Features of Ductular Reaction in Rats with Extrahepatic Cholestasis.

Ductular reaction develops during liver regeneration, fibrosis, and carcinogenesis. However, the types, stages of formation, and topography of ductular profiles in various pathologies remain insufficiently studied. Using the model of common bile duct occlusion, we showed that the number and topography of ductular profiles are closely related to the duration of biliary obstruction. The ductular profiles can be located inside the portal tract, along the existing bile ducts, and/or intramurally, around the portal vein, periportally, inside the lobules, in the portocaval fibrous connections, in the adventitia of the hepatic veins, in the septs connecting the portal tracts, and also in the "portal plate" of the liver. The ductular profiles can be formed as a result of expansion of existing bile ducts, cholangiocyte proliferation, as well as transdifferentiation of hepatocytes and activation of mesenchymal stem cells.

LIVER EXTRACELLULAR MATRIX PECULIARITIES IN MAMMALS AND AVIANS.

Analysis of liver matrix studies makes it obvious that knowledge about the connective tissue skeleton of the liver is not systematized, the terminology is contradictory, and the question of the construction of some components sometimes causes controversy. We set a goal to study the features of the construction of the connective tissue matrix of the liver of various mammals and birds in order to identify and systematize general and specific patterns of this structure. The liver of mammals with a gallbladder (pigs, sheep) and without a gallbladder (rats) and birds (domestic chickens with a gallbladder) was studied by the methods of anatomical preparation, histology, histochemistry, histotopography, immunohistochemistry, scanning electron microscopy of corrosion replicas and fluorescence microscopy. In the liver of mammals and birds, connective tissue membranes of various thicknesses and compositions around the portal tracts and hepatic veins are revealed. These membranes are connected in various ways with each other, the liver capsule and the intralobular network of connective tissue and form an extracellular matrix, which strengthens the structure of the liver tissue and helps the organ maintain its integrity in various pathological conditions.

STRUCTURAL CHANGES IN RATS' LIVER DURING THE FIRST 2 WEEKS FOLLOWING 2/3 PARTIAL HEPATECTOMY.

Aim of study - Investigation of changes in hepatocyte size and shape and architecture of the sinusoidal network in 2-week dynamics after resection 2/3 of the liver. The experiments were performed on 16 adult male Wistar rats weighing 190-200 grams who underwent 2/3 resection of liver, while a resected portion of the liver of the same rat was considered as a control. We examined liver tissue by histological, immunohistochemical, morphometrical methods, and the architecture of the sinusoidal capillary network by electron microscopy of corrosion casts. The study was conducted in 24 hours, 48 hours, 96 hours, 1 week, and 2 weeks after surgery. The shape and size of the hepatocytes in the first and third zones of the liver acinus change with the term of the experiment. With changes in the shape and size of hepatocytes, new intercellular connections are formed, including with the involvement of atypical membrane protrusions of deformed neighboring hepatocytes. One week after regeneration, electron microscopic examination of corrosion casts reveals a network of sinusoids that spatially define lobules of different shapes and sizes, including those that appear to be a combination of two "normal" lobules. Superficial sinusoids are often markedly dilated (up to 25 µm). In addition, small-diameter (6-7µm) sinusoidal casts with a rough surface and small bud-shaped protrusions are observed in some areas, giving the line of this a zigzag shape. The existence of hepatic vein tributaries and associated with them large sinusoids, found In single areas, reveals the characteristic feature of vascular sprouting. Based on the data obtained, it can be assumed that despite the recovery of liver mass, the regeneration process is not complete. Regenerated liver undergoes a permanent process of transformation of hepatocytes' shape and size, as well as the transformation of the vascular network, which is the basis for changes in the spatial architecture of the liver lobules.

Spatial Organization of the Transport of Interstitial Fluid and Lymph in Rat Liver (Scanning Electron Microscopy of Injection Replicas).

