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Sample records for intrahepatic fish bone

  1. SWALLOWED FISH BONES IN MALI

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    Sacko HB

    2015-07-01

    Full Text Available Objective: To study the different aspects, clinical, diagnostic and therapeutic of 114 cases of fish bones in the upper digestive tract . Methods: One hundred fourteen patients with fish bones suspected in the upper digestive tract were admitted in our department between February 2010 and October 2012. Results: There was a predominance of the male: 66 men (58%. The average age of the patients was 26 years with extremes 3 to 62 years old. The tongue base and vallecula are constituted the principals locations 66.66%. In the majority of the cases the fish bones were removed by direct pharyngoscopy in 43.86 %. We have not notified any serious complications. Conclusion: Therefore this study shows the foreign fish bones are frequently just as well in children as adult. The fish bones are particularly lodged in tongue base. The classical methods of extraction are permit to remove the all foreign fish bones.

  2. Oroesophageal Fish Bone Foreign Body.

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    Kim, Heung Up

    2016-07-01

    Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.

  3. Archaeological Fish Bones Online: a digital archive of Sydney fishes

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    Sarah Colley

    2010-12-01

    Full Text Available The article presents the Archaeological Fish Bone Images sustainable digital archive and XTF-based image search and presentation tools developed with University of Sydney Library. The archive contains over 500 images of modern and archaeological fish remains and was developed as part of an archaeological research project into colonial and traditional Aboriginal fishing practices in Sydney, New South Wales, Australia from c.3000 years ago to the late 19th century. Links are provided to research information about fish ecology and fishing, the cultural and historical significance of fish taxa and details of taxonomic and anatomical nomenclature. Archaeological fish-bone images at the University of Sydney The article explains how and why the archive was developed, and identifies and discusses the research implications of significant gaps in current fish reference collections. Archive content is useful to researchers who need to identify and interpret fish remains of the same or similar biological taxa from Sydney or elsewhere. The design of the archive and online tools is relevant to other applications that use digital images to aid identification and interpretation of archaeological and other collections.

  4. Pectoral girdle bones in eurypterygian fishes

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    Yazdan Keivany

    2014-10-01

    Full Text Available Bones of the pectoral girdle skeleton in representatives of 48 genera in 41 families of eurypterygian fishes were studied. The structure and position of the pectoral girdle is relatively stable in eurypterygians. It consists of the extrascapula, posttemporal, supracleithrum, cleithrum, postcleithrum, scapula, coracoid, actinosts, and fin rays. An ectocoracoid is present in some Gasterosteiformes. Most eurypterygians have a posttemporal with distinct dorsal and ventromedial processes. The dorsal process ligamentously articulates with the epioccipital and the ventromedial process with the intercalary when present, and when absent, with the posteroventral margins of the pterotic and exoccipital. In most taxa, the supracleithrum bears a sensory canal and articulates with the posttemporal anteriorly and with the cleithrum posteriorly. The cleithrum is Y-shaped consisting of the anterodorsal, posterodorsal, and ventral rami. Dorsal and ventral postcleithra are present in some Eurypterygii. The scapula articulates with the cleithrum and bears a foramen which is complete or open anteriorly and bordered by the cleithral ventral ramus. Most taxa have four autogenous actinosts that increase in size gradually from the first to the fourth, but in some, the first actinost is fused. The dorsalmost ray is rudimentary in some taxa.

  5. Wandering Fish Bone: a Case of Pelvic Abscess due to Rectum Perforation Resulting from an Accidental Fish Bone Ingestion

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    Sirous Abbasi

    2010-09-01

    Full Text Available Fish bone is the most common foreign body that is ingested accidentally and can be caused gastrointestinal complications such as perforation, abstraction, and abscess. We describe a 75-year-old man who suffered from constipation, diarrhea, and fever and chills for 3 months. He had mild tenderness in hypogasteric region and also mild tenderness and swelling on anterior rectal wall and prostate upon clinical examination. The abdominal and pelvic sonography and CT scan findings suggested existence of abscess in the space of between bladder and rectum. The patient underwent laparotomy to drainage the pelvic abscess. The surgeon found a 6-cm fish bone which was embedded in the abscess. The presented case indicated the importance of accidental fish bone ingestion and its possible complications. In addition, the patients with abdominal pain, GI bleeding, and fever of unknown origin living in the seaside regions, the wandering fish bone as a differential diagnosis should be kept in mind.

  6. Fabrication of hydroxyapatite from fish bones waste using reflux method

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    Cahyanto, A.; Kosasih, E.; Aripin, D.; Hasratiningsih, Z.

    2017-02-01

    The aim of this present study was to investigate the fabrication of hydroxyapatites, which were synthesized from fish bone wastes using reflux method. The fish bone wastes collected from the restaurant were brushed and boiled at 100°C for 10 minutes to remove debris and fat. After drying, the fish bones were crushed, and ball milled into a fine powder. The fish bone wastes were then processed by refluxing using KOH and H3PO4 solutions. The samples were calcined at 900°C and characterized by X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectrometry (FT-IR). The XRD pattern of samples after treatment revealed that the peak of hydroxyapatite was observed and the bands of OH- and PO4 3- were observed by FT-IR. The scanning electron microscope evaluation of sample showed the entangled crystal and porous structure of hydroxyapatite. In conclusion, the hydroxyapatite was successfully synthesized from fish bone wastes using reflux method.

  7. Migrated pharyngeal fish bone causing spondylodiscitis. Case report

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    Aluizio Augusto Arantes Júnior

    2014-03-01

    Full Text Available Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone that penetrated the longus colli fascia and carved into vertebral body C3.

  8. Synthesis and characterization of hydroxyapatite from fish bone waste

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    Marliana, Ana, E-mail: na-cwith22@yahoo.co.id; Fitriani, Eka; Ramadhan, Fauzan; Suhandono, Steven; Yuliani, Keti; Windarti, Tri [Chemistry Department, Faculty of Science and Mathematics, Diponegoro University, Indonesia, 50 275 (Indonesia)

    2015-12-29

    Waste fish bones is a problem stemming from activities in the field of fisheries and it has not been used optimally. Fish bones contain calcium as natural source that used to synthesize hydroxyapatite (HA). In this research, HA synthesized from waste fish bones as local wisdom in Semarang. The goal are to produce HA with cheaper production costs and to reduce the environmental problems caused by waste bones. The novelty of this study was using of local fish bone as a source of calcium and simple method of synthesis. Synthesis process of HA can be done through a maceration process with firing temperatures of 1000°C or followed by a sol-gel method with firing at 550°C. The results are analyzed using FTIR (Fourier Transform Infrared), XRD (X-Ray Diffraction) and SEM-EDX (Scanning Electron Microscopy-Energy Dispersive X-Ray). FTIR spectra showed absorption of phosphate and OH group belonging to HA as evidenced by the results of XRD. The average grain size by maceration and synthesized results are not significant different, which is about 69 nm. The ratio of Ca/P of HA by maceration result is 0.89, then increase after continued in the sol-gel process to 1.41. Morphology of HA by maceration results are regular and uniform particle growth, while the morphology of HA after the sol-gel process are irregular and agglomerated.

  9. Intrahepatic ovulation

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    Artur L. Wozniak, HBSc

    2014-01-01

    Full Text Available Ectopic ovaries are a rare finding in the literature, with fewer than 50 published cases to date. This phenomenon has been found in the omentum, bladder, mesentery, and uterus; attached to the colon; inside the left labia majora; and in the kidney. Various etiologies have been proposed, including postsurgical or postinflammatory transplantation, malignant origins, and abnormal embryologic development. We report the ultrasonographic, computed tomographic (CT, and magnetic resonance (MR imaging of, what is to the best of our knowledge, the first case of an intrahepatic ectopic ovary.

  10. Design and testing of small scale fish meat bone separator useful for fish processing.

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    Ali Muhammed, M; Manjunatha, N; Murthy, K Venkatesh; Bhaskar, N

    2015-06-01

    The present study relates to the food processing machinery and, more specifically machine for producing boneless comminuted meat from raw fish fillet. This machine is of belt and drum type meat bone separator designed for small scale fish processing in a continuous mode. The basic principal involved in this machine is compression force. The electric geared motor consists of 1HP and the conveyor belt has a linear velocity of 19 to 22 m min(-1), which was sufficient to debone the fish effectively. During the meat bone separation trials an efficiency up to 75 % on dressed fish weight basis was observed and with a capacity to separate 70 kg h(-1) of meat from fish at the machine speed of 25 rpm. During the trials, it was demonstrated that there was no significant change in the proximate composition of comminuted fish meat when compared to unprocessed fish meat. This design has a greater emphasis on hygiene, provision for cleaning-in-place (CIP) and gives cost effective need and reliability for small scale industries to produce fish meat in turn used for their value added products.

  11. Comparative analysis of intermuscular bones in fish of different ploidies.

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    Li, Ling; Zhong, Zezhou; Zeng, Ming; Liu, Shaojun; Zhou, Yi; Xiao, Jun; Wang, Jun; Liu, Yun

    2013-04-01

    We documented the number, morphology, and distribution of intermuscular bones in five fishes of different ploidy: Carassius auratus (Abbr.WCC, 2n=100), Carassius auratus variety PengZe (Abbr.PZCC, 3n=150), improved triploid crucian carp (Abbr.ITCC, 3n=150), improved red crucian carp (Carassius auratus red var., Abbr.IRCC, ♀, 2n=100), and improved allotetraploids (Abbr.G×AT, ♂, 4n=200). The number of intermuscular bones in WCC, PZCC, and G×AT ranged from 78 to 83 ([Formula: see text]=81), 80 to 86 ([Formula: see text]=84), and 77 to 84 ([Formula: see text]=82), respectively. The numbers in ITCC and IRCC were significantly lower, ranging from 77 to 82 ([Formula: see text]=79) and 58 to 77 ([Formula: see text]=71), respectively. The average number of intermuscular bones in each sarcomere, ranked in order from highest to lowest, was 0.721 (WCC), 0.673 (PZCC), 0.653 (G×AT), 0.633 (ITCC), and 0.608 (IRCC). There was no difference between ITCC and G×AT or between G×AT and PZCC. However, the average number of intermuscular bones in the sarcomeres of ITCC, WCC, and PZCC differed significantly, as did that of IRCC and the four other kinds of fish. The intermuscular bone of these five fishes was divided into seven shape categories, non-forked (), one-end-unequal-bi-fork (), one-end-equal-bi-fork (Y), one-end-multi-fork, two-end-bi-fork, two-end-multi-fork, and tree-branch types. Generally, the morphological complexity was higher in the anterior intermuscular bones than in the posterior body. The number of intermuscular bones was similar but not equal between the left and right sides of the body. ITCC had significantly fewer intermuscular bones than either WCC or PZCC, making it of greater commercial value. Additionally, IRCC and ITCC had fewer intermuscular bones than WCC. Our observations are significant in both fish bone developmental biology and genetic breeding.

  12. A prospective study of epidemiological risk factors for ingestion of fish bones in Singapore.

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    Arulanandam, Shalini; Das De, Soumen; Kanagalingam, Jeevendra

    2015-06-01

    Ingestion of fish bones is a common clinical complaint among adult patients. The aim of this study was to evaluate the epidemiological and behavioural risk factors for fish bone ingestion. Between 2009 and 2010, a physician-administered questionnaire was administered to 112 consecutive patients who presented to the emergency department of an adult tertiary hospital with the complaint of fish bone ingestion. The wearing of dentures, the use of utensils to eat fish and the practice of deboning fish in one's mouth were found to be associated with an increased risk of fish bone ingestion. To prevent the occurrence of fish bone ingestion and its possible complications, at-risk populations should be advised on the precautions to take when eating boned fish.

  13. DIETARY FISH OIL-INDUCED CHANGES IN INTRAHEPATIC CHOLESTEROL TRANSPORT AND BILE-ACID SYNTHESIS IN RATS

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    SMIT, MJ; TEMMERMAN, AM; WOLTERS, H; KUIPERS, F; BEYNEN, AC; VONK, RJ

    Hepatic cholesterol metabolism was studied in rats fed purified diets supplemented (9% wt/wt) with either fish oil (FO) (n-3 fatty acids) or corn oil (CO) (n-6 fatty acids) for 4 wk. Rats were equipped with permanent catheters in heart, bile duct, and duodenum to allow studies under normal feeding

  14. Small-bowel perforation caused by fish bone

    Institute of Scientific and Technical Information of China (English)

    Sheng-Der Hsu; De-Chuan Chan; Yao-Chi Liu

    2005-01-01

    A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis. We report the case of a 62-year-old woman who experienced severe pain in the right iliac fossa and fever for about five days before arrival at our hospital. The presumptive diagnosis was acute purulent appendicitis and an emergency appendectomy was planned. Swelling and erythema were noted in a segment of the small bowel in the lower right abdomen. A tiny pointed object was found penetrating the inflamed portion of the bowel, which proved to be a sharp fish bone (gray snapper). The bone was removed, followed by segmental resection of the terminal ileum and ascending colon. The postoperative course was uneventful.

  15. Fish-bone associated infected urachal cyst: a case report

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    Kang, Chae Hoon; Kim, You Me [Dankook University Hospital, Cheonan (Korea, Republic of)

    2006-04-15

    Congenital urachal abnormalities are more common in children, but urachal cyst is more frequently seen in adults. Infection within a cyst produces significant symptoms, which may explain the fact that three times as many infected cysts as uninfected urachal cysts are detected in adults. We report here on a case of infected urachal cyst with a fish bone and also the fistular formation between the ileum and urachus in a 63-year-old male with a history of urinary frequency and a tender mass at the lower abdominal quadrant.

  16. Characterization of powdered fish heads for bone graft biomaterial applications.

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    Oteyaka, Mustafa Ozgür; Unal, Hasan Hüseyin; Bilici, Namık; Taşçı, Eda

    2013-01-01

    The aim of this study was to define the chemical composition, morphology and crystallography of powdered fish heads of the species Argyrosomus regius for bone graft biomaterial applications. Two sizes of powder were prepared by different grinding methods; Powder A (coarse, d50=68.5 µm) and Powder B (fine, d50=19.1 µm). Samples were analyzed using X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscopy (SEM), thermogravimetry (TG), and energy dispersive X-ray spectroscopy (EDS). The powder was mainly composed of aragonite (CaCO3) and calcite (CaCO3). The XRD pattern of Powder A and B matched standard aragonite and calcite patterns. In addition, the calcium oxide (CaO) phase was found after the calcination of Powder A. Thermogravimetry analysis confirmed total mass losses of 43.6% and 47.3% in Powders A and B, respectively. The microstructure of Powder A was mainly composed of different sizes and tubular shape, whereas Powder B showed agglomerated particles. The high quantity of CaO and other oxides resemble the chemical composition of bone. In general, the powder can be considered as bone graft after transformation to hydroxyapatite phase.

  17. Bimanual, intra-operative, fluoroscopy-guided removal of nasopharyngeal migratory fish bone from carotid space.

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    Al-Abduwani, J A; Bhargava, D; Sawhney, S; Al-Abri, R

    2010-07-01

    We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool. We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen. To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

  18. Dietary Habits, Nutrients and Bone Mass in Spanish Premenopausal Women: The Contribution of Fish to Better Bone Health

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    Julian F. Calderon-Garcia

    2012-12-01

    Full Text Available The moderate consumption of fish is recommended for a healthy diet and is also a feature of the Mediterranean diet. Fish is a major food group in diets throughout the world, and studies show that fish consumption is associated with a lower risk of a number of conditions. Spain has one of the highest annual per capita consumptions of fish worldwide. As fish is a source of high quality protein; n-3 polyunsaturated fatty acids; vitamins, such as A and D; and minerals, such as selenium, calcium, iodine, magnesium, copper and zinc, nutrients that have positive effects on bone characteristics, it has been proposed that its consumption could improve bone health. In this cross-sectional study, we have investigated the relationship between dietary habits and nutrient intake of 151 Spanish premenopausal women and analyzed the association of fish consumption on bone mass measured by quantitative ultrasound of the phalanges. A higher (P < 0.05 bone mass and vitamin D intake (P < 0.05 was observed in the group with a fish intake of 5–7 servings/week. We conclude that increased fish consumption is helpful in maintaining an adequate bone mass in Spanish premenopausal women.

  19. Dietary habits, nutrients and bone mass in Spanish premenopausal women: the contribution of fish to better bone health.

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    Calderon-Garcia, Julian F; Moran, Jose M; Roncero-Martin, Raul; Rey-Sanchez, Purificacion; Rodriguez-Velasco, Francisco J; Pedrera-Zamorano, Juan D

    2012-12-27

    The moderate consumption of fish is recommended for a healthy diet and is also a feature of the Mediterranean diet. Fish is a major food group in diets throughout the world, and studies show that fish consumption is associated with a lower risk of a number of conditions. Spain has one of the highest annual per capita consumptions of fish worldwide. As fish is a source of high quality protein; n-3 polyunsaturated fatty acids; vitamins, such as A and D; and minerals, such as selenium, calcium, iodine, magnesium, copper and zinc, nutrients that have positive effects on bone characteristics, it has been proposed that its consumption could improve bone health. In this cross-sectional study, we have investigated the relationship between dietary habits and nutrient intake of 151 Spanish premenopausal women and analyzed the association of fish consumption on bone mass measured by quantitative ultrasound of the phalanges. A higher (P < 0.05) bone mass and vitamin D intake (P < 0.05) was observed in the group with a fish intake of 5-7 servings/week. We conclude that increased fish consumption is helpful in maintaining an adequate bone mass in Spanish premenopausal women.

  20. Comparison of structural, architectural and mechanical aspects of cellular and acellular bone in two teleost fish.

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    Cohen, Liat; Dean, Mason; Shipov, Anna; Atkins, Ayelet; Monsonego-Ornan, Efrat; Shahar, Ron

    2012-06-01

    The histological diversity of the skeletal tissues of fishes is impressive compared with that of other vertebrate groups, yet our understanding of the functional consequences of this diversity is limited. In particular, although it has been known since the mid-1800s that a large number of fish species possess acellular bones, the mechanical advantages and consequences of this structural characteristic - and therefore the nature of the evolution of this feature - remain unclear. Although several studies have examined the material properties of fish bone, these have used a variety of techniques and there have been no direct contrasts of acellular and cellular bone. We report on a comparison of the structural and mechanical properties of the ribs and opercula between two freshwater fish - the common carp Cyprinus carpio (a fish with cellular bone) and the tilapia Oreochromis aureus (a fish with acellular bone). We used light microscopy to show that the bones in both fish species exhibit poor blood supply and possess discrete tissue zones, with visible layering suggesting differences in the underlying collagen architecture. We performed identical micromechanical testing protocols on samples of the two bone types to determine the mechanical properties of the bone material of opercula and ribs. Our data support the consensus of literature values, indicating that Young's moduli of cellular and acellular bones are in the same range, and lower than Young's moduli of the bones of mammals and birds. Despite these similarities in mechanical properties between the bone tissues of the fish species tested here, cellular bone had significantly lower mineral content than acellular bone; furthermore, the percentage ash content and bone mineral density values (derived from micro-CT scans) show that the bone of these fishes is less mineralized than amniote bone. Although we cannot generalize from our data to the numerous remaining teleost species, the results presented here suggest

  1. Use of diagnostic bones to identify and estimate original lengths of ingested prey fishes

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    Hansel, H.C.; Duke, S.D.; Lofy, P.T.; Gray, G.A.

    1988-01-01

    We examined and measured cleithra, dentaries, opercles, and pharyngeal arches – bones found to persist during digestion of most prey fish – to identify 24 prey fish species and back-calculate their original fork length. Eighteen of the 24 species examined could be easily distinguished; however, for certain congenerics, identification was neither consistent nor reliable for all bones within the size ranges examined. Relations between bone length and fish length were linear for 14 species for which the sample sizes were adequate (N > 30); coefficients of determination (r 2) ranged from 0.79 to 0.99. Diagnostic characteristics and measurements of these bones provided reliable identification of genera and species and estimates of original fork lengths of partly digested prey fish from three predators. This method, compared with that of examining only prey fish in a measurable condition, greatly increased the amount of dietary information available from gut analysis.

  2. Fish bones--a highly available calcium source for growing pigs.

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    Malde, M K; Graff, I E; Siljander-Rasi, H; Venäläinen, E; Julshamn, K; Pedersen, J I; Valaja, J

    2010-10-01

    In general, there is a lack of scientific documentation of nutritional value of marine by-products. The bone fraction from fish has been regarded as waste. Due to the high mineral content of fish bones, this material can be well suitable as a natural calcium source. In the present study, apparent calcium absorption of different fish bone sources was tested using growing pigs. The experimental diets consisted of boiled salmon frames, or salmon, saithe or cod bones treated with enzymes. Calcium carbonate (CaCO(3)) was used as control. The experimental diets were formulated to contain 0.7% total calcium of which the added calcium source to be tested contributed about 71% (study 1) and 86% (study 2). Except for the calcium and phosphorus sources, the animals received similar basal diets. Apparent calcium digestibility coefficient was calculated using yttrium as indicator (both studies) and was based on complete collection of faeces and urine (study 2). The experimental design was parallel and cross-over in study 1 and study 2, respectively. In study 1, piglets getting salmon bone treated with enzymes had significantly higher calcium absorption than piglets getting boiled fish bone or calcium carbonate. Therefore, in the second study only enzymatically treated fish bones were included. The higher calcium absorption from enzymatically treated salmon bone was also found in study 2, but this time not significant. Calcium from boiled salmon bones in study I, and from enzymatically treated saithe and cod bones in study II were absorbed as well as the calcium carbonate control. The results indicate that fish bones may be a useful and well absorbed calcium source. Due to the high mineral content of the bone fraction, salmon bones can be well suitable as a natural calcium and phosphorus source in, for example, food, feed or as supplement.

  3. Intrahepatic cholestasis of pregnancy.

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    Williamson, Catherine; Geenes, Victoria

    2014-07-01

    Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease that typically presents in the third trimester. The clinical features are maternal pruritus in the absence of a rash and deranged liver function tests, including raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including spontaneous preterm delivery, meconium staining of the amniotic fluid, and stillbirth. It is commonly treated with ursodeoxycholic acid. There is accumulating evidence to suggest that intrahepatic cholestasis of pregnancy has a lasting influence on both maternal and fetal health. We review the etiology, diagnosis, and management of this intriguing condition.

  4. Intrahepatic cholestasis of pregnancy

    National Research Council Canada - National Science Library

    Geenes, Victoria; Williamson, Catherine

    2009-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile acids and increased rates of adverse fetal outcomes...

  5. Production of microscale particles from fish bone by gas flow assisted laser ablation

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    Boutinguiza, M.; Lusquinos, F.; Comesana, R.; Riveiro, A.; Quintero, F. [Dpto. Fisica Aplicada, Universidad de Vigo, ETSI Industriales, Lagoas-Marcosende 9, 36310 Vigo (Spain); Pou, J. [Dpto. Fisica Aplicada, Universidad de Vigo, ETSI Industriales, Lagoas-Marcosende 9, 36310 Vigo (Spain)], E-mail: jpou@uvigo.es

    2007-12-15

    Recycled wastes from fish and seafood can constitute a source of precursor material for different applications in the biomedical field such as bone fillers or precursor material for bioceramic coatings to improve the osteointegration of metallic implants. In this work, fish bones have been used directly as target in a laser ablation system. A pulsed Nd:YAG laser was used to ablate the fish bone material and a transverse air flow was used to extract the ablated material out of the interaction zone. The particles collected at a filter were in the micro and nanoscale range. The morphology as well as the composition of the obtained particles were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX) and transmission electron microscopy (TEM). The results reveal that the composition of the analyzed particles is similar to that of the inorganic part of the fish bone.

  6. Different ossification patterns of intermuscular bones in fish with different swimming modes.

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    Yao, Wenjie; Lv, Yaoping; Gong, Xiaoling; Wu, Jiaming; Bao, Baolong

    2015-01-01

    Intermuscular bones are found in the myosepta in teleosts. However, there is very little information on the development and ossification of these intermuscular bones. In this study, we performed an in-depth investigation of the ossification process during development in zebrafish (Danio rerio) and Japanese eel (Anguilla japonica). In Japanese eel, a typical anguilliform swimmer, the intermuscular bones ossified predominantly from the anterior to the posterior. By contrast, in the zebrafish, a sub-carangiform or carangiform swimmer, the intermuscular bones ossified predominantly from the posterior to the anterior regions of the fish. Furthermore, tail amputation affected the ossification of the intermuscular bones. The length of the intermuscular bones in the posterior area became significantly shorter in tail-amputated zebrafish and Japanese eels, and both had less active and lower swimming speeds; this indicates that swimming might induce the ossification of the intermuscular bones. Moreover, when a greater length of tail was amputated in the zebrafish, the intermuscular bones became even shorter. Tail amputation affected the length and ossification of intermuscular bones in the anterior part of the fish, close to the head, differently between the two fish: they became significantly shorter in the zebrafish, but did not in the Japanese eel. This might be because tail amputation did not significantly affect the undulations in the anterior of the Japanese eel, especially near the head. This study shows that the ossification of intermuscular bones might be induced through mechanical force loadings that are produced by swimming.

  7. Different ossification patterns of intermuscular bones in fish with different swimming modes

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    Wenjie Yao

    2015-12-01

    Full Text Available Intermuscular bones are found in the myosepta in teleosts. However, there is very little information on the development and ossification of these intermuscular bones. In this study, we performed an in-depth investigation of the ossification process during development in zebrafish (Danio rerio and Japanese eel (Anguilla japonica. In Japanese eel, a typical anguilliform swimmer, the intermuscular bones ossified predominantly from the anterior to the posterior. By contrast, in the zebrafish, a sub-carangiform or carangiform swimmer, the intermuscular bones ossified predominantly from the posterior to the anterior regions of the fish. Furthermore, tail amputation affected the ossification of the intermuscular bones. The length of the intermuscular bones in the posterior area became significantly shorter in tail-amputated zebrafish and Japanese eels, and both had less active and lower swimming speeds; this indicates that swimming might induce the ossification of the intermuscular bones. Moreover, when a greater length of tail was amputated in the zebrafish, the intermuscular bones became even shorter. Tail amputation affected the length and ossification of intermuscular bones in the anterior part of the fish, close to the head, differently between the two fish: they became significantly shorter in the zebrafish, but did not in the Japanese eel. This might be because tail amputation did not significantly affect the undulations in the anterior of the Japanese eel, especially near the head. This study shows that the ossification of intermuscular bones might be induced through mechanical force loadings that are produced by swimming.

  8. Characterization of derived natural hydroxyapatite (HAp) obtained from different types of tilapia fish bones and scales

    Science.gov (United States)

    Fara, A. N. K. A.; Abdullah, H. Z.

    2015-07-01

    Hydroxyapatite, (HAp), Ca10(PO4)6(OH)2, is recognised as a biomaterial that is widely used for bone implant due to its chemical and structural similarity to the mineral components in human bone and enamel. The elements of HAp are primarily composed of calcium and phosphorus molar ratio of calcium to phosphorous is 1.67 capable to promote bone in-growth into prosthetic implant. Enormous amounts of by-product waste produced from fish factories generated an undesirable environmental impact. Thus, this study was conducted to obtain natural biological HAp from different types of tilapia fish bones and scales from fishery waste. Therefore, fish bones and scales can be as cheap source to produce biological HAp for medical applications. For this purpose, fish bones and scales of tilapia fish were boiled at 100°C to remove adhering meat and other impurities. Later, fish bones and scales were separated into several groups and subjected to different calcination temperatures of 800° C and 900° C for 3h respectively. Afterward, all calcined samples were crushed to form a fine powder. The XRD result revealed the presence of derived Hapfrom the samples powder and were identical with standard Hap. Thermo Gravimetric Analysis was carried out to show the thermal stability of the HAp powder from different types of fish bones and scales. SEM results show porous structure appeared in calcined samples compared to raw samples. The findings are the promising alternative to produce calcium and phosphorus from fishery wastes that beneficial to medical applications.

  9. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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  10. Method to measure the force to pull and to break pin bones of fish.

    Science.gov (United States)

    Balaban, Murat O; Jie, Hubert; Yin Yee, Yin; Alçiçek, Zayde

    2015-02-01

    A texture measurement device was modified to measure the force required to pull pin bones from King salmon (Oncorhynchus tshawytscha), snapper (Pagrus auratus), and kahawai (Arripis trutta). Pulled bones were also subjected to tension to measure the breaking force. For all fish, the pulling force depended on the size of the fish, and on the length of the pin bone (P bones. For example, fresh small salmon (about 1500 g whole) required 600 g on average to pull pin bones, and large fish (about 3700 g whole) required 850 g. Longer bones required greater pulling force. The breaking force followed the same trend. In general, the breaking force was greater than the pulling force. This allows the removal of the bones without breaking them. There was no statistically significant (P > 0.05) difference between the forces (both pulling and breaking) from fresh and frozen/thawed samples, although in general frozen/thawed samples required less force to pull. With the quantification of pulling and breaking forces for pin bones, it is possible to design and build better, "more intelligent" pin bone removal equipment.

  11. Quantitative analysis of Cu and Co adsorbed on fish bones via laser-induced breakdown spectroscopy

    Science.gov (United States)

    Rezk, R. A.; Galmed, A. H.; Abdelkreem, M.; Ghany, N. A. Abdel; Harith, M. A.

    2016-09-01

    In the present work, laser-induced breakdown spectroscopy (LIBS) has been applied for qualitative and quantitative analysis of heavy metals adsorbed by fish bones. Fish bones were used as a natural and low cost heavy metal sorbent (mainly Cu and Co) from synthetic wastewater. The removal efficiency of the adsorbent was studied as a function of initial metal concentration and pH value. Optimal experimental conditions were evaluated for improving the sensitivity of LIBS technique through parametric dependence studies. Furthermore, calibration curves were constructed based on X-ray fluorescence (XRF) analysis technique, whereas, the limits of detection (LOD) for Cu and Co were calculated. The results were validated by comparing LIBS data with those obtained by XRF spectrometry. The results of the two techniques are strongly correlated which verified the feasibility of using LIBS to detect traces of heavy metals adsorbed from wastewater by fish bones. This study reflects the potential of using LIBS in environmental applications.

  12. Transgenic medaka fish as models to analyze bone homeostasis under micro-gravity conditions in vivo

    Science.gov (United States)

    Winkler, C.; Wagner, T.; Renn, J.; Goerlich, R.; Schartl, M.

    Long-term space flight and microgravity results in bone loss that can be explained by reduced activity of bone-forming osteoblast cells and/or an increase in activity of bone resorbing osteoclast cells. Osteoprotegerin (OPG), a secreted protein of 401 amino acids, has been shown to regulate the balance between osteoblast and osteoclast formation and thereby warrants constant bone mass under normal gravitational conditions. Consistent with this, earlier reports using transgenic mice have shown that increased activation of OPG leads to exc essive bone formation (osteopetrosis), while inactivation of OPG leads to bone loss (osteoporosis). Importantly, it has recently been reported that expression of murine OPG is regulated by vector averaged gravity (Kanematsu et al., 2002, Bone 30, p553). The small bony fish medaka (Oryzias latipes ) has attracted increasing attention as genetic model system to study developmental and pathological processes. To analyze the molecular mechanisms of bone formation in this small vertebrate, we have isolated two related genes, opr-1 and opr -2, from medaka. Our phylogenetic analysis revealed that both genes originated from a common ancestor by fish-specific gene duplication and represent the orthologs of the mammalian OPG gene. Both opr genes are differentially expressed during embryonic and larval development, in adult tissues and in cultured primary osteoblast cells. We have characterized their promoter regions and identified consensus binding sites for transcription factors of the bone-morphogenetic-protein (BMP) p thway and for core-binding-factor-1Aa (cbfa1). Cbfa1 has been shown to be the key regulator of OPG expression during several steps of osteoblast differentiation in mammals. This opens the possibility that the mechanisms controlling bone formation in teleost fish and higher vertebrates are regulated by related mechanisms. We are currently generating transgenic medakafish expressing a GFP reporter gene under control of the

  13. Medical treatment for a fish bone-induced ileal micro-perforation: A case report

    Institute of Scientific and Technical Information of China (English)

    Chein-Chung Kuo; Tsu-Kang Jen; Cheng-Hsin Wen; Chih-Ping Liu; Hai-Sung Hsiao; Yao-Chi Liu; Kuan-Ho Chen

    2012-01-01

    Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

  14. Performance of broilers fed with snail (Pomacea caniculata meal as substitute to fish meal or meat and bone meal

    Directory of Open Access Journals (Sweden)

    Ulep, LJL.

    1991-01-01

    Full Text Available Snail meal was used as a substitution to fish meat and bone meal in broiler rations. Final weightand feed conversion efficiency of the birds, profit and return on investment differed significantly among treatments. Feed consumption and production costs were comparable. Results show that snail meal can replace fish or meat and bone meal in broiler diets.

  15. Refinement of the $n-\\alpha$ and $p-\\alpha$ fish-bone potential

    CERN Document Server

    Smith, E; Papp, Z

    2012-01-01

    The fishbone potential of composite particles simulates the Pauli effect by nonlocal terms. We determine the $n-\\alpha$ and $p-\\alpha$ fish-bone potential by simultaneously fitting to the experimental phase shifts. We found that with a double Gaussian parametrization of the local potential can describe the $n-\\alpha$ and $p-\\alpha$ phase shifts for all partial waves.

  16. Impairment of mineralization by metavanadate and decavanadate solutions in a fish bone-derived cell line.

    Science.gov (United States)

    Tiago, Daniel M; Laizé, Vincent; Cancela, M Leonor; Aureliano, Manuel

    2008-06-01

    Vanadium, a trace metal known to accumulate in bone and to mimic insulin, has been shown to regulate mammalian bone formation using in vitro and in vivo systems. In the present work, short- and long-term effects of metavanadate (containing monomeric, dimeric, tetrameric and pentameric vanadate species) and decavanadate (containing decameric vanadate species) solutions on the mineralization of a fish bone-derived cell line (VSa13) were studied and compared to that of insulin. After 2 h of incubation with vanadate (10 microM in monomeric vanadate), metavanadate exhibited higher accumulation rates than decavanadate (6.85 +/- 0.40 versus 3.95 +/- 0.10 microg V/g of protein, respectively) in fish VSa13 cells and was also shown to be less toxic when applied for short periods. In longer treatments with both metavanadate and decavanadate solutions, similar effects were promoted: stimulation of cell proliferation and strong impairment (75%) of extracellular matrix (ECM) mineralization. The effect of both vanadate solutions (5 microM in monomeric vanadate), on ECM mineralization was increased in the presence of insulin (10 nM). It is concluded that chronic treatment with both vanadate solutions stimulated fish VSa13 cells proliferation and prevented ECM mineralization. Newly developed VSa13 fish cells appeared to be appropriate in the characterization of vanadate effects on vertebrate bone formation, representing a good alternative to mammalian systems.

  17. Intrahepatic cholestasis in pregnancy

    Directory of Open Access Journals (Sweden)

    Savić Ž.

    2014-01-01

    Full Text Available Abnormal liver function tests occur in 3-5% of pregnancies, with many potential causes, including coincidental liver disease (most commonly viral hepatitis or gallstones and underlying chronic liver disease. Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis. Intrahepatic cholestasis of pregnancy (ICP is a cholestatic disorder characterized by pruritus with onset in the second or third trimester of pregnancy, elevated serum aminotransferases and bile acid levels, and spontaneous relief of signs and symptoms within two to three weeks after delivery. ICP is observed in 0.4-1% of pregnancies in most areas of Central and Western Europe and North America. Genetic and hormonal factors, but also environmental factors may contribute to the pathogenesis of ICP. Intrahepatic cholestasis of pregnancy increases the risk of preterm delivery (19­60%, meconium staining of amniotic fluid (27%, fetal bradycardia (14%, fetal distress (22-41%, and fetal loss (0.4-4.1%, particularly when associated with fasting serum bile acid levels >40 μmol/L. Important ICP-induced changes in serum profiles of amidated bile acids were observed, involving both a marked increase in cholic acid concentration and a shift towards a higher proportion of taurine-conjugated species. Ursodeoxycholic acid (10-20 mg/kg/d is today regarded as the first line treatment for intrahepatic cholestasis of pregnancy. Delivery has been recommended in the 37-38th week when lung maturity has been established.

  18. Intrahepatic cholestasis of pregnancy

    Directory of Open Access Journals (Sweden)

    Beuers Ulrich

    2007-05-01

    Full Text Available Abstract Intrahepatic cholestasis of pregnancy (ICP is a cholestatic disorder characterized by (i pruritus with onset in the second or third trimester of pregnancy, (ii elevated serum aminotransferases and bile acid levels, and (iii spontaneous relief of signs and symptoms within two to three weeks after delivery. ICP is observed in 0.4–1% of pregnancies in most areas of Central and Western Europe and North America, while in Chile and Bolivia as well as Scandinavia and the Baltic states roughly 5–15% and 1–2%, respectively, of pregnancies are associated with ICP. Genetic and hormonal factors, but also environmental factors may contribute to the pathogenesis of ICP. Intrahepatic cholestasis of pregnancy increases the risk of preterm delivery (19–60%, meconium staining of amniotic fluid (27%, fetal bradycardia (14%, fetal distress (22–41%, and fetal loss (0.4–4.1%, particularly when associated with fasting serum bile acid levels > 40 μmol/L. The hydrophilic bile acid ursodeoxycholic acid (10–20 mg/kg/d is today regarded as the first line treatment for intrahepatic cholestasis of pregnancy. Delivery has been recommended in the 38th week when lung maturity has been established.

  19. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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  20. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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    Full Text Available ... What are the limitations of TIPS? What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)? A transjugular intrahepatic ... encourage linking to this site. × Recommend RadiologyInfo to a friend Send to (friend's e-mail address): From ( ...

  1. Intrahepatic cholestasis of pregnancy

    Institute of Scientific and Technical Information of China (English)

    Victoria Geenes; Catherine Williamson

    2009-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile acids and increased rates of adverse fetal outcomes. The etiology of ICP is complex and not fully understood, but it is likely to result from the cholestatic effects of reproductive hormones and their metabolites in genetically susceptible women. Equally unclear are the mechanisms by which the fetal complications occur. This article reviews the epidemiology, clinical features, diagnosis, etiology and management of ICP.

  2. Recurrent Upper Quadrant Pain: A Fish Bone Secondary to Gastric Perforation and Liver Abscess

    Directory of Open Access Journals (Sweden)

    Hui Liang

    2011-12-01

    Full Text Available A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.

  3. Intrahepatic cholangiocarcinoma: current perspectives

    Directory of Open Access Journals (Sweden)

    Buettner S

    2017-02-01

    Full Text Available Stefan Buettner, Jeroen LA van Vugt, Jan NM IJzermans, Bas Groot Koerkamp Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands Abstract: Intrahepatic cholangiocarcinoma (ICC is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15% present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction. Keywords: intrahepatic cholangiocarcinoma, diagnosis, treatment, developments 

  4. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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  5. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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  6. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

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  7. Stable Isotopic Shifts in Fish Bones from Multiple Archeological Coastal Middens in Penobscot Bay, Maine

    Science.gov (United States)

    Harris, C.; Johnson, B.; Ambrose, W. G.; Bourque, B.; Dostie, P.; Crowley, E.

    2010-12-01

    The carbon and nitrogen stable isotope compositions of collagen extracted from well-preserved archeological fish bones has the potential to provide useful information on fish diets and food web dynamics over time. Previous work on the Turner Farm archaeological site in Penobscot Bay, Gulf of Maine, reveals significant shifts in fish diets have occurred since European colonization (post 1620’s). The objective of the present study was to analyze samples from other archaeological sites within Penobscot Bay to characterize the spatial extent of the isotopic shift measured at Turner Farm. Stratified cod, flounder, and sculpin bones were analyzed from eight coastal middens located approximately 50km apart from one another within Penobscot Bay. The bones were sampled from three time horizons (0kya, 0.5-1kya, and 2.2-2.4kya). All bone samples were demineralized in 0.2M HCl at 4°C for 2 to 7 days and then extracted in 0.25M NaOH at 4°C for 1 to 2 hours. After freeze-drying, the bulk isotopic composition of each sample was analyzed using the EA-IRMS. In all stratigraphic horizons analyzed, cod were more enriched in δ13C and δ15N than sculpin, and flounder were the most depleted in δ13C and δ15N . However, the isotopic offsets between the fish species decreased from 2.4kya to the present. The nitrogen isotope composition was relatively constant over time and space for all species, implying that trophic levels for the fishes analyzed have not changed significantly in Penobscot Bay for the last 2,400 years. The carbon isotope composition also appears to be constant spatially in Penobscot Bay, however, the modern signal was more depleted than the paleo signal in all three species. The difference between the modern and paleo δ13C is ~5‰ for cod and flounder, and ~9‰ for sculpin. These shifts may, in part, be explained by decreases in both primary producer and prey species diversity, as kelp forests replace eelgrass beds in the Gulf of Maine.

  8. Extraction and characterisation of apatite- and tricalcium phosphate-based materials from cod fish bones

    Energy Technology Data Exchange (ETDEWEB)

    Piccirillo, C.; Silva, M.F. [CBQF/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal); Pullar, R.C. [Dept. Engenharia de Materiais e Ceramica/CICECO, Universidade de Aveiro, Aveiro (Portugal); Braga da Cruz, I. [CBQF/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal); WeDoTech, CiDEB/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal); Jorge, R. [WeDoTech, CiDEB/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal); Pintado, M.M.E. [CBQF/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal); Castro, P.M.L., E-mail: plcastro@porto.ucp.pt [CBQF/Escola Superior de Biotecnologia, Universidade Catolica Portuguesa, Porto (Portugal)

    2013-01-01

    Apatite- and tricalcium phosphate-based materials were produced from codfish bones, thus converting a waste by-product from the food industry into high added-valued compounds. The bones were annealed at temperatures between 900 and 1200 Degree-Sign C, giving a biphasic material of hydroxyapatite and tricalcium phosphate (Ca{sub 10}(PO{sub 4}){sub 6}(OH){sub 2} and {beta}-Ca(PO{sub 4}){sub 3}) with a molar proportion of 75:25, a material widely used in biomedical implants. The treatment of the bones in solution prior to their annealing changed the composition of the material. Single phase hydroxyapatite, chlorapatite (Ca{sub 10}(PO{sub 4}){sub 6}Cl{sub 2}) and fluorapatite (Ca{sub 10}(PO{sub 4}){sub 6}F{sub 2}) were obtained using CaCl{sub 2} and NaF solutions, respectively. The samples were analysed by several techniques (X-ray diffraction, infrared spectroscopy, scanning electron microscopy and differential thermal/thermogravimetric analysis) and by elemental analyses, to have a more complete understanding of the conversion process. Such compositional modifications have never been performed before for these materials of natural origin to tailor the relative concentrations of elements. This paper shows the great potential for the conversion of this by-product into highly valuable compounds for biomedical applications, using a simple and effective valorisation process. - Highlights: Black-Right-Pointing-Pointer Apatite and calcium phosphate compounds extraction from cod fish bones Black-Right-Pointing-Pointer Bone calcination: biphasic material hydroxyapatite-calcium phosphate production Black-Right-Pointing-Pointer Bone pre-treatments in solution change the material composition. Black-Right-Pointing-Pointer Single phase materials (hydroxy-, chloro- or fluoroapatite) are obtained. Black-Right-Pointing-Pointer Concentration of other elements (Na, F, Cl) suitable for biomedical applications.

  9. Microbial load, acidity, lipid oxidation and volatile basic nitrogen of irradiated fish and meat-bone meals.

    Science.gov (United States)

    Al-Masri, M R; Al-Bachir, M

    2007-04-01

    Experiments were carried out to study the effect of different doses of gamma irradiation (0, 5, 10, 15 and 20 kilo gray; kGy) on some nutritive components and chemical aspects pertaining to quality of fish meal and meat-bone meal. The radiation doses required to reduce the total microbial load and Salmonella sp. one log cycle (D(10)) in fish meal and meat-bone meal were determined. Results indicated that gamma irradiation of fish meal and meat-bone meal with 5-20 kGy doses had no effects on the total acidity values but increased the values of lipid oxidation and total volatile basic nitrogen. D(10) of total microbial load and Salmonella sp. were 833 and 313 Gy for fish meal and 526 Gy and 278 Gy for meat-bone meal, respectively. It can be concluded that radiation processing could be employed in the recycling of fish and meat-bone meals by using them as feedstuffs in poultry diets with no fear of losing their nutritive components.

  10. Intrahepatic cholestasis without jaundice

    Institute of Scientific and Technical Information of China (English)

    Thomas Namdar; Andreas Raffel; Stefan Andreas Topp; Jan Schulte am Esch; Günther Fürst; Wolfram Trudo Knoefel; Claus Ferdinand Eisenberger

    2009-01-01

    BACKGROUND: Cholangiocarcinoma (CC), the most common biliary tract malignancy, is frequently seen in advanced unresectable stages and is typically localized extrahepatically. Early diagnosis is unusual because of nonspeciifc symptoms. Painless jaundice is usually the ifrst sign of tumor. METHOD: We present a patient with a CC (Klatskin tumor) with a complete biliary drainage by an aberrant bile duct without jaundice. RESULTS: A 67-year-old woman presented with persisting elevation of liver parameters. Diagnostic tests showed a Klatskin tumor typeⅡ. A curative right hepatic trisegmentectomy was performed after liver volume augmentation by preoperative vein embolization. CONCLUSIONS: A direct drainage of the right posterior bile duct into the common bile duct as an aberrant hepatic duct is a rare variation and is present in less than 5% of the population. In case of persistently perturbed liver function tests, an aberrant bile duct can cover up severe intrahepatic cholestasis and even obscure the diagnosis of a Klatskin tumor. Up to now it has not been described in the literature.

  11. Pathology of intrahepatic cholangiocarcinoma

    Science.gov (United States)

    Vijgen, Sandrine; Terris, Benoit

    2017-01-01

    Intrahepatic cholangiocarcinoma (iCC) is a primary carcinoma of the liver with increasing significance and major pathogenic, clinical and therapeutic challenges. Classically, it arises from malignant transformation of cholangiocytes bordering small portal bile duct (BD) to second-order segmental large BDs. It has three major macroscopic growth pattern [mass-forming (MF), periductal infiltrative (PI), and intraductal growth (IG)] and histologically is a desmoplastic stroma-rich adenocarcinoma with cholangiocyte differentiation. Recent data pointed out noteworthy degree of heterogeneity in regards of their epidemiology and risk factors, pathological and molecular features, pathogenesis, clinical behaviors and treatment. Notably, several histological variants are described and can coexist within the same tumor. Several different cells of origin have also been depicted in a fraction of iCCs, amongst which malignant transformation of ductules, of hepatic stem/progenitor cells, of periductal glands or through oncogenic reprogramming of adult hepatocytes. A degree of pathological overlap with hepatocellular carcinoma (HCC) may be observed in a portion of iCC. A series of precursor lesions are today characterized and emphasize the existence of a multistep carcinogenesis process. Overall, these new data have brought up in proposal of new histological or molecular classifications, which could soon replace current anatomic-based classification and could have major impact on establishment of prognosis and on development of novel target treatment approaches. PMID:28261592

  12. Intrahepatic Transposition of Bile Ducts

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

  13. Amino acid and proximate composition of fish bone gelatin from different warm-water species: A comparative study

    Science.gov (United States)

    Atma, Y.

    2017-03-01

    Research on fish bone gelatin has been increased in the last decade. The quality of gelatin depends on its physicochemical properties. Fish bone gelatin from warm-water fishes has a superior amino acid composition than cold-water fishes. The composition of amino acid can determine the strength and stability of gelatin. Thus, it is important to analyze the composition of amino acid as well as proximate composition for potential gelatin material. The warm water fish species used in this study were Grass carp, Pangasius catfish, Catfish, Lizard fish, Tiger-toothed croaker, Pink perch, Red snapper, Brown spotted grouper, and King weakfish. There werre five dominant amino acid in fish bone gelatin including glycine (21.2-36.7%), proline (8.7-11.7%), hydroxyproline (5.3-9.6%), alanine (8.48-12.9%), and glutamic acid (7.23-10.15%). Different warm-water species has some differences in amino acid composition. The proximate composition showed that fishbone gelatin from Pangasius catfish has the highest protein content. The water composition of all fishbone gelatin was well suited to the standard. Meanwhile, based on ash content, only gelatin from gelatin Pangasius catfish met the standard for food industries.

  14. Distant skeletal muscle metastasis from intrahepatic cholangiocarcinoma presenting as Budd-Chiari syndrome

    Institute of Scientific and Technical Information of China (English)

    Oh Sung Kwon; Young Sook Park; Jong Eun Joo; Dae Won Jun; Sang Heum Kim; Mee Yeon Chung; Nam In Kim; Moon Hee Song; Han Hyo Lee; Seung Hwan Kim; Yoon Ju Jo

    2007-01-01

    Intrahepatic cholangiocarcinoma is a malignant neoplasm arising from the biliary epithelium, which frequently invades adjacent organs or metastasizes to other visceral organs such as the lungs, bones, adrenals, and brain. However, distant skeletal muscle metastasis of cholangiocarcinoma has never been described before to the best of our knowledge and, furthermore, Budd-Chiari syndrome secondary to intrahepatic cholangiocarcinoma is also extremely rare. Here we present the first case overall of distant muscle metastasis from intrahepatic cholangiocarcinoma presenting as Budd-Chiari syndrome. A 44-year-old man admitted to the hospital with complaints of abdominal distension, edema of both legs, back pain and anorexia of 30 o" duration. Computed tomography and ultrasonography-guided percutaneous muscle biopsy established intrahepatic cholangiocarcinoma with disseminated thrombosis from inferior vena cava to bilateral iliac and femoral veins, and multiple skeletal muscle metastases in bilateral buttock and erector spinal muscle.

  15. Familial cholestasis: progressive familial intrahepatic cholestasis, benign recurrent intrahepatic cholestasis and intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    van der Woerd, Wendy L; van Mil, Saskia W C; Stapelbroek, Janneke M; Klomp, Leo W J; van de Graaf, Stan F J; Houwen, Roderick H J

    2010-10-01

    Progressive familial intrahepatic cholestasis (PFIC) type 1, 2 and 3 are due to mutations in ATP8B1, ABCB11 and ABCB4, respectively. Each of these genes encodes a hepatocanalicular transporter, which is essential for the proper formation of bile. Mutations in ABCB4 can result in progressive cholestatic disease, while mutations in ATP8B1 and ABCB11 can result both in episodic cholestasis, referred to as benign recurrent intrahepatic cholestasis (BRIC) type 1 and 2, as well as in progressive cholestatic disease. This suggests a clinical continuum and these diseases are therefore preferably referred to as ATP8B1 deficiency and ABCB11 deficiency. Similarly PFIC type 3 is designated as ABCB4 deficiency. Heterozygous mutations in each of these transporters can also be associated with intrahepatic cholestasis of pregnancy. This review summarizes the pathophysiology, clinical features and current as well as future therapeutic options for progressive familial- and benign recurrent intrahepatic cholestasis as well as intrahepatic cholestasis of pregnancy. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic Trauma

    Directory of Open Access Journals (Sweden)

    Dimitrios Symeonidis

    2012-01-01

    Full Text Available Ingestion of gastrointestinal foreign bodies represents a challenging clinical scenario. Increased morbidity is the price for the delayed diagnosis of complications and timely treatment. We present a case of 57-year-old female patient which was admitted in the emergency room department complaining of a mid-epigastric pain over the last twenty-four hours. Based on the patient's history, physical examination and elevated serum amylase levels, a false diagnosis of pancreatitis, was initially adopted. However, a CT scan confirmed the presence of a radiopaque foreign body in the pancreatic head and the presence of air bubbles outside the intestinal lumen. The patient was unaware of the ingestion of the foreign body. At laparotomy, after an oblique duodenotomy, a fish bone pinned in the pancreatic head after the penetration of the medial aspect of the second portion of the duodenal wall was identified and successfully removed. The patient had an uneventful postoperative recovery. Wide variation in clinical presentation characterizes the complicated fish bone ingestions. The strategically located site of penetration in the visceral wall is responsible for the often extraordinary gastrointestinal tract injury patterns. Increased level of suspicion is of paramount importance for the timely diagnosis and treatment.

  17. Fish bone as a nidus for stone formation in the common bile duct: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Lee, Sang Kwon; Kwon, Jung Hyeok; Woo, Seong Ku [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Park, Won Kyu [Youngnam University Hospital, Daegu (Korea, Republic of)

    2004-09-15

    We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed.

  18. EFEK KOLAGEN DARI BERBAGAI JENIS TULANG IKAN TERHADAP KUALITAS MIOFIBRIL PROTEIN IKAN SELAMA PROSES DEHIDRASI [Effect of Various Fish Bone Collagens on the Quality of Myofibril Fish Protein During Dehydration Process

    Directory of Open Access Journals (Sweden)

    Yudhomenggolo Sastro Darmanto*

    2012-06-01

    Full Text Available Increase in fish fillet export in Indonesia has caused an increase in its waste such as bones, spines, skin and entrails of fish. Fish bones can be processed by demineralization to produce collagen, an important food additive. The effect of addition of 5% of collagen obtained from fresh water, brackish water and sea water fish bone on the fish protein miofibril of grouper was investigated in this research. Water sorption isotherm, Ca-ATPase activity, gel strength, water holding capacity, folding test and viscosity during dehydration process were evaluated. The results showed that collagens made from various fish bones have different Ca-ATPase activity. The reduction rate of Ca-ATPase activity were in accordance with the reduction of water sorbtion isotherm, gel forming ability, water holding capacity, viscosity and folding test during dehydration process.

  19. Purification of matrix Gla protein from a marine teleost fish, Argyrosomus regius: calcified cartilage and not bone as the primary site of MGP accumulation in fish.

    Science.gov (United States)

    Simes, D C; Williamson, M K; Ortiz-Delgado, J B; Viegas, C S B; Price, P A; Cancela, M L

    2003-02-01

    Matrix Gla protein (MGP) belongs to the family of vitamin K-dependent, Gla-containing proteins, and in mammals, birds, and Xenopus, its mRNA was previously detected in extracts of bone, cartilage, and soft tissues (mainly heart and kidney), whereas the protein was found to accumulate mainly in bone. However, at that time, it was not evaluated if this accumulation originated from protein synthesized in cartilage or in bone cells because both coexist in skeletal structures of higher vertebrates and Xenopus. Later reports showed that MGP also accumulated in costal calcified cartilage as well as at sites of heart valves and arterial calcification. Interestingly, MGP was also found to accumulate in vertebra of shark, a cartilaginous fish. However, to date, no information is available on sites of MGP expression or accumulation in teleost fishes, the ancestors of terrestrial vertebrates, who have in their skeleton mineralized structures with both bone and calcified cartilage. To analyze MGP structure and function in bony fish, MGP was acid-extracted from the mineralized matrix of either bone tissue (vertebra) or calcified cartilage (branchial arches) from the bony fish, Argyrosomus regius, separated from the mineral phase by dialysis, and purified by Sephacryl S-100 chromatography. No MGP was recovered from bone tissue, whereas a protein peak corresponding to the MGP position in this type of gel filtration was obtained from an extract of branchial arches, rich in calcified cartilage. MGP was identified by N-terminal amino acid sequence analysis, and the resulting protein sequence was used to design specific oligonucleotides suitable to amplify the corresponding DNA by a mixture of reverse transcription-polymerase chain reaction (RT-PCR) and 5'rapid amplification of cDNA (RACE)-PCR. In parallel, ArBGP (bone Gla protein, osteocalcin) was also identified in the same fish, and its complementary DNA cloned by an identical procedure. Tissue distribution/accumulation was

  20. Sarcomatoid Change in Intrahepatic Cholangiocarcinoma

    DEFF Research Database (Denmark)

    Albrechtsen, Nicolai Jacob Wewer; Zhang, Da; Abdulkarim, Bashar;

    2013-01-01

    Sarcomatoid transformation is a rare but well documented change that may occur in intrahepatic cholangiocarcinomas.We report a tumor of this type to illustrate the difficulties in properly diagnosing cholangiocarcinoma when only the sarcomatous component is sampled by transcutaneous needle biopsy...

  1. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

    Medline Plus

    Full Text Available ... Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Transjugular Intrahepatic ... and esophagus in patients with cirrhosis. Tell your doctor if there’s a possibility you are pregnant and ...

  2. Primary intrahepatic malignant epithelioid mesothelioma

    Directory of Open Access Journals (Sweden)

    Iraklis Perysinakis

    2014-01-01

    CONCLUSION: To our knowledge this is the eighth adult case of primary intrahepatic malignant mesothelioma reported in the literature. These tumors are rarely diagnosed preoperatively. Absence of previous asbestos exposure does not exclude malignant mesothelioma from the differential diagnosis. Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy.

  3. Progressive familial intrahepatic cholestasis

    Directory of Open Access Journals (Sweden)

    Baussan Christiane

    2009-01-01

    Full Text Available Abstract Progressive familial intrahepatic cholestasis (PFIC refers to heterogeneous group of autosomal recessive disorders of childhood that disrupt bile formation and present with cholestasis of hepatocellular origin. The exact prevalence remains unknown, but the estimated incidence varies between 1/50,000 and 1/100,000 births. Three types of PFIC have been identified and related to mutations in hepatocellular transport system genes involved in bile formation. PFIC1 and PFIC2 usually appear in the first months of life, whereas onset of PFIC3 may also occur later in infancy, in childhood or even during young adulthood. Main clinical manifestations include cholestasis, pruritus and jaundice. PFIC patients usually develop fibrosis and end-stage liver disease before adulthood. Serum gamma-glutamyltransferase (GGT activity is normal in PFIC1 and PFIC2 patients, but is elevated in PFIC3 patients. Both PFIC1 and PFIC2 are caused by impaired bile salt secretion due respectively to defects in ATP8B1 encoding the FIC1 protein, and in ABCB11 encoding the bile salt export pump protein (BSEP. Defects in ABCB4, encoding the multi-drug resistant 3 protein (MDR3, impair biliary phospholipid secretion resulting in PFIC3. Diagnosis is based on clinical manifestations, liver ultrasonography, cholangiography and liver histology, as well as on specific tests for excluding other causes of childhood cholestasis. MDR3 and BSEP liver immunostaining, and analysis of biliary lipid composition should help to select PFIC candidates in whom genotyping could be proposed to confirm the diagnosis. Antenatal diagnosis can be proposed for affected families in which a mutation has been identified. Ursodeoxycholic acid (UDCA therapy should be initiated in all patients to prevent liver damage. In some PFIC1 or PFIC2 patients, biliary diversion can also relieve pruritus and slow disease progression. However, most PFIC patients are ultimately candidates for liver transplantation

  4. Fluorescent in-situ hybridization (FISH for BCR/ABL in chronic myeloid leukemia after bone marrow transplantation

    Directory of Open Access Journals (Sweden)

    Maria de Lourdes Lopes Ferrari Chauffaille

    2001-01-01

    Full Text Available CONTEXT: Identification of Philadelphia chromosome or BCR/ABL gene rearrangement in chronic myeloid leukemia is important at diagnosis as well as after treatment. OBJECTIVE: To compare the results of karyotyping using fluorescent in-situ hybridization (FISH upon diagnosis and 1 year after bone marrow transplantation in 12 patients. TYPE OF STUDY: Diagnostic test and residual disease detection. SETTING: Hematology and Hemotherapy Department, Federal University of São Paulo/Escola Paulista de Medicina, São Paulo, Brazil. SAMPLE: 12 patients with chronic myeloid leukemia at diagnosis and 1 year after bone marrow transplantation. DIAGNOSTIC TEST: Karyotyping was done in the usual way and the BCR/ABL gene-specific probe was used for FISH. MAIN MEASUREMENTS: Disease at diagnosis and residual. RESULTS: At diagnosis, 10 patients presented t(9;22(q34.1;q11 as well as positive FISH. Two cases did not have metaphases but FISH was positive. After bone marrow transplantation, 8 patients presented normal karyotype, 1 had persistence of identifiable Philadelphia chromosome and 3 had no metaphases. Two cases showed complete chimera and 2 had donor and host cells simultaneously. FISH was possible in all cases after bone marrow transplantation and confirmed the persistence of identifiable Philadelphia chromosome clone in one patient, and identified another that did not present metaphases for analysis. Cases that showed mixed chimera in karyotype were negative for BCR/ABL by FISH. CONCLUSION: The applicability of FISH is clear, particularly for residual disease detection. Classical and molecular cytogenetics are complementary methods.

  5. Optimisation extraction of chondroitin sulfate from fish bone by high intensity pulsed electric fields.

    Science.gov (United States)

    He, Guidan; Yin, Yongguang; Yan, Xiaoxia; Yu, Qingyu

    2014-12-01

    High intensity pulsed electric fields (PEF) was used to extract chondroitin sulphate (CS) from fish bone. Results show that PEF extraction speed is much faster, and the content of CS is much higher compared with traditional methods. Variation of PEF parameters and the content of CS were determined by single factor experiments. The processing conditions were optimised by quadratic general rotary unitised design experiments. The maximum yield of 6.92 g/L was achieved under the following conditions: material-liquid ratio of 1:15 g/mL, electric field intensity of 16.88 kV/cm, pulse number of 9, and NaOH concentration of 3.24%. The purity of CS was analysed by agarose gel electrophoresis. CS purity was high, and the extract did not contain any other glycosaminoglycans. PEF can be widely used to extract CS with non-thermal performance, high speed, and low pollution.

  6. Effects of nano-scaled fish bone on the gelation properties of Alaska pollock surimi.

    Science.gov (United States)

    Yin, Tao; Park, Jae W

    2014-05-01

    Gelation properties of Alaska pollock surimi as affected by addition of nano-scaled fish bone (NFB) at different levels (0%, 0.1%, 0.25%, 0.5%, 1% and 2%) were investigated. Breaking force and penetration distance of surimi gels after setting increased significantly as NFB concentration increased up to 1%. The first peak temperature and value of storage modulus (G'), which is known to relate to the unfolding and aggregation of light meromyosin, increased as NFB concentration increased. In addition, 1% NFB treatment demonstrated the highest G' after gelation was completed. The activity of endogenous transglutaminase (TGase) in Alaska pollock surimi increased as NFB calcium concentration increased. The intensity of myosin heavy chain cross-links also increased as NFB concentration increased indicating the formation of more ε-(γ-glutamyl) lysine covalent bond by endogenous TGase and calcium ions from NFB. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Thermal properties of natural nanostructured hydroxyapatite extracted from fish bone waste

    Science.gov (United States)

    Coelho, T. M.; Nogueira, E. S.; Weinand, W. R.; Lima, W. M.; Steimacher, A.; Medina, A. N.; Baesso, M. L.; Bento, A. C.

    2007-04-01

    In a previous study, natural hydroxyapatite (HAp) from the bones of Brazilian river fish was calcined at 900 °C (4-12 h), and optical characterization using the near infrared photoacoustic spectroscopy technique enabled the establishment of 8 h as the best calcination time for nanostructure stabilization when milled in a high-energy milling device [T. M. Coelho, E. S. Nogueira, W. R. Weinand, W. M. Lima, A. Steimacher, A. N. Medina, M. L. Baesso, and A. C. Bento, J. Appl. Phys. 100, 094312 (2006)]. The fish wastes used were from species such as pintado (Pseudoplatystoma corruscans), jaú (Paulicea lutkeni), and cachara (Pseudoplatystoma fasciatum). In this study, the characterization of the thermal properties of the same natural HAp is discussed for samples milled from 0 to 32 h, with nanostructures from 80 to 24 nm. The powders were pressed into disks at 350 MPa and sintered for 4 h at 1000 °C. Thermophysical parameters were obtained by thermal wave interferometry and nonadiabatic relaxation calorimetry. Results for thermal diffusivity and thermal conductivity showed that the parameters increase with milling time, although they present a transition (a plateau) in the interval from 8 to 16 h. Two different slopes were observed and this was interpreted as being due to the size of the crystallites, which fall rapidly, dropping from 80 nm to near 22 nm when milling time is increased from 0 to 16 h, and forming agglomerates up to 32 h.

  8. Isolation and Characterization of Nano-Hydroxyapatite from Salmon Fish Bone

    Directory of Open Access Journals (Sweden)

    Jayachandran Venkatesan

    2015-08-01

    Full Text Available Nano-Hydroxyapatite (nHA was isolated from salmon bone by alkaline hydrolysis. The resulting nHA was characterized using several analytical tools, including thermogravimetric analysis (TGA, Fourier transform infrared spectroscopy (FT-IR, X-ray diffraction analysis (XRD, scanning electron microscopy (SEM and transmission electron microscopy (TEM, to determine the purity of the nHA sample. The removal of organic matter from the raw fish was confirmed by TGA. FT-IR confirmed the presence of a carbonated group and the similarities to synthetic Sigma HA. XRD revealed that the isolated nHA was amorphous. Microscopy demonstrated that the isolated nHA possessed a nanostructure with a size range of 6–37 nm. The obtained nHA interacted with mesenchymal stem cells (MSCs and was non-toxic. Increased mineralization was observed for nHA treated MSCs compared to the control group. These results suggest that nHA derived from salmon is a promising biomaterial in the field of bone tissue engineering.

  9. Splenosis simulating an intrahepatic mass

    Institute of Scientific and Technical Information of China (English)

    晁明; 徐宏伟

    2004-01-01

    Splenosis is the autotransplantation of splenic tissue that usually follows traumatic rupture of the spleen. Splenic implants may be seeded within or beyond the peritoneal cavity.1 The most frequent locations of splenosis in the descending order are the serosal surface of the small intestine, the greater omentum, parietal peritoneum, surface of the large intestine, mesentery, undersurface of the diaphragm and the thorax.1,2 However, intrahepatic splenosis is very rare. We recently encountered a patient in whom results of ultrasonography (US) and computed tomography (CT) revealed an intrahepatic mass that consisted of ectopic splenic tissue. To our knowledge, this is the fifth report of ectopic splenic tissue in the liver in the English-language literature. We present the imaging findings of the splenic implants in the liver and discuss the diagnosis and its practical significance.

  10. SARCOMATOID CHANGE IN INTRAHEPATIC CHOLANGIOCARCINOMA

    OpenAIRE

    Wewer Albrechtsen; Da Zhang; A. Bashar Abdulkarim; Damjanov Ivan

    2013-01-01

    Sarcomatoid transformation is a rare but well documented change that may occur in intrahepatic cholangiocarcinomas. We report a tumor of this type to illustrate the difficulties in properly diagnosing cholangiocarcinoma when only the sarcomatous component is sampled by transcutaneous needle biopsy. The proper diagnosis of the tumor was suggested by finding the expression of cytokeratin 7 in the sarcomatous spindle cells. The surgically resected tumor comprised a spindle cell sarcomatous and a...

