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1.
BMC Surg ; 19(1): 162, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694627

RESUMO

BACKGROUND: Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. CASE PRESENTATION: Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. CONCLUSION: We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.


Assuntos
Doenças dos Ductos Biliares/etiologia , Ductos Biliares/lesões , Complicações Pós-Operatórias/cirurgia , Adulto , Colecistectomia Laparoscópica/efeitos adversos , Drenagem , Feminino , Hepatectomia/efeitos adversos , Humanos , Doença Iatrogênica , Fígado/patologia , Masculino , Pessoa de Meia-Idade
2.
Nat Rev Gastroenterol Hepatol ; 16(8): 497-511, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31165788

RESUMO

Bile duct epithelial cells, also known as cholangiocytes, regulate the composition of bile and its flow. Acquired, congenital and genetic dysfunctions in these cells give rise to a set of diverse and complex diseases, often of unknown aetiology, called cholangiopathies. New knowledge has been steadily acquired about genetic and congenital cholangiopathies, and this has led to a better understanding of the mechanisms of acquired cholangiopathies. This Review focuses on findings from studies on Alagille syndrome, polycystic liver diseases, fibropolycystic liver diseases (Caroli disease and congenital hepatic fibrosis) and cystic fibrosis-related liver disease. In particular, knowledge on the role of Notch signalling in biliary repair and tubulogenesis has been advanced by work on Alagille syndrome, and investigations in polycystic liver diseases have highlighted the role of primary cilia in biliary pathophysiology and the concept of biliary angiogenic signalling and its role in cyst growth and biliary repair. In fibropolycystic liver disease, research has shown that loss of fibrocystin generates a signalling cascade that increases ß-catenin signalling, activates the NOD-, LRR- and pyrin domain-containing 3 inflammasome, and promotes production of IL-1ß and other chemokines that attract macrophages and orchestrate the process of pericystic and portal fibrosis, which are the main mechanisms of progression in cholangiopathies. In cystic fibrosis-related liver disease, lack of cystic fibrosis transmembrane conductance regulator increases the sensitivity of epithelial Toll-like receptor 4 that sustains the secretion of nuclear factor-κB-dependent cytokines and peribiliary inflammation in response to gut-derived products, providing a model for primary sclerosing cholangitis. These signalling mechanisms may be targeted therapeutically and they offer a possibility for the development of novel treatments for acquired cholangiopathies.


Assuntos
Doenças dos Ductos Biliares/genética , Síndrome de Alagille/fisiopatologia , Doenças dos Ductos Biliares/tratamento farmacológico , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/fisiopatologia , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Cistos/genética , Cistos/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Humanos , Hepatopatias/genética , Hepatopatias/fisiopatologia , Terapia de Alvo Molecular/métodos , Receptores Notch/fisiologia , Transdução de Sinais/fisiologia
3.
Ann Surg Oncol ; 26(9): 2981-2984, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147989

RESUMO

BACKGROUND: Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. METHODS: A 52-year-old man underwent laparoscopic cholecystectomy at another institution 8 years previously, which resulted in a bile duct injury. His postoperative period was complicated by jaundice and cholangitis. He was treated with endoscopic retrograde cholangiopancreatography and multiple endoprostheses for 3 years, after which the endoprostheses were removed, and he was sent to the authors' institution. Computed tomography showed that the left liver had signs of disturbed perfusion and dilation of the left intrahepatic bile duct. The patient was asymptomatic and refused any further attempt at surgical correction of the lesion. He was accompanied for 5 years. Magnetic resonance imaging showed progressive atrophy of the left liver. Finally, 3 months before this writing, he presented with intermittent episodes of cholangitis. A multidisciplinary team decided to perform left hepatectomy with Roux-en-Y hepatojejunostomy via a robotic approach. The left liver was atrophied, and left hepatectomy was performed. Fluorescence imaging was used to identify the right bile duct. At opening of the right bile duct, small stones were found and removed. Antecolic Roux-en-Y hepaticojejunostomy then was performed. RESULTS: The operative time was 335 min. Recovery was uneventful, and the patient was discharged on postoperative day 4. CONCLUSIONS: Robotic repair of bile duct injuries is feasible and safe, even when liver resection is necessary. This video may help oncologic surgeons to perform this complex procedure.


