patients with malignant obstruction of the biliary hila and contralateral portal vein steno-occlusion

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Son, Rak Chae; Gwon, Dong Il; Ko, Heung Kyu; Kim, Jong Woo; Ko, Gi Young [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2015-06-15

To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

Insights into the mechanics of en-échelon sigmoidal vein formation using ultra-high resolution photogrammetry and computed tomography

Science.gov (United States)

Thiele, Samuel T.; Micklethwaite, Steven; Bourke, Paul; Verrall, Michael; Kovesi, Peter

2015-08-01

Two novel techniques, photo based reconstruction (photogrammetry) and computed tomography (CT), are used to investigate the formation of an exceptional array of sigmoidal veins in a hand sample from Cape Liptrap, Southern Victoria, and to provide constraint on models for their development. The accuracies of the photogrammetric models were tested by comparison with a laser scan generated three dimensional (3D) model. The photogrammetric model was found to be accurate to at least 0.25 mm and substantially more detailed than the laser scan. A methodology was developed by which 3D structural measurements could be extracted from the photogrammetric model. This was augmented with the CT model which, through its capacity to elucidate internal structure, was used to constrain the geometry and linkage of structures within the rock volume. The photogrammetric and CT data were then combined with detailed photomicrographs to evaluate the evolution of the sigmoidal veins in the sample. The angle between the sigmoidal vein margins and an inferred shear zone, as well as the orientations of the crystal fibres, were found to imply a rotation of >27°. However coeval pressure solution seams and older veinlets in the rock bridges between the veins were only found to have rotated by ∼10°, an observation not easily explained using existing models for sigmoidal vein formation. A new model is proposed in which a significant component of sigmoidal vein geometry is due to localised dilation caused by slip on the pressure solution seams. The process involves strain partitioning onto pressure solution seams, which leads to exaggeration of sigmoidal vein geometries. If not accounted for, the apparent vein rotation due to slip partitioning introduces errors into calculations of simple shear and volume strain based on sigmoidal arrays of this type. Furthermore, the CT data demonstrated that in 3D the veins are continuous and channel-like, implying a far higher degree of connectivity and

A Vein Map Biometric System

Directory of Open Access Journals (Sweden)

Felix Fuentes

2013-08-01

Full Text Available There is increasing demand world-wide, from government agencies and the private sector for cutting-edge biometric security technology that is difficult to breach but userfriendly at the same time. Some of the older tools, such as fingerprint, retina and iris scanning, and facial recognition software have all been found to have flaws and often viewed negatively because of many cultural and hygienic issues associated with them. Comparatively, mapping veins as a human barcode, a new technology, has many advantages over older technologies. Specifically, reproducing a three-dimensional model of a human vein system is impossible to replicate. Vein map technology is distinctive because of its state-of-the-art sensors are only able to recognize vein patterns if hemoglobin is actively flowing through the person

Deep vein thrombosis of the leg

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Lee, Eun Hee; Rhee, Kwang Woo; Jeon, Suk Chul; Joo, Kyung Bin; Lee, Seung Ro; Seo, Heung Suk; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

1987-04-15

Ascending contrast venography is the definitive standard method for the diagnosis of deep vein thrombosis (DVT) of the lower extremities. Authors analysed 22 cases of DVT clinically and radiographically. 1.The patients ranged in age from 15 to 70 yrs and the most prevalent age group was 7th decade (31%). There was an equal distribution of males and females. 2.In 11 cases of 22 cases, variable etiologic factors were recognized, such as abdominal surgery, chronic bedridden state, local trauma on the leg, pregnancy, postpartum, Behcet's syndrome, iliac artery aneurysm, and chronic medication of estrogen. 3.Nineteen cases out of 22 cases showed primary venographic signs of DVT, such as well-defined filling defect in opacified veins and narrowed, irregularly filled venous lumen. In only 3 cases, the diagnosis of DVT was base upon the segmental nonvisualization of deep veins with good opacification of proximal and distal veins and presence of collaterals. 4.Extent of thrombosis: 3 cases were confined to calf vein, 4 cases extended to femoral vein, and 15 cases had involvement above iliac vein. 5.In 17 cases involving relatively long segment of deep veins, propagation pattern of thrombus was evaluated by its radiologic morphology according to the age of thrombus: 9 cases suggested central or antegrade propagation pattern and 8 cases, peripheral or retrograde pattern. 6.None of 22 cases showed clinical evidence of pulmonary embolism. The cause of the rarity of pulmonary embolism in Korean in presumed to be related to the difference in major involving site and propagation pattern of DVT in the leg.

