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1.
Medicine (Baltimore) ; 99(4): e18677, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977857

RESUMO

To investigate whether postoperative hepatic hemodynamics have an impact on graft function.Using a retrospective cohort with 262 adult living donor liver transplantation (LDLT) recipients, we discussed the relationship between postoperative hepatic hemodynamics and patient outcomes.According to the definition of early allograft dysfunction (EAD), the patients were classified into the EAD group (43 patients) and the non-EAD group (219 patients). In terms of postoperative hemodynamic parameters, there was no significant differences between these 2 groups regarding hepatic artery flow (HAF), hepatic artery velocity (HAV), portal vein flow (PVF), and portal vein velocity (PVV), except for the hepatic artery resistance index (HARI) which was somewhat higher in the EAD group on postoperative day 3 (POD3) (0.70 vs 0.61, P < .05). According to these results, we used a ROC curve and found that a HARI of 0.68 was the cutoff point (with 73.8% sensitivity and 58.3% specificity) for predicting EAD after LDLT. In addition, multivariate analysis showed that fulminant hepatic failure, pretransplant hepatorenal syndrome, and HARI ≥ 0.68 on POD3 were independent risk factors for postoperative EAD.Our results showed that postoperative hemodynamics might influence graft function by altering hepatic artery flow.


Assuntos
Sobrevivência de Enxerto/fisiologia , Artéria Hepática/patologia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Resistência Vascular/fisiologia , Adolescente , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18737, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914090

RESUMO

Portal vein thrombosis (PVT) might impair the prognosis of cirrhotic patients. However, formation of de novo PVT after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients without preexisting PVT was rarely reported. Moreover, it is not known whether warfarin is efficient in preventing de novo PVT after TIPS. The current study aimed to investigate retrospectively the incidence and location of de novo PVT, and preventive effects of warfarin on de novo PVT after TIPS for cirrhotic patients. Patients who received TIPS placement between March 1, 2015 and March 1, 2016 in our hospital were screened retrospectively. Patients without preexisting PVT before TIPS and those who were followed up for at least 12 months were included. There were 2 groups: 1 group received warfarin (warfarin group) post-TIPS, while another group (control group) did not receive prophylactic drug to prevent PVT. Their baseline characteristics and follow-up data were retrieved. The occurrence of PVT, adverse events due to warfarin, difference in stent patency and clinical complications such as stent dysfunction, hepatic encephalopathy, mortality, liver cancer, variceal bleeding, infection, and liver failure, and results of follow-up biochemical examination were compared. Eighty-three patients without preexisting PVT were included. There were 56 patients in the control group and 27 in the warfarin group. The incidence of PVT in the warfarin group was 14.8% (4/27), whereas the incidence in the control group was 42.9% (24/56, P = .013). The location of de novo PVT was mainly at left portal vein. Adverse events due to warfarin was mostly mild, such as hemorrhinia and gingival hemorrhage. No significant difference regarding to stent patency and clinical complications between the 2 groups was found. At 24-month after-TIPS, for the remaining patients in both groups, the total bilirubin was significantly increased while the red blood cell count was significantly decreased in control group compared with those in warfarin group (P < .05). PVT could commonly occur after TIPS in patients without preexisting PVT. Warfarin could prevent PVT in these patients, and might improve patient's liver function.


Assuntos
Cirrose Hepática/cirurgia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Trombose/etiologia , Trombose/prevenção & controle , Varfarina/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Varfarina/efeitos adversos
3.
Vasc Endovascular Surg ; 54(1): 36-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31570064