Assuntos
Anastomose em-Y de Roux/métodos , Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Hepatectomia/métodos , Jejunostomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Gravação em Vídeo
4.
Medicine (Baltimore) ; 98(23): e16033, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169745

RESUMO

BACKGROUND: The worldwide organ shortage continues to be the main limitation of liver transplantation. To bridge the gap between the demand and supply of liver grafts, it becomes necessary to use extended criteria donor livers for transplantation. Hypothermic machine perfusion (HMP) is designed to improve the quality of preserved organs before implantation. In clinical liver transplantation, HMP is still in its infancy. METHODS: A systematic search of the PubMed, EMBASE, Springer, and Cochrane Library databases was performed to identify studies comparing the outcomes in patients with HMP versus static cold storage (SCS) of liver grafts. The parameters analyzed included the incidences of primary nonfunction (PNF), early allograft dysfunction (EAD), vascular complications, biliary complications, length of hospital stay, and 1-year graft survival. RESULTS: A total of 6 studies qualified for the review, involving 144 and 178 liver grafts with HMP or SCS preservation, respectively. The incidences of EAD and biliary complications were significantly reduced with an odds ratio (OR) of 0.36 (95% confidence interval [CI] 0.17-0.77, P = .008) and 0.47 (95% CI 0.28-0.76, P = .003), respectively, and 1-year graft survival was significantly increased with an OR of 2.19 (95% CI 1.14-4.20, P = .02) in HMP preservation compared to SCS. However, there was no difference in the incidence of PNF (OR 0.30, 95% CI 0.06-1.47, P = .14), vascular complications (OR 0.69, 95% CI 0.29-1.66, P = .41), and the length of hospital stay (mean difference -0.30, 95% CI -4.10 to 3.50, P = .88) between HMP and SCS preservation. CONCLUSIONS: HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.


Assuntos
Hipotermia Induzida/métodos , Transplante de Fígado/métodos , Preservação de Órgãos/métodos , Perfusão/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Aloenxertos/irrigação sanguínea , Doenças dos Ductos Biliares/epidemiologia , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/prevenção & controle , Feminino , Sobrevivência de Enxerto , Humanos , Incidência , Fígado/irrigação sanguínea , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Disfunção Primária do Enxerto/epidemiologia , Disfunção Primária do Enxerto/etiologia , Disfunção Primária do Enxerto/prevenção & controle , Fatores de Tempo
5.
Medicine (Baltimore) ; 98(20): e15600, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096464

RESUMO

INTRODUCTION: Congenital hepatic fibrosis (CHF) is a rare autosomal recessive disease derived from biliary dysgenesis secondary to ductal plate malformation and is often accompanied by renal cysts or increased renal echogenicity. PATIENT CONCERNS: A 25-year-old woman was admitted to our hospital with splenomegaly and hepatic cirrhosis of a 3-month duration and fever accompanied by abdominal pain for 3 days. The second patient was a 25-year-old male referred to our hospital with hepatomegaly and splenomegaly of 6-year duration who had experienced fever for 3 months and abdominal distension for 1 week. Both 25-year-old patients were found to have CHF with polycystic kidney disease. DIAGNOSIS: Radiological imaging, including computed tomography (CT), magnetic resonance imaging (MRI), and sonography, revealed hepatic fibrosis, portal hypertension, splenomegaly, ascites, bile duct malformation, polycystic kidneys, and CHF. For the first patient, a liver biopsy confirmed the pathological features of CHF, and genetic testing revealed three heterozygous missense mutations, which were classified as "undetermined" in the public Wilson's disease/ATP7B and ADPKD/PKD1 databases. INTERVENTIONS: The first patient had undergone a splenectomy for anemia 2 months previously. Because there is no radical cure for CHF, and due to economic reasons, neither patient received liver transplantation. Therefore, we administered only anti-fibrotic supportive treatment for symptoms. OUTCOMES: Both patients were discharged after their symptoms improved, and both survived for 2 years of follow-up. CONCLUSION: These cases highlight the value of radiological imaging, pathological examination, and genetic evaluation for the diagnosis of CHF. When an individual with unexplained cirrhosis presents with bile duct dilation and malformation as well as polycystic kidneys, the possibility of CHF should be considered. For individuals found to have polycystic kidneys at a young age, the results of liver function tests and imaging examinations including Fibroscan imaging should be continuously and dynamically monitored to enable early diagnosis of CHF.