Deep vein thrombosis of the leg

International Nuclear Information System (INIS)

Lee, Eun Hee; Rhee, Kwang Woo; Jeon, Suk Chul; Joo, Kyung Bin; Lee, Seung Ro; Seo, Heung Suk; Hahm, Chang Kok

1987-01-01

Ascending contrast venography is the definitive standard method for the diagnosis of deep vein thrombosis (DVT) of the lower extremities. Authors analysed 22 cases of DVT clinically and radiographically. 1.The patients ranged in age from 15 to 70 yrs and the most prevalent age group was 7th decade (31%). There was an equal distribution of males and females. 2.In 11 cases of 22 cases, variable etiologic factors were recognized, such as abdominal surgery, chronic bedridden state, local trauma on the leg, pregnancy, postpartum, Behcet's syndrome, iliac artery aneurysm, and chronic medication of estrogen. 3.Nineteen cases out of 22 cases showed primary venographic signs of DVT, such as well-defined filling defect in opacified veins and narrowed, irregularly filled venous lumen. In only 3 cases, the diagnosis of DVT was base upon the segmental nonvisualization of deep veins with good opacification of proximal and distal veins and presence of collaterals. 4.Extent of thrombosis: 3 cases were confined to calf vein, 4 cases extended to femoral vein, and 15 cases had involvement above iliac vein. 5.In 17 cases involving relatively long segment of deep veins, propagation pattern of thrombus was evaluated by its radiologic morphology according to the age of thrombus: 9 cases suggested central or antegrade propagation pattern and 8 cases, peripheral or retrograde pattern. 6.None of 22 cases showed clinical evidence of pulmonary embolism. The cause of the rarity of pulmonary embolism in Korean in presumed to be related to the difference in major involving site and propagation pattern of DVT in the leg

Bilateral meandering pulmonary veins

Energy Technology Data Exchange (ETDEWEB)

Thupili, Chakradhar R.; Udayasankar, Unni [Pediatric Imaging, Imaging Institute Cleveland Clinic, Cleveland, OH (United States); Renapurkar, Rahul [Imaging Institute Cleveland Clinic, Thoracic Imaging, L10, Cleveland, OH (United States)

2015-06-15

Meandering pulmonary veins is a rare clinical entity that can be mistaken for more complex congenital syndromes such as hypogenetic lung syndrome. We report imaging findings in a rare incidentally detected case of bilateral meandering pulmonary veins. We briefly discuss the role of imaging in diagnosing this condition, with particular emphasis on contrast-enhanced CT. (orig.)

Observation of portal circulation through superior mesenteric vein by enteric coated capsule of thallium-201

Energy Technology Data Exchange (ETDEWEB)

Tonami, Norihisa; Nakajima, Kenichi; Watanabe, Naoto; Seto, Mikito; Yokoyama, Kunihiko; Shuke, Noriyuki; Michigishi, Takatoshi; Takayama, Teruhiko; Aburano, Tamio; Hisada, Kinichi