Using the method of scanning electron microscopy of injection replicas, we studied the movement of a new injection mass between the blood microcirculation system, interstitial space, lymphatic system, and bile transport system in rat liver under normal conditions and 3 days after the occlusion of the common bile duct. The casts of the perisinusoidal spaces of Disse's after injection of the injection mass through the portal vein and common bile duct were obtained. Their direct transition not only in "leakages" structurally related to lymphatic capillaries in interlobular spaces, but also in perivascular spaces around the portal and hepatic veins. The flow of the injection mass through the perivascular spaces leads to the formation of peculiar "sheaths" around hepatic veins and components of the portal complex. The proposed approach allows effective visualization of the structural basis of interaction of various compartments of the fluid microcirculation in the liver under normal and pathological conditions.

OVARIAN CANCER TREATMENT OPTIMIZATION: THE COMPLEX ANALYSIS OF THE RESULTS OF CYTOREDUCTIVE SURGERY, MICROSCOPIC MALIGNANCY AND T-LYMPHOCYTIC INFILTRATION OF THE TUMOR.

The paper discusses 64 cases of ovarian cancer (observed in 2016-2019). Patients underwent cytoreductive surgery. Both Shimizu/Silverberg system and the "Two-tier" system were used to grade the tumor differentiation of serous carcinomas. The grade of the differentiation was specified by expression of oncoprotein p53. The tumor infiltrating lymphocytes (TILs) labeled with immunohistochemical markers - CD2, CD3, CD4, CD8 - were evaluated for the intensity of expression in both - the ovarian tumor parenchyma and stroma. Quantitative assessment of expression was performed by a computer program ImageJ. The survival of patients with ovarian cancer was examined by using the Kaplan-Meier curves and calculations of Cox Hazard Ratio (HR). Multiple regression analyses of factors influencing surgical intervention was performed by a logarithmic regression method. According to the obtained data, the carcinogenesis of high-grade and low-grade serous ovarian carcinoma is different: low-grade forms are always preceded by serous cystadenoma and/or serous cystadenofibroma, which progresses to borderline serous carcinomas and then to low-grade invasive carcinoma; high-grade serous carcinomas are not developed from the progression of low-grade invasive carcinomas and are the product of the de novo formation. p53 may be used as an additional molecular-biological feature for specifying the grade of microscopic malignancy of the tumor in the cases, when the moderate differentiation is established by Shimizu/Silverberg system. The antineoplastic and/or prognostic role of the tumor-infiltrating T lymphocytes is not fully evident and needs further investigation. High-grade (G3) of ovarian carcinoma and the neoadjuvant chemotherapy are the factors having a significant impact in defining the effectiveness of the surgical treatment of ovarian cancer.

RELATIONSHIP BETWEEN ORAL SQUAMOUS CELL CARCINOMA AND IMPLANTS (REVIEW).

In this review, we have discussed the relationships between oral squamous cell carcinoma (OSCC) and dental implants. In the last decade, dental implants have been widely used for the treatment of complete or partial edentulism. Despite the fact that they have seen incredible success and the use of dental implants increases, concerns over safety and efficiency is rising as well. The literature analysis has shown that the number of reported cases when the OSCC development is associated with peri implantitis is gradually increasing. The possibility of squamous cell carcinoma development must be considered when evaluating the peri-implantitis. We highly recommend periodic oral and radiographic examination after the implant placement. The patients with peri-implantitis that do not respond to conventional treatment methods, and the patients who have a severe or rapid progression of peri-implantitis require biopsy. The histopathological examination will aid with the differential diagnosis between peri-implantitis and OSCC, and hence, provide the correct diagnosis.

MORPHOLOGICAL CHANGES IN THE LIVER AFTER 8 HOURS OF PRESERVATION BY MACHINE PERFUSION.