Assuntos
Doenças Genéticas Inatas/diagnóstico , Cirrose Hepática/diagnóstico , Adulto , Doenças dos Ductos Biliares/etiologia , Feminino , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/diagnóstico por imagem , Doenças Genéticas Inatas/patologia , Humanos , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino , Doenças Renais Policísticas/etiologia , Esplenomegalia/etiologia
6.
Transplant Proc ; 51(3): 1002-1005, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30979439

RESUMO

Increased biliary complications in hepatopulmonary syndrome (HPS) have been hypothesized due to post-transplant hypoxemia. Supporting this hypothesis, we report histopathological findings from an explant liver allograft where the recipient suffered severe and prolonged post-operative hypoxemia. A 4-year-old child underwent liver transplantation (LT) for decompensated chronic liver disease complicated by severe HPS. The post-operative period was complicated by severe prolonged hypoxemia. HPS resolved completely 6 months after LT only to recur 3 months later due to graft dysfunction. The child underwent retransplantation 8 months after the first LT. The explant liver showed bile duct loss along with ulceration and fibrosis of large hilar bile ducts biliary, suggestive of ischemic cholangiopathy. Based on the histopathology findings, we suggest that severe prolonged hypoxemia during post-transplant period could cause ischemic cholangiopathy, which can lead to biliary complications.


Assuntos
Doenças dos Ductos Biliares/etiologia , Ductos Biliares/irrigação sanguínea , Síndrome Hepatopulmonar/cirurgia , Hipóxia/complicações , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Aloenxertos , Doenças dos Ductos Biliares/diagnóstico , Pré-Escolar , Colangiografia , Síndrome Hepatopulmonar/diagnóstico , Humanos , Masculino
7.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796069
8.
Can J Surg ; 62(1): 44-51, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30484989

RESUMO

Background: Outcomes in liver transplantation with organs obtained via donation after cardiocirculatory death (DCD) have been suboptimal compared to donation after brain death, attributed mainly to the high incidence of ischemic cholangiopathy (IC). We evaluated the effect of a 10-year learning curve on IC rates among DCD liver graft recipients at a single centre. Methods: We analyzed all DCD liver transplantation procedures from July 2006 to July 2016. Patients were grouped into early (July 2006 to June 2011) and late (July 2011 to July 2016) eras. Those with less than 6 months of follow-up were excluded. Primary outcomes were IC incidence and IC-free survival rate. Results: Among the 73 DCD liver transplantation procedures performed, 70 recipients fulfilled the selection criteria, 32 in the early era and 38 in the late era. Biliary complications were diagnosed in 19 recipients (27%). Ischemic cholangiopathy was observed in 8 patients (25%) in the early era and 1 patient (3%) in the late era (p = 0.005). The IC-free survival rate was higher in the late era than the early era (98% v. 79%, p = 0.01). The warm ischemia time (27 v. 24 min, p = 0.049) and functional warm ischemia time (21 v. 17 min, p = 0.002) were significantly lower in the late era than the early era. Conclusion: We found a significant reduction in IC rates and improvement in ICfree survival among DCD liver transplantation recipients after a learning curve period that was marked by more judicious donor selection with shorter procurement times.


Assuntos
Doenças dos Ductos Biliares/prevenção & controle , Morte , Doença Hepática Terminal/cirurgia , Isquemia/prevenção & controle , Transplante de Fígado/efeitos adversos , Isquemia Quente/normas , Adulto , Idoso , Doenças dos Ductos Biliares/etiologia , Canadá , Bases de Dados Factuais , Feminino , Sobrevivência de Enxerto , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Doadores de Tecidos , Coleta de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/normas , Transplantados , Resultado do Tratamento
9.
Dig Dis Sci ; 64(3): 759-772, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30465176

