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Objective:In this study, the liver, spleen, and hepatic portal vein in the portal venous phase images of abdominal enhanced computed tomography (CT) are artificially segmented and annotated, and the radiomics features are extracted from them. A model for predicting portal pressure in patients with hepatitis B virus (HBV) related cirrhosis is constructed by combining radiomics features with clinical indicators.Methods:A total of 171 patients who had abdominal enhancement CT examination and trans-jugular hepatic venous pressure gradient (HVPG) measurement at the same time were enrolled from January 2016 to May 2020 in the Zhongshan Hospital Affiliated to Fudan University. The liver, spleen, and hepatic portal vein in the portal venous phase images of the CT were manually labeled by using ITK-SNAP 3.8 software. The radiomics features of these three sites were extracted using Python programming, and an HVPG prediction model was established.Results:A total of 171 patients was included in the study. The average age was (51.1±10.3)years, of which 134(78.4%) were males, and the average HVPG was 16.87±5.695. A total of 2 553 radiomics features were extracted from three sites of the portal venous phase images of abdominal enhanced CT in each patient. The 2 553 features extracted were screened using LASSO, and by combing with clinical features and radiomics features, the predictive model of HVPG was obtained: m_HVPG=31.622+ 0.028 8T×total bile acids-6.31(portal venous wavelet-LHH_glcm_ClusterShade)=0.253(portal venous wavelet-LHL_glszm_LargeAreaLowGrayLevelEmphasis)-20.9(spleen wavelet-LLH_glcm_Correlation)-0.000 127(liver original_shape_SurfaceArea)+ 2.79(liver wavelet-LLH_glcm_ClusterShade). The coefficient of determination R2 was 0.345. Conclusions:The study suggests that radiomics features of the liver, spleen, and portal venous combined with clinical features may be used as a non-invasive method to assess the portal pressure in patients with HBV-related cirrhosis.
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Acute stress disorder is a transient mental disorder caused by sudden and unusual stressful life events or persistent difficulties in a period of time after acute traumatic events. Cirrhotic patients with portal hypertension complicated by upper gastrointestinal bleeding suffer from immediate or rapidly developing symptoms, which often lead to acute stress disorder. This review summarizes risk factors and clinical nursing strategies of acute stress disorder, so as to provide evidence for starting early intervention, strengthening clinical nursing, and improving prognosis and mood.
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ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.
RESUMO Racional: O tratamento de escolha para pacientes com hipertensão portal esquistossomótica com sangramento de varizes é a desconexão ázigo-portal mais esplenectomia (DAPE) associada à terapia endoscópica. Porém, estudos mostram aumento do calibre das varizes em alguns pacientes durante o seguimento em longo prazo. Objetivo: Avaliar o impacto da DAPE e tratamento endoscópico pós-operatório no comportamento das varizes esofágicas e recidiva hemorrágica, de pacientes esquistossomóticos. Métodos: Foram estudados 36 pacientes com seguimento superior a cinco anos, distribuídos em dois grupos: queda da pressão portal abaixo de 30% e acima de 30% comparados com o calibre das varizes esofágicas no pós-operatório precoce e tardio além do índice de recidiva hemorrágica. Resultados: Após a DAPE houve diminuição significativa no calibre das varizes esofágicas que, durante o seguimento aumentaram de calibre e foram controladas com tratamento endoscópico. A queda da pressão portal não influenciou significativamente o comportamento do calibre das varizes no pós-operatório precoce nem tardio nem os índices de recidiva hemorrágica. Conclusão: A queda na pressão portal não influenciou significativamente a variação dos calibres das varizes ao comparar os diâmetros pré e pós-operatórios precoces ou tardios. A comparação entre a queda de pressão do portal e as taxas de ressangramento também não foi significativa.