Patients with refractory cardiac arrest, who have undergone Extracorporeal Life Support (ECLS) for resuscitation, but have not achieved cardiac recovery, can be considered as potential donors (Cardiac Death Donors). In such cases, it takes time to notify and obtain the principle consent of the relatives and finalize the clinical and legal documents. During this time, prior to obtaining consent for the removal of organs, ECLS can be extended. In this case, the extracorporeal circulation implies organ preservation "in situ" until the ethical, religious and organizational problems should be decided. Correspondingly, the identification of safe time terms during which the donor organs do not suffer by the changes not compatible with transplantation is extremely important. We aimed to study the morphological changes in the liver after 8 hours of extracorporeal circulation in experiments. The investigation was performed on 6 sheep with simulated cardiac arrest and undergone 8-hours extracorporeal circulation with own blood by using of new portable perfusion apparatus, made on the basis of a universal volumetric blood pump of our own design. The device was connected to the body through the femoral artery and vein with special cannulas. The biopsy of the liver was performed before the starting of perfusion, and on 4 and 8 hours of the experiment. The histological slices were stained by H&E and were assessed by standard criteria: level of steatosis (large-droplet macrovesicular steatosis [ld-MaS] and/or small-droplet macrovesicular steatosis [sd-MaS]); mononuclear portal inflammatory cell infiltrates; bile ductular proliferation; cholestasis; venous congestion; hepatocellular necrosis. Before the perfusion, no venous congestion, hepatocellular necrosis or ld-MaS were observed; Less than 3% of cells were suffered by sd-MaS; mononuclear portal inflammatory cell infiltrates were found only in several areas. Mild mixed ld-MaS and sd-MaS was found in less than 5 % and 10% of the cells accordingly on the 4 and 8 hours after in vivo Machine perfusion. Similarly the mild venous congestion was present in 1 out of 6 livers after 4-hours perfusion and in 2 out of 6 livers after 8-hours Perfusion. The number of necrotic hepatocytes and portal triads infiltrated with mononuclear cells did not exceed 10% and 15% accordingly. However, there were no differences in the degree of biliary damage - cholestasis or ductular proliferation - correlating with the terms of the experiment. Taking into the consideration all internationally accepted criteria of donor liver histological assessment, 8-hour in vivo perfusion of the liver in Cardiac Death Donors by using of the machine of own design providing the pulsatile blood flow guarantees the satisfactory preservation of liver making it useful for successful transplantation.

PERCEPTION OF ORAL PROBLEMS IN PATIENTS WITH ADVANCED CANCER.

The results of the previous research, aimed to study the per-ception of and attitude to the end-of-life in the incurable cancer patients as well as the elderly aged 85 and older, revealed that independently from the cause of the life limitation, perceptions of and attitudes to the end-of-life are mainly similar. Moreover, it must be highlighted that the complaints on oral cavity were stated only by the single patients from the sample. We aimed to verify if the less attention from the sides of pa-tients towards the oral cavity symptoms/complaints were caused by the "poor" format of semi-structured interviews that were not focused on the oral status. The sample of the research included 50 advanced cancer pa-tients aged 20 to 75, under integrated palliative treatment (care). We applied for two-part questionnaire in the first part of which the patients had to choose one out of the alternative answers to the concrete questions related to oral cavity problems. The sec-ond part of the questionnaire was filled by the researcher/dentist based on the information obtained through examination of the patient's oral cavity. Based on the results of the data processing it was concluded that conditions recorded by a dentist were more severe and seri-ous in comparison to what the patients stated. Furthermore, it must be taken into consideration that the con-ditions and pathologies of oral cavity registered during our re-search are subject to improvement and treatment and, relevant-ly, their correct management has potential to improve the quality of life for incurable cancer patients.

ON THE TOPIC OF SURGICAL DEBULKING OF EPITHELIAL OVARIAN CANCER (REVIEW).