RESUMO

BACKGROUND: Macrophage migration inhibitory factor (MIF) is involved in many acute and chronic inflammatory diseases. However, its role in intrahepatic bile duct (IBD) cell damage associated with severe acute pancreatitis (SAP) remains unclear. AIMS: This study was aimed to identify the role of MIF and its underlying mechanisms in SAP complicated by IBD cell damage. METHODS: Forty-eight specific-pathogen-free male Wistar rats were randomly divided into four groups (N = 12): a sham operation group (SO group) and three SAP model groups (SAP-3h, SAP-6h, and SAP-12h). Immunohistochemistry was used to detect the expression of MIF and P38 in IBD cells. MIF mRNA expression in IBD cells was observed using real-time fluorescent quantitative polymerase chain reaction (real-time PCR). In addition, Western blotting was performed to detect the protein expression of P38, phosphorylated P38 (P-P38), nuclear factor-κB (NF-κB p65), and tumor necrosis factor alpha (TNF-α). Enzyme-linked immunosorbent assays were used to analyze the levels of TNF-α, IL-1ß, and IL-6 in the IBD of rats. RESULTS: Compared with the SO group, the expression of MIF in the IBD was significantly upregulated both at mRNA and at protein levels in the SAP group. Besides, the protein expression levels of P38, P-P38, NF-κB, p65, TNF-α, IL-1ß, and IL-6 in the IBD in rats were also significantly increased in the SAP group and the levels increased gradually as acute pancreatitis progressed (all P < 0.05). CONCLUSIONS: MIF may promote the IBD injury and inflammatory reaction in SAP via activating the P38-MAPK and NF-κB signaling pathways.


Assuntos
Doenças dos Ductos Biliares/etiologia , Ductos Biliares Intra-Hepáticos/metabolismo , Oxirredutases Intramoleculares/metabolismo , Fatores Inibidores da Migração de Macrófagos/metabolismo , Pancreatite/complicações , Doença Aguda , Animais , Doenças dos Ductos Biliares/genética , Doenças dos Ductos Biliares/metabolismo , Doenças dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/patologia , Modelos Animais de Doenças , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Oxirredutases Intramoleculares/genética , Fatores Inibidores da Migração de Macrófagos/genética , Masculino , Pancreatite/genética , Pancreatite/metabolismo , Pancreatite/patologia , Fosforilação , Ratos Wistar , Índice de Gravidade de Doença , Transdução de Sinais , Fator de Transcrição RelA/metabolismo , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
10.
Rev Gastroenterol Peru ; 38(3): 280-284, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30540732

RESUMO

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.


Assuntos
Doenças dos Ductos Biliares/etiologia , Hemorragia Gastrointestinal/etiologia , Doença de Gaucher/complicações , Hemangioma Cavernoso/complicações , Hipertensão Portal/complicações , Veia Porta/anormalidades , Veia Porta/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Dilatação Patológica/etiologia , Terapia de Reposição de Enzimas , Vesícula Biliar/irrigação sanguínea , Doença de Gaucher/diagnóstico , Doença de Gaucher/tratamento farmacológico , Glucosilceramidase/uso terapêutico , Humanos , Hipertensão Portal/diagnóstico por imagem , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/patologia , Veia Porta/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Esplenectomia , Veia Esplênica/diagnóstico por imagem , Veia Esplênica/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
11.
Int J Surg ; 60: 164-172, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30439536

RESUMO

BACKGROUND: Since the introduction of laparoscopic cholecystectomy (LC), a substantial increase in bile duct injury (BDI) incidence was noted. Multiple methods to prevent this complication have been developed and investigated. The most suitable method however is subject to debate. In this systematic review, the different modalities to aid in the safe performance of LC and prevent BDI are delineated. MATERIALS AND METHODS: A systematic search for articles describing methods for the prevention of BDI in LC was conducted using EMBASE, Medline, Web of science, Cochrane CENTRAL and Google scholar databases from inception to 11 June 2018. RESULTS: 90 studies were included in this systematic review. Overall, BDI preventive techniques can be categorized as dedicated surgical approaches (Critical View of Safety (CVS), fundus first, partial laparoscopic cholecystectomy), supporting imaging techniques (intraoperative radiologic cholangiography, intraoperative ultrasonography, fluorescence imaging) and others. Dedicated surgical approaches demonstrate promising results, yet limited research is provided. Intraoperative radiologic cholangiography and ultrasonography demonstrate beneficial effects in BDI prevention, however the available evidence is low. Fluorescence imaging is in its infancy, yet this technique is demonstrated to be feasible and larger trials are in preparation. CONCLUSION: Given the low sample sizes and suboptimal study designs of the studies available, it is not possible to recommend a preferred method to prevent BDI. Surgeons should primarily focus on proper dissection techniques, of which CVS is most suitable. Additionally, recognition of hazardous circumstances and knowledge of alternative techniques is critical to complete surgery with minimal risk of injury to the patient.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/métodos , Complicações Intraoperatórias/prevenção & controle , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/prevenção & controle , Colangiografia/métodos , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Masculino , Ultrassonografia/métodos
12.
Transplant Proc ; 50(9): 2705-2710, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30401381