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Humans , Schistosomiasis , Esophageal and Gastric Varices/surgery , Hypertension, Portal/surgery , Recurrence , Splenectomy , Follow-Up Studies , Portal Pressure , Gastrointestinal Hemorrhage/surgery , Gastrointestinal Hemorrhage/etiologyABSTRACT
Objective: To analyze the relationship of hepatic transit time and portal vein pressure in the patients with portal hypertension and esophagogastric varices, and to clarify its clinical significance. Methods: A total of 50 hospitalized patients underwent esophagogastric venous embolization due to portal hypertension and esophagogastric varices were selected as observation group, and 50 patients without history of liver disease and clinical manifestations of liver disease (hospitalized or out-patient) were selected as control group. All patients underwent liver contrast enhanced ultrasound. The free portal pressure (FPP) was measured by ultrasound guided portal vein puncture for operating pathways in the patients in observation group. The hepatic artery-hepatic vein transit time (HA-HVTT), the hepatic portal vein-hepatic vein transit time (PV-HVTT), the liver parenchyma- hepatic vein transit time (PA-HVTT) of the patients were compared between two groups. The correlations between HA-HVTT, PV-HVTT, PA-HVTT and FPP of the patients in observation group were analyzed. Results: The HA-HVTT, PV-HVTT and PA-HVTT of the patients in observation group were significantly shorter than those in control group 0=5.078, P<0. 01; t=\2. 163, P<0. 01; t=2. 649, PC0.01). The HA-HVTT, PV-HVTT and PA-HVTT had negative correlations with FPP in observation group ( r= 0.799, P
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Objective To summarize the changing rules of free portal pressure (FPP) after splenectomy combined with pericardial devascularization and investigate its influencing factors.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 55 patients with portal hypertension who were admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2016 to September 2018 were collected.There were 39 males and 16 females,aged from 17 to 67 years,with a median age of 46 years.FPP was measured using CT portal vein angiography before splenectomy and intraoperative manometry after cantheterization to the right gastroepiploic veins.Observation indicators:(1) comparison between intraoperative and postoperative FPP;(2) dynamic changes of FPP at the seventh postoperative day;(3) comparison of FPP before and after Valsalva manoeuvre;(4) relationship of FPP with mean arterial pressure and heart rate.Measurement data with normal distribution were represented as Mean ±SD.Repeated measurement data were analyzed using repeated ANOVA.Paired data were analyzed by the paired t test.The linear correlation analysis was done for relevance.Results (1) Comparison between intraoperative and postoperative FPP:55 patients underwent open splenectomy combined with pericardial devascularization.The FPP before splenectomy,after splenectomy combined with pericardial devascularization intraoperatively,at the first and the seventh day postoperatively was (34±6)cmH2O (1 cmH2O=0.098 kPa),(28±6)cmH2O,(34±5)cmH2O and (30±5)cmH2O,respectively,showing a statistically significant difference (F=43.23,P＜0.05).The FPP before splenectomy was statistically significant different from the FPP after splenectomy combined with pericardial devascularization intraoperatively,at the first and the seventh day postoperatively,respectively (P ＜ 0.05).The FPP after splenectomy combined with pericardial devascularization intraoperatively was statistically significant different from the FPP at the first and the seventh day postoperatively,respectively (P＜0.05).There was a statistically significant difference between FPP at the first and the seventh day postoperatively (P ＜ 0.05).(2) Dynamic changes of FPP at the seventh postoperative day:the FPP was (30 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(28 ± 5) cmH2 O,(28± 5) cmH2 O,(28 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(30 ± 5) cmH2 O,(30± 5)cmH2O,(30±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(32±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(30± 5) cmH2O,(30±5) cmH2O from 00:00 to 24:00 at the seventh day postoperatively.Level of FPP was higher from 12:00 to 21:00 and lower from 01:00 to 08:00,with a peak value at 17:00 and valley value from 04:00 to 06:00.(3) Comparison of FPP before and after Valsalva maneuvre:the FPP was (30± 5) cmH2O and (32± 5) cmH20 before and after Valsalva manoeuvre,respectively,showing a statistically significant difference (t =82.72,P＜ 0.05).(4) Relationship of FPP with mean arterial pressure and heart rate.Linear correlation analysis showed positive correlations of FPP with mean arterial pressure and heart rate respectively,but the correlation was not significant (r =0.10,0.16,P＜ 0.05).Conclusions FPP can be reduced significantly after splenectomy combined with pericardial devascularization intraoperatively and it rises briefly again after operation.FPP has regularly circadian fluctuations and is significantly increased by Valsalva Manoeuvre.There is a positive correlation of FPP with mean arterial pressure and heart rate respectively,but the correlation is not significant.