  11. Hydroxyapatite from fish scale for potential use as bone scaffold or regenerative material

    Energy Technology Data Exchange (ETDEWEB)

    Pon-On, Weeraphat, E-mail: fsciwpp@ku.ac.th [Department of Physics, Faculty of Science, Kasetsart University, Bangkok (Thailand); Suntornsaratoon, Panan [Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok (Thailand); Charoenphandhu, Narattaphol [Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok (Thailand); Department of Physiology, Faculty of Science, Mahidol University, Bangkok (Thailand); Thongbunchoo, Jirawan [Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok (Thailand); Krishnamra, Nateetip [Center of Calcium and Bone Research, Faculty of Science, Mahidol University, Bangkok (Thailand); Department of Physiology, Faculty of Science, Mahidol University, Bangkok (Thailand); Tang, I. Ming [Department of Materials Science, Faculty of Science, Kasetsart University, Bangkok 10900 (Thailand)

    2016-05-01

    The present paper studies the physico-chemical, bioactivity and biological properties of hydroxyapatite (HA) which is derived from fish scale (FS) (FSHA) and compares them with those of synthesized HA (sHA) obtained by co-precipitation from chemical solution as a standard. The analysis shows that the FSHA is composed of flat-plate nanocrystal with a narrow width size of about 15–20 nm and having a range of 100 nm in length and that the calcium phosphate ratio (Ca/P) is 2.01 (Ca-rich CaP). Whereas, synthesized HA consists of sub-micron HA particle having a Ca/P ratio of 1.65. Bioactivity test shows that the FSHA forms more new apatite than does the sHA after being incubated in simulated body fluid (SBF) for 7 days. Moreover, the biocompatibility study shows a higher osteoblast like cell adhesion on the FSHA surface than on the sHA substrate after 3 days of culturing. Our results also show the shape of the osteoblast cells on the FSHA changes from being a rounded shape to being a flattened shape reflecting its spreading behavior on this surface. MTT assay and ALP analysis show significant increases in the proliferation and activity of osteoblasts over the FSHA scaffold after 5 days of culturing as compared to those covering the sHA substrates. These results confirm that the bio-materials derived from fish scale (FSHA) are biologically better than the chemically synthesized HA and have the potential for use as a bone scaffold or as regenerative materials. - Highlights: • Preparation of hydroxyapatite (HA) which is derived from fish scale (FS) (FSHA) and their bioactivities • The FSHA is composed of flat-plate nanocrystal with a narrow size of 15–20 nm. • Bioactivity test shows that the FSHA forms more new apatite than does the sHA after being incubated SBF. • In vitro cell availability tests show a higher cell adhesion on the FSHA surface.

  12. Extra luminal migration of ingested fish bone to the spleen as an unusual cause of splenic rupture: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Melibea Sierra-Ruiz

    2016-01-01

    Conclusion: FB ingestion is a relatively benign condition; however, some serious complications can arise infrequently. The patient reported herein is the first in the literature to present a splenic rupture due to extra luminal migration of an ingested fish bone.

  13. The rice FISH BONE gene encodes a tryptophan aminotransferase, which affects pleiotropic auxin-related processes.

    Science.gov (United States)

    Yoshikawa, Takanori; Ito, Momoyo; Sumikura, Tsuyoshi; Nakayama, Akira; Nishimura, Takeshi; Kitano, Hidemi; Yamaguchi, Isomaro; Koshiba, Tomokazu; Hibara, Ken-Ichiro; Nagato, Yasuo; Itoh, Jun-Ichi

    2014-06-01

    Auxin is a fundamental plant hormone and its localization within organs plays pivotal roles in plant growth and development. Analysis of many Arabidopsis mutants that were defective in auxin biosynthesis revealed that the indole-3-pyruvic acid (IPA) pathway, catalyzed by the TRYPTOPHAN AMINOTRANSFERASE OF ARABIDOPSIS (TAA) and YUCCA (YUC) families, is the major biosynthetic pathway of indole-3-acetic acid (IAA). In contrast, little information is known about the molecular mechanisms of auxin biosynthesis in rice. In this study, we identified a auxin-related rice mutant, fish bone (fib). FIB encodes an orthologue of TAA genes and loss of FIB function resulted in pleiotropic abnormal phenotypes, such as small leaves with large lamina joint angles, abnormal vascular development, small panicles, abnormal organ identity and defects in root development, together with a reduction in internal IAA levels. Moreover, we found that auxin sensitivity and polar transport activity were altered in the fib mutant. From these results, we suggest that FIB plays a pivotal role in IAA biosynthesis in rice and that auxin biosynthesis, transport and sensitivity are closely interrelated.

  14. Improvement of sweet potato yield using mixtures of ground fish bone and plant residues

    Directory of Open Access Journals (Sweden)

    A C Novianantya

    2017-01-01

    Full Text Available The Indonesian government begins to promote food diversification program. The government expects the Indonesian people can consume food crops other than rice, such as wheat, potatoes and sweet potatoes. While, the level of production of sweet potato production decreased in the period of 2012-2015 with total production of only 2,218,992 t/ha. In an effort to increase the production of sweet potato, improvements are needed through application of organic fertilizers like composts. The purpose of this study was to explore the effect of composted manure with ground fish bone, legume residues, and Tithonia on soil chemical properties and sweet potato production includes tuber weight and levels of starch sweet potato crops.The results showedthat application of 5 t compost/ha and 35 kg Trichoderma biofertilizer/ha increased pH, water content, organic carbon, total N, available P, total Kl, CEC,exchangeable Ca, plant height, tuber weight and levels of sweet potato starc

  15. Sarcomatoid change in intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Albrechtsen Wewer Nicolai

    2013-03-01

    Full Text Available Sarcomatoid transformation is a rare but well documented change that may occur in intrahepatic cholangiocarcinomas. We report a tumor of this type to illustrate the difficulties in properly diagnosing cholangiocarcinoma when only the sarcomatous component is sampled by transcutaneous needle biopsy. The proper diagnosis of the tumor was suggested by finding the expression of cytokeratin 7 in the sarcomatous spindle cells. The surgically resected tumor comprised a spindle cell sarcomatous and an adenocarcinomatous component accounting for approximately 30% and 70% of the total tumor mass respectively

  16. Skin, bone and muscle collagen extraction from the trash fish, leather jacket (Odonus niger) and their characterization.

    Science.gov (United States)

    Muralidharan, Nagarajan; Jeya Shakila, Robinson; Sukumar, Durairaj; Jeyasekaran, G

    2013-12-01

    Acid soluble (ASC) and pepsin soluble (PSC) collagens were extracted from the skin, bone and muscle of a trash fish, leather jacket (Odonus niger) by three different extraction methods. Method I gave 46-50% yield for ASC, Method II gave 49-58% yield for both ASC and PSC and Method III gave 64-71% yield for PSC. The addition of pepsin had increased the yield by 30-45%. The yields of collagen from skin and bone were higher than muscle. SDS-PAGE pattern revealed that skin and bone collagen as Type I collagen with a typical (α1)2α2 chains and muscle collagen as Type V collagen with a typical α1α3α2 chains. Td values of bone and muscle collagen were high (30-32 °C) compared to skin collagen (27-28 °C). The higher imino acids (190 residues/1,000 residues) were found responsible for the higher Td values. The trash fish, leather jacket can therefore be exploited effectively for collagen as it has got good thermal properties for pharmaceutical and biomedical applications.

  17. Clinical grading of intrahepatic cholestasis pregnancy

    National Research Council Canada - National Science Library

    Pradhan, Meena; Shao, Yong

    2013-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is the pregnancy induced liver disorder causing intense itching of palm, sole or even whole body especially in the evening at late second and third trimester...

  18. Genetics Home Reference: benign recurrent intrahepatic cholestasis

    Science.gov (United States)

    ... All Close All Description Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodes of liver dysfunction called ... a lack of appetite. A common feature of BRIC is the reduced absorption of fat in the ...

  19. Molecular profiling of intrahepatic cholangiocarcinoma

    DEFF Research Database (Denmark)

    Oliveira, Douglas V N P; Zhang, Shanshan; Chen, Xin

    2017-01-01

    INTRODUCTION: Intrahepatic cholangiocarcinoma (iCCA) is the second most frequent primary tumor of the liver and a highly lethal disease. Therapeutic options for advanced iCCA are limited and ineffective due to the largely incomplete understanding of the molecular pathogenesis of this deadly tumor....... Areas covered: The present review article outlines the main studies and resulting discoveries on the molecular profiling of iCCA, with a special emphasis on the different techniques used for this purpose, the diagnostic and prognostic markers identified, as well as the genes and pathways that could...... be potentially targeted with innovative therapies. Expert commentary: Molecular profiling has led to the identification of distinct iCCA subtypes, characterized by peculiar genetic alterations and transcriptomic features. Targeted therapies against some of the identified genes are ongoing and hold great promise...

  20. Multiple intrahepatic pseudocysts in acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    David Casado; Luis Sabater; Julio Calvete; Empar Mayordomo; Luis Aparisi; Juan Sastre; Salvador Lledo

    2007-01-01

    Liver pseudocysts are a very rare complication in acute pancreatitis with only a few cases previously described. The lack of experience and literature on this condition leads to difficulties in the differential diagnosis and management. We report herein a case of acute pancreatitis who developed multiple intrahepatic pseudocysts. After complete imaging evaluation, the diagnosis was still unclear and the patient was operated on. The presence of liver lesions in patients with acute pancreatitis should raise the possibility of intrahepatic pseudocysts.

  1. Fishing

    Institute of Scientific and Technical Information of China (English)

    姜群山

    2002-01-01

    @@ Last Saturday my cousin (表兄) came to my home. We were very happy to see each other. We decided that the next day we went to fish. We got up very early that day. When we left home,the moon could still be seen in the sky.

  2. A Preliminary Study of the Suitability of Archival Bone Marrow and Peripheral Blood Smears for Diagnosis of CML Using FISH.

    Science.gov (United States)

    Charwudzi, Alice; Olayemi, Edeghonghon E; Ekem, Ivy; Olopade, Olufunmilayo; Coyle, Mariann; Benneh, Amma Anima; Allotey, Emmanuel Alote

    2014-01-01

    Background. FISH is a molecular cytogenetic technique enabling rapid detection of genetic abnormalities. Facilities that can run fresh/wet samples for molecular diagnosis and monitoring of neoplastic disorders are not readily available in Ghana and other neighbouring countries. This study aims to demonstrate that interphase FISH can successfully be applied to archival methanol-fixed bone marrow and peripheral blood smear slides transported to a more equipped facility for molecular diagnosis of CML. Methods. Interphase FISH was performed on 22 archival methanol-fixed marrow (BM) and 3 peripheral blood (PB) smear slides obtained at diagnosis. The BM smears included 20 CML and 2 CMML cases diagnosed by morphology; the 3 PB smears were from 3 of the CML patients at the time of diagnosis. Six cases had known BCR-ABL fusion results at diagnosis by RQ-PCR. Full blood count reports at diagnosis were also retrieved. Result. 19 (95%) of the CML marrow smears demonstrated the BCR-ABL translocation. There was a significant correlation between the BCR-ABL transcript detected at diagnosis by RQ-PCR and that retrospectively detected by FISH from the aged BM smears at diagnosis (r = 0.870; P = 0.035). Conclusion. Archival methanol-fixed marrow and peripheral blood smears can be used to detect the BCR-ABL transcript for CML diagnosis.

  3. A Preliminary Study of the Suitability of Archival Bone Marrow and Peripheral Blood Smears for Diagnosis of CML Using FISH

    Directory of Open Access Journals (Sweden)

    Alice Charwudzi

    2014-01-01

    Full Text Available Background. FISH is a molecular cytogenetic technique enabling rapid detection of genetic abnormalities. Facilities that can run fresh/wet samples for molecular diagnosis and monitoring of neoplastic disorders are not readily available in Ghana and other neighbouring countries. This study aims to demonstrate that interphase FISH can successfully be applied to archival methanol-fixed bone marrow and peripheral blood smear slides transported to a more equipped facility for molecular diagnosis of CML. Methods. Interphase FISH was performed on 22 archival methanol-fixed marrow (BM and 3 peripheral blood (PB smear slides obtained at diagnosis. The BM smears included 20 CML and 2 CMML cases diagnosed by morphology; the 3 PB smears were from 3 of the CML patients at the time of diagnosis. Six cases had known BCR-ABL fusion results at diagnosis by RQ-PCR. Full blood count reports at diagnosis were also retrieved. Result. 19 (95% of the CML marrow smears demonstrated the BCR-ABL translocation. There was a significant correlation between the BCR-ABL transcript detected at diagnosis by RQ-PCR and that retrospectively detected by FISH from the aged BM smears at diagnosis (r=0.870; P=0.035. Conclusion. Archival methanol-fixed marrow and peripheral blood smears can be used to detect the BCR-ABL transcript for CML diagnosis.

  4. Successful management of an aortoesophageal fistula caused by a fish bone--case report and review of literature.

    Science.gov (United States)

    Kelly, Stephen L; Peters, Paul; Ogg, Murray J; Li, Alan; Smithers, Bernard M

    2009-05-08

    We report a case of aortoesophageal fistula (AEF) caused by a fish bone that had a successful outcome. Aortoesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Over one hundred cases of AEF secondary to foreign body ingestion have been documented but only seven, including our case, have survived over 12 months. Treatment involved stabilising the patient with a Sengstaken-Blakemore tube and insertion of a thoracic aortic endovascular stent-graft. Unfortunately the stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest.

  5. Pruritus and dermographism due to intrahepatic cholestasis of infancy.

    Science.gov (United States)

    Evans, J; Beer, W; Davies, R

    1978-04-01

    A case report of intrahepatic cholestasis of infancy presenting with chronic severe pruritus is described. This presentation is compared with similar cases attending this unit. Intrahepatic cholestasis of infancy and the pathogenesis of puritus associated with cholestasis are briefly discussed.

  6. Molecular cytogenetic aberrations in Tunisian patients with multiple myeloma identified by cIg-FISH in fixed bone marrow cells.

    Science.gov (United States)

    Gmidène, A; Avet-Loiseau, H; Sennana, H; Ben Abdallah, I; Khlif, A; Meddeb, B; Elloumi, M; Saad, A

    2012-01-01

    Cytogenetic studies in multiple myeloma (MM) are hampered by the hypo-proliferative nature of plasma cells. In order to circumvent this problem, we have used a combination of immunolabeling of cytoplasmic Ig light chains (λ or κ) and FISH (cIg-FISH), which allowed a comprehensive detection of the most common and/or recurrent molecular cytogenetic aberrations on fixed bone marrow cells of 70 Tunisian patients. Translocations involving the chromosome 14q32 region were observed in 32 cases (45.7%), including 18 cases with a t(11;14), 8 cases with a t(4;14), and 2 cases with a t(14;16). Deletions of the 13q14 region (D13S319/RB1) were detected in 18.6%, and deletions of the 17p13 region (TP53) in 5.7% of the cases, respectively. Of all patients with a D13S319/RB1 deletion, 61.5% also carried a 14q32 translocation, whereas TP53 deletions were associated with a t(11;14) in 2 cases (50%) and a D13S319 deletion in 1 case (25%). Our results suggest that there is a correlation between the presence of 14q32 translocations and chromosome 13q14 deletions in MM patients and that cIg-FISH is more sensitive as compared to conventional karyotyping in detecting molecular cytogenetic abnormalities in this disease. Copyright © 2011 S. Karger AG, Basel.

  7. Bone

    Science.gov (United States)

    Helmberger, Thomas K.; Hoffmann, Ralf-Thorsten

    The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1:2000.

  8. Radionuclides and trace elements in fish collected upstream and downstream of Los Alamos National Laboratory and the doses to humans from the consumption of muscle and bone.

    Science.gov (United States)

    Fresquez, P R; Kraig, D H; Mullen, M A; Naranjo, L

    1999-09-01

    The purpose of this study was to determine radionuclide and trace element concentrations in bottom-feeding fish (catfish, carp, and suckers) collected from the confluences of some of the major canyons that cross Los Alamos National Laboratory (LANL) lands with the Rio Grande (RG) and the potential radiological doses from the ingestion of these fish. Samples of muscle and bone (and viscera in some cases) were analyzed for 3H, 90Sr, 137Cs, totU, 238Pu, 239,240Pu, and 241Am and Ag, As, Ba, Be, Cr, Cd, Cu, Hg, Ni, Pb, Sb, Se, and Tl. Most radionuclides, with the exception of 90Sr, in the muscle plus bone portions of fish collected from LANL canyons/RG were not significantly (p < 0.05) higher from fish collected upstream (San Ildefonso/background) of LANL. Strontium-90 in fish muscle plus bone tissue significantly (p < 0.05) increases in concentration starting from Los Alamos Canyon, the most upstream confluence (fish contained 3.4E-02 pCi g-1 [126E-02 Bq kg-1]), to Frijoles Canyon, the most downstream confluence (fish contained 14E-02 pCi g-1 [518E-02 Bq kg-1]). The differences in 90Sr concentrations in fish collected downstream and upstream (background) of LANL, however, were very small. Based on the average concentrations (+/- 2SD) of radionuclides in fish tissue from the four LANL confluences, the committed effective dose equivalent from the ingestion of 46 lb (21 kg) (maximum ingestion rate per person per year) of fish muscle plus bone, after the subtraction of background, was 0.1 +/- 0.1 mrem y-1 (1.0 +/- 1.0 microSv y-1), and was far below the International Commission on Radiological Protection (all pathway) permissible dose limit of 100 mrem y-1 (1000 microSv y-1). Of the trace elements that were found above the limits of detection (Ba, Cu, and Hg) in fish muscle collected from the confluences of canyons that cross LANL and the RG, none were in significantly higher (p < 0.05) concentrations than in muscle of fish collected from background locations.

  9. Comparison of amino acid digestibility coefficients for soybean meal, canola meal, fish meal, and meat and bone meal among 3 different bioassays

    Science.gov (United States)

    The objective of this study was to determine amino acid digestibility of 4 feedstuffs [soybean meal (SBM), canola meal, fish meal, and meat and bone meal (MBM)] using the precision-fed cecectomized rooster assay (PFR), the standardized ileal assay (SIAAD), and a newly developed precision-fed ileal b...

  10. Successful management of an aortoesophageal fistula caused by a fish bone – case report and review of literature

    Directory of Open Access Journals (Sweden)

    Li Alan

    2009-05-01

    Full Text Available Abstract We report a case of aortoesophageal fistula (AEF caused by a fish bone that had a successful outcome. Aortoesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Over one hundred cases of AEF secondary to foreign body ingestion have been documented but only seven, including our case, have survived over 12 months. Treatment involved stabilising the patient with a Sengstaken-Blakemore tube and insertion of a thoracic aortic endovascular stent-graft. Unfortunately the stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest.

  11. Calcium and phosphorus determination in bones of low value fishes, Sardinella longiceps (Valenciennes and Trichiurus savala (Cuvier, from Parangipettai, Southeast Coast of India

    Directory of Open Access Journals (Sweden)

    Logesh AR

    2012-05-01

    Full Text Available Objective: To investigate calcium and phosphorus levels in the bones of low value fishes Sardinella longiceps (oil sardine and Trichiurus savala (ribbon fish. Methods: Bones and skeletal remains were subjected to alkaline-alcohol treatment for specified period of time and were then dried and pulverized. Calcium and phosphorus levels were determined by both volumetric and instrumental methods using atomic absorption spectroscopy. Results: Volumetric analysis of calcium and phosphorus were 28.98% and 14.2% in oil sardine; 24.2% and 11.6% in ribbon fish respectively. Atomic absorption spectroscopy analysis of calcium and phosphorus were 32.73% and 17.2% for oil sardine and 27.17% and 10.83% for ribbon fish respectively. Protein level was 4.82% in oil sardine and 3.97% in ribbon fishes. Conclusions: The findings of the present study revealed that sardine bones are rich in calcium and will be utilized for the production of calcium powder to treat osteoporosis.

  12. Dietary protein derived from dried bonito fish improves type-2 diabetes mellitus-induced bone frailty in Goto-Kakizaki rats.

    Science.gov (United States)

    Ochiai, Masaru; Kuroda, Takashi; Gohtani, Shoichi; Matsuo, Tatsuhiro

    2015-04-01

    Type-2 diabetes mellitus (T2DM) induces bone frailty. Protein and polyunsaturated fatty acids (PUFA) contained in fish can be effective in enhancing bone quality, but the bone developing effect of fish protein containing less PUFA has not been evaluated in young animals with T2DM. We prepared a bonito fish (BF) and defatted BF (DBF) and hypothesized that protein contained in BF and DBF would be effective for mitigating the effects of T2DM-induced bone frailty. We mainly evaluated the effect of dietary BF and DBF on bone and apparent calcium absorption in young Goto-Kakizaki (GK) rats with T2DM. GK rats were divided into 3 groups based on diets (casein, BF, and DBF) and fed with each diet for 6 wk. Wistar rats were fed with the casein diet as a non-T2DM control. Bone mass, bone strength, apparent calcium absorption, and serum biochemical parameters were determined. The dry weight and strength of the femurs were lower in the GK rats than in the Wistar rats fed with the casein diet. Dietary intake of the BF and DBF diets enhanced the maximum load and dry weight of the femurs and suppressed the serum alkaline phosphatase activity although the apparent calcium absorption was lower in the GK rats fed with the BF and DBF diets than in those fed with the casein diet. These parameters were not different between the rats fed with the BF and DBF diets. Our data suggest that protein contained in the BF and DBF diets improved T2DM-induced bone frailty.

  13. Supplementation with fish oil and genistein, individually or in combination, protects bone against the adverse effects of methotrexate chemotherapy in rats.

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    Rethi Raghu Nadhanan

    Full Text Available Cancer chemotherapy has been shown to induce long-term skeletal side effects such as osteoporosis and fractures; however, there are no preventative treatments. This study investigated the damaging effects of anti-metabolite methotrexate (MTX subcutaneous injections (0.75 mg/kg BW for five days and the potential protective benefits of daily oral gavage of fish oil at 0.5 mL/100 g BW (containing 375 mg of n-3 PUFA/100 g BW, genistein (2 mg/100 g BW, or their combination in young adult rats. MTX treatment alone significantly reduced primary spongiosa height and secondary spongiosa trabecular bone volume. Bone marrow stromal cells from the treated rats showed a significant reduction in osteogenic differentiation but an increase in adipogenesis ex vivo. Consistently, stromal cells had significantly higher mRNA levels of adipogenesis-related proliferator activator activated receptor-γ (PPAR-γ and fatty acid binding protein (FABP4. MTX significantly increased the numbers of bone-resorbing osteoclasts and marrow osteoclast precursor cell pool while significantly enhancing the mRNA expression of receptor activator for nuclear factor kappa B ligand (RANKL, the RANKL/osteoprotegerin (OPG ratio, interleukin-6 (IL-6, and tumor necrosis factor-α (TNF-α in the bone. Supplementary treatment with fish oil and/or genistein significantly preserved trabecular bone volume and osteogenesis but suppressed MTX-induced adipogenesis and increases in osteoclast numbers and pro-osteoclastogenic cytokine expression. Thus, Fish oil and/or genistein supplementation during MTX treatment enabled not only preservation of osteogenic differentiation, osteoblast number and bone volume, but also prevention of MTX treatment-induced increases in bone marrow adiposity, osteoclastogenic cytokine expression and osteoclast formation, and thus bone loss.

  14. Unusual causes of intrahepatic cholestatic liver disease

    Institute of Scientific and Technical Information of China (English)

    Elias E Mazokopakis; John A Papadakis; Diamantis P Kofteridis

    2007-01-01

    We report five cases with unusual causes of intrahepatic cholestasis,including consumption of Teucrium polium (family Lamiaceae) in the form of tea,Stauffer's syndrome,treatment with tamoxifen citrate for breast cancer,infection with Coxiella Burnetii (acute Q fever),and infection with Brucella melitensis (acute brucellosis).

  15. The transjugular intrahepatic portosystemic shunt (TIPS)

    Energy Technology Data Exchange (ETDEWEB)

    Owen, A.R. [Department of Radiology, Austin Health, Heidelberg, Melbourne (Australia)], E-mail: andrewowen@doctors.org.uk; Stanley, A.J. [Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow (United Kingdom); Vijayananthan, A. [Department of Biomedical Imaging, University of Malaya, Kuala Lumpur (Malaysia); Moss, J.G. [Department of Radiology, Gartnavel General Hospital, Glasgow (United Kingdom)

    2009-07-15

    The creation of an intrahepatic portosystemic shunt via a transjugular approach (TIPS) is an interventional radiological procedure used to treat the complications of portal hypertension. TIPS insertion is principally indicated to prevent or arrest variceal bleeding when medical or endoscopic treatments fail, and in the management refractory ascites. This review discusses the development and execution of the technique, with focus on its clinical efficacy. Patient selection, imaging surveillance, revision techniques, and complications are also discussed.

  16. Autophagy in intra-hepatic cholangiocarcinoma

    OpenAIRE

    Huang, Jing Li; Hezel, Aram F.

    2012-01-01

    Intra-hepatic cholangiocarcinoma (IHCC) is a primary cancer of the liver that shares histological features with the hepatic bile ducts from which it is thought to arise. The incidence of this disease is increasing, possibly related to increased inflammatory liver diseases such as viral hepatitis and steatohepatitis (commonly called “fatty liver”), induced by obesity, diabetes, and other metabolic derangements. Its prognosis is generally poor with early metastasis and presently there are limit...

  17. Intrahepatic chemoembolization in unresectable pediatric liver malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Arcement, C.M.; Towbin, R.B.; Meza, M.P.; Kaye, R.D.; Carr, B.I. [Department of Radiology, Children' s Hospital of Pittsburgh, PA (United States); Gerber, D.A.; Mazariegos, G.V.; Reyes, J. [Department of Transplant Surgery, Children' s Hospital of Pittsburgh, PA (United States)

    2000-11-01

    Objective. To determine the effectiveness of a new miltidisciplinary approach using neoadjuvant intrahepatic chemoembolization (IHCE) and liver transplant (OLTx) in patients with unresectable hepatic tumors who have failed systemic chemotherapy. Materials and methods. From November 1989 to April 1998, 14 children (2-15 years old) were treated with 50 courses of intra-arterial chemotherapy. Baseline and post-treatment contrast-enhanced CT and alpha-fetoprotein levels were performed. Seven had hepatoblastoma, and 7 had hepatocellular carcinoma (1 fibrolamellar variant). All patients had subselective hepatic angiography and infusion of cisplatin and/or adriamycin (36 courses were followed by gelfoam embolization). The procedure was repeated every 3-4 weeks based on hepatic function and patency of the hepatic artery. Results. Six of 14 children received orthotopic liver transplants (31 courses of IHC). Pretransplant, 3 of 6 showed a significant decrease in alpha-fetoprotein, while only 1 demonstrated a significant further reduction in tumor size. Three of 6 patients are disease free at this time. Three of 6 patients died of metastatic tumor 6, 38, and 58 months, respectively post-transplant. One of 14 is currently undergoing treatment, has demonstrated a positive response, and is awaiting OLTx. Three of 14 withdrew from the program and died. Four of 14 patients developed an increase in tumor size, developed metastatic disease, and were not transplant candidates. Two hepatic arteries thrombosed, and one child had a small sealed-off gastric ulcer as complications of intrahepatic chemoembolization. Conclusion. The results of intrahepatic chemoembolization are promising and suggest that some children who do not respond to systemic therapy can be eventually cured by a combination of intrahepatic chemoembolization orthotopic liver transplant. Alpha-fetoprotein and cross-sectional imaging appear to be complementary in evaluating tumor response. IHCE does not appear to convert

  18. Heterogeneity of the intrahepatic biliary epithelium

    Institute of Scientific and Technical Information of China (English)

    Shannon Glaser; Heather Francis; Sharon DeMorrow; Gene LeSage; Giammarco Fava; Marco Marzioni; Julie Venter; Gianfranco Alpini

    2006-01-01

    The objectives of this review are to outline the recent findings related to the morphological heterogeneity of the biliary epithelium and the heterogeneous pathophysiological responses of different sized bile ducts to liver gastrointestinal hormones and peptides and liver injury/toxins with changes in apoptotic, proliferative and secretory activities. The knowledge of biliary function is rapidly increasing because of the recognition that biliary epithelial cells (cholangiocytes) are the targets of human cholangiopathies, which are characterized by proliferation/damage of bile ducts within a small range of sizes. The unique anatomy, morphology, innervation and vascularization of the biliary epithelium are consistent with function of cholangiocytes within different regions of the biliary tree. The in vivo models [e.g., bile duct ligation (BDL), partial hepatectomy, feeding of bile acids,carbon tetrachloride (CCl4) or α-naphthylisothiocyanate (ANIT)] and the in vivo experimental tools [e.g., freshly isolated small and large cholangiocytes or intrahepatic bile duct units (IBDU) and primary cultures of small and large murine cholangiocytes] have allowed us to demonstrate the morphological and functional heterogeneity of the intrahepatic biliary epithelium.These models demonstrated the differential secretory activities and the heterogeneous apoptotic and proliferative responses of different sized ducts. Similar to animal models of cholangiocyte proliferation/injury restricted to specific sized ducts, in human liver diseases bile duct damage predominates specific sized bile ducts.Future studies related to the functional heterogeneity of the intrahepatic biliary epithelium may disclose new pathophysiological treatments for patients with cholangiopathies.

  19. Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

    Directory of Open Access Journals (Sweden)

    Oyewole Ezekiel O

    2011-04-01

    Full Text Available Abstract Introduction A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature. Case presentation We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours. Conclusion We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.

  20. A study on the meat and bone meal and poultry by-product meal as protein substitutes of fish meal in practical diets for Litopenaeus vannamei juveniles

    Science.gov (United States)

    Zhu, Wei; Mai, Kangsen; Zhang, Baigang; Wang, Fuzhen; Yu, Yu

    2004-10-01

    A study was conducted to evaluate the effects of meat and bone meal (MBM) and poultry by-product meal (PBM) as the replacement of fish meal in the diets on the growth performance, survival and apparent digestibility coefficients (ADC) of Litopenaeus vannamei. The basal diets were formulated with 22% fish meal and other ingredients which provided about 40% protein and 9% lipid in the diet. The experimental diets included MBM or PBM to replace 0, 20%, 40%, 60% and 80% of total fish meal respectively. All diets were iso-nitrogenous and isocaloric in gross terms. The results showed that there were no significant differences (Pτ;0.05) in growth performance and ADC among the treatments fed with the diets in which 0 60% fish meal had been replaced with MBM, while the percent weight gain (WG, %), body length gain (BLG, %) and ADC significantly decreased when the MBM was up to 80% of the fish meal. There were no significant differences (Pτ;0.05) in growth performance and ADC among all the treatments fed with the diets in which 0 80% fish meal had been replaced with PBM.

  1. A Study on the Meat and Bone Meal and Poultry By-product Meal as Protein Substitutes of Fish Meal in Practical Diets for Litopenaeus vannamei Juveniles

    Institute of Scientific and Technical Information of China (English)

    ZHU Wei; MAI Kangsen; ZHANG Baigang; WANG Fuzhen; YU Yu

    2004-01-01

    A study was conducted to evaluate the effects of meat and bone meal(MBM)and poultry by-product meal(PBM)as the replacement of fish meal in the diets on the growth performance, survival and apparent digestibility coefficients(ADC)of Litopenaeus vannamei. The basal diets were formulated with 22% fish meal and other ingredients which provided about 40% protein and 9% lipid in the diet. The experimental diets included MBM or PBM to replace 0, 20%, 40%, 60% and 80% of total fish meal respectively. All diets were iso-nitrogenous and isocaloric in gross terms. The results showed that there were no significant differences(P>0.05)in growth performance and ADC among the treatments fed with the diets in which 0-60% fish meal had been replaced with MBM, while the percent weight gain(WG,%), body length gain(BLG,%)and ADC significantly decreased when the MBM was up to 80% of the fish meal. There were no significant differences(P>0.05)in growth performance and ADC among all the treatments fed with the diets in which 0-80% fish meal had been replaced with PBM.

  2. Radiopaque intrahepatic duct stones in plain radiograph: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Suh, Chang Hae; Park, Chan Sup; Chung, Won Kyun [College of Medicine, Inha University, Seongnam (Korea, Republic of)

    1994-04-15

    We experienced 3 cases of intrahepatic duct stones detected on plain radiographs. The patients had history of multiple episodes of recurrent cholangitis. Radiographic characteristics of these stones included multiple, round or rectangular radiopaque densities surrounded by calcified rim; these densities showed a branching pattern along the intrahepatic ducts.

  3. New Insights on Intrahepatic Cholestasis of Pregnancy.

    Science.gov (United States)

    Floreani, Annarosa; Gervasi, Maria Teresa

    2016-02-01

    Intrahepatic cholestasis of pregnancy (ICP) is characterized by maternal pruritus, and elevated serum transaminases and bile acids. Genetic defects in at least 6 canalicular transporters have been found. Association studies stress the variability of genotypes, different penetrance, and influence of environmental factors. Serum autotaxin is a sensitive, specific, and robust diagnostic marker. Elevated maternal bile acids correlate with fetal complications. Long-term sequelae for mothers include the gallstone risk and chronic liver disease. There is an association between ICP and hepatitis C. Current treatment is ursodeoxycholic acid, owing to benefits on pruritus, liver function, safety, and decreased rates of adverse effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Intrahepatic cholestasis of pregnancy: Recent advances.

    Science.gov (United States)

    Ovadia, Caroline; Williamson, Catherine

    2016-01-01

    Intrahepatic cholestasis of pregnancy, also known as obstetric cholestasis, is a pruritic condition of pregnancy characterized by an underlying elevation in circulating bile acids and liver derangement, and associated with adverse fetal outcomes, such as preterm labor and stillbirth. Limited understanding of the underlying pathophysiology and mechanisms involved in adverse outcomes has previously restricted treatment options and pregnancy management. Recent advances in these research fields provide tantalizing targets to improve the care of pregnant women affected by this condition. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Sepsis as a cause of intrahepatic cholestasis

    Directory of Open Access Journals (Sweden)

    Rudić Jelena

    2009-01-01

    Full Text Available Introduction. The causes of intrahepatic cholestasis include cholestatic viral hepatitis, primary biliary cirrhosis, benign recurrent cholestasis, primary sclerosing cholangitis and sepsis. During sepsis, proinflammatory cytokines and nitric oxide cause cholestasis by impairing hepatocellular and ductal bile formation. Case Outline. We report a 48-year-old woman who was admitted to hospital due to malaise, jaundice, fever and pain in the neck. Physical examination revealed jaundice, tachycardia (pulse rate was 120/min, hypotension 90/60 mm Hg. Laboratory findings showed normocytic normochromic anaemia, inflammatory syndrome and abnormal liver function tests indicating cholestasis and hepatocellular necrosis. Abdominal ultrasonography detected hepatosplenomegaly. Chest computed tomography showed bronchopneumonic infiltrates. Percutaneous liver biopsy was performed using a Menghini needle of 1.4 mm. Pathohystological analysis of the liver tissue confirmed reactive, intrahepatic cholestasis. Blood cultures isolated Staphylococcus aureus. After the diagnosis was established the treatment with broad-spectrum antibiotics was carried out, resulting in the improvement of general condition of the patient, regression of inflammatory syndrome, disappearance of cholestasis and regression of pulmonary infiltrates. Abdominal ultrasonography after antibiotic treatment did not show hepatosplenomegaly. Conclusion. Concerning patients with cholestasis of uncertain origin, we should always think of sepsis as a possible cause in order to start antibiotic treatment in time.

  6. Menopause after a history of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Turunen, Kaisa; Helander, Kristiina; Mattila, Kari J; Sumanen, Markku

    2013-11-01

    Intrahepatic cholestasis of pregnancy is a hormone-provoked disorder that fades quickly after parturition. The aim of this study was to establish whether a history of intrahepatic cholestasis of pregnancy reduces the use of hormone therapy for menopausal symptoms and, irrespective of hormone therapy, whether intrahepatic cholestasis is associated with other health aspects after menopause. In 2010, questionnaires were sent to a cohort of women who delivered in Tampere University Hospital, Finland, from 1969 to 1988. The study population comprised postmenopausal women with a history of intrahepatic cholestasis of pregnancy (n = 189) and their controls (n = 416). The main outcome measures were the use of hormone therapy and other means of alleviating menopausal symptoms, and the diseases the women reported. There were no differences in the use of hormone therapy between the two groups. Of the diseases reported, breast cancer, hepatobiliary diseases, and hypothyroidism were more frequent among women with a history of intrahepatic cholestasis of pregnancy, whereas cardiac arrhythmia was less frequent. With respect to other diseases, there were no differences. A history of intrahepatic cholestasis of pregnancy does not reduce the use of hormone therapy. However, when physicians prescribe hormone therapy for these women, a history of intrahepatic cholestasis of pregnancy calls for attention in view of its association with gallstones.

  7. CLINICAL AND MORPHOLOGICAL DIAGNOSTIC INTRAHEPATIC BILE DUCTS PAUCITY

    Directory of Open Access Journals (Sweden)

    O. E. Iryshkin

    2013-01-01

    Full Text Available Aim. To study the clinica-morphological features of syndromatic and nonsyndromatic paucity of intrahepatic bile ducts in pediatric liver transplant recipients. Methods and results. The clinical records were analyzed and histological studies of native livers of 20 children, who had suffered from paucity of intrahepatic bile ducts and to whom liver transplantation were made, were completed. The obtained data indicate higher levels of AST in patients with nonsyndromatic paucity of intrahepaticbile ducts (p = 0,023. Ductopenia was the more frequent indication of syndromatic form of paucity of intrahepatic bile ducts (p = 0,01, while ductular proliferations, which form «ductular structure», were discovered more often in nonsyndromatic paucity of intrahepaticbile ducts (p = 0,03. The extent of inflammatory-destructive changes was more expressed in nonsyndromatic pauci- ty of intrahepatic bile ducts (p = 0,01. Fibrosis or cirrhosis was formed more often in nonsyndromatic paucity of intrahepatic bile ducts (p = 0,008. Conclusion. Our results indicate more severe clinical and morphological manifestations in nonsyndromatic paucity of intrahepatic bile ducts. These findings may suggest about heavier liver condition in patient with nonsyndromatic form of paucity of intrahepatic bile ducts. 

  8. Effect of replacement of fish meal by meat and bone meal and poultry by-product meal in diets on the growth and immune response of Macrobrachium nipponense.

    Science.gov (United States)

    Yang, Yong; Xie, Shouqi; Lei, Wu; Zhu, Xiaoming; Yang, Yunxia

    2004-08-01

    The potential use of poultry by-product meal (PBM) and meat and bone meal (MBM) as alternative dietary protein sources for juvenile Macrobrachium nipponense was studied by a 70-day growth trial. Triplicate groups of M. nipponense (initial body weight: 0.37 g) were fed at 20.7-22.4 degrees C on each of the five isoenergetic and isonitrogenous diets (protein content about 38%) with different replacement of fish meal by MBM or PBM. The control diet used white fish meal as the sole protein source, the other four diets were prepared with 15% or 50% fish meal protein substituted by either MBM (MBM(15), MBM(50)) or PBM (PBM(15), PBM(50)). The results showed that replacement of fish meal by MBM in diets did not affect growth performance of M. nipponense (P > 0.05), while specific growth rate in PBM(15) was significantly higher than that in other groups (P meal protein in diets for M. nipponense.

  9. Minyak ikan Lemuru (Sardinella longicep menurunkan apoptosis osteoblas pada tulang alveolaris tikus wistar (Fish oil of Lemuru (Sardinella longicep reduced the osteoblast apoptosis in wistar rat alveolar bone

    Directory of Open Access Journals (Sweden)

    Didin Erma Indahyani

    2013-12-01

    Full Text Available Background: Periodontal disease is caused by periodontopatogen bacteria resulting the alveolar bone damage. The decrease of osteoblasts and the increased of osteoclasts can cause bone destruction. The decrease of osteoblasts, due to a disturbance of differentiation, proliferation and apoptosis. Inflammatory mediators are prostaglandin E2 (PGE2, interleukin-1 (IL-1, IL-6 also tumor necrosis alpha (TNF-α stimulates osteoblast apoptosis through gene expression, signaling molecules and receptor-forming osteoblasts. Fish oil of Lemuru, which is widely encountered in Indonesian coast, containing n-3 poly unsaturated fatty acids (n-3 PUFAs are quite high. Consumption of fish oil shown to reduce the expression of PGE2, IL-1, IL-6 and TNF-α. Purpose: The purpose of this study was to examine the effect of Lemuru (Sardinella longicep fish oil on osteoblast apoptosis of rat alveolar bone induced periodontal infection. Methods: Thirty Wistar rats, male, age 5 days, divided into 3 groups: group I rats induced with normal saline, group II rats induced by LPS, and group III rats induced with lemuru fish oil and LPS. Each group was divided into 2 sub-groups that would be sacrified at 13 days and 21 days of age. Fish oil was given at a dose 1ml/300-350 grams. Lipopolysaccharide (LPS induced with the purpose to cause periodontal infection in the maxillary buccal fold molar region with dose 5μl LPS/PBS 0.03 ml. After decapitation and decalcification, the maxilla was cut in 5μm thickness. Apoptosis was analyzed on DNA and detected by TUNEL reaction (transferase-mediated digoxigenin-deoxy-UTP nick end labeling. Results: The results showed that apoptosis of osteoblast cells was significantly smaller in rats induced by Lemuru fish oil. Conclusion: The study showed that Lemuru fish oil reduced the osteoblast apoptosis of rats alveolar bone induced periodontal infection by LPS.Latar belakang: Penyakit periodontal akibat bakteri peridontopatogen, menyebabkan

  10. Clinical grading of Intrahepatic Cholestasis Pregnancy

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    Meena Pradhan

    2013-06-01

    Full Text Available Intrahepatic cholestasis of pregnancy (ICP is the pregnancy induced liver disorder causing intense itching of palm, sole or even whole body especially in the evening at late second and third trimester. This disease categorized into mild and severe ICP according to raised level of LFT including serum level of Bile acid and Cholic acid. ICP has less morbidity to mother but significant risk for fetus in uterus. The predisposing element to cause intense pruritus is because of high amount of bile acid in maternal serum. Toxic bile acids affect fetal cardiomyocytes that retained in fetus body causing sudden intrauterine fetal death. ICP is commonly found in winter months and mostly itching of body occurs in the evening after sunset. Fetus in uterus is unsafe if mother’s bile acid exceeds normal value. ICP is successfully treated with Ursodeoxycholic acid (UDCA, S-adenosyl methionine (SAME, Dexamethasone and vitamin K. Keywords: itching; bile acid; obstetric cholestasis; Ursodeoxycholic cholic acid.

  11. Management of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Marschall, Hanns-Ulrich

    2015-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease during pregnancy, characterized by otherwise unexplained pruritus in late second and third trimester of pregnancy and elevated bile acids and/or transaminases. ICP is associated with an increased risk of adverse perinatal outcomes for the fetus and the later development of hepatobiliary disease for the mother. Bile acids should be monitored throughout pregnancy since fetal risk is increased at serum bile acids >40 µmol/l. Management of ICP consists of treatment with ursodeoxycholic acid, which reduces pruritus. Early elective delivery is common practice but should be performed on an individualized basis as long as strong evidence supporting this practice is lacking. Mothers should be followed-up for normalization of liver function tests 6-12 weeks after delivery. Future research in large-scale studies is needed to address the impact of ursodeoxycholic acid and early elective delivery on fetal outcome.

  12. Clinical grading of intrahepatic cholestasis pregnancy.

    Science.gov (United States)

    Pradhan, Meena; Shao, Yong

    2013-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is the pregnancy induced liver disorder causing intense itching of palm, sole or even whole body especially in the evening at late second and third trimester. This disease is categorized into mild and severe ICP according to raised level of LFT including serum level of bile acid and cholic acid. ICP has less morbidity to mother but significant risk to fetus in uterus. The predisposing element to cause intense pruritus is because of high amount of bile acid in maternal serum. Toxic bile acids affect fetal cardiomyocytes retained in fetus body causing sudden intrauterine fetal death. ICP is commonly found in winter months and mostly itching of body occurs in the evening after sunset. Fetus in uterus is unsafe if mother's bile acid exceeds normal value. ICP is successfully treated with Ursodeoxycholic acid (UDCA), S-adenosyl methionine (SAME), Dexamethasone and vitamin K.

  13. [Risks of intrahepatic cholestasis of pregnancy].

    Science.gov (United States)

    Bolier, A Ruth; Jebbink, Jiska M; van der Post, Joris A M; Oude Elferink, Ronald P J; Beuers, Ulrich

    2014-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is defined as pruritus during pregnancy in the absence of primary skin lesions, combined with an increase in serum total bile salts and/or abnormal serum liver tests. This article provides an insight into the diagnostic and therapeutic considerations by presenting two cases. ICP usually presents around 34 weeks of gestation, but can be present early in pregnancy as described in a 32-year-old patient pregnant after in-vitro fertilization. DNA analysis showed a mutation in the ABCB4 gene, causing MDR3 deficiency. Ursodeoxycholic acid treatment seems to alleviate maternal pruritus and possibly reduces perinatal risks related to the severe form of ICP, defined as fasted serum bile salt levels of ≥ 40 μmol/l at any point during the pregnancy. Short-term rifampicin treatment can be considered in patients with persistent pruritus. Induction of labour is advised only after 37 weeks of gestation in patients with severe ICP.

  14. Effect of Vinegar on Extraction Rate of Fish Bone Calcium%食醋对鱼骨中钙溶出的影响

    Institute of Scientific and Technical Information of China (English)

    赫美; 许鑫; 杨春瑜

    2011-01-01

    The extraction of fish bone calcium by vinegar was studied under the atmospheric pressure and high pressure. The results showed that the best acetic acid concentration and the ratio of the fish bone to vinegar solution were 0.9 mol/L and 1:20, respectively, for the extraction either under the atmospheric pressure or the high pressure. For extraction under the atmospheric pressure, the optimum extraction time and temperature were 60 min and 60℃ , respectively. For that under the high pressure, the best extraction time was 45 min.%鱼骨中钙含量相对丰富,在酸性条件下浸泡可使鱼骨中的钙溶出,提高人体吸收利用率,本文分别在常压和高压下利用食用醋酸(食醋)对鱼骨钙溶出的影响,得出钙充分溶出的工艺条件为:常压和高压下醋酸浓度都为0.9mol/L,常压下料液比为1∶20,高压下料液比为1∶20,常压下浸泡时间为60 min,高压为45 min,常压下浸泡温度60℃.

  15. Characterization of a new fish-derived bioactive neuropeptide involved in bone remodelling. Its physiological function and therapeutic potential.

    Directory of Open Access Journals (Sweden)

    Paula Suarez-Bregua

    2014-04-01

    Full Text Available A complex network of autocrine and paracrine signals, hormones and neuronal factors preserve the structural integrity of the skeleton and regulate mineral metabolism in vertebrates. We have characterized a new neuropeptide belonging to parathyroid hormone (PTH family. PTH family members are known to play a key role in maintaining mineral homeostasis, bone remodeling and in regulating embryonic development of skeleton and other tissues. This new neuropeptide is synthesized by two clusters of neurons located in lateral hypothalamus as showed in whole mount in situ hybridization. The functional characterization of the gene using a stable transgenic line revealed its key role in the regulation of bone mineral density. Moreover, phylogenetic analyses and comparative genomics results of conserved synteny reveal that this new neuropeptide is a new ohnolog of the PTH family present in teleosts and some tetrapods like chicken, but absent in mammals . Our findings suggest a new brain to bone pathway, where neuronal factors from hypothalamus signal to receptors on bone cells promoting bone remodeling. Further investigations about this new neuropeptide system would be relevant for developing therapies for bone mineral disorders in humans, since this neuropeptide has a conserved domain similar to other PTH-related peptides which have anabolic effects on bone.

  16. Comparison of amino acid digestibility coefficients for soybean meal, canola meal, fish meal, and meat and bone meal among 3 different bioassays.

    Science.gov (United States)

    Kim, E J; Utterback, P L; Parsons, C M

    2012-06-01

    The objective of this study was to determine amino acid digestibility of 4 feedstuffs [soybean meal (SBM), canola meal, fish meal, and meat and bone meal (MBM)] using the precision-fed cecectomized rooster assay (PFR), the standardized ileal assay (SIAAD), and a newly developed precision-fed ileal broiler assay (PFC). For the PFR, cecectomized roosters were precision-fed approximately 30 g of feed sample, and excreta were collected 48 h postfeeding. For the SIAAD, 16-d-old broilers were fed a semipurified diet containing the feed samples as the only source of protein from 17 to 21 d, with ileal digesta collected at 21 d. For the PFC, 22-d-old broilers were precision-fed 10 g of feed sample mixed with chromic oxide, and ileal digesta were collected at 4 h postfeeding. Digestibility coefficients were standardized using a nitrogen-free diet for the SIAAD and PFC and using fasted roosters for the PFR. There were generally no consistent differences in standardized amino acid digestibility values among assays, and values were in general agreement among assays, particularly for SBM and MBM. Differences did occur among methods for amino acid digestibility in fish meal; however, these differences were not consistent among methods or amino acids. The results of the study indicated that all 3 bioassays are acceptable for determining the amino acid digestibility of SBM, canola meal, MBM, and fish meal for poultry.

  17. Age-Related Loss in Bone Mineral Density of Rats Fed Lifelong on a Fish Oil-Based Diet Is Avoided by Coenzyme Q10 Addition

    Science.gov (United States)

    Varela-López, Alfonso; Ochoa, Julio J.; Llamas-Elvira, José M.; López-Frías, Magdalena; Planells, Elena; Ramirez-Tortosa, MCarmen; Ramirez-Tortosa, Cesar L.; Giampieri, Francesca; Battino, Maurizio; Quiles, José L.

    2017-01-01

    During aging, bone mass declines increasing osteoporosis and fracture risks. Oxidative stress has been related to this bone loss, making dietary compounds with antioxidant properties a promising weapon. Male Wistar rats were maintained for 6 or 24 months on diets with fish oil as unique fat source, supplemented or not with coenzyme Q10 (CoQ10), to evaluate the potential of adding this molecule to the n-3 polyunsaturated fatty acid (n-3 PUFA)-based diet for bone mineral density (BMD) preservation. BMD was evaluated in the femur. Serum osteocalcin, osteopontin, receptor activator of nuclear factor-κB ligand, ostroprotegerin, parathyroid hormone, urinary F2-isoprostanes, and lymphocytes DNA strand breaks were also measured. BMD was lower in aged rats fed a diet without CoQ10 respect than their younger counterparts, whereas older animals receiving CoQ10 showed the highest BMD. F2-isoprostanes and DNA strand breaks showed that oxidative stress was higher during aging. Supplementation with CoQ10 prevented oxidative damage to lipid and DNA, in young and old animals, respectively. Reduced oxidative stress associated to CoQ10 supplementation of this n-3 PUFA-rich diet might explain the higher BMD found in aged rats in this group of animals. PMID:28241421

  18. Age-Related Loss in Bone Mineral Density of Rats Fed Lifelong on a Fish Oil-Based Diet Is Avoided by Coenzyme Q10 Addition

    Directory of Open Access Journals (Sweden)

    Alfonso Varela-López

    2017-02-01

    Full Text Available During aging, bone mass declines increasing osteoporosis and fracture risks. Oxidative stress has been related to this bone loss, making dietary compounds with antioxidant properties a promising weapon. Male Wistar rats were maintained for 6 or 24 months on diets with fish oil as unique fat source, supplemented or not with coenzyme Q10 (CoQ10, to evaluate the potential of adding this molecule to the n-3 polyunsaturated fatty acid (n-3 PUFA-based diet for bone mineral density (BMD preservation. BMD was evaluated in the femur. Serum osteocalcin, osteopontin, receptor activator of nuclear factor-κB ligand, ostroprotegerin, parathyroid hormone, urinary F2-isoprostanes, and lymphocytes DNA strand breaks were also measured. BMD was lower in aged rats fed a diet without CoQ10 respect than their younger counterparts, whereas older animals receiving CoQ10 showed the highest BMD. F2-isoprostanes and DNA strand breaks showed that oxidative stress was higher during aging. Supplementation with CoQ10 prevented oxidative damage to lipid and DNA, in young and old animals, respectively. Reduced oxidative stress associated to CoQ10 supplementation of this n-3 PUFA-rich diet might explain the higher BMD found in aged rats in this group of animals.

  19. [Intrahepatic cholestasis of pregnancy : Rare but important].

    Science.gov (United States)

    Kremer, A E; Wolf, K; Ständer, S

    2017-02-01

    Intrahepatic cholestasis of pregnancy (ICP) is a liver-specific disorder occurring in approximately 0.5-2.0% of all pregnancies with a considerable variation in certain ethnic groups. ICP usually runs a benign course for the mother and is characterized by maternal pruritus mainly in the third trimester, elevated transaminases and fasting total serum bile salts and increased fetal adverse events. The etiology of ICP is only partially understood but seems to be multifactorial. Cholestasis-inducing effects of certain female sex hormones and their metabolites play an important role in genetically susceptible women. The mechanisms resulting in fetal complications such as spontaneous preterm labour, antepartum passage of meconium, asphyxia events, still birth and fetal death are not well understood. Certain sulfated progesterone metabolites are likely to play a role in the pathogenesis of pruritus in ICP. In contrast to pregnancy-related dermatoses, pruritus does not present with primary skin alterations. However, intense scratching may cause secondary skin changes such as abrasions, excoriations and sometimes prurigo nodularis. Treatment is based on ursodeoxycholate treatment to reduce pruritus and hepatic impairment as well as elective delivery between gestation week 37-38 to pre-empt potential stillbirths. This article reviews clinical symptoms, diagnosis, treatment and in particular pathogenesis of pruritus in ICP.

  20. The pathophysiology of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Dixon, Peter H; Williamson, Catherine

    2016-04-01

    A number of liver disorders are specific to pregnancy. Amongst these, intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis (OC), is the commonest, affecting approximately 1 in 140 UK pregnancies. Patients commonly present in the third trimester with severe pruritus and deranged serum liver tests; bile acids are elevated, in severe cases >40 μmol/L. Although the disease is considered relatively benign for the mother, increased rates of adverse fetal outcomes, including stillbirth, are associated with ICP. As our knowledge of the mechanisms underlying bile acid homeostasis has advanced in the last 15 years our understanding of ICP has grown, in particular with respect to genetic influences on susceptibility to the disease, the role of reproductive hormones and their metabolites and the possible identity of the pruritic agents. In this review, we will describe recent advances in the understanding of this condition with a particular emphasis on how aspects of genetic and reproductive hormone involvement in pathophysiology have been elucidated. We also review recent developments regarding our knowledge of placental and fetal pathophysiology and the long-term health consequences for the mother and child. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Intrahepatic arterioportal shunt: helical CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Quiroga, S.; Sebastia, M.C.; Moreiras, M.; Pallisa, E.; Rius, J.M.; Alvarez-Castells, A. [I. D. I. Hospital General i Universitari Vall d`Hebron, Barcelona (Spain). Servei de Radiodiagnostic

    1999-08-01

    The purpose of this study was to characterize the appearance of intrahepatic arterioportal shunts (APS) on two-phase helical CT, with emphasis on the importance of the hepatic arterial-dominant phase (HAP) to demonstrate perfusion disorders. We review eight cases of APS diagnosed by helical CT in our institution from January 1996 to March 1997 and describe the CT findings that established diagnosis. Five of them were confirmed by angiography. In seven (87.5 %) cases of APS we found early enhancement of the peripheral portal branches during the HAP of helical CT, whereas the superior mesenteric and splenic veins remained unenhanced. In five (62.5 %) cases of APS, transient, peripheral, triangular parenchymal enhancement was depicted during the HAP of helical CT; in four of these cases there was associated early enhancement of the portal branches. Helical CT can show perfusion alterations that might remain undiagnosed with conventional CT. An understanding of the hemodynamic changes that occur in APS can help in the interpretation of focal transient hepatic parenchymal enhancement and to differentiate APS from hypervascular tumors. We believe that the helical CT findings described herein are characteristic enough to suggest the diagnosis of APS. (orig.) With 3 figs., 1 tab., 16 refs.

  2. Intrahepatic cholangiocarcinoma: current management and emerging therapies.

    Science.gov (United States)

    Rahnemai-Azar, Amir A; Weisbrod, Allison B; Dillhoff, Mary; Schmidt, Carl; Pawlik, Timothy M

    2017-05-01

    Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify 'target-able' molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients. Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies. Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.

  3. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Science.gov (United States)

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  4. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Directory of Open Access Journals (Sweden)

    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  5. Pyogenic liver abscess due to fish bone: case report = Absceso hepático piógeno por hueso de pescado: reporte de un caso

    Directory of Open Access Journals (Sweden)

    Alejandro Vega Molina

    2013-10-01

    Full Text Available We report the case of a man who consulted the emergency department of Hospital el Tunal in Bogotá, Colombia, because of six days of progressive abdominal pain in the upper right quadrant, associated with jaundice and fever; there was no relevant information in his medical history. On admission he was found in poor general condition and required management in the intensive care unit; diagnostic imaging studies documented a multiseptate collection in the left hepatic lobe, and a foreign body. He was submitted to laparotomy in which a fish bone was found as the cause of the abscess. After drainage of the collection and with antibiotic therapy evolution was favorable.

  6. Characterization and Utilization of Calcium Oxide (CaO Thermally Decomposed from Fish Bones as a Catalyst in the Production of Biodiesel from Waste Cooking Oil

    Directory of Open Access Journals (Sweden)

    Aldes Lesbani

    2016-12-01

    Full Text Available Thermal decomposition of fish bones to obtain calcium oxide (CaO was conducted at various temperatures of 400, 500, 800, 900, 1000, and 1100 °C. The calcium oxide was then characterized using X-ray diffractometer, FTIR spectrophotometer, and SEM analysis. The calcium oxide obtained from the decomposition at 1000 °C was then used as a catalyst in the production of biodiesel from waste cooking oil. Diffraction pattern of the calcium oxide produced from decomposition at 1000 °C showed a pattern similar to that of the calcium oxide produced by the Joint Committee on Powder Diffraction Standard (JCDPS. The diffractions of 2θvalues at 1000 °C were 32.2, 37.3, 53.8, 64.1, and67.3 deg. The FTIR spectrum of calcium oxide decomposed at 1000 °C has a specific vibration at wave-length 362 cm-1, which is similar to the specific vibration of Ca-O. SEM analysis of the calcium oxide indicated that the calcium oxide’s morphology shows a smaller size and a more homogeneous structure, compared to those of fish bones. Theuse of calcium oxide as a catalyst in the production of biodiesel from waste cooking oil resulted in iod number of 15.23 g/100 g KOH, density of 0.88 g/cm3, viscosity of 6.00 cSt, and fatty acid value of 0.56 mg/KOH. These characteristic values meet the National Standard of Indonesia (SNI for biodiesel.

  7. Intrahepatic haematoma in a patient on long-term haemodialysis.

    Science.gov (United States)

    Lai, K N; Disney, A P; Mathew, T H

    Spontaneous intrahepatic haematoma is an uncommon potentially fatal complication in uraemic patients receiving long-term haemodialysis, particularly in those taking anticoagulant and antiplatelet drugs. Prompt diagnosis, withdrawal of anticoagulant and antiplatelet therapy, cautious transfusion, and careful dialysis with regional heparinisation are essential in the management and may help to avoid surgical intervention in the presence of a tendency to bleed. Noninvasive organ imaging such as ultrasonography and computerised axial tomography are helpful in diagnosis and monitoring of progress. A case of intrahepatic haematoma in a 37-year-old man who had been receiving long-term haemodialysis since 1976 is described.

  8. Radiofrequency ablation for incidentally identified primary intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Witold Zgodzinski; N.Joseph Espat

    2005-01-01

    Cholangiocarcinoma is the second most common primary hepato-biliary malignancy. The majority of patients with primary hepatic tumors are not suitable candidates for resection, due to advanced stage of the disease at presentation, anatomic limitations and medical comorbidities. At present, radiofrequency ablation (RFA) may offer an alternative, feasible and safe therapy for selected patients with hepatic tumors, who are not otherwise candidates for hepatic resection. Herein, we present the case of successful RFA in a patient with a solitary, primary intrahepatic cholangiocarcinoma. The patient remained free of disease 24 mo after the procedure, and is still followed up. This is the first report of RFA application inthe treatment of primary intrahepatic cholangiocarcinoma.

  9. Diets based on virgin olive oil or fish oil but not on sunflower oil prevent age-related alveolar bone resorption by mitochondrial-related mechanisms.

    Directory of Open Access Journals (Sweden)

    Pedro Bullon

    Full Text Available BACKGROUND/OBJECTIVES: Aging enhances frequency of chronic diseases like cardiovascular diseases or periodontitis. Here we reproduced an age-dependent model of the periodontium, a fully physiological approach to periodontal conditions, to evaluate the impact of dietary fat type on gingival tissue of young (6 months old and old (24 months old rats. METHODS/FINDINGS: Animals were fed life-long on diets based on monounsaturated fatty acids (MUFA as virgin olive oil, n-6 polyunsaturated fatty acids (n-6PUFA, as sunflower oil, or n-3PUFA, as fish oil. Age-related alveolar bone loss was higher in n-6PUFA fed rats, probably as a consequence of the ablation of the cell capacity to adapt to aging. Gene expression analysis suggests that MUFA or n-3PUFA allowed mitochondria to maintain an adequate turnover through induction of biogenesis, autophagy and the antioxidant systems, and avoiding mitochondrial electron transport system alterations. CONCLUSIONS: The main finding is that the enhanced alveolar bone loss associated to age may be targeted by an appropriate dietary treatment. The mechanisms involved in this phenomenon are related with an ablation of the cell capacity to adapt to aging. Thus, MUFA or n-3PUFA might allow mitochondrial maintaining turnover through biogenesis or autophagy. They might also be able to induce the corresponding antioxidant systems to counteract age-related oxidative stress, and do not inhibit mitochondrial electron transport chain. From the nutritional and clinical point of view, it is noteworthy that the potential treatments to attenuate alveolar bone loss (a feature of periodontal disease associated to age could be similar to some of the proposed for the prevention and treatment of cardiovascular diseases, a group of pathologies recently associated with age-related periodontitis.

  10. Intrahepatic cholestasis of pregnancy: When should you look further?

    NARCIS (Netherlands)

    Hardikar, W.; Kansal, S.; Oude Elferink, R.P.J.; Angus, P.

    2009-01-01

    Pruritis with abnormal liver function tests is the classical presentation of intrahepatic cholestasis of pregnancy (ICP), a condition associated with significant fetal complications. Although the etiology of ICP is unclear in many cases, certain features of the clinical presentation should alert the

  11. Intrahepatic cholestasis of pregnancy: When should you look further?

    NARCIS (Netherlands)

    Hardikar, W.; Kansal, S.; Oude Elferink, R.P.J.; Angus, P.

    2009-01-01

    Pruritis with abnormal liver function tests is the classical presentation of intrahepatic cholestasis of pregnancy (ICP), a condition associated with significant fetal complications. Although the etiology of ICP is unclear in many cases, certain features of the clinical presentation should alert the

  12. Calcified Klatskin tumor mimicking intrahepatic stone: case report.

    Science.gov (United States)

    Park, H S; Han, J K; Lee, H S; Lee, K H; Kim, S H; Kim, K W; Kim, Y J; Kim, H-C; Choi, B I

    2005-01-01

    Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man.

  13. An Exceptional Case of Spontaneous Fistulization of an Intrahepatic ...

    African Journals Online (AJOL)

    ADMIN

    larger intrahepatic ducts Caroli's disease develops.But, when the entire ... Biliary cysts are associated with significant complications such as stone formation, cholangitis, secondary biliary .... Caroli's disease usually remains asymptomatic during the first 20 years, and may also remain ... Though not common, spontaneous.

  14. Iron Deficiency Impairs Intra-Hepatic Lymphocyte Mediated Immune Response.

    Directory of Open Access Journals (Sweden)

    Eliano Bonaccorsi-Riani

    Full Text Available Hepatic expression of iron homeostasis genes and serum iron parameters predict the success of immunosuppression withdrawal following clinical liver transplantation, a phenomenon known as spontaneous operational tolerance. In experimental animal models, spontaneous liver allograft tolerance is established through a process that requires intra-hepatic lymphocyte activation and deletion. Our aim was to determine if changes in systemic iron status regulate intra-hepatic lymphocyte responses. We used a murine model of lymphocyte-mediated acute liver inflammation induced by Concanavalin A (ConA injection employing mice fed with an iron-deficient (IrDef or an iron-balanced diet (IrRepl. While the mild iron deficiency induced by the IrDef diet did not significantly modify the steady state immune cell repertoire and systemic cytokine levels, it significantly dampened inflammatory liver damage after ConA challenge. These findings were associated with a marked decrease in T cell and NKT cell activation following ConA injection in IrDef mice. The decreased liver injury observed in IrDef mice was independent from changes in the gut microflora, and was replicated employing an iron specific chelator that did not modify intra-hepatic hepcidin secretion. Furthermore, low-dose iron chelation markedly impaired the activation of isolated T cells in vitro. All together, these results suggest that small changes in iron homeostasis can have a major effect in the regulation of intra-hepatic lymphocyte mediated responses.

  15. Coenzyme Q in pregnant women and rats with intrahepatic cholestasis.

    Science.gov (United States)

    Martinefski, Manuela R; Contin, Mario D; Rodriguez, Myrian R; Geréz, Estefanía M; Galleano, Mónica L; Lucangioli, Silvia E; Bianciotti, Liliana G; Tripodi, Valeria P

    2014-08-01

    Intrahepatic cholestasis of pregnancy is a high-risk liver disease given the eventual deleterious consequences that may occur in the foetus. It is accepted that the abnormal accumulation of hydrophobic bile acids in maternal serum are responsible for the disease development. Hydrophobic bile acids induce oxidative stress and apoptosis leading to the damage of the hepatic parenchyma and eventually extrahepatic tissues. As coenzyme Q (CoQ) is considered an early marker of oxidative stress in this study, we sought to assess CoQ levels, bile acid profile and oxidative stress status in intrahepatic cholestasis. CoQ, vitamin E and malondialdehyde were measured in plasma and/or tissues by HPLC-UV method whereas serum bile acids by capillary electrophoresis in rats with ethinyl estradiol-induced cholestasis and women with pregnancy cholestasis. CoQ and vitamin E plasma levels were diminished in both rats and women with intrahepatic cholestasis. Furthermore, reduced CoQ was also found in muscle and brain of cholestatic rats but no changes were observed in heart or liver. In addition, a positive correlation between CoQ and ursodeoxycholic/lithocholic acid ratio was found in intrahepatic cholestasis suggesting that increased plasma lithocholic acid may be intimately related to CoQ depletion in blood and tissues. Significant CoQ and vitamin E depletion occur in both animals and humans with intrahepatic cholestasis likely as the result of increased hydrophobic bile acids known to produce significant oxidative stress. Present findings further suggest that antioxidant supplementation complementary to traditional treatment may improve cholestasis outcome. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Idiopathic non-cirrhotic intrahepatic portal hypertension: common cause of cryptogenic intrahepatic portal hypertension in a Southern Indian tertiary hospital.

    Science.gov (United States)

    Madhu, Kadiyala; Avinash, Balekuduru; Ramakrishna, Banumathi; Eapen, C E; Shyamkumar, N K; Zachariah, Uday; Chandy, George; Kurian, George

    2009-01-01

    Patients with intrahepatic portal hypertension and negative etiological work-up for liver disease are often labeled as having cryptogenic cirrhosis. The aim of this study was to evaluate causes of liver disease in patients with unexplained intrahepatic portal hypertension. We retrospectively analyzed cause of liver disease in all patients with cryptogenic intrahepatic portal hypertension who underwent liver biopsies between June 2005 to June 2007 in our center. Five hundred and seventeen patients underwent liver biopsies of whom 227 had portal hypertension. Of these, the cause of liver disease could not be detected prior to liver biopsy in 62 patients. Causes of liver disease identified after liver biopsy in these 62 patients were: idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH) (30 patients, 48%), cirrhosis (14), fatty liver disease (7) and other causes (11). Initial presentations in idiopathic NCIPH patients were splenomegaly and anemia (18 patients), variceal bleed (9) and ascites (3). Median age (range) of patients at first presentation was 32 (15-57) years, and 19 were male. Majority (90%) were in Child's class A. Hepatic vein pressure gradient was <5 mmHg in 2 of 7 NCIPH patients tested. We identified 30 patients with idiopathic NCIPH at our center over the 2 year study period. The clinical presentation and investigations of NCIPH closely mimic cryptogenic cirrhosis. Idiopathic NCIPH should be considered as a differential diagnosis of cryptogenic cirrhosis in India.