1988-06-01

A new method of oral administration of an enteric coated capsule of /sup 201/Tl (/sup 201/Tl-capsule) was developed to evaluate the portal circulation through the superior mesenteric vein (SMV). The /sup 201/Tl-capsule was not collapsed in the artificial gastric juice, whereas it melted soon after soaking in the artificial intestinal juice. In a clinical trial of 42 cases, /sup 201/Tl was satisfactory released in the duodenum in 36 cases where clear liver images were observed except in 1 patient. Heart to liver ratio (HL) at 60 or 90 min after duodenal release of /sup 201/Tl was 0.32+-0.07 (mean +-1 s.d.) in normal controls, 0.34+-0.12 in chronic hepatitis, 0.31+-0.12 in acute hepatitis, 0.45+-0.13 in liver cirrhosis and 0.48+-0.32 in cirrhosis with hepatocellular carcinoma. In 11 patients who had both oral and rectal studies with /sup 201/Tl, 7 showed a high HL ratio of more than 0.8 in the rectal study but only 1 showed a similarly high ratio of 1.07 in the oral study. In the group of varied liver disorders we have studied so far, it was found that most of the SMV blood flowed into the liver and the degree of portal systemic shunting (PSS) from the SMV was much smaller compared to that from the inferior mesenteric vein. The present study with oral administration of the /sup 201/Tl-capsule was of value in understanding portal circulation through the SMV, however, this technique seemed of limited usefulness for evaluating overall pathologic PSS.

Observation of portal circulation through superior mesenteric vein by enteric coated capsule of thallium-201

International Nuclear Information System (INIS)

Tonami, Norihisa; Nakajima, Kenichi; Watanabe, Naoto; Seto, Mikito; Yokoyama, Kunihiko; Shuke, Noriyuki; Michigishi, Takatoshi; Takayama, Teruhiko; Aburano, Tamio; Hisada, Kinichi; Tanaka, Nobuyoshi; Kobayashi, Kenichi

1988-01-01

A new method of oral administration of an enteric coated capsule of 201 Tl ( 201 Tl-capsule) was developed to evaluate the portal circulation through the superior mesenteric vein (SMV). The 201 Tl-capsule was not collapsed in the artificial gastric juice, whereas it melted soon after soaking in the artificial intestinal juice. In a clinical trial of 42 cases, 201 Tl was satisfactory released in the duodenum in 36 cases where clear liver images were observed except in 1 patient. Heart to liver ratio (H/L) at 60 or 90 min after duodenal release of 201 Tl was 0.32±0.07 (mean ±1 s.d.) in normal controls, 0.34±0.12 in chronic hepatitis, 0.31±0.12 in acute hepatitis, 0.45±0.13 in liver cirrhosis and 0.48±0.32 in cirrhosis with hepatocellular carcinoma. In 11 patients who had both oral and rectal studies with 201 Tl, 7 showed a high H/L ratio of more than 0.8 in the rectal study but only 1 showed a similarly high ratio of 1.07 in the oral study. In the group of varied liver disorders we have studied so far, it was found that most of the SMV blood flowed into the liver and the degree of portal systemic shunting (PSS) from the SMV was much smaller compared to that from the inferior mesenteric vein. The present study with oral administration of the 201 Tl-capsule was of value in understanding portal circulation through the SMV, however, this technique seemed of limited usefulness for evaluating overall pathologic PSS. (orig.)

Developmental anatomy of the liver from computerized three-dimensional reconstructions of four human embryos (from Carnegie stage 14 to 23).

Science.gov (United States)

Lhuaire, Martin; Tonnelet, Romain; Renard, Yohann; Piardi, Tullio; Sommacale, Daniele; Duparc, Fabrice; Braun, Marc; Labrousse, Marc

2015-07-01

Some aspects of human embryogenesis and organogenesis remain unclear, especially concerning the development of the liver and its vasculature. The purpose of this study was to investigate, from a descriptive standpoint, the evolutionary morphogenesis of the human liver and its vasculature by computerized three-dimensional reconstructions of human embryos. Serial histological sections of four human embryos at successive stages of development belonging to three prestigious French historical collections were digitized and reconstructed in 3D using software commonly used in medical radiology. Manual segmentation of the hepatic anatomical regions of interest was performed section by section. In this study, human liver organogenesis was examined at Carnegie stages 14, 18, 21 and 23. Using a descriptive and an analytical method, we showed that these stages correspond to the implementation of the large hepatic vascular patterns (the portal system, the hepatic artery and the hepatic venous system) and the biliary system. To our knowledge, our work is the first descriptive morphological study using 3D computerized reconstructions from serial histological sections of the embryonic development of the human liver between Carnegie stages 14 and 23. Copyright © 2015 Elsevier GmbH. All rights reserved.

Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results

Energy Technology Data Exchange (ETDEWEB)

Lee, Kwang Hun; Lee, Do Yun; Won, Jong Yoon [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sang Joon [Hallym University College of Medicine, Seoul (Korea, Republic of); Kim, Jae Kyu; Yoon, Woong [Chonnam National University Hospital, Gwangju (Korea, Republic of)

2003-03-01

To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible.

Transcaval transjugular intrahepatic portosystemic shunt: preliminary clinical results

International Nuclear Information System (INIS)

Lee, Kwang Hun; Lee, Do Yun; Won, Jong Yoon; Park, Sang Joon; Kim, Jae Kyu; Yoon, Woong

2003-01-01

To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins. Transcaval TIPS, performed in six patients, was indicated by active variceal bleeding (n=2), recurrent variceal bleeding (n=2), intractable ascites (n=1), and as a bridge to liver transplantation (n=1). The main reasons for transcaval rather than classic TIPS were the presence of an unusually acute angle between the hepatic veins and the level of the portal bifurcation (n=3), hepatic venous occlusion (n=2), and inadequate small hepatic veins (n=1). Technical and functional success was achieved in all patients. The entry site into liver parenchyma from the inferior vena cava was within 2 cm of the atriocaval junction. Procedure-related complications included the death of one patient due to hemoperitoneum despite the absence of contrast media spillage at tractography, and another suffered reversible hepatic encephalopathy. In patients with unusual anatomy between the hepatic veins and portal bifurcation, and inaccessible or inadequate hepatic veins, transcaval TIPS creation is feasible

[11C]palmitate kinetics across the splanchnic bed in arterial, portal and hepatic venous plasma during fasting and euglycemic hyperinsulinemia

International Nuclear Information System (INIS)

Guiducci, Letizia; Jaervisalo, Mikko; Kiss, Jan; Nagren, Kjell; Viljanen, Antti; Naum, Alexandru G.; Gastaldelli, Amalia; Savunen, Timo; Knuuti, Juhani; Salvadori, Piero A.; Ferrannini, Ele; Nuutila, Pirjo; Iozzo, Patricia

2006-01-01

Purpose: The liver is fundamental in regulating lipid metabolism, and it supplies fatty acids (FA) to the rest of the body in the form of triglycerides (TG); the time-related relevance of this process is incompletely defined. The aim of the study was to investigate the appearance of labeled TG in the hepatic vascular bed after [ 11 C]palmitate injection during fasting and insulin stimulation. Methods: Plasma [ 11 C]palmitate kinetics in arterial, portal and hepatic venous lipid fractions was studied in eight anesthetized pigs during fasting or euglycemic hyperinsulinemia. Plasma analyses were conducted at 10 and 40 min after tracer injection. Corresponding liver positron emission tomography (PET) images were acquired for the semiquantitative determination of hepatic FA uptake. Results: At 10 min, plasma levels of unchanged [ 11 C]palmitate were lower in hyperinsulinemic than in fasting experiments in the artery and in the portal vein (P≤.03), suggesting faster clearance. Levels of unmetabolized [ 11 C]palmitate did not differ between portal and arterial plasma. In the fasting state, a tendency to a positive arterial and portal vs. hepatic venous gradient was observed, indicative of net hepatic [ 11 C]palmitate extraction. Labeled TG were already detectable at 10 min (fasting vs. hyperinsulinemia, ns) and were higher in fasting than in hyperinsulinemic animals at 40 min (92±1% and 82±6% of arterial plasma radioactivity). Higher proportions of labeled TG were recovered in portal vein plasma, suggesting release by the gut. The portal and the arterial-portal vs. hepatic venous TG gradient tended to be positive. Accordingly, hepatic FA uptake was higher, but declined more rapidly during fasting than during hyperinsulinemia. Conclusion: The study indicates that the redistribution of [ 11 C]palmitate between different lipid pools occurs within the short time interval of most PET experiments and is strongly influenced by insulin. Labeled TG constitute an additional