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BACKGROUND/AIMS: In recent years, greater assessment accuracy after transjugular intrahepatic portosystemic shunt (TIPS) to ascertain prognosis has become important in decompensated cirrhosis due to portal hypertension. The aim of this study was to assess the ratio of the portal pressure gradient (PPG) pre-TIPS (pre-PPG) to albumin (PPA), which influence ascites formation in cirrhotic patients in the 6-months after TIPS placement, and is a metric introduced in our study. METHODS: This was a retrospective cohort study of 58 patients with decompensated cirrhosis admitted to an academic hospital for the purpose of TIPS placement. We collected the following data: demographics, laboratory measures, and PPG during the TIPS procedure. Then we analyzed the association between the above data and ascites formation post-TIPS in cirrhosis patients. RESULTS: Twenty-two patients with ascites and 28 without ascites were evaluated. Univariate and binary logistic regression analysis were adjusted for the following variables: to determine prognosis; Child-Pugh scores, lymphocyte count, platelet count, hemoglobin level, albumin level and pre-PPG or PPA. The outcome showed that PPA was better than pre-PPG and albumin for predicting ascites according to area under receiver operating characteristic curves and a statistical model that also showed PPA’s influence 6-months post-TIPS. CONCLUSIONS: The combined measurement of pre-PPG and albumin, defined as PPA, may provide a better way to predict post-TIPS ascites in decompensated cirrhosis, which underlines the need for a large clinical trial in the future.
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Humans , Ascites , Cohort Studies , Demography , Fibrosis , Hypertension, Portal , Logistic Models , Lymphocyte Count , Models, Statistical , Platelet Count , Portal Pressure , Portasystemic Shunt, Surgical , Prognosis , Retrospective Studies , ROC Curve , Serum AlbuminABSTRACT
Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement in the normal porcine model.Methods Four pigs,2 male and 2 female,aged 8-12 months,weighing 20-30 kg were selected in the experiment.Under general anesthesia and EUS guidance,a 22 G fine needle connected to electrocardiograph monitor with a central vein pressure manometer was used to puncture and measure pressures in the portal vein (PV) and hepatic vein (HV) or inferior vena cava (IVC).Pressures were measured three times for each vessel and the mean pressure was recorded.The PPG was recorded as the difference between the PV pressure and HV or IVC pressure.Vital signs during and after the procedure and operation-related complications were monitored.Results EUS-PPG measurement was successful in all targeted vessels.The PV pressure,HV or IVC pressure,and PPG was 11.0±1.0 mmHg(1 mmHg=0.133 kPa),7.3±1.1 mmHg and 3.8±0.9 mmHg,respectively.No adverse event occurred.Conclusion EUS-PPG measurement has a high successful rate and reliable accuracy and safety reflecting the portal vein pressure.