  17. 不同骨胶原蛋白的黏度特性研究%Study on viscosity of fish bone collagen

    Institute of Scientific and Technical Information of China (English)

    胡建平

    2011-01-01

    In this paper,four kinds of fish bone collagen as a raw material for the extraction and initial purification,through the characteristics of protein-determination of hydroxyproline to determine the content of collagen,and collagen extracted to the nature o%对4种鱼骨进行胶原蛋白提取与纯化,对羟脯氨酸含量测定确定胶原蛋白含量,对胶原蛋白的黏度进行研究。结果表明:4种鱼骨胶原蛋白分子量主要分布均在80.0ku以上,增大胶原蛋白溶液浓度和添加10%以内丙三醇和乙醇都能使胶原蛋白溶液黏度增加;pH对胶原蛋白的黏度影响很大,pH4时,黏度最大;NaC1和CaC12的存在都会引起胶原蛋白溶液黏度下降。

  18. Immunological basis in the pathogenesis of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Larson, Spencer P; Kovilam, Oormila; Agrawal, Devendra K

    2016-01-01

    Intrahepatic cholestasis of pregnancy poses a great risk to both maternal and fetal health. Despite extensive research, much of the pathogenesis of this disorder is unknown. The increase in bile acids observed in patients with intrahepatic cholestasis of pregnancy has been noted to cause a change in the immune system from the normally mediated TH2 response to one that is more oriented towards TH1. In this literature review, we have critically reviewed the current literature regarding the changes in the immune system and the potential effects of immunological changes in the management of the patient. The current treatment, ursodeoxycholic acid, is also discussed along with potential combination therapies and future directions for research.

  19. Intrahepatic Duct Stones Harboring Ascariasis Ova: A Case Report.

    Science.gov (United States)

    Lee, Chen-Fang; Lee, Wei-Chen; Wu, Ren-Chin; Chen, Tse-Ching

    2016-03-01

    Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication-hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.

  20. Septic candidasis with intrahepatic cholestasis and immunoglobuline deficiency after renal transplantation.

    Science.gov (United States)

    Zazgornik, J; Schmidt, P; Kopsa, H; Fill, W; Deutsch, E

    1975-10-01

    Two renal allograft recipients with acquired immunoglobulin deficiency had a disseminated infection with candida albicans. Septic fever, intrahepatic cholestasis and pulmonary mycotic disease were the prominent clinical symptoms. Recurrence of septic fever during the clinical course was associated with increase of intrahepatic cholestasis. On the other hand there was an amelioration of cholestasis when effective antimycotic therapy was instituted. In our patients there was no evidence that intrahepatic cholestasis was drug-related. It was assumed that toxic metabolits of candida albicans were responsible for intrahepatic cholestasis.

  1. Primary amyloidosis presenting intrahepatic cholestasis and fulminant hepatic failure

    Directory of Open Access Journals (Sweden)

    Ozturk Ates

    2015-06-01

    Full Text Available A 69-year-old man noticed abdominal pain located on right upper quadrant. Physical examination showed hepatosplenomegaly and icteric discoloration of sclera. On evaluation, patient was diagnosed to have hepatic amyloidosis related monoclonal gammopathy of undetermined significance (MGUS and sinusoidal obstruction syndrome with intrahepatic cholestasis. In this case report we emphasize fulminant hepatic failure due to primer amyloidosis in diagnosed with MGUS patient.

  2. Intrahepatic cholestasis of pregnancy: a critical clinical review.

    Science.gov (United States)

    Gabzdyl, Elizabeth M; Schlaeger, Judith M

    2015-01-01

    Intrahepatic cholestasis of pregnancy is the most common liver disease of pregnancy. It is characterized by pruitus, elevated levels of maternal serum bile salts, and normal or mildly elevated liver enzymes occurring after 30 weeks of pregnancy. The primary risks associated with this condition include preterm delivery, meconium-stained amniotic fluid, and stillbirth. Management of intrahepatic cholestasis of pregnancy utilizes a 2-prong approach of oral medications and comfort measures along with active management close to term. The goal of active management has been to deliver women between 37 and 39 weeks of gestation in order to prevent the risk of stillbirth. Currently, expert opinions vary as to recommendations for fetal surveillance and induction of labor. Controversy exists as to whether there is an increased incidence of stillbirth between 37 and 39 weeks of gestation. This critical clinical review is a comprehensive overview of intrahepatic cholestasis of pregnancy, including background, controversies, and care of the pregnant woman with this condition and how to provide appropriate follow-up care later after delivery.

  3. Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yu Mingan [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Liang Ping, E-mail: Liangping301@hotmail.com [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Yu Xiaoling; Cheng Zhigang; Han Zhiyu; Liu Fangyi; Yu Jie [Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China)

    2011-11-15

    Objective: To evaluate the efficacy and safety of sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma. Materials and methods: From May 2006 to March 2010, 15 patients (11 men, 4 women; mean age, 57.4 years) with 24 histologically proven intrahepatic primary cholangiocarcinoma lesions (mean tumor size, 3.2 {+-} 1.9 cm; range, 1.3-9.9 cm) were treated with microwave ablation. Results: Thirty-eight sessions were performed for 24 nodules in 15 patients. The follow-up period was 4-31 months (mean, 12.8 {+-} 8.0 months). The ablation success rate, the technique effectiveness rate, and the local tumor progression rate were 91.7% (22/24), 87.5% (21/24), and 25% (6/24) respectively according to the results of follow-up. The cumulative overall 6, 12, 24 month survival rates were 78.8%, 60.0%, and 60.0%, respectively. Major complication occurred including liver abscess in two patients (13.3%) and needle seeding in one patient (6.7%). Both complications were cured satisfied with antibiotic treatment combined to catheter drainage for abscess and resection for needle seeding. The minor complications and side effects were experienced by most patients which subsided with supportive treatment. Conclusion: Microwave ablation can be used as a safe and effective technique to treat intrahepatic primary cholangiocarcinoma.

  4. Mandarin Fish and Fine Fried Noodles

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    Ingredients: one mandarin fish, shredded scallion and ginger, cooking wine, ground pepper, corn starch, salt and flour. Direction: 1. Scale and clean the fish. Remove the skin and bones. Cut the fish meat into slivers. Add shredded scallion and ginger, cooking wine, ground pepper and salt to the fish

  5. Intrahepatic Pseudoaneurysms Complicating Transjugular Liver Biopsy in Liver Transplantation Patients: Three Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Seung Won; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Sung, Kyu Bo [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    An intrahepatic pseudoaneurysm is a rare complication following transjugular liver biopsy. Transarterial embolization is considered a safe and effective treatment for treating pseudoaneurysms. Herein we report three cases of intrahepatic pseudoaneurysms following transjugular liver biopsies. The three pseudoaneurysms were managed by the following methods: transarterial embolization, percutaneous transhepatic embolization, and close observation

  6. Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Vural Yilmaz, Zehra; Gencosmanoglu Turkmen, Gulenay; Daglar, Korkut; Yılmaz, Elif; Kara, Ozgur; Uygur, Dilek

    2017-01-01

    Intrahepatic cholestasis of pregnancy is the most common pregnancy specific liver disease and related with adverse maternal and perinatal outcome. Red blood cell distribution width, an anisocytosis marker in a complete blood count, has been used as an inflammation marker in various diseases. However the association of red blood cell distribution width with intrahepatic cholestasis of pregnancy is unknown. We aimed to evaluate the relationship between red blood cell distribution width and intrahepatic cholestasis of pregnancy. Ninety pregnant women with intrahepatic cholestasis of pregnancy and ninety healthy pregnant women were included in the study. Their clinical and laboratory characteristics including red blood cell distribution width, liver function tests, fasting and postprandial bile acid concentrations were analyzed. Serum red blood cell distribution width cell levels were significantly higher in pregnants with intrahepatic cholestasis of pregnancy than healthy pregnants. We also demonstrated that red blood cell distribution Width levels were higher in severe disease than mild disease and was significantly correlated with fasting and postprandial bile acid concentration in intrahepatic cholestasis of pregnancy group. Our study showed that red blood cell distribution width, an easy and inexpensive marker; were associated with intrahepatic cholestasis of pregnancy and can be used as a diagnostic and prognostic marker in intrahepatic cholestasis of pregnancy.

  7. Impaired fetal myocardial deformation in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Fan, Xuemei; Zhou, Qichang; Zeng, Shi; Zhou, Jiawei; Peng, Qinghai; Zhang, Ming; Ding, Yiling

    2014-07-01

    To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy. Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10-40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT-proBNP were analyzed. Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT-proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (-10.56% ± 1.83% versus -18.36% ± 1.11%; P cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes. © 2014 by the American Institute of Ultrasound in Medicine.

  8. Mucins and NCAM (CD56 in intrahepatic cholangiocarcinogenesis

    Directory of Open Access Journals (Sweden)

    Anna Beatriz Telles Esperança

    2014-06-01

    Full Text Available Introduction: Cholangiocarcinoma is the second most common malignant neoplasm of the hepatobiliary system. During cholangiocarcinogenesis phenotypic changes occur in the ductal epithelium, including the expression of mucins (MUC. However, the evaluating studies of the expression of mucins in the different stages of cholangiocarcinogenesis are scarce. CD56 has also contributed in differentiating benign ductal proliferation and cholangiocarcinoma; however, its expression has not been evaluated in dysplastic epithelium of the bile duct yet. Objective: To assess immunohistochemical profile of (MUC 1, 2, 5, 6, and CD56 in cholangiocarcinoma, pre-neoplastic and reactive lesions in the epithelium of intrahepatic bile ducts. Material and methods: Immunohistochemical expression of MUC 1, 2, 5, 6, and CD56 were studied for 11 cases of cholangiocarcinoma and 83 intrahepatic bile ducts (67 reactive and 16 dysplastic. Variables were considered significant when p < 0.05. Results: The expression of MUC1 occurred in about 90% of the cholangiocarcinomas, contrasting with the low frequency of positive cases in reactive and dysplastic bile ducts (p < 0.001. However, there was no statistically significant difference in the expression of MUC5, MUC6 and CD56 between the reactive or dysplastic lesions and cholangiocarcinoma. The anti-MUC2 antibody was negative in all cases. Conclusions: MUC1 contributed for the differential diagnosis between cholangiocarcinoma and pre-neoplastic and reactive/regenerative lesions of intrahepatic bile ducts, and it should compose the antibodies panel aiming at improvement of these differential diagnoses. In contrast, MUC2, MUC5, MUC6 and CD56 were not promising in differentiating all the phases of cholangiocarcinogenesis.

  9. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

    Science.gov (United States)

    Aydin, Unal; Yazici, Pinar; Coker, Ahmet

    2007-01-01

    Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

  10. Etiological and clinicopathologic characteristics of intrahepatic cholangiocarcinoma in young patients

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To investigate the prevalence,risk factors,and clinicopathologic characteristics of intrahepatic cholangiocarcinoma(ICC)in young patients.METHODS:A retrospective analysis was performed in ICC patients referred to the Eastern Hepatobiliary Surgery Hospital in Shanghai,China.Among 317 consecutively enrolled patients,40 patients were aged ≤40 years(12.61%).We compared the risk factors and clinicopathologic characteristics of these patients(groupⅠ:n=40)with those aged>40 years(group Ⅱ:n=277).RESULTS:Group I...

  11. Effects of a dietary mixture of meat and bone meal, feather meal, blood meal, and fish meal on nitrogen utilization in finishing Holstein steers.

    Science.gov (United States)

    Knaus, W F; Beermann, D H; Robinson, T F; Fox, D G; Finnerty, K D

    1998-05-01

    Our objective was to determine to what extent rate and efficiency of protein gain in finishing cattle can be enhanced by feeding an amino acid-balanced mixture of undegraded intake proteins. The Cornell Net Carbohydrate and Protein System (CNCPS) model was used to formulate a corn-based diet that would meet the rumen requirements for 410-kg large-framed steers with an estrogen implant and fed an ionophore. The CNCPS model was also used to formulate a highly undegradable intake protein (UIP) mixture from meat and bone meal, blood meal, fish meal, and hydrolyzed feather meal to provide the amino acids needed to supplement those derived from microbial protein to better meet amino acid requirements for growth. Four Holstein steers weighing 407 kg were offered a 90:10 concentrate-forage diet at hourly intervals at 95% of ad libitum intake. The steers were injected with 500 microg of estradiol-17beta at 12-h intervals to mimic the effects of an estrogenic implant. Treatments planned consisted of inclusion of the UIP mixture at 0, 2.5, 5, and 7.5% of the diet DM. Dry matter intake was fixed at 6.4 kg/d, and DM digestibility was not significantly affected by varying the amount of UIP addition. Apparent digestibility of N increased (P = .011) from 63.8 to 65.8, 70.7, and 71.5%, the amount of N absorbed increased (P = .001) from 73 to 84, 100, and 106 g/d, and N balance increased (P = .003) from 20 to 30, 33, and 39 g/d when UIP was fed at 0, 2.6, 5.2, and 7.8% of diet DM, respectively. The efficiency of N use increased 39.7%, and biological value increased 31.6% when the UIP mixture was added to the diet. Circulating concentrations of plasma urea N (PUN) were increased (P = .017) from 4.5 for the control diet to 5.7, 6.2, and 6.1 mg/dL when the UIP mixture was added at 2.6, 5.2, and 7.8%, respectively. Corresponding IGF-I concentrations were also increased from 491 to 558 and 624 ng/mL with 2.6 and 5.2% levels of UIP addition. Plasma glucose, NEFA, and insulin

  12. Fish gelatin.

    Science.gov (United States)

    Boran, Gokhan; Regenstein, Joe M

    2010-01-01

    Gelatin is a multifunctional ingredient used in foods, pharmaceuticals, cosmetics, and photographic films as a gelling agent, stabilizer, thickener, emulsifier, and film former. As a thermoreversible hydrocolloid with a narrower gap between its melting and gelling temperatures, both of which are below human body temperature, gelatin provides unique advantages over carbohydrate-based gelling agents. Gelatin is mostly produced from pig skin, and cattle hides and bones. Some alternative raw materials have recently gained attention from both researchers and the industry not just because they overcome religious concerns shared by Jews and Muslims but also because they provide, in some cases, technological advantages over mammalian gelatins. Fish skins from a number of fish species are among the other sources that have been comprehensively studied as sources for gelatin production. Fish skins have a significant potential for the production of high-quality gelatin with different melting and gelling temperatures over a much wider range than mammalian gelatins, yet still have a sufficiently high gel strength and viscosity. Gelatin quality is industrially determined by gel strength, viscosity, melting or gelling temperatures, the water content, and microbiological safety. For gelatin manufacturers, yield from a particular raw material is also important. Recent experimental studies have shown that these quality parameters vary greatly depending on the biochemical characteristics of the raw materials, the manufacturing processes applied, and the experimental settings used for quality control tests. In this review, the gelatin quality achieved from different fish species is reviewed along with the experimental procedures used to determine gelatin quality. In addition, the chemical structure of collagen and gelatin, the collagen-gelatin conversion, the gelation process, and the gelatin market are discussed.

  13. Fibroblast growth factor receptor 2 translocations in intrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Graham, Rondell P; Barr Fritcher, Emily G; Pestova, Ekaterina; Schulz, John; Sitailo, Leonid A; Vasmatzis, George; Murphy, Stephen J; McWilliams, Robert R; Hart, Steven N; Halling, Kevin C; Roberts, Lewis R; Gores, Gregory J; Couch, Fergus J; Zhang, Lizhi; Borad, Mitesh J; Kipp, Benjamin R

    2014-08-01

    Patients with cholangiocarcinoma often present with locally advanced or metastatic disease. There is a need for effective therapeutic strategies for advanced stage cholangiocarcinoma. Recently, FGFR2 translocations have been identified as a potential target for tyrosine kinase inhibitor therapies. This study evaluated 152 cholangiocarcinomas and 4 intraductal papillary biliary neoplasms of the bile duct for presence of FGFR2 translocations by fluorescence in situ hybridization and characterized the clinicopathologic features of cases with FGFR2 translocations. Thirteen (10 women, 3 men; 8%) of 156 biliary tumors harbored FGFR2 translocations, including 12 intrahepatic cholangiocarcinomas (12/96; 13%) and 1 intraductal papillary neoplasm of the bile duct. Histologically, cholangiocarcinomas with FGFR2 translocations displayed prominent intraductal growth (62%) or anastomosing tubular glands with desmoplasia (38%). Immunohistochemically, the tumors with FGFR2 translocations frequently showed weak and patchy expression of CK19 (77%). Markers of the stem cell phenotype in cholangiocarcinoma, HepPar1 and CK20, were negative in all cases. The median cancer-specific survival for patients whose tumors harbored FGFR2 translocations was 123 months compared to 37 months for cases without FGFR2 translocations (P = .039). This study also assessed 100 cholangiocarcinomas for ERBB2 amplification and ROS1 translocations. Of the cases tested, 3% and 1% were positive for ERBB2 amplification and ROS1 translocation, respectively. These results confirm that FGFR2, ERRB2, and ROS1 alterations are potential therapeutic targets for intrahepatic cholangiocarcinoma.

  14. Impaired fetal adrenal function in intrahepatic cholestasis of pregnancy

    Science.gov (United States)

    Wang, Chunfang; Chen, Xiaojun; Zhou, Shu-Feng; Li, Xiaotian

    2011-01-01

    Summary Background Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-associated liver disease of unknown etiology. The aim of this study was to investigate the change in maternal and fetal adrenal function in clinical and experimental ICP. Material/Methods The maternal and fetal serum levels of cortisol and dehydroepiandrosterone sulfate (DHEAS) were determined in 14 women with ICP and in pregnant rats with estrogen-induced intrahepatic cholestasis. Results In women with ICP, the fetal serum cortisol and DHEAS levels were significantly higher than those in women with normal pregnancy, after correcting the impact of gestational age at delivery. The relationship between fetal cortisol and maternal cholic acid levels was bidirectional; the fetal cortisol tended to increase in mild ICP, while it decreased in severe ICP. In pregnant rats with estrogen-induced cholestasis, the fetal cortisol level was significantly lower in the group with oxytocin injection, compared with the group without oxytocin injection (191.92±18.86 vs. 272.71±31.83 ng/ml, P<0.05). In contrast, the fetal cortisol concentration was increased after oxytocin injection in normal control rats. Conclusions The data indicate that fetal stress-responsive system is stimulated in mild ICP, but it is suppressed in severe ICP, which might contribute to the occurrence of unpredictable sudden fetal death. Further studies are warranted to explore the role of impaired fetal adrenal function in the pathogenesis of ICP and the clinical implications. PMID:21525808

  15. Giant Intrahepatic Portal Vein Aneurysm: Leave it or Treat it?

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagdeesh S; Nageshwar Reddy, D

    2017-03-01

    Portal vein aneurysm (PVA) is a rare vascular dilatation of the portal vein. It is a rare vascular anomaly representing less than 3% of all visceral aneurysms and is not well understood. Usually, PVA are incidental findings, are asymptomatic, and clinical symptoms are proportionally related to size. Patients present with nonspecific epigastric pain or gastrointestinal bleeding with underlying portal hypertension. PVA may be associated with various complications such as biliary tract compression, portal vein thrombosis/rupture, duodenal compression, gastrointestinal bleeding, and inferior vena cava obstruction. Differential diagnoses of portal vein aneurysms are solid, cystic, and hypervascular abdominal masses, and it is important that the radiologists be aware of their multi-modality appearance; hence, the aim of this article was to provide an overview of the available literature to better simplify various aspects of this rare entity and diagnostic appearance on different modality with available treatment options. In our case, a 55-year-old male patient came to the gastroenterology OPD for further management of pancreatitis with portal hypertension and biliary obstruction with plastic stents in CBD and PD for the same. In this article, we have reported a case of largest intrahepatic portal vein aneurysm and its management by endovascular technique. As per our knowledge, this is the largest intrahepatic portal vein aneurysm and first case where the endovascular technique was used for the treatment of the same.

  16. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  17. Fish Allergy

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old Fish Allergy KidsHealth > For Parents > Fish Allergy Print A ... From Home en español Alergia al pescado About Fish Allergy A fish allergy is not exactly the ...

  18. The etiology of intrahepatic cholestasis of pregnancy: towards solving a monkey puzzle.

    Science.gov (United States)

    Webb, Gwilym J; Elsharkawy, Ahmed M; Hirschfield, Gideon M

    2014-01-01

    Clinical and epidemiological findings implicate genetic predisposition and the effects of elevated steroids in pregnancy in the pathogenesis of intrahepatic cholestasis of pregnancy. To date, a number of studies have identified polymorphisms encoding biliary canalicular transporters, including those encoded by ABCB4 and ABCB11, which are associated with intrahepatic cholestasis of pregnancy. Questions remain regarding divergent findings between populations and the relative contributions of these polymorphisms. In a large study of Western European women with intrahepatic cholestasis of pregnancy, Dixon et al. (this issue) provide further insights into the genetics of this cholestatic syndrome, which contribute to ongoing evaluation of cholestasis generally.

  19. Intrahepatic portosystemic venous shunts: diagnosis by Doppler ultrasound; Cortocircuitos venosos portosistemicos intrahepaticos: diagnostico mediante ecografia Doppler

    Energy Technology Data Exchange (ETDEWEB)

    Garofano, M. P.; Medina, A.; Lopez, G.; Garrido, C. [Hospital Universitario Virgen de las Nieves. Granada (Spain)

    2001-07-01

    Intrahepatic portosystemic venous shunts are venous vascular lesions that allow intrahepatic portal vessels to communicate with hepatic veins. They may present in patients with portal hypertension or b discovered incidentally; it is considered that the latter may be congenital or acquired. A noninvasive methods. Doppler ultrasound aids in the diagnosis of these anomalous communications by providing images of the vessels and the direction, velocity and volume of the blood flow through the shunt. We present four cases of intrahepatic portosystemic venous shunt. (Author) 8 refs.

  20. [Study on the relationship between prenatal monitoring index in intrahepatic cholestasis of pregnancy and perinatal prognosis].

    Science.gov (United States)

    Lu, Junling; Kuang, Jingxia; Cheng, Xiaolin

    2014-11-01

    To investigate the association between prenatal monitoring index in intrahepatic cholestasis of pregnancy and the perinatal prognosis, as well as the characteristics of perinatal situations. A retrospective study on the clinical data of 88 cases intrahepatic cholestasis of pregnancy and prognosis that were treated in our hospital from Jan. 2011 to Jan. 2014 was carried out. Relationship between prenatal monitoring index in intrahepatic cholestasis of pregnancy and perinatal prognosis, together with the epidemiological features of infants were analyzed. The incidence rates of perinatal meconium stained amniotic fluid, asphyxia neonatorum, premature and fetal distress were significantly higher in the study group than those in the controls, with differences statistically significant (P intrahepatic cholestasis of pregnancy, with most frequently seen as meconium stained amniotic fluid. It was necessary to monitor the level of prenatal CG, ALT, AST, TBIL and TBA in puerperant in predicting the perinatal prognosis.

  1. Three-dimensional reconstructions of intrahepatic bile duct tubulogenesis in human liver

    DEFF Research Database (Denmark)

    Vestentoft, Peter S; Jelnes, Peter; Hopkinson, Branden M

    2011-01-01

    biliary tree forms through several developmental stages involving an initial transition of primitive hepatocytes into cholangiocytes shaping the ductal plate followed by a process of maturation and remodeling where the intrahepatic biliary tree develops through an asymmetrical form of cholangiocyte...

  2. Transcriptomic and histopathological analysis of cholangiolocellular differentiation trait in intrahepatic cholangiocarcinoma

    DEFF Research Database (Denmark)

    Rhee, Hyungjin; Ko, Jung Eun; Chung, Taek

    2017-01-01

    BACKGROUND & AIMS: Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous entity with diverse etiologies, morphologies, and clinical outcomes. Recently, histopathological distinction of cholangiolocellular differentiation (CD) of iCCA has been suggested. However, its genome-wide molecular feat...

  3. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment

    Directory of Open Access Journals (Sweden)

    Satoshi Yasuda

    2015-01-01

    Conclusion: Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis.

  4. Simultaneous intrahepatic and subgaleal hemorrhage in antiphospholipid syndrome following anticoagulation therapy.

    Science.gov (United States)

    Park, In-Chul; Baek, Yang-Hyun; Han, Sang-Young; Lee, Sung-Wook; Chung, Won-Tae; Lee, Sung-Won; Kang, Sang-Hyeon; Cho, Duk-Song

    2013-10-14

    Warfarin is a widely used anticoagulant. Interindividual differences in drug response, a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically. An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis. Six years later, she developed right flank pain. We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy. After stopping oral anticoagulation, a follow-up computed tomography showed improvement in the hemorrhage. After restarting warfarin because of a recurrent thrombosis, the intrahepatic hemorrhage recurred. We decided to start clopidogrel and hydroxychloroquine instead of warfarin. The patient has not developed further recurrent thrombotic or bleeding episodes. Intrahepatic hemorrhage is a very rare complication of warfarin, and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.

  5. Cardiac and renal effects of a transjugular intrahepatic portosystemic shunt in cirrhosis

    DEFF Research Database (Denmark)

    Busk, Troels M; Bendtsen, Flemming; Møller, Søren

    2013-01-01

    Refractory ascites and recurrent variceal bleeding are among the serious complications of portal hypertension and cirrhosis for which a transjugular intrahepatic portosystemic shunt (TIPS) can be used. Cirrhotic patients have varying degrees of haemodynamic derangement, mainly characterized...

  6. Intrahepatic cholestasis of pregnancy: When should you look further?

    Institute of Scientific and Technical Information of China (English)

    Winita Hardikar; Shivani Kansal; Ronald P J Oude Elferink; Peter Angus

    2009-01-01

    Pruritis with abnormal liver function tests is the classical presentation of intrahepatic cholestasis of pregnancy (ICP), a condition associated with significant fetal complications. Although the etiology of ICP is unclear in many cases, certain features of the clinical presentation should alert the practitioner to the possibility of an underlying metabolic defect,which may not only affect subsequent pregnancies,but may be an indicator of more serious subsequent liver disease. We report a kindred of Anglo-Celtic descent, among whom many members present with ICP, gallstones or cholestasis related to use of oral contraception. Genetic studies revealed a novel mutation in the ABCB4 gene, which codes for a phospholipid transport protein. The clinical significance of this mutation and the importance of identifying such patients are discussed.

  7. A clinical approach to intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Diken, Zaid; Usta, Ihab M; Nassar, Anwar H

    2014-01-01

    Intrahepatic cholestasis of pregnancy (ICP) has a varying prevalence worldwide. The etiology behind this disease remains not fully understood with multiple factors influencing its development including genetic variations, dietary factors, hormonal changes, and environmental influences. Presenting mainly during the third trimester with generalized itching and resolving spontaneously postpartum, this condition is still associated with fetal morbidity and mortality. The diagnosis is based on clinical presentation in association with biochemical abnormalities. Elevation in total bile acid levels is the most frequent laboratory abnormality and seems to be the most important for gauging further management of the disease. The most appropriate gestational age for the delivery of women with ICP is yet to be determined. In this review we discuss the epidemiology, clinical features, diagnosis, etiology, and management of ICP, trying to shed light on some controversial aspects of the disease.

  8. Bile peritonitis due to intra-hepatic bile duct rupture.

    Science.gov (United States)

    Lochan, R; Joypaul, B V

    2005-11-14

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one. We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

  9. The molecular genetics of intrahepatic cholestasis of pregnancy

    Science.gov (United States)

    Dixon, P H; Williamson, C

    2008-01-01

    Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, causes maternal pruritus and liver impairment, and may be complicated by spontaneous preterm labour, fetal asphyxial events and intrauterine death. Our understanding of the aetiology of this disease has expanded significantly in the last decade due to a better understanding of the role played by genetic factors. In particular, advances in our knowledge of bile homeostasis has led to the identification of genes that play a considerable role in susceptibility to ICP. In this review we consider these advances and discuss the disease in the context of bile synthesis and metabolism, focusing on the genetic discoveries that have shed light on the molecular aetiology and pathophysiology of the condition. PMID:27582788

  10. Rifampicin in the treatment of severe intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Geenes, Victoria; Chambers, Jenny; Khurana, Rshmi; Shemer, Elisabeth Wikstrom; Sia, Winnie; Mandair, Dalvinder; Elias, Elwyn; Marschall, Hanns-Ulrich; Hague, William; Williamson, Catherine

    2015-06-01

    To describe the use of combined ursodeoxycholic acid (UDCA) and rifampicin treatment in intrahepatic cholestasis of pregnancy (ICP). A questionnaire survey of 27 women with 28 affected pregnancies identified via the UK and International Obstetric Medicine forum. The clinical case notes of women with ICP treated with combined UDCA and rifampicin therapy were reviewed, and data regarding maternal and perinatal outcomes extracted. Serum bile acids remained high whilst taking UDCA as monotherapy. In 14 pregnancies (54%) serum bile acids decreased following the introduction of rifampicin. In 10 pregnancies (38%), there was a 50% reduction in serum bile acids. There were no adverse effects reported with either drug. This is the first report of the use of rifampicin in ICP. The data suggest that combined treatment with UDCA and rifampicin is an effective way of treating women with severe ICP who do not respond to treatment with UDCA alone. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. [INTRAHEPATIC CHOLESTASIS OF PREGNANCY: STATE-OF-THE-ART].

    Science.gov (United States)

    Maev, I V; Andreev, D N; Dicheva, D T; Kaznacheeva, T V

    2015-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a relatively benign cholestatic pathology of the liver developing in II or III trimester of pregnancy and characterized by itchy skin and enhanced serum bile acid levels. The cause of ICP is unknown; it may have a multifactor nature involving genetic (ABCB4, EXR, ABCC2 genes), hormonal (estrogens, progesterone), and environmental factors. As a rule, ICP first manifests itself on weeks 28-30 of pregnancy in the form of pruritus especially pronounced at night time. Almost half of the patients develop jaundice, usually within 1-4 weeks after appearance of pruritus. The enhanced serum bile acid level is sometimes the first or the sole laboratory sign of the disease. Ursodeoxycholic acid is currently the drug of choice for the treatment of ICP due to its confirmed effectiveness and safety.

  12. Evaluation of ventricular repolarization in pregnant women with intrahepatic cholestasis.

    Science.gov (United States)

    Kirbas, Ozgur; Biberoglu, Ebru Hacer; Kirbas, Ayse; Daglar, Korkut; Kurmus, Ozge; Danisman, Nuri; Biberoglu, Kutay

    2015-01-01

    Bile acids can induce arrhythmia by altering cardiomyocyte contractility or electrical conduction. The aim of this study was to investigate, by means of QT dispersion parameter detected by simple standard electrocardiogram (ECG), ventricular repolarization changes in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP). In this case-control study including 75 pregnant women with cholestasis and 35 healthy, uncomplicated pregnancy cases, electrocardiographic QT interval durations and QT dispersion (QT-disp) parameters, corrected for the patients' heart rate using the Hodges formula, were investigated. Maximum corrected QT interval values were significantly higher in the severe ICP group than in the control group (p cholestasis when compared to the normal ones. This simple ECG parameter can be used to screen high-risk women, in order to better target counseling regarding lifestyle modifications and to conduct closer follow up and management of women with a history of ICP. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Intrahepatic cholestasis of pregnancy: When should you look further?

    Science.gov (United States)

    Hardikar, Winita; Kansal, Shivani; Elferink, Ronald P J Oude; Angus, Peter

    2009-01-01

    Pruritis with abnormal liver function tests is the classical presentation of intrahepatic cholestasis of pregnancy (ICP), a condition associated with significant fetal complications. Although the etiology of ICP is unclear in many cases, certain features of the clinical presentation should alert the practitioner to the possibility of an underlying metabolic defect, which may not only affect subsequent pregnancies, but may be an indicator of more serious subsequent liver disease. We report a kindred of Anglo-Celtic descent, among whom many members present with ICP, gallstones or cholestasis related to use of oral contraception. Genetic studies revealed a novel mutation in the ABCB4 gene, which codes for a phospholipid transport protein. The clinical significance of this mutation and the importance of identifying such patients are discussed. PMID:19266607

  14. Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems

    Science.gov (United States)

    Kondrackiene, Jurate; Kupcinskas, Limas

    2008-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder. Maternal effects of ICP are mild; however, there is a clear association between ICP and higher frequency of fetal distress, preterm delivery, and sudden intrauterine fetal death. The cause of ICP remains elusive, but there is evidence that mutations in genes encoding hepatobiliary transport proteins can predispose for the development of ICP. Recent data suggest that ursodeoxycholic acid is currently the most effective pharmacologic treatment, whereas obstetric management is still debated. Clinical trials are required to identify the most suitable monitoring modalities that can specifically predict poor perinatal outcome. This article aims to review current achievements and unsolved problems of ICP. PMID:18855975

  15. Intrahepatic cholestasis in subclinical and overt hyperthyroidism: two case reports

    Directory of Open Access Journals (Sweden)

    Soylu Aliye

    2008-04-01

    Full Text Available Abstract Introduction Non-specific abnormalities in liver function tests might accompany the clinical course of hyperthyroidism. Hyperthyroidism can cause the elevation of hepatic enzymes and bilirubin. Jaundice is rare in overt hyperthyroidism, especially in subclinical hyperthyroidism. On the other hand, the use of anti-thyroid drugs has rarely been associated with toxic hepatitis and cholestatic jaundice. Case presentation Here we present two cases of cholestasis that accompanied two distinct forms of clinical hyperthyroidism. The first patient had a clinical presentation of severe cholestasis in the absence of congestive failure related to hyperthyroidism. The second case had developed intrahepatic cholestasis in the presence of subclinical hyperthyroidism, and improved with rifampicin treatment. Conclusion Hyperthyroidism should be a consideration in non-specific liver dysfunction.

  16. Bile peritonitis due to intra-hepatic bile duct rupture

    Institute of Scientific and Technical Information of China (English)

    R Lochan; BV Joypaul

    2005-01-01

    Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

  17. Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems

    Institute of Scientific and Technical Information of China (English)

    Jurate Kondrackiene; Limes Kupcinskas

    2008-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-related liver disorder. Maternal effects of ICP are mild; however, there is a clear association between ICP and higher frequency of fetal distress, preterm delivery, and sudden intrauterine fetal death. The cause of ICP remains elusive, but there is evidence that mutations in genes encoding hepatobiliary transport proteins can predispose for the development of ICP. Recent data suggest that ursodeoxycholic acid is currently the most effective pharmacologic treatment, whereas obstetric management is still debated. Clinical trials are required to identify the most suitable monitoring modalities that can specifically predict poor perinatal outcome. This article aims to review current achievements and unsolved problems of ICP.

  18. The miRNAome of Opisthorchis viverrini induced intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Jin Peng

    2014-12-01

    Full Text Available Intrahepatic cholangiocarcinoma (ICC is an aggressive cancer, arising in the biliary ducts that extend into the liver. The highest incidence of ICC occurs in Southeast Asia, particularly in the Mekong River Basin countries of Thailand, Laos, Cambodia, and Vietnam, where it is strongly associated with chronic infection by the food-borne liver fluke Opisthorchis viverrini (OV, one of only three eukaryote pathogens considered Group one carcinogens. Intrahepatic cholangiocarcinoma is usually diagnosed at an advanced stage, with a poor prognosis and survival often less than 24 months. Hence, biomarkers that enable the early detection of ICC would be desirable and have a potentially important impact on the public health in the resource-poor regions where this cancer is most prevalent. As microRNAs (miRNAs remain well preserved after formalin fixation, there is much interest in developing them as biomarkers that can be investigated using tumor biopsy samples preserved in formalin fixed paraffin embedded (FFPE tumor blocks. Recently, we reported the first comprehensive profiling of tissue-based miRNA expression using FFPE from the three most common subtypes of OV-induced ICC tumors: moderately differentiated ICC, papillary ICC, and well-differentiated ICC. We observed that each subtype of OV-induced ICC exhibited a distinct miRNA profile, which suggested the involvement of specific sets of miRNAs in the progression of this cancer. In addition, non-tumor tissue adjacent to ICC tumor tissue on the same FFPE block shared a similar miRNA dysregulation profile with the tumor tissue than with normal (non-tumor liver tissue (individuals without ICC or OV infection. Herein, we provide a detailed description of the microarray analysis procedures used to derive these findings.

  19. Clinicopathological Characteristics and Prognostic Factors of Intrahepatic Biliary Cystadenocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Ming-Yue Xu; Xian-Jie Shi; Tao Wan; Yu-Rong gang; Hong-Guang Wang; Wen-Zhi Zhang; Lei He

    2015-01-01

    Background:Surgical resection is generally considered the main curative treatment for intrahepatic biliary cystadenocarcinoma (IBCA) or suspected IBCAs,but controversy exists regarding the prognosis for IBCAs.This study aimed to describe the clinicopathological characteristics of IBCA and identify prognostic factors that may influence the survival of patients treated with surgical procedures.Methods:Thirty-four patients with histologically confirmed IBCA treated between January 2000 and June 2014 were included.The clinical characteristics of patients with IBCA were compared with those of 41 patients with intrahepatic biliary cystadenoma (IBC);factors that significant difference were analyzed for prognosis analysis of IBCA using multivariate/univariate Cox proportional hazards regression models.Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.Results:IBCAs had a strong female predominance,and the most common presenting symptoms were abdominal pain or discomfort.Compared with IBCs,IBCAs occurred in older patients,in more male patients,and were associated statistically significant abnormal increase in alanine aminotransferase (P =0.01) and total bilirubin (P =0.04).Mural nodules were more frequently seen with IBCAs and may associate with malignancy.It was difficult to differentiate between IBC and IBCA based on laboratory examination and imaging findings.Although complete resection is recommended,enucleation with negative margins also achieved good outcomes.Median overall patient survival was 76.2 months;survival at 1,3,and 5 years was 88.0%,68.7%,and 45.8%,respectively.Radical resection and noninvasive tumor type were independent prognostic factors for overall survival.Conclusions:It remains difficult to distinguish between cystadenomas and cystadenocarcinomas based on laboratory examination and image findings.Complete resection is recommended for curative treatment,and patients should be closely followed

  20. Is Hepatectomy Necessary in Dealing with Left Hepatolithiasis with Intrahepatic Duct Stricture?

    Directory of Open Access Journals (Sweden)

    Dominique Franco

    1997-01-01

    Full Text Available Background: Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Hepatic resection has recently been advocated as one of the treatment modalities for hepatolithiasis; however, this procedure is not without risk. This study was designed to achieve complete clearance of the stones, eliminate bile stasis, and avoid the potential risks of hepatic resection in the patient with hepatolithiasis and intrahepatic biliary stricture.

  1. Review to better understand the macroscopic subtypes and histogenesis of intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Yuichi; Sanada; Yujo; Kawashita; Satomi; Okada; Takashi; Azuma; Shigetoshi; Matsuo

    2014-01-01

    Intrahepatic cholangiocarcinoma is macroscopically classified into three subtypes, mass-forming-type, periductal infiltrating-type, and intraductal growth-type. Each subtype should be preoperatively differentiated to perform the valid surgical resection. Recent researches have revealed the clinical, radiologic, pathobiological characteristics of each subtype. We reviewed recently published studies covering various aspects of intrahepatic cholangiocarcinoma(ICC), focusing especially on the macroscopic subtypes and stem cell features to better understand the pathophysiology of ICC and to establish the valid therapeutic strategy.

  2. Evaluation of standardized ileal digestible valine:lysine, total lysine:crude protein, and replacing fish meal, meat and bone meal, and poultry byproduct meal with crystalline amino acids on growth performance of nursery pigs from seven to twelve kilograms.

    Science.gov (United States)

    Nemechek, J E; Tokach, M D; Dritz, S S; Goodband, R D; DeRouchey, J M

    2014-04-01

    Five experiments were conducted to evaluate replacing fish meal, meat and bone meal, and poultry byproduct meal with crystalline AA for 7- to 12-kg pigs. In all experiments, pigs (PIC TR4 × 1050) were fed a common diet for 3 d postweaning, treatment diets for 14 d (d 0 to 14), and, again, a common diet for 14 d (d 14 to 28). Treatment diets were corn-soybean meal based and formulated to contain 1.30% standardized ileal digestible (SID) Lys. Experiment 1 evaluated replacing dietary fish meal with crystalline AA. For the 6 treatments, crystalline Lys, Met, Thr, Trp, Ile, Val, Gln, and Gly all increased to maintain minimum AA ratios as fish meal decreased (4.50, 3.60, 2.70, 1.80, and 0.90 to 0.00%). There was no difference in ADG, ADFI, or G:F among treatments, validating a low-CP, AA-fortified diet for subsequent experiments. Experiment 2 evaluated deleting crystalline AA from a low-CP, AA-fortified diet with 6 treatments: 1) a positive control similar to the diet validated in Exp. 1, 2) positive control with l-Ile deleted, 3) positive control with l-Trp deleted, 4) positive control with l-Val deleted, 5) positive control with l-Gln and l-Gly deleted, and 6) positive control with l-Ile, l-Trp, l-Val, l-Gln, and l-Gly deleted (NC). Pigs fed the positive control or Ile deleted diet had improved (P meal was adjusted as a source of dispensable N to achieve the target Lys:CP. There were no differences in growth performance among pigs fed different Lys:CP diets. Experiment 4 evaluated increasing SID Val:Lys with Val at 57.4, 59.9, 62.3, 64.7, 67.2, and 69.6% of Lys. Average daily gain and ADFI increased (quadratic, P meal, meat and bone meal, or poultry byproduct meal). Low- and high-crystalline AA diets contained 4.5 or 1% fish meal, 6 or 1.2% meat and bone meal, and 6 or 1% poultry byproduct meal, respectively. No AA × protein source interactions were observed. From d 0 to 14, no differences in growth performance among protein sources was found, whereas increasing

  3. Longitudinal profiles of 15 serum bile acids in patients with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Tribe, Rachel M; Dann, Anthony T; Kenyon, Anna P; Seed, Paul; Shennan, Andrew H; Mallet, Anthony

    2010-03-01

    Increased maternal serum bile acids are implicated in intrahepatic cholestasis of pregnancy. Individual bile acid profiles and their relationship with disease progression, however, remain unknown. The purpose of this prospective study was to determine the temporal changes in bile acids in normal pregnancy and in pregnancies complicated with intrahepatic cholestasis of pregnancy and pruritus gravidarum. A validated method for the evaluation of 15 bile acids (conjugated and unconjugated) in a single serum sample was developed using high-performance liquid chromatography/mass spectrometry (HPLC-MS) with an electrospray interface. Bile acid concentrations were assessed in samples (16 weeks of gestation to 4 weeks postpartum) from women with, or who later developed, intrahepatic cholestasis of pregnancy (n=63) and were compared with those from normal pregnant women (n=26) and from women with pruritus gravidarum (n=43). Intrahepatic cholestasis of pregnancy was associated with a predominant increase in cholic acid conjugated with taurine and glycine, from 24 weeks of pregnancy. Ursodeoxycholic acid (UDCA) treatment (> or =21 days, n=15) significantly reduced serum taurocholic and taurodeoxycholic acid concentrations (Ppregnancy and pregnancy associated with pruritus gravidarum. The bile acid profiles and effects of treatment by UDCA implicate a role for taurine-conjugated bile acids in the syndrome of intrahepatic cholestasis of pregnancy. [corrected] With regard to individual bile acid profiles, pruritus gravidarum is a disorder quite distinct from intrahepatic cholestasis of pregnancy.

  4. Huge hepatocellular carcinoma with multiple intrahepatic metastases: An aggressive multimodal treatment.

    Science.gov (United States)

    Yasuda, Satoshi; Nomi, Takeo; Hokuto, Daisuke; Yamato, Ichiro; Obara, Shinsaku; Yamada, Takatsugu; Kanehiro, Hiromichi; Nakajima, Yoshiyuki

    2015-01-01

    Huge hepatocellular carcinoma (HCC) possesses a potential risk for spontaneous rupture, which leads to a life-threatening complication with a high mortality rate. In addition, a large HCC is frequently accompanied by intrahepatic metastases. We describe, the case of a 74-year-old woman with a huge extrahepatically expanding HCC with multiple intrahepatic metastases who was treated by liver resection with repeated transcatheter arterial chemoembolization (TACE). To prevent tumor rupture or bleeding, we performed right hepatectomy. After the operation, TACE was applied for multiple intrahepatic metastases in the remnant liver. Furthermore, the elevated protein induced vitamin K absence (PIVKA II) level had decreased to limits within the normal range. Three months after the first TACE, computed tomography revealed several recurrences in the liver. TACE was applied for the second and third time and the tumors were well controlled. Although, liver resection is occasionally performed for patients with huge HCC to avoid spontaneous tumor rupture, only surgical approach might not be sufficient for such advanced HCC. To achieve long-term survival, it is necessary to control the residual intrahepatic tumors. We could control multiple intrahepatic metastases with repeated TACEs after hepatectomy. Multimodal treatment involving hepatectomy and TACE might be a good treatment strategy for patients with huge HCC with multiple intrahepatic metastases if the tumors are localized in the liver without distant or peritoneal metastasis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Analysis of Factors Influencing Quality of Life of Patients with Permanent Colostomy with Fish-Bone Diagram%鱼骨图对永久性肠造口人生活质量的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    汤利萍; 李乐; 王霞

    2015-01-01

    目的:运用鱼骨图分析影响肠造口人生活质量的因素,为进一步提高其生活质量提供指导。方法动态追踪105例行永久性结肠造口人的资料。建立信息库,每月随访1次,持续追踪1年,了解造口人基本信息、术后并发症、造口护理情况、心理状况等,采用鱼骨图法对造口人肠造口术后生活质量的影响因素进行分析和评价。结果影响肠造口人生活质量的因素包括医生、护士、造口人及家属、社会支持。结论采用鱼骨图法能对生活质量的影响因素进行全面有效分析,了解肠造口人术后生活状态的原因,为其自我管理和护理提供全面、有效的指导。%Objective To analyze the factors influencing the quality of life of patients with per-manent colostomy using fish-bone diagram,and to provide guides for improving the quality of life of patients with permanent colostomy.Methods Data of 105 patients with permanent colostomy were dynamically tracked,and the database was established.The follow-up was performed once per month for 1 year to know the basic information,postoperative complications,nursing situation and psychological status of patients.In addition,the factors influencing the quality of life of pa-tients with permanent colostomy were analyzed and evaluated using fish-bone diagram.Results The factors influencing the quality of life of patients with permanent colostomy included doctors, nurses,patients and their families,and social supports.Conclusion Fish-bone diagram can be used for comprehensively and effectively analyzing the factors influencing the life of quality,un-derstanding the state of life and providing guides for self-management and nursing in patients with permanent colostomy.

  6. Fish Hearing.

    Science.gov (United States)

    Blaxter, J. H. S.

    1980-01-01

    Provides related information about hearing in fish, including the sensory stimulus of sound in the underwater environment, mechanoreceptors in fish, pressure perception and the swimbladder, specializations in sound conduction peculiar to certain fish families. Includes numerous figures. (CS)

  7. Fish Allergy

    Science.gov (United States)

    ... in a clear and consistent manner, so that consumers with food allergies and their caregivers can be informed as ... the menu, cross-contact with fish is possible. Ethnic ... fish. Avoid foods like fish sticks and anchovies. Some individuals with ...

  8. Adjuvant therapy for intrahepatic cholangiocarcinoma: the debate continues.

    Science.gov (United States)

    Zhu, Andrew X; Knox, Jennifer J

    2012-01-01

    Presentation of the Case A 37-year-old woman presented at 35 weeks of gestation with her third child with failure to adequately gain weight and was noted by her obstetrician to have delay in the growth of her baby. Ultrasound of the abdomen incidentally revealed the presence of a liver lesion. After additional evaluation, she ultimately delivered her daughter at 36 weeks uneventfully. She subsequently underwent additional evaluation. Liver magnetic resonance imaging (MRI) revealed a 5-cm solitary solid mass in segment 4A of the liver, concerning for malignancy. Serum α-fetoprotein, carcinoembryonic antigen, cancer antigen (CA)19-9, CA15-3, and CA125 were all normal. Liver biopsy was positive for adenocarcinoma. The tumor cells demonstrated a phenotype suggesting a possible breast primary, although the immunohistochemistry did not support that diagnosis and the tumor was negative for mammaglobin, gross cystic disease fluid protein (GCDFP)-15, estrogen receptor (ER), and progesterone receptor (PR) (Table 1). The tumor was also CDX2 and cardiotrophin-1 negative, but cytokeratin (CK) 19 positive. Her endoscopic retrograde cholangiopancreatography, upper endoscopy, colonoscopy, breast mammogram, and breast MRI were completely normal. A positron emission tomography-computed tomography scan showed a fluorodeoxyglucose-avid 5.8-cm × 6.0-cm hypoattenuating lesion with peripheral enhancement involving segment 4 and segment 8 at the dome. In addition, central necrosis within the lesion was noted. The left main portal vein was mildly attenuated by the mass. She eventually underwent a left hepatectomy en bloc with caudate resection, portal lymphadenectomy, cholecystectomy, and omental pedicle flap. On exploration of the abdomen, no additional disease was noted. The final pathology revealed a 9.4-cm moderately to poorly differentiated adenocarcinoma of the intrahepatic bile ducts. Venous invasion was present. Perineural invasion was absent. The margins were negative. Thirteen

  9. Intrahepatic transplantation of CD34+ cord blood stem cells into newborn and adult NOD/SCID mice induce differential organ engraftment.

    Science.gov (United States)

    Wulf-Goldenberg, Annika; Keil, Marlen; Fichtner, Iduna; Eckert, Klaus

    2012-04-01

    In vivo studies concerning the function of human hematopoietic stem cells (HSC) are limited by relatively low levels of engraftment and the failure of the engrafted HSC preparations to differentiate into functional immune cells after systemic application. In the present paper we describe the effect of intrahepatically transplanted CD34(+) cells from cord blood into the liver of newborn or adult NOD/SCID mice on organ engraftment and differentiation. Analyzing the short and long term time dependency of human cell recruitment into mouse organs after cell transplantation in the liver of newborn and adult NOD/SCID mice by RT-PCR and FACS analysis, a significantly high engraftment was found after transplantation into liver of newborn NOD/SCID mice compared to adult mice, with the highest level of 35% human cells in bone marrow and 4.9% human cells in spleen at day 70. These human cells showed CD19 B-cell, CD34 and CD38 hematopoietic and CD33 myeloid cell differentiation, but lacked any T-cell differentiation. HSC transplantation into liver of adult NOD/SCID mice resulted in minor recruitment of human cells from mouse liver to other mouse organs. The results indicate the usefulness of the intrahepatic application route into the liver of newborn NOD/SCID mice for the investigation of hematopoietic differentiation potential of CD34(+) cord blood stem cell preparations.

  10. Extracorporal albumin dialysis (MARS) improves cholestasis and normalizes low apo A-I levels in a patient with benign recurrent intrahepatic cholestasis (BRIC)

    NARCIS (Netherlands)

    Sturm, E; Franssen, CFM; Gouw, A; Staels, B; Boverhof, R; de Knegt, RJ; Stellaard, F; Bijleveld, CMA; Kuipers, F

    The familial cholestatic diseases Benign Recurrent Intrahepatic Cholestasis (BRIC) and Progessive Familial Intrahepatic Cholestasis type 1 (PFIC1) are characterized by intermittent or permanently elevated plasma bile salt levels, therapy-resistant extreme pruritus and peculiar biochemical

  11. Fishes and humankind III. Editorial.

    Directory of Open Access Journals (Sweden)

    Andrew K. G. Jones

    1999-12-01

    Full Text Available The publication of this group of three papers form part of the 1987 meeting of the International Council for Archaeozoologists Fish Remains Working Group which took place at the University of York, U. K. The papers illustrate an increased awareness of the significance of ichthyological research to archaeology and cover three areas of research: taphonomy; fishing artefacts; and fish remains recovered from an excavation. Jones sheds some light on the relative robustness of the bewildering array of elements in a fish skeleton by recording damage to a skeleton when it is trampled. His paper suggests an index of robustness which might be used to assess the degree of fragmentation in archaeological assemblages. Kemp reports on the excavation of a small medieval building located adjacent to medieval fish ponds created by Cistercian monks in North Yorkshire, England. In addition to the structural evidence, an impressive assemblage of weights, presumably net weights, found on or near the site is published. Perhaps most significant is a large lead weight which may have been used to weight catches of fish from the ponds. Fish remains recovered from two excavations at the quayside at Newcastle-upon-Tyne, England are discussed by Nicholson. Around 6000 identified bones form the basis for the study, the majority of which were identified as Gadid (cod family or herring. While the main food fishes typify fish bone assemblages from most post-Roman urban archaeological sites, the identification of small fishes such as sandeels, smelt, gobies and buttefish may indicate the utilisation of fish not nowadays considered as food at all. Given the diversity of species (30 individual species identified it is suggested that the remains from the main bone-producing organic horizons, dated to the late twelfth to thirteenth centuries, may include discard from a nearby fishmarket.

  12. Bone Biopsy

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Biopsy Bone biopsy uses a needle and imaging ... the limitations of Bone Biopsy? What is a Bone Biopsy? A bone biopsy is an image-guided ...

  13. 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.

  14. Perinatal outcomes with intrahepatic cholestasis of pregnancy in twin pregnancies.

    Science.gov (United States)

    Liu, Xiaohua; Landon, Mark B; Chen, Yan; Cheng, Weiwei

    2016-01-01

    To describe perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). We conducted a retrospective cohort study of women delivered at a large tertiary obstetric center in Shanghai, China from January 2006 to May 2014. Delivery data were abstracted from medical records of all twin gestations delivered at the hospital. A total of 129/1922(6.7%) twin and 1190/92 273 singleton (1.3%) pregnancies were complicated by ICP. An increased risk of stillbirth among twin pregnancies was observed (3.9% and 0.8% in the ICP and non-ICP groups, respectively; aOR 5.75, 95% CI 2.00-16.6). Stillbirths with ICP and twins occurred between 33 and 35 weeks gestation compared to 36-38 weeks gestation among singletons. ICP in twins was also associated with an increased risk of preterm birth (pregnancies complicated by ICP also had increased meconium staining of amniotic fluid and lower birth weight. Twin pregnancies with ICP have significantly increased risks of adverse perinatal outcomes including stillbirth and preterm birth. Stillbirth occurs at an earlier gestational age in twin gestation compared to singletons, suggesting that earlier scheduled delivery should be considered in these women.

  15. Role of inflammation in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Biberoglu, Ebru; Kirbas, Ayse; Daglar, Korkut; Kara, Ozgur; Karabulut, Erdem; Yakut, Halil Ibrahim; Danisman, Nuri

    2016-03-01

    Intrahepatic cholestasis of pregnancy (ICP), the most common liver disease in pregnancy, is characterized by elevated serum total bile acid and/or transaminase concentration, and pruritus. Interleukin-6 (IL-6) is a key regulator of the immune response, hematopoiesis and inflammation. We examined both IL-6 and the frequently used inflammatory marker high-sensitivity C-reactive protein (hs-CRP) at baseline in the same study population as for the primary endpoint, in order to provide a new perspective on the pathogenesis of ICP. In this controlled cross-sectional study 65 consecutive pregnant women with ICP (34 with mild and 31 with severe disease) and 40 healthy women with uncomplicated pregnancies (control group) were examined. IL-6 and hs-CRP were compared between the groups. While serum IL-6 was significantly higher in the mild ICP (P = 0.01) and severe ICP (P = 0.001) groups than in the control group, hs-CRP was similar between the groups. Interleukin-6 may have an essential role, apart from CRP, in the pathogenesis of ICP and, also, is a more sensitive marker of inflammation. © 2016 Japan Society of Obstetrics and Gynecology.

  16. Placental proteome alterations in women with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    He, Pei; Wang, Furong; Jiang, Yan; Zhong, Yi; Lan, Yongfei; Chen, Shuqing

    2014-09-01

    To investigate differences in the placental proteomes of women with intrahepatic cholestasis of pregnancy (ICP) and those with a normal pregnancy. Ten pregnant women diagnosed with ICP were recruited at the First People's Hospital of Yuhang District from October 2011 to September 2012; 10 age-matched healthy pregnant women acted as controls. Total placental proteins were extracted and subjected to two-dimensional polyacrylamide gel electrophoresis followed by mass spectrometry to identify proteins that were differentially expressed in the two groups. In total, 37 protein spots with differentially expressed proteins were found. These comprised proteins involved in cytoskeleton activity, blood coagulation, and platelet activation as well as chaperones, heat shock proteins, RNA-binding and calcium-binding proteins, and various enzymes. The placentas of women with ICP displayed significant proteome differences compared with women with a normal pregnancy. The results indicate that a variety of mechanisms and proteins may contribute to the development of ICP. Further verification and research are required to elucidate the exact roles of these proteins in ICP pathogenesis. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Intrahepatic cholestasis of pregnancy: new insights into its pathogenesis.

    Science.gov (United States)

    Floreani, Annarosa; Caroli, Diego; Lazzari, Roberta; Memmo, Alessia; Vidali, Elisa; Colavito, Davide; D'Arrigo, Antonello; Leon, Alberta; Romero, Roberto; Gervasi, Maria Teresa

    2013-09-01

    To search a specific gene expression profile in women with intrahepatic cholestasis of pregnancy (ICP) and to evaluate the maternal and foetal outcome. We consecutively enrolled 12 women with ICP and 12 healthy pregnant controls. The gene expression profile was assayed with the microarray technique including a panel of 5541 human genes. Microarray data were validated by real-time PCR technique. Caesarean delivery was performed in eight patients with ICP versus three controls (p = 0.05). ICP women delivered at earlier gestational age than control (p < 0.001). Foetal distress was recorded in two babies, but we failed to find any correlation between bile salt concentration and foetal distress. Twenty genes potentially correlated with ICP were found differentially expressed (p < 0.05). Among these, three belong to genetic classes involved in pathogenic mechanisms of ICP: (1) pathophysiology of pruritus (GABRA2, cases versus controls = 2, upregulated gene); (2) lipid metabolism and bile composition (HLPT, cases versus controls = 0.6, down-regulated gene) and (3) protein trafficking and cytoskeleton arrangement (KIFC3, cases versus controls = 0.5, down-regulated gene). Different gene expression may contribute to the complex pathogenesis of ICP. An upregulation of GABRA2 receptor may indicate that GABA may play a role in the pathogenesis of pruritus in this condition.

  18. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Ozkan, Sebiha; Ceylan, Yasin; Ozkan, Orhan Veli; Yildirim, Sule

    2015-06-21

    Intrahepatic cholestasis of pregnancy (ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries (9.2%-15.6% and 1.5%, respectively) than in Europe (0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue.

  19. The role of interleukin-17 in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kirbas, Ayse; Biberoglu, Ebru; Ersoy, Ali Ozgur; Dikmen, Asiye Ugras; Koca, Cemile; Erdinc, Seval; Uygur, Dilek; Caglar, Turhan; Biberoglu, Kutay

    2016-03-01

    Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, is characterized by pruritus, abnormal liver function and elevated serum bile acid levels. The main cause of ICP has not yet been identified. We aimed to provide a new perspective to the pathogenesis of by investigating the possible association of circulating interleukin-17 (IL-17) that is a recently discovered proinflammatory cytokine levels with ICP. In this controlled cross-sectional study, maternal venous blood samples were obtained from 33 consecutive pregnant women with ICP (15 with mild and 18 with severe forms of the disease) and 25 healthy women with uncomplicated pregnancies (as the control group) and IL-17 levels were compared among the groups. Although serum IL-17 levels were significantly higher in the severe ICP group than in the control group (p = 0.022), there were no significant differences between the mild and severe ICP groups or between the control and mild ICP groups. Explaining the mechanisms of hepatocyte injury might contribute to the existing therapeutic strategies for treating cholestatic diseases. Changes in IL-17 levels may shed light on the pathogenesis of ICP.

  20. Intrahepatic cholestasis of pregnancy and timing of delivery.

    Science.gov (United States)

    Lo, Jamie O; Shaffer, Brian L; Allen, Allison J; Little, Sarah E; Cheng, Yvonne W; Caughey, Aaron B

    2015-01-01

    We examined the morbidities from delivery at earlier gestational ages versus intrauterine fetal demise (IUFD) for women with intrahepatic cholestasis of pregnancy (ICP) to determine the optimal gestational age for delivery. A decision-analytic model was created to compare delivery at 35 through 38 weeks gestation for different delivery strategies: (1) empiric steroids; (2) steroids if fetal lung maturity (FLM) negative; (3) wait a week and retest if FLM negative; or (4) deliver immediately. Literature review identified 18 studies that estimated IUFD in ICP; we used the mean rate, 1.74%, and assumed a uniform distribution from 34 to 40 weeks gestation. Large cohort data was used to calculate neonatal morbidity rates at each gestational age. Maternal and neonatal quality-adjusted life years (QALYs) were combined. Univariate sensitivity and Monte Carlo analyses were performed to test for robustness. Immediate delivery at 36 weeks without FLM testing and steroid administration was the optimal strategy as compared to delivery at 36 weeks with steroids (+47 QALYs) and as compared to immediate delivery at 35 weeks (+210 QALYs). Our results were robust up to a 30% increase in the rate of IUFD. Immediate delivery at 36 weeks in women with ICP is the optimal delivery strategy.

  1. Intra-hepatic cholestasis of pregnancy: A comprehensive review

    Directory of Open Access Journals (Sweden)

    Sangita Ghosh

    2013-01-01

    Full Text Available Intra-hepatic cholestasis of pregnancy is a cholestatic disorder characterized by i pruritus, with onset in the third trimester of pregnancy, without any primary skin lesions, ii elevated fasting serum bile acids > 10 μmol / L (and elevated serum transaminases, iii spontaneous relief of signs and symptoms within two to three weeks after delivery, and iv absence of other disease that cause pruritus and jaundice. It is believed to be a multi-factorial disease with interplay between genetic, environmental and hormonal factors. Incidence is between 0.02% to 2.4% of all pregnancies; with wide geographical variations. Maternal prognosis is usually good but can result in adverse fetal outcomes like meconium staining of amniotic fluid, fetal bradycardia and even fetal loss. Response to anti-histaminic is poor. Of all the medical therapies that have been described for the treatment for IHCP, ursodeoxycholic acid has the best response in relieving pruritus in mother, and probably has a role in preventing even the perinatal complications. Timely diagnosis and treatment is urged in order to prevent fetal complications and an early delivery between 37 to 38 weeks should be contemplated in severe cases, especially once fetal lung maturity is attained.

  2. Intrahepatic synthese of immunoglobulin G in chronic liver disease.

    Science.gov (United States)

    Kronborg, I J; Knopf, P M

    1980-04-01

    A method has been developed to measure the in vitro production of immunoglobulin (Ig) by liver biopsy specimens. Five to 30 mg of liver tissue was cultured for 24 h in Dulbecco's modified Eagle's medium/10% foetal calf serum (FCS) containing radiolabelled leucine (L-[4,5-3H] leucine). The culture medium was collected, centrifuged and the supernatant dialysed to remove labelled leucine. The residual radioactivity was a measure of newly synthesized 3H-labelled proteins released into the medium. The quantity of IgG was determined by immunoprecipitation with monospecific antisera to IgG heavy chains. The presence of IgG in the supernatant was confirmed by chromatography on protein-A Sepharose column. In 6 biopsies without evidence of active inflammation (4 normal and 2 fatty liver by histological criteria) less than 1% of the protein synthesized was IgG. In contrast in the presence of active inflammation in 4 cases of alcoholic hepatitis the IgG percentage ranged from 2 to 6%. Maximal levels of IgG production were detected in 3 cases of chronic active hepatitis (CAH) and ranged from 5 to 30%. The increased Ig synthesis by the liver in alcoholic hepatitis and CAH is presumed to be an index of the intrahepatic host response and may have important implications for mechanisms of liver damage in these diseases.

  3. Transjugular intrahepatic portosystemic shunt in liver transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Armin Finkenstedt; Ivo W Graziadei; Karin Nachbaur; Werner Jaschke; Walter Mark; Raimund Margreiter; Wolfgang Vogel

    2009-01-01

    AIM: To evaluate the efficacy of transjugular intrahepatic portosystemic shunts (TIPSs) after liver transplantation (LT).METHODS: Between November 1996 and December 2005, 10 patients with severe recurrent hepatitis C virus infection ( n = 4), ductopenic rejection ( n = 5) or portal vein thrombosis ( n = 1) were included in this analysis. Eleven TIPSs (one patient underwent two TIPS procedures) were placed for management of therapy-refractory ascites ( n = 7), hydrothorax ( n = 2)or bleeding from colonic varices ( n = 1). The median time interval between LT and TIPS placement was 15(4-158) mo.RESULTS: TIPS placement was successful in all patients. The mean portosystemic pressure gradient was reduced from 12.5 to 8.7 mmHg. Complete and partial remission could be achieved in 43% and 29%of patients with ascites. Both patients with hydrothorax did not respond to TIPS. No recurrent bleeding was seen in the patient with colonic varices. Nine of 10patients died during the study period. Only one of two patients, who underwent retransplantation after the TIPS procedure, survived. The median survival period after TIPS placement was 3.3 (range 0.4-20) mo. The majority of patients died from sepsis with multiorgan failure.

  4. Intrahepatic cholestasis of pregnancy: correlation of preterm delivery with bile acids.

    Science.gov (United States)

    Pata, Ozlem; Vardarelı, Eser; Ozcan, Alihan; Serteser, Mustafa; Unsal, Ibrahim; Saruç, Murat; Unlü, Cihat; Tözün, Nurdan

    2011-12-01

    The aim of this study was to determine the incidence, obstetrical and fetal complication rates of intrahepatic cholestasis of pregnancy in patients managed actively around 38 weeks and evaluate the correlation of these results with liver function tests and bile acids. In this cohort study 3710 women were booked for delivery, of which 32 pregnant women were diagnosed as intrahepatic cholestasis of pregnancy. All data concerning obstetric- medical history, laboratory results, symptom onset time, pruritus degree, treatment response, and delivery time and infants information were recorded in the study protocol. Statistical analyses were conducted with SPSS 12.0 version and correlations were assessed by Spearman Rank correlation analysis. The incidence of intrahepatic cholestasis of pregnancy was 0.86%. The symptoms appeared around 32 weeks. 16.6% multiparas had a previously affected pregnancy and 21.8% of intrahepatic cholestasis of pregnancy patients had family history of intrahepatic cholestasis of pregnancy. Symptom onset varied according to season (p<0.05). Most patients (69.5%) were diagnosed in winter and the beginning of spring. There were no reported cases of clinical maternal jaundice, bleeding tendency or stillbirth. Pruritus was decreased by ursodeoxycholic acid treatment. Total bile acids tended to be higher in patients with preterm delivery (r=0.409, p=0.038). Total bile acids are correlated with preterm delivery. An attempt to deliver at around 38 weeks may improve perinatal outcome.