RESUMO

OBJECTIVES: Although traumatic injuries to the superior mesenteric vein (SMV), portal vein (PV), and hepatic vein (HV) are rare, their impact is significant. Small single center reports estimate mortality rates ranging from 29% to 100%. Our aim is to elucidate the incidence and outcomes associated with each injury due to unique anatomic positioning and varied tolerance of ligation. We hypothesize that SMV injury is associated with a lower risk of mortality compared to HV and PV injury in adult trauma patients. METHODS: The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis. RESULTS: From 1,403,466 patients, 966 (0.07%) had a single major hepatoportal venous injury with 460 (47.6%) involving the SMV, 281 (29.1%) involving the PV, and 225 (23.3%) involving the HV. There was no difference in the percentage of patients undergoing repair or ligation between SMV, PV, and HV injuries (P > .05). Compared to those with PV and HV injuries, patients with SMV injury had a higher rate of concurrent bowel resection (38.5% vs 12.1% vs 7.6%, P < .001) and lower mortality (33.3% vs 45.9% vs 49.3%, P < .01). After controlling for covariates, traumatic SMV injury increased the risk of mortality (odds ratio [OR] 1.59, confidence interval [CI] = 1.00-2.54, P = .05) in adult trauma patients; however, this was less than PV injury (OR = 2.77, CI = 1.56-4.93, P = .001) and HV injury (OR = 2.70, CI = 1.46-4.99, P = .002). CONCLUSION: Traumatic SMV injury had a lower rate of mortality compared to injuries of the HV and PV. SMV injury increased the risk of mortality by 60% in adult trauma patients, whereas PV and HV injuries nearly tripled the risk of mortality.


Assuntos
Veias Hepáticas/lesões , Veia Porta/lesões , Lesões do Sistema Vascular/epidemiologia , Adolescente , Adulto , Criança , Bases de Dados Factuais , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/cirurgia , Adulto Jovem
4.
Zhonghua Yi Xue Za Zhi ; 99(45): 3554-3557, 2019 Dec 03.
Artigo em Chinês | MEDLINE | ID: mdl-31826570

RESUMO

Objective: To assess the feasibility and value of real-time image fusion technique guiding the procedure of transjugular intrahepatic portosystemic shunt(TIPS). Methods: From July 2017 to May 2018,a total of 48 consecutive patients complicated by portal venous hypertension due to cirrhosis who underwent TIPS were prospectively allocated into two groups that 27 cases underwent normal TIPS and 21 cases underwent image fusion guided TIPS. There were 25 males and 23 females with a mean age of 29-74(51±10) years. The differences of portal vein(PV) between image fusion angiographyand digital subtraction angiography(DSA), and the times of puncture PV, X-ray exposure dose and exposure time and contrast agent amount of all cases were collected and analyzed. Results: The longitudinal and traverse difference of PV between image fusion angiography and DSA were 1.7-2.5(2.1±0.2) mm and 0.9-1.8(1.4±0.3) mm, respectively.The times of puncture PV, X-ray exposure time and dose, and contrast agent amount between normal TIPS group and image fusion guided TIPS group were 1-7(3.8±0.6) times vs 1-3(2.0±0.6) times, 41-63(53±8)min vs 27-42(35±5) min, 513-787(644±96) mGy vs 357-524(423±59) mGy,102-196(151±23) ml vs 87-145(105±14) ml(all P<0.05), respectively. Conclusions: There are minor differences between image fusion angiography of PV and DSA. Real-time image fusion guided TIPS is feasible and valuable to reduce intraprocedural X-ray exposure time and dose and contrast agent amount of TIPS.


Assuntos
Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Adulto , Idoso , Feminino , Humanos , Cirrose Hepática , Masculino , Pessoa de Meia-Idade , Veia Porta , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Anticancer Res ; 39(12): 6603-6620, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810926

RESUMO

BACKGROUND: In clinical medicine, little is known about the use of allografts for portal vein (PV) reconstruction after pancreaticoduodenectomy (PD). Portal and caval systems are physiologically different, therefore the properties of allografts from caval and portal systems were studied here in a pig model. MATERIALS AND METHODS: PD with PV reconstruction with allogeneic venous graft from PV or inferior vena cava (IVC) was performed in 26 pigs. Biochemical analysis and ultrasonography measurements were performed during a 4-week monitoring period. Computer simulations were used to evaluate haemodynamics in reconstructed PV and explanted allografts were histologically examined. RESULTS: The native PV and IVC grafts varied in histological structure but were able to adapt morphologically after transplantation. Computer simulation suggested PV grafts to be more susceptible to thrombosis development. Thrombosis of reconstructed PV occurred in four out of five cases in PV group. CONCLUSION: This study supports the use of allografts from caval system for PV reconstruction in clinical medicine when needed.