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Objective:To analyze the relationship of hepatic transit time and portal vein pressure in the patients with portal hypertension and esophagogastric varices, and to clarify its clinical significance.Methods:A total of50hospitalized patients underwent esophagogastric venous embolization due to portal hypertension and esophagogastric varices were selected as observation group, and 50patients without history of liver disease and clinical manifestations of liver disease (hospitalized or out-patient) were selected as control group, All patients underwent liver contrast enhanced ultrasound.The free portal pressure (FPP) was measured by ultrasound guided portal vein puncture for operating pathways in the patients in observation group.The hepatic artery-hepatic vein transit time (HA-HVTT) , the hepatic portal vein-hepatic vein transit time (PV-HVTT) , the liver parenchymahepatic vein transit time (PA-HVTT) of the patients were compared between two groups.The correlations between HA-HVTT, PV-HVTT, PA-HVTT and FPP of the patients in observation group were analyzed.Results:The HA-HVTT, PV-HVTT and PA-HVTT of the patients in observation group were significantly shorter than those in control group (t=5.078, P＜0.01;t=12.163, P＜0.01;t=2.649, P＜0.01) .The HA-HVTT, PV-HVTT and PA-HVTT had negative correlations with FPP in observation group (r=-0.799, P＜0.01;r=-0.554, P＜0.01;r=-0.735, P＜0.01) .The linear relationship between HA-HVTT and FPP was Y=-0.410X+7.254;the linear relationship between PV-HVTT and FPP was Y=-0.355X+4.983;the linear relationship between PA-HVTT and FPP was Y=-0.566X+4.997.Conclusion:Liver transit time can be used as an effective index to judge the portal vein pressure, and it can provide the theroretical basis for the diagnosis and treatment of portal hypertension in the patients.
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The occurrence of small liver syndrome and liver failure is still a serious complication that threatens the survival of patients after small liver transplantation or extended liver resection.Therefore,it is very important to understandthe mechanism of liver regeneration after operation and look for effective ways to promote liver regeneration.Many experiments have confirmed that changes in portal venous pressure (PVP) may be necessary to initiate and maintain liver regeneration processes and even terminate liver regeneration.This article reviews the recent research progress about the effect of PVP on liver regeneration.
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Objective To explore the effect and mechanism of heme oxygenase-1 (HO-1) gene modified bone marrow mesenchymal stem cells (BMMSCs) on rat reduced-size liver transplantation.Methods 50 male Brown Norway (BN) rats were used to prepare BMMSCs.Male Lewis and BN rats were 75,respectively.BN rats were randomly divided into model group (n =25),stem cell group (n =25) and combined group (n =25).Acute rejection models following 50％ reduced-size transplantaton were established in rats using two-cuff technique,1 ml of normal saline,BMMSCs suspension,or HO-1/BMMSCs suspension were injected immediately after surgery.Rats were executed at an instant,3rd,7th and 14th day after surgery to identify BMMSCs and HO-1/adenovirus infection efficiency.Evaluated hepatic pathology by HE staining.Liver function indexes were detected.Portal vein pressure on 7th day after surgery was detected.The levels of endothelin-1 (ET-1) and nitric oxide (NO) in serum were detected using ELISA.The expressions of ET-1 in liver were detected by immunohistochemistry staining and Western blotting.Results High purity BMMSCs were obtained and HO-1/BMMSCs were successfully infected.Compared with model group,liver tissue injury and rejection were alleviated in stem cell group and combined group,liver function was improved,and the combined group was superior to stem cell group.The portal vein pressure in model group,stem cell group,and combined group were 21.3±0.2 mmHg,11.2±0.2 mmHg,and 10.1±0.1 mmHg,respectively.The portal vein pressure in three groups showed a decreasing trend,difference was statistically significant (P＜0.05).On the 3rd,7th and 14th day after surgery,compared with model group,the expression levels of ET-1 and NO in the stem cell group and the combined group were decreased,and the combined group was significantly lower than stem cell group (P＜ 0.05).Conclusion HO-1/BMMSCs improved liver function and portal vein pressure after reduced-size liver transplantation in rats,and may play a protective role by regulating ET-1/NO expression.
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Portal hypertension refers to a series of clinical manifestations caused by elevated pressure of the portal vein system, which can cause portal hypertension by causing portal venous obstruction and / or increased blood flow. A typical clinical manifestation in patients with decompensated cirrhosis is portal hypertension. A severe complication of portal hypertension is esophagogastric varices bleeding, refractory ascites, and hepatic encephalopathy. The effective reduction of portal pressure can reduce the incidence of complications, improve the prognosis and reduce the mortality. At present, the commonly used clinical methods for reducing portal hypertension include drug therapy, minimally invasive interventions, surgical treatment, and liver transplantation. This article reviews the current status of integrated traditional Chinese and Western medicine for portal hypertension.