  5. Intrahepatic cholestasis of pregnancy is common among patients' first-degree relatives.

    Science.gov (United States)

    Turunen, Kaisa; Helander, Kristiina; Mattila, Kari J; Sumanen, Markku

    2013-09-01

    Intrahepatic cholestasis of pregnancy has been shown to have a genetic predisposition. We studied whether Finnish women who had suffered from the disorder reported their first-degree relatives to have had liver dysfunction during their pregnancies. Questionnaires were sent in autumn 2010 to a total of 544 former intrahepatic cholestasis of pregnancy patients and 1235 controls, all having delivered during 1969-1988. The response rate was 66.2%. The incidence of intrahepatic cholestasis is 0.5-1.5% of pregnancies in Finland. In our survey, altogether 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3) and 10.3% of daughters (odds ratio 4.8) of women who had suffered from intrahepatic cholestasis of pregnancy had had liver dysfunction during pregnancy. Our findings strengthen the earlier knowledge of the genetic component in intrahepatic cholestasis of pregnancy. We suggest that all pregnant women are asked about their family history regarding liver dysfunction during pregnancy. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Alanine aminotransferase as a predictor of adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Ekiz, Ali; Kaya, Basak; Avci, Muhittin Eftal; Polat, Ibrahim; Dikmen, Selin; Yildirim, Gokhan

    2016-01-01

    To evaluate the associations between adverse perinatal outcomes and serum transaminase levels at the time of diagnosis in patients with intrahepatic cholestasis of pregnancy. We performed a retrospective analysis of patients hospitalized for evaluation of intrahepatic cholestasis of pregnancy from January 2013 to June 2014 in a tertiary center. Seventy-one patients were divided into two groups according to the presence (Group I) or absence of adverse perinatal outcomes (Group II). The mean aminotransferase levels and conjugated bilirubin levels at the time of diagnosis were significantly higher in Group I than in Group II. Receiver operating characteristic curve analysis revealed that the alanine aminotransferase level could predict adverse perinatal outcomes with 76.47% sensitivity and 78.38% specificity, and the cut-off value was 95 IU/L. Among patients with intrahepatic cholestasis of pregnancy, those with adverse perinatal outcomes were significantly older, had an earlier diagnosis, and had higher alanine aminotransferase levels. Using the 95-IU/L cut-off value, patients with intrahepatic cholestasis of pregnancy had a 3.54-fold increased risk for adverse perinatal outcomes. Patients with intrahepatic cholestasis of pregnancy and high alanineaminotransferase levels should be followed up for possible adverse perinatal outcomes.

  7. Intrahepatic porto-hepatic venous shunts in Rendu-Osler-Weber disease: imaging demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Shunro; Mori, Hiromu; Yamada, Yasunari; Hayashida, Tomoko; Hori, Yuzo; Kiyosue, Hiro [Department of Radiology, Oita Medical University, Idaigaoka 1-1, Hasama-machi, 879-5593, Oita (Japan)

    2004-04-01

    This study describes the imaging features of the intrahepatic portohepatic venous (PHV) shunt, which is a potential cause of portosystemic encephalopathy in Rendu-Osler-Weber disease. Six patients with Rendu-Osler-Weber disease (two men, four women; age range 42-73 years) were retrospectively studied. There were two from one family and three from another family. Of these patients, one was diagnosed with definitive portosystemic encephalopathy because of a psychiatric disorder. We retrospectively reviewed the radiological examinations, including abdominal angiography (n=6), three-phase dynamic helical computed tomography (CT; n=3), and conventional enhanced CT (n=1). In one patient, CT during angiography and CT angioportography were also performed. Evaluation was placed on the imaging features of intrahepatic PHV shunts. On angiography, intrahepatic PHV shunts showing multiple and small shunts <5 mm in diameter in an apparent network were detected in all patents. In two patients, a large shunt with a size of either 7 or 10 mm was associated. These intrahepatic PHV shunts were predominantly distributed in the peripheral parenchyma. Intrahepatic PHV shunts would be characterized by small and multiple shunts in an apparent network on the periphery with or without a large shunt. (orig.)

  8. Bone Densitometry (Bone Density Scan)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Densitometry (DEXA) Bone densitometry, also called dual-energy ... limitations of DEXA Bone Densitometry? What is a Bone Density Scan (DEXA)? Bone density scanning, also called ...

  9. Fish allergy and fish allergens

    DEFF Research Database (Denmark)

    Kuehn, A; Hilger, Christiane; Ollert, Markus

    2016-01-01

    but patients with this phenotype constitute an important sub-group among fish-allergic individuals. 2. Newly identified fish allergens, enolases, aldolases, and fish gelatin, are of high relevance as the majority of the fish-allergic individuals seem to develop specific IgE against these proteins. The present...

  10. Prediction of cardiovascular risk by electrocardiographic changes in women with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Biberoglu, Ebru Hacer; Kirbas, Ayse; Kirbas, Ozgur; Iskender, Cantekin; Daglar, Halil Korkut; Koseoglu, Cemal; Uygur, Dilek; Danisman, Nuri

    2015-01-01

    We aimed to investigate P wave characteristics in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP). In this case-control study, including 59 pregnant women with intrahepatic cholestasis and 28 with healthy uncomplicated pregnancies, electrocardiographic maximum (Pmax) and minimum (Pmin) P-wave durations and P-wave dispersion (Pd) parameters were investigated. While Pmin and Pd values were significantly lower in women both with mild and severe ICP when compared to healthy pregnant women (p Intrahepatic cholestasis predisposes to cardiovascular complications. P-wave durations and Pd constitute a recent contribution to the field of noninvasive electrocardiology. Our data clearly demonstrated that these parameters were significantly altered in pregnant women with ICP when compared to the normal ones. This important association can be used to screen for women with an increased risk to better target counseling on lifestyle modifications and to closer follow-up and management of women with a history of ICP.

  11. Clinicopathological and prognostic significance of epithelial mesenchymal transition-related protein expression in intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Yao X

    2012-10-01

    Full Text Available Xing Yao,1,* Xiang Wang,1,* Zishu Wang,2,* Licheng Dai,1 Guolei Zhang,1 Qiang Yan,1 Weimin Zhou11Huzhou Central Hospital, Zhejiang Huzhou, 2Department of Medical Oncology, First Affiliated Hospital, Bengbu Medical College, Anhui, People’s Republic of China *These authors contributed equally to this workBackground: The aim of this study was to examine the patterns of expression of epithelial-mesenchymal transition (EMT-related proteins in intrahepatic cholangiocarcinoma. The clinicopathological and prognostic value of these markers was also evaluated.Methods: We detected the expression status of three EMT-related proteins, ie, E-cadherin, vimentin, and N-cadherin, by immunohistochemistry in consecutive intrahepatic cholangiocarcinoma specimens from 96 patients.Results: The frequency of loss of the epithelial marker E-cadherin, and acquisition of mesenchymal markers, vimentin and N-cadherin, in intrahepatic cholangiocarcinoma was 43.8%, 37.5% and 57.3%, respectively. Altered expression of EMT markers was associated with aggressive tumor behavior, including lymph node metastasis, undifferentiated-type histology, advanced tumor stage, venous invasion, and shorter overall survival. Moreover, loss of E-cadherin was retained as an independent prognostic factor for patients with intrahepatic cholangiocarcinoma in multivariate analysis.Conclusion: Our results suggest that the EMT process is associated with tumor progression and a poor outcome in patients with intrahepatic cholangiocarcinoma, and inhibition of EMT might offer novel promising molecular targets for the treatment of affected patients.Keywords: intrahepatic cholangiocarcinoma, epithelial-mesenchymal transition, expression, prognosis, immunohistochemistry

  12. Two Anomalies in One: A Rare Case of an Intrahepatic Gallbladder with a Cholecystogastric Fistula

    Directory of Open Access Journals (Sweden)

    Mohammad F. Ali

    2017-03-01

    Full Text Available The gallbladder can be situated in a variety of anomalous positions. An intrahepatic gallbladder – the second most common ectopic location of the gallbladder – is one that is completely embedded within the liver parenchyma. Described in the literature as early as 1935, intrahepatic gallbladders predominantly result from a developmental anomaly but in some instances have been reported to be secondary to chronic inflammation. The significance of an intrahepatic gallbladder lies in the fact that 60% of the cases are associated with gallstones and may present a challenge for the general surgeon during cholecystectomy and other biliary operations in addition to causing misdiagnosis on imaging. Intrahepatic gallbladders are unusual, but the incidence of an intrahepatic gallbladder with a cholecystogastric fistula is rare. Cholecystogastric fistulas commonly are a complication of long-term cholelithiasis or chronic cholecystitis with subsequent gallstone ileus. Herein, we present the case of an 80-year-old man who presented with 2 months of progressive weakness, fatigue, decreased appetite, and intermittent right-sided abdominal pain, and was found to have a markedly distended and irregular intrahepatic gallbladder measuring 12.2 × 11.5 × 13.4 cm on CT, as well as a cholecystogastric fistula on esophagogastroduodenoscopy. During esophagogastroduodenoscopy, the gallbladder was entered directly via the fistulous tract. The patient was on i.v. antibiotics with tube feeds via a nasojejunal tube initially, followed by p.o. which he tolerated. He was eventually discharged with referral for surgical evaluation. Given the potential for cholelithiasis and fistulation, physicians should have a high index of suspicion and recommend timely endoscopic and/or surgical management to avoid future complications.

  13. Bile Duct Leaks from the Intrahepatic Biliary Tree: A Review of Its Etiology, Incidence, and Management

    Directory of Open Access Journals (Sweden)

    Sorabh Kapoor

    2012-01-01

    Full Text Available Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.

  14. Does bilioenteric anastomosis impair results of liver resection in primary intrahepatic lithiasis?

    Institute of Scientific and Technical Information of China (English)

    Paulo; Herman; Marcos; V; Perini; Vincenzo; Pugliese; Julio; Cesar; Pereira; Marcel; Autran; C; Machado; William; A; Saad; Luiz; AC; D; Albuquerque; Ivan; Cecconello

    2010-01-01

    AIM:To evaluate the long-term results of liver resection for the treatment of primary intrahepatic lithiasis.Prognostic factors,especially the impact of bilioenteric anastomosis on recurrence of symptoms were assessed.METHODS:Forty one patients with intrahepatic stones and parenchyma fibrosis/atrophy and/or biliary stenosis were submitted to liver resection.Resection was associated with a Roux-en-Y hepaticojejunostomy in all patients with bilateral stones and in those with unilateral disease and dilation of...

  15. Maternal circulating levels of irisin in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kirbas, Ayse; Daglar, Korkut; Timur, Hakan; Biberoglu, Ebru; Inal, Hasan Ali; Kara, Ozgur; Yilmaz, Zehra; Turkmen, Gülenay; Danisman, Nuri

    2016-11-01

    Intrahepatic cholestasis of pregnancy (ICP), the most common liver disease in pregnancy, is characterized by elevated serum total bile acid levels and pruritus. It has become clear that bile acids are no longer labeled as simple detergent-like molecules, but also represent complex hormonal metabolic regulators. ICP has also been associated with increased incidence rates of gestational diabetes mellitus. Irisin is a newly discovered myokine that is able to regulate glucose and lipid levels, thus improving insulin sensitivity. In this study, maternal serum irisin levels were analyzed in order to provide a new perspective on the pathogenesis of ICP. In this controlled cross-sectional study, 58 consecutive pregnant women with ICP (30 with mild and 28 with severe disease) and 30 healthy women with uncomplicated pregnancies (as the control group) were examined. The maternal irisin, fasting blood glucose, fasting insulin and homeostatic model assessment of insulin resistance levels of the two groups were compared. Serum irisin levels were significantly higher in the severe ICP group than in the mild ICP and control groups (p = 0.005 and p < 0.001, respectively). At the best cut-off level of 908.875 pg/ml, irisin accurately predicted ICP [AUC = 0.827 (95% CI: 0.745-0.909; p < 0.001)] with sensitivity and specificity rates of 72.5 and 86.8%, respectively. There was a significant negative correlation between irisin and fasting blood glucose levels (r = -0.399; p = 0.021). The results of this study indicate that serum irisin levels were significantly higher in women with ICP compared to healthy pregnant controls. However, it is difficult to infer whether high irisin level is a cause or effect of ICP.

  16. Differential intrahepatic phospholipid zonation in simple steatosis and nonalcoholic steatohepatitis.

    Directory of Open Access Journals (Sweden)

    Julia Wattacheril

    Full Text Available Nonalcoholic fatty liver disease (NAFLD occurs frequently in a setting of obesity, dyslipidemia and insulin resistance, but the etiology of the disease, particularly the events favoring progression to nonalcoholic steatohepatitis (NASH as opposed to simple steatosis (SS, are not fully understood. Based on known zonation patterns in protein, glucose and lipid metabolism, coupled with evidence that phosphatidylcholine may play a role in NASH pathogenesis, we hypothesized that phospholipid zonation exists in liver and that specific phospholipid abundance and distribution may be associated with histologic disease. A survey of normal hepatic protein expression profiles in the Human Protein Atlas revealed pronounced zonation of enzymes involved in lipid utilization and storage, particularly those facilitating phosphatidylcholine (PC metabolism. Immunohistochemistry of obese normal, SS and NASH liver specimens with anti-phosphatidylethanomine N-methyltransferase (PEMT antibodies showed a progressive decrease in the zonal distribution of this PC biosynthetic enzyme. Phospholipid quantitation by liquid chromatography mass spectrometry (LC-MS in hepatic extracts of Class III obese patients with increasing NAFLD severity revealed that most PC species with 32, 34 and 36 carbons as well as total PC abundance was decreased with SS and NASH. Matrix assisted laser desorption ionization-imaging mass spectrometry (MALDI-IMS imaging revealed strong zonal distributions for 32, 34 and 36 carbon PCs in controls (minimal histologic findings and SS that was lost in NASH specimens. Specific lipid species such as PC 34:1 and PC 36:2 best illustrated this phenomenon. These findings suggest that phospholipid zonation may be associated with the presence of an intrahepatic proinflammatory phenotype and thus have broad implications in the etiopathogenesis of NASH.

  17. Bacteremia and "Endotipsitis" following transjugular intrahepatic portosystemic shunting

    Science.gov (United States)

    Mizrahi, Meir; Roemi, Lilach; Shouval, Daniel; Adar, Tomer; Korem, Maya; Moses, Alon; Bloom, Alan; Shibolet, Oren

    2011-01-01

    AIM: To identify all cases of bacteremia and suspected endotipsitis after Transjugular intrahepatic portosystemic shunting (TIPS) at our institution and to determine risk factors for their occurrence. METHODS: We retrospectively reviewed records of all patients who underwent TIPS in our institution between 1996 and 2009. Data included: indications for TIPS, underlying liver disease, demographics, positive blood cultures after TIPS, microbiological characteristics, treatment and outcome. RESULTS: 49 men and 47 women were included with a mean age of 55.8 years (range 15-84). Indications for TIPS included variceal bleeding, refractory ascites, hydrothorax and hepatorenal syndrome. Positive blood cultures after TIPS were found in 39/96 (40%) patients at various time intervals following the procedure. Seven patients had persistent bacteremia fitting the definition of endotipsitis. Staphylococcus species grew in 66% of the positive cultures, Candida and enterococci species in 15% each of the isolates, and 3% cultures grew other species. Multi-variate regression analysis identified 4 variables: hypothyroidism, HCV, prophylactic use of antibiotics and the procedure duration as independent risk factors for positive blood cultures following TIPS (P < 0.0006, 0.005, 0.001, 0.0003, respectively). Prophylactic use of antibiotics before the procedure was associated with a decreased risk for bacteremia, preventing mainly early infections, occurring within 120 d of the procedure. CONCLUSION: Bacteremia is common following TIPS. Risk factors associated with bacteremia include failure to use prophylactic antibiotics, hypothyroidism, HCV and a long procedure. Our results strongly support the use of prophylaxis as a means to decrease early post TIPS infections. PMID:21731907

  18. Chemometric approach to evaluate element distribution in muscle, liver and fish bone of roach (Rutilus rutilus), silver bream (Blicca bjoerkna) and crucian carp (Carassius carassius) from Swarzędzkie Lake (Poland) using ICP-MS and FIAS-CVAAS techniques.

    Science.gov (United States)

    Chudzińska, Maria; Komorowicz, Izabela; Hanć, Anetta; Gołdyn, Ryszard; Barałkiewicz, Danuta

    2016-11-01

    The content of elements in fish tissues and organs from Swarzędzkie Lake was investigated in order to evaluate the possible risk associated with their consumption by animals as well as humans. Samples of muscle, liver and fish bone of three fish species; roach (Rutilus rutilus), silver bream (Blicca bjoerkna) and crucian carp (Carassius carassius) were collected from seine catches undertaken as part of the biomanipulation of Swarzędzkie Lake. Element concentration (Al, As, Cd, Co, Cr, Cu, Hg, Ni, Pb, Zn) was determined by inductively coupled plasma mass spectrometry (ICP-MS), with the exception of Hg where the flow injection analysis system cold vapour atomic absorption spectrometry (FIAS-CVAAS) was applied. The study indicated a large variation in the occurrence of the investigated elements in different parts of the fish body. The highest content of Al and Zn was stated in all fish organs for each fish species. The majority of the applied statistical and chemometric methods (e.g., PCA, CA) refer to roach since we had a large number of data for this species. The obtained results were assessed in terms of their accuracy and precision using certified reference material of Fish Muscle ERM BB422.

  19. Antarctic Fishes.

    Science.gov (United States)

    Eastman, Joseph T.; DeVries, Arthur L.

    1986-01-01

    Explains the adaptations to Antarctic waters that Notothenioidei, a group of advanced bony fishes, have exhibited. Discusses the fishes' mechanisms of production of antifreeze properties and their capacities for neutral buoyancy in water. (ML)

  20. Fish Dishes.

    Science.gov (United States)

    Derby, Marie

    2003-01-01

    Describes an art project that was inspired by Greek pottery, specifically dishes shaped as fish. Explains that fourth-grade students drew a fish shape that was later used to create their clay version of the fish. Discusses how the students examined the pottery to make decisions about color and design. (CMK)

  1. Bone within a bone

    Energy Technology Data Exchange (ETDEWEB)

    Williams, H.J.; Davies, A.M. E-mail: wendy.turner@roh.nhs.uk; Chapman, S

    2004-02-01

    The 'bone within a bone' appearance is a well-recognized radiological term with a variety of causes. It is important to recognize this appearance and also to be aware of the differential diagnosis. A number of common conditions infrequently cause this appearance. Other causes are rare and some remain primarily of historical interest, as they are no longer encountered in clinical practice. In this review we illustrate some of the conditions that can give the bone within a bone appearance and discuss the physiological and pathological aetiology of each where known.

  2. Genetics and Molecular Modeling of New Mutations of Familial Intrahepatic Cholestasis in a Single Italian Center.

    Directory of Open Access Journals (Sweden)

    Isabella Giovannoni

    Full Text Available Familial intrahepatic cholestases (FICs are a heterogeneous group of autosomal recessive disorders of childhood that disrupt bile formation and present with cholestasis of hepatocellular origin. Three distinct forms are described: FIC1 and FIC2, associated with low/normal GGT level in serum, which are caused by impaired bile salt secretion due to defects in ATP8B1 encoding the FIC1 protein and defects in ABCB11 encoding bile salt export pump protein, respectively; FIC3, linked to high GGT level, involves impaired biliary phospholipid secretion due to defects in ABCB4, encoding multidrug resistance 3 protein. Different mutations in these genes may cause either a progressive familial intrahepatic cholestasis (PFIC or a benign recurrent intrahepatic cholestasis (BRIC. For the purposes of the present study we genotyped 27 children with intrahepatic cholestasis, diagnosed on either a clinical or histological basis. Two BRIC, 23 PFIC and 2 BRIC/PFIC were identified. Thirty-four different mutations were found of which 11 were novel. One was a 2Mb deletion (5'UTR- exon 18 in ATP8B1. In another case microsatellite analysis of chromosome 2, including ABCB11, showed uniparental disomy. Two cases were compound heterozygous for BRIC/PFIC2 mutations. Our results highlight the importance of the pathogenic role of novel mutations in the three genes and unusual modes of their transmission.

  3. HELLP syndrome preceded by intrahepatic cholestasis of pregnancy: one serious itch

    Science.gov (United States)

    Jebbink, Jiska; Tabbers, Merit; Afink, Gijs; Beuers, Ulrich; Elferink, Ronald Oude; Ris-Stalpers, Carrie; van der Post, Joris

    2014-01-01

    We present four women with seven ongoing pregnancies. Five pregnancies were complicated by intrahepatic cholestasis of pregnancy (ICP) and severe haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome with uncommon maternal morbidity. The combination of ICP and HELLP syndrome has not previously been reported. Awareness is warranted to accurately identify this combination of pregnancy-specific diseases with severe maternal morbidity. PMID:24711473

  4. Intrahepatic cholestasis of pregnancy : Maternal and fetal outcomes associated with elevated bile acid levels

    NARCIS (Netherlands)

    Brouwers, Laura; Koster, Maria P H; Page-Christiaens, Godelieve C M L; Kemperman, Hans; Boon, Janine; Evers, Inge M.; Bogte, Auke; Oudijk, Martijn A.

    2015-01-01

    Objective The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored. Study Design

  5. Frequency of intrahepatic cholestasis of pregnancy in Punjab Pakistan: A single centre study.

    Science.gov (United States)

    Hafeez, Muhammad; Ansari, Asma; Parveen, Saima; Salamat, Amjad; Aijaz, Anjum

    2016-02-01

    To find out the frequency of intrahepatic cholestasis of pregnancy and its identification parameters. The cross-sectional observational study was conducted in the Department of Medicine and the Department of Obstetrics, Combined Military Hospital, Kharian, from October 2013 to March 2014, and comprised all pregnant patients having symptoms suggestive of intrahepatic cholestasis which was confirmed after systemic inquiry, examination and biochemical analysis. Patients with cholestasis due to another reason, coagulopathies, thrombocytopenia and tumours were excluded. The patients were followed up till delivery to see the effects of cholestasis on mother and child. Out of 1001 obstetric patients, 31(3.1%) had intrahepatic cholestasis of pregnancy. Pruritus was the main symptom in 25 (85%) patients followed by rash in 20 (65%). In 20 (64%) patients, labour was induced. Mode of delivery was Caesarean Section in 18 (58%) patients and 9 (29%) had postpartum haemorrhage. Regarding neonatal complications, 22 (70%) required admission to neonatal intensive care and 15 (48%) had meconium aspiration. A high frequency of intrahepatic cholestasis of pregnancy was observed. It had significant impact on maternal and foetal health.

  6. Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy

    Directory of Open Access Journals (Sweden)

    Maria Maldonado

    2017-01-01

    Full Text Available Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT of 117.8 seconds, International Normalized Ratio (INR of 10.34, and elevated transaminases suggestive of intrahepatic cholestasis of pregnancy. Her serum vitamin K level was undetectable (<0.1 nMol/L. Initial therapy consisted of intramuscular replacement of vitamin K and administration of fresh frozen plasma. Her hematuria and preterm labor resolved and she was discharged. She presented in active labor and delivered at 27 weeks and 1 day. Her bile acids (93 μ/L and INR (2.32 had worsened. She delivered a male infant, 1150 grams with Apgar scores 7 and 9. The newborn received 0.5 mg of intramuscular vitamin K shortly after delivery but went on to develop bilateral grade III intraventricular hemorrhages by day 5. Intrahepatic cholestasis in pregnancy and nutrition issues were identified as the main risk factors for the severe coagulopathy of this patient. This case underlines the importance of evaluation of possible severe coagulopathy in patients with intrahepatic cholestasis of pregnancy in order to avoid serious maternal or fetal adverse outcomes.

  7. Spontaneous perforation of gallbladder with intrahepatic biloma formation: sonographic signs and correlation with computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hollanda, Erick Sabbagh de; Torres, Ulysses dos Santos; Gual, Fabiana; Oliveira, Eduardo Portela de; Cardoso, Luciana Vargas; Criado, Divanei Aparecida Bottaro, E-mail: usantor@yahoo.com.br [Faculdade de Medicina de Sao Jose do Rio Preto (Famerp), SP (Brazil). Hospital de Base

    2013-09-15

    Spontaneous perforation of gallbladder is a severe and infrequent complication of acute cholecystitis that requires early and accurate diagnosis. Concomitant development of intrahepatic collections is rarely observed in such cases. The present report emphasizes the relevance of imaging studies in this setting, describing the typical sonographic and tomographic findings for the diagnosis of such condition. (author)

  8. Partial External Biliary Diversion in Children With Progressive Familial Intrahepatic Cholestasis and Alagille Disease

    NARCIS (Netherlands)

    Yang, Huiqi; Porte, Robert J.; Verkade, Henkjan J.; De Langen, Zacharias J.; Hulscher, Jan B. F.

    2009-01-01

    Background: Partial external biliary diversion (PEBD) is a promising treatment for children with progressive familial intrahepatic cholestasis (PFIC) and Alagille disease. Little is known about long-term Outcomes. Patients and Methods: A retrospective chart review of all patients undergoing PEBD in

  9. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + beta-blocker for prevention of variceal rebleeding

    NARCIS (Netherlands)

    Holster, I.L.; Tjwa, E.T.; Moelker, A.; Wils, A.; Hansen, B.E.; Vermeijden, J.R.; Scholten, P.; Hoek, B. van; Nicolai, J.J.; Kuipers, E.J.; Pattynama, P.M.; Buuren, H.R. van

    2016-01-01

    Gastroesophageal variceal bleeding in patients with cirrhosis is associated with significant morbidity and mortality, as well as a high rebleeding risk. Limited data are available on the role of transjugular intrahepatic portosystemic shunt (TIPS) with covered stents in patients receiving standard e

  10. Endoscopic transcystic stent placement for an intrahepatic abscess due to gallbladder perforation

    Institute of Scientific and Technical Information of China (English)

    Myung Soo Kang; Do Hyun Park; Ki Du Kwon; Jeong Hoon Park; Suck-Ho Lee; Hong-Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2007-01-01

    Perforation of the gallbladder with cholecystohepatic communication is a rare cause of liver abscess. Because it is a rare entity, the treatment modality has not been fully established. We report for the first time a patient with an intrahepatic abscess due to gallbladder perforation successfully treated by endoscopic stent placement into the gallbladder who had a poor response to continuous percutaneous drainage.

  11. Genetics and Molecular Modeling of New Mutations of Familial Intrahepatic Cholestasis in a Single Italian Center

    Science.gov (United States)

    Giovannoni, Isabella; Callea, Francesco; Bellacchio, Emanuele; Torre, Giuliano; De Ville De Goyet, Jean; Francalanci, Paola

    2015-01-01

    Familial intrahepatic cholestases (FICs) are a heterogeneous group of autosomal recessive disorders of childhood that disrupt bile formation and present with cholestasis of hepatocellular origin. Three distinct forms are described: FIC1 and FIC2, associated with low/normal GGT level in serum, which are caused by impaired bile salt secretion due to defects in ATP8B1 encoding the FIC1 protein and defects in ABCB11 encoding bile salt export pump protein, respectively; FIC3, linked to high GGT level, involves impaired biliary phospholipid secretion due to defects in ABCB4, encoding multidrug resistance 3 protein. Different mutations in these genes may cause either a progressive familial intrahepatic cholestasis (PFIC) or a benign recurrent intrahepatic cholestasis (BRIC). For the purposes of the present study we genotyped 27 children with intrahepatic cholestasis, diagnosed on either a clinical or histological basis. Two BRIC, 23 PFIC and 2 BRIC/PFIC were identified. Thirty-four different mutations were found of which 11 were novel. One was a 2Mb deletion (5’UTR- exon 18) in ATP8B1. In another case microsatellite analysis of chromosome 2, including ABCB11, showed uniparental disomy. Two cases were compound heterozygous for BRIC/PFIC2 mutations. Our results highlight the importance of the pathogenic role of novel mutations in the three genes and unusual modes of their transmission. PMID:26678486

  12. A fatal case of primary basaloid squamous cell carcinoma in the intrahepatic bile ducts

    DEFF Research Database (Denmark)

    Kirkegaard, Johan; Grunnet, Mie; Hasselby, Jane Preuss

    2014-01-01

    of diagnosis but expired 20 months after surgery with epidural, lung, and spine metastasis. In addition to the unusual clinical presentation, the diagnosis of the liver tumor was that of a primary basaloid squamous cell carcinoma of the intrahepatic bile ducts, an entity with only one previous report...

  13. Tumor Implantation into the Intrahepatic Bile Duct after Percutaneous Ethanol Injection Therapy for Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Shogo Tanaka

    2009-11-01

    Full Text Available A 74-year-old man who had undergone transcatheter arterial embolization for hepatitis C virus-related hepatocellular carcinoma (Couinaud’s segment III/IV in April 2003 and percutaneous ethanol injection for recurrence at the same site in February 2006 was found to have dilation of the intrahepatic bile duct by computed tomography in October 2008. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography showed a thrombosis occupying the left hepatic duct to the lateral branches with peripheral bile duct dilation. Serum concentration of alpha-fetoprotein was elevated. We performed a left hepatectomy under a preoperative diagnosis of hepatocellular carcinoma with bile duct invasion. The cut surface of the resected specimen showed a tumor thrombosis occupying the region between the left hepatic duct and lateral branches, but no tumor in the liver parenchyma. Histologic examination showed that the thrombosis in the intrahepatic bile duct was hepatocellular carcinoma. Since part of the hepatocellular carcinoma in the region treated with percutaneous ethanol injection was adjacent to the tumor thrombosis in the intrahepatic bile duct in diagnostic imaging, we diagnosed implantation into the intrahepatic bile duct due to percutaneous ethanol injection. The postoperative course was uneventful and the patient is doing well without recurrence 8 months after the operation.

  14. Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kawakita, Tetsuya; Parikh, Laura I; Ramsey, Patrick S; Huang, Chun-Chih; Zeymo, Alexander; Fernandez, Miguel; Smith, Samuel; Iqbal, Sara N

    2015-10-01

    We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated. Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P < .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P < .01) and ursodeoxycholic acid use (P = .02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1.45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively). In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid. Copyright © 2015 Elsevier Inc

  15. Radiation Exposure in Transjugular Intrahepatic Portosystemic Shunt Creation

    Energy Technology Data Exchange (ETDEWEB)

    Miraglia, Roberto, E-mail: rmiraglia@ismett.edu; Maruzzelli, Luigi, E-mail: lmaruzzelli@ismett.edu; Cortis, Kelvin, E-mail: kelvincortis@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); D’Amico, Mario, E-mail: mdamico@ismett.edu [University of Palermo, Department of Radiology (Italy); Floridia, Gaetano, E-mail: gfloridia@ismett.edu; Gallo, Giuseppe, E-mail: ggallo@ismett.edu; Tafaro, Corrado, E-mail: ctafaro@ismett.edu; Luca, Angelo, E-mail: aluca@ismett.edu [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy)

    2016-02-15

    PurposeTransjugular intrahepatic portosystemic shunt (TIPS) creation is considered as being one of the most complex procedures in abdominal interventional radiology. Our aim was twofold: quantification of TIPS-related patient radiation exposure in our center and identification of factors leading to reduced radiation exposure.Materials and methodsThree hundred and forty seven consecutive patients underwent TIPS in our center between 2007 and 2014. Three main procedure categories were identified: Group I (n = 88)—fluoroscopic-guided portal vein targeting, procedure done in an image intensifier-based angiographic system (IIDS); Group II (n = 48)—ultrasound-guided portal vein puncture, procedure done in an IIDS; and Group III (n = 211)—ultrasound-guided portal vein puncture, procedure done in a flat panel detector-based system (FPDS). Radiation exposure (dose-area product [DAP], in Gy cm{sup 2} and fluoroscopy time [FT] in minutes) was retrospectively analyzed.ResultsDAP was significantly higher in Group I (mean ± SD 360 ± 298; median 287; 75th percentile 389 Gy cm{sup 2}) as compared to Group II (217 ± 130; 178; 276 Gy cm{sup 2}; p = 0.002) and Group III (129 ± 117; 70; 150 Gy cm{sup 2}p < 0.001). The difference in DAP between Groups II and III was also significant (p < 0.001). Group I had significantly longer FT (25.78 ± 13.52 min) as compared to Group II (20.45 ± 10.87 min; p = 0.02) and Group III (19.76 ± 13.34; p < 0.001). FT was not significantly different between Groups II and III (p = 0.73).ConclusionsReal-time ultrasound-guided targeting of the portal venous system during TIPS creation results in a significantly lower radiation exposure and reduced FT. Further reduction in radiation exposure can be achieved through the use of modern angiographic units with FPDS.

  16. Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis of Pregnancy.

    Science.gov (United States)

    Furrer, Romana; Winter, Katharina; Schäffer, Leonhard; Zimmermann, Roland; Burkhardt, Tilo; Haslinger, Christian

    2016-11-01

    To evaluate postpartum blood loss in women with treated intrahepatic cholestasis of pregnancy. In a retrospective case-control study, 15,083 deliveries including 348 women with intrahepatic cholestasis of pregnancy (2.3%) were analyzed from 2004 to 2014. To adjust for differences in baseline characteristics, a propensity analysis was performed and women in the control group were matched to the women in the intrahepatic cholestasis of pregnancy group in a 5:1 ratio. Blood loss was analyzed by estimated blood loss and Δ hemoglobin (Hb, difference between prepartum and postpartum Hb). A subgroup analysis regarding severity of intrahepatic cholestasis of pregnancy based on maximum bile acid level (mild [less than 40 micromoles/L], moderate [40-99 micromoles/L], and severe intrahepatic cholestasis of pregnancy [100 micromoles/L or greater]) was performed. Differences in estimated blood loss, ΔHb, and meconium staining between subgroups were analyzed. A Spearman rank correlation was performed to evaluate the association of bile acid levels and blood loss within subgroups. Estimated blood loss (median 400 [300-600] mL compared with 400 [300-600] mL, P=.22), ΔHb (14.0 [5.0-22.0] compared with 12.0 [4.0-21.0] g/L, P=.09), meconium staining (14.5% compared with 11.4%, P=.12), and number of stillbirths after 26 weeks of gestation (0.6% compared with 1.8%, P=.10) were not significantly different in the study compared with the control group. In moderate and severe intrahepatic cholestasis of pregnancy, meconium staining was observed significantly more often compared with that in a control group (23.0% and 32.3% compared with 11.4%, Pintrahepatic cholestasis of pregnancy. In our cohort of women with intrahepatic cholestasis of pregnancy who are treated with ursodeoxycholic acid and have planned delivery (induction of labor or planned cesarean delivery) at 38 weeks of gestation, no differences in postpartum blood loss were seen.

  17. Exome sequencing identifies frequent inactivating mutations in BAP1, ARID1A and PBRM1 in intrahepatic cholangiocarcinomas

    Science.gov (United States)

    Selaru, Florin M; Streppel, Mirte M; Lucas, Donald J; Niknafs, Noushin; Guthrie, Violeta Beleva; Maitra, Anirban; Argani, Pedram; Offerhaus, G Johan A; Roa, Juan Carlos; Roberts, Lewis R; Gores, Gregory J; Popescu, Irinel; Alexandrescu, Sorin T; Dima, Simona; Fassan, Matteo; Simbolo, Michele; Mafficini, Andrea; Capelli, Paola; Lawlor, Rita T; Ruzzenente, Andrea; Guglielmi, Alfredo; Tortora, Giampaolo; de Braud, Filippo; Scarpa, Aldo; Jarnagin, William; Klimstra, David; Karchin, Rachel; Velculescu, Victor E; Hruban, Ralph H; Vogelstein, Bert; Kinzler, Kenneth W; Papadopoulos, Nickolas; Wood, Laura D

    2014-01-01

    Through exomic sequencing of 32 intrahepatic cholangiocarcinomas, we discovered frequent inactivating mutations in multiple chromatin-remodeling genes (including BAP1, ARID1A and PBRM1), and mutation in one of these genes occurred in almost half of the carcinomas sequenced. We also identified frequent mutations at previously reported hotspots in the IDH1 and IDH2 genes encoding metabolic enzymes in intrahepatic cholangiocarcinomas. In contrast, TP53 was the most frequently altered gene in a series of nine gallbladder carcinomas. These discoveries highlight the key role of dysregulated chromatin remodeling in intrahepatic cholangiocarcinomas. PMID:24185509

  18. Gelatin sponge particle embolization of spontaneously putured intrahepatic arterial aneurysms in a patient with polyarteritis nodosa: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Myung Jin; Noh, Kyung Hee; Kim, Young Jun; Jeon, Doo Sung [Dept. of Radiology, Presbyterian Medical Center, Jeonju (Korea, Republic of)

    2017-01-15

    Multiple intrahepatic arterial aneurysms and spontaneous aneurysmal rupture associated with polyarteritis nodosa leading to hemoperitoneum are extremely rare occurrences, but the conditions can be life-threatening if left untreated because of the risk of massive hemorrhage. We report a case of a high-risk surgical patient with polyarteritis nodosa complicated by spontaneous rupture of multiple intrahepatic arterial aneurysms. He was initially treated with emergency gelatin sponge particle embolization, followed by maintenance steroid treatment. Complete resolution of intrahepatic arterial aneurysms was observed at follow-up.

  19. Metallothionein overexpression and its prognostic relevance in intrahepatic cholangiocarcinoma and extrahepatic hilar cholangiocarcinoma (Klatskin tumors).

    Science.gov (United States)

    Schmitz, Klaus Jürgen; Lang, Hauke; Kaiser, Gernot; Wohlschlaeger, Jeremias; Sotiropoulos, Georgios Charalambos; Baba, Hideo Andreas; Jasani, Bharat; Schmid, Kurt Werner

    2009-12-01

    Metallothionein is a group of small molecular weight cysteine-rich proteins with a broad variety of functions. Metallothionein has been shown to regulate apoptosis and proliferation. Overexpression of metallothionein frequently occurs in human tumors and is related to prognosis as well as therapy response. However, metallothionein expression and its clinical relevance in cholangiocarcinoma have not been investigated. The present study aimed to analyze metallothionein over-expression and its possible prognostic impact in intrahepatic cholangiocarcinoma and hilar extrahepatic cholangiocarcinoma (Klatskin tumors). We investigated the relationship of immunohistochemically demonstrated metallothionein expression with various clinicopathological parameters in a series of 56 intrahepatic and 56 extrahepatic cholangiocarcinoma. In noncancerous bile duct epithelia metallothionein was only occasionally weakly expressed; strong metallothionein overexpression (>50% metallothionein -positive tumor cells) was noted in 7 (12.5%) of 56 intrahepatic cholangiocarcinoma and 14 (25%) of 56 Klatskin tumors, which was associated with poor clinical outcome in univariate Kaplan-Meier testing in both intrahepatic cholangiocarcinoma (P = .002) and Klatskin tumors (P = .034). Moreover, strong metallothionein expression was identified as an independent prognostic parameter in multivariate Cox regression analysis in both intrahepatic cholangiocarcinoma (P = .005) and Klatskin tumors (P = .035). In contrast, cholangiocarcinoma with a papillary phenotype (8/112; 7.1%) exhibited a significant lack of strong metallothionein expression in all 8 of 8 cases. Strong metallothionein expression is identified as an independent poor prognostic parameter, and determination of the metallothionein expression may serve as an additional tool for the therapeutic management of patients with cholangiocarcinoma. In comparison, lack of metallothionein expression seems to be associated with cholangiocarcinoma with a

  20. Neonatal Outcomes in Fetuses With a Persistent Intrahepatic Right Umbilical Vein.

    Science.gov (United States)

    Canavan, Timothy P; Hill, Lyndon M

    2016-10-01

    A fetal persistent intrahepatic right umbilical vein has been linked to anomalies and genetic disorders but can be a normal variant. We conducted a retrospective review to determine other sonographic findings that can stratify fetuses for further evaluation. A total of 313 fetuses had a persistent intrahepatic right umbilical vein identified on 17- to 24-week sonography. The outcome was any major congenital anomaly or an adverse neonatal outcome, which was defined as aneuploidy, fetal demise, or neonatal death. A total of 217 patients (69.3%) had a normal neonatal outcome. Sixty-nine patients (22.0%) were lost to follow-up. Five fetuses (2.1%) had aneuploidy; 4 of the 5 had additional sonographic findings, and 1 had an isolated persistent intrahepatic right umbilical vein. Twenty-four fetuses had a major anomaly in association with the persistent right umbilical vein; 26 additional fetuses had soft sonographic markers associated with karyotypic abnormalities but were chromosomally normal. Of those with adverse neonatal outcomes, 12 had a congenital heart defect (57%). An additional sonographic finding with a persistent intrahepatic right umbilical vein was predictive of a congenital anomaly or an adverse neonatal outcome (P right umbilical vein had a 0.4% risk for a congenital anomaly or an adverse neonatal outcome. A persistent intrahepatic right umbilical vein should prompt an extended anatomic survey and a fetal cardiac evaluation. If the survey and cardiac anatomy are reassuring, no further follow-up is needed. If additional findings are identified, genetic counseling and invasive testing should be considered.

  1. The Relationship of Fat Distribution and Insulin Resistance with Lumbar Spine Bone Mass in Women.

    Directory of Open Access Journals (Sweden)

    Francisco J A de Paula

    Full Text Available Bone marrow harbors a significant amount of body adipose tissue (BMAT. While BMAT might be a source of energy for bone modeling and remodeling, its increment can also represent impairment of osteoblast differentiation. The relationship between BMAT, bone mass and insulin sensitivity is only partially understood and seems to depend on the circumstances. The present study was designed to assess the association of BMAT with bone mineral density in the lumbar spine as well as with visceral adipose tissue, intrahepatic lipids, HOMA-IR, and serum levels of insulin and glucose. This cross-sectional clinical investigation included 31 non-diabetic women, but 11 had a pre-diabetes status. Dual X-ray energy absorptiometry was used to measure bone mineral density and magnetic resonance imaging was used to assess fat deposition in BMAT, visceral adipose tissue and liver. Our results suggest that in non-diabetic, there is an inverse relationship between bone mineral density in lumbar spine and BMAT and a trend persists after adjustment for weight, age, BMI and height. While there is a positive association between visceral adipose tissue and intrahepatic lipids with serum insulin levels, there is no association between BMAT and serum levels of insulin. Conversely, a positive relationship was observed between BMAT and serum glucose levels, whereas this association was not observed with other fat deposits. These relationships did not apply after adjustment for body weight, BMI, height and age. The present study shows that in a group of predominantly non-obese women the association between insulin resistance and BMAT is not an early event, as occurs with visceral adipose tissue and intrahepatic lipids. On the other hand, BMAT has a negative relationship with bone mineral density. Taken together, the results support the view that bone has a complex and non-linear relationship with energy metabolism.

  2. The Relationship of Fat Distribution and Insulin Resistance with Lumbar Spine Bone Mass in Women.

    Science.gov (United States)

    de Paula, Francisco J A; de Araújo, Iana M; Carvalho, Adriana L; Elias, Jorge; Salmon, Carlos E G; Nogueira-Barbosa, Marcello H

    2015-01-01

    Bone marrow harbors a significant amount of body adipose tissue (BMAT). While BMAT might be a source of energy for bone modeling and remodeling, its increment can also represent impairment of osteoblast differentiation. The relationship between BMAT, bone mass and insulin sensitivity is only partially understood and seems to depend on the circumstances. The present study was designed to assess the association of BMAT with bone mineral density in the lumbar spine as well as with visceral adipose tissue, intrahepatic lipids, HOMA-IR, and serum levels of insulin and glucose. This cross-sectional clinical investigation included 31 non-diabetic women, but 11 had a pre-diabetes status. Dual X-ray energy absorptiometry was used to measure bone mineral density and magnetic resonance imaging was used to assess fat deposition in BMAT, visceral adipose tissue and liver. Our results suggest that in non-diabetic, there is an inverse relationship between bone mineral density in lumbar spine and BMAT and a trend persists after adjustment for weight, age, BMI and height. While there is a positive association between visceral adipose tissue and intrahepatic lipids with serum insulin levels, there is no association between BMAT and serum levels of insulin. Conversely, a positive relationship was observed between BMAT and serum glucose levels, whereas this association was not observed with other fat deposits. These relationships did not apply after adjustment for body weight, BMI, height and age. The present study shows that in a group of predominantly non-obese women the association between insulin resistance and BMAT is not an early event, as occurs with visceral adipose tissue and intrahepatic lipids. On the other hand, BMAT has a negative relationship with bone mineral density. Taken together, the results support the view that bone has a complex and non-linear relationship with energy metabolism.

  3. Intrahepatic distribution of hepatitis B virus antigens in patients with and without hepatocellular carcinoma

    Science.gov (United States)

    Safaie, Parham; Poongkunran, Mugilan; Kuang, Ping-Ping; Javaid, Asad; Jacobs, Carl; Pohlmann, Rebecca; Nasser, Imad; Lau, Daryl TY

    2016-01-01

    AIM: To study the intrahepatic expression of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) in chronic hepatitis B patients with and without hepatocellular carcinoma. METHODS: A total of 33 chronic hepatitis B patients (mean age of 40.3 ± 2.5 years), comprising of 14 HBeAg positive and 19 HBeAg negative patients; and 13 patients with hepatitis B virus related hepatocellular carcinoma (mean age of 49.6 ± 4.7 years), were included in our study. Immunohistochemical staining for HBcAg and HBsAg was done using standard streptavidin-biotin-immunoperoxidase technique on paraffin-embedded liver biopsies. The HBcAg and HBsAg staining distributions and patterns were described according to a modified classification system. RESULTS: Compared to the HBeAg negative patients, the HBeAg positive patients were younger, had higher mean HBV DNA and alanine transaminases levels. All the HBeAg positive patients had intrahepatic HBcAg staining; predominantly with “diffuse” distribution (79%) and “mixed cytoplasmic/nuclear” pattern (79%). In comparison, only 5% of the HBeAg-negative patients had intrahepatic HBcAg staining. However, the intrahepatic HBsAg staining has wider distribution among the HBeAg negative patients, namely; majority of the HBeAg negative cases had “patchy” HBsAg distribution compared to “rare” distribution among the HBeAg positive cases. All but one patient with HCC were HBeAg negative with either undetectable HBV DNA or very low level of viremia. Intrahepatic HBcAg and HBsAg were seen in 13 (100%) and 10 (77%) of the HCC patients respectively. Interestingly, among the 9 HCC patients on anti-viral therapy with suppressed HBV DNA, HBcAg and HBsAg were detected in tumor tissues but not the adjacent liver in 4 (44%) and 1 (11%) patient respectively. CONCLUSION: Isolated intrahepatic HBcAg and HBsAg can be present in tumors of patients with suppressed HBV DNA on antiviral therapy; that may predispose them to cancer development

  4. Fish health and fish quality

    DEFF Research Database (Denmark)

    Ingerslev, Hans-Christian

    Aquaculture is an expanding worldwide industry producing an increasing amount of fish every year. The quality of the fish meat is dependent upon many biological and non-biological factors. Infectious diseases are known to cause bleedings and damage of the muscle tissue that may lead to scarring...... are poorly described in fish. The present work in this thesis focused on: 1) examination of potential changes in the quality regarding texture of the muscle tissue in rainbow trout (Oncorhynchus mykiss) after previous infection with the bacterial pathogens Yersinia ruckeri and Vibrio anguillarum; 2...... of these studies showed that previous infections by Yersinia ruckeri and Vibrio anguillarum gave rise to subsequent changes regarding textural quality parameters in fresh fish meat, while no differences were seen for cold-smoked meat from the same fish. The texture in previous infected fish was less flaky and less...

  5. Fish remains and humankind

    Directory of Open Access Journals (Sweden)

    Andrew K G Jones

    1997-08-01

    Full Text Available The four papers in this issue represent a trawl of the reports presented to the Fourth meeting of the International Council for Archaeozoology (ICAZ Fish Remains Working Group, which met at the University of York in 1987. The conference discussed material from many parts of the world - from Australasia to the north-west coast of America - and many eras, ranging in date from the early Pleistocene to the 1980s. It demonstrated both the variety of work being carried out and the growing interest in ancient fish remains. Internet Archaeology plans to publish other batches of papers from this conference. These reports will demonstrate the effort being made to distinguish between assemblages of fish remains which have been deposited by people and those which occur in ancient deposits as a result of the action of other agents. To investigate this area, experiments with modern material and observations of naturally occurring fish bone assemblages are supplemented with detailed analysis of ancient and modern fish remains. The papers published here illustrate the breadth of research into osteology, biogeography, documentary research, and the practicalities of recovering fish remains. Read, digest and enjoy them! Using the Internet for publishing research papers is not only ecologically sound (saving paper, etc. it disseminates scholarship to anyone anywhere on the planet with access to what is gradually becoming necessary technology in the late 20th century. Hopefully, future groups of papers will include video and audio material recorded at the conference, and so enable those who could not attend to gain further insights into the meeting and the scholarship underpinning this area of research.

  6. Bone scan

    Science.gov (United States)

    ... legs, or spine fractures) Diagnose a bone infection (osteomyelitis) Diagnose or determine the cause of bone pain, ... 2015:chap 43. Read More Broken bone Metabolism Osteomyelitis Review Date 12/10/2015 Updated by: Jatin ...

  7. Bone Cancer

    Science.gov (United States)

    Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another ... more common. There are three types of bone cancer: Osteosarcoma - occurs most often between ages 10 and ...

  8. Bone Diseases

    Science.gov (United States)

    Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly ... childhood and your teens, your body adds new bone faster than it removes old bone. After about ...

  9. Bone Markers

    Science.gov (United States)

    ... markers may be seen in conditions such as: Osteoporosis Paget disease Cancer that has spread to the bone (metastatic bone disease) Hyperparathyroidism Hyperthyroidism Osteomalacia in adults and rickets in children—lack of bone mineralization, ...

  10. Fish parasites

    DEFF Research Database (Denmark)

    This book contains 22 chapters on some of the most important parasitic diseases in wild and farmed fish. International experts give updated reviews and provide solutions to the problems......This book contains 22 chapters on some of the most important parasitic diseases in wild and farmed fish. International experts give updated reviews and provide solutions to the problems...

  11. Intrahepatic cholestasis of pregnancy: A risk factor for cancer, autoimmune and cardiovascular diseases?

    Science.gov (United States)

    Erlinger, Serge

    2016-04-01

    The authors show, in an elegant population-based study, a significant association between intrahepatic cholestasis of pregnancy and liver and biliary cancer. This association is most probably related to the high frequency of hepatitis C and gallstone disease in women with intrahepatic cholestasis of pregnancy, both being risk factors for liver and biliary cancer. In addition, the study clearly shows an increased risk of diabetes mellitus and autoimmune diseases, such as thyroid diseases, psoriasis, autoimmune arthropathies and Crohn's disease, and a small increase in cardiovascular diseases. In practice, a follow-up of liver function tests 6-12 weeks after delivery is strongly recommended to detect a possible associated liver disease. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Neutrophil-to-lymphocyte ratio as a diagnostic marker of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kirbas, Ayse; Biberoglu, Ebru; Daglar, Korkut; İskender, Cantekin; Erkaya, Salim; Dede, Hülya; Uygur, Dilek; Danisman, Nuri

    2014-09-01

    In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and total bile acid (TBA) concentration in pregnant women with intrahepatic cholestasis of pregnancy (ICP). Fasting and postprandial TBA, NLR, and aminotransferase (AST/ALT) levels in the blood samples of 65 pregnant women with intrahepatic cholestasis were examined in this prospective case-control study. Thirty-three of the patients had mild disease and 32 had severe disease; 70 healthy women in uncomplicated pregnancies served as the control group. Not only was the mean NLR elevated in the pregnant women with cholestasis when compared to the controls, but it also predicted the severity of the cholestasis. The correlation between fasting TBA and NLR was significant. Although TBA is still the diagnostic standard, NLR can be used as an initial screening tool due to its high specificity. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Successful Outcome of Chronic Intrahepatic Cholestasis in an Adult Patient with Sickle Cell/β+ Thalassemia

    Directory of Open Access Journals (Sweden)

    Efthymia Vlachaki

    2014-01-01

    Full Text Available Sickle cell/β+ thalassemia (Hb S/β+thal is considered as a variant form of sickle cell disease. Acute episodes of vasoocclusive pain crisis are characteristic for sickle cell disorders and may be complicated by an acute or chronic life-threatening organ dysfunction. Chronic intrahepatic cholestasis is a rare and severe complication in sickle cell disease, characterized by marked hyperbilirubinemia and acute hepatic failure with an often fatal course. Despite the fact that patients with Hb S/β+thal usually have a mild type of disease, herein we describe an interesting case of chronic intrahepatic cholestasis with successful outcome in an adult patient with Hb S/β+thal.

  14. Biochemical Characterization of P4-ATPase Mutations Associated with Intrahepatic Cholestatic Disease

    DEFF Research Database (Denmark)

    Gantzel, Rasmus; Vestergaard, Anna Lindeløv; Mikkelsen, Stine;

    The cholestatic disorders progressive familial intrahepatic cholestasis type 1 (PFIC1, also referred to as Byler’s disease) and benign recurrent intrahepatic cholestasis type 1 (BRIC1) are caused by mutation of the P4-ATPase ATP8B1. The substrate of ATP8B1 is very likely to be phosphatidylserine...... families have been investigated, and more than 50 distinct disease mutations have been identified, with roughly half being missense mutations. In this project we try to answer the question whether PFIC1 mutations are generally more disturbing than BRIC1 mutations with respect to expression, structural...... stability and function. We investigate the mutations in our well functioning system of ATP8A2, being expressed in mammalian HEK293T cells, affinity-purified, and reconstituted in lipid vesicles. Well-known mutations from both groups of patients have been selected for study. I91P in ATP8A2 (L127P in ATP8B1...

  15. Biochemical characterization of P4-ATPase mutations associated with Intrahepatic Cholestatic Disease

    DEFF Research Database (Denmark)

    Gantzel, Rasmus; Vestergaard, Anna Lindeløv; Mikkelsen, Stine

    Progressive familial intrahepatic cholestasis type 1 (PFIC1) and benign recurrent intrahepatic cholestasis type 1 (BRIC1) are caused by mutation of the P4-ATPase ATP8B1 that flips phospholipid from the exoplasmic leaflet to the cytoplasmic leaflet of canalicular membranes. It is hypothesized...... that PFIC1 mutations are the most disturbing with respect to expression, structural stability and/or function. Although recent data indicates that the specific phospholipid substrate of ATP8B1 is phosphatidylcholine (PC) [1] whereas ATP8A2 flips phosphatidylserine (PS) and phosphatidylethanolamine (PE......), there may be several mechanistic similarities between ATP8B1 and ATP8A2, and here we investigate known disease mutations using our well-functioning methodology for expression, affinity purification and assay of the partial reactions of ATP8A2. Mutations I91P (L127P in ATP8B1) and L308F (I344F) are located...

  16. Asymptomatic Intrahepatic Portosystemic Venous Shunt: To Treat or Not To Treat?

    Science.gov (United States)

    Palvanov, Arkadiy; Marder, Ruth Leah; Siegel, David

    2016-09-01

    Intrahepatic portosystemic venous shunts (IPSVSs) are rare vascular malformations. They can be asymptomatic or present with various symptoms including encephalopathy. We present two cases of IPSVS, one involving a patient presenting with altered mental status and the other discovered incidentally. While there is no question that patients presenting with symptomatic IPSVS should undergo definitive treatment, there is no consensus regarding elective therapy for asymptomatic lesions.

  17. Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

    Institute of Scientific and Technical Information of China (English)

    Tae; Hoon; Lee; Sang-Heum; Park; Sae; Hwan; Lee; Chang-Kyun; Lee; Suck-Ho; Lee; Il-Kwun; Chung; Hong; Soo; Kim; Sun-Joo; Kim

    2010-01-01

    The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous techniques.Traditionally,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively cannulated.When selective intrahepatic bile duct(IHD) cannulation fai...

  18. Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

    Energy Technology Data Exchange (ETDEWEB)

    Niessen, Christoph; Jung, Ernst Michael; Wohlgemuth, Walter A. [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany); Trabold, Benedikt [Department of Anaesthesia, University Medical Center Regensburg, Regensburg D-93053 (Germany); Haimerl, Michael; Schreyer, Andreas; Stroszczynski, Christian; Wiggermann, Philipp [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany)

    2013-07-01

    We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.

  19. Calorie Restricted High Protein Diets Downregulate Lipogenesis and Lower Intrahepatic Triglyceride Concentrations in Male Rats

    Directory of Open Access Journals (Sweden)

    Lee M. Margolis

    2016-09-01

    Full Text Available The purpose of this investigation was to assess the influence of calorie restriction (CR alone, higher-protein/lower-carbohydrate intake alone, and combined CR higher-protein/lower-carbohydrate intake on glucose homeostasis, hepatic de novo lipogenesis (DNL, and intrahepatic triglycerides. Twelve-week old male Sprague Dawley rats consumed ad libitum (AL or CR (40% restriction, adequate (10%, or high (32% protein (PRO milk-based diets for 16 weeks. Metabolic profiles were assessed in serum, and intrahepatic triglyceride concentrations and molecular markers of de novo lipogenesis were determined in liver. Independent of calorie intake, 32% PRO tended to result in lower homeostatic model assessment of insulin resistance (HOMA-IR values compared to 10% PRO, while insulin and homeostatic model assessment of β-cell function (HOMA-β values were lower in CR than AL, regardless of protein intake. Intrahepatic triglyceride concentrations were 27.4 ± 4.5 and 11.7 ± 4.5 µmol·g−1 lower (p < 0.05 in CR and 32% PRO compared to AL and 10% PRO, respectively. Gene expression of fatty acid synthase (FASN, stearoyl-CoA destaurase-1 (SCD1 and pyruvate dehydrogenase kinase, isozyme 4 (PDK4 were 45% ± 1%, 23% ± 1%, and 57% ± 1% lower (p < 0.05, respectively, in CR than AL, regardless of protein intake. Total protein of FASN and SCD were 50% ± 1% and 26% ± 1% lower (p < 0.05 in 32% PRO compared to 10% PRO, independent of calorie intake. Results from this investigation provide evidence that the metabolic health benefits associated with CR—specifically reduction in intrahepatic triglyceride content—may be enhanced by consuming a higher-protein/lower-carbohydrate diet.

  20. Prognosis of hepatocellular carcinoma patients with extrahepatic metastasis and the controllability of intrahepatic lesions.

    Science.gov (United States)

    Lee, Jung Il; Kim, Ja Kyung; Kim, Do Young; Ahn, Sang Hoon; Park, Jun Yong; Kim, Seung Up; Kim, Beom Kyung; Han, Kwang Hyub; Lee, Kwan Sik

    2014-04-01

    Although advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is recommended to be treated by a systemic chemotherapeutic agent without local treatment targeting the liver, studies reported that causes of death in these patients were mostly from progression of intrahepatic lesions. Thus, this study investigated prognosis and factors predicting survival in these patients so as to evaluate the role of local treatments against intrahepatic lesions when the patients already had extrahepatic metastasis. This retrospective study evaluated medical records of 277 patients with HCC and extrahepatic metastasis. The median survival was 5.9 months, and 257 patients died during the follow up. Factors affecting survival of HCC patients with extrahepatic metastasis were poor response to treatment of hepatic lesions (HR 2.207; 95% CI; p < 0.001), applying local treatment specifically targeting intrahepatic lesions (HR 0.591; 95% CI 0.436-0.803; p = 0.001), intrahepatic tumor size larger than 3 cm (HR 2.065; 95% CI 1.444-2.954; p < 0.001), and ECOG performance status 2 or higher (HR 1.543; 95% CI 1.057-2.253; p = 0.025). The patients with either complete or partial response to the therapy had 1- and 2-year survival rate of 48.8 and 12.1% whereas patient with either stable or progressive disease had 1-year survival rate of 11.4%. These results suggest that even in the HCC patients with extrahepatic metastasis, effective local treatment may still be beneficial for the survival especially in patients with acceptable performance status.

  1. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Deepak, E-mail: deepakjain02@yahoo.com; Arora, Ankur, E-mail: aroradrankur@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Deka, Pranjal, E-mail: drpranjaldeka@gmail.com [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India); Mukund, Amar, E-mail: dramarmukund@gmail.com; Bhatnagar, Shorav, E-mail: drshorav@yahoo.com [Institute of Liver and Biliary Sciences, Department of Radiology (India); Jindal, Deepti, E-mail: deepijindal@rediffmail.com; Kumar, Niteen, E-mail: drniteenkumar@gmail.com; Pamecha, Viniyendra, E-mail: viniyendra@yahoo.co.uk [Institute of Liver and Biliary Sciences, Department of Hepatopancreatobiliary Surgery (India)

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  2. Assessing the risk of drug-induced cholestasis using unbound intrahepatic concentrations.

    Science.gov (United States)

    Riede, Julia; Poller, Birk; Huwyler, Jorg; Camenisch, Gian

    2017-03-02

    Inhibition of the bile salt export pump (BSEP) has been recognized as a key factor in the development of drug-induced cholestasis (DIC). The risk of DIC in human has previously been assessed using in vitro BSEP inhibition data (IC50) and unbound systemic drug exposure under assumption of the "free drug hypothesis". This concept, however, is unlikely valid as unbound intrahepatic drug concentrations are affected by active transport and metabolism. To investigate this hypothesis we experimentally determined the in vitro liver-to-blood partition coefficients (Kp,uu) for 18 drug compounds using the hepatic Extended Clearance Model (ECM). In vitro-in vivo translatability of Kp,uu values was verified for a subset of compounds in rat. Consequently, unbound intrahepatic concentrations were calculated from clinical exposure (systemic and hepatic inlet) and measured Kp,uu data. Using these values, corresponding safety margins against BSEP IC50 values were determined and compared to the clinical incidence of DIC. Depending on the ECM class of a drug, in vitro Kp,uu values deviated up to 14-fold from unity and unbound intrahepatic concentrations were affected accordingly. The use of in vitro Kp,uu-based safety margins allowed to separate clinical cholestasis frequency into three classes (no cholestasis, cholestasis in ≤ 2%, and in > 2% of subjects) for 17 out of 18 compounds. This assessment was significantly superior compared to using unbound extracellular concentrations as a surrogate for intrahepatic concentrations. Furthermore, the assessment of Kpuu according to ECM provides useful guidance for the quantitative evaluation of genetic and physiological risk factors for the development of cholestasis.

  3. The roles of Notch1 expression in the migration of intrahepatic cholangiocarcinoma

    OpenAIRE

    Zhou, Qi; Wang, Yafeng; Peng, Baogang; Liang, Lijian; Li, Jiaping

    2013-01-01

    Background Notch signaling, a critical pathway for tissue development, contributes to tumorigenesis in many tissues; however, the roles of Notch signaling in Intrahepatic Cholangiocarcinoma (ICC) remains unclear. In this study, we evaluated the expression and effects of Notch1 on cell migration in ICC. Methods Multiple cellular and molecular approaches were performed including gene transfection, siRNA transfection, RT-PCR, Western blotting, Rac activation assays and immunofluorescence. Result...

  4. Role of ABCC2 common variants in intrahepatic cholestasis of pregnancy

    Institute of Scientific and Technical Information of China (English)

    Silvia Sookoian; Gustavo Castano; Carlos J Pirola

    2008-01-01

    The pathogenesis of intrahepatic cholestasis of pregnancy (ICP), a disorder that adversely affects maternal wellbeing and fetal outcome, is unclear. However, multiple factors probably interact along with a genetic predisposition. We would like to add some comments on a paper recently published concerning the role of ABCB11 and ABCC2 polymorphisms in both ICP and contraceptive-induced cholestasis, especially in the light of our recently published findings about a positive association between ICP and ABCC2 common variants.

  5. Ultrasonic Contrast Portography for Demonstration of Intrahepatic Porto-systemic Shunts

    Directory of Open Access Journals (Sweden)

    Yi-Hong Chou

    2016-03-01

    Full Text Available Spontaneous intrahepatic porto-systemic shunts (IHPSS can be disclosed with ultrasound (US and color Doppler ultrasound (CDU. However, direct evidence of the shunt on US or CDU may not be convincing. In this report we demonstrate the presence of IHPSS by ultrasonic contrast portography with intravenous injection of microbubble-based contrast agent (MBCA. With this technique, the MBCA was depicted to enter the hepatic vein through the shunt, and then flowed into the inferior vena cava.

  6. Intrahepatic peribiliary perivascular epithelioid cell tumor (PEComa) associated with heterotopic pancreas: A case report.

    Science.gov (United States)

    Kiriyama, Yuka; Tsukamoto, Tetsuya; Mizoguchi, Yoshikazu; Ishihara, Shin; Horiguchi, Akihiko; Tokoro, Takamasa; Kato, Yutaro; Sugioka, Atsushi; Kuroda, Makoto

    2016-08-20

    Perivascular epithelioid-cell tumor (PEComa) is a group of rare mesenchymal neoplasms that express myomelanocytic-cell markers and exhibit a wide variety of histopathological features. Although heterotopic pancreas has been reported to occur in the gastrointestinal tract, intrahepatic heterotopic pancreas has been reported only rarely. We present a case of intrahepatic PEComa that showed a strong regional correlation with the presence of heterotopic pancreas. An intrahepatic tumor and biliary dilatation was incidentally discovered during a diagnostic evaluation to investigate low-back pain in a 47-year-old Japanese male. Cholangiocarcinoma was suspected and a left hemihepatectomy performed. Histological examination revealed a 3 × 3.8-mm tumor in the neighboring B2 bile duct. Histological and immunohistochemical investigations revealed the presence of a PEComa and pancreatic acini within the tumor mass. PEComa in the hepatobiliary and pancreatic regions are extremely rare. The presence of heterotopic pancreas is also relatively uncommon. The strong regional association of these 2 lesions raises the possibility of a PEComa originating from heterotopic pancreas or from an irritable response caused by heterotopic pancreas.

  7. Clinical effect of laparoscopic hepatolobectomy in patients with intrahepatic bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Pei Yu; Yan-Xia Zhong

    2016-01-01

    Objective:To study the clinical effect of laparoscopic hepatolobectomy in patients with intrahepatic bile duct stones. Methods:Patients with intrahepatic bile duct stones receiving hepatolobectomy were chosen for study, patients receiving laparoscopic surgery and patients receiving open surgery were screened and enrolled in laparoscopic group and open group respectively, and then degree of stress response, degree of liver damage and Nrf2-ARE signaling pathway function of two groups were compared. Results:At T1 and T2 points in time, stress indicators and Nrf2-ARE signaling pathway function of two groups had no difference;at T3 and T4 points in time, blood sugar, cortisol and angiotensin levels of laparoscopic group were lower, and insulin level as well as Nrf2 and ARE contents were higher;at T4 point in time, 8-OhdG, PCO, CYP1A and CYP3A contents of laparoscopic group were lower. Conclusion: Laparoscopic hepatolobectomy helps to relieve stress response, protect liver cells from damage and enhance Nrf2-ARE signaling pathway function;it’s an ideal method of surgical treatment of intrahepatic bile duct stones.