RESUMO

BACKGROUND: Biliary complication is one of the major donor complications during and after hepatectomy in living donor liver transplantation (LDLT). We evaluated risk factors for donor biliary complication in adult-to-adult LDLT. PATIENTS AND METHODS: From March 2002 to November 2016, 126 consecutive patients who underwent donor hepatectomy in adult-to-adult LDLT were divided into 2 groups according to biliary compilations: nonbiliary complication (non-BC) group (n = 114) and biliary complication (BC) group (n = 12). RESULTS: Among 126 donor hepatectomies, 35 patients (28%) experienced perioperative complications, including 10 (7.9%) with Clavien-Dindo classification grade III. Biliary complications occurred in 12 patients (9.5%): bile leakage in 10 and intraoperative bile duct injury in 2. Additional computed tomography- and/or ultrasound-guided drainage or exchange of original drain was required in 7 patients. In comparison between BC and non-BC groups, future remnant liver volume was significantly higher in the BC group than in the non-BC group (63% vs 40%; P = .02). In multivariate analysis, larger future remnant liver volume (P = .005) and shorter operating time (P = .02) were identified as independent risk factors for biliary complications. We had 2 patients with intraoperative bile duct injury: both were successfully treated by duct-to-duct biliary anastomosis with insertion of biliary stent or T-tube. CONCLUSION: Large remnant liver volume was a significant risk factor for biliary complications, especially biliary leakage, after donor hepatectomy. For intraoperative bile duct injury, duct-to-duct anastomosis with biliary stent is a feasible method to recover.


Assuntos
Ductos Biliares/lesões , Hepatectomia/efeitos adversos , Doadores Vivos , Complicações Pós-Operatórias/patologia , Adolescente , Adulto , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Feminino , Hepatectomia/métodos , Humanos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco , Coleta de Tecidos e Órgãos/efeitos adversos
13.
Semin Liver Dis ; 38(4): 333-339, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30357770

RESUMO

TGR5 (GPBAR1) is a G protein-coupled receptor activated by primary and secondary bile acids, which is expressed in different nonparenchymal cells of the liver, such as sinusoidal endothelial cells, Kupffer cells, cholangiocytes as well as activated hepatic stellate cells. In liver, TGR5 modulates microcirculation, inflammation, regeneration, biliary secretion and proliferation as well as gallbladder filling. Absence of TGR5 renders mice more susceptible toward infectious, inflammatory, metabolic as well as cholestatic liver injuries. It is unknown whether TGR5 plays a role in the pathogenesis of human nonalcoholic steatohepatitis and cholestatic liver diseases such as primary sclerosing cholangitis and primary biliary cholangitis. However, overexpression of TGR5 has been detected in human intra- and extrahepatic cholangiocarcinoma as well as in cystic cholangiocytes, where the receptor promotes cell proliferation, anti-apoptosis as well as cyst growth. While TGR5 agonists may improve various aspects of metabolic, inflammatory, and cholestatic liver diseases, TGR5 inhibitors may attenuate disease progression in polycystic liver disease and cholangiocarcinoma.