Assuntos
Simulação por Computador , Pancreaticoduodenectomia , Veia Porta/cirurgia , Veia Cava Inferior/transplante , Aloenxertos , Anastomose Cirúrgica/métodos , Animais , Cadáver , Feminino , Hemodinâmica , Masculino , Tamanho do Órgão , Tratamentos com Preservação do Órgão , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiologia , Complicações Pós-Operatórias/etiologia , Piloro , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fluxo Sanguíneo Regional , Suínos , Coleta de Tecidos e Órgãos , Ultrassonografia , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiologia , Trombose Venosa/etiologia
6.
Medicine (Baltimore) ; 98(50): e18362, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852141

RESUMO

BACKGROUND: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the presence of portal vein tumor thrombosis (PVTT) is considered to indicate an advanced stage of hepatocellular carcinoma (HCC) with nearly no cure. Hepatic resection and transarterial chemoembolization (TACE) have recently been recommended for treatment of HCC with PVTT. METHODS: We conducted a systematic review to compare the overall survival between patients with HCC and PVTT undergoing hepatectomy, TACE or conservative treatment including sorafenib chemotherapy. The PubMed, Web of Science, and Cochrane Library databases were searched. All relevant studies were considered. Hazard ratios with 95% confidence intervals were calculated for comparison of the cumulative overall survival. Ten retrospective studies met the inclusion criteria and were included in the review. RESULTS: Overall survival was not higher in the hepatectomy group than TACE group. But survival rate was higher in hepatectomy group than conservative group. The subgroup analysis demonstrated that hepatectomy was superior in patients without PVTT in the main trunk than in patients with main portal vein invasion. In patients without main PVTT, hepatectomy has showed more benefit than TACE. However, there has been no significant difference between the hepatectomy and TACE groups among patients with main PVTT. CONCLUSION: For patients with resectable HCC and PVTT, hepatectomy might be more effective in patients without PVTT in the main trunk than TACE or conservative treatment.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica/mortalidade , Hepatectomia/mortalidade , Neoplasias Hepáticas , Veia Porta/cirurgia , Sorafenibe/uso terapêutico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Tratamento Conservador/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Masculino , Taxa de Sobrevida , Resultado do Tratamento , Trombose Venosa
7.
Zhonghua Nei Ke Za Zhi ; 58(12): 894-898, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31775452

RESUMO

Objective: Portal vein thrombosis (PVT) is a rare and severe clinical manifestation of antiphospholipid syndrome (APS), as well as a predictor of poor prognosis. This study was conducted to explore the clinical features and risk factors of PVT in APS patients. Methods: A total of 123 APS patients diagnosed from 2012 to 2019 were retrospectively enrolled. The diagnosis of PVT was made according to the 2009 American College of Liver Diseases (AASLD) criteria. Clinical and laboratory data were collected. A multivariate (MV) logistic regression model was constructed using a stepwise forward selection procedure among those candidate univariables with P values<0.10. Results: A total of 28 cases with PVT, and 95 control cases without PVT were finally enrolled.The 28 APS-PVT patients included 5 males and 23 females with age range from 17 to 63 years. Clinical manifestations included acute thrombosis in 8 patients, chronic thrombosis in 16, and 4 with portal vein spongiform. As to the involved vessels, single portal vein thrombosis was seen in 20 patients, portal combined with superior mesenteric vein (SMV) and splenic vein in one patient, portal plus SMV in 4 and only SMV in 3 patients. Other manifestations were portal hypertension (16/28), esophageal varices (13/28), spleen infarction (7/28) and gastrointestinal bleeding (4/28). Two antiphospholipid antibodies were positive in 13 cases. Triple positive antibodies were seen in 7 cases. Multivariate logistic regression analysis showed that disease duration less than 0.5 years (OR=72.74, 95%CI 7.50-705.45, P<0.001), hypoalbuminemia (OR=356.45, 95%CI 19.19-6 620.14, P<0.001), and elevated erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) (OR=14.41, 95%CI 1.49-139.20, P<0.001) were independent risk factors for PVT in APS. Conclusion: PVT is usually misdiagnosed due to insidious onset. Short disease duration, hypoalbuminemia and elevated ESR/CRP are risk factors for PVT in APS. Better understanding, early diagnosis and treatment will improve the clinical outcome.