  8. Transcatheter embolization of a congenital intrahepatic arterioportal venous malformation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Sing, T.M.Y.S.; Wong, K.P.; Young, N. [Westmead Hospital, Westmead, NSW, (Australia). Department of Radiaology; Le, S.D.V. [Bankstown-Lidcombe Hospital, Bankstown, NSW, (Australia). Department of Nuclear Medicine and Ultrasound

    1997-08-01

    Congenital intrahepatic arterioportal venous malformations (APVM) are uncommon lesions. A congenital intrahepatic APVM found incidentally in a 51 -year-old man during pre-operative aortography for an abdominal aortic aneurysm is reported here. This was successfully treated by transcatheter embolization of the involved hepatic artery prior to surgical repair of the aortic aneurysm. A 51-year-old smoker was admitted for pre-operative aortography of an abdominal aortic aneurysm (AAA). Liver function tests showed a mildly elevated alkaline phosphatase. There was no previous history of liver disease or trauma. Aortography demonstrated a large infra-renal AAA measuring 10 cm in diameter and 20 cm in length. The coeliac axis was noted to be grossly dilated with tortuous veins seen to the right side of the lower thoracic spine on delayed images. Coeliac angiography revealed a dilated intrahepatic vascular abnormality in the left lobe of the liver with late opacification of the portal vein. Contrast abdominal CT demonstrated the AAA and the dilated coeliac axis feeding a large vascular malformation in the lateral aspect of the left lobe of the liver. The arterial inflow was via the left hepatic artery and a large vein was seen leading into the left portal vein. Endoscopy showed no oesophageal varices. (authors). 11 refs., 7 figs.

  9. Excessive bilirubin elevation in a patient with hereditary spherocytosis and intrahepatic cholestasis.

    Science.gov (United States)

    Wree, A; Canbay, A; Müller-Beissenhirtz, H; Dechêne, A; Gerken, G; Dührsen, U; Lammert, F; Nückel, H

    2011-08-01

    Hereditary spherocytosis is a common hemolytic anemia with an estimated incidence of 1 / 2500 births. It is caused by a molecular defect in one or more of the proteins of the red blood cell cytoskeleton. Mutations in the ABCB11 gene, encoding the bile salt export pump, can entail progressive familial intrahepatic cholestasis and benign recurred intrahepatic cholestasis. A 18 year old Turkish patient with hereditary spherocytosis was admitted to hospital with pruritus and severe jaundice. Ultrasound examination presented stones in gallbladder and bile duct. After endoscopic retrograde cholangiography with extraction of small bile duct stones abdominal pain resolved and liver enzymes normalized within a few days, but bilirubin and bile acids remained highly elevated. Liver biopsy revealed a severe canalicular cholestasis. Genetic analysis showed the compound heterozygous variants ABCB11 A 444V and 3084A > G. Treatment with ursodesoxycholic acid and intermittent therapy with prednisone reduced pruritus and jaundice with concomitant improvement of blood test. Here we report the first case of a patient with combined hereditary spherocytosis and compound heterozygous ABCB11 gene variants predisposing to intrahepatic cholestasis. Therefore, patients with hemolytic disorders should be investigated for bile acid transporter diseases in case of hyperbilirubinemia and severe cholestasis.

  10. Diabetes mellitus increases the risk of intrahepatic recurrence of hepatocellular carcinoma after surgical resection.

    Science.gov (United States)

    Choi, Yunseon; Choi, YoungKil; Choi, Chang Soo; Lee, Yun-Han

    2017-05-12

    The relationship between cancer and metabolism has recently been receiving attention. We investigated the prognostic influence of type 2 diabetes mellitus in patients with hepatocellular carcinoma (HCC) treated with curative resection. The records of 58 patients who underwent curative resection for HCC pT1-2N0M0 between 2010 and 2014 were reviewed retrospectively. Fourteen patients (24.1%) had diabetes mellitus at diagnosis. Local control (LC) was defined as time to recurrence in the liver. The median follow-up was 23.3 months. Relapses occurred in 20 patients (34.5%) during the follow-up period; 17 of them developed intrahepatic recurrence, which was associated with diabetes mellitus (p = 0.013) and alpha fetoprotein (AFP) levels >500 ng/mL (p = 0.019). Overall relapses (n = 20) were related to T stage (p = 0.044), AFP level (p = 0.005), and diabetes (p = 0.044). The 3-year local control (intrahepatic control), disease-free survival, and overall survival rates were 56.7%, 50.5%, and 84.3%, respectively. LC was affected by diabetes mellitus (p = 0.046), Barcelona Clinic Liver Cancer staging (pDiabetes was also associated with reduced LC in the subgroup with hepatitis B-related HCC (n = 44, p = 0.028). Diabetes mellitus is correlated with intrahepatic HCC recurrence after surgery. Greater attention should be paid to managing patients with HCC and diabetes mellitus.

  11. Postpartum Acute Liver Dysfunction: A Case of Acute Fatty Liver of Pregnancy Developing Massive Intrahepatic Calcification

    Science.gov (United States)

    Bhat, Khalid Javid; Shovkat, Rabia; Samoon, Hamad Jeelani

    2015-01-01

    The function of the liver is particularly affected by the unique physiologic milieu of the pregnancy. Pregnancy-related liver diseases encompass a spectrum of different etiologies that are related to gestation or one of its complications. Hepatic calcification, a rare entity, is usually associated with infectious, vascular, or neoplastic lesions in the liver. To the best of our knowledge, only one case of rapidly occurring pregnancy-related intrahepatic calcification has been documented in a patient with severe eclampsia or hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. Here we present a case of immediate “postpartum” acute fatty liver of pregnancy (AFLP) in a 23-year-old hypertensive primigravida, complicated by acute renal dysfunction who developed dense intrahepatic calcification in less than a month after the initial diagnosis. A multidisciplinary approach for the management was used, to which the patient responded aptly. This case illustrates the first description of intrahepatic calcification in AFLP syndrome and highlights some of the challenges met in making the final diagnosis. PMID:27785315

  12. Trousseau's Syndrome Caused by Intrahepatic Cholangiocarcinoma: An Autopsy Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Takashi Yuri

    2014-05-01

    Full Text Available An autopsy case report of Trousseau's syndrome caused by intrahepatic cholangiocarcinoma is presented, and seven previously reported cases are reviewed. A 73-year-old woman experiencing light-headedness and dementia of unknown cause for 6 months developed severe hypotonia. A hypointense lesion compatible with acute cerebral infarction was detected by magnetic resonance imaging. Abdominal computed tomography revealed an ill-defined large liver mass in the right lobe. The mass was not further investigated because of the patient's poor condition. She died of multiple organ failure, and an autopsy was conducted. Postmortem examination revealed intrahepatic cholangiocarcinoma, fibrous vegetations on the mitral valves and multiple thromboemboli in the cerebrum, spleen and rectum. Trousseau's syndrome is defined as an idiopathic thromboembolism in patients with undiagnosed or concomitantly diagnosed malignancy. This syndrome is encountered frequently in patients with mucin-producing carcinomas, while the incidence in patients with intrahepatic cholangiocarcinoma is uncommon. We found that tissue factor and mucin tumor marker (CA19-9, CA15-3 and CA-125 expression in cancer cells may be involved in the pathogenesis of thromboembolism. A patient with unexplained thromboembolism may have occult visceral malignancy; thus, mucin tumor markers may indicate the origin of a mucin-producing carcinoma, and postmortem examination may play an important role in revealing the hidden malignancy.

  13. Hybrid technique coil embolisation for intrahepatic arterioportal fistula in a cat: case report

    Directory of Open Access Journals (Sweden)

    Akiko Uemura

    2016-04-01

    Full Text Available Case summary A 13-month-old, female, mixed breed, 4.0 kg cat was referred with a 6 month history of decreased appetite, loss of vigour and intermittent vomiting. Physical examination revealed no cyanosis or wasting, and no audible heart murmur was auscultated. Blood profile revealed mild anaemia and mildly elevated postprandial serum ammonia (109 µg/dl. Abdominal ultrasonography revealed dilation of an intrahepatic portal vein branch and an intrahepatic aneurysm, with splenomegaly and ascites. Hepatic arteriovenous fistula/hepatic artery–portal vein fistula with multiple acquired portosystemic shunts was strongly suspected. Medical control was achieved using antibiotics, liver-protecting agents, a low-protein diet and blood transfusions. However, because medical treatment proved ineffective, coil embolisation was performed on day 11, using a hybrid approach via the mesenteric vein. Subsequent follow-up showed good appetite, with no signs of diarrhoea or ascites. Abdominal ultrasonography revealed that the mosaic pattern around the site of coil placement in the portal vein branch had improved and pulsatility had disappeared. Relevance and novel information Intrahepatic arterioportal fistula involves a circulatory shunt between the hepatic artery and the hepatic or portal vein within the liver, and may be congenital or acquired. Both forms have been reported in humans, but most cases in cats have been congenital. Few reports have described treatment methods or prognosis in cats. We report here that coil embolisation using a hybrid approach is a procedure offering easy, effective treatment by blocking hepatofugal blood flow.

  14. One Fish, Two Fish, Redfish, You Fish!

    Science.gov (United States)

    White, Katherine; Timmons, Maryellen; Medders, Paul

    2011-01-01

    The recreational fishing activity presented in this article provides a hands-on, problem-based experience for students; it unites biology, math, economics, environmental policy, and population dynamics concepts. In addition, the activity allows students to shape environmental policy in a realistic setting and evaluate their peers' work. By…

  15. Fighting fish

    Science.gov (United States)

    Duchi, E.; Guerrini, V.; Rinaldi, S.; Schaeffer, G.

    2017-01-01

    We introduce new combinatorial structures, called fighting fish, that generalize directed convex polyominoes by allowing them to branch out of the plane into independent substructures. On the one hand the combinatorial structure of fighting fish appears to be particularly rich: we show that their generating function with respect to the perimeter and number of tails is algebraic, and we conjecture a mysterious multivariate equidistribution property with the left ternary trees introduced by Del Lungo et al On the other hand, fighting fish provide a simple and natural model of random branching surfaces which displays original features: in particular, we show that the average area of a uniform random fighting fish with perimeter 2n is of order n 5/4: to the best of our knowledge this behaviour is non-standard and suggests that we have identified a new universality class of random structures. Dedicated to Tony Guttmann on the occasion of his 70th birthday.

  16. Bone Densitometry (Bone Density Scan)

    Science.gov (United States)

    ... of DXA Bone Densitometry? What is a Bone Density Scan (DXA)? Bone density scanning, also called dual-energy x-ray absorptiometry ( ... is today's established standard for measuring bone mineral density (BMD). An x-ray (radiograph) is a noninvasive ...

  17. Bone marrow aspiration

    Science.gov (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  18. Virginia ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for marine, estuarine, anadromous, and brackishwater fish species in Virginia. Vector polygons in this data...

  19. Hawaii ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for reef, marine, estuarine, and native stream fish species in coastal Hawaii. Vector polygons in this data...

  20. Alabama ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for marine, estuarine, and freshwater fish species in Alabama. Vector polygons in this data set represent...

  1. Louisiana ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for freshwater (inland) fish species in coastal Louisiana. Vector polygons represent water-bodies and other...

  2. [Is intrahepatic cholangiojejunostomy in liver hilus-localized malignant occlusive jaundice a better alternative to endoscopic transhepatic drainage?].

    Science.gov (United States)

    Paquet, K J; Koussouris, P

    1987-10-01

    The malignant obstruction of the hepatic confluence has a poor prognosis and no chance of cure. Therefore the therapy of choice today is usually a transpapillary drainage and surgical interventions are avoided. Before the indication for a transhepatic drainage is established the malignant etiology of this disease should be verified in every case and inoperability should be cleared in case of doubt by laparotomy. In a few cases a curative resection is possible. From January 1st, 1979 to September 1st, 1986 we succeeded in a curative resection in one out of fourteen cases; in thirteen cases an intrahepatic cholangio-enterostomy, eleven times with the left intrahepatic duct and two times with the right intrahepatic duct, was performed. Though the rate of postoperative complication was 54%, in hospital mortality was only 7%. The curatively operated woman is now living for six years postoperatively and the man with a benign intrahepatic stricture after right hepatectomy because of hepatocellular cancer is now living 44 months after the first operation. The mean survival time of the palliative operated patients is 12.3 months. Thus the intrahepatic cholangio-enterostomy seems to be superior to the endoscopic transpapillary drainage in comparable cases of tumor obstruction of the hepatic confluence concerning life quality and life expectancy.

  3. Localized intrahepatic bile duct dilatation without a visible mass or stone as depicted on CT images: findings of malignancy prediction

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ju Wan; Kim, Gab Chul; Jeong, Han Young; Lee, Hui Joong; Lee, Jae Hyuck; Ryeom, Hun Kyu [Kyungpook National University Hospital, Daegu (Korea, Republic of); Kim, Jong Yeol [Kumi Cha Medical Center, Collge of Medicine, Pochon CHA University, Kumi (Korea, Republic of)

    2008-09-15

    This study was preformed to evaluate factors that can predict the presence of a malignancy for localized intrahepatic bile duct dilatation without a visible mass or stone as depicted on CT images. A total of 29 patients (male: 16, female: 13) who had localized intrahepatic bile duct dilatation without a visible mass, stone or injury as depicted on CT images were included in the study. A history of extrahepatic malignancy and biliary stone disease, tumor marker levels, CT findings of the intrahepatic bile duct and associated findings were reviewed. The findings were analyzed between two groups (patients with a malignancy and patients with benign disease) on follow-up. In 29 patient, 11 patients had malignant lesions (four metastases and seven cholangiocarcinomas). The history of an extrahepatic malignancy and the shape of an intrahepatic duct obstruction or stenosis as seen on CT were significantly correlated with the results between the benign and malignant group of patients. The follow-up results of the malignant group of patients indicated that for six patients who had developed a new mass, one patient each showed aggravation of ductal dilatation and thickening of the ductal wall. When a patient with localized intrahepatic bile duct dilatation without a definite cause has a history of an extrahepatic malignancy or shows abrupt tapering or irregular narrowing on CT images, short-term follow-up should be performed. The patient should be investigated carefully for mass formation or a change of the dilated bile duct due to a possibility of malignant ductal dilatation.

  4. 斑点叉尾(鲴)鱼骨胶原多肽螯合钙的制备及其特征%Preparation and characterization of collagen polypeptide chelated calcium from fish bone powder of channel catfish (Ictalurus punctatus)

    Institute of Scientific and Technical Information of China (English)

    陆剑锋; 孟昌伟; 李进; 宫子慧; 林琳; 叶应旺; 姜绍通

    2012-01-01

    Calcium is essential for living organisms. Even with an apparently sufficient intake of dietary calcium,there is some concern that inadequate calcium is absorbed by the small intestine,due to precipitation of insoluble calcium salts in the neutral to slightly basic intestinal lumen. Some studies revealed that peptides have the capacity to chelate Ca and to prevent the precipitation of insoluble calcium salts, thereby increasing the amount of soluble Ca availability for absorption across the mucosa. However,the mechanism and degree of calcium ion binding are still unclear. In this paper, the combinations between collagen polypeptide(from the enzymatic hydrolysate of channel catfish bone powder) and calcium ion were studied by measuring chelate rate. On the basis of results of single-factor experiments, the Box-Behnken central composite design and response surface method were adopted to obtain the optimum conditions for chelation. The optimal chelate conditions were determined as:chelate temperature 60 ℃,chelate pH 5. 4,chelate time 1. 5 h and ratio of collagen polypeptide to calcium 2:1 (W/W). Under the optimized conditions, the chelate rate of Ca-collagen polypeptide could reach 82.53%. The formation of Ca-collagen polypeptide chelate was confirmed by the UV-VIS and FT-IR spectra. The characterization of amino acid composition of the chelate was similar to typical collagen-like protein. This research provides a practical guideline and a theoretical basis for fully utilizing fish bone protein resources and developing the deep processed products.%以斑点叉尾(鲴)鱼骨酶解胶原多肽液和氯化钙为原料,螯合率为指标,在一定条件下制备胶原多肽螯合钙,并考察温度、pH、时间、多肽与钙的质量比对螯合率的影响.在单因素实验结果的基础上,采用Box-Behnken中心组合设计和响应面分析法,确定最佳螯合工艺条件为温度60℃、pH 5.4、时间1.5h、质量比2∶1,此条件下,螯合率达82.53%.

  5. Fishing Access Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — The Vermont Fish & Wildlife Department maintains developed fishing access areas. These sites provide public access to waters in Vermont for shore fishing...

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

    Directory of Open Access Journals (Sweden)

    Seiichiro Kojima

    2016-09-01

    Full Text Available 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.

  7. Selective Preservation of Fossil Ghost Fish

    Science.gov (United States)

    Meacham, Amanda

    2016-04-01

    A unique type of fossil fish preservation has been discovered in the Angelo Member (Fossil Lake) of the Green River Formation. The Angelo Member is a predominately evaporative deposit dominated by dolomite, but contains facies of fossiliferous laminated calcimicrite. Fossil fish occurring in two beds conspicuously lack bones. Fish in the lower bed are only preserved as organic material, including skin, pigments, and eyes. Fish in the upper bed have three-dimensional etching where bones once existed but also contain skin, pigments, and eyes. The top third of the upper bed often contains calcite crystals that are pseudomorphs after trona and possibly halite. Preliminary mineralogical analysis and mapping of evaporate facies suggests that this unique preservation may be related to lake geochemical conditions, such as high pH and alkalinity. To our knowledge, this is the first time this type of preservation has been observed and studied. Fossils and sediments within these beds are being studied both vertically and laterally through the one-meter thick sequence containing the fossil fish using XRD, isotopic, SEM, thin section, and total organic carbon analysis. Nine quarries, 0.5-1 meter square, were excavated for both fossils and rock samples along with 17 additional rock sample locations across an approximately 25-kilometer square region. This investigation has the capability of reconstructing the paleoenvironment and lake chemistry of Fossil Lake during the deposition of the "ghost-fish" beds and solving the mystery of the "missing bones" and the unusual process of preservation.

  8. More bones found at Stillwater, more clues to ancient people's culture

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This article is about bones from 125 individuals that date back 5,000 to 10,000 years. The bones were discovered in the Stillwater Management Area.

  9. The impact of intrahepatic cholestasis of pregnancy on fetal cardiac and peripheral circulation

    Science.gov (United States)

    Kurtulmuş, Seçil; Gür, Esra Bahar; Öztekin, Deniz; Güleç, Ebru Şahin; Okyay, Duygu; Gülhan, İbrahim

    2015-01-01

    Objective The aim of this study was to evaluate changes in fetal cardiac and peripheral circulation in pregnancies complicated with intrahepatic cholestasis. Material and Methods The Doppler examination results of 22 pregnant subjects complicated with intrahepatic cholestasis of pregnancy (ICP) and 44 healthy controls were compared. The parameters of fetal cardiac circulation were pulmonary artery and aortic (Ao) peak systolic velocity (PSV), pulmonary vein (Pv), peak velocity index (PVI) and pulsatility index (PI), mitral valve (MV) and tricuspid valve (TV), early diastole (E)- and atrial contraction (A)-wave peak velocity ratio (E/A), and isthmus aortic peak systolic velocity (IAo PSV). The parameters of fetal peripheral circulation were middle cerebral artery (MCA) and umbilical artery (UA) PI, resistance index (RI), systolic/diastolic (S/D) ratio. Fetal obstetric Doppler monitoring was conducted weekly before 36 weeks and biweekly after that, and the results were compared with the normal reference values for gestational age. Results The Doppler parameters of fetal cardiac and peripheral circulation did not significantly differ between the two groups. S/D ratio readings in the ICP group were significantly above 2 SD before 35 weeks of gestation. Women with ICP had increased risks of preterm delivery, neonatal unit admission, and meconium-stained amniotic fluid compared with those in the controls. Conclusion Fetuses of pregnant women with ICP showed no differences in the evaluation of cardiac and peripheral Doppler measurements compared with fetuses of healthy mothers. The Doppler investigation of the umbilical artery may be useful in monitoring of pregnancies complicated by early onset intrahepatic cholestasis. PMID:26097388

  10. Genetic determinants of drug-induced cholestasis and intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Pauli-Magnus, Christiane; Meier, Peter J; Stieger, Bruno

    2010-05-01

    Intrahepatic cholestasis of pregnancy and drug-induced cholestasis are two clinically important forms of acquired cholestatic liver disease. The understanding of the underlying mechanisms of acquired cholestasis has recently made considerable progress by the identification of canalicular ATP-binding cassette (ABC) transporters as likely targets for these forms of cholestasis. Cholestasis of pregnancy is linked to estrogen and progesterone metabolites. These metabolites have been shown to impair the bile salt export pump (BSEP) function by an indirect mechanism. In addition, genetic variants (as well as mutants) of the genes coding for the phosphatidylcholine translocator MDR3 and BSEP and for the farnesoid X receptor, which is critical in the transcriptional activation of MDR3 ( ABCB4) and BSEP ( ABCB11) have been associated with intrahepatic cholestasis of pregnancy. The pathogenesis of drug-induced liver injury encompasses a wide spectrum of mechanisms, some of which are still poorly understood. BSEP is now known to be subject to drug inhibition in susceptible patients. Information on genetic factors rendering individuals susceptible to inhibition of BSEP by drugs or their metabolites is still scarce. Besides rare mutations that have been linked to drug-induced cholestasis, the common p.V444A polymorphism of BSEP has been identified as a potential risk factor. In this review, the authors summarize key concepts of physiology of bile formation, diagnostic principles to indentify these forms of acquired cholestasis, as well as pathogenetic mechanisms leading to intrahepatic cholestasis of pregnancy or drug-induced cholestasis. In addition, they review the current knowledge on genetic susceptibility factors for these two forms of cholestasis.

  11. Surgical management of intrahepatic vessels in children with stage Ⅲ/Ⅳ hepatoblastoma

    Institute of Scientific and Technical Information of China (English)

    PANG Yan-li; ZHAO Wei; YANG He-ying; LIU Qiu-liang; ZHANG Da; QIN Pan; YUE Ming

    2013-01-01

    Background Hepatoblastoma (HB) is a rare childhood tumor.We investigated the effect of intraoperative management of the intrahepatic major vessels in children with HB.Methods Between April 2005 and August 2012,surgical resection was performed on 50 children with hepatoblastoma.These children were divided into a vessel-ligation group (n=20) and a vessel-repair group (n=30).In the vessel-ligation group,the intrahepatic major vessels were ligated and removed together with the tumor and the affected liver lobe/liver parenchyma.In the vessel-repair group,the affected intrahepatic major vessels were dissected and preserved as much as possible and the normal liver lobe/liver parenchyma and blood supply from these vessels were also preserved.The outcomes were analyzed by postoperative follow-up.Results In the vessel-ligation group,two patients gave up surgery,six patients underwent palliative resection,and 12 patients underwent en b/oc resection; four patients died of liver failure and eight patients fully recovered and were discharged.In the vessel-repair group,all 30 patients underwent en b/oc resection and were discharged after satisfactory healing.After a follow-up time of 5-36 months (median:20 months),two patient in the vessel-ligation group survived and 22 patients in the vessel-repair group survived.Conclusions Patients with HB can be successfully treated by tumor resection with vascular repair.This method prevents postoperative liver failure,ensures Patient safetv during the perioperative period,and allows for early chemotherapy.

  12. Intrahepatic Left to Right Portoportal Venous Collateral Vascular Formation in Patients Undergoing Right Portal Vein Ligation

    Energy Technology Data Exchange (ETDEWEB)

    Lienden, K. P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Center, University of Amsterdam, Department of Interventional Radiology (Netherlands); Hoekstra, L. T. [Academic Medical Center, University of Amsterdam, Department of Surgery (Netherlands); Bennink, R. J. [Academic Medical Center, University of Amsterdam, Department of Nuclear Medicine (Netherlands); Gulik, T. M. van [Academic Medical Center, University of Amsterdam, Department of Surgery (Netherlands)

    2013-12-15

    Purpose: We investigated intrahepatic vascular changes in patients undergoing right portal vein ligation (PVL) or portal vein embolization (PVE) in conjunction with the ensuing hypertrophic response and function of the left liver lobe. Methods: Between December 2008 and October 2011, 7 patients underwent right PVL and 14 patients PVE. Computed tomographic (CT) volumetry to assess future remnant liver (FRL) and functional hepatobiliary scintigraphy were performed in all patients before and 3 weeks after portal vein occlusion. In 18 patients an intraoperative portography was performed to assess perfusion through the occluded portal branches. Results: In all patients after initially successful PVL, reperfused portal veins were observed on CT scan 3 weeks after portal occlusion. This was confirmed in all cases during intraoperative portography. Intrahepatic portoportal collaterals were identified in all patients in the PVL group and in one patient in the PVE group. In all other PVE patients, complete occlusion of the embolized portal branches was observed on CT scan and on intraoperative portography. The median increase of FRL volume after PVE was 41.6 % (range 10-305 %), and after PVL was only 8.1 % (range 0-102 %) (p = 0.179). There were no differences in FRL function between both groups. Conclusion: Preoperative PVE and PVL are both methods to induce hypertrophy of the FRL in anticipation of major liver resection. Compared to PVE, PVL seems less efficient in inducing hypertrophy of the nonoccluded left lobe. This could be caused by the formation of intrahepatic portoportal neocollateral vessels, through which the ligated portal branches are reperfused within 3 weeks.

  13. Role of ErbB family receptor tyrosine kinases in intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Aberrant expression and signaling of epidermal growth factor receptor (ErbB) family receptor tyrosine kinases, most notably that of ErbB2 and ErbB1, have been implicated in the molecular pathogenesis of intrahepatic cholangiocarcinoma. Constitutive overexpression of ErbB2 and/or ErbB1 in malignant cholangiocytes has raised interest in the possibility that agents which selectively target these receptors could potentially be effective in cholangiocarcinoma therapy. However, current experience with such ErbB-directed therapies have at best produced only modest responses in patients with biliary tract cancers. This review provides a comprehensive and critical analysis of both preclinical and clinical studies aimed at assessing the role of altered ErbB2 and/or ErbB1 expression, genetic modifications, and dysregulated signaling on cholangiocarcinoma development and progression. Specific limitations in experimental approaches that have been used to assess human cholangiocarcinoma specimens for ErbB2 and/or ErbB1 overexpression and gene amplification are discussed. In addition, current rodent models of intrahepatic cholangiocarcinogenesis associated with constitutive ErbB2 overexpression are reviewed. Select interactive relationships between ErbB2 or ErbB1 with other relevant molecular signaling pathways associated with intrahepatic cholangiocarcinoma development and progression are also detailed, including those linking ErbB receptors to bile acid, cyclooxygenase-2, interleukin-6/gp130, transmembrane mucins, hepatocyte growth factor/Met, and vascular endothelial growth factor signaling. Lastly, various factors that can limit therapeutic efficacy of ErbB-targeted agents against cholangiocarcinoma are considered.

  14. Osedax borings in fossil marine bird bones

    Science.gov (United States)

    Kiel, Steffen; Kahl, Wolf-Achim; Goedert, James L.

    2011-01-01

    The bone-eating marine annelid Osedax consumes mainly whale bones on the deep-sea floor, but recent colonization experiments with cow bones and molecular age estimates suggesting a possible Cretaceous origin of Osedax indicate that this worm might be able grow on a wider range of substrates. The suggested Cretaceous origin was thought to imply that Osedax could colonize marine reptile or fish bones, but there is currently no evidence that Osedax consumes bones other than those of mammals. We provide the first evidence that Osedax was, and most likely still is, able to consume non-mammalian bones, namely bird bones. Borings resembling those produced by living Osedax were found in bones of early Oligocene marine flightless diving birds (family Plotopteridae). The species that produced these boreholes had a branching filiform root that grew to a length of at least 3 mm, and lived in densities of up to 40 individuals per square centimeter. The inclusion of bird bones into the diet of Osedax has interesting implications for the recent suggestion of a Cretaceous origin of this worm because marine birds have existed continuously since the Cretaceous. Bird bones could have enabled this worm to survive times in the Earth's history when large marine vertebrates other than fish were rare, specifically after the disappearance of large marine reptiles at the end-Cretaceous mass extinction event and before the rise of whales in the Eocene.

  15. Do bacteria, not fish, produce 'fish kairomone'?

    NARCIS (Netherlands)

    Ringelberg, J.; Van Gool, E.

    1998-01-01

    Fish-associated chemicals enhance phototactic downward swimming in Daphnia. If perch were treated with the antibiotic ampicillin, this enhancement was significantly decreased. Therefore, not fish, but bacteria associated with fish, seem to produce this kairomone. [KEYWORDS: Diel vertical migration;

  16. Immaturity of the biliary excretory system predisposes neonates to intrahepatic cholestasis.

    Science.gov (United States)

    Abernathy, C O; Utili, R; Zimmerman, H J

    1979-06-01

    Intrahepatic cholestasis associated with both gram-negative bacterial infections and total parenteral nutrition (TPN) is observed more frequently in neonates than in older children or adults. Factors involved in the pathogenesis of this syndrome are uncertain. The cholestatic effects of gram-negative bacterial infections appear to result from the inhibitory effects of endotoxin on bile flow. Since the adverse effects of both endotoxin and TPN on bile flow involve primarily the bile acid-independent portion, the immaturity of the neonatal hepatic excretory system which an inadequate bile acid-dependent fraction of bile would explain the increased susceptibility of the neonate to endotoxin- and, perhaps, to TPN-induced cholestasis.

  17. Liver resection for the treatment of a congenital intrahepatic portosystemic venous shunt

    Institute of Scientific and Technical Information of China (English)

    Michail Papamichail; Amir Ali; Alberto Quaglia; John Karani; Nigel Heaton

    2016-01-01

    Intrahepatic portosystemic shunts (IPSS) are rare congenital anomalies arising from disordered portal vein em-bryogenesis. It has been described in both children and adults and may be asymptomatic or be associated with a variety of neurophysiological and pulmonary complications. When rec-ognized, early intervention to occlude the shunt will reverse the associated complications. Literature review reports of surgical and radiological occlusion of the shunt, but due to its rarity, a standard therapeutic protocol has not been established. A case of a 38-year-old woman with abdominal pain and low grade encephalopathy, diagnosed with an IPSS and treated by right hepatectomy was reported.

  18. Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.

    Science.gov (United States)

    Pereira, Keith; Carrion, Andres F; Martin, Paul; Vaheesan, Kirubahara; Salsamendi, Jason; Doshi, Mehul; Yrizarry, Jose M

    2015-12-01

    Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

  19. Intrahepatic Portosystemic Venous Shunt: Successful Embolization Using the Amplatzer Vascular Plug II

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Ju; Shin, Byung Seok; Lee, In Ho; Ohm, Joon Young; Lee, Byung Seok; Ahn, Moon Sang [Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon (Korea, Republic of); Kim, Ho Jun [Dept. of Radiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon (Korea, Republic of)

    2012-11-15

    A 67-year-old woman presented with memory impairment and behavioral changes. Brain MRI indicated hepatic encephalopathy. Abdominal CT scans revealed an intrahepatic portosystemic venous shunt that consisted of two shunt tracts to the aneurysmal sac that communicated directly with the right hepatic vein. The large tract was successfully occluded by embolization using the newly available AMPLATZERTM Vascular Plug II and the small tract was occluded by using coils. The patient's symptoms disappeared after shunt closure and she remained free of recurrence at the 3-month follow-up evaluation.

  20. Successful pregnancy after ileal exclusion in progressive familial intrahepatic cholestasis type 2.

    Science.gov (United States)

    Czubkowski, Piotr; Jankowska, Irena; Pawlowska, Joanna

    2015-01-01

    Progressive familial intrahepatic cholestasis type 2 (PFIC 2) results from mutations in ABCB11 gene coding bile salt export pump (BSEP). Medical treatment is usually unsuccessful and surgery intervention is necessary. Partial external biliary diversion (PEBD) is regarded as the first choice of surgical treatment. Ileal exclusion (IE) is an alternative operation if external stoma is not tolerated; however, a favorable outcome is uncertain. In chronic liver diseases pregnancy brings additional risk of deterioration of liver function and generally is not recommended. We present the first case report of successful pregnancy in a genetically confirmed PFIC 2 patient after surgical conversion from PEBD to IE.

  1. Novel Image Guidance Techniques for Portal Vein Targeting During Transjugular Intrahepatic Portosystemic Shunt Creation.

    Science.gov (United States)

    Farsad, Khashayar; Kaufman, John A

    2016-03-01

    The most challenging part of transjugular intrahepatic portosystemic shunt creation is arguably the transvenous access from the hepatic vein to the portal vein. As experience and technology have evolved, the image guidance aspect of this critical step in the procedure has become more robust. Improved means to target the portal vein include both direct and indirect methods of portal vein opacification, cross-sectional imaging for both targeting and access, and novel use of transabdominal and intravascular ultrasound guidance. These techniques are described herein.

  2. RE: Endovascular Treatment of Congenital Intrahepatic Portosystemic Shunts with Amplatzer Plugs

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Alonso, Jose; Lipsich, Jose [Hospital Nacional de Pediatria ' JP Garrahan' , Combate de los Pozos, Buenos (Argentina)

    2012-01-15

    In our paper entitled 'Endovascular treatment of congenital portal vein fistulas with the Amplatzer occlusion device' published in the Journal of Vascular and Interventional Radiology in 2004, we already reported the use of the AVP in the treatment of an intrahepatic portosystemic venous shunt. This situation does not undervalue the quality of the reported case, but for didactic purposes, we believe it is important to state that the work of Dr. Lee confirms, as was previously reported, that these devices are useful and safe for these rare situations.

  3. Anabolic Androgen-induced Intrahepatic Cholestasis Presented With Normal AND#947;-Glutamyl-Transpeptidase

    Directory of Open Access Journals (Sweden)

    Savvoula Savvidou

    2014-04-01

    A case report of a young male with remarkable jaundice due to acute anabolic androgen-induced cholestasis is presented. Interestingly, and #947;-glutamyl transpeptidase remained normal throughout the patient's diagnostic workup. Histopathology was indicative of pure, and ldquo;bland and rdquo; intrahepatic cholestasis with minimal inflammation but significant fibrosis. The patient was successfully treated with ursodeoxycholic acid and glucocorticosteroids. The significance of normal and #947;-glutamyl transpeptidase along with the histopathological findings and the possible pathophysiological mechanisms are finally discussed. [J Interdiscipl Histopathol 2014; 2(2.000: 98-103

  4. Late obstruction of the intrahepatic common bile duct after seat-belt injury.

    Science.gov (United States)

    Dryburgh, P R; White, J A

    1980-09-27

    A patient is reported in whom obstructive jaundice developed 10 weeks after seat-belt injury to the abdomen. Laparotomy at the time of injury revealed extensive lacerations of the liver and haematoma in the head of the pancreas. The patient's presentation with jaundice led to a diagnosis of an intrahepatic haematoma, falsely substantiated by radio-isotope studies. At operation, complete obstruction of the intrapancreatic portion of the common bile duct was found. This, most likely a result of vascular damage with subsequent cicatrization, was treated satisfactorily by choledochoduodenostomy.

  5. Diffusion weighted MRI in intrahepatic bile duct adenoma arising from the cirrhotic liver

    Energy Technology Data Exchange (ETDEWEB)

    An, Chansik [Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sumi; Choi, Yoon Jung [National Health Insurance Corporation Ilsan Hospital, Goyang (Korea, Republic of)

    2013-10-15

    A 64-year-old male patient with liver cirrhosis underwent a CT study for hepatocellular carcinoma surveillance, which demonstrated a 1.4-cm hypervascular subcapsular tumor in the liver. On gadoxetic acid-enhanced MRI, the tumor showed brisk arterial enhancement and persistent hyperenhancement in the portal phase, but hypointensity in the hepatobiliary phase. On diffusion-weighted MRI, the tumor showed an apparent diffusion coefficient twofold greater than that of the background liver parenchyma, which suggested that the lesion was benign. The histologic diagnosis was intrahepatic bile duct adenoma with alcoholic liver cirrhosis.

  6. Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Jonathan; Montomoli; Peter; Holland-Fischer; Giampaolo; Bianchi; Henning; GrФnbk; Hendrik; Vilstrup; Giulio; Marchesini; Marco; Zoli

    2010-01-01

    AIM:To investigate the effect of transjugular intra-hepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.METHODS: Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for t...

  7. Pancreaticoportal Fistula and Disseminated Fat Necrosis After Revision of a Transjugular Intrahepatic Portosystemic Shunt

    Energy Technology Data Exchange (ETDEWEB)

    Klein, Seth J., E-mail: kleins@mir.wustl.edu; Saad, Nael [Washington University School of Medicine, Interventional Radiology Section, Mallinckrodt Institute of Radiology (United States); Korenblat, Kevin [Washington University School of Medicine, Division of Gastroenterology, Department of Internal Medicine (United States); Darcy, Michael D. [Washington University School of Medicine, Interventional Radiology Section, Mallinckrodt Institute of Radiology (United States)

    2013-04-15

    A 59-year old man with alcohol related cirrhosis and portal hypertension was referred for transjugular intrahepatic portosystemic shunt (TIPS) to treat his refractory ascites. Ten years later, two sequential TIPS revisions were performed for shunt stenosis and recurrent ascites. After these revisions, he returned with increased serum pancreatic enzyme levels and disseminated superficial fat necrosis; an iatrogenic pancreaticoportal vein fistula caused by disruption of the pancreatic duct was suspected. The bare area of the TIPS was subsequently lined with a covered stent-graft, and serum enzyme levels returned to baseline. In the interval follow-up period, the patient has clinically improved.

  8. Liver resection for the treatment of a congenital intrahepatic portosystemic venous shunt

    Institute of Scientific and Technical Information of China (English)

    Michail Papamichail; Amir Ali; Alberto Quaglia; John Karani; Nigel Heaton

    2015-01-01

    Intrahepatic portosystemic shunts (IPSS) are rare congenital anomalies arising from disordered portal vein em-bryogenesis. It has been described in both children and adults and may be asymptomatic or be associated with a variety of neurophysiological and pulmonary complications. When rec-ognized, early intervention to occlude the shunt will reverse the associated complications. Literature review reports of surgical and radiological occlusion of the shunt, but due to its rarity, a standard therapeutic protocol has not been established. A case of a 38-year-old woman with abdominal pain and low grade encephalopathy, diagnosed with an IPSS and treated by right hepatectomy was reported.

  9. Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Chih Yang; Liang, Po Chin [National Taiwan University Hospital, Taipei (China)

    2010-08-15

    A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach

  10. Relationship between serum HBV RNA levels and intrahepatic viral as well as histologic activity markers in entecavir-treated patients.

    Science.gov (United States)

    Wang, Jing; Yu, Yiqi; Li, Guojun; Shen, Chuan; Meng, Zhefeng; Zheng, Jianming; Jia, Yanhong; Chen, Shaolong; Zhang, Xiao; Zhu, MengQi; Zheng, Jiangjiang; Song, Zhangzhang; Wu, Jing; Shao, Lingyun; Qian, Peiyu; Mao, Xiaona; Wang, Xuanyi; Huang, Yuxian; Zhao, Caiyan; Zhang, Jiming; Qiu, Chao; Zhang, Wenhong

    2017-09-01

    In diagnostics, serum hepatitis B virus (HBV)-RNA levels are valuable when the HBV-DNA load in circulation is effectively suppressed by nucleos(t)ide analogue (NUC) therapy. This study aimed to determine the intrahepatic viral replication activity reflected in serum HBV-RNA and whether HBV-RNA contributes to liver histological changes in NUC-treated patients. A cross-sectional set of serum and liver biopsy samples was obtained from entecavir-treated patients with undetectable levels of serum HBV-DNA. The correlations between HBV-RNA concentration in serum and levels of peripheral and intrahepatic viral replicative forms and histological scores were analyzed. Quasispecies of serum HBV-RNA and intrahepatic viral replicative forms were examined by deep sequencing. HBV-RNA-positive hepatocytes were visualized by in situ hybridization. Serum HBV-RNA was detected in 35 of 47 patients (74.47%, 2.33-4.80 log10 copies/mL). These levels correlated not only with the intrahepatic HBV-RNA level and the ratio of intrahepatic HBV-RNA to covalently closed circular DNA (cccDNA), but also with the histological scores for grading and staging. From the view of quasispecies, serum HBV-RNA was more genetically homogenous with contemporaneously sampled intrahepatic HBV-RNA relative to cccDNA pool and dynamically changed over time in consecutive samples. In situ histology study revealed that HBV-RNA-positive hepatocytes were clustered in foci, sporadically distributed across the lobules, and co-localized with hepatitis B surface antigen. Serum HBV-RNA levels reflect intrahepatic viral transcriptional activity and are associated with liver histopathology in patients receiving NUC therapy. Our study sheds light on the nature of HBV-RNA in the pathogenesis of chronic HBV infection and has implications for the management of chronic hepatitis B during NUC therapy. Serum HBV-RNA levels are indicative of the intrahepatic transcriptional activity of covalently closed circular DNA and are

  11. Diffuse-Type Caroli Disease with Characteristic Central Dot Sign Complicated by Multiple Intrahepatic and Common Bile Duct Stones.

    Science.gov (United States)

    Hwang, Moon Joo; Kim, Tae Nyeun

    2017-07-01

    Caroli disease (CD) is a rare congenital malformation of the liver characterized by non-obstructive, segmental, cystic dilatation of the intrahepatic bile ducts (IHDs). The clinical course is usually asymptomatic for the first 5-20 years, and symptoms may seldom occur throughout the patient's life. Bile stagnation leads to recurrent episodes of cholangitis, stone formation, or liver abscesses, and biliary cirrhosis usually occurs years later. Here we report on a 42-year-old man diagnosed with diffuse-type CD with a characteristic central dot sign, who had multiple intrahepatic and common bile duct (CBD) stones. CBD stones were treated successfully with endoscopic retrograde cholangiopancreatography (ERCP).

  12. Microscopic recognition and identification of fish meal in compound feeds

    NARCIS (Netherlands)

    Raamsdonk, van L.W.D.; Prins, Theo; Rhee, van de N.; Vliege, J.J.M.; Pinckaers, V.G.Z.

    2017-01-01

    Fish meal is an accepted ingredient in compound feed. Unauthorised application is primarily enforced by visual inspection, i.e., microscopy. In order to document the visually available diversity, fragments of bones and scales of 17 teleost fish species belonging to seven different orders were

  13. The Fishing Cat

    Institute of Scientific and Technical Information of China (English)

    孙雅飞; 乐伟国

    2008-01-01

    @@ 一、故事内容 A cat goes fishing every day. He wants to eat fish, but he can't catch any fish. One day, he goes to the river as usual. Suddenly, a fish comes out. He catches the fish and putsthe fish in the basket. He's very happy, but he forgest to put the lid on the basket.

  14. Analysis by Fish Bone Diagram on Human Resources Flow in Community Health Service Institutions in China%我国社区卫生人力流动影响因素鱼骨图分析

    Institute of Scientific and Technical Information of China (English)

    张强; 吴少玮; 方鹏骞

    2012-01-01

    Objective: Analyzing and classifying the factors which affect the human resources' flow, then provide some suggestions to steady the human resources. Methods: By literature analysis, collecting the literature about human resources flow and analyzing the factor of human resources' flow in community health service institutions by fish bone diagram. Results: The factors which affect the stability of human resources in community health service institution could be divided into social factors, organizational factors and personal factors. Conclusion: Effects of the human resources's flow in community health service institutions:social factors, government investment for community health service institutions was not full, security system was not perfect; organizational factors, such as incentive management system, promotion system are not perfect; personal factors such as age, gender, profession, education, job title and so on. Suggestions: In order to steady the human resources in community health service institution, increase the reasonable input to community health service; give the right to community health service institutions for choosing the right person to work; raise the income level; establish a reasonable system of personnel training and a rational system for health staffs title promotion; implement the flexible management to the staff in community health service institutions.%目的:通过对影响社区卫生人力流动的影响因素进行分析,提出稳定社区卫生人力的建议.方法:通过个人访谈和文献查阅收集资料,运用鱼骨图分析法,对于我国社区卫生人力资源流动的影响因素进行分析.结果:影响社区卫生人力资源流动的影响因素可以分为社会因素、组织因素和个人因素3部分.结论:影响我国社区人力资源流动的影响因素有以下几个方面:社会因素方面,政府投入不足,保障制度不健全;机构层面,管理制度如激励机制、晋升制度不健全;

  15. Hepatobiliary scintigraphy in chronic intrahepatic cholestasis. Diagnosis of primary sclerosing cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Aburano, Tamio; Takayama, Teruhiko; Shuke, Noriyuki

    1987-05-01

    Primary sclerosing cholangitis (PSC) is a rare disease of unknown origin, leading to chronic intermittent cholestasis. Due to its low incidence, insidious clinical onset and varied clinical picture, the diagnosis is often delayed by years. PSC is sometimes diagnosed falsely as another disease of chronic intermittent cholestasis, primary biliary cirrhosis (PBC). In the present study, the hepatobiliary imaging with Tc-99m diethyl IDA was done in a total of 14 patients with chronic intermittent cholestasis including 3 patients with PSC and 11 patients with PBC, in order to decide its clinical usefulness as a noninvasive method for the differentiation between PSC and PBC. All three patients with PSC showed a typical pattern of radionuclide stasis within the area of intrahepatic and/or extrahepatic ductal system, representing the stenosis on endoscopic retrograde cholangiogram. On the other hand, none of 11 patients with PBC showed any radionuclide stasis within the area of intrahepatic and/or extrahepatic ductal system. This result suggests that the radionuclide hepatobiliary imaging may be a noninvasive method for investigating patients with chronic intermittent cholestasis, leading to earlier differentiation between PSC and PBC.

  16. Intrahepatic cholangiocarcinoma in a patient with Wilson's disease: a case report.

    Science.gov (United States)

    Mukai, Yosuke; Wada, Hiroshi; Eguchi, Hidetoshi; Yamada, Daisaku; Asaoka, Tadafumi; Noda, Takehiro; Kawamoto, Koichi; Gotoh, Kunihito; Takeda, Yutaka; Tanemura, Masahiro; Umeshita, Koji; Hori, Yumiko; Morii, Eiichi; Doki, Yuichiro; Mori, Masaki

    2016-12-01

    The incidence of hepatobiliary malignancies, and especially intrahepatic cholangiocarcinoma (ICC), for patients with Wilson's disease (WD), is very low, even for cirrhotic patients. A 44-year-old male was admitted to our department for treatment of a liver tumor. He was diagnosed with WD at the age of 15. According to radiological findings, his liver tumor was a suspected hepatocellular carcinoma (HCC) or a combined hepatocellular and cholangiocellular carcinoma. A partial resection of liver segments 8 (S8) and 5 (S5) was subsequently performed due to the intraoperative suspicion of intrahepatic metastasis at the surface of S5. Postoperative histology revealed that the resected portion of S8 contained an ICC; the removed S5 portion comprised a regenerative nodule with hemosiderosis. To date, the patient has survived without tumor recurrence for more than 44 months following surgery. A survey of the literature, inclusive of case reports, would suggest that surgical resection is the primary course of action for a WD patient with ICC, if liver function can be preserved and curative resection performed.

  17. Usefulness of fetal monitoring in intrahepatic cholestasis of pregnancy: a prospective study.

    Science.gov (United States)

    Suri, Vanita; Jain, Reenu; Aggarwal, Neelam; Chawla, Yogesh K; Kohli, K K

    2012-12-01

    To study the role of fetal surveillance in intrahepatic cholestasis of pregnancy. A total of 69 women with obstetric cholestasis were included. Fetal surveillance began at 34 weeks or later at diagnosis and included daily maternal record of fetal movements, biophysical profile (i.e., non-stress test, amniotic fluid volume assessment using the four quadrant amniotic fluid index), and Doppler flow velocimetry. Fetal monitoring was done weekly before 36 weeks and biweekly after that. There were no abnormal non-stress test readings and all pregnancies had good biophysical profile. One hundred and sixty Doppler measurements [Systolic-Diastolic (S/D ratio) and Pourcelot index (PR)] were taken from 67 patients at scheduled intervals during the study period. Findings were compared to gestation matched reference values of Doppler flow velocities of umbilical artery of normal pregnant population. Fifty-six out of 160 PR indices and 33 out of 162 S/D ratio readings were above 2 SD and these results were found to be statistically significant. However, there was no significant correlation with the serum levels of alanine transaminase (r=-0.071) or with aspartate transaminase (r=0.058). Further, there was no correlation of Doppler with rates of preterm delivery or meconium-stained liquor. Doppler investigation of the umbilical artery might be of some value in recognition of the specific risk of fetal compromise in pregnancies complicated by intrahepatic cholestasis.

  18. The role of steroid hormones in the development of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Pařízek, A; Dušková, M; Vítek, L; Šrámková, M; Hill, M; Adamcová, K; Šimják, P; Černý, A; Kordová, Z; Vráblíková, H; Boudová, B; Koucký, M; Malíčková, K; Stárka, L

    2015-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a disorder of liver function, commonly occurring in the third trimester but sometimes also as soon as the end of the second trimester of pregnancy. Symptoms of this disorder include pruritus, plus abnormal values of bile acids and hepatic transaminases. After birth, symptoms disappear and liver function returns to normal. Though ICP is relatively non-complicated and often symptomatically mild from the point-of-view of the mother, it presents a serious risk to the fetus, making this disease the subject of great interest. The etiology and pathogenesis of ICP is multifactorial and as yet not fully elucidated. Hormonal factors likely play a significant role, along with genetic as well as exogenous factors. Here we summarize the knowledge of changes in steroid hormones and their role in the development of intrahepatic cholestasis of pregnancy. In addition, we consider the role of exogenous factors as possible triggers of steroid hormone changes, the relationship between metabolic steroids and bile acids, as well as the combination of these factors in the development of ICP in predisposed pregnant women.

  19. Elevation of gamma-glutamyl transferase in adult: Should we think about progressive familiar intrahepatic cholestasis?

    Science.gov (United States)

    Oliveira, Hugo M; Pereira, Cláudia; Santos Silva, Ermelinda; Pinto-Basto, Jorge; Pessegueiro Miranda, Helena

    2016-02-01

    There are three types of progressive familial intrahepatic cholestasis (PFIC). Type 3 is characterized by elevated gamma-glutamyl transferase (γ-GT) and it can be diagnosed in adolescence/adulthood. The genetic defect of PFIC 3 appears to explain the pathogenesis of intrahepatic cholestasis of pregnancy (ICP). Draw attention to this rare disease, especially in adulthood, and clarify the association between ICP and PFIC 3. We describe a series of cases from a Portuguese northern family with two brothers presenting chronic cholestasis since adolescence. Brother 1: since 15-years-old with pruritus and elevated γ-GT ∼6x. Brother 2: pre-term, due to severe maternal pruritus and jaundice, since 13-years-old with pruritus, jaundice and ∼8x γ-GT elevation. Common causes of cholestasis were excluded and liver histologies were nonspecific. Research for mutation on ABCB4 gene showed mutations in both alleles. Disease and mechanisms that determine cholestasis are complex and their understanding may provide new therapeutics. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  20. Colestasis intrahepática por dietiletilbestrol Intrahepatic cholestasis due to diethylstilbestrol

    Directory of Open Access Journals (Sweden)

    María Julia Cigales Reyes

    2007-12-01

    Full Text Available El síndrome ictérico es causa frecuente de ingreso en nuestros hospitales, en particular la colestasis, término preferido al de íctero obstructivo, ya que no es imprescindible que exista una obstrucción mecánica. Puede ser provocado por causas intrahepáticas o extrahepáticas, entre las primeras, la toxicidad medicamentosa constituye la segunda causa más frecuente. Se presentó un paciente que se atendió con colestasis intrahepática como efecto adverso del dietiletilbestrol, medicamento que se utiliza frecuentemente para el tratamiento de la neoplasia de próstataThe icteric syndrome is a frequent cause of admission in our hospitals, particularly, cholestasis, a term preferred for obstructive icterus, since the existance of a mechanical obstruction is not indispensable. It may be produced by intrahepatic or extrahepatic causes. Among the first, drug toxicity is the second most common cause. A patient with intrahepatic cholestasis as an adverse effect of diethylstilbestrol, a drug that is usually used for the treatment of prostatic neoplasia, was presented

  1. [Stevens-Johnson syndrome plus intrahepatic cholestasis caused by clindamycin or chlorpheniramine].

    Science.gov (United States)

    Sahagún Flores, J E; Soto Ortiz, J A; Tovar Méndez, C E; Cárdenas Ochoa, E C; Hernández Flores, G

    2009-05-15

    A 48-year-old woman was hospitalized with the diagnosis of hepatitis. She presented with symptoms of jaundice, headache, elevated bilirubin, and elevated hepatic enzymes. She related a recent episode of a bronchial infection that was treated during the previous eight days with paracetamol (500mg, 2 doses only), chlorpheniramine, betamethasone and clindamycin. After an initial clinical and laboratorial improvement, she began to complain of pruritus of the palms and soles. Thereafter, vesicles evolving to blisters developed and a deterioration of her general health ensued. Serologies for hepatitis A, B, and C viruses were negative. Intrahepatic cholestasis and Stevens Johnson Syndrome (SJS) were the final diagnosis. The association of the Stevens Johnson Syndrome and intrahepatic cholestasis simultaneously, related to adverse drug reactions, is very rare. The drugs reportedly involved are mainly antibiotics, such as ampicillin, vancomycin, amoxicillin/clavulinic acid and erythromycin. Other drugs involved are non-steroidal anti-inflamatory drugs, such as mefenamic acid, ibuprofen, and sulindac. The reactions can be minor or severe and can even cause death, an outcome that has been reported in patients of all races and ethnic groups, but appears to be more rare in patients of Latin origin. We present a discussion of this case and review the main characteristics of the Stevens Johnson Syndrome.

  2. Clinical heterogeneity of neonatal intrahepatic cholestasis caused by citrin deficiency: case reports from 16 patients.

    Science.gov (United States)

    Tazawa, Yusaku; Kobayashi, Keiko; Abukawa, Daiki; Nagata, Ikuo; Maisawa, Shunichi; Sumazaki, Ryo; Iizuka, Toshiyuki; Hosoda, Yoshito; Okamoto, Manabu; Murakami, Jun; Kaji, Shunsaku; Tabata, Ayako; Lu, Yao Bang; Sakamoto, Osamu; Matsui, Akira; Kanzaki, Susumu; Takada, Goro; Saheki, Takeyori; Iinuma, Kazuie; Ohura, Toshihiro

    2004-11-01

    A deficiency of citrin, which is encoded by the SLC25A13 gene, causes both adult-onset type II citrullinemia (CTLN2) and neonatal intrahepatic cholestasis (NICCD). We analyzed 16 patients with NICCD to clarify the clinical features of the disease. Severe intrahepatic cholestasis with fatty liver was the most common symptom, but the accompanying clinical features were variable, namely; suspected cases of neonatal hepatitis or biliary atresia, positive results from newborn screening, tyrosinemia, failure to thrive, hemolytic anemia, bleeding tendencies and ketotic hypoglycemia. Laboratory data showed elevated serum bile acid levels, hypoproteinemia, low levels of vitamin K-dependent coagulation factors, and hypergalactosemia. Hypercitrullinemia was detected in 11 out of 15 patients examined. Most of the patients were given a lactose-free and/or medium chain triglycerides-enriched formula and lipid-soluble vitamins. The prognosis of the 16 patients is going fairy well at present, but we should observe these patients carefully to see if they manifest any symptom of CTLN2 in the future.

  3. Intrahepatic Vascular Anatomy in Rats and Mice--Variations and Surgical Implications.

    Directory of Open Access Journals (Sweden)

    Constanze Sänger

    Full Text Available The intra-hepatic vascular anatomy in rodents, its variations and corresponding supplying and draining territories in respect to the lobar structure of the liver have not been described. We performed a detailed anatomical imaging study in rats and mice to allow for further refinement of experimental surgical approaches.LEWIS-Rats and C57Bl/6N-Mice were subjected to ex-vivo imaging using μCT. The image data were used for semi-automated segmentation to extract the hepatic vascular tree as prerequisite for 3D visualization. The underlying vascular anatomy was reconstructed, analysed and used for determining hepatic vascular territories.The four major liver lobes have their own lobar portal supply and hepatic drainage territories. In contrast, the paracaval liver is supplied by various small branches from right and caudate portal veins and drains directly into the vena cava. Variations in hepatic vascular anatomy were observed in terms of branching pattern and distance of branches to each other. The portal vein anatomy is more variable than the hepatic vein anatomy. Surgically relevant variations were primarily observed in portal venous supply.For the first time the key variations of intrahepatic vascular anatomy in mice and rats and their surgical implications were described. We showed that lobar borders of the liver do not always match vascular territorial borders. These findings are of importance for the design of new surgical procedures and for understanding eventual complications following hepatic surgery.

  4. Intrahepatic biliary cystic neoplasms: Surgical results of 9 patients and literature review

    Institute of Scientific and Technical Information of China (English)

    Ali Emre; Kür(s)at Rahmi Serin; (I)lgin (O)zden; Yaman Tekant; Orhan Bilge; Aydin Alper; Mine Güllüo(g)lu; Koray Güven

    2011-01-01

    AIM: To investigate the eligible management of the cystic neplasms of the liver.METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were reviewed retrospectively. Informed consent was obtained from the patients and approval was obtained from the designated review board of the institution.RESULTS: All patients were female with a median(range) age of 49 (27-60 years). The most frequent symptom was abdominal pain in 6 of the patients. Four patients had undergone previous laparotomy (with otherdiagnoses) which resulted in incomplete surgery or recurrences. Liver resection (n=6) or enucleation (n=3) was performed. The final diagnosis was intrahepatic biliary cystadenoma in 8 patients and cystadenocarcinoma in 1 patient. All symptoms resolved after surgery.There has been no recurrence during a median (range)31 (7-72) mo of follow up.CONCLUSION: In spite of the improvement in imagingmodalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal(liver resection or enucleation) of these lesions yields satisfying long-term results.

  5. Intrahepatic natural killer T cell populations are increased in human hepatic steatosis

    Institute of Scientific and Technical Information of China (English)

    Michael Adler; Sarah Taylor; Kamalu Okebugwu; Herman Yee; Christine Fielding; George Fielding; Michael Poles

    2011-01-01

    AIM: To determine if natural killer T cell (NKT) populations are affected in nonalcoholic fatty liver disease(NAFLD).METHODS: Patients undergoing bariatric surgery underwent liver biopsy and blood sampling during surgery.The biopsy was assessed for steatosis and immunocyte infiltration. Intrahepatic lymphocytes (IHLs) were isolated from the remainder of the liver biopsy,and peripheral blood mononuclear cells (PBMCs) were isolated from the blood. Expression of surface proteins on both IHLs and PBMCs were quantified using flow cytometry.RESULTS: Twenty-seven subjects participated in this study. Subjects with moderate or severe steatosis had a higher percentage of intrahepatic CD3+/CD56+ NKT cells (38.6%) than did patients with mild steatosis(24.1%, P = 0.05) or those without steatosis (21.5%, P= 0.03). Patients with moderate to severe steatosis alsohad a higher percentage of NKT cells in the blood (12.3%) as compared to patients with mild steatosis (2.5% P =0.02) and those without steatosis (5.1%, P = 0.05).CONCLUSION: NKT cells are significantly increased in the liver and blood of patients with moderate to severe steatosis and support the role of NKT cells in NAFLD.

  6. Fish hemoglobins

    Directory of Open Access Journals (Sweden)

    P.C. de Souza

    2007-06-01

    Full Text Available Vertebrate hemoglobin, contained in erythrocytes, is a globular protein with a quaternary structure composed of 4 globin chains (2 alpha and 2 beta and a prosthetic group named heme bound to each one. Having myoglobin as an ancestor, hemoglobin acquired the capacity to respond to chemical stimuli that modulate its function according to tissue requirements for oxygen. Fish are generally submitted to spatial and temporal O2 variations and have developed anatomical, physiological and biochemical strategies to adapt to the changing environmental gas availability. Structurally, most fish hemoglobins are tetrameric; however, those from some species such as lamprey and hagfish dissociate, being monomeric when oxygenated and oligomeric when deoxygenated. Fish blood frequently possesses several hemoglobins; the primary origin of this finding lies in the polymorphism that occurs in the globin loci, an aspect that may occasionally confer advantages to its carriers or even be a harmless evolutionary remnant. On the other hand, the functional properties exhibit different behaviors, ranging from a total absence of responses to allosteric regulation to drastic ones, such as the Root effect.

  7. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

    OpenAIRE

    Christine Sävervall; Freja Lærke Sand; Simon Francis Thomsen

    2015-01-01

    Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.

  8. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

    Science.gov (United States)

    Sävervall, Christine; Sand, Freja Lærke; Thomsen, Simon Francis

    2015-01-01

    Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy. PMID:26609305

  9. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

    Directory of Open Access Journals (Sweden)

    Christine Sävervall

    2015-01-01

    Full Text Available Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.

  10. Are Postprandial Bile Acid Levels Helpful in Predicting Perinatal Complications in Patients with Intrahepatic Cholestasis of Pregnancy?

    Directory of Open Access Journals (Sweden)

    Kudret Erkenekli

    2015-06-01

    Results: Gestational diabetes and preterm delivery occurred more frequently in patients with intrahepatic cholestasis of pregnancy patients. The rate of primary cesarean delivery was more common in in patients with intrahepatic cholestasis of pregnancy patients. The rate of growth-restricted infants was higher in the patients who received ursodeoxycholic acid. Nenoatal intensive care unit admissions and overall neonatal complications, as well as spontaneous preterm deliveries, were similar among in patients with intrahepatic cholestasis of pregnancy regardless of ursodeoxycholic acid therapy. In the receiver operating characteristic analysis, the area under curve values for postprandial and fasting bile acids to predict neonatal complications were 0.64 and 0.70, respectively. Conclusion: Intrahepatic cholestasis of pregnancy patients increases certain perinatal complications, such as preterm deliveries and neonatal morbidity. Postprandial serum bile acid levels are inferior to fasting serum bile acid levels in the prediction of obstetric complications. ursodeoxycholic acid does not seem to improve perinatal outcomes. [Cukurova Med J 2015; 40(2.000: 212-220

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Endoscopic variceal ligation plus propranolol vs. transjugular intrahepatic portosystemic stent shunt : A long-term randomized trial

    NARCIS (Netherlands)

    Sauer, P; Hansmann, J; Richter, GM; Stremmel, W; Stiehl, A

    2002-01-01

    Background and Study Aims: After a first variceal bleeding episode in patients with cirrhosis of the liver, treatment with transjugular intrahepatic portosystemic stent shunt (TIPS) and endoscopic variceal ligation (EVL) plus propranolol were compared, with regard to prevention of variceal rebleedin

  13. Decrease of deleted in malignant brain tumour-1 (DMBT-1) expression is a crucial late event in intrahepatic cholangiocarcinoma

    DEFF Research Database (Denmark)

    Sasaki, M; Huang, S-F; Chen, M-F

    2003-01-01

    AIMS: To investigate the participation of DMBT-1, a candidate tumour suppressor gene, in the development of intrahepatic cholangiocarcinoma via intraductal papillary neoplasm of the liver (IPN-L) arising in hepatolithiasis. DMBT-1 plays a role in mucosal immune defence. METHODS AND RESULTS: The e...

  14. Intrahepatic and hilar mass-forming cholangiocarcinoma: Qualitative and quantitative evaluation with diffusion-weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Fattach, Hassan El, E-mail: hassangreenmed@gmail.com [Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris (France); Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris (France); Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris (France); UMR INSERM 965-Paris 7 “Angiogenèse et recherche translationnelle”, 2 rue Amboise Paré, 75010 Paris (France); Guerrache, Youcef, E-mail: docyoucef05@yahoo.fr [Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris (France); Dautry, Raphael, E-mail: raphael.dautry@lrb.aphp.fr [Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris (France); Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris (France); and others

    2015-08-15

    Highlights: • DW-MR imaging helps depicts all intrahepatic or hilar mass-forming cholangiocarcinomas. • DW-MRI provides best conspicuity of intrahepatic or hilar mass-forming cholangiocarcinomas than the other MRI sequences (P < 0.001). • The use of normalized ADC using the liver as reference organ results in the most restricted distribution of ADC values of intrahepatic or hilar mass-forming cholangiocarcinomas (variation coefficient = 16.6%). - Abstract: Objective: To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-forming cholangiocarcinoma with diffusion-weighted magnetic resonance imaging (DW-MRI). Materials and methods: Twenty-eight patients with histopathologically proven mass-forming cholangiocarcinoma (hilar, n = 17; intrahepatic, n = 11) underwent hepatic DW-MRI at 1.5-T using free-breathing acquisition and three b-values (0,400,800 s/mm{sup 2}). Cholangiocarcinomas were evaluated qualitatively using visual analysis of DW-MR images and quantitatively with conventional ADC and normalized ADC measurements using liver and spleen as reference organs. Results: All cholangiocarcinomas (28/28; 100%) were visible on DW-MR images. DW-MRI yielded best conspicuity of cholangiocarcinomas than the other MRI sequences (P < 0.001). Seven cholangiocarcinomas (7/11; 64%) showed hypointense central area on DW-MR images. Conventional ADC value of cholangiocarcinomas (1.042 × 10{sup −3} mm{sup 2}/s ± 0.221 × 10{sup −3} mm{sup 2}/s; range: 0.616 × 10{sup −3} mm{sup 2}/s to 2.050 × 10{sup −3} mm{sup 2}/s) was significantly lower than that of apparently normal hepatic parenchyma (1.362 × 10{sup −3} mm{sup 2}/s ± 0.187 × 10{sup −3} mm{sup 2}/s) (P < 0.0001), although substantial overlap was found. No significant differences in ADC and normalized ADC values were found between intrahepatic and hilar cholangiocarcinomas. The use of normalized ADC using the liver as reference organ resulted in the most restricted

  15. Bone cutting.

    Science.gov (United States)

    Giraud, J Y; Villemin, S; Darmana, R; Cahuzac, J P; Autefage, A; Morucci, J P

    1991-02-01

    Bone cutting has always been a problem for surgeons because bone is a hard living material, and many osteotomes are still very crude tools. Technical improvement of these surgical tools has first been their motorization. Studies of the bone cutting process have indicated better features for conventional tools. Several non-conventional osteotomes, particularly ultrasonic osteotomes are described. Some studies on the possible use of lasers for bone cutting are also reported. Use of a pressurised water jet is also briefly examined. Despite their advantages, non-conventional tools still require improvement if they are to be used by surgeons.

  16. Late-Onset Drug-Induced Cholestasis in a Living-Related Liver Transplant Donor With Progressive Familial Intrahepatic Cholestasis.

    Science.gov (United States)

    Harmancı, Özgür; Ensaroğlu, Fatih; Özçay, Figen; Öcal, Serkan; Korkmaz, Murat; Özdemir, B Handan; Selçuk, Haldun; Moray, Gökhan; Haberal, Mehmet

    2015-11-01

    We present a rare case of progressive familial intrahepatic cholestasis within a family. A 34-yearold female became a living-related liver transplant donor for her son, who had the disease. Nine years after the transplant, the mother developed severe intrahepatic cholestasis, for which she was evaluated after using an oral contraceptive drug. She presented with jaundice, pruritus, and increased bilirubin levels, together with elevated gamma glutamyl transferase and alkaline phosphatase levels. A liver biopsy revealed findings consistent with intrahepatic cholestasis. However, despite follow-up management and cessation of the insulting drug, her total bilirubin count continuously increased to 20 mg/dL and was accompanied by intractable pruritus. A total of 9 plasmapheresis sessions were performed, and she was started on a regimen of ursodeoxycholic acid (13 mg/kg/d) and cholestyramine (4 g, 3 times daily). The clinical and laboratory picture dramatically improved following cessation of the oral contraceptive, plasmapheresis sessions, and drug treatment. The patient's cholestasis normalized within 3 months, and she recovered uneventfully. A genetic analysis of the whole family revealed that both parents were heterozygous for the mutation c.124G>A in ABCB11, and the son was homozygous for this mutation. These findings supported varying degrees of bile salt export pump deficiency in the family members. Defective bile salt excretory system function can result in a wide spectrum of clinical presentations, ranging from progressive familial intrahepatic cholestasis requiring liver transplant to late-onset drug-induced cholestasis. Our findings suggest that, in a heterozygous carrier of a progressive familial intrahepatic cholestasis mutation, drug-induced cholestasis is responsive to treatment, after which the clinical picture can normalize within 3 months.