Assuntos
Ácidos e Sais Biliares/metabolismo , Doenças dos Ductos Biliares/metabolismo , Hepatopatias/metabolismo , Receptores Acoplados a Proteínas-G/metabolismo , Animais , Doenças dos Ductos Biliares/etiologia , Colangiocarcinoma/etiologia , Colangiocarcinoma/metabolismo , Colestase/metabolismo , Células Epiteliais/metabolismo , Humanos , Hipertensão Portal/metabolismo , Hepatopatias/etiologia , Camundongos , Transdução de Sinais
16.
Eur J Radiol ; 106: 46-55, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30150050

RESUMO

PURPOSE: Our study was aimed to assess the diagnostic value of MR cholangiopancreatography (MRCP) and MR imaging at 3 T device when evaluating biliary adverse events after liver transplantation. MATERIALS AND METHODS: A series of 384 MR examinations in 232 liver transplant subjects with suspected biliary complications (impaired liver function tests and/or biliary abnormalities on ultrasound) were performed at 3 T device (GE-DISCOVERY MR750; GE Healthcare). After the acquisition of axial 3D dual-echo T1-weighted images and T2-weighted sequences (propeller and SS-FSE), MRCP was performed through coronal thin-slab 3D-FRFSE and coronal oblique thick-slab SSFSE T2w sequences. DW-MRI of the liver was performed using an axial spin-echo echo-planar sequence with multiple b values (150, 500, 1000, 1500 s/mm2) in all diffusion directions. Contrast-enhanced MRCP was performed in 25/232 patients. All MR images were blindly evaluated by two experienced abdominal radiologists in consensus to determine the presence of biliary complications, whose final diagnosis was based on direct cholangiography, surgery and integrating clinical follow-up with ultrasound and/or MRI findings. RESULTS: In 113 patients no biliary abnormality was observed. The remaining 119 subjects were affected by one or more of the following complications: non-anastomotic strictures including typical ischemic-type biliary lesions (n = 67), anastomotic strictures (n = 34), ampullary dysfunction (n = 4), anastomotic leakage (n = 4), stones, sludge and casts (n = 65), vanishing bile duct (n = 1). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of the reviewers for the detection of all types of biliary complications were 99%, 96%, 95%, 99% and 97%, respectively. CONCLUSION: MR cholangiopancreatography and MR imaging at 3 T device are extremely reliable for detecting biliary complications after liver transplantation.


Assuntos
Fístula Anastomótica/diagnóstico por imagem , Doenças dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares/diagnóstico por imagem , Colangiografia , Imagem de Difusão por Ressonância Magnética , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Fístula Anastomótica/patologia , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
17.
Radiologia ; 60(6): 521-533, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30001830

RESUMO

This article uses a practical approach to explain the imaging findings for vascular and biliary complications after total liver transplantation in adults, comparing them to the normal imaging findings after transplantation. It emphasizes the radiologic management of patients who have undergone transplantations and explains the treatment of the different complications by interventional radiology. The information provided comes from the authors' experience and a thorough, up-to-date review of the indexed literature.


Assuntos
Doenças dos Ductos Biliares/etiologia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doenças Vasculares/etiologia , Artéria Hepática , Humanos , Veia Porta
18.
Eur J Pediatr ; 177(8): 1261-1269, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29868931

RESUMO

We studied the etiological spectrum, clinicolaboratory and histological profile, and outcome of infants and children under 18 years of age presenting between December 2010 and May 2016 with histological evidence of paucity of intralobular bile ducts (PILBD, bile ducts to portal tract ratio < 0.6) Post-transplant PILBD was excluded. Of 632 pediatric liver biopsies screened, 70 had PILBD-44 were infants. PILBD was classified histologically into destructive (n = 50) and non-destructive PILBD (n = 20). Presentations were jaundice (98%), organomegaly (94%), pale stools (50%), and pruritus (43%). Infants had more cholestasis but less fibrosis on histology. Overall, 29 required liver transplantation (LT) for portal hypertension (n = 26), decompensation (n = 25), growth failure (n = 20), intractable pruritus (n = 5), and recurrent cholangitis (n = 2). Destructive PILBD has an odds for poor outcome (decompensation or need for LT within 1 year) of 1.53 (95% CI = 1.15-2.04). On binary logistic regression analysis, poor outcome was related to advanced fibrosis on liver biopsy [Exp (B) = 5.46, 95% CI = 1.56-19.04]. CONCLUSION: PILBD was present in 11% of pediatric liver biopsies and has a varied etiological spectrum. Destructive PILBD has poor outcome. Need for LT is guided by the presence of advanced fibrosis. What is Known: • Natural history of syndromic ductal paucity (Alagille syndrome) is complex. • Duct loss is commonly seen with late presentation of biliary atresia. What is New: • The study classifies the etiological spectrum of ductal paucity histologically into destructive and non-destructive. • Destructive duct loss carries poor prognosis regardless of the etiology of liver disease with subsequent need for liver transplantation.