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A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization. Potential clinical applications of EUS-guided portal venous access include angiography, measurement of the portosystemic pressure gradient, EUS-guided transhepatic intrahepatic portosystemic shunt creation and portal vein sampling for the evaluation in gastrointestinal cancer. The following article reviews the different devices and techniques employed in these applications.
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Angiography , Endosonography , Gastrointestinal Neoplasms , Portal Pressure , Portal Vein , Portasystemic Shunt, Surgical , Ultrasonography , Vascular Access DevicesABSTRACT
Objective To observe the efficacy of different degrees of portal vein ligation on portal pressure and liver regeneration of the unligated lobe in rats.Methods Seventy-two healthy male SpragueDawley rats were randomly divided into three groups:group A (sham,n =24);group B (n =24) undergoing 70％ portal vein ligation;group C (n =24) undergoing 90％ portal vein ligation.And then the portal pressure and liver regeneration rate (HRR) of the unligated lobe were detected immcdiately and postoperatively at each observation time point in each group.The serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),hepatic proliferating cell nuclear antigen (PCNA) were compared at each observation time point,and the histological changes were observed by HE staining.Results The HRR of the unligated lobe in group B and group C increased obviously postoperatively at each time point,and the HRR in group C was significantly higher than that in group B [(220.1 ± 4.3) ％,(246.3 ± 5.6) ％,(261.4 ±2.3)％ vs (128.2 ±3.7)％,(143.4 ±8.7)％,(150.7 ±7.0)％,P＜0.05].The serum ALT and AST increased obviously on day 1 and then gradually declined,and the serum ALT and AST in group C was significantly higher than those in group B on day 1 [(821.7 ± 158.3) U/L,(1 372.0 ± 376.2) U/L vs (398.6 ± 80.4) U/L,(860.4 ± 80.0) U/L,P ＜ 0.05].The immediate portal pressure in both groups were obviously increased postoperatively and then gradually declined,and the portal pressure in group C was higher than that in group B at each observation time point [(23.5 ± 1.1)cmH2O,(18.8 ±0.9)cmH2O,(17.8±1.0)cmH2O,(16.6 ±1.0)cmH2O,(15.9±1.3)cmH2O vs (17.4 ±1.0)cmH2O,(16.5 ±1.2)cmH2O,(15.3±1.0)cmH2O,(10.2±1.2)cmH2O,(10.0±1.1)cmH2O,P＜0.05].ThePCNA index in group C was higher than that in group B on day 1 and3 [(21.5 ±1.1)％,(28.2±1.3)％ vs (12.8 ± 2.1) ％,(18.8 ± 1.9) ％,P ＜ 0.05].More foca1 necrosis of the unligated lobe were observed in group C on day 1,which were more than those in group B.Conclusion Higher degree of portal vein ligation could cause higher portal pressure,which leads to the greater regeneration of the unligated lobe.
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The measurement of portal vein pressure (PVP) is important for the evaluation of therapeutic efficacy and prognosis in patients with liver cirrhosis.Aims: To investigate a non-invasive method for evaluating PVP in model of liver cirrhosis in rats.Methods: Liver cirrhosis model in rats was induced by intraperitoneal injection with thioacetamide.Magnetic resonance imaging with TOF sequence was used to measure portal vein diameter (PVD).PVP was detected directly by transvenous catheterization of portal vein.Body weight, liver weight, spleen weight, liver volume and spleen volume were determined.The hydroxyproline content in liver was determined by alkaline hydrolysis assay, proportion of collagen area in liver was detected by Sirius red staining.Results: Liver cirrhosis model in rats was successfully established after intraperitoneal injection for 20 weeks.Compared with control group, mean PVP, liver weight, liver volume, spleen weight, PVD, liver volume/body weight (LV/BW) ratio, spleen volume/body weight (SV/BW) ratio, hydroxyproline content and proportion of collagen area were significantly increased in model group (P<0.05), and body weight was significantly decreased (P<0.001).PVP was positively correlated with LV/BW ratio and proportion of collagen area (P<0.05).Conclusions: LV/BW and proportion of collagen area can indirectly reflect the PVP, and may provide a non-invasive approach for evaluation of portal hypertension.