Surgical debulking is a relatively new and promising treatment for epithelial ovarian cancer. The aim of the study was to analyze current literature data to identify the best algorithms in order to promote the wider adoption of cytoreductive treatment based on the principles of evidence-based medicine. Such an analysis is important, since different studies contain contradictory results and their authors often point out the need for additional data to develop reliable recommendations. The review is based on articles published in journals indexed in PubMed, Web of Science (Clarivate Analytics) and Scopus, with an impact factor (IF)> 1, H-index> 50 and Q1 or Q2 category (according to Scimago Journal & Country Ranking). The data is classified according to the National Comprehensive Cancer Network (NCCN) principles.

DUCTULAR REACTION AT THE EARLY AND LATE STAGES OF BILIARY OBSTRUCTION: IS THE MECHANISM THE SAME?

Ductular reaction (DR) is one of the classical features of biliary obstruction in humans as well as in experimental models. It is the histological phenomenon expressed by the increased number of ductular profiles (DPs), which is especially intensively studied in rodents' model of common bile duct ligation (CBDL). However, some issues related with DR in long-term CBDL are not clear enough. The liver tissue of male Wistar rats (150-200 g) subjected to CBDL were studied histologically (H&E). The architectonics of the biliary tract was studied by investigation of the corrosion casts obtained by retrograde injection (trough CBD) the solidified mass prepared on the basis of "Protacryl M" widely implemented in orthopedic dentistry. The casts were investigated by electro-optic device ProScope-HR with magnification X10, X50 and X200. DR accompanying CBDO is featured by the development of new DPs, the number of which is permanently increased in association with the prolongation of the terms of Cholestasis. DPs continue to develop in all areas of liver lobules - from portal/periportal region up to the regions containing central veins (hepatic veins tributaries of small calibers). The part of DPs has wide lumens, while the lumens of another part of DPs are hardly notable. In spite of evident ductular metaplasia of hepatic tissue, the small groups of normal by form and structure hepatocytes forming the separate small islets could be revealed. Histological features of these hepatocytes support the proposition that these cells maintain the functional activity on the 4th-5th weeks after CBDO. The results of investigations of biliary corrosion casts on the 4th and 5th weeks of CBDO show that solidifying mass cannot reach the small ducts/ductules and especially bile canaliculi. This fact confirms the interruption of ductular-canalicular junctions (IDCJ). We propose that due to IDCJ the increased pressure in preserved bile canaliculi should stipulate the mitotic activity and biliary trans-differentiation of hepatocytes on the late terms of CBDO and support the generation of ductal-like structures and appearance of new DPs. These ductules generally are not drained into the entire biliary tree.

INFLUENCE OF TESTOSTERONE ON MORPHOLOGICAL CHANGES IN PANCREATIC ISLETS AND LIVER TISSUE OF RATS WITH ALLOXAN-INDUCED DIABETES.

The role of exogenous testosterone (methyltrienolone) in the repair of damaged pancreatic islet and liver cells during alloxan diabetes was studied. Modeling of diabetes was performed through single intraperitoneal injection of Alloxan, with the dose 2 mg per 10 g of body weight. Pancreatic and liver tissues were investigated microscopically using 3-4 µm slices embedded in paraffin and stained with hematoxylin and eosin. Software Adobe Photoshop was used to measure the areas of pancreatic islets as well as areas of necrotic foci in these islets of animals with Alloxan-induced experimental diabetes. The degree of liver damage was assessed by a 5-score "visual scale". The animals with diabetes revealed degenerative changes of pancreatic islets and liver tissue, the intensity of which correlates with the time-period passed since diabetic modeling. These changes correspond to the metabolic abnormalities described for various experimental models or clinical cases of diabetes. The study revealed that treatment of Alloxan-induced diabetes with testosterone (methyltrienolone) restores not only the biochemical disorders (as previously described) but also supports to reverse the pathological changes in pancreatic and liver tissues.

BILIARY ATRESIA: CURRENT CONCEPTS AND FUTURE PROSPECTS (REVIEW).