Assuntos
Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/imunologia , Cirrose Hepática/imunologia , Veia Porta/patologia , Trombose/imunologia , Trombose Venosa/fisiopatologia , Adolescente , Adulto , Síndrome Antifosfolipídica/complicações , Feminino , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose/complicações , Trombose Venosa/complicações , Adulto Jovem
8.
Gan To Kagaku Ryoho ; 46(11): 1791-1793, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31748495

RESUMO

A 65-year-old woman was diagnosed with simultaneous hepatic metastasis of rectal cancer with portal venous tumor thrombi(Vp3)that developed in the bifurcation of the portal vein. Four days from the first visit, abdominal dynamic contrastenhanced CT image on the portal venous phase shows that the tumor thrombi progressed in the main trunk of the portal vein (Vp4). We decided that it was a condition of oncologic emergency and initiated FOLFOXIRI plus BV therapy. After 12 courses, tumor shrinkage and regression of the portal venous tumor thrombi were achieved, but conversion surgery was impossible because the collateral circulation of the hepatic portal region remained. The treatment target was changed to the extension of the survival period. The initiation and reinitiation of FOLFOXIRI plus BV therapy and maintenance of 5-FU/l-LV plus BV therapy contributed to disease control in 24 months and survival period of 36months.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Hepáticas , Neoplasias Retais , Trombose Venosa , Idoso , Camptotecina/análogos & derivados , Feminino , Fluoruracila , Hepatectomia , Humanos , Leucovorina , Neoplasias Hepáticas/tratamento farmacológico , Compostos Organoplatínicos , Veia Porta , Neoplasias Retais/complicações , Neoplasias Retais/tratamento farmacológico , Trombose Venosa/etiologia
9.
Vasc Health Risk Manag ; 15: 449-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695400

RESUMO

Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.


Assuntos
Veias Mesentéricas , Veia Porta , Veia Esplênica , Trombose Venosa , Anticoagulantes/uso terapêutico , Humanos , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Circulação Esplâncnica , Veia Esplênica/diagnóstico por imagem , Veia Esplênica/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/epidemiologia , Trombose Venosa/fisiopatologia
10.
Rozhl Chir ; 98(9): 350-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31698910

RESUMO

INTRODUCTION: There is evidence that mesenchymal stem cells (MSCs) could trans-differentiate into the liver cells in vitro and in vivo and thus may be used as an unfailing source for stem cell therapy of liver disease. Combination of MSCs (with or without their differentiation in vitro) and minimally invasive procedures as laparoscopy or Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a chance for many patients waiting for liver transplantation in vain. METHODS: Over 30 millions of autologous MSCs at passage 3 were transplanted via the portal vein in an eight months old miniature pig. The deposition of transplanted cells in liver parenchyma was evaluated histologically and the trans-differential potential of CM-DiI labeled cells was assessed by expression of pig albumin using immunofluorescence. RESULTS: Three weeks after transplantation we detected the labeled cells (solitary, small clusters) in all 10 samples (2 samples from each lobe) but no diffuse distribution in the samples. The localization of CM-DiI+ cells was predominantly observed around the portal triads. We also detected the localization of albumin signal in CM-DiI labeled cells. CONCLUSION: The study results showed that the autologous MSCs (without additional hepatic differentiation in vitro) transplantation through the portal vein led to successful infiltration of intact miniature pig liver parenchyma with detectable in vivo trans-differentiation. NOTES as well as other newly developed surgical approaches in combination with cell therapy seem to be very promising for the treatment of hepatic diseases in near future.


Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Veia Porta , Animais , Cirurgia Endoscópica por Orifício Natural , Suínos , Porco Miniatura , Transplante Autólogo
11.
Rozhl Chir ; 98(9): 379-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31698915

RESUMO

INTRODUCTION: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. PATIENTS AND METHODS: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. RESULTS: The mean FLRV increase was 206.6 cm3 46 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. CONCLUSION: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.