Assuntos
Doenças dos Ductos Biliares/congênito , Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/anormalidades , Adolescente , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/terapia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Prognóstico , Estudos Retrospectivos
19.
World J Surg ; 42(10): 3134-3142, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29616319

RESUMO

INTRODUCTION: In laparoscopic transcystic common bile duct exploration (LTCBDE), the risk of acute pancreatitis (AP) is well recognized. The present study assesses the incidence, risk factors, and clinical impact of AP in patients with choledocholithiasis treated with LTCBDE. METHODS: A retrospective database was completed including patients who underwent LTCBDE between 2007 and 2017. Univariate and multivariate analyses were performed by logistic regression. RESULTS: After exclusion criteria, 447 patients were identified. There were 70 patients (15.7%) who showed post-procedure hyperamylasemia, including 20 patients (4.5%) who developed post-LTCBDE AP. Of these, 19 were edematous and one was a necrotizing pancreatitis. Patients with post-LTCBDE AP were statistically more likely to have leukocytosis (p < 0.004) and jaundice (p = 0.019) before surgery and longer operative times (OT, p < 0.001); they were less likely to have incidental intraoperative diagnosis (p = 0.031) or to have biliary colic as the reason for surgery (p = 0.031). In the final multivariate model, leukocytosis (p = 0.013) and OT (p < 0.001) remained significant predictors for AP. Mean postoperative hospital stay (HS) was significantly longer in AP group (p < 0.001). CONCLUSION: The risk of AP is moderate and should be considered in patients with preoperative leukocytosis and jaundice and exposed to longer OT. AP has a strong impact on postoperative HS.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/cirurgia , Pancreatite/etiologia , Doença Aguda , Adulto , Idoso , Doenças dos Ductos Biliares/etiologia , Ducto Colédoco , Feminino , Humanos , Período Intraoperatório , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Pancreatite/cirurgia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Liver Transpl ; 24(8): 1050-1061, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29633539

RESUMO

Biliary complication (BC) is still regarded as the Achilles' heel of a living donor liver transplantation (LDLT). This study aims to evaluate the longterm outcomes of the duct-to-duct (DD) biliary reconstruction using 7-0 suture and to identify the risk factors of BCs after LDLTs. Data of 140 LDLTs between 2006 and 2015 were analyzed. All biliary reconstructions were performed as DD anastomoses using 7-0 suture: 102 for the right lobe, 20 for the left lobe, and 18 for right posterior sector grafts. BC was defined as a bile leakage (BL) or a biliary stricture (BS), and the median follow-up time after LDLT was 65 months. A total of 19 recipients (13.5%) developed BCs (8 BLs and 16 BSs) after LDLT. The survival rates between recipients with and without BCs were 83% and 86.7%, respectively (P = 0.88). In univariate analyses, the risk factors for BC were small diameter of the graft's bile duct, long warm ischemic time, small graft-to-recipient weight ratio, and no use of external biliary stent (EBS). The graft's bile duct diameter ≤ 3 mm and no use of EBS were determined as independent risk factors (hazard ratios of 9.74 and 7.68, respectively) in multivariate analyses. The 116 recipients with EBS had no BL, 11 had BSs (9%), while 24 without EBS had 8 BLs (33%) and 5 BSs (21%). After a propensity score match between the recipients with and without EBS, the EBS group (24) developed only 1 BS (4%). In conclusion, DD anastomosis using 7-0 suture combined with EBS could provide favorable longterm outcomes after LDLT, which should thus be considered the surgical technique of choice for LDLTs.


Assuntos
Doenças dos Ductos Biliares/epidemiologia , Ductos Biliares/cirurgia , Doença Hepática Terminal/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/patologia , Feminino , Seguimentos , Humanos , Transplante de Fígado/instrumentação , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents , Técnicas de Sutura , Fatores de Tempo , Isquemia Quente/efeitos adversos , Adulto Jovem
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