Treatment of biliary atresia is a major challenge in pediatric surgery. Early diagnosis and availability of Kasai procedure with its modern modifications improve outcome of biliary atresia treatment. But Kasai procedure does not fully restore anatomical integrity of biliary tract, because Oddi sphincter is not included in reconstructed system. Constant reflux of intestinal content into the biliary tree is a cause of recurrent cholangitis and change in biliary epithelium that, which is a predisposing factor for cholangiocarcinoma. Various methods have been developed to improve Kasai procedure and prevent the reflux (anti-reflux valve, different enteric conduits, etc.). Many authors used biological grafts made from artery, vein, appendix, urether as well as synthetic materials to restore hepaticocholedochus. Although, neither of these methods were implemented in clinical practice. Nowadays, huge attention is paid to organ and tissue bioengineering. Present advances of tissue bioengineering may assist to create bile duct equivalent, which can be used to restore biliary tract in patients with biliary atresia.

[BREATH TEST WITH LOCALLY PRODUCED 13С-UREA (TBILISI, GEORGIA) IN DIAGNOSTICS OF HELICOBACTER PYLORI INFECTION].

Comparative assessment of results of detection of Helicobacter pylori (Hp) infection by breath tests with standard and locally produced 13С urea was done in 213 patients with gastric and duodenal pathology, including those who already were undergone the surgery. Invasive endoscopic biopsy test including rapid urease test (RUT), smear cytology and histology were also performed (tissue samples were obtained after endoscopy or surgery). RUT was carried out with the help of URE-HP test kit. Serological test for Hp antibodies was performed by IFA using kit ELISA. 13С urea breath test (UBT) was conducted for the determination of 13/12CO2 in breath samples by using of infrared spectroscope. In I group (125 patients) UBT was performed with standard 13С urea, in II group (88 patients) with locally produced 13С urea. Based on 5 different methods of Hp infection testing Hp positivity in 172 (80,8%) and Hp negativity in 41 (19,2%) patients were revealed. 13С-UBT showed the highest diagnostic value (accuracy-97,5%, sensibility-97,0%, specificity-100%) in Hp infection diagnosis. The (accuracy, sensibility and specificity of breath test with locally issued 13С urea (98,7%, 98,5% and 100% respectively) are the same as those for BT with standard 13С urea (96,7%, 96,2% and 100% respectively). These parameters are also highly credible in control of treatment efficiency (96,7%, 90,0% and 100% respectively). The correlation of index DOB‰ of breath test with results of RUT was revealed In Hp positive patients. This can serve as a marker of Hp infection rate. Preliminarily, in pre-clinical experimental study, harmless of locally issued 13С-urea from point of view of acute/sub-acute toxicity and allergy development was confirmed. The advantages (noninvasiveness, simplicity, rapidity, safety) and high diagnostic value of UBT (with both standard as well as locally produced 13С-urea) provide the opportunity to offer 13С-UBT as screening method of Hp infection diagnosis. It also should be recommended as a method of choice for controlling of Hp treatment efficiency. Taking into the consideration all above-mentioned we may recommend locally produced 13С-urea (Tbilisi, Georgia) for certification and further application.

[THEORETICAL BACKGROUND OF FINDING ORGANS FOR TRANSPLANTATION AMONG NON-HEART BEATING DONORS UNDER UNSUCCESSFUL EXTRACORPOREAL RESUSCITATION (LITERATURE REVIEW)].

The number of patients who are in the "Transplant Waiting List" is increasing each year. At the same time, as a result of the significant shortage of donor organs, part of the patients dies without waiting till surgery. According to the Maastricht classification for non-heart beating donors, the patients, who had cardiac arrest outside the hospital (in the uncontrolled by medical staff conditions) should be considered as a potential donors of category II. For these patients, the most effective resuscitation is recommended. The extracorporeal life support (ECLS) considers the connection to a special artificial perfusion system for the restoration of blood circulation out-of-hospital with further transportation to the hospital. If restoration of independent cardiac activity does not occur, in spite of the full range of resuscitative measures, these patients may be regarded as potential donors. The final decision should be received in the hospital, by the council of physicians, lawyers and patient's family members. Until the final decision, the prolongation of ECLS and maintaining adequate systemic and organic circulation is recommended.