Assuntos
Embolização Terapêutica , Veia Porta , Etanol , Hepatectomia , Humanos , Ligadura , Neoplasias Hepáticas/terapia
12.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 777-781, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734992

RESUMO

Objective: To investigate the safety, feasibility, and preliminary clinical experience of ultrasonic guided percutaneous portal vein punctures combined bi-directional angiography in the treatment by transjugular intrahepatic portosystemic shunt(TIPS). Methods: From January 2016 to June 2018, 15 patients with TIPS from our hospital who were treated by ultrasonic guided percutaneous portal vein punctures combined with bi-directional angiography were enrolled,and were recruited as experimental group. During the same period, 30 patients who were treated by TIPS combined with traditional methods were enrolled, and were recruited as control group. There was no statistical difference in baseline characteristics between the two groups (P > 0.05). The portal pressure difference in preoperative and postoperative, the fluoroscopy time, the number of puncture needles and complications were recorded. After treatment, the patients were followed up through outpatient service or telephone method. Results: The technical success rate was 100% in experimental group, and 96.7% in control group. In the experimental group, number of percutaneous transhepatic portal vein puncture by needle was 1-3 (average, 2.13 ± 0.74), and the number of portal vein puncture needles in the control group were 1-11 (average, 4.16 ± 2.13). The number of puncture needles in the experimental group were significantly decreased than in the control group (P < 0.001). In the experimental group, the fluoroscopy time was 18 ~ 46 (average 29.64 ± 8.79) minutes. In the control group, the fluoroscopy time was 12 ~ 150 (average 44.57 ± 26.84) minutes.The fluoroscopy time was significantly reduced in the experimental group compared with the control group(P = 0.023). Conclusion: Ultrasound-guided portal vein combined with bidirectional angiog-raphy is safe, feasible, and reliable in the treatment by TIPS. Compare with traditional TIPS, it can reduce the fluoroscopy time, the number of puncture needles and the liver injury.


Assuntos
Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática , Angiografia , Fluoroscopia , Humanos , Agulhas , Pressão na Veia Porta , Punções , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
13.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 813-816, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31735000

RESUMO

Portal vein thrombosis (PVT) is one of the serious complications in the decompensated stage of liver cirrhosis, which is often accompanied by the aggravation of liver cirrhosis and other complications and in severe cases; it may induce gastroesophageal variceal hemorrhage and endanger the lives of patients. Furthermore, the most common complication in decompensated stage of cirrhosis is history of gastroesophageal variceal hemorrhage and the formation of PVT that may be a risk factor to promote each other. Presently, there are guidelines for diagnosis and treatment of gastroesophageal variceal hemorrhage in liver cirrhosis, but there is still a lack of in-depth understanding of cirrhosis complicated with PVT. This paper summarizes advances in the study of gastroesophageal variceal hemorrhage complicated with PVT in liver cirrhosis in order to enhance the understanding of risk factors for diagnosis and treatment.


Assuntos
Varizes Esofágicas e Gástricas/patologia , Hemorragia Gastrointestinal/patologia , Cirrose Hepática/patologia , Veia Porta/patologia , Humanos , Fatores de Risco
14.
Eur. j. anat ; 23(6): 425-433, nov. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-185085

RESUMO

Thorough knowledge of the variation of intrahepatic course of the portal vein is essential for pre-operative assessment of various hepatic surgeries like hepatectomy and live donor liver transplant. This study aims to determine the variation in the branching pattern of the portal vein in South Indian population. The branching pattern of the portal vein was studied by 3D reconstruction of 100 contrast-enhanced computed tomography images and in 15 formalin fixed livers using modified luminal casting technique. Radiologically, the normal portal vein anatomy was seen in 89%. The most common variation was trifurcation of portal vein (5%). A rare anomaly was noted in one case where the left portal vein gave a branch to segment VII. Using the modified luminal casting technique all the 15 specimens displayed Type I portal vein anatomy. The most common variation in the intrahepatic branching pattern ob-served was the right posterior segmental division supplying segment VIII. A rare left portal vein variation, in which it gave branches to segments V and VIII was noted. In this study, variations in the segmental supply of the portal vein were observed, which have not been studied in detail previously in the Indian population. Variations on the left portal vein are infrequent. A prior knowledge of such variations will help the interventional radiologists to reduce misinterpretations and subsequent misdiagnosis and guide the hepatobiliary