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As endoscopic ultrasound (EUS) equipment improves, the diagnostic and therapeutic applications of EUS in patients with portal hypertension (pHTN) have been increasingly explored. Various EUS-guided vascular interventions for pHTN have been evaluated in human or animal studies. EUS has been shown to be useful in variceal and perforating feeding veins identification, prediction of variceal recurrence/rebleeding, and assessment of response to pharmacological therapy for pHTN. When compared to conventional endoscopic therapies, EUS-guided therapy for varices and/or perforating feeding veins can ensure intra-variceal delivery of injection therapy, allow real-time monitoring of variceal obliteration, and provide injection therapy under pure EUS guidance when the target varix is endoscopically obscured. While the feasibility of EUS-guided assessment of portal hemodynamics and creation of intrahepatic portosystemic shunt has been evaluated, further studies would be needed to assess the long term outcomes before routine application.
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Animals , Humans , Hemodynamics , Hypertension, Portal , Portasystemic Shunt, Surgical , Ultrasonography , Varicose Veins , VeinsABSTRACT
Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.
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Adhesives , Aneurysm, False , Endosonography , Esophageal and Gastric Varices , Hemorrhage , Models, Animal , Portal Pressure , Portal Vein , Stents , Ultrasonography , Varicose VeinsABSTRACT
Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of > or =20% or to < or =12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease.
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Humans , Chronic Disease , Hemodynamics , Hemorrhage/etiology , Hepatic Veins/physiology , Hypertension, Portal/complications , Liver Cirrhosis/diagnosis , Liver Diseases/complications , Portal PressureABSTRACT
Objective To investigate the protective effect and mechanism of irbesartan and edaravone on the rat liver transplantation model using small-for-size graft during acute phase of reperfusion.MethodsWe used 300 S-D rats for small-for-size graft liver transplantation,and the light rats were used as donors.Survived recipients were divided into five groups according table of random number:group A,control group; group B,edaravone treatment group; group C,irbesartan treatment group; group D,irbesartan and edaravone treatment group; group E,sham operation group.The rat 30％ small-for-size graft model was established.Six rats in each group were sacrificed randomly at 6th and 24th h after reperfusion respectively. The survival rate of animals and portal pressure were investigated.The rats in every group were sacrificed and blood samples were collected for liver function measurement.The contents of SOD and MDA in liver tissues were measured.Fresh liver tissue was used to detect the mRNA expression of Egr-1,ET1 and Bax by RT-PCR. Paraffinembedded liver specimens were used to assay apoptosis (TUNEL).Six rats at each time point in each group were studied.Results(1) One-week survival rate in the groups A,B,C,D and E was 8.33％(1/12),33.3％ (4/12),58.7％ (7/12),83.3％ (10/12),and 100％ (12/12),respectively,P＜0.05; (2) There was significant difference in the portal pressure,ALT,AST,MDA,SOD,Egr-1,ET-1,Bax,and the apoptotic index between treatment groups and control group,especially in the group D,P＜0.05 or P＜0.01.Conclusion Irbesartan and edaravone could protect small-for-size graft in partial liver transplantation probably by reducing portal vein pressure and diminishing ischemia reperfusion injury.The combined use of Irbesartan and edaravone is more effective than irbesartan or edaravone used alone.