Abdominal organ donation: surgical aspects and recommended practice guidelines for controlled donation of brain-dead donor.

The shortage of organ donors along with the increased number of waiting recipients have created the need for new strategies to expand the organ pool from donations after brain death. Organ procurement from brain-dead deceased donors is a complex task. Multiple, complicated operations are performed simultaneously. Very often, this involves numerous physicians and transplant coordinators. An extensive coordination between the thoracic and abdominal surgical teams is crucial for the successful procurement of all suitable organs. The quality of donor organs and the successful recovery therefore depends on a good communication. Organ procurement for transplantation should generally be performed in a calm and dignified atmosphere. The last wishes of the organ donor itself or the relatives must be respected unconditionally. In general, a dignified and respectful treatment of the organ donor is a condition sine qua non for each person involved in the process of organ procurement. The purpose of this article was to focus on the surgical aspects of organ donation after brain death. The proposed recommendations, in cases where they are applicable, are acceptable, however, one should never forget the importance of the ethical side of the issue with respect to the doctor-donating side relationship.

Investigation of functional activity human dental pulp stem cells at acute and chronic pulpitis.

UNLABELLED: It is already recognized that together with the other connective tissues organ-specific progenic stem cells are also found in postnatal dental pulp. This group of undifferentiated cells is only 1% of total cell population of the pulp. The aim of the study was the identification of stem cells in human dental pulp, detection of their localization and assessment of functional activity during inflammation process and/or at norm. The obtained results showed that at acute pulpitis the pulp stroma is hypocellular in comparison with the norm but cells proliferative activity is low. CD 133 and NCAM (CD 56) positive stem cells were found in perivascularl space of the pulp stroma and in Hohle layer. At process prolongation and transition to the chronic phase pulp stroma is hypercellular, the cells with large, rounded or oval-shaped nuclei with clear chromatin appear together with fibroblasts. They are distributed as about entire thickness of the stroma as especially Hohle layer. In such cells higher proliferative activity (Ki67 expression) was observed. The cells in the mentioned proliferation phase are intensively marked by CD133, the rate of which is high in Hohle layer and along it. A large number of NCAM (CD 56) positive cells appear in pulp stroma. CONCLUSIONS: During pulpitis an involvement of stem cells into the process of reparative dentinogenesis should be conducted stepwise. In acute cases of the disease, stem cell perivascularl mobilization and proliferation and its migration to Hohle layer occur in response to irritation /stimulation. Chronification of the process leads not only to the migration of stem cells to the periphery of the pulp but also s their В«maturationВ¼ (increase of NCAM expression in the stem cells), which causes an increase the number of dentin producing active odontoblasts and initiation of reparative dentinogenesis.

Unknown bile ductuli accompanying hepatic vein tributaries (experimental study).

Studying Ductular reaction (DR) at early stages after common bile duct ligation (CBDL) in rats we revealed some ductular profiles (DPs) of unusual location - accompanying different caliber tributaries of hepatic veins (THV) including central and sub-lobular venules. We investigated the essence and genesis of these atypically located ductuli. 28 Wistar Rat livers were studied histologically and immunohistochemically in norm and after 6, 12 and 24 hours of CBDL. Biliary system of part of the animals was preliminary injected by Indian Ink. After CBDL the number of DPs including the ones accompanying large and small THV was increased. The diameters of DPs found immediately at central and sublobular veins were varying from 5 to 15 mВµ and of DPs located in the adventitia of the large THV are varying from 10 to 30 mВµ. The cell of these DPs were CK19, CK7 and OV6 positive, but Ki-67 negative, what confirms their belonging to cholangiocytes but denies their proliferative genesis. In the sites of crossing of different size portal tracts (PT) and THV with integration of their connective tissue sheaths were revealed some biliary ducts/ductules dislocated from PT towards the THV and situated within their adventitia. The Indian Ink injected via CBD was found in both - portal and perivenous DPs as well as in bile canaliculi, what confirms their inter-continuity. The biliary ductules dislocated from PT toward THV may accompany hepatic venous pathways reversely up to central venules. These finest ductuli having spare function are likely to communicate with bile canaliculi.