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Índia , Doadores de Tecidos , Liberação de Cirurgia/métodos , Hepatectomia , Fígado/anatomia & histologia , Fígado/diagnóstico por imagem , Veia Porta/anormalidades
15.
Arq Gastroenterol ; 56(3): 246-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633719

RESUMO

BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Adenocarcinoma/mortalidade , Adulto , Idoso , Brasil/epidemiologia , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Morbidade , Neoplasias Pancreáticas/mortalidade , Pancreaticoduodenectomia/mortalidade , Veia Porta/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
16.
J Cancer Res Clin Oncol ; 145(12): 2995-3003, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31664520

RESUMO

PURPOSE: To describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis. METHODS: This study included 50 patients with a postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7- and CK19-negative HCC (control group) who attended our hospital between January 2015 and December 2018. All patients underwent Gd-EOB-DTPA-enhanced MRI within 1 month before surgery. Arterial phase (AP), portal venous phase (PVP), delayed phase (DP) and hepatobiliary phase (HBP) images were transferred into a radiomics platform. Volumes of interest covered the whole tumor. The dimensionality of the radiomics features were reduced using LASSO. Four classifiers, including multi-layer perceptron (MLP), support vector machines (SVM), logistic regression (LR) and K-nearest neighbor (KNN) were used to distinguish DPHCC from CK7- and CK19-negative HCC. Kaplan-Meier survival analysis was used to assess 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups. RESULTS: The best preoperative diagnostic power for DPHCC will likely be derived from a combination of different phases and classifiers. The sensitivity, specificity and accuracy of LR in PVP (0.740, 0.780, 0.766), DP (0.893, 0.700, 0.798), HBP (0.800, 0.720, 0.756) and MLP in PVP (0.880, 0.720, 0.798) were better performance. The 1-year DFS and OS of the patients in the observation group were 69% and 78%, respectively. The 1-year DFS and OS of the patients in the control group were 83% and 85%, respectively. Kaplan-Meier survival analysis showed no statistical difference in DFS and OS between groups (P = 0.231 and 0.326), but DFS and OS were numerically lower in patients with DPHCC. CONCLUSION: The radiomics features extracted from Gd-EOB-DTPA-enhanced MR images can be used to diagnose preoperative DPHCC. DPHCC is more likely to recur and cause death than HCC, suggesting that active postoperative management of patients with DPHCC is required.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Gadolínio DTPA/administração & dosagem , Neoplasias Hepáticas/diagnóstico , Carcinoma Hepatocelular/patologia , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fenótipo , Veia Porta/patologia , Prognóstico
17.
Mymensingh Med J ; 28(4): 727-733, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599233

RESUMO

Cirrhotic patients have hepatic vein waveform abnormalities (HVWA). Both Doppler ultrasonography of hepatic venous wave form (HVWF) and portal Doppler flowmetry (PDF) can non invasively recognize hepatic vein wave form abnormalities and determine severity of esophageal varices. Here we applied cross sectional study and found out the relation between HVWF and PDF and duration of the study from July 2016 to June 2017 in a tertiary Medical College Hospital, Bangladesh. 49 purposively taken diagnosed, hospital admitted, cirrhotic patients were included. Face to face interview and reviewing of records were the source of data and it was analyzed by SPSS windows version-12 software programs. At first, local ethical committee approved the study protocol, p<0.05 was statistically significant and 95% was confidence interval. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. Alternative diagnostic investigations would be either HVWF or PDF. HVWF were normal triphasic. Abnormal biphasic and monophasic PDF consisted of the maximum values of portal flow velocity, portal vein flow volume, diameter of the portal vein, and congestion index. Small and large varices were the easiest form of endoscopic grading of esophageal varices. No clinical or echocardiographic feature of right sided heart failure had found in any patient. Both HVWF and PDF can certainly demonstrate the presence of varices but only HVWF detected severity of esophageal varices - monophasic wave (60.47%) in Doppler USG which signified (<0.05) large varices (67.44%) in endoscopy and in biphasic wave (31.53%) in Doppler USG which signified small varices (32.66%) in endoscopy. Patients who developed varices had portal vein diameter (PVD) and congestion index (CI) were higher (p<0.02) and portal vein velocity (PVV) was lower (p<0.05) than whom did not develop varices, but severity of varices could not be detected. Portal vein flow volume (PVFV) did not signify the presence or severity of varices. Moderately positive correlation (correlation co-efficient was 0.0064) was found between Doppler USG of HVWF and esophagogastroduodenoscopic in severity detection varices. In determination of severity of esophageal varices in patients with liver cirrhosis Hepatic venous Doppler sonography plays more vital role than PDF.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico por imagem , Cirrose Hepática , Reologia , Ultrassonografia Doppler , Bangladesh , Estudos Transversais , Humanos , Veia Porta
18.
Anticancer Res ; 39(10): 5821-5830, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570487