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Objective To investigate the relationship between the changes of portal pressure gradient after selective devascularization with postoperative complications and recurrent bleeding of gastroesophageal varix in patients of portal hypertension. Methods The clinical data of 135 cases of portal hypertension undergoing selective devascularization was collected. Portal pressure gradient was measured before splenectomy and after selective devascularization, and was analyzed against postoperative complications and recurrent bleeding. Results In this study, 135 patients of portal hypertension underwent selective devascularization, two cases died during perioperative period ( 1.5% ). Postoperatively patients were divided into three groups based on PPG ＜ 12 mm Hg after selective devascularization (62 cases), HVPG ≥ 12 mm Hg but a more than 20% of decrease off the pre-splenectomy baseline (41 cases) and HVPG ≥12 mm Hg with less than 20% of decrease from the baseline (32 cases). The postoperative complications between the three groups were of no significant difference ( P ＞ 0. 05 ). The 1,2,3 year cumulative rate of no variceal rebleeding of the three groups were 100% vs. 100% vs. 95%; 100%vs. 97% vs. 90%; and 100% vs. 93% vs. 87% (x2 =6. 859, P = 0. 032). COX regression analysis indicated portal vein pressure gradient was an independent prognostic factor of variceal bleeding recurrence (P=0.002). 1,2,3 year cumulative survival rates of the three groups were 100% vs. 100% vs. 94%; 98% vs. 95% vs. 92%; 97% vs. 93% vs. 88%, there were no significant difference among the three groups ( x2 = 2. 917, P = 0. 233 ). Conclusions The decrease in the PPG after selective devascularization is a predictor for the risk of rebleeding but not for survival after selective devascularization.
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CONTEXTO: A hipertensão portal exerce papel importante na patogênese da ascite. OBJETIVO: Avaliar o gradiente de pressão venosa hepática e a presença de ascite em pacientes com cirrose. MÉTODOS: Foram estudados 83 pacientes com cirrose. Todos os doentes realizaram estudo ecográfico para a identificação de ascite e foram submetidos a estudo hemodinâmico hepático para determinação do gradiente de pressão venosa hepática. RESULTADOS: Na população avaliada, observou-se ascite em 70 doentes (84,3 por cento), sendo que a média geral do gradiente de pressão venosa hepática foi de 15,26 ± 6,46 mm Hg. Não houve diferença estatisticamente significante (P = 0,061) quando avaliadas as médias do gradiente de pressão venosa hepática nos pacientes com (14,70 ± 6,43 mm Hg) e sem ascite (18,64 ± 5,78 mm Hg). Ao ser utilizado nível de corte de 8 mm Hg, para se avaliar o risco do desenvolvimento de ascite, observou-se que nos pacientes que apresentaram o gradiente de pressão venosa hepática superior a 8 mm Hg, o risco relativo do desenvolvimento de ascite foi de 0,876 (0,74-1,03), P = 0,446. CONCLUSÃO: Nível pressórico de 8 mm Hg, determinado pelo gradiente de pressão venosa hepática, não define a presença ou ausência de ascite no paciente cirrótico e, tendo em vista a similitude das médias de pressão dos pacientes com e sem derrame peritonial, não se pode definir um ponto de corte para o surgimento de tal complicação.
CONTEXT: Portal hypertension plays an important role in the pathogenesis of ascites. OBJECTIVES: To evaluate the hepatic venous pressure gradient and the presence of ascites in cirrhotic patients. METHODS: Eighty-three patients with cirrhosis were evaluated. All of the patients were submitted to ultrasonography to identify ascites and to a hepatic hemodynamic investigation to determine the hepatic venous pressure gradient. RESULTS: In the population evaluated, ascites was observed in 70 patients (84.3 percent), and the mean hepatic venous pressure gradient was 15.26 ± 6.46 mm Hg. There was no statistically significant difference (P = 0.061) between the means of hepatic venous pressure gradient in patients with (14.70 ± 6.43 mm Hg) and without ascites (18.64 ± 5.78 mm Hg). When using a cut-off point of 8 mm Hg in order to assess the risk of developing ascites, patients with hepatic venous pressure gradient above 8 mm Hg were found to have a relative risk of 0.876 (CI = 0.74-1.03), (P = 0.446) of progressing to ascites. CONCLUSIONS: The pressure level of 8 mm Hg, as determined by the hepatic venous pressure gradient, does not define the presence or absence of ascites in the cirrhotic patient, and in view of the similarity between mean pressures in patients with or without peritoneal effusion, it is impossible to define a cut-off point for the emergence of such complication.