Helicobacter and hepatobiliary diseases: conceptual view and review of the literature.

Authors conducted the analysis of multiple data concerning the possible role of Helicobacters in pathogenesis of different hepato-biliary disorders in clinical as well as in experimental settings. Two pathways of Helicobacters penetration into hepato-biliary system - "translocation" and "ascending way" - are discussed. Selection of "control group" in both - clinical and experimental studies - is identified as one of crucial problems. It is concluded, that there is a need for further clinical and experimental studies to determine the participation of different Helicobacters in the initiation/pathogenesis of the hepatobiliary system. It is important to develop reliable experimental model, where only Helicobacters cause the pathology of liver and bile tract and where the selection of "adequate control group" is possible. For the identification of helicobacter strains in humans (where the problem of "adequate control group" selection will always remain), it is greatly important to conduct the complex study of multiple data of histological (immunohistochemical, fluorescence, etc.), cultural and molecular investigations of helicobacter species with subsequent phylogenetic analyses in different hepatobiliary diseases.

New model of veno-venous bypass for management of anhepatic phase in experimental study on dogs.

Blood is shunted from the inferior vena cava and portal vein to the superior vena caval system to prevent congestion in the lower parts of the body during the anhepatic phase (AP) of liver transplantation. It leads to overload in the superior vena caval system retarding cranial outflow due to a nonphysiological blood redistribution. To overcome this problem, we developed a new bypass in dogs: blood is shunted from the inferior (caudal) vena cava and portal vein to the suprahepatic inferior (caudal) vena cava. This model was compared with traditional one with or without a pump. Blood pressure and flow parameters were estimated during 3 hours of AP in four groups of four dogs each. The current study showed that a nontraditional scheme of venous bypass reduced circulatory complications during AP, especially in the cranial vena caval system, although a low rate of congestion remains in the caudal vena cava and portal vein systems. Whereas the same scheme using a pump effectively prevented congestion in all of the systems: cranial, caudal, and portal. We concluded that application of a nontraditional bypass scheme, providing venous blood return into suprahepatic part of caudal vena cava, can be considered to be a method of choice for experimental liver transplantation.

Experimental liver autotransplantation with novel scheme of veno-venous bypass as a model of liver denervation and delymphatization.

The impact of denervation and delymphatization (DD) on liver tissue remains a topic of major interest in liver transplantation, as the organ or its part continues to function well. Various chemical and/or surgical interventions have been developed to achieve in situ liver denervation and delymphatization, but it is evident that DD can be achieved only through "ectomia", ie, complete isolation of the organ from adjacent and connected structures. This Study describes a liver DD model based on a technique of autotransplantation (replantation), maximally preventing ischemia in the transplanted (replanted) graft and dyscirculatory complications in the recipient. Experiments were performed on eight male mongrel dogs. Venous reservoir and roller pumps were used in a forced nontraditional bypass scheme. Autotransplantation was performed by step-by-step dissection of the suprahepatic, infrahepatic, and portal structures, leading to DD, with subsequent recovery of the blood vessel and bile duct. DD was achieved successfully with stable hemodynamic parameters during all surgery periods. All animals survived. This model of liver autotransplantation lead to DD of the organ. It was characterized by hemodynamic stability of the liver as well as of the whole body at every stage of the surgery, proffering liver DD for experimental studies.