  17. Intrahepatic CD8+ lymphocyte trapping during tolerance induction using mushroom derived formulations: A possible role for liver in tolerance induction

    Institute of Scientific and Technical Information of China (English)

    Mony Shuvy; Tiberiu Hershcovici; Cristina Lull-Noguera; Harry Wichers; Ofer Danay; Dan Levanon; Lidya Zolotarov; Yaron Ilan

    2008-01-01

    AIM: To determine the immunomodulatory effect of Shiitake (a mushroom extract),we tested its effect on liver-mediated immune regulation in a model of immune-mediated colitis.METHODS: Four groups of mice were studied.Colitis was induced by intracolonic instillation of TNBS in groups A and B.Groups A and C were treated daily with Shiitake extract,while groups B and D received bovine serum albumin.Mice were evaluated for development of macroscopic and microscopic.The immune effects of Shiitakke were determined by FACS analysis of intra-hepatic and intrasplenic lymphocytes and IFN-γ ELISPOT assay.RESULTS: Administration of Shiitake resulted in marked alleviation of colitis,manifested by significant improvement in the macroscopic and microscopic scores,and by reduction in IFN-γ-producing colonies in group A,compared to group B mice (1.5 pfu/mL vs 3.7 pfu/mL,respectively).This beneficial effect was associated with a significant increase in the intrahepatic CD8+ lymphocyte trapping,demonstrated by an increased intrasplenic/intrahepatic CD4/CD8 lymphocyte ratio.These effects were accompanied by a 17% increase in the number of intrahepatic natural killer T (NKT) cells.A similar effect was observed when Shiitake was administered to animals without disease induction.CONCLUSION: Shiitake extract affected livermediated immune regulation by altering the NKT lymphocyte distribution and increasing intrahepatic CD8+ T lymphocyte trapping,thereby leading to alleviation of immune-mediated colitis.

  18. DIFFERENCE IN BIOLOGICAL CHARACTERISTICS AND SENSITIVITY TO CHEMOTHERAPY AND RADIOTHERAPY BETWEEN INTRAHEPATIC AND EXTRAHEPATIC CHOLANGIOCARCINOMA CELLS IN VITRO

    Institute of Scientific and Technical Information of China (English)

    Xiao-ran He; Xiao-peng Wu

    2008-01-01

    Objective To investigate and compare the biological characteristics and sensitivity to chemotherapy and radiother-apy of intrahepatic and extrahepatie cholangiocarcinoma cells in vitro.Methods The intrahepatic and extrahepatie eholangiocarcinoma cell lines were established, and cells with steady passage were chosen to study the biological characteristics including morphology, growth dynamics, chromosome, and levels of cancer antigen (CA)125, CA 19-9, alpha-fetoprotein (AFP), and carcino-embryonic antigen (CEA).M.eanwhile, MTT assay was used to determine the sensitivity of both kinds of cells to 6 chemotherapeutic drugs, inclu-ding cisplatin, paclitaxel, harringtonine, 5-fluorouracil, vincristine, and aelacimomycin, and the inhibitory rate of ceils under the irradiation of 10 Gy ray was also measured.Reanlts The intrahepatic cholangiocarcinoma cells were mostly fusiform in shape, and extrahepatic eholangiocar-cinoma cells were mostly round or polygon in shape. Their doubling time was 26. 3 hours and 23.1 hours, respectively.Their average number of chromosomes was 59 (range, 38-84) and 67 (range, 49-103 ), respectively. The chromo-some karyotypes of most intrahepatlc ebolangiocarcinoma cells were hyperdiploid and hypotriploid, while hypertriploid was predominant in extrahepatic cholangioearcinoma cells. The level of CA 125 in supernatant of extrahepatic cholangio-carcinoma cells increased obviously, while levels of other determined tumor markers in both kinds of cells were all with-in normal range. The intrahepatic cholangiocarcinoma cells were low sensitive to cisplatin and paclitaxel, but not sensi-tive to the other 4 chemotherapeutic drugs. The extrahepatic cholangiocarcinoma cells were high sensitive to eisplatin,but not sensitive to the other 5 drugs. Both kinds of cells had poor sensitivity to radiotherapy.Conelusions Intrahepatic and extrahepatie cbolangiocareinoma cells show differences in shape, doubling time,chromosome karyotype, tumor marker level, and

  19. Bone Hill National Wildlife Refuge [Land Status Map

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This map was produced by the Division of Realty to depict landownership at Bone Hill National Wildlife Refuge. It was generated from rectified aerial photography,...

  20. Fish Tales

    Energy Technology Data Exchange (ETDEWEB)

    McLerran, L.

    2010-07-06

    This talk is about fishing and the friendships that have resulted in its pursuit. It is also about theoretical physics, and the relationship of imagination and fantasy to the establishment of ideas about nature. Fishermen, like theoretical physicists, are well known for their inventive imaginations. Perhaps neither are as clever as sailors, who conceived of the mermaid. If one doubts the power of this fantasy, one should remember the ghosts of the many sailors who drowned pursuing these young nymphs. An extraordinary painting by J. Waterhouse is shown as Fig. 1. The enchantment of a mermaid must reflect an extraordinary excess of imagination on the part of the sailor, perhaps together with an impractical turn of mind. A consummated relationship with a mermaid is after all, by its very nature a fantasy incapable of realization. To a theoretical physicist, she is symbolic of many ideas we develop. There are many truths known to fisherman in which one might also find parallels to the goals of scientists: (1) A fish is the only animal that keeps growing after its death; (2) Nothing makes a fish bigger than almost being caught; (3) ''...of all the liars among mankind, the fisherman is the most trustworthy.'' (William Sherwood Fox, in Silken Lines and Silver Hooks); and (4) Men and fish are alike. They both get into trouble when they open their mouths. These quotes may be interpreted as reflecting skepticism regarding the honesty of fisherman, and probably do not reflect adequate admiration for a creative imagination. Is it fair to criticize a person for believing a falsehood that he or she sincerely believes to be true? The fisherman simultaneously invents the lie, and believes in it himself. The parallel with theoretical physics is perhaps only approximate, although we physicists may invent stories that we come to believe, on some rare occasions our ideas actually correspond to a more or less true descriptions of nature. These minor philosophical

  1. Fish Immunoglobulins

    Science.gov (United States)

    Mashoof, Sara; Criscitiello, Michael F.

    2016-01-01

    The B cell receptor and secreted antibody are at the nexus of humoral adaptive immunity. In this review, we summarize what is known of the immunoglobulin genes of jawed cartilaginous and bony fishes. We focus on what has been learned from genomic or cDNA sequence data, but where appropriate draw upon protein, immunization, affinity and structural studies. Work from major aquatic model organisms and less studied comparative species are both included to define what is the rule for an immunoglobulin isotype or taxonomic group and what exemplifies an exception. PMID:27879632

  2. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy

    Science.gov (United States)

    Kong, Xiang; Kong, Yan; Zhang, Fangyuan; Wang, Tingting; Yan, Jin

    2016-01-01

    Abstract Background: Intrahepatic cholestasis of pregnancy (ICP) is a specific pregnancy-related disorder without standard medical therapies. Ursodeoxycholic acid (UDCA) is the most used medicine, but the efficacy and safety of UDCA remain uncertain. Several meta-analyses had been made to assess the effects of UDCA in ICP. However, the samples were not large enough to convince obstetricians to use UDCA. We conducted a meta-analysis to evaluate the effects and safety of UDCA in patients with ICP, which included only randomized controlled trials (RCTs). Methods: Six databases were searched. The search terms were “ursodeoxycholicacid,” “therapy,” “management,” “treatment,” “intrahepatic cholestasis of pregnancy,” “obstetric cholestasis,” “recurrent jaundice of pregnancy,” “pruritus gravidarum,” “idiopathic jaundice of pregnancy,” “intrahepatic jaundice of pregnancy,” and “icterus gravidarum.” Randomized controlled trials of UDCA versus control groups (included using other medicines) among patients with ICP were included. The primary outcomes were improved pruritus scores and liver function. Secondary outcomes were the maternal and fetal outcomes in patients with ICP. Data were extracted from included RCTs. The Mantel–Haenzel random-effects model or fixed-effects model was used for meta-analysis. Results: A total of 12 RCTs involving 662 patients were included in the meta-analysis. In pooled analyses that compared UDCA with all controls, UDCA was associated with resolution of pruritus (risk ratio [RR], 1.68; 95% confidence interval [CI],1.12–2.52; P = 0.01),decrease of serum levels of alanine aminotransferase (ALT) (standardized mean difference (SMD), −1.36; 95% CI, −2.08 to −0.63; P 0.05). No trials reported adverse effects on mothers and fetuses except nausea and emesis. Conclusion: UDCA is effective and safe to improve pruritus and liver function in ICP. UDCA also reduced adverse maternal and fetal outcomes

  3. Clinical effect of laparoscopic left lateral hepatectomy in treatment of intrahepatic bile duct stones

    Directory of Open Access Journals (Sweden)

    LING Xinjian

    2017-08-01

    Full Text Available ObjectiveTo investigate the surgical method, safety, and clinical effect of laparoscopic left lateral hepatectomy in the treatment of intrahepatic bile duct stones. MethodsA total of 30 patients with intrahepatic bile duct stones who were admitted to our hospital from January 2015 to December 2016 were enrolled, and according to the surgical procedure, these patients were divided into conventional group (15 patients and laparoscopic group (15 patients. The patients in the conventional group were treated with open left lateral hepatectomy, and those in the laparoscopic group were treated with minimally invasive laparoscopic left lateral hepatectomy. Surgical indices were observed, and postoperative complications and liver function parameters were compared between the two groups. The t-test was used for comparison of normally distributed continuous data, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. ResultsThe laparoscopic group had significant reductions in the time to passage of gas by anus (1.02±0.51 d vs 1.98±0.36 d, t=5.956, P<0.001 and length of postoperative hospital stay (883±0.81 d vs 11.83±0.42 d, t=5.830, P<0.001 compared with the conventional group. Compared with the conventional group, the laparoscopic group had a significantly lower alanine aminotransferase level (125.8±91.9 U/L vs 214.1±99.6 U/L, t=2.52, P=002 and a significantly higher serum albumin level (33.2±3.7 g/L vs 28.9±4.3 g/L, t=2.94, P=0.01 at 5 days after surgery. Conclusion Compared with conventional open surgery, laparoscopic left lateral hepatectomy has the features of little trauma, rapid postoperative recovery, and little influence on liver function in the treatment of intrahepatic bile duct stones and has a marked clinical effect. Therefore, it holds promise for clinical application.

  4. Fishing activities

    Science.gov (United States)

    Oberle, Ferdinand; Puig, Pere; Martin, Jacobo; Micallef, Aaron; Krastel, Sebastian; Savini, Alessandra

    2018-01-01

    Unlike the major anthropogenic changes that terrestrial and coastal habitats underwent during the last centuries such as deforestation, river engineering, agricultural practices or urbanism, those occurring underwater are veiled from our eyes and have continued nearly unnoticed. Only recent advances in remote sensing and deep marine sampling technologies have revealed the extent and magnitude of the anthropogenic impacts to the seafloor. In particular, bottom trawling, a fishing technique consisting of dragging a net and fishing gear over the seafloor to capture bottom-dwelling living resources has gained attention among the scientific community, policy makers and the general public due to its destructive effects on the seabed. Trawling gear produces acute impacts on biota and the physical substratum of the seafloor by disrupting the sediment column structure, overturning boulders, resuspending sediments and imprinting deep scars on muddy bottoms. Also, the repetitive passage of trawling gear over the same areas creates long-lasting, cumulative impacts that modify the cohesiveness and texture of sediments. It can be asserted nowadays that due to its recurrence, mobility and wide geographical extent, industrial trawling has become a major force driving seafloor change and affecting not only its physical integrity on short spatial scales but also imprinting measurable modifications to the geomorphology of entire continental margins.

  5. Deep Fish.

    Science.gov (United States)

    Ishaq, Omer; Sadanandan, Sajith Kecheril; Wählby, Carolina

    2017-01-01

    Zebrafish ( Danio rerio) is an important vertebrate model organism in biomedical research, especially suitable for morphological screening due to its transparent body during early development. Deep learning has emerged as a dominant paradigm for data analysis and found a number of applications in computer vision and image analysis. Here we demonstrate the potential of a deep learning approach for accurate high-throughput classification of whole-body zebrafish deformations in multifish microwell plates. Deep learning uses the raw image data as an input, without the need of expert knowledge for feature design or optimization of the segmentation parameters. We trained the deep learning classifier on as few as 84 images (before data augmentation) and achieved a classification accuracy of 92.8% on an unseen test data set that is comparable to the previous state of the art (95%) based on user-specified segmentation and deformation metrics. Ablation studies by digitally removing whole fish or parts of the fish from the images revealed that the classifier learned discriminative features from the image foreground, and we observed that the deformations of the head region, rather than the visually apparent bent tail, were more important for good classification performance.

  6. Multimodal Therapy including Yttrium-90 Radioembolization as a Bridging Therapy to Liver Transplantation for a Huge and Locally Advanced Intrahepatic Cholangiocarcinoma.

    Science.gov (United States)

    Rayar, Michel; Levi Sandri, Giovanni Battista; Houssel-Debry, Pauline; Camus, Christophe; Sulpice, Laurent; Boudjema, Karim

    2016-09-01

    Treatment of intrahepatic cholangiocarcinoma remains a major challenge. For an unresectable lesion without extrahepatic spread, liver transplantation could be a potential solution but it is still associated with poor oncologic results owing to the absence of effective neoadjuvant treatment. We report the case of a young man with locally advanced intrahepatic cholangiocarcinoma presenting with multiple intrahepatic metastases and vascular structure involvement. The lesion was significantly downstaged by a multimodal therapy including intra-arterial Yttrium-90 radioembolization, systemic chemotherapy and external radiotherapy, allowing liver transplantation. Three years after the procedure, oncologic outcome is excellent with no sign of recurrence. Multimodal therapy including Yttrium-90 radioembolization could be relevant as neoadjuvant treatment before liver transplantation for unresectable intrahepatic cholangiocarcinoma.

  7. [Research advances in diagnosis and treatment of post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy].

    Science.gov (United States)

    Yang, J F; Zhang, B Q

    2016-07-20

    Transjugular intrahepatic portosystemic shunt (TIPS) has become an important minimally invasive interventional technique for the treatment of complications of cirrhotic portal hypertension, and currently, it is often used in cirrhotic patients with esophagogastric variceal bleeding (EVB), intractable ascites, hepatic hydrothorax, and Budd-Chiari syndrome. On one hand, TIPS can effectively reduce portal vein pressure and the risk of EVB and intractable ascites; on the other hand, it may reduce the blood flow in liver perfusion, aggravate liver impairment, and cause porto-systemic encephalopathy. Related influencing factors should be evaluated comprehensively in order to prevent the development of post-TIPS hepatic encephalopathy. The diagnosis and treatment of post-TIPS hepatic encephalopathy is still a great challenge in current clinical practice. This article reviews the diagnosis and treatment of post-TIPS hepatic encephalopathy to enhance people's knowledge of this disease.

  8. Resveratrol reduces matrix metalloproteinases and alleviates intrahepatic cholestasis of pregnancy in rats.

    Science.gov (United States)

    Chen, Zhong; Hu, Lingqing; Lu, Mudan; Shen, Zongji

    2016-04-01

    Intrahepatic cholestasis of pregnancy (ICP) is a severe liver disorder occurring specifically in pregnancy, and matrix metalloproteinase (MMP)-2 and MMP-9 were found to be elevated in ICP patients. Using ethinylestradiol-induced ICP rats as the model, we examined the effect of resveratrol on ICP symptoms such as bile flow rate, serum enzymatic activities, and TBA concentration, as well as MMP levels, and compared with the known ICP drug ursodeoxycholic acid. Both MMP-2 and MMP-9 were upregulated in ICP rats, and resveratrol treatment could inhibit the elevation of both MMPs, whereas ursodeoxycholic acid did not exhibit any effect. Although ursodeoxycholic acid alleviated ICP symptoms, resveratrol treatment in general exhibited better outcome in restoring bile flow rate, serum enzymatic activities, and TBA concentration. Our results for the first instance strongly supported the potential of RE as a new therapeutic agent in treating ICP, possibly through inhibiting MMP-2 and MMP-9.

  9. Delayed liver laceration following transjugular intrahepatic portosystemic shunt for portal hypertension.

    Science.gov (United States)

    Liu, Kai; Fan, Xin-Xin; Wang, Xu-Lin; He, Chang-Sheng; Wu, Xing-Jiang

    2012-12-28

    The transjugular intrahepatic portosystemic shunt (TIPS) is an acceptable procedure that has proven benefits in the treatment of patients who have complications from portal hypertension due to liver cirrhosis. Delayed liver laceration is a rare complication of the TIPS procedure. We describe a patient with portal hypertension due to liver cirrhosis, who suddenly presented with abdominal hemorrhage and liver laceration 8 d after TIPS. Few reports have described complications after TIPS placement. To the best of our knowledge, this is the first report describing delayed liver laceration. This potential and serious complication appears to be specific and fatal for TIPS in portal hypertension. We advocate careful attention to the technique to avoid this complication, and timely treatment is extremely important.

  10. Hypervitaminosis A inducing intra-hepatic cholestasis--a rare case report.

    Science.gov (United States)

    Ramanathan, Vivek S; Hensley, Gary; French, Samuel; Eysselein, Victor; Chung, David; Reicher, Sonya; Pham, Binh

    2010-04-01

    The use of over-the-counter supplements is commonplace in today's health conscious society. We present an unusual case of intrahepatic cholestasis caused by vitamin A intoxication. The patient consumed one Herbalife shake with two multivitamin tablets of the same brand for 12 years. When calculated this equated to more than the recommended daily allowance for vitamin A consumption. Deranged liver function tests were consistent with a cholestatic process. Liver biopsy was obtained and revealed features pathognomonic of vitamin A toxicity, without the usual fibrosis. When the supplements were ceased, his jaundice and alkaline phosphatase completely normalized. This case highlights the importance of health care providers documenting non-prescribed dietary supplements and considering them in the etiology of cholestatic liver disease.

  11. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    Directory of Open Access Journals (Sweden)

    Shinsuke Takenaga

    2016-11-01

    Full Text Available Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL, and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS.

  12. Transjugular Intrahepatic Portosystemic Shunt (TIPS Migration to the Heart Diagnosed by Emergency Department Ultrasound

    Directory of Open Access Journals (Sweden)

    Carlan Wendler

    2012-12-01

    Full Text Available A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS. On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was noted to have multiple premature atrial contractions, corroborating the irregular heart rhythm on physical exam. A focused bedside emergency ultrasound of the heart was then performed. This exam revealed an apparent foreign body in the right atrium. It appeared as if the patient’s TIPS had migrated from the heart into the right atrium. This case, as well as the literature describing thisunusual complication of TIPS placement, is reviewed in this case report

  13. Transjugular Intrahepatic Portosystemic Shunt for Maintenance of Portal Venous Patency in Liver Transplant Candidates

    Directory of Open Access Journals (Sweden)

    Ron Charles Gaba

    2013-01-01

    Full Text Available Maintenance of portal venous patency is vital to liver transplant candidates, as the presence of portal vein thrombosis (PVT adversely impacts clinical outcomes by increasing surgical complexity and decreasing postoperative survival. By enhancing portal venous blood flow, transjugular intrahepatic portosystemic shunt (TIPS creation may enable clearance of PVT and preservation of portal venous patency in cirrhotic patients. Herein, we describe four cases in which TIPS produced and sustained an open portal venous system in liver transplant candidates with partial PVT. All patients demonstrated rapid and effective flow-enabled clearance of clot and intermediate to long-term preservation of portal venous flow. On this basis, we propose that maintenance of portal venous patency in liver transplant candidates with partial PVT represents a developing indication for TIPS.

  14. [Intrahepatic cholestasis associated with parenteral nutrition: an experimental study in rats].

    Science.gov (United States)

    Salas Martínez, J; Morán Penco, J M; Mahedero Ruiz, G; García Gamito, F; Limón Mora, M; Maciá Botejara, E; Vinagre Velasco, L M

    1989-01-01

    Intrahepatic cholestasis is a condition often observed in patients receiving parenteral nutrition, especially in new born babies who are underweight (taurina. This makes it impossible to achieve a correct conjugation of toxic biliary acids. The access of nutrients to the liver may have an effect on this. An experimental study on rats was performed, administering an oral diet at the expense of lipids (20% Intralipid, 60% of caloric needs) and glucose (40% of caloric needs) in one group, another group received amino acid supplements to this diet (16N) at a proteic rate of 2 gr/kg of weight and day orally, with an identical diet to the above, except that the proteic intake was intraperitoneal. Two control groups were established. We found a microvacuolization in hepatic fat with the help of an electronic microscope in the groups lacking proteins and those with oral or intraperitoneal supplements of amino acids, as well as an increase in plasmatic AST.

  15. Inactivation of Smad4 is a prognostic factor in intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    YAN Xue-qiang; ZHANG Wei; ZHANG Bi-xiang; LIANG Hui-fang; ZHANG Wan-guang; CHEN Xiao-ping

    2013-01-01

    Background Smad4 is found mutated in many cancers.It acts as a tumor suppressor in the regulation of TGF-β signaling pathway.The objective of this work was to study the expression of Smad4 in intrahepatic cholangiocarcinoma (ICC) and its relationship with the biological behavior and prognosis of the disease.Methods Forty-nine paraffin-embedded ICC specimens and nine normal liver tissues were analyzed by immunohistochemical methods using Smad4 monoclonal antibodies.The expression of Smad4 was compared with the clinical pathological characteristics of the patients.Results The expression of Smad4 was 100% positive in normal liver tissues,which was higher than that in the ICC (44.9%).Negative labeling of the Smad4 protein was found in 26.1% (6/23) of well-differentiated ICCs and 61.5%(16/26) of poorly to moderately differentiated ICCs,and 34.3% (12/35) and 71.4% (10/14) showed negative Smad4 labeling (P=0.018) of ICC at pathological Tumor Node Metastasis (pTNM) stage Ⅰ-Ⅱ and pTNM stage Ⅲ-Ⅳ separately.Furthermore,72% (8/11) of lymph node metastatic ICCs and 73.3% (11/15) of intrahepatic metastatic ICCs showed negative labeling of the Smad4 protein.The loss of Smad4 expression in those metastatic ICCs was significantly more severe compared with non-metastatic ICCs (P=0.000).Conclusions The expression of Smad4 was associated with the histological grade,clinical stage,and metastasis of ICC (P <0.05).The detection of Smad4 may be helpful in determining the degree of malignancy and prognosis of ICC.

  16. Intrahepatic cytokine profile in renal-transplant patients infected by hepatitis C virus.

    Science.gov (United States)

    Kamar, Nassim; Rostaing, Lionel; Sandres-Saune, Karine; Selves, Janick; Barthe, Carole; Dubois, Martine; Alric, Laurent; Durand, Dominique; Izopet, Jacques

    2005-08-01

    In order to examine the immunopathogenesis of hepatitis C virus (HCV)-related liver injury in renal-transplant patients, intra-hepatic cytokine profiles were examined in 38 liver biopsies from 38 patients by measuring messenger RNA (mRNA) concentrations by a real-time PCR method of a Th1 cytokine (i.e., interferon (IFN)-gamma), a Th2 cytokines (i.e., interleukine (IL)-10), a proinflammatory cytokine (i.e., IL-8), and a potent fibrogenic factor (transforming growth factor [TGF]-beta). There was no significant difference in TGF-beta, IFN-gamma, IL-10, or IL-8 levels of expression according to liver-activity grade, liver-fibrosis stage, the concentration of HCV RNA at liver biopsies, or the HCV genotype. However, IFN-gamma/beta-actin mRNA concentration was higher than the IL-10/beta-actin mRNA concentration in patients with F3 Metavir score. Median IFN-gamma/beta-actin mRNA concentration tended to be higher in patients with A3 and A4 Metavir activity grades compared with those with A0 and A1 activity grades. There was a significant correlation between the duration of HCV infection and both TGF-beta/beta-actin (r(2)=0.19, P=0.04) and IL-8/beta-actin mRNA concentrations (r(2)=0.19, P=0.03). IFN-gamma/beta-actin mRNA concentration also increased according to the duration of HCV (r(2)=0.19, P=0.07). Finally, there was a significant correlation between the duration of HCV infection and liver fibrosis stage (r(2)=0.17, P=0.045). Intrahepatic Th1 cytokine profile seems to be predominant in patients with extensive fibrosis and activity scores, suggesting that it might be responsible for liver injury in renal transplant patients.

  17. Residual intrahepatic stones after percutaneous biliary extraction : longterm follow up of complications

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Seung Min; Shim, Hyung Jin; Lee, Hwa Yeon; Lim, Sang Jun; Park, Hyo Jin; Kim, Yang Soo; Choi, Young Hee [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Kwak, Byung Kuck [National Medical Center, Seoul (Korea, Republic of); Park, Ji Young [Sung Ae Hospital, Seoul (Korea, Republic of)

    1997-08-01

    To evaluate and compare the radiologic and clinical follow-up of complications between a group in whom stone removal after percutaneous biliary extraction had been complete, and a group in whom this had been incomplete. Twenty-two patients in whom stone removal had been incomplete, and 20 from whom stones had been completely removed were evaluated with particular attention to complications such as cholangitis, liver abscess, biliary sepsis, and pain. Cholangitis was diagnosed on the basis of typical clinical symptoms such as pain, high fever, jaundice and leukocytosis. Pain without other cholangitic symptoms was excluded. Liver abscess was diagnosed by percutaneous aspiration of pus, and biliary sepsis by bacterial growth on blood culture, or laboratory findings such as increased fibrinogen products, decreased fibrinogen, and increased prothrombin time with cholangitic symptoms. 'Complete removal' means no residual stones on follow-up sonogram and cholangiogram performed within three to seven days after pecutaneous biliary extraction. Mean follow-up period was 26.5 months in the incomplete removal group and 34.2 months in the complete removal group. In twelve of 22 patients (54.5%) in the incomplete removal group, complications occurred, as follows:cholangitis, ten cases (45.5%);liver absces, one (4.5%);biliary sepsis, one (4.5%);and pain, seven(31.8%). In contrast, only two of twenty patients (10%) in the complete removal group suffered complications, all of which involved the recurrence of stones in the common duct, and cholangitis. Complete removal of intrahepatic stones significantly helps to reduce the incidence of possible complications. Even in the case of an impacted stone, aggressive interventional procedures, aimed at complete removal, should be considered. If nonsurgical procedures fail, early partial hepatectomy should be considered, particulary for the stones localized in the left intrahepatic duct.

  18. Radioembolization of hepatic tumors. Flow redistribution after the occlusion of intrahepatic arteries

    Energy Technology Data Exchange (ETDEWEB)

    Lauenstein, T.C. [University Hospital Essen (Germany). Radiology; Heusner, T.A.; Antoch, G. [University Hospital Duesseldorf (Germany). Radiology; Hamami, M.; Bockisch, A. [University Hospital Essen (Germany). Dept. of Nuclear Medicine; Ertle, J.; Schlaak, J.F.; Gerken, G. [University Hospital Essen (Germany). Gastroenterology and Hepatology

    2011-11-15

    Radioembolization using 90yttrium is an emerging therapy option for unresectable liver malignancies. In order to reduce the number of yttrium injections, endovascular occlusion of a segmental hepatic artery has been proposed. The aim of this study was to assess whether sufficient vascular redistribution of the occluded liver segments through intrahepatic collaterals can be observed. 27 patients with hepatocellular carcinoma (n = 16) or hepatic metastases (n = 11) were studied. Hepatic angiography was performed on average 16 days prior to radioembolization. The segment II/III artery (n = 9) or the segment IV artery (n = 18) was occluded using coils. Technectium-99m-labeled macroaggregated albumin (99mTc-MAA) was injected into the right and the remaining part of the left hepatic artery in order to identify any hepatic volume not included in the perfused area. Patients underwent a SPECT/CT on average 1 h after the 99mTc-MAA injection. Two radiologists evaluated the SPECT/CT scans regarding the presence of non-perfused hepatic segments. Furthermore, hepatic perfusion was assessed by digital subtraction angiography (DSA) on the day of radioembolization. In 16 / 27 patients (59 %) a perfusion of the occluded liver segment was visible on the SPECT/CT scan. In 8 / 11 patients without flow redistribution at the time of the SPECT/CT, perfusion of the occluded segment through hepatic collaterals was observed during angiography prior to radioembolization. Hence, flow redistribution was eventually found in 24 / 27 patients (89 %). Flow redistribution after the occlusion of intrahepatic arteries prior to radioembolization can be successfully induced in the majority of patients with anatomical variants of the hepatic arteries. (orig.)

  19. Bone x-ray

    Science.gov (United States)

    ... or broken bone Bone tumors Degenerative bone conditions Osteomyelitis (inflammation of the bone caused by an infection) ... Multiple myeloma Osgood-Schlatter disease Osteogenesis imperfecta Osteomalacia Osteomyelitis Paget disease of the bone Rickets X-ray ...

  20. Fishing amplifies forage fish population collapses.

    Science.gov (United States)

    Essington, Timothy E; Moriarty, Pamela E; Froehlich, Halley E; Hodgson, Emma E; Koehn, Laura E; Oken, Kiva L; Siple, Margaret C; Stawitz, Christine C

    2015-05-26

    Forage fish support the largest fisheries in the world but also play key roles in marine food webs by transferring energy from plankton to upper trophic-level predators, such as large fish, seabirds, and marine mammals. Fishing can, thereby, have far reaching consequences on marine food webs unless safeguards are in place to avoid depleting forage fish to dangerously low levels, where dependent predators are most vulnerable. However, disentangling the contributions of fishing vs. natural processes on population dynamics has been difficult because of the sensitivity of these stocks to environmental conditions. Here, we overcome this difficulty by collating population time series for forage fish populations that account for nearly two-thirds of global catch of forage fish to identify the fingerprint of fisheries on their population dynamics. Forage fish population collapses shared a set of common and unique characteristics: high fishing pressure for several years before collapse, a sharp drop in natural population productivity, and a lagged response to reduce fishing pressure. Lagged response to natural productivity declines can sharply amplify the magnitude of naturally occurring population fluctuations. Finally, we show that the magnitude and frequency of collapses are greater than expected from natural productivity characteristics and therefore, likely attributed to fishing. The durations of collapses, however, were not different from those expected based on natural productivity shifts. A risk-based management scheme that reduces fishing when populations become scarce would protect forage fish and their predators from collapse with little effect on long-term average catches.

  1. Sport Fishing Regulations

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The regulations for sport fishing on St. Vincent National Wildlife Refuge are outlined in this document. Fishing is only permitted from sunrise to sunset, and only...

  2. Fish Springs pond snail

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Communication scenario between the branch of Listing and Recovery, Fish and Wildlife Enhancement, and Fish Springs National Wildlife Refuge (NWR), in regards to the...

  3. Fish tapeworm infection

    Science.gov (United States)

    Fish tapeworm infection is an intestinal infection with the tapeworm parasite found in fish. ... The fish tapeworm ( Diphyllobothrium latum ) is the largest parasite that infects humans. Humans become infected when they eat raw ...

  4. Got a Sick Fish?

    Science.gov (United States)

    ... Welfare Veterinary Careers Public Health Got a sick fish? Fish with disease can show a variety of signs. If you notice your pet fish having any unusual disease signs, contact your veterinarian ...

  5. Radio-opacity of commonly consumed bony fish in kelantan, malaysia.

    Science.gov (United States)

    Irfan, M; Ahmad Helmy, A K; Wan Shah Jihan, W D

    2012-10-01

    Fish is one of the major sources of protein among Malaysians. This has made incidents of fish bones lodged in the throat fairly common clinical problems. Plain radiograph, which is the first line of imaging in such cases, has been reported to have low sensitivity. Besides the location, the degree of radio-opacity of the bone is another important factor and is species dependent. This study was undertaken to determine the radio-opacity of bones from commonly consumed fish in Malaysia. A total of 15 types of fish were identified, six of them were opaque even when embedded and three were visualized in the simulated airway. In terms of radio-opacity, the commonly consumed fish in Malaysia possessed opaque bones and this fact can help doctors identify the location of the foreign body in the throat.

  6. NR1H4 analysis in patients with progressive familial intrahepatic cholestasis, drug-induced cholestasis or intrahepatic cholestasis of pregnancy unrelated to ATP8B1, ABCB11 and ABCB4 mutations.

    Science.gov (United States)

    Davit-Spraul, Anne; Gonzales, Emmanuel; Jacquemin, Emmanuel

    2012-12-01

    Farnesoid X receptor (FXR, NR1H4) controls bile acid homeostasis. NR1H4 variants may predispose to intrahepatic cholestasis of pregnancy (ICP). We report on NR1H4 analysis in eight patients with progressive familial intrahepatic cholestasis (PFIC) and in eight women with either ICP and/or drug-induced cholestasis (DIC) in whom no disease causing mutation in ATP8B1, ABCB11 and/or ABCB4 were found. No NR1H4 mutation was found in PFIC patients. In one woman with ICP/DIC, a NR1H4 heterozygous variant (c.-1G>T) was found. This suggests that a NR1H4 mutation is not or rarely involved in hepatocellular cholestasis of unknown cause. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  7. Fish mycobacteriosis (Tuberculosis)

    Science.gov (United States)

    Parisot, T.J.; Wood, J.W.

    1959-01-01

    The etiologic agent for the bacterial disease, "fish tuberculosis" (more correctly "mycobacteriosis"), was first observed in carp in 189& from a pond in France. Subsequently similar agents have been isolated from or observed in fish in fresh water, salt water, and brackish water, in fish in aquaria, hatcheries, and natural habitat~ (wild populations of fish). The disease has been recognized as an important infection among hatchery reared salmonid fishes on the West Coast of the United States, and in aquarium fishes such as the neon tetra, the Siamese fighting fish, and in salt water fish held in zoological displays.

  8. No Fishing Now,More Fish Later

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Fishing ban for ecological purposes starts on the Pearl River Since April1,a two-month ban on fishing has been imposed on the Pearl River valley in south China.It is the first fishing ban in this area with the purpose of preserving biodiversity in China’s third longest

  9. Microbiological spoilage of fish and fish products

    DEFF Research Database (Denmark)

    Gram, Lone; Huss, Hans Henrik

    1996-01-01

    Spoilage of fresh and lightly preserved fish products is caused by microbial action. This paper reviews the current knowledge in terms of the microbiology of fish and fish products with particular emphasis on identification of specific spoilage bacteria and the qualitative and quantitative...

  10. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  11. Bone graft

    Science.gov (United States)

    ... around the area. The bone graft can be held in place with pins, plates, or screws. Why ... Orthopaedic Surgery, San Francosco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  12. Low Bone Density

    Science.gov (United States)

    ... Information › Bone Density Exam/Testing › Low Bone Density Low Bone Density Low bone density is when your ... compared to people with normal bone density. Detecting Low Bone Density A bone density test will determine ...

  13. Plastic fish

    CERN Multimedia

    Antonella Del Rosso

    2015-01-01

    In terms of weight, the plastic pollution in the world’s oceans is estimated to be around 300,000 tonnes. This plastic comes from both land-based and ocean-based sources. A lecture at CERN by chemist Wolfgang Trettnak addressed this issue and highlighted the role of art in raising people’s awareness.   Artwork by Wolfgang Trettnak. Packaging materials, consumer goods (shoes, kids’ toys, etc.), leftovers from fishing and aquaculture activities… our oceans and beaches are full of plastic litter. Most of the debris from beaches is plastic bottles. “PET bottles have high durability and stability,” explains Wolfgang Trettnak, a chemist by education and artist from Austria, who gave a lecture on this topic organised by the Staff Association at CERN on 26 May. “PET degrades very slowly and the estimated lifetime of a bottle is 450 years.” In addition to the beach litter accumulated from human use, rivers bring several ki...

  14. Platynosomum fastosum-induced chronic intrahepatic cholangitis and Spirometra spp. infections in feral cats from Grand Cayman.

    Science.gov (United States)

    Headley, S A; Gillen, M A; Sanches, A W D; Satti, M Z

    2012-06-01

    The occurrence of platynosomiasis and intestinal sparganosis is described in feral cats from Grand Cayman, Cayman Islands. Spirometra spp. was observed within the intestine of 18.18% (10/55) of cats; 1.18% (1/55) of cats demonstrated gross and histological manifestation of parasitism by Platynosomum fastosum, but 14.5% (8/55) of cats had the characteristic pathological manifestations of P. fastosum-induced intrahepatic cholangitis without the concomitant presence of the intraductal trematode. Combined parasitism (Spirometra spp. and P. fastosum) was observed in 9.09% (5/55) of feral cats. Significant pathological findings were only associated with the hepatic fluke, P. fastosum, and were grossly characterized by moderate hepatomegaly with enlarged and dilated bile ducts. Examples of cestodes with morphological features characteristic of Spirometra spp. were observed within the small intestine without any associated pathological lesion. The histopathological evaluation of liver fragments revealed chronic intrahepatic cholangitis with and without the associated intraductal trematode, and was characterized by marked periductal fibrosis, adenomatous proliferation of bile duct epithelium, dilation of intrahepatic bile ducts and portal accumulations of inflammatory cells. The occurrence of the cestode in feral cats coupled with factors that are unique to Grand Cayman makes this island the ideal location for sporadic cases of human sparganosis.

  15. The relationship between the internal oxidation-reduction system and fetal distress on pregnant patients with intrahepatic cholestasis.

    Science.gov (United States)

    Zhou, B; Wang, C-H; Ding, R-B; Chen, J-G; Che, Y-H; Deng, Y-X

    2015-10-01

    To discuss the relationship between the internal oxidation-reduction system and fetal distress in pregnant patients with intrahepatic cholestasis in order to provide a new basis for clinical treatment and research. From March 2012 to March 2015, eighty patients with intrahepatic cholestasis of pregnancy (ICP) were selected and divided into two groups: the distressed group (n = 31) and non-distressed group (n = 49). We compared the two groups for differences in MDA, SOD, NO level, GSH level, venous blood and total bile acid level. The relevance of the oxidation-reduction system indicators and the venous blood and total bile acid levels, as well as the differences in the delivery outcome and fetal distress, were compared between the two groups. The serum MDA level of the distressed group was higher than the non-distressed group while the SOD, NO, and GSH levels were lower than the non-distressed group. All differences were statistically significant (p intrahepatic cholestasis, which are MDA, SOD, NO and GSH levels, may contribute to the occurrence of fetal distress.

  16. Accuracy analysis of intrahepatic fat density measurements using dual-energy computed tomography: Validation using a test phantom.

    Science.gov (United States)

    Arai, Tomohiro; Misawa, Masaki; Arai, Miki; Shinozaki, Masafumi; Sakamoto, Kayo; Yajima, Yoshinobu; Nozaki, Yuichi; Tajima, Tsuyoshi; Sato, Masanori; Hinoshita, Fumihiko

    2017-01-01

    Currently, no standardized method for measuring intrahepatic fat density via conventional computed tomography (CT) exists. We aim to quantify intrahepatic fat density via material decomposition analysis using rapid kilovolt peak-switching dual-energy (RSDE) CT. Homogenized porcine liver and fat (lard) were mixed in various ratios to produce phantoms for fat density verification. The actual fat density was measured on the basis of the phantom volume and weight, and these measurements were used as reference densities. The fat and liver mass attenuation coefficients, which were used as the material basis pairs, were employed in the material decomposition analysis. Then, the measured fat density of each phantom was compared with the reference densities. For fat content differences exceeding 2%, the measured fat density for the phantoms became statistically significant (p densities and RSDE-measured fat densities was reasonably high (R > 0.9997); this indicates the validity of this analysis method. Intrahepatic fat density can be measured using the mass attenuation coefficients of fat and liver in a material decomposition analysis. Given the knowledge of the accuracy and the limitations found in this study, our method can quantitatively evaluate fat density.

  17. Intrahepatic infiltrating NK and CD8 T cells cause liver cell death in different phases of dengue virus infection.

    Science.gov (United States)

    Sung, Jui-Min; Lee, Chien-Kuo; Wu-Hsieh, Betty A

    2012-01-01

    Elevated liver enzyme level is an outstanding feature in patients with dengue. However, the pathogenic mechanism of liver injury has not been clearly demonstrated. In this study, employing a mouse model we aimed to investigate the immunopathogenic mechanism of dengue liver injury. Immunocompetent C57BL/6 mice were infected intravenously with dengue virus strain 16681. Infected mice had transient viremia, detectable viral capsid gene and cleaved caspase 3 in the liver. In the mean time, NK cell and T cell infiltrations peaked at days 1 and 5, respectively. Neutralizing CXCL10 or depletion of Asialo GM1(+) cells reduced cleaved caspase 3 and TUNEL(+) cells in the liver at day 1 after infection. CD8(+) T cells infiltrated into the liver at later time point and at which time intrahepatic leukocytes (IHL) exhibited cytotoxicity against DENV-infected targets. Cleaved caspase 3 and TUNEL(+) cells were diminished in mice with TCRβ deficiency and in those depleted of CD8(+) T cells, respectively, at day 5 after infection. Moreover, intrahepatic CD8(+) T cells were like their splenic counterparts recognized DENV NS4B(99-107) peptide. Together, these results show that infiltrating NK and CD8(+) T cells cause liver cell death. While NK cells were responsible for cell death at early time point of infection, CD8(+) T cells were for later. CD8(+) T cells that recognize NS4B(99-107) constitute at least one of the major intrahepatic cytotoxic CD8(+) T cell populations.

  18. Intrahepatic infiltrating NK and CD8 T cells cause liver cell death in different phases of dengue virus infection.

    Directory of Open Access Journals (Sweden)

    Jui-Min Sung

    Full Text Available Elevated liver enzyme level is an outstanding feature in patients with dengue. However, the pathogenic mechanism of liver injury has not been clearly demonstrated. In this study, employing a mouse model we aimed to investigate the immunopathogenic mechanism of dengue liver injury. Immunocompetent C57BL/6 mice were infected intravenously with dengue virus strain 16681. Infected mice had transient viremia, detectable viral capsid gene and cleaved caspase 3 in the liver. In the mean time, NK cell and T cell infiltrations peaked at days 1 and 5, respectively. Neutralizing CXCL10 or depletion of Asialo GM1(+ cells reduced cleaved caspase 3 and TUNEL(+ cells in the liver at day 1 after infection. CD8(+ T cells infiltrated into the liver at later time point and at which time intrahepatic leukocytes (IHL exhibited cytotoxicity against DENV-infected targets. Cleaved caspase 3 and TUNEL(+ cells were diminished in mice with TCRβ deficiency and in those depleted of CD8(+ T cells, respectively, at day 5 after infection. Moreover, intrahepatic CD8(+ T cells were like their splenic counterparts recognized DENV NS4B(99-107 peptide. Together, these results show that infiltrating NK and CD8(+ T cells cause liver cell death. While NK cells were responsible for cell death at early time point of infection, CD8(+ T cells were for later. CD8(+ T cells that recognize NS4B(99-107 constitute at least one of the major intrahepatic cytotoxic CD8(+ T cell populations.

  19. Intrahepatic cholangiocarcinoma in a worker at an offset color proof-printing company: An autopsy case report.

    Science.gov (United States)

    Tomimaru, Yoshito; Kobayashi, Shogo; Wada, Hiroshi; Hama, Naoki; Kawamoto, Koichi; Eguchi, Hidetoshi; Kira, Toshihiko; Morii, Eiichi; Doki, Yuichiro; Mori, Masaki; Nagano, Hiroaki

    2015-04-01

    A 40-year-old Japanese man visited our hospital after test results indicated elevated hepatobiliary enzymes. He had worked at a printing plant for 8 years and been exposed to organic solvents, including 1,2-dichloropropane (1,2-DCP) and dichloromethane (DCM). Abdominal computed tomography (CT) showed an intrahepatic tumor with dilation of the intrahepatic bile duct. He was diagnosed with intrahepatic cholangiocarcinoma. He had no known risk factors for cholangiocarcinoma. Extended left hepatectomy with lymph node dissection was performed and the tumor was histologically diagnosed as well-differentiated adenocarcinoma. A histological examination also showed biliary intraepithelial preneoplastic lesions in non-cancerous liver areas. Two years after surgery, the patient developed jaundice, esophageal varices and ascites. A CT examination showed liver cirrhosis without recurrence of the cholangiocarcinoma. Although a liver transplantation was planned as a therapeutic option for his liver cirrhosis, his liver failure progressed rapidly and he died before transplantation could be performed. At autopsy, fibrosis was found in the whole liver, especially in the wall of the bile duct and periductal area suggesting chronic bile duct injury due to exposure to organic solvents. Taken together, the current case may suggest that exposure to organic solvents, including 1,2-DCP and DCM, is a risk factor for cholangiocarcinoma. Identifying risk factors for cholangiocarcinoma will help identify the mechanism and help prevent development of the disease.

  20. A small solitary non-parasitic hepatic cyst causing an intra-hepatic bile duct stricture: a case report

    Directory of Open Access Journals (Sweden)

    Hong Taeho

    2010-08-01

    Full Text Available Abstract Introduction We report an unusual presentation of a small hepatic cyst causing cholangitis. Case presentation A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct. Conclusion A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.

  1. Bone marrow transplant

    Science.gov (United States)

    Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical ...

  2. Three Kinds of Fish

    DEFF Research Database (Denmark)

    Høst, Jeppe Engset

    2012-01-01

    There are three kinds of fish. Fish you were given, fish you bought and fish you lease. This might sound a bit odd, but it is nevertheless the basis for the activities of Danish commercial fishers since the introduction of transferable fishing concessions (TFCs) in 2007. In the current 2012 reform...... of market based systems are wild speculation, concentration and monopolization of fishing access and subsequent leasing with fishing communities and new entrants very likely being worse off (see for example the chapter “From fishing rights to financial derivatives” is this volume or Olson 2011; Sumaila 2010...... will examine five Danish fishing operations and discuss how they have reacted in different ways to the newly introduced system of transferable fishing concessions. By introducing TFCs as a solution to fleet overcapacity, the EU Commission will also be introducing a system where buying, selling and leasing...

  3. Effects of various feed supplements containing fish protein hydrolysate or fish processing by-products on the innate immune functions of juvenile coho salmon (oncorhynchus kisutch)

    Science.gov (United States)

    Murray, A.L.; Pascho, R.J.; Alcorn, S.W.; Fairgrieve, W.T.; Shearer, K.D.; Roley, D.

    2003-01-01

    Immunomodulators administered to fish in the diet have been shown in some cases to enhance innate immune defense mechanisms. Recent studies have suggested that polypeptide fractions found in fish protein hydrolysates may stimulate factors in fish important for disease resistance. For the current study, groups of coho salmon were reared on practical feeds that contained either fish meal (Control diet), fish meal supplemented with cooked fish by-products, or fish meal supplemented with hydrolyzed fish protein alone, or with hydrolyzed fish protein and processed fish bones. For each diet group, three replicate tanks of fish were fed the experimental diets for 6 weeks. Morphometric measurements, and serologic and cellular assays were used to evaluate the general health and immunocompetence of fish in the various feed groups. Whereas the experimental diets had no effect on the morphometric and cellular measurements, fish fed cooked by-products had increased leucocrit levels and lower hematocrit levels than fish from the other feed groups. Innate cellular responses were increased in all feed groups after feeding the four experimental diets compared with pre-feed results. Subgroups of fish from each diet group were also challenged with Vibrio anguillarum (ca. 7.71 ?? 105 bacteria ml-1) at 15??C by immersion. No differences were found in survival among the various feed groups.

  4. Portal flow and arterioportal shunting after transjugular intrahepatic portosystemic shunt creation.

    Science.gov (United States)

    Itkin, Maxim; Trerotola, Scott O; Stavropoulos, S William; Patel, Aalpen; Mondschein, Jeffrey I; Soulen, Michael C; Tuite, Catherine M; Shlansky-Goldberg, Richard D; Faust, Thomas W; Reddy, K Rajender; Solomon, Jeffrey A; Clark, Timothy W I

    2006-01-01

    It was postulated that a transjugular intrahepatic portosystemic shunt (TIPS) produces arterioportal shunting and accounts for reversed flow in the intrahepatic portal veins (PVs) after creation of the TIPS. This study sought to quantify this shunting in patients undergoing TIPS creation and/or revision with use of a direct catheter-based technique and by measuring changes in blood oxygenation within the TIPS and the PV. This prospective study consisted of 26 patients. Median Model for End-stage Liver Disease and Child-Pugh scores were 13 and 9, respectively. Primary TIPS creation was attempted in 21 patients and revision of failing TIPS was undertaken in five. In two patients, TIPS creation was unsuccessful. All TIPS creation procedures but one were performed with use of polytetrafluoroethylene-covered stent-grafts. Flow within the main PV (Q(portal)) was measured with use of a retrograde thermodilutional catheter before and after TIPS creation/revision, and TIPS flow (Q(TIPS)) was measured at procedure completion. The amount of arterioportal shunting was assumed to be the increase between final Q(portal) and Q(TIPS), assuming Q(TIPS) was equivalent to the final Q(portal) plus the reversed flow in the right and left PVs. Oxygen saturation within the TIPS and the PV was determined from samples obtained during TIPS creation and revision. Mean Q(portal) before TIPS creation was 691 mL/min; mean Q(portal) after TIPS creation was 1,136 mL/min, representing a 64% increase (P = .049). Mean Q(TIPS) was 1,631 mL/min, a 44% increase from final Q(portal) (P = .0009). Among cases of revision, baseline Q(portal) was 1,010 mL/min and mean Q(portal) after TIPS revision was 1,415 mL/min, a 40% increase. Mean Q(TIPS) was 1,693 mL/min, a 20% increase from final Q(portal) (P = .42). Arterioportal shunting rates were 494 mL/min after TIPS creation and 277 mL/min after TIPS revision, representing 30% of total Q(TIPS) after TIPS creation and 16% of Q(TIPS) after TIPS revision. No

  5. 3-dimensional resin casting and imaging of mouse portal vein or intrahepatic bile duct system.

    Science.gov (United States)

    Walter, Teagan J; Sparks, Erin E; Huppert, Stacey S

    2012-10-25

    In organs, the correct architecture of vascular and ductal structures is indispensable for proper physiological function, and the formation and maintenance of these structures is a highly regulated process. The analysis of these complex, 3-dimensional structures has greatly depended on either 2-dimensional examination in section or on dye injection studies. These techniques, however, are not able to provide a complete and quantifiable representation of the ductal or vascular structures they are intended to elucidate. Alternatively, the nature of 3-dimensional plastic resin casts generates a permanent snapshot of the system and is a novel and widely useful technique for visualizing and quantifying 3-dimensional structures and networks. A crucial advantage of the resin casting system is the ability to determine the intact and connected, or communicating, structure of a blood vessel or duct. The structure of vascular and ductal networks are crucial for organ function, and this technique has the potential to aid study of vascular and ductal networks in several ways. Resin casting may be used to analyze normal morphology and functional architecture of a luminal structure, identify developmental morphogenetic changes, and uncover morphological differences in tissue architecture between normal and disease states. Previous work has utilized resin casting to study, for example, architectural and functional defects within the mouse intrahepatic bile duct system that were not reflected in 2-dimensional analysis of the structure(1,2), alterations in brain vasculature of a Alzheimer's disease mouse model(3), portal vein abnormalities in portal hypertensive and cirrhotic mice(4), developmental steps in rat lymphatic maturation between immature and adult lungs(5), immediate microvascular changes in the rat liver, pancreas, and kidney in response in to chemical injury(6). Here we present a method of generating a 3-dimensional resin cast of a mouse vascular or ductal network

  6. Efficacy comparison of precise and traditional liver resection in treatment of intrahepatic bile duct stones

    Directory of Open Access Journals (Sweden)

    ZHANG Shengjun

    2015-10-01

    Full Text Available ObjectiveTo compare the efficacy of precise and traditional liver resection in the treatment of intrahepatic bile duct stones. MethodsOne hundred and twenty-seven patients with intrahepatic bile duct stones who were treated with surgery in our hospital from December 2008 to December 2014 were selected and divided into precise liver resection group (n=72 and traditional liver resection group (n=55 based on the type of surgery. The operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, postoperative complications (incision infection, biliary fistula, lung infection, and pleural effusion, hospitalization cost, postoperative residual calculi, and postoperative calculus recurrence were compared between the two groups. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. Survival data were analyzed using survival function. ResultsThere were significant differences in operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, and hospitalization cost between the precise liver resection group and the traditional liver resection group (t=3.720, 58.681, 19.169, 5.990, and 6.944; all P<0.05. There were no significant differences in postoperative complications including incision infection, biliary fistula, lung infection, and pleural effusion between the two groups (all P>0.05. There were also no significant differences in the incidence rates of postoperative residual calculi and calculus recurrence between the two groups (all P>0.05. The survival analysis of postoperative calculus recurrence time showed that there was no significant difference in calculus recurrence time between the two groups (P>0.05. ConclusionCompared with traditional liver resection, precise liver resection has the advantages of shorter operation time, less intraoperative bleeding, less

  7. Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Yang GW

    2015-05-01

    Full Text Available Guo-Wei Yang,* Qing Zhao,* Sheng Qian, Liang Zhu, Xu-Dong Qu, Wei Zhang, Zhi-Ping Yan, Jie-Min Cheng, Qing-Xin Liu, Rong Liu, Jian-Hua Wang Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China *These authors contributed equally to this work Aim: To retrospectively evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA combined with simultaneous transarterial chemoembolization (TACE in the treatment of patients with advanced intrahepatic cholangiocarcinoma (ICC.Methods: All patients treated with ultrasound-guided percutaneous MWA combined with simultaneous TACE for advanced ICC at our institution were included. Posttreatment contrast-enhanced computed tomography and/or magnetic resonance imaging were retrieved and reviewed for tumor response to the treatment. Routine laboratory studies, including hematology and liver function tests were collected and analyzed. Procedure-related complications were reviewed and survival rates were analyzed.Results: From January 2011 to December 2014, a total of 26 advanced ICC patients were treated at our single institute with ultrasound-guided percutaneous MWA combined with simultaneous TACE. There were 15 males and eleven females with an average age of 57.9±10.4 years (range, 43–75 years. Of 26 patients, 20 (76.9% patients were newly diagnosed advanced ICC without any treatment, and six (23.1% were recurrent and treated with surgical resection of the original tumor. The complete ablation rate was 92.3% (36/39 lesions for advanced ICC. There were no major complications observed. There was no death directly from the treatment. Median progression-free survival and overall survival were 6.2 and 19.5 months, respectively. The 6-, 12-, and 24-month survival rates were 88.5%, 69.2%, and 61.5%, respectively.Conclusion: The study suggests that ultrasound-guided percutaneous MWA combined with simultaneous TACE

  8. Bone development

    DEFF Research Database (Denmark)

    Tatara, M.R.; Tygesen, Malin Plumhoff; Sawa-Wojtanowicz, B.

    2007-01-01

    The objective of this study was to determine the long-term effect of alpha-ketoglutarate (AKG) administration during early neonatal life on skeletal development and function, with emphasis on bone exposed to regular stress and used to serve for systemic changes monitoring, the rib. Shropshire ram...... the groups were recorded int erms of: (1) growth rate, (2) body weight at days 14, 28 and 130 of age or (3) final body weight. The weight and length of ribs were, however, significantly increased in the lambs given AKG for the first 14 days of neonatal life by 8.2% and 3.2%, respectively (P....01). Furthermore, AKG administration induced significantly higher bone mineral density of the cortical bone by 7.1% (P

  9. [Bone transplant].

    Science.gov (United States)

    San Julián, M; Valentí, A

    2006-01-01

    We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.

  10. Bone mineral content and bone metabolism in young adults with severe periodontitis

    DEFF Research Database (Denmark)

    Wowern von, N.; Westergaard, J.; Kollerup, G.

    2001-01-01

    Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis......Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis...

  11. Bone lesion biopsy

    Science.gov (United States)

    Bone biopsy; Biopsy - bone ... needle is gently pushed and twisted into the bone. Once the sample is obtained, the needle is ... sample is sent to a lab for examination. Bone biopsy may also be done under general anesthesia ...

  12. Facts about Broken Bones

    Science.gov (United States)

    ... Room? What Happens in the Operating Room? Broken Bones KidsHealth > For Kids > Broken Bones Print A A ... sticking through the skin . What Happens When a Bone Breaks? It hurts to break a bone! It's ...

  13. Calcium and bones

    Science.gov (United States)

    Bone strength and calcium ... calcium (as well as phosphorus) to make healthy bones. Bones are the main storage site of calcium in ... your body does not absorb enough calcium, your bones can get weak or will not grow properly. ...

  14. Broken Bones (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Broken Bones KidsHealth > For Parents > Broken Bones Print A A ... bone fragments in place. When Will a Broken Bone Heal? Fractures heal at different rates, depending upon ...

  15. Bone biopsy (image)

    Science.gov (United States)

    A bone biopsy is performed by making a small incision into the skin. A biopsy needle retrieves a sample of bone and it ... examination. The most common reasons for bone lesion biopsy are to distinguish between benign and malignant bone ...

  16. Hepatic and splanchnic perfusion and oxygenation after transjugular intrahepatic portosystemic shunt.

    Science.gov (United States)

    Cervera, M; Añón, R; Palmero, J; Martínez, J; Garcés, R; Ripollés, T; Moreno-Osset, E; Alamán, G; Antón, M

    2000-04-01

    in patients with cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) decreases the pressure in the portal vein by rerouting nearly all the portal blood flow to the systemic circulation. This may lead to hypoperfusion of the liver and worsening function. Our aim was to investigate whether TIPS actually reduced hepatic and splanchnic perfusion. we studied 25 patients who required placement of a TIPS (20 for variceal bleeding and 5 for refractory ascites). We evaluated the clinical condition, laboratory results, blood velocity in the portal vein and hepatic artery by echo-Doppler ultrasonography, systemic hemodynamic-oxygenation status and hemodynamic-oxygenation status in the portal and suprahepatic veins before TIPS, 15 min after the procedure, and 30 days later. Hepatic and splanchnic perfusion were evaluated as the arteriovenous difference in O2 content and as the O2 extraction rates in the hepatic and splanchnic territories. TIPS induced an immediate decrease in portal pressure, a significant increase in systemic hyperdynamic state, and an increase in blood flow velocity in the portal vein and hepatic artery. Thirty days after the procedure these changes persisted, although they were somewhat attenuated. Although splanchnic and liver perfusion were not changed 15 min or 30 days after TIPS, there was a slight tendency toward a decrease in liver perfusion during follow-up. TIPS increased the hyperdynamic state in the systemic side. However, portal blood shunting did not change liver or splanchnic perfusion.

  17. Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

    Institute of Scientific and Technical Information of China (English)

    Min Joung Kim; Byoung Kuk Jang; Woo Jin Chung; Jae Seok Hwang; Young Hwan Kim

    2012-01-01

    We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO),which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS).A 57-year-old man was admitted to the emergency room suffering from melena.He had undergone BRTO to treat gastric varix bleeding 5 mo before admission.Endoscopy and a computed tomography (cr) scan showed complete obliteration of the gastric varix,but the nodular varices in the second portion of the duodenum expanded after BRTO,and spurting blood was seen.TIPS was performed for treatment of duodenal variceal bleeding,because attempts at endoscopic varix ligation were unsuccessful.The postoperative course was uneventful and the patient was discharged without complications.A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices,but multinodular hepatocellular carcinoma had developed.He died of hepatic failure 28 mo after TIPS.

  18. Predictors of premature delivery in patients with intrahepatic cholestasis of pregnancy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the predictive value of clinical symptoms and biochemical parameters for prematurity in intrahepatic cholestasis of pregnancy (ICP).METHODS: Sixty symptomatic patients with ICP were included in this retrospective analysis. Preterm delivery was defined as delivery before 37 wk gestation.Predictors of preterm delivery were disclosed by binary multivariate logistic regression analysis.RESULTS: Mean time of delivery was 38.1 ± 1.7 wk.No stillbirths occurred. Premature delivery was observed in eight (13.3%) patients. Total fasting serum bile acids were higher (47.8 ± 15.2 vs 41.0 ± 10.0 μmol/L, P <0.05), and pruritus tended to start earlier (29.0 ± 3.9 vs 31.6 ± 3.3 wk, P = 0.057) in patients with premature delivery when compared to those with term delivery.Binary multivariate logistic regression analysis revealed that early onset of pruritus (OR 1.70, 95% CI 1.23-2.95,P = 0.038) and serum bile acid (OR 2.13, 95% CI 1.13-3.25, P = 0.013) were independent predictors of preterm delivery.CONCLUSION: Early onset of pruritus and high levels of serum bile acids predict preterm delivery in ICP, and define a subgroup of patients at risk for poor neonatal outcome.

  19. Effect of Intrahepatic Cholestasis of Pregnancy on Cytokines, Hemorheology and Coagulation Function of Pregnant Women

    Institute of Scientific and Technical Information of China (English)

    YU Cui-ge; LI Lian-xiang; LIU Xiao-qin; SHI Jian-yong

    2015-01-01

    Objective:To explore the effect of intrahepatic cholestasis of pregnancy (ICP) on the cytokines, hemorheology and coagulation function of pregnant women. Methods: A total of 43 singleton pregnant women with ICP delivered in Shaanxi Provincial People’s Hospital from June 2014 to June 2015 were selected as observation group, and 45 singleton healthy pregnant women accompanied by indications of cesarean section were selected as control group. Automatic Viscometer was used to detect the hematological indexes, Automatic Coagulometer to detect the indexes related to coagulation function and radioimmunoassay to determine the levels of cell inflammatory factors, and the pregnancy outcomes were closely observed. Results:The levels of interleukin-12 (IL-12), interleukin-18 (IL-18), tumor necrosis factor-α (TNF-α), high and low shear rates of whole blood viscosity, hematokrit, plasma viscosity and erythrocyte sedimentation rate (ESR) in observation group were all dramatically higher than those in control group, and all the differences were statistically signiifcant (P0.05). When compared with control group, the levels of D-dimer (D-D) and fibrinogen (FIB) in observation group increased dramatically (P0.05). Conclusion: Both the hemorheology and coagulation function of pregnant women with ICP manifest signiifcantly high viscosity and hypercoagulability, and the release of cell inlfammatory factors increases, which all exert adverse inlfuence on pregnancy outcome.

  20. Hepatitis viruses infection and risk of intrahepatic cholangiocarcinoma: evidence from a meta-analysis

    Directory of Open Access Journals (Sweden)

    Zhou Yanming

    2012-07-01

    Full Text Available Abstract Background Studies investigating the association between Hepatitis B virus (HBV and hepatitis C virus (HCV infections and intrahepatic cholangiocarcinoma (ICC have reported inconsistent findings. We conducted a meta-analysis of epidemiological studies to explore this relationship. Methods A comprehensive search was conducted to identify the eligible studies of hepatitis infections and ICC risk up to September 2011. Summary odds ratios (OR with their 95% confidence intervals (95% CI were calculated with random-effects models using Review Manager version 5.0. Results Thirteen case–control studies and 3 cohort studies were included in the final analysis. The combined risk estimate of all studies showed statistically significant increased risk of ICC incidence with HBV and HCV infection (OR = 3.17, 95% CI, 1.88-5.34, and OR = 3.42, 95% CI, 1.96-5.99, respectively. For case–control studies alone, the combined OR of infection with HBV and HCV were 2.86 (95% CI, 1.60-5.11 and 3.63 (95% CI, 1.86-7.05, respectively, and for cohort studies alone, the OR of HBV and HCV infection were 5.39 (95% CI, 2.34-12.44 and 2.60 (95% CI, 1.36-4.97, respectively. Conclusions This study suggests that both HBV and HCV infection are associated with an increased risk of ICC.

  1. Risk factors for intrahepatic cholangiocarcinoma: A case- control study in China

    Institute of Scientific and Technical Information of China (English)

    Yan-Ming Zhou; Zheng-Feng Yin; Jia-Mei Yang; Bin Li; Wen-Yu Shao; Feng Xu; Yu-Lan Wang; Dian-Qi Li

    2008-01-01

    AIM: To carry out a hospital-based case-control study to investigate risk factors for intrahepatic cholangiocarcinoma (ICC) in China.METHODS: A total of 312 ICC cases and 438 matched controls were included in the study. The presence of diabetes mellitus, hypertention, hepatolithiasis, primary sclerosing cholangitis, liver fluke infection (Clonorchis sinensis), was investigated through clinical records. Blood from all participants was tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using conditional logistic regression.RESULTS: Compared with controls, ICC patients had a higher prevalence of HBsAg seropositivity (48.4% vs 9.6%, P < 0.000), and hepatolithiasis (5.4% vs 1.1%, P = 0.001). By multivariate analysis, the significant risk factors for development of ICC were HBsAg seropositivity (adjusted OR, 8.876, 95% CI, 5.973-13.192), and hepatolithiasis (adjusted OR, 5.765, 95% CI, 1.972-16.851). The prevalence of anti-HCV seropositivity, diabetes mellitus, hypertention, cigarette smoking, and alcohol consumption were not significantly different between cases and controls.CONCLUSION: These findings suggest that HBV infection and hepatolithiasis are strong risk factors for development of ICC in China.

  2. In Search of an Accurate Evaluation of Intrahepatic Cholestasis of Pregnancy

    Directory of Open Access Journals (Sweden)

    Manuela Martinefski

    2012-01-01

    Full Text Available Until now, biochemical parameter for diagnosis of intrahepatic cholestasis of pregnancy (ICP mostly used is the rise of total serum bile acids (TSBA above the upper normal limit of 11 μM. However, differential diagnosis is very difficult since overlapped values calculated on bile acids determinations, are observed in different conditions of pregnancy including the benign condition of pruritus gravidarum. The aim of this work was to determine the better markers in ICP for a precise diagnosis together with parameters associated with severity of symptoms and treatment evaluation. Serum bile acid profiles were evaluated using capillary electrophoresis in 38 healthy pregnant women and 32 ICP patients and it was calculated the sensitivity, specificity, accuracy, predictive values and the relationships of certain individual bile acids in pregnant women in order to replace TSBA determinations. The evaluation of the results shows that LCA and UDCA/LCA ratio provided information for a more complete and accurate diagnosis and evaluation of ICP than calculation of solely TSBA levels in pregnant women.

  3. Monitoring intrahepatic cholestasis of pregnancy using the fetal myocardial performance index: a cohort study.

    Science.gov (United States)

    Henry, A; Welsh, A W

    2015-11-01

    To investigate use of the fetal myocardial performance index (MPI) in assessing intrahepatic cholestasis of pregnancy (ICP). This was a cohort study including cross-sectional and longitudinal data from 31 women with ICP recruited from June 2012 to March 2014. Fetal left, right and delta MPI (LMPI, RMPI and DMPI), and routine measures of fetal growth and wellbeing, were obtained at each ultrasound examination. Results were evaluated with respect to gestational age (GA)-adjusted reference intervals, level of maternal serum bile acid (SBA) and fetal outcome. Lower SBA (≥ 7.5 and 2 SD above the GA-adjusted reference mean was not significantly greater than for the lower SBA group. On analysis of all data from those cases with more than one examination, no significant correlation was found between SBA concentration and any of the MPI variables. LMPI values increase above the population GA-adjusted mean in cases of ICP, particularly amongst women with higher SBA. A significant correlation between IRT and LMPI at initial examination and increasing SBA concentration was found. A future multicenter prospective study may clarify the prognostic utility of MPI in ICP. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  4. Placental ADAMTS-12 Levels in the Pathogenesis of Preeclampsia and Intrahepatic Cholestasis of Pregnancy.

    Science.gov (United States)

    Oztas, Efser; Ozler, Sibel; Ersoy, Ali O; Erkenekli, Kudret; Sucak, Ayhan; Ergin, Merve; Uygur, Dilek; Danisman, Nuri

    2016-04-01

    Our aim was to determine whether placental A Disintegrin-like Metalloproteinase with ThromboSpondin motif 12 (ADAMTS-12), arylesterase (ARES) levels, total oxidant status (TOS), and total antioxidant status (TAS) differ in preeclampsia, intrahepatic cholestasis of pregnancy (ICP), and uncomplicated pregnancies or not. A prospective case-control study was carried out including 84 pregnant women (26 with ICP, 28 preeclamptic patients, and 30 healthy controls). Levels of ADAMTS-12, TAS, TOS, and ARES were studied in the supernatants of placental tissue homogenates. Placental ADAMTS-12 levels were distributed as 240.9 pg/mg in ICP, 289.7 pg/mg in preeclampsia, and 310.8 pg/mg in control groups. Levels of ADAMTS-12 (odds ratio = 6.509, 95% confidence interval:1.070-39.592, P = .042) in the placenta of the ICP were significantly lower than those in preeclampsia and control groups (P = .004), but no statistical significant difference was determined between preeclampsia and control groups. Decreased levels of placental ADAMTS-12 were found to be associated with ICP, suggesting a possible role of inflammation in the pathogenesis. © The Author(s) 2015.

  5.  Efficacy and safety of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Parízek, Antonín; Simják, Patrik; Cerný, Andrej; Sestinová, Alena; Zdenková, Anna; Hill, Martin; Dusková, Michaela; Vlk, Radovan; Kokrdová, Zuzana; Koucký, Michal; Vítek, Libor

    2016-01-01

     Background and aims. Patients with intrahepatic cholestasis of pregnancy (ICP) benefit from ursodeoxycholic acid (UDCA) treatment. Since there is still certain reluctance to use UDCA in pregnant women, mainly due to warnings in the official SPC information in respective drug leaflets, our objective was to assess the efficacy and safety of UDCA during pregnancy. Our retrospective multicentric study was performed on 191 consecutive pregnant women with ICP treated with UDCA. Any maternal and/or fetal complications of the UDCA treatment were searched for; healthy pregnant women (n = 256) served as controls. The UDCA treatment improved liver disease status in the majority of the affected women (86.1%). This treatment was well tolerated, with only negligible skin reactions (0.5%) and mild diarrhea (4.7%). No complications attributable to UDCA treatment were detected during the fetal life, delivery, or the early neonatal period. We confirmed the good efficacy and safety of UDCA treatment in pregnancy for both mothers and fetuses/neonates.

  6. Oxidative stress markers in intrahepatic cholestasis of pregnancy: a prospective controlled study.

    Science.gov (United States)

    Hu, Y-Y; Liu, J-C; Xing, A-Y

    2015-09-01

    Intrahepatic cholestasis of pregnancy (ICP), characterized by skin pruritus and elevation of serum aminotransferase activity and bile acid concentration in the mother, is one of the most common liver disorders in pregnancy. It was proved that ICP might lead to fetal distress by triggering oxidative damage. Total bile acids (TBA) are an established marker for assessment of the severity of ICP. The aim of this study was to explore associations of TBA levels with levels of the oxidative stress markers 8-epimer of prostaglandin F2alpha (8-iso-PGF2α), superoxide dismutase (SOD) and glutathione peroxidase (Gpx) in ICP. Maternal plasma levels of 8-iso-PGF2α, SOD and Gpx were examined in ICP patients (n=40) and normal pregnancy controls (n=47) using an enzyme-linked immunosorbent assay (ELISA) analysis. Plasma levels of 8-iso-PGF2α and Gpx were significantly lower in ICP patients than in controls (p = 0.006 and 0.002, respectively), while no significant difference was observed in SOD levels between the two groups. Levels of 8-iso-PGF2α and TBA were negatively correlated (r = -0.277, p = 0.01, Spearman's correlation coefficient). The clinical severity of ICP is closely related to the degree of lipid peroxidation, and the natural antioxidant system might fail to work effectively in the presence of lipid peroxidation damage in ICP.

  7. Effect of intrahepatic cholestasis of pregnancy on maternal serum screening tests.

    Science.gov (United States)

    Türkmen, G G; Timur, H; Yilmaz, Z; Kirbas, A; Daglar, K; Tokmak, A; Uygur, D; Danişman, N

    2016-01-01

    In this study, we aimed to evaluate whether the changes in the first and second trimester maternal serum biochemical markers used for prenatal screening are associated with euploid pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). A total of 94 pregnant women were included in this retrospective comparative study. Thirty-seven women whose pregnancy was complicated with ICP constituted the study group whereas 57 of them constituted the control group. All hospital records were examined in terms of combined first trimester screening test and second trimester triple test parameters. Perinatal outcomes were also recorded. No significant difference was observed between the two groups in term of age, BMI, and obstetric history (all p > 0.05). Mean serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and serum bile acid concentrations in the study group were significantly higher than in the controls (p pregnancies complicated by ICP and healthy pregnancies in terms of first and second trimester maternal serum screening test results.

  8. Identification of Matrix Metalloproteinase-2 and 9 as Biomarker of Intrahepatic Cholestasis of Pregnancy.

    Science.gov (United States)

    Chen, Zhong; Shen, Zongji; Hu, Lingqing; Lu, Mudan; Feng, Yizhong

    2017-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a severe liver disease uniquely occurring during pregnancy. In this study we aimed to identify novel biomarker for the diagnosis of ICP in Chinese population. 50 healthy pregnant women, 50 mild ICP patients and 48 severe ICP patients were enrolled for this study. Liver function tests, including serum total bilirubin, direct bilirubin, alanine transaminase, aspartate aminotransferase and cholyglycine, were performed in all participants. After an overnight fast serum levels of total bile acids (TBA), matrix metalloproteinase (MMP)-2 and MMP-9 were measured, and their correlation with liver function tests were analyzed. The observed increase in serum TBA in ICP patients was not statistically significant which made it unreliable for diagnosis of ICP in Chinese population. On the other hand, both MMP-2 and MMP-9 serum levels exhibited a progressive and significant elevation in mild and severe ICP patients compared with healthy pregnant women, which also positively correlated with liver function tests. Serum levels of both MMP-2 and MMP-9 could be reliably used as laboratory abnormalities for accurate diagnosis and sensitive grading of ICP in Chinese population.

  9. The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes

    Directory of Open Access Journals (Sweden)

    Hu Y

    2014-05-01

    Full Text Available Yun Hu, Yi-Ling Ding, Ling Yu Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China Introduction: To investigate the impact of intrahepatic cholestasis of pregnancy (ICP with hepatitis B virus (HBV infection on perinatal outcomes. Methods: In the study, 200 pregnant women were divided into four groups, including 50 cases with ICP and HBV infection, 50 cases with ICP, 50 cases with HBV infection, and 50 healthy pregnancies. The delivery process and perinatal outcomes were analyzed among different groups. Results: When compared to the healthy pregnancy group, significantly increased rates of premature rupture of membranes, meconium-stained amniotic fluid, and cesarean section were observed in cases of ICP, HBV infection, or ICP patients with HBV (P<0.05. Specifically, the rates of HBV infection in the newborn, fetal distress, neonatal asphyxia, and birth defects in the newborn, and infant Apgar scores were higher in ICP pregnancies with HBV (56%, 48%, 16%, and 48%, respectively than in the other groups (P<0.05. Conclusion: ICP combined with HBV infection has a clear influence on perinatal infant outcomes. Keywords: premature rupture of membranes, meconium-stained amniotic fluid, cesarean section, fetal distress, neonatal asphyxia, birth defects, Apgar scores

  10. Intrahepatic cholestasis of pregnancy: maternal and fetal outcomes associated with elevated bile acid levels.

    Science.gov (United States)

    Brouwers, Laura; Koster, Maria P H; Page-Christiaens, Godelieve C M L; Kemperman, Hans; Boon, Janine; Evers, Inge M; Bogte, Auke; Oudijk, Martijn A

    2015-01-01

    The primary aim of this study was to investigate the correlation between pregnancy outcome and bile acid (BA) levels in pregnancies that were affected by intrahepatic cholestasis of pregnancy (ICP). In addition, correlations between maternal and fetal BA levels were explored. We conducted a retrospective study that included women with pruritus and BA levels ≥10 μmol/L between January 2005 and August 2012 in 3 large hospitals in the Netherlands. The study group was divided in mild (10-39 μmol/L), moderate (40-99 μmol/L), and severe (≥100 μmol/L) ICP. Main outcome measures were spontaneous preterm birth, meconium-stained amniotic fluid, asphyxia, and perinatal death. Univariate and multivariate logistic regression analysis was used to study associations between BA levels and adverse outcome. A total of 215 women were included. Gestational age at diagnosis and gestational age at delivery were significantly lower in the severe, as compared with the mild, ICP group (P pregnancy outcome. Levels of BA correlate between mother and fetus. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Effect of Bile Acid on Fetal Lung in Rat Model of Intrahepatic Cholestasis of Pregnancy

    Directory of Open Access Journals (Sweden)

    Ling Yu

    2014-01-01

    Full Text Available Objective. To determine the correlation between maternal bile acid (BA level and fetal pulmonary surfactant in rats and study the effects of BA on fetal lung in rat model of intrahepatic cholestasis of pregnancy. Methods. Forty pregnant rats were treated with (A 5.5 mg/kg BA, (B 1.4 mg/kg BA, and (C 1 ml physiological saline. Levels of total bile acid (TBA, ALT, AST, TBIL, DBIL, and SP-A were determined and the lungs of fetal rats were analyzed for pathological changes. Results. Groups A and B intervened with BA showed significant higher level of TBA in both maternal and fetal serum, more mortality rate of fetal rats, more concentration of SP-A in fetal serum, and wider alveolus mesenchyme of fetal rats than the control Group C. Higher level of BA associated with increased fetal risk and lower numerical density of mitochondria in type II alveolar epithelial cells. The levels of TBA in maternal serum were found to have significant positive correlation with those in fetal serum and SP-A level but negatively with the area of alveolus and the numerical density of lamellar body. Conclusions. The TBA level in maternal serum showed significant association with lung pathological changes in fetal rats.

  12. Primary bile acids as potential biomarkers for the clinical grading of intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Chen, Jianbo; Deng, Wenping; Wang, Junwei; Shao, Yong; Ou, Minglin; Ding, Min

    2013-07-01

    To identify possible biomarkers for the clinical grading of intrahepatic cholestasis of pregnancy (ICP) through serum bile acid (SBA) profiling in women with ICP. Serum samples were collected in the last trimester of pregnancy from 33 women with severe ICP, 28 women with mild ICP, and 35 women with a normal pregnancy. The SBA levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Patients with severe ICP had significantly higher serum levels of taurochenodeoxycholic acid, tauroursodeoxycholic acid, glycocholic acid (GCA), taurocholic acid (TCA), and glycochenodeoxycholic acid than women with mild ICP or a normal pregnancy. Primary bile acid species, in particular TCA and GCA, were the main bile acids detected and their levels were significantly higher in the severe ICP group than in the other 2 groups. There is an obvious difference in the SBA profiles of women with severe ICP and those with mild ICP, indicating that primary bile acids may be useful biomarkers for the clinical grading of ICP. Implementation of primary bile acid testing in clinical practice may help clinicians to determine the appropriate management strategy for patients with ICP. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. MiR-145 functions as a tumor suppressor targeting NUAK1 in human intrahepatic cholangiocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Xiong, Xinkui; Sun, Daoyi; Chai, Hao; Shan, Wengang [Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province (China); Key Laboratory of Living Donor Liver Transplantation, Ministry of Public Health, Nanjing, Jiangsu Province (China); Yu, Yue [Key Laboratory of Living Donor Liver Transplantation, Ministry of Public Health, Nanjing, Jiangsu Province (China); Pu, Liyong [Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province (China); Key Laboratory of Living Donor Liver Transplantation, Ministry of Public Health, Nanjing, Jiangsu Province (China); Cheng, Feng, E-mail: docchengfeng@njmu.edu.cn [Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province (China); Key Laboratory of Living Donor Liver Transplantation, Ministry of Public Health, Nanjing, Jiangsu Province (China)

    2015-09-18

    The dysregulation of micro (mi)RNAs is associated with cancer development. The miRNA miR-145 is downregulated in intrahepatic cholangiocarcinoma (ICC); however, its precise role in tumor progression has not yet been elucidated. Novel (nua) kinase family (NUAK)1 functions as an oncogene in various cancers and is a putative target of miR-145 regulation. In this study, we investigated the regulation of NUAK1 by miR-145 in ICC. We found that miR-145 level was significantly decreased in ICC tissue and cell lines, which corresponded with an increase in NUAK1 expression. NUAK1 was found to be a direct target of miR-145 regulation. The overexpression of miR-145 in ICC cell lines inhibited proliferation, growth, and invasion by suppressing NUAK1 expression, which was associated with a decrease in Akt signaling and matrix metalloproteinase protein expression. Similar results were observed by inhibiting NUAK1 expression. These results demonstrate that miR-145 can prevent ICC progression by targeting NUAK1 and its downstream effectors, and can therefore be useful for clinical diagnosis and targeted therapy of ICC. - Highlights: • MiR-145 suppresses ICC proliferation and invasion abilities. • We demonstrated that miR-145 directly targets NUAK1 in ICC. • MiR-145 expression in ICC was associated with Akt signaling and MMPs expression.

  14. In vitro proliferation and differentiation of hepatic oval cells and their potential capacity for intrahepatic transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Z.; Chen, J. [Liaocheng People' s Hospital, Department of Hepatobiliary Surgery, Liaocheng, Shandong, China, Department of Hepatobiliary Surgery, Liaocheng People’s Hospital, Liaocheng, Shandong (China); Li, L.; Ran, J.H.; Liu, J. [The First People' s Hospital of Kunming, Kunming, Yunnan, China, The First People’s Hospital of Kunming, Kunming, Yunnan (China); Gao, T.X.; Guo, B.Y. [Dongchangfu Hospital of Women and Child Health Care, Liaocheng, Shandong (China); Li, X.H.; Liu, Z.H.; Liu, G.J.; Gao, Y.C.; Zhang, X.L. [Liaocheng People' s Hospital, Department of Hepatobiliary Surgery, Liaocheng, Shandong, China, Department of Hepatobiliary Surgery, Liaocheng People’s Hospital, Liaocheng, Shandong (China)

    2013-07-30

    Hepatic oval cells (HOCs) are recognized as facultative liver progenitor cells that play a role in liver regeneration after acute liver injury. Here, we investigated the in vitro proliferation and differentiation characteristics of HOCs in order to explore their potential capacity for intrahepatic transplantation. Clusters or scattered HOCs were detected in the portal area and interlobular bile duct in the liver of rats subjected to the modified 2-acetylaminofluorene and partial hepatectomy method. Isolated HOCs were positive for c-kit and CD90 staining (99.8% and 88.8%, respectively), and negative for CD34 staining (3.6%) as shown by immunostaining and flow cytometric analysis. In addition, HOCs could be differentiated into hepatocytes and bile duct epithelial cells after leukemia inhibitory factor deprivation. A two-cuff technique was used for orthotopic liver transplantation, and HOCs were subsequently transplanted into recipients. Biochemical indicators of liver function were assessed 4 weeks after transplantation. HOC transplantation significantly prolonged the median survival time and improved the liver function of rats receiving HOCs compared to controls (P=0.003, Student t-test). Administration of HOCs to rats also receiving liver transplantation significantly reduced acute allograft rejection compared to control liver transplant rats 3 weeks following transplantation (rejection activity index score: control=6.3±0.9; HOC=3.5±1.5; P=0.005). These results indicate that HOCs may be useful in therapeutic liver regeneration after orthotopic liver transplantation.

  15. [Effect of endoplasmic reticulum stress in trophocytes on the pathogenesis of intrahepatic cholestasis of pregnancy].

    Science.gov (United States)

    Yu, Y; Zhou, C L; Yu, T T; Han, X J; Shi, H Y; Wang, H Z; Shen, J J; He, J

    2017-06-25

    Objective: To evaluate the effect of endoplasmic reticulum stress in trophocytes, in patients with intrahepatic cholestasis of pregnancy (ICP). Methods: Sixty-one pregnant women who were hospitalized in Women's Hospital, School of Medicine, Zhejiang University from January to December 2015 were recruited. Thirty-one women who were diagnosed as ICP were defined as the ICP group and 30 healthy pregnant women were defined as the control group. The localization and expression intensity of glucose regulated protein 78 (GRP-78) in placental tissues were detected by immunohistochemistry technique. Electronic microscope was used to observe ultra-microstructure change of the endoplasmic reticulum in trophocytes and cell line Swan71. Reverse transcription (RT)-PCR and western blot were used to investigate the expression of GRP-78 mRNA and protein in Swan 71 cell. Results: (1) GRP-78 protein was mainly expressed in the cytoplasm of cytotrophoblasts and syncytiotrophoblasts. The protein expression of GRP-78 in placentas of the ICP group (13.2±2.4) was significantly higher than that in the control group (7.8±1.3, Pstress of trophocytes may be involved in the pathogenesis of ICP.

  16. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ingraham, Christopher R., E-mail: cringra@uw.edu; Padia, Siddharth A., E-mail: spadia@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington, Department of Interventional Radiology (United States); Easterling, Thomas R., E-mail: easter@uw.edu [University of Washington, Department of Obstetrics and Gynecology (United States); Liou, Iris W., E-mail: irisl@medicine.washington.edu [University of Washington, Department of Medicine (United States); Kanal, Kalpana M., E-mail: kkanal@uw.edu [University of Washington, Physics Section, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington, Department of Interventional Radiology (United States)

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  17. Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage.

    Science.gov (United States)

    Loffroy, Romaric; Estivalet, Louis; Cherblanc, Violaine; Favelier, Sylvain; Pottecher, Pierre; Hamza, Samia; Minello, Anne; Hillon, Patrick; Thouant, Pierre; Lefevre, Pierre-Henri; Krausé, Denis; Cercueil, Jean-Pierre

    2013-10-07

    Acute variceal hemorrhage, a life-threatening condition that requires a multidisciplinary approach for effective therapy, is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy, the presence of large esophageal varices with recent stigmata of bleeding, or fresh blood visible in the stomach with no other source of bleeding identified. Transfusion of blood products, pharmacological treatments and early endoscopic therapy are often effective; however, if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs, transjugular intrahepatic portosystemic shunt (TIPS) is recommended as rescue treatment. The TIPS represents a major advance in the treatment of complications of portal hypertension. Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS, which has a 90% to 100% success rate. However, TIPS is associated with a mortality of 30% to 50% in such a setting. Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure, before the clinical condition worsens. Furthermore, admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively. This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage, particularly as a rescue therapy following failure of endoscopic approaches.

  18. Urinary reducing substances in neonatal intrahepatic cholestasis caused by citrin deficiency

    Directory of Open Access Journals (Sweden)

    Ajmal Kader

    2014-06-01

    Full Text Available Neonatal cholestasis due to citrin deficiency is an autosomal recessive metabolic disorder caused by mutations in SLC25A13 gene. Mutations in this gene have a relatively high prevalence in East-Asian races compared to European or Afro-Caribbean races. Mutations in both sets of chromosomes often lead to self-limiting early onset cholestasis and growth retardation referred as neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD. It is associated with a wide range of metabolic derangements including galactosemia and aminoacidemia, which can be detected on the newborn blood spot screening. Galactose, being a reducing sugar, can also be detected using Clinitest® (Clinitest® Reagent Tablets, Bayer Corporation, Diagnostics Division, Elkhart, IN, USA, a common screening test used in the work up of metabolic and hepatic diseases. In the western population classical galactosemia is often suspected when non glucose reducing substances are detected in the urine of infants with cholestasis. However in East-Asian races the prevalence of classical galactosemia is very low whilst galactosemia due to altered uridine diphosphate-galactose epimerase activity in NICCD is more common. We present a case of NICCD in an East-Asian infant with cholestasis and persistently positive urine reducing substance. Conclusion: NICCD deficiency should be considered as a differential diagnosis in any infant with cholestasis and persistently positive urinary reducing substances.

  19. Pregnancy outcomes and prognostic factors in patients with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Madazli, R; Yuksel, M A; Oncul, M; Tuten, A; Guralp, O; Aydin, B

    2015-05-01

    The aim of this study was to describe maternal and fetal characteristics associated with intrahepatic cholestasis of pregnancy (ICP) and to determine clinical and biochemical predictors of fetal complications. A total of 89 singleton pregnancies with ICP were analysed, retrospectively. All data concerning laboratory results, symptom onset time, treatment response, delivery time and infant information were recorded in the study protocol. The mean gestational age at diagnosis was 32.6 ± 3.4 weeks; mean time of delivery was 36.8 ± 1.9 weeks. Binary logistic regression revealed that gestational age at diagnosis was predictive of preterm delivery (OR = 2.3, 95% CI: 1.5-3.3, p = 0.001). The incidence of respiratory distress syndrome (RDS), fetal growth restriction, fetal distress and preterm delivery were significantly higher in patients who were diagnosed before 30 weeks than after 34 weeks' gestation (p < 0.01). Gestational age at diagnosis is an important independent factor predicting adverse perinatal outcomes in patients with ICP.

  20. Diet induced obesity has an influence on intrahepatic T cell responses.

    Science.gov (United States)

    Gaur, Pratibha; Cebula, Marcin; Riehn, Mathias; Hillebrand, Upneet; Hauser, Hansjörg; Wirth, Dagmar

    2017-04-01

    Obesity is accompanied with systemic inflammation and pre-conditions to severe alterations in liver environment and functions. So far, it remains elusive to which extent obesity modulates immune responses during hepatotropic virus infections as well as in autoimmune hepatitis. In this study we investigated the influence of obesity on the intrahepatic immune response, in particular on the function of CD8 T cells as the crucial players in clearance of virus infected hepatocytes. We established high fat induced obesity in transgenic mouse models with hepatocyte specific expression of a model antigen (Ova). We investigated the immune response upon adoptive transfer of antigen specific T cells and in mice with continuous thymic output of antigen specific T cells, mimicking the situations upon acute infection and autoimmunity, respectively. Irrespective of the metabolic condition, adoptive T cell transfer resulted in a transient hepatitis with no obvious differences concerning the acute T cell response. In the situation of autoimmunity, we observed a transient hepatitis in lean mice, whereas an extended hepatitis with a reduced antigen clearance capacity was found in obese mice. Our results demonstrate that obesity affects T cell function and increases the severity of autoimmune hepatitis while it has no impact on the acute T cell response. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [A case of curative resection after downsizing chemotherapy in initially unresectable locally advanced intrahepatic cholangiocarcinoma].

    Science.gov (United States)

    Aoki, Yu; Suzuki, Takayuki; Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Takano, Shigetsugu; Okamura, Daiki; Suzuki, Daisuke; Sakai, Nozomu; Kagawa, Shingo; Miyazaki, Masaru

    2014-11-01

    This case report describes an 83-year-old man with intrahepatic cholangiocarcinoma who was referred by a local hospital. Abdominal computed tomography (CT) showed a large tumor in hepatic segments 4, 5, and 8 involving the right hepatic vein and inferior vena cava, which is normally indicative of an unresectable locally advanced tumor. After systemic chemotherapy with gemcitabine and cisplatin, the observed decrease in the level of tumor marker suggested that the cancer was responding to treatment, while radiological findings showed the main tumor shrunk without the presence of distant metastases. Thus, hepatic left trisectionectomy with bile duct resection was performed after portal vein embolization. Pathological examination revealed negative margins (R0). Eighteen months after surgery, the patient is free of disease and shows no signs of recurrence. An initially unresectable, locally advanced biliary tract cancer may be down sized by chemotherapy, which makes radical resection possible, at least in a proportion of patients. This approach provides longer survival and may have a potential for disease eradication as a new multidisciplinary approach for patients with unresectable locally advanced biliary tract cancer.

  2. Comparison of a new stent and Wallstent for transjugular intrahepatic portosystemic shunt in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Gao Jun Teng; Michael A. Bettmann; P. Jack Hoopes; Li Yang

    2001-01-01

    AIM To evaluate a new balloon-expandablestainless steel stent (Cordis stent ) in atransjugular intrahepatic portosystemic shunt(TIPS) porcine model and compared withWallstent.METHODS TIPS was performed in 26 normaldomestic pigs weighing 20 kg-30 kg using aCordis stent or Wallstent (13 pigs in each stent).All pigs were sacrificed at the 14th day afterTIPS. The stent deployment delivery system,stent patency, and stent recoil after placementwere evaluated. Proliferative response inrepresentative histological sections from thecenter, hepatic and portal regions of the twostent designs were quantified.RESULTS The shunt was widely patent in 4pigs in the Cordis stent group (4/12, prematuredead in 1 pig), and in 5 pigs in the Wallstentgroup (5/13). All remaining stents of bothdesigns were occluded or stenotic. The meanquantified proliferation including thickness ofthe proliferation and the ratio of proliferation:total area in three assayed regions in Cordisstent and Wallstent was 2.18 mm:2.00 mm, and59.18 mm2: 51.66 mm2, respectively (P >0.05).The delivery system and mechanical propertiesof the Cordis stent fuctioned well.CONCLUSION The new Cordis stent isappropriate for TIPS procedure.

  3. A case of advanced intrahepatic cholangiocarcinoma successfully treated with chemosensitivity test-guided systemic chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Kazumichi Abe; Takeru Wakatsuki; Fumiko Katsushima; Kyoko Monoe; Yukiko Kanno; Atsushi Takahashi; Junko Yokokawa; Hiromasa Ohira

    2009-01-01

    Intrahepatic cholangiocarcinoma (ICC) is a relatively rare and highly fatal neoplasm that arises from the biliary epithelium. Prognosis is generally poor and survival is limited to a few months. Here we present a case of advanced ICC successfully treated by chemosensitivity test-guided systemic chemotherapy combining S-1 and cisplatin (CDDP). A 65-year-old woman with a liver tumor was referred to our hospital on November 21, 2007. Abdominal ultrasonography and computed tomography (CT) showed low-density masses of 50 and 15 mm in diameter, respectively in segment Ⅷ of the liver and in the enlarged lymph node in the para-aorta. Ultrasonography-guided fine needle biopsy diagnosed the tumors as ICC. Since the patient was inoperable for lymph node metastasis, she underwent systemic chemotherapy with gemcitabine. Six months after initiation of chemotherapy, CT revealed ICC progression in the liver and pleural dissemination with pleural effusion. The patient was admitted to our hospital for anticancer drug sensitivity testing on June 9, 2008. Based on the sensitivity test results, we elected to administer systemic chemotherapy combining S-1 and CDDP. Two months into the second chemotherapy treatment, CT revealed a reduction of the tumors in the liver and lymph node and a decrease in pleural effusion.After eight cycles of the second chemotherapy, 17 mo after ICC diagnosis, she is alive and well with no sign of recurrence. We conclude that chemosensitivity testing may effectively determine the appropriate chemotherapy regimen for advanced ICC.

  4. A New Mutation Causing Progressive Familiar Intrahepatic Cholestasis Type 3 in Association with Autoimmune Hepatitis

    Directory of Open Access Journals (Sweden)

    Hugo M Oliveira

    2017-03-01

    Full Text Available Background: Some patients exhibit features of both autoimmune hepatitis (AIH and primary sclerosing cholangitis (PSC. Similarly, patients with progressive familial intrahepatic cholestasis type 3 (PFIC3 may share histological features with PSC. Case report: We report the case of a 22-year-old man who, since he was 5 years of age, has presented with pruritus, an approximately ninefold elevation of aminotransferases, and γ-glutamyl transferase levels ~10 times the upper limit. Initially he was diagnosed with an overlap syndrome of small duct PSC plus AIH. However, fluctuations in liver enzymes were observed over the following years. Analysis of the ABCB4 gene indicated the diagnosis of PFIC3, revealing a mutation not previously reported. Conclusion: With this case report we aim to describe a new mutation, raise awareness of this rare pathology and highlight the importance of genetic testing of the ABCB4 gene in patients with autoimmune liver disease (mainly small duct PSC with incomplete response to immunosuppressive treatment.

  5. MUC1 and MUC5AC mucin expression in liver fluke-associated intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Chanchai Boonla; Banchob Sripa; Peti Thuwajit; Ubon Cha-On; Anucha Puapairoj; Masanao Miwa; Sopit Wongkham

    2005-01-01

    AIM: To investigate the expressions of MUC1 and MUC5AC in intrahepatic cholangiocarcinoma (ICC). Association of expressions of mucins MUC1 and MUC5AC with clinical findings, metastasis, and survival of the liver fluke-associated ICC patients was determined.METHODS: The expressions of MUC1 and MUC5AC mucins were examined by immunohistochemical staining in 87cases of histologically-proven ICC. The expressions of mucins in relationship between clinicopathological significance and prognosis of the patients were evaluated.RESULTS: Fifty-two patients (60%) exhibited both MUC1 and MUC5AC expressions, whereas 31% expressed either MUC1or MUC5AC, and 9% expressed neither. High MUC1immunoreactivity displayed a significant correlation with tumor progression as reflected by vascular invasion (P<0.001),whereas high expression of MUC5AC significantly correlated with neural invasion (P = 0.022) and advanced ICC stage (P = 0.008). Patients with high expression of MUC1 had a significantly shorter survival (P = 0.0002). According to multivariate analyses, MUC1 reactivity (P = 0.026),histological grading and stage of tumor represented the least probability of survival.CONCLUSION: MUC1 is overexpressed in liver flukeassociated cholangiocarcinoma and relates to vascular invasion and poor prognosis, whereas MUC5AC mucin is neoexpressed and relates to neural invasion and advanced ICC stage. High MUC1 expression in tumor may be useful for predicting the poor outcome of ICC patients.

  6. Glycoconjugates as noninvasive probes of intrahepatic metabolism. III. Application to galactose assimilation by the intact rat

    Energy Technology Data Exchange (ETDEWEB)

    Hellerstein, M.K.; Munro, H.N.

    1988-04-01

    A tracer methodology has been developed for noninvasive assessment of intrahepatic metabolism of administered labeled sugars. In this procedure, we measure the output of the label from the liver in two glycoconjugates derived from hepatic UDP-glucose, namely, glucuronic acid formed through UDP-glucuronic acid and excreted in the urine following acetaminophen administration, and galactose formed through UDP-galactose and then secreted in the carbohydrate portion of glycoproteins in the plasma. Comparison of the distribution of label from various sugar precursors in these end-products can indicate exchanges between hepatic UDP-glucose, UDP-galactose, and UDP-glucuronic acid. In this study we apply the technique to explore whether the enzyme UDP-galactose-4-epimerase catalyzing the step UDP-galactose to UDP-glucose is nonequilibrium and therefore potentially has a regulatory role for utilization of free galactose. The specific activity in the two glycoconjugates was compared when either (1-3H)galactose or (U-14C)glucose was the infused precursor sugar. In rats under a variety of conditions (fasting, oral refeeding, intravenous administration of galactose), label from (1-3H)galactose accumulated in glycoprotein-bound galactose much more than in acetaminophen-bound glucuronic acid, in comparison to label from (U-14C)glucose, demonstrating limitation of the rate of transfer from UDP-galactose to UDP-glucose at the epimerase step. Accordingly, epimerase is suggested to have a regulatory role in the galactose assimilation pathway.

  7. GNAS1 T393C Polymorphism Is Associated with Clinical Course in Patients with Intrahepatic Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Klaus J. Schmitz

    2007-02-01

    Full Text Available BACKGROUND/AIMS: The GNAS1 locus encodes the Gas protein, which stimulates the formation of cycloadenosinemonophosphate (cAMP. The cAMP pathway mediates pleiotropic effects, including the regulation of apoptosis and proliferation. We have recently shown that TT genotypes of the single-nucleotide polymorphism T393C in the gene GNAS1 predict the clinical outcome of patients with various carcinomas. METHODS: Eighty-seven patients with intrahepatic cholangiocarcinoma (ICC were retrospectively genotyped to elucidate a potential association between T393C genotypes and clinical outcome. RESULTS: ICCs of patients with homozygous TT genotypes revealed a higher proliferation rate and a lower apoptotic rate. Homozygous TT patients were at highest risk for cancer-related deaths (hazard ratio = 2.74; 95% confidence interval = 1.03-7.28 compared with C-allele carriers. Kaplan-Meier curves for disease-specific overall and local recurrence-free survival in a subgroup with Ro-resected ICC showed a significant association of T393 homozygosity with outcome, which was confirmed in multivariate Cox regression analysis. CONCLUSIONS: GNAS1 T393C is a novel independent host factor for disease progression in patients with ICC. Our finding that TT homozygosity (and not CC homozygosity was associated with unfavorable clinical outcome points to the complex and differing functional effects induced by GNAS1 T393C polymorphism in various human carcinomas.

  8. Neonatal Intrahepatic Cholestasis Caused by Citrin Deficiency Differentiated from Biliary Atresia.

    Science.gov (United States)

    Gong, Zhenhua; Xu, Wei-Jue; Tian, Guo-Li; Zhang, Ting; Lv, Zhibao

    2016-06-01

    Purpose The aim of this article is to differentiate neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) from biliary atresia (BA) by total hexose. Methods A total of 11 patients with NICCD, 29 patients with BA, and 4,898 children as controls were involved in this study. The blood concentration of amino acids, carnitine, acylcarnitines, and total hexose were measured in dry blood spots (DBS) using tandem mass spectrometry (MS/MS). Results In the patients with NICCD, the blood concentration of the total hexose (15.3 ± 9.0 mmol/L vs. 7.3 ± 2.7 mmol/L; p  10 mmol/L), Cit (> 55 µmol/L) to diagnose NICCD, the sensitivity and specificity were 66.7 and 97.8% and 90.0 and 99.1%, respectively, and all of the areas under the receiver-operating characteristic curves were greater than 0.85. Conclusion Elevated total hexose in DBS measured by MS/MS associated with elevated amino acids, especially Cit can be used to diagnose NICCD and differentiate it from BA. Georg Thieme Verlag KG Stuttgart · New York.

  9. Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM: To analyze the change of dimethylarginine plasma levels in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt (TIPS). METHODS: TO determine arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and nitric oxide (NO) plasma levels, blood samples were collected from the superior cava, hepatic, and portal vein just before, directly after, and 3 mo after TIPS-placement.RESULTS: A significant increase in the arginine/ADMA ratio after TIPS placement was shown. Moreover, TIPS placement enhanced renal function and thereby decreased systemic SDMA levels. In patients with renal dysfunction before TIPS placement, both the arginine/ ADMA ratio and creatinine clearance rate increased significantly, while this was not the case in patients with normal renal function before TIPS placement. Hepatic function did not change significantly after TIPS placement and no significant decline in ADMA plasma levels was measured.CONCLUSION: The increase of the arginine/ADMA ratio after TIPS placement suggests an increase in intracellular NO bioavailability. In addition, this study suggests that TIPS placement does not alter dimethylarginine dimethylaminohydrolase (DDAH) activity and confirms the major role of the liver as an ADMA clearing organ.

  10. Molecular hydrogen attenuates hypoxia/reoxygenation injury of intrahepatic cholangiocytes by activating Nrf2 expression.

    Science.gov (United States)

    Yu, Jianhua; Zhang, Weiguang; Zhang, Rongguo; Jiang, Guixing; Tang, Haijun; Ruan, Xinxian; Ren, Peitu; Lu, Baochun

    2015-11-01

    Hypoxia/reoxygenation (H/R) injury of cholangiocytes causes serious biliary complications during hepatobiliary surgeries. Molecular hydrogen (H2) has been shown to be effective in protecting various cells and organs against oxidative stress injury. Human liver cholangiocytes were used to determine the potential protective effects of hydrogen against cholangiocyte H/R injury and explore the underlying mechanisms. We found that H2 ameliorated H/R-induced cholangiocytes apoptosis. Our study revealed that H2 activated NF-E2-related factor 2 (Nrf2) and downstream cytoprotective protein expression. However, the protective function of H2 was abolished when Nrf2 was silenced. Apoptosis in cholangiocytes isolated from a rat model of liver ischemia/reperfusion injury indicated that H2 significantly attenuates ischemia/reperfusion cholangiocyte injury in vivo. In conclusion, our study shows that H2 protects intrahepatic cholangiocytes from hypoxia/reoxygenation-induced apoptosis in vitro or in vivo, and this phenomenon may depend on activating Nrf2 expression.

  11. Intrahepatic mass-forming cholangiocarcinoma: prognostic value of preoperative gadoxetic acid-enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Jieun; Chung, Yong Eun; Kim, Myeong-Jin; Choi, Jin-Young [Yonsei University, College of Medicine, Department of Radiology, Research Institute of Radiological Science, Seoul (Korea, Republic of); Nahm, Ji Hae; Park, Young Nyun [Yonsei University, College of Medicine, Department of Pathology, Seoul (Korea, Republic of); Kim, Ha Yan [Yonsei University, College of Medicine, Biostatistics Collaboration Unit, Severance Hospital, Seoul (Korea, Republic of); Kim, Kyung-Sik [Yonsei University, College of Medicine, Department of General Surgery, Seoul (Korea, Republic of)

    2016-02-15

    To assess whether gadoxetic acid-enhanced MRI could be used as a prognostic factor for intrahepatic mass-forming cholangiocarcinomas (IMCCs). Forty-one patients with pathologically proven IMCCs who underwent preoperative gadoxetic acid-enhanced MRI were included. The signal intensity of the IMCCs on hepatobiliary phase (HBP) MRI was qualitatively analyzed by two radiologists, and categorized into intermediate or hypointense groups. Analysis of clinicopathological prognostic factors and correlations of imaging and histology were also performed. Survival time and time to recurrence (TTR) were analyzed. Of the 41 IMCCs, 23 were in the intermediate group and 18 were in the hypointense group on HBP MRI. IMCCs in the intermediate group were associated with shorter survival time (P = 0.048) and TTR (P = 0.002) than the IMCCs of the hypointense group. Only the intermediate group on HBP MRI had a significantly shorter TTR on multivariate analysis (P = 0.012). The IMCCs of the intermediate group showed a tendency for more abundant tumour fibrous stroma than those of the hypointense group (P = 0.027). The enhancement of IMCCs on HBP gadoxetic acid-enhanced MRI appears to correlate with tumour aggressiveness and outcomes due to the tumour fibrous stromal component. Thus, HBP images could be a useful prognostic factor for IMCCs after surgery. (orig.)

  12. Perbedaan Manifestasi Klinis dan Laboratorium Kolestasis Intrahepatal dengan Ekstrahepatal pada Bayi

    Directory of Open Access Journals (Sweden)

    Dwi Prasetyo

    2016-05-01

    Full Text Available Physiological jaundice found in infants and most symptoms are often mild. Jaundice symptoms usually disappear within 2 weeks after birth. In conjugated jaundice defects in intra-hepatic production, transmembran transport from bile, i.e. cholestasis intra hepatic (IH, or extra-hepatic (EH obstruction/cholestasis occur, resulting in bile barriers. This study was conducted to look at the differences in the clinical and laboratory manifestations of IH and EH cholestasis in infants. A cross-sectional study was performed on 72 infants with cholestasis who came to Dr. Hasan Sadikin General Hospital Bandung, during the period of January 2014–December 2015. Data analysis was performed with Pearson Chi-square test and Mann-Whitney. Subjects consisted of 43 (60% infant boys and 29 (40% infant girls, IH cholestasis were 61 (85% and EH cholestasis were 11 (15.3%. Significant differences in the clinical manifestations of acites with IH and EH cholestasis were found (p=0.047, whereas insignificant differences in venectation, hepatomegaly and splenomegaly were observed. On examination of stool color, no significant difference was found (p=0.936. The same was true for laboratory results of total bilirubin, direct bilirubin, serum glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and gamma glutamyl transferase. In conclusion, we found differences in clinical manifestation of acites, while for other clinical manifestations and laboratory results no differences were found between IH and EH cholestasis.

  13. Analysis of the histologic features in the differential diagnosis of intrahepatic neonatal cholestasis

    Institute of Scientific and Technical Information of China (English)

    Maria Angela Bellomo-Brandao; Cecilia AF Escanhoela; Luciana R Meirelles; Gilda Porta; Gabriel Hessel

    2009-01-01

    AIM: To compare the histologic features of the liver in intrahepatic neonatal cholestasis (IHNC) with infectious,genetic-endocrine-metabolic, and idiopathic etiologies.METHODS: Liver biopsies from 86 infants with IHNC were evaluated. The inclusion criteria consisted of jaundice beginning at 3 mo of age and a hepatic biopsy during the 1st year of life. The following histologic features were evaluated: cholestasis, eosinophilia, giant cells, erythropoiesis, siderosis, portal fibrosis, and the presence of a septum.RESULTS: Based on the diagnosis, patients were classified into three groups: group 1 (infectious; n = 18),group 2 (genetic-endocrine-metabolic; n = 18), and group 3 (idiopathic; n = 50). There were no significant differences with respect to the following variables:cholestasis, eosinophilia, giant cells, siderosis, portal fibrosis, and presence of a septum. A significant difference was observed with respect to erythropoiesis,which was more severe in group 1 (Fisher's exact test,P = 0.016).CONCLUSION: A significant difference was observed in IHNC of infectious etiology, in which erythropoiesis was more severe than that in genetic-endocrine-metabolic and idiopathic etiologies, whereas there were no significant differences among cholestasis, eosinophilia,giant cells, siderosis, portal fibrosis, and the presence of a septum.

  14. Bone densitometry

    DEFF Research Database (Denmark)

    Ravn, Pernille; Alexandersen, P; Møllgaard, A

    1999-01-01

    The bisphosphonates have been introduced as alternatives to hormone replacement therapy (HRT) for the treatment and prevention of postmenopausal osteoporosis. The expected increasing application in at clinical practice demands cost-effective and easily handled methods to monitor the effect on bone...

  15. Upregulation of PDZK1 by Calculus Bovis Sativus May Play an Important Role in Restoring Biliary Transport Function in Intrahepatic Cholestasis

    Directory of Open Access Journals (Sweden)

    Dong Xiang

    2017-01-01

    Full Text Available Intrahepatic cholestasis is a main cause of hepatic accumulation of bile acids leading to liver injury, fibrosis, and liver failure. Our previous studies proved that Calculus Bovis Sativus (CBS can restore biliary transport function through upregulating the multidrug resistance-associated protein 2 (MRP2 and breast cancer resistance protein (BCRP in 17α-ethynylestradiol- (EE- induced intrahepatic cholestasis rats. The regulation mechanism of CBS on these transporters, however, remains unclear. This study was designed to evaluate the possible relationship between the effect of CBS on transport activities and the regulation of CBS on the expression of PDZK1, a mainly scaffold protein which can regulate MRP2 and BCRP. Intrahepatic cholestasis model was induced in rats with injection of EE for five consecutive days and then the biliary excretion rates and cumulative biliary excretions were measured. The mRNA and protein expression levels of PDZK1 were detected by reverse transcription-quantitative real-time polymerase chain reaction, western blot, and immunohistochemical analysis. When treated with CBS, cumulative biliary excretions and mRNA and protein expressions of PDZK1 were significantly increased in intrahepatic cholestasis rats. This study demonstrated that CBS exerted a beneficial effect on EE-induced intrahepatic cholestasis rats by restoring biliary transport function, which may result from the upregulation of PDZK1 expression.

  16. Osteoclasts prefer aged bone

    DEFF Research Database (Denmark)

    Henriksen, K; Leeming, Diana Julie; Byrjalsen, I

    2007-01-01

    We investigated whether the age of the bones endogenously exerts control over the bone resorption ability of the osteoclasts, and found that osteoclasts preferentially develop and resorb bone on aged bone. These findings indicate that the bone matrix itself plays a role in targeted remodeling...... of aged bones....

  17. A flippase-independent function of ATP8B1, the protein affected in familial intrahepatic cholestasis type1, is required for apical protein expression and microvillus formation in polarized epithelial cells

    NARCIS (Netherlands)

    Verhulst, P.M.|info:eu-repo/dai/nl/304834505; van der Velden, L.M.; Oorschot, V.M.J.; van Faassen, E.E.H.|info:eu-repo/dai/nl/071100938; Klumperman, J.; Houwen, R.H.J.; Pomorski, T.; Holthuis, J.C.M.|info:eu-repo/dai/nl/153674520; Klomp, L.W.J.

    2010-01-01

    Mutations in ATP8B1 cause familial intrahepatic cholestasis type 1, a spectrum of disorders characterized by intrahepatic cholestasis, reduced growth, deafness, and diarrhea. ATP8B1 belongs to the P4 P-type adenosine triphosphatase (ATPase) family of putative aminophospholipid translocases, and loss

  18. Umatilla - Rough Fish Eradication

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — In order to enhance environmental conditions in the McCormack Slough on Umatilla NWR, the population of rough fish, including common carp (Cyprinus carpio) and...

  19. Textbook of fish health

    National Research Council Canada - National Science Library

    Post, George

    1987-01-01

    Written to fill the great need for a fish disease textbook for college students, this new edition contains the latest information and important discoveries related to those fish diseases that affect man economically...

  20. Scorpion fish sting

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002849.htm Scorpion fish sting To use the sharing features on this page, please enable JavaScript. Scorpion fish are members of the family Scorpaenidae, which ...

  1. Pittsburgh Fish Fry Locations

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Lenten Fish Fry records for the Greater Pittsburgh region. Data is collected before and during the Lenten fish fry season each year by Code for Pittsburgh. Data is...

  2. Intrahepatic transneedle inoculation of VX2 particles for obtaining a solitary hepatic tumor in an animal model

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jin Han; Choi, Jong Cheol; Shin, Tae Beom; Park, Byeong Ho [Dong-A University, School of Medicine, Busan (Korea, Republic of)

    2005-07-15

    The purpose of this study was to develop a large animal (rabbit) model which has a proper solitary intrahepatic tumor with lower leakage rates through less traumatic methods. Consequently, we evaluated tumor progression following the intrahepatic inoculation of VX2 cells into New Zealand white rabbits to acquire baseline data on the progression of a VX2 tumor. Twenty New Zealand white rabbits, each weighting 2.5-3 kg, were selected for this study. A 1 mm{sup 3} VX2 tumor fragment was created and then minced to enable the particles to pass through a 21 G needle mounting in a tuberculin syringe with 0.1 ml of normal saline. The minced VX2 tumor particles were injected into the subcapsular parenchyma of the left hepatic lobe. A 21 G needle was used to avoid penetrating large hepatic vessels. In order to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route, a purse-string suture around the puncture site was made using black silk 4-0. The tumor particles were then injected through the center of the suture. While removing the needle, the suture was tightened to prevent hemorrhage or leakage of the VX2 tumor cells through the injection route. Finally, the injection site was covered with a Surgical patch. The inoculated intrahepatic VX2 tumors were then imaged with a 16 channel multidetector CT every week for the duration of the study. The CT images covered from the lung apex to the pelvic floor. Two radiologists evaluated the size, location, and peritoneal seeding of the tumors as well as metastasis of other organs. Three rabbits were sacrificed as random beginning in the second week, and this process continued on a weekly basis for the duration of the study. The CT images and pathologic findings for the sacrificed rabbits were correlated. The inoculated intrahepatic VX2 tumors were not visible in the first week. By the second week 66.7% were visible on CT images and by the third week all tumors were visible. Of the twenty rabbits, three (15

  3. 49 CFR 173.218 - Fish meal or fish scrap.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Fish meal or fish scrap. 173.218 Section 173.218... Fish meal or fish scrap. (a) Except as provided in Column (7) of the HMT in § 172.101 of this subchapter, fish meal or fish scrap, containing at least 6%, but not more than 12% water, is authorized...

  4. Medusivorous fishes, a review

    NARCIS (Netherlands)

    Ates, R.M.L.

    1988-01-01

    A preliminary review is presented of fish species having consumed pelagic Cnidaria (Scyphozoa and Hydrozoa) as well as Ctenophora. Quantitative data are scarce. Knowledge of morphological and physiological adaptations of fishes foraging on gelatinous plankton is almost non-existent. Many fish specie

  5. Medusivorous fishes, a review

    OpenAIRE

    Ates, R.M.L.

    1988-01-01

    A preliminary review is presented of fish species having consumed pelagic Cnidaria (Scyphozoa and Hydrozoa) as well as Ctenophora. Quantitative data are scarce. Knowledge of morphological and physiological adaptations of fishes foraging on gelatinous plankton is almost non-existent. Many fish species consume medusae and some reasons to suspect that there are even more that do so, are discussed.

  6. Medusivorous fishes, a review

    NARCIS (Netherlands)

    Ates, R.M.L.

    1988-01-01

    A preliminary review is presented of fish species having consumed pelagic Cnidaria (Scyphozoa and Hydrozoa) as well as Ctenophora. Quantitative data are scarce. Knowledge of morphological and physiological adaptations of fishes foraging on gelatinous plankton is almost non-existent. Many fish

  7. Intrahepatic Transcriptional Signature Associated with Response to Interferon-α Treatment in the Woodchuck Model of Chronic Hepatitis B.

    Directory of Open Access Journals (Sweden)

    Simon P Fletcher

    2015-09-01

    Full Text Available Recombinant interferon-alpha (IFN-α is an approved therapy for chronic hepatitis B (CHB, but the molecular basis of treatment response remains to be determined. The woodchuck model of chronic hepatitis B virus (HBV infection displays many characteristics of human disease and has been extensively used to evaluate antiviral therapeutics. In this study, woodchucks with chronic woodchuck hepatitis virus (WHV infection were treated with recombinant woodchuck IFN-α (wIFN-α or placebo (n = 12/group for 15 weeks. Treatment with wIFN-α strongly reduced viral markers in the serum and liver in a subset of animals, with viral rebound typically being observed following cessation of treatment. To define the intrahepatic cellular and molecular characteristics of the antiviral response to wIFN-α, we characterized the transcriptional profiles of liver biopsies taken from animals (n = 8-12/group at various times during the study. Unexpectedly, this revealed that the antiviral response to treatment did not correlate with intrahepatic induction of the majority of IFN-stimulated genes (ISGs by wIFN-α. Instead, treatment response was associated with the induction of an NK/T cell signature in the liver, as well as an intrahepatic IFN-γ transcriptional response and elevation of liver injury biomarkers. Collectively, these data suggest that NK/T cell cytolytic and non-cytolytic mechanisms mediate the antiviral response to wIFN-α treatment. In summary, by studying recombinant IFN-α in a fully immunocompetent animal model of CHB, we determined that the immunomodulatory effects, but not the direct antiviral activity, of this pleiotropic cytokine are most closely correlated with treatment response. This has important implications for the rational design of new therapeutics for the treatment of CHB.

  8. Relationship between the intrahepatic expression of 'e' and 'c' epitopes of the nucleocapsid protein of hepatitis B virus and viraemia.

    Science.gov (United States)

    Ballaré, M; Lavarini, C; Brunetto, M R; Petruzzelli, E; Dovis, M; Molino, G; Bonino, F

    1989-01-01

    The relationship between hepatitis B viraemia and intrahepatic HBV nucleocapsid proteins (HBcAg and HBeAg) was studied in 18 patients with chronic hepatitis B. Monoclonal antibodies (MoABs) were obtained in BALB/c mice primed with recombinant HBV nucleocapsid proteins. Four MoABs reacting with recombinant proteins gave positive results in competitive assays. Two reacted as anti-HBc and two as anti-HBe. One of them showed a strong affinity for the cytoplasmic, membrane-bound antigen (P23e) of infected hepatocytes while the latter showed a higher specificity for serum HBeAg than for the intrahepatic antigen. Anti-HBc MoABs had a staining capacity for liver cell nuclei comparable with that of polyclonal antibodies. Overall the anti-HBc MoABs stained the liver cell nuclei in 86% of cases, while anti-HBe MoABs stained in 58% of cases. The hepatocyte cytoplasm was stained by anti-HBc MoABs and anti-HBe MoABs in 64% and 72% of cases respectively. Not one of 12 control liver biopsies was stained. Viraemia (HBV-DNA) was measured by dot blot hybridization and was correlated with the number of hepatocytes containing the nucleocapsid antigen. The highest levels of HBV-DNA (greater than 10(8) genomes/ml) were detected in patients with prevalent nuclear staining while the lowest ones were observed in those with prevalent cytoplasmic expression of this antigen. The application of anti-HBV-nucleocapsid MoABs in diagnostics requires careful scrutiny since some are specific for the circulating antigen while others show a higher affinity for the intrahepatic antigen. PMID:2467769

  9. Intrahepatic Transcriptional Signature Associated with Response to Interferon-α Treatment in the Woodchuck Model of Chronic Hepatitis B

    Science.gov (United States)

    Fletcher, Simon P.; Chin, Daniel J.; Gruenbaum, Lore; Bitter, Hans; Rasmussen, Erik; Ravindran, Palanikumar; Swinney, David C.; Birzele, Fabian; Schmucki, Roland; Lorenz, Stefan H.; Kopetzki, Erhard; Carter, Jade; Triyatni, Miriam; Thampi, Linta M.; Yang, Junming; AlDeghaither, Dalal; Murredu, Marta G.; Cote, Paul; Menne, Stephan

    2015-01-01

    Recombinant interferon-alpha (IFN-α) is an approved therapy for chronic hepatitis B (CHB), but the molecular basis of treatment response remains to be determined. The woodchuck model of chronic hepatitis B virus (HBV) infection displays many characteristics of human disease and has been extensively used to evaluate antiviral therapeutics. In this study, woodchucks with chronic woodchuck hepatitis virus (WHV) infection were treated with recombinant woodchuck IFN-α (wIFN-α) or placebo (n = 12/group) for 15 weeks. Treatment with wIFN-α strongly reduced viral markers in the serum and liver in a subset of animals, with viral rebound typically being observed following cessation of treatment. To define the intrahepatic cellular and molecular characteristics of the antiviral response to wIFN-α, we characterized the transcriptional profiles of liver biopsies taken from animals (n = 8–12/group) at various times during the study. Unexpectedly, this revealed that the antiviral response to treatment did not correlate with intrahepatic induction of the majority of IFN-stimulated genes (ISGs) by wIFN-α. Instead, treatment response was associated with the induction of an NK/T cell signature in the liver, as well as an intrahepatic IFN-γ transcriptional response and elevation of liver injury biomarkers. Collectively, these data suggest that NK/T cell cytolytic and non-cytolytic mechanisms mediate the antiviral response to wIFN-α treatment. In summary, by studying recombinant IFN-α in a fully immunocompetent animal model of CHB, we determined that the immunomodulatory effects, but not the direct antiviral activity, of this pleiotropic cytokine are most closely correlated with treatment response. This has important implications for the rational design of new therapeutics for the treatment of CHB. PMID:26352406

  10. [Characteristics of the plasma amino acid spectrum of neonatal intrahepatic cholestasis caused by citrin deficiency].

    Science.gov (United States)

    Fu, Hai-yan; Wang, Xiao-hong; Lu, Yi; Zhang, Shao-ren; Fang, Ling-juan; Chen, Rui; Yu, Hui; Zhu, Qi-rong; Wang, Jian-she

    2013-12-01

    To investigate the plasma amino acid spectrum in infants more than 1-year-old with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) in order to identify potential diagnostic markers of NICCD. Infants less than 1 year of age who had been referred to our hospital for investigation of suspected conjugated hyperbilirubinemia between June 2003 and June 2009 were eligible for enrollment. A total of 182 infants were enrolled and divided into three groups: infants diagnosed with NICCD (n = 24), according to gene testing and/or western blotting results; infants diagnosed with biliary atresia (BA; n = 20), according to intra-operative cholangiography findings; and infants diagnosed with idiopathic neonatal intrahepatic hepatitis (INH; n = 138), according to exclusionary findings for diseases affecting the extrahepatic biliary system and no positive serology results to indicate infections with hepatitis B, C, A or E, toxoplasmosis, rubella, herpes simplex, human immunodeficiency virus-1, or syphilis. The plasma amino acid spectrum of each infant was analyzed by tandem mass spectrometry (MS/MS). The concentrations of 18 amino acids, as well as the ratio of each amino acid to total amino acids, were compared among the three groups. Selected ratios of amino acids were analyzed by receiver operating characteristic (ROC) curve analysis. Compared with the BA and INH groups, the NICCD group had significantly lower levels of alanine (Ala; 175.7 and 205.7 vs. 136.3 mumol/L, P = 0.0001), aspartic acid (Asp; 47.5 and 43.1 vs. 31.55 mumol/L, P = 0.0041), glutamic acid (Glu; 276.16 and 263.24 vs. 175.71 mumol/L, P = 0.0075) and tryptophan (Trp; 41.90 and 47.97 vs. 28.51 mumol/L, P = 0.0003), but significantly higher levels of methionine (Met; 28.24 and 29.35 vs. 71.40 mumol/L, P = 0.0390), tyrosine (Tyr; 55.8 and 57.02 vs. 116.81 mumol/L, P = 0.0072) and citrulline (Cit; 15.09 and 15.65 vs. 97.42 mumol/L, P = 0.0001). The ratio of each amino acid to total amino acids

  11. Cytomegalovirus may mimic the presentation of intrahepatic cholestasis and hemolysis, elevated liver enzymes and low platelets in immunosuppressed pregnant women.

    Science.gov (United States)

    Wander, Gurleen; Neuberger, Francesa; Dhanjal, Mandish K; Nelson-Piercy, Catherine; Soh, May Ching

    2016-09-01

    Most published cases of cytomegalovirus infection in pregnancy relate to congenital abnormalities in neonates infected in early pregnancy, while the mother remains asymptomatic. We describe a diagnostically challenging case of an immunosuppressed woman with scleroderma who developed deranged liver function tests attributed to intrahepatic cholestasis of pregnancy and haemolysis, elevated liver enzymes and low platelets syndrome but was ultimately found to have disseminated cytomegalovirus. Cytomegalovirus can present in a myriad of ways. Clinicians caring for immunocompromised pregnant women should consider cytomegalovirus as a possible differential diagnosis when reviewing abnormal liver function tests.

  12. Consequences of TCDD treatment on intra-hepatic lymphocytes during liver regeneration.

    Science.gov (United States)

    Horras, Christopher J; Lamb, Cheri L; King, Allie L; Hanley, Jason R; Mitchell, Kristen A

    2012-01-01

    Increasing evidence demonstrates a physiological role for the aryl hydrocarbon receptor (AhR) in regulating hepatocyte cell cycle progression. Previous studies have used a murine model of liver regeneration to show that exposure to the potent exogenous AhR ligand, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), suppresses hepatocyte proliferation in vivo. Based on recent reports that natural killer (NK) cells negatively regulate liver regeneration, coupled with the well-established immunomodulatory effects of TCDD, it was hypothesized that alterations in lymphocyte activation contribute to the suppression of liver regeneration in TCDD-treated mice. To test this, mice were treated with TCDD (20 μg/kg) 1 day prior to 70% partial hepatectomy (PH), in which two-thirds of the liver was surgically resected. Lymphocytes were collected from the remnant liver and analyzed by flow cytometry. Whereas exposure to TCDD did not alter the number of NK cells or CD3(+) T-cells recovered from the regenerating liver, it reduced the percentage and number of intra-hepatic NKT cells 42 h after PH. With regard to lymphocyte activation, TCDD treatment transiently increased CD69 expression on NK and NKT cells 12 h after PH, but had no effect on intracellular levels of IFNγ in NK, NKT, or CD3(+) T-cells. To determine the relevance of NK cells to the suppression of liver regeneration by TCDD, mice were treated with anti-Asialo GM-1 (ASGM-1) antibody to deplete NK cells prior to TCDD treatment and PH, and hepatocyte proliferation was measured using bromodeoxyuridine incorporation. Exposure to TCDD was found to inhibit hepatocyte proliferation in the regenerating liver of NK cell-depleted mice and control mice to the same extent. Hence, it is unlikely that enhanced numbers or increased activation of NK cells contribute to the suppression of liver regeneration in TCDD-treated mice.

  13. Effect of transforming growth factor-β1 on human intrahepatic cholangiocarcinoma cell growth

    Institute of Scientific and Technical Information of China (English)

    Tetsuya Shimizu; Takashi Tajiri; Shigeki Yokomuro; Yoshiaki Mizuguchi; Yutaka Kawahigashi; Yasuo Arima; Nobuhiko Taniai; Yasuhiro Mamada; Hiroshi Yoshida; Koho Akimaru

    2006-01-01

    AIM: To elucidate the biological effects of transforming growth factor-β1 (TGF-β1) on intrahepatic cholangiocarcinoma (ICC).METHODS: We investigated the effects of TGF-β1 on human ICC cell lines (HuCCT1, MEC, and HuH-28) by monitoring the influence of TGF-β1 on tumor growth and interleukin-6 (IL-6) expression in ICC cells.RESULTS: All three human ICC cell lines produced TGF-β1 and demonstrated accelerated growth in the presence of TGF-β1 with no apoptotic effect. Studies on HuCCT1 revealed a TGF-β1-induced stimulation of the expression of TGF-β1, as well as a decrease in TGF-β1 mRNA expression induced by neutralizing anti-TGF-β1 antibody. These results indicate that TGF-β1 stimulates the production and function of TGF-β1 in an autocrine fashion. Further, IL-6 secretion was observed in all three cell lines and exhibited an inhibitory response to neutralizing anti-TGF-β1 antibody. Experiments using HuCCT1 revealed a TGF-β1-induced acceleration of IL-6 protein expression and mRNA levels. These findings demonstrate a functional interaction between TGF-β1 and IL-6. All three cell lines proliferated in the presence of IL-6. In contrast, TGF-β1 induced no growth effect in HuCCT1 in the presence of small interfering RNA against a specific cell surface receptor of IL-6 and signal transducer and activator of transcription-3.CONCLUSION: ICC cells produce TGF-β1 and confer a TGF-β1-induced growth effect in an autocrine fashion.TGF-β1 activates IL-6 production, and the functional interaction between TGF-β1 and IL-6 contributes to ICC cell growth by TGF-β1.

  14. 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.

  15. Antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts.

    Directory of Open Access Journals (Sweden)

    Yun-Ping Lim

    Full Text Available The objective of this study was to determine the association between the use of antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts (MNLIHD.We used the research database of the Taiwan National Health Insurance Program to conduct a population-based, case-control study. We identified 9944 patients with antiarrhythmic history who were first diagnosed as having MNLIHD between 2005 and 2010. We identified an additional 19,497 patients with antiarrhythmic history in the same period who did not develop MNLIHD and were frequency-matched using age, sex, and index year to form a control group. Five commercially available antiarrhythmic agents, amiodarone, mexiletine, propafenone, quinidine, and procainamide, were analyzed.The adjusted odds ratio (OR of MNLIHD was 1.60 (95% confidence interval [CI], 1.45-1.77 for amiodarone users versus nonamiodarone users. In subgroup analysis, amiodarone use was significantly associated with an increased risk of MNLIHD with an adjusted OR of 18.0 (95% CI, 15.7-20.5 for patients with comorbidities compared to an OR of 2.43 (95% CI, 1.92-3.06 for those without comorbidities. After adjustment for age, sex, statins, anti-diabetes medications, non-steroidal antiinflammatory drugs, propafenone use, quinidine use, and comorbidities, the ORs were 1.49, 1.66, and 1.79 for MNLIHD associated with annual mean defined daily doses of ≤ 30, 31-145, and >145, respectively.The results of the present study indicated that amiodarone might be associated with the development of MNLIHD in a dose-dependent manner, particularly among patients with comorbidities.

  16. Hepatitis B virus infection: A favorable prognostic factor for intrahepatic cholangiocarcinoma after resection

    Institute of Scientific and Technical Information of China (English)

    Hua-Bang Zhou; Meng-Chao Wu; He-Ping Hu; Hui Wang; Yu-Qiong Li; Shuang-Xi Li; Hao Wang; Dong-Xun Zhou; Qian-Qian Tu; Qing Wang; Shan-Shan Zou

    2011-01-01

    AIM: To study the prognostic factors for intrahepatic cholangiocarcinoma (ICC) and evaluate the impact of chronic hepatitis B virus (HBV) infection on survival rate of ICC patients. METHODS: A total of 155 ICC patients who underwent macroscopic curative resections (R0 and R1) were enrolled in this retrospective study and divided into group A with HBV infection and group B without HBV infection according to their chronic HBV infection, represented by positive hepatitis B surface antigen (HBsAg) in serum or in liver tissue. Clinicopathological characteristics and survival rate of the patients were evaluated. RESULTS: All patients underwent anatomical resection. Their 1- and 3-year survival rates were 60.6% and 32.1%, respectively. Multivariate analyses revealed that HBV infection, hepatolithiasis, microscopic satellite lesion, and lymphatic metastasis were the independent prognostic factors for the survival rate of ICC patients. The median disease-free survival time of the patients was 5.0 mo. The number of tumors, microscopic satellite lesion, and vascular invasion were the independent prognostic factors for the disease-free survival rate of the patients. The prognostic factors affecting the survival rate of ICC patients with HBV infection and those without HBV infection were not completely consistent. Alkaline phosphatase > 119 U/L, microscopic satellite lesion, vascular invasion, and lymphatic metastasis were the independent factors for the patients with HBV infection, while r-glutamyltransferase > 64 U/L, microscopic satellite lesion, and poor tumor differentiation were the independent factors for the patients without HBV infection. CONCLUSION: HBV infection is a valuable clinical factor for predicting tumor invasiveness and clinical outcome of ICC patients. ICC patients with HBV infection should be distinguished from those without HBV infection because they have different clinicopathological characteristics, prognostic factors and outcomes after surgical

  17. Fetal outcomes in pregnancies complicated by intrahepatic cholestasis of pregnancy in a Northern California cohort.

    Directory of Open Access Journals (Sweden)

    Michelle Rook

    Full Text Available BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP has important fetal implications. There is increased risk for poor fetal outcomes, including preterm delivery, meconium staining of amniotic fluid, respiratory distress, fetal distress and demise. METHODS: One hundred and one women diagnosed with ICP between January 2005 and March 2009 at San Francisco General Hospital were included in this study. Single predictor logistic regression models were used to assess the associations of maternal clinical and biochemical predictors with fetal complications. Clinical predictors analyzed included age, race/ethnicity, gravidity, parity, history of liver or biliary disease, history of ICP in previous pregnancies, and induction. Biochemical predictors analyzed included serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, albumin, total protein, and total bile acids (TBA. RESULTS: The prevalence of ICP was 1.9%. Most were Latina (90%. Labor was induced in the majority (87% and most were delivered by normal spontaneous vaginal delivery (84%. Fetal complications occurred in 33% of the deliveries, with respiratory distress accounting for the majority of complications. There were no statistically significant clinical or biochemical predictors associated with an increased risk of fetal complications. Elevated TBA had little association with fetal complications until reaching greater than 100 µmoL/L, with 3 out of 5 having reported complications. ICP in previous pregnancies was associated with decreased risk of fetal complications (OR 0.21, p = 0.046. There were no cases of late term fetal demise. CONCLUSIONS: Maternal clinical and laboratory features, including elevated TBA, did not appear to be substantial predictors of fetal complications in ICP.

  18. Transjugular intrahepatic portosystemic shunt: results and prognostic factors in patients with post-necrotic liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Joo [Kyungbook National University College of Medicine, Taegu (Korea, Republic of)

    1997-01-01

    To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt(TIPS) in the management of gastroesophageal variceal bleeding and predictive factors for long-term survival in patients with post-necrotic liver cirrhosis. A total of 49 patients with post-necrotic liver cirrhosis underwent TIPS over a recent three-year period. Forty-five had a history of hepatitis B viral infection, and four, of hepatitis C viral infection. In all patients, the indication for the procedure was variceal bleeding. Child-Pugh class was A in seven patients, B in 16 and C in 26 patients at the time of the last bleeding. The effectiveness of portal decompression and bleeding control was evaluated. Long-term survival was calculated by the Kaplan-Meier method and predictive factors were analyzed using the Wilcoxon test. The procedure was technically successful in all cases. The portosystemic pressure gradient decreased significantly from 21.4 {+-} 6.4 mmHg to 12.0 {+-} 5.1 mmHg(N=45). Active variceal bleeding was controlled in 34 of the 37 emergency patients. The total length of follow-up was from one day to three and a half years(mean : 383 {+-} 357 days). Rebleeding developed in 17 patients (35%). Hepatic encephalopathy, either newly developed or aggravated, occurred in 16 (32.7%). The thirty-day mortality rate was 20.4%, and the one-year survival rate was 63.8%. The significant predictive factors for poor prognosis were Child-Pugh class C and post-TIPS hepatic encephalopathy. TIPS is effective in portal decompression in the patients with variceal bleeding due to post-necrotic liver cirrhosis. The Child-Pugh classification and hepatic encephalopathy after TIPS are considered to be significant predictive factors for long-term survival.

  19. Prevention of potential complications related to transjugular intrahepatic portosystemic shunt procedure: efficacy of polytetrafluoroethylene stent grfat

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Jae Hong; Seong, Chang Kyu [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of); Kim, Young Hwan; Choi, Jin Soo; Lee, Sang Kwon; Kim, Gab Chul [School of Medicine, Keimyung Univ., Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Seong, Nak Kwan; Park, Young Chan [School of Medicine, Daegu Catholic Univ., Daegu (Korea, Republic of)

    2004-11-01

    The purpose of this study was to assess the efficacy of a polytetrafluoroethylene (PTFE) stent graft for preventing potential complications related to a transjugular intrahepatic portosystemic shunt (TIPS). Between January 2002 and March 2003, seven patients (males: 5, females: 2, mean age: 44) underwent TIPS stent placement using the PTFE stent graft (Nitis,Taewoong, Seoul, Korea) to prevent potential complications such as life threatening hemoperitoneum, hemobilia and early stent occlusion. Three patients were admitted for esophageal varix bleeding, three patients were admitted for gastric varix bleeding and one patient was admitted for umbilical bleeding. The extrahepatic portal vein was punctured inadvertently in four patients (main portal vein: 1 case, portal vein bifurcation: 3 cases), but contrast media extravasation into the peritoneal cavity on the tractogram was noted only in two patients. Two of four patients had chronic portal vein occlusion with intra- and extrahepatic cavernous transformation. The bile duct was inadvertently punctured and visualized on the tractogram in three patients. All the identified biliary trees or contrast media extravasations observed on the tractograms were successfully sealed off on the post-procedure portograms. The immediate post-procedure clinical recovery courses were uneventful in all patients (no hemobilia or hemoperitoneum was noted). Bleeding control was successful in all patients. The one patient who had Child-Pugh cIass C disease died of hepatic encephalopathy 3 days after TIPS placement. Five of the six living patients have not shown any complications or rebleeding during the follow up periods (9-23 months). The one patient who had biliary communication on the tractogram rebled due to TIPS stent stenosis 25 days after TIPS, and this patient was successfully treated by TIPS revision. Potential complications related to TIPS procedure can be successfully prevented with PTFE stent graft placement.

  20. Primum non nocere: how active management became modus operandi for intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Henderson, Cassandra E; Shah, Reena R; Gottimukkala, Sri; Ferreira, Khaldun K; Hamaoui, Abraham; Mercado, Ray

    2014-09-01

    The Royal College of Obstetrics and Gynecology does not endorse routine active management of intrahepatic cholestasis of pregnancy (ICP)-affected pregnancies. In contrast, the American College of Obstetricians and Gynecologists supports active management protocols for ICP. To investigate this controversy, we evaluated the evidence supporting ICP as a medical indication for early term delivery and the evolution of active management protocols for ICP. Sixteen articles published between 1986 and 2011 were identified. We created 2 groups based on whether obstetric care included active management. Group 1 comprised 6 uncontrolled reports without active management that were published between 1967 and 1983 that described high perinatal mortality rates that primarily were related to prematurity sequel. This group became the fundamental 'core' evidence for ICP-associated stillbirths and by extrapolation justification for active management. Group 2 was comprised of 10 reports in which the authors credited empirically adopted active management with the observed low stillbirth rates in ICP-affected pregnancies. Although the group 1 articles routinely are cited as evidence of ICP-associated stillbirth risk, the 1.2% stillbirth rate (4/331) in this group is similar to the background stillbirth rates of 1.1% (11/1000) and 0.6% (6/1000) in 1967 and 2011, respectively (P = .062 and P = .0614, respectively). Likewise, the stillbirth rates for articles in group 2 were similar to their respective national stillbirth rate. Nevertheless, group 2 articles have become the evidence-based support for active management. We found no evidence to support the practice of active management for ICP. Copyright © 2014 Mosby, Inc. All rights reserved.

  1. Intrahepatic cholestasis of pregnancy is associated with an increased risk of gestational diabetes.

    Science.gov (United States)

    Martineau, Marcus; Raker, Christina; Powrie, Raymond; Williamson, Catherine

    2014-05-01

    To evaluate the association between intrahepatic cholestasis of pregnancy (ICP) and gestational diabetes mellitus (GDM). A retrospective case-control study of pregnancy outcomes in 57,724 women managed at a university teaching hospital in Rhode Island, USA, in whom universal screening for GDM had been performed and who were assessed for the incidence of ICP. Pregnancies complicated by ICP or GDM between February 2005 and June 2011 were identified from the electronic patient records using appropriate ICD codes. A total of 125 cases were required to detect a difference in the incidence of GDM in ICP at 5% significance with 80% power. Demographic and clinical outcome data (including maternal age, ethnic group, BMI, and infant weight and gender) were also collected. Of the 57,724 pregnancies, 143 were complicated by ICP (0.25%) and 4880 by GDM (8.5%). Nineteen ICP cases had GDM. The incidence of GDM in ICP was 13.6% (19/140, OR 1.68 CI 1.04-2.72). Where gestational ages were available (n=105), of those screened for GDM prior to developing ICP, 13.4% (11/82, OR 1.64 CI 0.88-3.06) had a confirmed diagnosis, rising to 30% (7/23, OR 4.69 CI 1.98-11.1) in cases that were screened following the onset of cholestasis. Simple linear regression analysis of adjusted birth weight centiles in ICP revealed a significant linear trend of increasing centiles with gestational age (p=0.005). These data support the hypothesis that the incidence of GDM is higher in women predisposed to developing ICP. It is likely that this susceptibility increases further following the onset of cholestasis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?

    Science.gov (United States)

    Oztas, Efser; Erkenekli, Kudret; Ozler, Sibel; Ersoy, Ali Ozgur; Kurt, Mevlut; Oztas, Erkin; Uygur, Dilek; Danisman, Nuri

    2015-11-01

    Our aim was to investigate whether any hematological changes readily detectable by simple complete blood count (CBC), as well as fasting and postprandial total serum bile acid (SBA) levels, have diagnostic values for the prediction of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP). A prospective, case control study was carried out including 217 pregnant women (117 women with ICP and 100 healthy controls). The main outcome measures investigated were preterm delivery, APGAR scores, and neonatal unit admission. A multivariate logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes. Compared with controls, women with ICP had significantly higher mean platelet volume (MPV) (mean 10.2±1.0 vs. 11.0±1.3; P<0.001) and platelet distribution width (PDW) (mean 13.1±2.3 vs. 14.7±2.8; P<0.001) values. Analysis with logistic regression revealed that the probability of preterm delivery did not increase until MPV levels exceeded 11.2 fL [odds ratio (OR)=2.68, 95% confidence interval (CI)=1.13-6.32, P=0.025], and total bilirubin levels exceeded 0.6 mg/dL (OR=3.13, 95% CI=1.21-8.09, P=0.019). Considering the low APGAR scores, only increased postprandial total SBA levels of ≥51 μmol/L were found to be predictive significantly (OR=3.02, 95% CI=1.07-8.53, P=0.037). Our study suggests that increased MPV and total bilirubin levels are associated with preterm delivery, and increased postprandial total SBA levels are predictive for low APGAR in ICP patients.

  3. Early induction of labor in high-risk intrahepatic cholestasis of pregnancy: what are the costs?

    Science.gov (United States)

    Friberg, Anne Katrine; Zingmark, Vera; Lyndrup, Jens

    2016-10-01

    Induction of labor among pregnant women with high levels of total bile acid (TBA) is common among clinicians. We examined, if women with intrahepatic cholestasis of pregnancy (ICP) and TBA ≥ 40 μmol/l have a higher risk of maternal-fetal complications, when labor is induced at 37 weeks of gestation, compared with induction of labor at term in women with low-risk ICP. Retrospective cohort study of 16,185 women delivering at Roskilde University Hospital in the period 2006-2011. Women with high-risk ICP (TBA ≥ 40 μmol/l) had labor induced at 37 weeks of gestation; women with low-risk ICP (TBA < 40 μmol/l) at term. Mode of delivery, duration of induction procedures, highest level of TBA and alanine aminotransferase (ALT) and for the neonates: Apgar scores at 5 min, umbilical cord pHs and SBEs, NICU admissions and birthweights. The incidences of ICP was 1.2 % (95 % CI 1.05-1.39 %) altogether and for high-risk ICP 0.4 % (95 % CI 0.27-0.46 %). No difference was found in mode of delivery, length of induction of labor nor in neonatal outcomes, except for an expected difference in birthweight. In high-risk ICP, ALT was not raised in 10.3 % (95 % CI 2.5-18.2 %). Early induction of labor at 37 weeks of gestation seems justified in high-risk ICP, as, except for abbreviating gestational age by 9 days with 296 g smaller babies, induction of labor was not followed by detectable maternal-fetal disadvantages and is favored by an expected major reduction in ICP stillbirth risk.

  4. Comparative proteomics analysis of placenta from pregnant women with intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Zhang, Ting; Guo, Yueshuai; Guo, Xuejiang; Zhou, Tao; Chen, Daozhen; Xiang, Jingying; Zhou, Zuomin

    2013-01-01

    Intrahepatic cholestasis of pregnancy (ICP) usually occurs in the third trimester and associated with increased risks in fetal complications. Currently, the exact cause of this disease is unknown. In this study we aim to investigate the potential proteins in placenta, which may participate in the molecular mechanisms of ICP-related fetal complications using iTRAQ-based proteomics approach. The iTRAQ analysis combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to separate differentially expressed placental proteins from 4 pregnant women with ICP and 4 healthy pregnant women. Bioinformatics analysis was used to find the relative processes that these differentially expressed proteins were involved in. Three apoptosis related proteins ERp29, PRDX6 and MPO that resulted from iTRAQ-based proteomics were further verified in placenta by Western blotting and immunohistochemistry. Placental apoptosis was also detected by TUNEL assay. Proteomics results showed there were 38 differentially expressed proteins from pregnant women with ICP and healthy pregnant women, 29 were upregulated and 9 were downregulated in placenta from pregnant women with ICP. Bioinformatics analysis showed most of the identified proteins was functionally related to specific cell processes, including apoptosis, oxidative stress, lipid metabolism. The expression levels of ERp29, PRDX6 and MPO were consistent with the proteomics data. The apoptosis index in placenta from ICP patients was significantly increased. This preliminary work provides a better understanding of the proteomic alterations of placenta from pregnant women with ICP and may provide us some new insights into the pathophysiology and potential novel treatment targets for ICP.

  5. A Comprehensive Evaluation of Steroid Metabolism in Women with Intrahepatic Cholestasis of Pregnancy.

    Science.gov (United States)

    Pařízek, Antonín; Hill, Martin; Dušková, Michaela; Vítek, Libor; Velíková, Marta; Kancheva, Radmila; Šimják, Patrik; Koucký, Michal; Kokrdová, Zuzana; Adamcová, Karolína; Černý, Andrej; Hájek, Zdeněk; Stárka, Luboslav

    2016-01-01

    Intrahepatic cholestasis of pregnancy (ICP) is a common liver disorder, mostly occurring in the third trimester. ICP is defined as an elevation of serum bile acids, typically accompanied by pruritus and elevated activities of liver aminotransferases. ICP is caused by impaired biliary lipid secretion, in which endogenous steroids may play a key role. Although ICP is benign for the pregnant woman, it may be harmful for the fetus. We evaluated the differences between maternal circulating steroids measured by RIA (17-hydroxypregnenolone and its sulfate, 17-hydroxyprogesterone, and cortisol) and GC-MS (additional steroids), hepatic aminotransferases and bilirubin in women with ICP (n = 15, total bile acids (TBA) >8 μM) and corresponding controls (n = 17). An age-adjusted linear model, receiver-operating characteristics (ROC), and multivariate regression (a method of orthogonal projections to latent structure, OPLS) were used for data evaluation. While aminotransferases, conjugates of pregnanediols, 17-hydroxypregnenolone and 5β-androstane-3α,17β-diol were higher in ICP patients, 20α-dihydropregnenolone, 16α-hydroxy-steroids, sulfated 17-oxo-C19-steroids, and 5β-reduced steroids were lower. The OPLS model including steroids measured by GC-MS and RIA showed 93.3% sensitivity and 100% specificity, while the model including steroids measured by GC-MS in a single sample aliquot showed 93.3% sensitivity and 94.1% specificity. A composite index including ratios of sulfated 3α/β-hydroxy-5α/β-androstane-17-ones to conjugated 5α/β-pregnane-3α/β, 20α-diols discriminated with 93.3% specificity and 81.3% sensitivity (ROC analysis). These new data demonstrating altered steroidogenesis in ICP patients offer more detailed pathophysiological insights into the role of steroids in the development of ICP.

  6. Intrahepatic cholestasis of pregnancy with concomitant hepatitis C virus infection, Joan C. Edwards SOM, Marshall University.

    Science.gov (United States)

    Belay, Tilahun; Woldegiorgis, Hailegiorgis; Gress, Todd; Rayyan, Yaser

    2015-04-01

    Intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus, otherwise unexplained deranged liver enzyme levels, and elevated levels of serum bile acid. ICP has been observed more commonly in hepatitis C virus (HCV) infected women than in women with no HCV infection, and some experts advocate testing for HCV infection in all patients with ICP. The aim of our study was to examine the clinical characteristics of pregnant women with ICP and HCV infection. We reviewed the records of pregnant women between 18 and 45 years of age over a period of 6 years with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of HCV infection, ICP, or both. We collected demographic, clinical, and financial data on all the patients and compared them with and without a diagnosis of ICP. There were 91 pregnant women with a diagnosis of HCV, and 41 (45%) of these women were diagnosed with ICP. HCV-infected patients with ICP had a significantly higher median viral load compared with those without ICP (495,000 vs. 8000 copies/ml, P<0.001). The median total financial charges spent for the care of ICP patients with HCV infection was significantly higher than that spent on ICP patients without HCV infection ($12,753.00 vs. $8970.00, P=0.01). We found a high prevalence of ICP among pregnant women infected with HCV, and those with ICP had a higher HCV viral load. Women with suspected ICP should be tested for the presence of HCV.

  7. Comparative proteomics analysis of placenta from pregnant women with intrahepatic cholestasis of pregnancy.

    Directory of Open Access Journals (Sweden)

    Ting Zhang

    Full Text Available INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP usually occurs in the third trimester and associated with increased risks in fetal complications. Currently, the exact cause of this disease is unknown. In this study we aim to investigate the potential proteins in placenta, which may participate in the molecular mechanisms of ICP-related fetal complications using iTRAQ-based proteomics approach. METHODS: The iTRAQ analysis combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS was performed to separate differentially expressed placental proteins from 4 pregnant women with ICP and 4 healthy pregnant women. Bioinformatics analysis was used to find the relative processes that these differentially expressed proteins were involved in. Three apoptosis related proteins ERp29, PRDX6 and MPO that resulted from iTRAQ-based proteomics were further verified in placenta by Western blotting and immunohistochemistry. Placental apoptosis was also detected by TUNEL assay. RESULTS: Proteomics results showed there were 38 differentially expressed proteins from pregnant women with ICP and healthy pregnant women, 29 were upregulated and 9 were downregulated in placenta from pregnant women with ICP. Bioinformatics analysis showed most of the identified proteins was functionally related to specific cell processes, including apoptosis, oxidative stress, lipid metabolism. The expression levels of ERp29, PRDX6 and MPO were consistent with the proteomics data. The apoptosis index in placenta from ICP patients was significantly increased. CONCLUSION: This preliminary work provides a better understanding of the proteomic alterations of placenta from pregnant women with ICP and may provide us some new insights into the pathophysiology and potential novel treatment targets for ICP.

  8. Autotaxin activity has a high accuracy to diagnose intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Kremer, Andreas E; Bolier, Ruth; Dixon, Peter H; Geenes, Victoria; Chambers, Jenny; Tolenaars, Dagmar; Ris-Stalpers, Carrie; Kaess, Bernhard M; Rust, Christian; van der Post, Joris A; Williamson, Catherine; Beuers, Ulrich; Oude Elferink, Ronald P J

    2015-04-01

    Intrahepatic cholestasis of pregnancy (ICP) is defined by pruritus, elevated total fasting serum bile salts (TBS) and transaminases, and an increased risk of adverse fetal outcome. An accurate diagnostic marker is needed. Increased serum autotaxin correlates with cholestasis-associated pruritus. We aimed at unraveling the diagnostic accuracy of autotaxin in ICP. Serum samples and placental tissue were collected from 44 women with uncomplicated pregnancies and 105 with pruritus and/or elevated serum transaminases. Autotaxin serum levels were quantified enzymatically and by Western blotting, autotaxin gene expression by quantitative PCR. Serum autotaxin was increased in ICP (mean ± SD: 43.5 ± 18.2 nmol ml(-1)min(-1), n=55, ppregnancy (16.8 ± 6.7 nmol ml(-1)min(-1), n=33), pre-eclampsia complicated by HELLP-syndrome (16.8 ± 8.9 nmol ml(-1)min(-1), n=17), and pregnant controls (19.6 ± 5.7 nmol ml(-1)min(-1), n=44). Longitudinal analysis during pregnancy revealed a marked rise in serum autotaxin with onset of ICP-related pruritus. Serum autotaxin was increased in women taking oral contraceptives. Increased serum autotaxin during ICP was not associated with increased autotaxin mRNA in placenta. With a cut-off value of 27.0 nmol ml(-1)min(-1), autotaxin had an excellent sensitivity and specificity in distinguishing ICP from other pruritic disorders or pre-eclampsia/HELLP-syndrome. Serum autotaxin displayed no circadian rhythm and was not influenced by food intake. Increased serum autotaxin activity represents a highly sensitive, specific and robust diagnostic marker of ICP, distinguishing ICP from other pruritic disorders of pregnancy and pregnancy-related liver diseases. Pregnancy and oral contraception increase serum autotaxin to a much lesser extent than ICP. Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  9. Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum.

    Science.gov (United States)

    Abu-Hayyeh, Shadi; Ovadia, Caroline; Lieu, TinaMarie; Jensen, Dane D; Chambers, Jenny; Dixon, Peter H; Lövgren-Sandblom, Anita; Bolier, Ruth; Tolenaars, Dagmar; Kremer, Andreas E; Syngelaki, Argyro; Noori, Muna; Williams, David; Marin, Jose J G; Monte, Maria J; Nicolaides, Kypros H; Beuers, Ulrich; Oude-Elferink, Ronald; Seed, Paul T; Chappell, Lucy; Marschall, Hanns-Ulrich; Bunnett, Nigel W; Williamson, Catherine

    2016-04-01

    A challenge in obstetrics is to distinguish pathological symptoms from those associated with normal changes of pregnancy, typified by the need to differentiate whether gestational pruritus of the skin is an early symptom of intrahepatic cholestasis of pregnancy (ICP) or due to benign pruritus gravidarum. ICP is characterized by raised serum bile acids and complicated by spontaneous preterm labor and stillbirth. A biomarker for ICP would be invaluable for early diagnosis and treatment and to enable its differentiation from other maternal diseases. Three progesterone sulfate compounds, whose concentrations have not previously been studied, were newly synthesized and assayed in the serum of three groups of ICP patients and found to be significantly higher in ICP at 9-15 weeks of gestation and prior to symptom onset (group 1 cases/samples: ICP n = 35/80, uncomplicated pregnancy = 29/100), demonstrating that all three progesterone sulfates are prognostic for ICP. Concentrations of progesterone sulfates were associated with itch severity and, in combination with autotaxin, distinguished pregnant women with itch that would subsequently develop ICP from pruritus gravidarum (group 2: ICP n = 41, pruritus gravidarum n = 14). In a third group of first-trimester samples all progesterone sulfates were significantly elevated in serum from low-risk asymptomatic women who subsequently developed ICP (ICP/uncomplicated pregnancy n = 54/51). Finally, we show mechanistically that progesterone sulfates mediate itch by evoking a Tgr5-dependent scratch response in mice. Our discovery that sulfated progesterone metabolites are a prognostic indicator for ICP will help predict onset of ICP and distinguish it from benign pruritus gravidarum, enabling targeted obstetric care to a high-risk population. Delineation of a progesterone sulfate-TGR5 pruritus axis identifies a therapeutic target for itch management in ICP. © 2015 The Authors. Hepatology published by Wiley Periodicals, Inc., on

  10. Severe intrahepatic cholestasis of pregnancy is a risk factor for preeclampsia in singleton and twin pregnancies.

    Science.gov (United States)

    Raz, Yael; Lavie, Anat; Vered, Yaffa; Goldiner, Ilana; Skornick-Rapaport, Avital; Landsberg Asher, Ysca; Maslovitz, Sharon; Levin, Ishai; Lessing, Joseph B; Kuperminc, Michael J; Rimon, Eli

    2015-09-01

    Intrahepatic cholestasis of pregnancy (ICP) is known to be associated with fetal complications. It recently was suggested to be associated possibly with preeclampsia (PET) as well. The objective of this study was to investigate that possibility. The study group included 78 women (54 singleton and 24 twin pregnancies) who had been diagnosed with ICP based on clinical presentation, elevated liver enzymes, and elevated total bile acids (>10 μmol/L). Disease severity was based on total bile acids levels as being severe (>40 μmol/L), moderate (20-40 μmol/L), or mild (10-20 μmol/L). The course of disease was reviewed carefully in each case. The control groups were comprised of apparently healthy women with singleton (n = 200) and twin (n = 100) pregnancies that were drawn randomly from a computerized registry of all the deliveries in our institution during the study period. The total incidence of PET was significantly higher for the patients with ICP who had singleton and twin pregnancies compared with the control groups (singletons: 7.4% vs 1.5%; P pregnancies compared with control subjects. Severe ICP, but not mild ICP, was a major risk factor for PET among women with either singleton or twin pregnancies. The timing of the initial presentation of ICP had no effect on PET incidence rates. Preeclampsia occurred usually 2-4 weeks after the diagnosis of ICP, and proteinuria preceded elevated blood pressure in all cases. Moreover, the total bile acid levels among 33 women who were diagnosed as having PET, but not ICP, were within normal range. ICP increases the incidence of PET; severe disease was a major risk factor for preeclampsia. Therefore, we strongly suggest including routine evaluation for preeclampsia in the treatment of women with moderate and severe ICP. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. A Comprehensive Analysis of Common Genetic Variation Around Six Candidate Loci for Intrahepatic Cholestasis of Pregnancy

    Science.gov (United States)

    Dixon, Peter H; Wadsworth, Christopher A; Chambers, Jennifer; Donnelly, Jennifer; Cooley, Sharon; Buckley, Rebecca; Mannino, Ramona; Jarvis, Sheba; Syngelaki, Argyro; Geenes, Victoria; Paul, Priyadarshini; Sothinathan, Meera; Kubitz, Ralf; Lammert, Frank; Tribe, Rachel M; Ch'ng, Chin Lye; Marschall, Hanns-Ulrich; Glantz, Anna; Khan, Shahid A; Nicolaides, Kypros; Whittaker, John; Geary, Michael; Williamson, Catherine

    2014-01-01

    OBJECTIVES: Intrahepatic cholestasis of pregnancy (ICP) has a complex etiology with a significant genetic component. Heterozygous mutations of canalicular transporters occur in a subset of ICP cases and a population susceptibility allele (p.444A) has been identified in ABCB11. We sought to expand our knowledge of the detailed genetic contribution to ICP by investigation of common variation around candidate loci with biological plausibility for a role in ICP (ABCB4, ABCB11, ABCC2, ATP8B1, NR1H4, and FGF19). METHODS: ICP patients (n=563) of white western European origin and controls (n=642) were analyzed in a case–control design. Single-nucleotide polymorphism (SNP) markers (n=83) were selected from the HapMap data set (Tagger, Haploview 4.1 (build 22)). Genotyping was performed by allelic discrimination assay on a robotic platform. Following quality control, SNP data were analyzed by Armitage's trend test. RESULTS: Cochran–Armitage trend testing identified six SNPs in ABCB11 together with six SNPs in ABCB4 that showed significant evidence of association. The minimum Bonferroni corrected P value for trend testing ABCB11 was 5.81×10−4 (rs3815676) and for ABCB4 it was 4.6×10−7(rs2109505). Conditional analysis of the two clusters of association signals suggested a single signal in ABCB4 but evidence for two independent signals in ABCB11. To confirm these findings, a second study was performed in a further 227 cases, which confirmed and strengthened the original findings. CONCLUSIONS: Our analysis of a large cohort of ICP cases has identified a key role for common variation around the ABCB4 and ABCB11 loci, identified the core associations, and expanded our knowledge of ICP susceptibility. PMID:24366234

  12. Role of postprandial bile acids in prediction of perinatal outcome in intrahepatic cholestasis of pregnancy.

    Science.gov (United States)

    Sargın Oruç, Ayla; Seçkin, Berna; Özcan, Nagihan; Özyer, Sebnem; Uzunlar, Özlem; Danışman, Nuri

    2014-07-01

    The aim of this study was to investigate the role of fasting and postprandial total bile acids (fTBA, ppTBA) in prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). A total of 111 patients, 57 with ICP and 54 controls, were evaluated for preterm birth (PTB), meconium-stained amnion (MSA), neonatal intensive-care unit admission and asphyxia. We further classified the ICP group as mild and severe. Logistic regression was performed to evaluate the associated biochemical and clinical parameters with adverse perinatal outcomes. In the ICP group, PTB, asphyxia, admission to neonatal intensive-care unit, and MSA were more frequently observed (P = 0.001, P = 0.027, P = 0.006 and P = 0.030, respectively). In subgroup analysis, PTB was more frequent in severe ICP cases than in mild cases (P = 0.028). Fasting and ppTBA were positively correlated with serum aspartate aminotransferase and alanine aminotransferase levels. Postprandial TBA and difference between fasting and postprandial TBA levels were associated with asphyxia (P = 0.014 and P = 0.023, respectively). Gestational age at diagnosis and fTBA were associated with adverse perinatal outcomes (P = 0.001 and P = 0.025, respectively). Postprandial TBA and difference of fasting and postprandial TBA are associated with asphyxia in ICP. The gestational age at diagnosis and fTBA are associated with adverse perinatal outcomes. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  13. Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts.

    Science.gov (United States)

    Andring, Brice; Kalva, Sanjeeva P; Sutphin, Patrick; Srinivasa, Rajiv; Anene, Alvin; Burrell, Marc; Xi, Yin; Pillai, Anil K

    2015-07-14

    To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt (TIPS) created using a stent graft. The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes. Digital Subtraction Angiographic images with a measuring catheter in two orthogonal planes was used to determine the TIPS stent-to-inferior vena cava distance (SIVCD), hepatic vein to parenchymal tract angle (HVTA), portal vein to parenchymal tract angle (PVTA), and the accessed portal vein. The length and diameter of the TIPS stent and the use of concurrent variceal embolization were recorded by review of the patient's procedure note. Data on re-intervention within 30 d of TIPS placement, recurrence of symptoms, and survival were collected through the patient's chart. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency of TIPS, time to recurrence of symptoms, and all-cause mortality. There was no significant association between the SIVCD and primary patency (P = 0.23), time to recurrence of symptoms (P = 0.83), or all-cause mortality (P = 0.18). The 3, 6, and 12-mo primary patency rates for a SIVCD ≥ 1.5 cm were 82.4%, 64.7%, and 50.3% compared to 89.3%, 83.8%, and 60.6% for a SIVCD of technical parameters and time to recurrence of symptoms or all-cause mortality. Recurrence of symptoms was associated with stent graft stenosis (P = 0.03). TIPS stent-to-caval distance and other parameters have no significant effect on primary patency, time to recurrence of symptoms, or all-cause mortality following TIPS with a stent-graft.

  14. Actual over 10-year survival after liver resection for patients with intrahepatic cholangiocarcinoma.

    Science.gov (United States)

    Si, Anfeng; Li, Jun; Xiang, Hongjun; Zhang, Shichao; Bai, Shilei; Yang, Pinghua; Zhang, Xiaofeng; Xia, Yong; Wang, Kui; Yan, Zhenlin; Lau, Wan Yee; Shi, Lehua; Shen, Feng

    2017-07-04

    Partial hepatectomy is a potentially curative therapy for intrahepatic cholangiocarcinoma (ICC). Unfortunately, the overall surgical prognosis remains dismal and the actual 10-year survival has not been reported. This study aimed to document 10-year actual survival rates, identify the prognostic factors associated with 10-year survival rate, and analyze the characteristics of patients who survived ≥ 10 years. Among 251 patients who underwent curative liver resection for ICC between 2003 and 2006 at the Eastern Hepatobiliary Surgery Hospital, 21 patients (8.4%) survived ≥ 10 years. The 5-, 7-, and 10-year overall survival rates were 32.3%, 22.3% and 8.4%, respectively. The 10-year cumulative incidence of ICC-related death and recurrence were 80.9% and 85.7%, respectively. Multivariate analysis based on competing risk survival analysis identified that tumor > 5 cm was independently associated with ICC-related death and recurrence (hazard ratios: 1.369 and 1.445, respectively), in addition to carcinoembryonic antigen (CEA) >10 U/mL, carbohydrate antigen 19-9 (CA19-9) >39 U/mL, multiple nodules, vascular invasion, nodal metastasis and local extrahepatic invasion. Patients who survived ≥ 10 years had a longer time to first recurrence, lower levels of CEA, CA19-9 and alkaline phosphatase, less perioperative blood loss, solitary tumor, smaller tumor size, and absence of nodal metastasis or local extrahepatic invasion. In conclusion, a 10-year survival after liver resection for ICC is possible and can be expected in approximately 8.4% of patients.

  15. Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

    Science.gov (United States)

    Savic, Lynn Jeanette; Chapiro, Julius

    2017-01-01

    Intrahepatic cholangiocarcinoma (ICC) is a rare disease and carries a poor prognosis with surgery remaining the only curative treatment option. However, due to the late presentation of symptoms and close proximity of the tumors to central hepatic structures, only about 30% of patients are classified eligible to resection. As for palliative approaches, ICC constitutes a possible indication for loco-regional therapies (LRT). As such, intra-arterial therapies (IAT) are reported to be feasible, safe and effective in inducing tumor response in unresectable ICC. The paradigm of IAT is premised on the selective delivery of embolic, chemotherapeutic agents to the tumor via its feeding arteries, thus allowing dose escalation within the carcinoma and reduction of systemic toxicity. Conventional transcatheter arterial chemoembolization (cTACE) so far remains the most commonly used IAT modality. However, drug-eluting beads (DEB)-TACE was initiated with the idea of more selective targeting of the tumor owing to the combined embolizing as well as drug-eluting properties of the microspheres used in this setting. Moreover, radioembolization is performed by intra-arterial administration of very small spheres containing β-emitting yttrium-90 (Y90-RE) to the site of the tumor. Clinical evidence exists in support of survival benefits for IAT in the palliative treatment of ICC compared to surgery and systemic chemotherapy. As for combination regimens, cTACE, DEB-TACE and Y90-RE are reported to achieve conversion of patients to surgery in a sequential treatment planning and simultaneous IAT combinations may provide a therapeutic option for treatment escalation. Regarding the current status of literature, controlled randomized prospective trials to compare different IAT techniques and combination therapies as well as treatment recommendations for different IAT modalities are needed. PMID:28261591

  16. NSAID Use and Risk of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: The Liver Cancer Pooling Project.

    Science.gov (United States)

    Petrick, Jessica L; Sahasrabuddhe, Vikrant V; Chan, Andrew T; Alavanja, Michael C; Beane-Freeman, Laura E; Buring, Julie E; Chen, Jie; Chong, Dawn Q; Freedman, Neal D; Fuchs, Charles S; Gaziano, John Michael; Giovannucci, Edward; Graubard, Barry I; Hollenbeck, Albert R; Hou, Lifang; Jacobs, Eric J; King, Lindsay Y; Koshiol, Jill; Lee, I-Min; Linet, Martha S; Palmer, Julie R; Purdue, Mark P; Rosenberg, Lynn; Schairer, Catherine; Sesso, Howard D; Sigurdson, Alice J; Wactawski-Wende, Jean; Zeleniuch-Jacquotte, Anne; Campbell, Peter T; McGlynn, Katherine A

    2015-12-01

    Chronic inflammation plays a pivotal role in the pathogenesis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), the two most common types of liver cancer. A number of prior experimental studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, may potentially protect against liver cancer. However, no observational study has examined the association between aspirin duration and dose or other over-the-counter non-aspirin NSAIDs, such as ibuprofen, and liver cancer incidence. Furthermore, the association between NSAID use and risk of ICC is unclear. As part of the Liver Cancer Pooling Project, we harmonized data on 1,084,133 individuals (HCC = 679, ICC = 225) from 10 U.S.-based prospective cohort studies. Cox proportional hazards regression models were used to evaluate multivariable-adjusted HRs and 95% confidence intervals (CI). Current aspirin use, versus nonuse, was inversely associated with HCC (HR, 0.68; 95% CI, 0.57-0.81), which persisted when restricted to individuals not using non-aspirin NSAIDs and in a 5- and 10-year lag analysis. The association between aspirin use and HCC risk was stronger for users who reported daily use, longer duration use, and lower dosage. Ibuprofen use was not associated with HCC risk. Aspirin use was associated with a reduced ICC risk in men (HR, 0.64; 95% CI, 0.42-0.98) but not women (HR, 1.34; 95% CI, 0.89-2.01; P(interaction) = 0.01). The observed inverse association between aspirin use and liver cancer in our study, together with previous data, suggests the merit of future intervention studies of aspirin and other agents that affect chronic inflammatory pathways for HCC and possibly ICC.

  17. Mutation inactivation of Nijmegen breakage syndrome gene (NBS1 in hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

    Directory of Open Access Journals (Sweden)

    Yan Wang

    Full Text Available Nijmegen breakage syndrome (NBS with NBS1 germ-line mutation is a human autosomal recessive disease characterized by genomic instability and enhanced cancer predisposition. The NBS1 gene codes for a protein, Nbs1(p95/Nibrin, involved in the processing/repair of DNA double-strand breaks. Hepatocellular carcinoma (HCC is a complex and heterogeneous tumor with several genomic alterations. Recent studies have shown that heterozygous NBS1 mice exhibited a higher incidence of HCC than did wild-type mice. The objective of the present study is to assess whether NBS1 mutations play a role in the pathogenesis of human primary liver cancer, including HBV-associated HCC and intrahepatic cholangiocarcinoma (ICC. Eight missense NBS1 mutations were identified in six of 64 (9.4% HCCs and two of 18 (11.1% ICCs, whereas only one synonymous mutation was found in 89 control cases of cirrhosis and chronic hepatitis B. Analysis of the functional consequences of the identified NBS1 mutations in Mre11-binding domain showed loss of nuclear localization of Nbs1 partner Mre11, one of the hallmarks for Nbs1 deficiency, in one HCC and two ICCs with NBS1 mutations. Moreover, seven of the eight tumors with NBS1 mutations had at least one genetic alteration in the TP53 pathway, including TP53 mutation, MDM2 amplification, p14ARF homozygous deletion and promoter methylation, implying a synergistic effect of Nbs1 disruption and p53 inactivation. Our findings provide novel insight on the molecular pathogenesis of primary liver cancer characterized by mutation inactivation of NBS1, a DNA repair associated gene.

  18. Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunts

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jonathan K., E-mail: jonathan.park09@gmail.com [David Geffen School of Medicine at UCLA, Department of Radiology (United States); Al-Tariq, Quazi Z., E-mail: qat200@gmail.com [Stanford University School of Medicine, Department of Radiology (United States); Zaw, Taryar M., E-mail: taryar.zaw@gmail.com; Raman, Steven S., E-mail: sraman@mednet.ucla.edu; Lu, David S.K., E-mail: dlu@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Department of Radiology (United States)

    2015-10-15

    PurposeTo assess radiofrequency (RF) ablation efficacy, as well as the patency of transjugular intrahepatic portosystemic shunts (TIPSs), in patients with hepatocellular carcinoma (HCC).Materials and MethodsRetrospective database review of patients with pre-existing TIPS undergoing RF ablation of HCC was conducted over a 159-month period ending in November 2013. TIPS patency pre- and post-RF ablation was assessed by ultrasound, angiography, and/or contrast-enhanced CT or MRI. Patient demographics and immediate post-RF ablation outcomes and complications were also reviewed.Results19 patients with 21 lesions undergoing 25 RF ablation sessions were included. Child-Pugh class A, B, and C scores were seen in 1, 13, and 5 patients, respectively. Eleven patients (58 %) ultimately underwent liver transplantation. Immediate technical success was seen in all ablation sessions without residual tumor enhancement (100 %). No patients (0 %) suffered liver failure within 1 month of ablation. Pre-ablation TIPS patency was demonstrated in 22/25 sessions (88 %). Of 22 cases with patent TIPS prior to ablation, post-ablation patency was demonstrated in 22/22 (100 %) at immediate post-ablation imaging and in 21/22 (95 %) at last follow-up (1 patient was incidentally noted to have occlusion 31 months later). No immediate complications were observed.ConclusionAblation efficacy was similar to the cited literature values for patients without TIPS. Furthermore, TIPS patency was preserved in the majority of cases. Patients with both portal hypertension and HCC are not uncommonly encountered, and a pre-existing TIPS does not appear to be a definite contraindication for RF ablation.

  19. Digital histology quantification of intra-hepatic fat in patients undergoing liver resection.

    Science.gov (United States)

    Parkin, E; O'Reilly, D A; Plumb, A A; Manoharan, P; Rao, M; Coe, P; Frystyk, J; Ammori, B; de Liguori Carino, N; Deshpande, R; Sherlock, D J; Renehan, A G

    2015-08-01

    High intra-hepatic fat (IHF) content is associated with insulin resistance, visceral adiposity, and increased morbidity and mortality following liver resection. However, in clinical practice, IHF is assessed indirectly by pre-operative imaging [for example, chemical-shift magnetic resonance (CS-MR)]. We used the opportunity in patients undergoing liver resection to quantify IHF by digital histology (D-IHF) and relate this to CT-derived anthropometrics, insulin-related serum biomarkers, and IHF estimated by CS-MR. A reproducible method for quantification of D-IHF using 7 histology slides (inter- and intra-rater concordance: 0.97 and 0.98) was developed. In 35 patients undergoing resection for colorectal cancer metastases, we measured: CT-derived subcutaneous and visceral adipose tissue volumes, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), fasting serum adiponectin, leptin and fetuin-A. We estimated relative IHF using CS-MR and developed prediction models for IHF using a factor-clustered approach. The multivariate linear regression models showed that D-IHF was best predicted by HOMA-IR (Beta coefficient(per doubling): 2.410, 95% CI: 1.093, 5.313) and adiponectin (β(per doubling): 0.197, 95% CI: 0.058, 0.667), but not by anthropometrics. MR-derived IHF correlated with D-IHF (rho: 0.626; p = 0.0001), but levels of agreement deviated in upper range values (CS-MR over-estimated IHF: regression versus zero, p = 0.009); this could be adjusted for by a correction factor (CF: 0.7816). Our findings show IHF is associated with measures of insulin resistance, but not measures of visceral adiposity. CS-MR over-estimated IHF in the upper range. Larger studies are indicated to test whether a correction of imaging-derived IHF estimates is valid. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Metabolic and histological implications of intrahepatic triglyceride content in nonalcoholic fatty liver disease.

    Science.gov (United States)

    Bril, Fernando; Barb, Diana; Portillo-Sanchez, Paola; Biernacki, Diane; Lomonaco, Romina; Suman, Amitabh; Weber, Michelle H; Budd, Jeffrey T; Lupi, Maria E; Cusi, Kenneth

    2017-04-01

    The cut-off point of intrahepatic triglyceride (IHTG) content to define nonalcoholic fatty liver disease (NAFLD) by proton magnetic resonance spectroscopy ((1) H-MRS) was established based on the 95th percentile in a group of healthy individuals (i.e., ≥5.56%). Whether this threshold correlates with metabolic and histological changes and whether a further accumulation of IHTG is associated with worsening of these parameters has not been properly assessed in a large cohort of patients. In this cross-sectional study, 352 subjects were carefully characterized with the following studies: liver (1) H-MRS; euglycemic insulin clamp with measurement of glucose turnover; oral glucose tolerance test; and a liver biopsy. Hepatic insulin sensitivity (suppression of endogenous glucose production by insulin) was affected early on after IHTG content was ∼1.5% and remained uniformly impaired (∼40%-45%), regardless of further IHTG accumulation. Skeletal muscle insulin sensitivity showed a gradual impairment at low degrees of IHTG accumulation, but remained unchanged after IHTG content reached the ∼6 ± 2% threshold. A similar pattern was observed for metabolic changes typically associated with NAFLD, such as hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C). In contrast, adipose tissue insulin sensitivity (suppression of free fatty acids by insulin) showed a continuous worsening across the spectrum of IHTG accumulation in NAFLD (r = -0.38; P disease (inflammation, ballooning, and fibrosis) was not associated with the amount of IHTG content. IHTG accumulation is strongly associated with adipose tissue insulin resistance (IR), supporting the current theory of lipotoxicity as a driver of IHTG accumulation. Once IHTG accumulation reaches ∼6 ± 2%, skeletal muscle IR, hypertriglyceridemia, and low HDL-C become fully established. Histological activity appears to have an early threshold and is not significantly influenced by increasing amounts of IHTG

  1. Intrahepatic peripheral cholangiocarcinoma (IPCC): comparison between perfusion ultrasound and CT imaging.

    Science.gov (United States)

    D'Onofrio, M; Vecchiato, F; Cantisani, V; Barbi, E; Passamonti, M; Ricci, P; Malagò, R; Faccioli, N; Zamboni, G; Pozzi Mucelli, R

    2008-02-01

    This study was done to compare the perfusion patterns of intrahepatic peripheral cholangiocarcinoma (IPCC) on contrast-enhanced ultrasound (CEUS) and dynamic computed tomography (CT). We retrospectively reviewed 23 histologically proven cases of IPCC. All lesions were studied by CEUS with sulfur hexafluoride-filled microbubbles coated with a phospholipid capsule, and by dynamic CT. Contrast-enhancement patterns were evaluated in the arterial phase (CEUS 10-20 s after the injection; CT 25-30 s after the injection) and in the delayed phase (CEUS 120 s after the injection; CT>2-3 min after the injection). Lesions were single in 18/23 cases (78%), single with nearby satellite lesions in 1/23 (4%) cases and multifocal with distant secondary lesions in 4/23 (17%) cases. Lesion diameter was 2-5 cm in 7/23 cases (30%), 5-7 cm in 13/23 cases (57%) and >7 cm in 3/23 (13%) cases. On CEUS, lesions were hypervascular in 16/23 cases (70%). On delayed-phase CEUS, 22/23 lesions (96%) were markedly hypoechoic. CT showed that the lesions were hypovascular in the arterial phase in 15/23 cases (66%) and hypervascular in 7/23 (30%) cases; one lesion (1/23; 4%) was isovascular. On delayed-phase CT, lesions were hyperdense in 17/23 cases (74%), hypodense in 5/23 (22%) cases and isodense in 1/23 (43%) cases. Enhancement discrepancy between delayed-phase CEUS (hypoechogenicity) and CT (hyperdensity) is common semiological findings in the study of IPCC.

  2. Outcomes of Locoregional Tumor Therapy for Patients with Hepatocellular Carcinoma and Transjugular Intrahepatic Portosystemic Shunts

    Energy Technology Data Exchange (ETDEWEB)

    Padia, Siddharth A., E-mail: spadia@uw.edu; Chewning, Rush H., E-mail: rchewnin@uw.edu; Kogut, Matthew J., E-mail: kogutm@uw.edu; Ingraham, Christopher R., E-mail: cringa@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Bhattacharya, Renuka, E-mail: renuka@uw.edu [University of Washington Medical Center, Division of Gastroenterology and Hepatology, Department of Medicine (United States); Kwan, Sharon W., E-mail: shakwan@uw.edu; Monsky, Wayne L., E-mail: wmonsky@uw.edu; Vaidya, Sandeep, E-mail: svaidya@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States); Hippe, Daniel S., E-mail: dhippe@uw.edu [University of Washington Medical Center, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington Medical Center, Section of Interventional Radiology, Department of Radiology (United States)

    2015-08-15

    PurposeLocoregional therapy for hepatocellular carcinoma (HCC) can be challenging in patients with a transjugular intrahepatic portosystemic shunt (TIPS). This study compares safety and imaging response of ablation, chemoembolization, radioembolization, and supportive care in patients with both TIPS and HCC.MethodsThis retrospective study included 48 patients who had both a TIPS and a diagnosis of HCC. Twenty-nine of 48 (60 %) underwent treatment for HCC, and 19/48 (40 %) received best supportive care (i.e., symptomatic management only). While etiology of cirrhosis and indication for TIPS were similar between the two groups, treated patients had better baseline liver function (34 vs. 67 % Child-Pugh class C). Tumor characteristics were similar between the two groups. A total of 39 ablations, 17 chemoembolizations, and 10 yttrium-90 radioembolizations were performed on 29 patients.ResultsAblation procedures resulted in low rates of hepatotoxicity and clinical toxicity. Post-embolization/ablation syndrome occurred more frequently in patients undergoing chemoembolization than ablation (47 vs. 15 %). Significant hepatic dysfunction occurred more frequently in the chemoembolization group than the ablation group. Follow-up imaging response showed objective response in 100 % of ablation procedures, 67 % of radioembolization procedures, and 50 % of chemoembolization procedures (p = 0.001). When censored for OLT, patients undergoing treatment survived longer than patients receiving supportive care (2273 v. 439 days, p = 0.001).ConclusionsAblation appears to be safe and efficacious for HCC in patients with TIPS. Catheter-based approaches are associated with potential increased toxicity in this patient population. Chemoembolization appears to be associated with increased toxicity compared to radioembolization.

  3. Three-Dimensional Path Planning Software-Assisted Transjugular Intrahepatic Portosystemic Shunt: A Technical Modification

    Energy Technology Data Exchange (ETDEWEB)

    Tsauo, Jiaywei, E-mail: 80732059@qq.com; Luo, Xuefeng, E-mail: luobo-913@126.com [West China Hospital of Sichuan University, Institute of Interventional Radiology (China); Ye, Linchao, E-mail: linchao.ye@siemens.com [Siemens Ltd, Healthcare Sector (China); Li, Xiao, E-mail: simonlixiao@gmail.com [West China Hospital of Sichuan University, Institute of Interventional Radiology (China)

    2015-06-15

    PurposeThis study was designed to report our results with a modified technique of three-dimensional (3D) path planning software assisted transjugular intrahepatic portosystemic shunt (TIPS).Methods3D path planning software was recently developed to facilitate TIPS creation by using two carbon dioxide portograms acquired at least 20° apart to generate a 3D path for overlay needle guidance. However, one shortcoming is that puncturing along the overlay would be technically impossible if the angle of the liver access set and the angle of the 3D path are not the same. To solve this problem, a prototype 3D path planning software was fitted with a utility to calculate the angle of the 3D path. Using this, we modified the angle of the liver access set accordingly during the procedure in ten patients.ResultsFailure for technical reasons occurred in three patients (unsuccessful wedged hepatic venography in two cases, software technical failure in one case). The procedure was successful in the remaining seven patients, and only one needle pass was required to obtain portal vein access in each case. The course of puncture was comparable to the 3D path in all patients. No procedure-related complication occurred following the procedures.ConclusionsAdjusting the angle of the liver access set to match the angle of the 3D path determined by the software appears to be a favorable modification to the technique of 3D path planning software assisted TIPS.

  4. Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

    Institute of Scientific and Technical Information of China (English)

    Tetsuya Shimizu; Takashi Tajiri; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Satoshi Matsumoto; Yoshiaki Mizuguchi; Shigeki Yokomuro; Yasuo Arima; Koho Akimaru

    2006-01-01

    We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct.Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct.On d 46 after surgery, a retrograde transhepatic biliary drainage (RTBD) tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative management, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

  5. Age-related Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunts.

    Science.gov (United States)

    Suraweera, Duminda; Jimenez, Melissa; Viramontes, Matthew; Jamal, Naadir; Grotts, Jonathan; Elashoff, David; Lee, Edward W; Saab, Sammy

    2017-04-01

    To compare age-related morbidity and mortality after transjugular intrahepatic portosystemic shunts (TIPS). We performed a retrospective chart review of patients who underwent TIPS at the University of California Los Angeles Medical Center between 2008 to 2014. Elderly patients (65 y and older) were matched with nonelderly patients (controls, below 65 y) by model for end-stage liver disease (MELD) score (±3), indication for TIPS (refractory ascites vs. variceal bleeding), serum sodium level (±5), in a ratio of 1:1. Endpoints measures were hospital stay post-TIPS, rifaximin, or lactulose use, TIPS failure at 30 days, readmission at 90 days, MELD at 90 days, and mortality at 90 days. A total of 30 patient matches were included in this study: 30 control and 30 elderly patients. The median [interquartile (IQR)] MELD scores for controls and elderly were 11 (9, 13.8) for the controls and 11.5 (9, 14.8) for elderly patients (P=0.139). There were no significant differences in serum sodium and indication for TIPS. Thirty and 90-day follow-up laboratory test results were also similar between elderly and control patients. Event-free survival at 90 days was similar between controls and elderly patients [odds ratio (OR), 0.86; 95% confidence interval (CI), 0.3-2.5; P>0.05]. There was a trend toward greater hospitalization (OR, 1.76; 95% CI, 0.52-5.95; P=0.546) and mortality (OR, 3.3; 95% CI, 0.3-14.01; P=0.182). The results of this study suggest event-free survival is similar between nonelderly and elderly patients. Although statistically significant, there is a tendency toward greater mortality and hospitalization in the elderly.

  6. Application study of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones

    Institute of Scientific and Technical Information of China (English)

    LU De-Bin; LI Qiao-Lin

    2016-01-01

    Objective:To study the clinical effect of regular hepatectomy with choledochoscope in treatment of intrahepatic bile duct stones (IBDS);Methods:A total of 76 cases of patients with complex IBDS treated in our hospital from August 2014 to July 2015 were selected and divided into experimental group (n=38) and control group (n=38) according to random number table, and baseline information of two groups was without statistical significance. Experimental group received regular hepatectomy with choledochoscope and control group received multiple hepatolobectomy. Hepatolobectomy as well as TBIL (total bilirubin), ALB (albumin), ALT (alanine aminotransferase), AST (aspartate aminotransferase), APTT (activated partial thromboplastin time), postoperative complications, recurrence, clinical effect and other indexes of two groups 1 d before operation and 7 d after operation were observed;Results:left hemihepatectomy, left lateral lobectomy, right hemihepatectomy, right posterior lobectomy as well as left lateral and right posterior lobectomy rates of experimental group were not statistically different from those of control group. TBIL, ALB, ALT, AST and APTT of experimental group 7d after operation were not statistically different from those of control group. Excellent and good rate of treatment of experimental group (97.37%) was significantly higher than that of control group (76.32%), incidence of postoperative complications (15.79%) was significantly lower than that of control group (44.74%), stone residue rate of experimental group (5.26%) was significantly lower than that of control group (23.68%), and comparison between groups showed statistical significance;Conclusion:Regular hepatectomy with choledochoscope treatment of IBDS has higher excellent and good rate, more stable liver function indexes as well as lower rate of stone residue and incidence of postoperative complications, and it’s worth application in clinical practice.

  7. Laparoscopic button cholecystostomy for progressive familial intrahepatic cholestasis in two children.

    Science.gov (United States)

    Schukfeh, Nagoud; Gerner, Patrick; Paul, Andreas; Kathemann, Simone; Metzelder, Martin

    2014-10-01

    Untreated, progressive familial intrahepatic cholestasis (PFIC) results in fibrosis, cirrhosis, and liver failure. It has been shown that partial external biliary diversion (PEBD) may prevent from liver transplantation in patients without cirrhosis. The aim of this study is to present a new laparoscopic technique using a button instead of a bowel conduit for PEBD. Two boys with PFIC (patient 1, 17 months; patient 2, 12 years) underwent laparoscopic button cholecystostomy using a 3-trocar technique by insertion of a 14 French MIC KEY button (Kimberly-Clark Worldwide, Inc, Draper, Utah, United States) at the gallbladder fundus secured with two absorbable purse-string sutures. Beside the suitability of the procedure, end points included course of serum bile acids, total bilirubin, liver enzymes, and pruritus at a follow-up of 6 months. No complications related to the operation occurred. Relieve of pruritus was achieved in both the children, due to adequate bile drainage during a follow-up period of 6 months. In patient 2, a 10-mm gallstone was removed simultaneously. In patient 1, serum bile acids decreased from 12.3 to 6.6 µmol/L and in patient 2, serum bile acids decreased from 106.3 to 2.9 µmol/L. Total bilirubin, aspartate amino transferase, alanine amino transferase, and gamma-glutamyltransferase are kept in normal ranges during follow-up. Patient's and parent's acceptance with the button was excellent. Laparoscopic button cholecystostomy is a simple, safe, and sufficient technique for PEBD in patients with PFIC. It achieves an adequate bile flow with consecutive relief of pruritus and avoids an enteric anastomosis. Georg Thieme Verlag KG Stuttgart · New York.

  8. Yttrium-90 Radioembolization for Unresectable Standard-chemorefractory Intrahepatic Cholangiocarcinoma: Survival, Efficacy, and Safety Study

    Energy Technology Data Exchange (ETDEWEB)

    Rafi, Shoaib; Piduru, Sarat M. [Emory University School of Medicine, Division of Interventional Radiology and Image Guided Medicine, Department of Radiology (United States); El-Rayes, Bassel; Kauh, John S. [Emory University School of Medicine, Department of Hematology and Medical Oncology (United States); Kooby, David A.; Sarmiento, Juan M. [Emory University School of Medicine, Department of Surgical Oncology in Surgery (United States); Kim, Hyun S., E-mail: kevin.kim@emory.edu [Emory University School of Medicine, Division of Interventional Radiology and Image Guided Medicine, Department of Radiology (United States)

    2013-04-15

    To assess the overall survival, efficacy, and safety of radioembolization with yttrium-90 (Y90) for unresectable standard-chemorefractory intrahepatic cholangiocarcinoma (ICC). Patients with unresectable standard-chemorefractory ICC treated with Y90 were studied. Survival was calculated from the date of first Y90 procedure. Tumor response was assessed with the Response Evaluation Criteria in Solid Tumors criteria on follow-up computed tomography or magnetic resonance imaging scans. National Cancer Institute Common Terminology Criteria (NCI CTCAE), version 3, were used for complications. Statistical analysis was performed by the Kaplan-Meier estimator by the log rank test. Nineteen patients underwent a total of 24 resin-based Y90 treatments. Median survival from the time of diagnosis and first Y90 procedure was 752 {+-} 193 [95 % confidence interval (CI) 374-1130] and 345 {+-} 128 (95 % CI 95-595) days, respectively. Median survival with Eastern Cooperative Oncology Group (ECOG) performance status 1 (n = 15) and ECOG performance status 2 (n = 4) was 450 {+-} 190 (95 % CI 78-822) and 345 {+-} 227 (95 % CI 0-790) days, respectively (p = .214). Patients with extrahepatic metastasis (n = 11) had a median survival of 404 {+-} 309 (95 % CI 0-1010) days versus 345 {+-} 117 (95 % CI 115-575) days for patients without metastasis (n = 8) (p = .491). No mortality was reported within 30 days from first Y90 radioembolization. One patient developed grade 3 thrombocytopenia as assessed by NCI CTCAE. Fatigue and transient abdominal pain were observed in 4 (21 %) and 6 (32 %) patients, respectively. Y90 radioembolization is effective for unresectable standard-chemorefractory ICC.

  9. Prognostic value of DNA alterations on chromosome 17p13.2 for intrahepatic cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Ubol Chuensumran; Sopit Wongkham; Chawalit Pairojkul; Siri Chauin; Songsak Petmitr

    2007-01-01

    AIM: To characterize and evaluate DNA alterations among intrahepatic cholangiocarcinoma (ICC) patients.METHODS: DNA from tumor and corresponding normal tissues of 52 patients was amplified with 33 arbitrary primers. The DNA fragment that alters most frequently in ICC was cloned, sequenced, and identified by comparison with known nucleotide sequences in the genome database (www.ncbi.nlm.nih.gov). The DNA copy numbers of the allelic alterations in cholangiocarcinoma were determined by quantitative real-time PCR and interpreted as allelic loss or DNA amplification by comparison with the reference gene. Associations between allelic imbalance and clinicopathological parameters of ICC patients were evaluated by x2-test.The Kaplan-Meier method was used to analyze survival rates.RESULTS: From 33 primers, an altered DNA fragment (518 bp) amplified from BC17 random primer was found frequently in the tumors analyzed and mapped to chromosome 17p13.2. Sixteen of 52 (31%) cases showed DNA amplification, while 7 (13%) showed allelic loss. Interestingly, DNA amplification on chromosome 17p13.2 was associated with a good prognosis, median survival time (wk) of amp vs no amp was 44.14 vs 24.14,P = 0.002; whereas allelic loss of this DNA sequence corresponded with a poor prognosis, median survival time (wk) of loss vs no loss was 18.00 vs 28.71, P =0.019). Moreover, Kaplan-Meier curves comparing the DNA alterations with survival depicted highly significant separation that the median survival time equal to DNA amplification, allelic loss, and normal was 44.14 wk,18.00 wk, and 24.29 wk, respectively (P = 0.005).CONCLUSION: Alterations in the DNA sequence on chromosome 17p13.2 may be involved in cholangiocarcinogenesis, and could be used as a prognostic marker in the treatment of ICC patients.

  10. Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function: A Pilot Study.

    Science.gov (United States)

    Gao, Jing; Zheng, Xiao; Zheng, Yuan-Yi; Zuo, Guo-Qing; Ran, Hai-Tao; Auh, Yong Ho; Waldron, Levi; Chan, Tiffany; Wang, Zhi-Gang

    2016-05-01

    To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function. We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV. During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively. Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction. © 2016 by the American Institute of Ultrasound in Medicine.

  11. Effects of growth hormone (GH) transgene and nutrition on growth and bone development in common carp.

    Science.gov (United States)

    Zhu, Tingbing; Zhang, Tanglin; Wang, Yaping; Chen, Yushun; Hu, Wei; Zhu, Zuoyan

    2013-10-01

    Limited information is available on effects of growth hormone transgene and nutrition on growth and development of aquatic animals. Here, we present a study to test these effects with growth-enhanced transgenic common carp under two nutritional conditions or feeding rations (i.e., 5% and 10% of fish body weight per day). Compared with the nontransgenic fish, the growth rates of the transgenic fish increased significantly in both feeding rations. The shape of the pharyngeal bone was similar among treatments, but the transgenic fish had relatively smaller and lighter pharyngeal bone compared with the nontransgenic fish. Calcium content of the pharyngeal bone of the transgenic fish was significantly lower than that of the nontransgenic fish. Feeding ration also affected growth rate but less of an effect on bone development. By manipulating intrinsic growth and controlling for both environment (e.g., feeding ration) and genetic background or genotype (e.g., transgenic or not), this study provides empirical evidence that the genotype has a stronger effect than the environment on pharyngeal bone development. The pharyngeal bone strength could be reduced by decreased calcium content and calcification in the transgenic carp.

  12. Isotopic and elemental analysis of fish tissues for provenance determination

    Science.gov (United States)

    Zannella, Carmela; Adamo, Paola; Opper, Christine; Schwendinger, Susanne; Knezevic, Sara; Van den Oever, Sabrina; Tchaikovsky, Anastassiya; Zitek, Andreas; Prohaska, Thomas

    2017-04-01

    The reliable tracing of the productions flows of food products through the entire supply chain is an essential requirement for all types of food commodities qualified by origin, composition and quality. This is a minimum requirement to implement safety for the consumer, enhance consumer confidence and countervail fraudulent practices. One important food commodity is fish and fish products. Reliable methods to trace the origin of fish have become of high importance. The investigation focused on the identification of adequate geochemical marker in fish meat and the corresponding linkage to the ambient water. The Sr/Ca ratio along with the 87Sr/86Sr isotope ratio analyzed by (multi collector) inductively coupled plasma mass spectrometry (MC ICP-MS) proved to be the most potential tools in this respect. For the first time, a direct link of fish meat to water could be accomplished.In addition, fish hard parts (otoliths, fin rays, fish bones) were under investigation to reconstruct the habitat changes during the lifespan of a fishes life. Fish hard parts have the potential to serve as "life time recorder". Thus the spatial investigation of the elemental and isotopic composition can be used to monitor habitat changes with time. The spatially resolved data of hard tissues was collected by means of Laser Ablation Split Stream ICP-MS/MC ICP-MS. This work is accomplished within the scope of the project "CSI: TRACE YOUR FOOD".

  13. Fish allergy: in review.

    Science.gov (United States)

    Sharp, Michael F; Lopata, Andreas L

    2014-06-01

    Globally, the rising consumption of fish and its derivatives, due to its nutritional value and divergence of international cuisines, has led to an increase in reports of adverse reactions to fish. Reactions to fish are not only mediated by the immune system causing allergies, but are often caused by various toxins and parasites including ciguatera and Anisakis. Allergic reactions to fish can be serious and life threatening and children usually do not outgrow this type of food allergy. The route of exposure is not only restricted to ingestion but include manual handling and inhalation of cooking vapors in the domestic and occupational environment. Prevalence rates of self-reported fish allergy range from 0.2 to 2.29 % in the general population, but can reach up to 8 % among fish processing workers. Fish allergy seems to vary with geographical eating habits, type of fish processing, and fish species exposure. The major fish allergen characterized is parvalbumin in addition to several less well-known allergens. This contemporary review discusses interesting and new findings in the area of fish allergy including demographics, novel allergens identified, immunological mechanisms of sensitization, and innovative approaches in diagnosing and managing this life-long disease.

  14. Do Fish Resist?

    Directory of Open Access Journals (Sweden)

    Dinesh Joseph Wadiwel

    2016-03-01

    Full Text Available There have been a number of scientific studies on the question of whether fish feel pain. Some have suggested that some fish indeed do feel pain and that this has significant welfare implications (2003. Others have argued that fish do not have the brain development necessary to feel pain. In terms of number of animals killed, the slaughter of sea animals for human consumption significantly exceeds that of any land animals that we use for food, and sea animal slaughter practices frequently lack any basic welfare protections. If fish can be shown to feel pain—or more importantly, if humans can agree that fish feel pain—then this would place a significant question mark over many contemporary fishing practices.  This article substitutes the question 'Do Fish Feel Pain?' with an alternative: 'Do Fish Resist?' It explores the conceptual problems of understanding fish resistance, and the politics of epistemology that surrounds and seeks to develop a conceptual framework for understanding fish resistance to human capture by exploring the development of fishing technologies - the hook, the net and contemporary aquaculture.

  15. Fish under exercise.

    Science.gov (United States)

    Palstra, Arjan P; Planas, Josep V

    2011-06-01

    Improved knowledge on the swimming physiology of fish and its application to fisheries science and aquaculture (i.e., farming a fitter fish) is currently needed in the face of global environmental changes, high fishing pressures, increased aquaculture production as well as increased concern on fish well-being. Here, we review existing data on teleost fish that indicate that sustained exercise at optimal speeds enhances muscle growth and has consequences for flesh quality. Potential added benefits of sustained exercise may be delay of ovarian development and stimulation of immune status. Exercise could represent a natural, noninvasive, and economical approach to improve growth, flesh quality as well as welfare of aquacultured fish: a FitFish for a healthy consumer. All these issues are important for setting directions for policy decisions and future studies in this area. For this purpose, the FitFish workshop on the Swimming Physiology of Fish ( http://www.ub.edu/fitfish2010 ) was organized to bring together a multidisciplinary group of scientists using exercise models, industrial partners, and policy makers. Sixteen international experts from Europe, North America, and Japan were invited to present their work and view on migration of fishes in their natural environment, beneficial effects of exercise, and applications for sustainable aquaculture. Eighty-eight participants from 19 different countries contributed through a poster session and round table discussion. Eight papers from invited speakers at the workshop have been contributed to this special issue on The Swimming Physiology of Fish.

  16. Zoonoses associated with fish.

    Science.gov (United States)

    Boylan, Shane

    2011-09-01

    The taxonomic group that composes the fishes is the most diverse group of vertebrates worldwide. The challenges of unique physiologies, a foreign environment, and many unknowns attract a passionate group of biologists and veterinarians. Economically, fishes have become vital as food, bait, and companion animals. Fishermen and fish handlers (processing plants) represent the historical human population exposed to fish zoonoses, but growth in aquaculture and aquarium hobbyists have led to an increase in published fish-borne zoonotic cases starting in the late 1950s that bloomed in the 1980s. Human physicians, particularly dermatologists and infectious disease specialists, are now more aware of fish-borne zoonoses, but they can be assisted with diagnosis when informed patients give more detailed histories with fish/water exposure.

  17. Dating of cremated bones

    NARCIS (Netherlands)

    Lanting, JN; Aerts-Bijma, AT; van der Plicht, J; Boaretto, E.; Carmi, I.

    2001-01-01

    When dating unburnt bone, bone collagen, the organic fraction of the bone, is used. Collagen does not survive the heat of the cremation pyre, so dating of cremated bone has been considered impossible. Structural carbonate in the mineral fraction of the bone, however, survives the cremation process.

  18. Southeast Alaska ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains biological resource data for estuarine, benthic, and pelagic fish in Southeast Alaska. Vector polygons in this data set represent locations of...

  19. Columbia River ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for marine, estuarine, anadromous, and freshwater fish species in Columbia River. Vector polygons in this...

  20. North Slope, Alaska ESI: FISH (Fish Polygons)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains sensitive biological resource data for marine, estuarine, anadromous, and freshwater fish species for the North Slope of Alaska. Vector...