RESUMO

BACKGROUND/AIM: The significance of the anatomical variations of proximal jejunal vein [the so-called 1st jejunal vein (J1v)] has been reported from a technical standpoint. The aim of this study was to retrospectively investigate the prognostic impact of the anatomical variations of J1v in the surgical treatment of resectable pancreatic cancer (PC). PATIENTS AND METHODS: A total of 49 patients with resectable PC located in the uncinate process were included in this study. The J1v converging pattern was divided into 2 groups in terms of its relation to the SMA (i.e., the J1v status): i) group D: the J1v travels posterior to the SMA; ii) group V: the J1v travels anterior to the SMA. The associations between the J1v status and surgical outcome were assessed. RESULTS: The 5-year survival rate after resection in group V (35%) was significantly lower than that in group D (70%) (p=0.029), and the J1v status of group V was the only independent negative prognostic factor (HR=5.49; 95% CI=1.69-19.3; p=0.005). CONCLUSION: The J1v converging pattern is a significant prognostic variable in patients with PC located in the uncinate process: the J1v status of group V was significantly associated with impaired survival.


Assuntos
Jejuno/patologia , Neoplasias Pancreáticas/patologia , Veia Porta/patologia , Idoso , Quimiorradioterapia/métodos , Feminino , Humanos , Jejuno/efeitos dos fármacos , Jejuno/efeitos da radiação , Masculino , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias/métodos , Pâncreas/efeitos dos fármacos , Pâncreas/patologia , Pâncreas/efeitos da radiação , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Veia Porta/efeitos dos fármacos , Veia Porta/efeitos da radiação , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
19.
Medicine (Baltimore) ; 98(38): e17182, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567959

RESUMO

The complete resection offers the best long-term survival for advanced hepatocellular carcinoma patients. ALPPS as a choice of resection, how is its outcome compared to one-stage resection, liver transplantation and TACE? This retrospective study included 20 ALPPS patients. To minimize the effect of confounding influences of measured covariates, PSM was performed. The overall survival (OS), morbidity, mortality and the increasing rate, KGR were analyzed. The OS in ALPPS group is 27.4 (±3.8 months) moths and the TACE group is 13.5(±1.2 months) (P < .001), LT group is 41.3 (±3.2 months) (P = .048), Resection group is 31.8 (±2.6 months) (P = .368). And the medium increasing volume is 209.5 cm (±61.5 cm) with the increasing ratio 52.4% (+26.9%). The ALPPS is a feasible treatment for HCC patients and it provides a better long-term survival than TACE and it is similar to Resection, less than LT.


Assuntos
Carcinoma Hepatocelular/cirurgia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Carcinoma Hepatocelular/mortalidade , Feminino , Hepatectomia/métodos , Hepatectomia/mortalidade , Humanos , Ligadura , Fígado/cirurgia , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Estudos Retrospectivos , Análise de Sobrevida
20.
Transplant Proc ; 51(9): 3111-3115, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611113

RESUMO

Extensive portosplenomesenteric thrombosis is regarded as a relative contraindication to liver transplantation because of the complexity of the surgical procedure. This report describes a case of living-donor liver transplantation (LDLT) for a patient with extensive portosplenomesenteric thrombosis, in whom portal flow was successfully restored by intraoperative transplenic portal vein and superior mesenteric vein stenting after surgical thrombectomy. The patient's liver function remained normal with a patent portal vein stent 6 months after LDLT, and Doppler ultrasonography demonstrated a normal wave form for portal flow. To the best of our knowledge, this is the world's first case of endovascular management of the portal vein via percutaneous transsplenic access during LDLT, demonstrating that transsplenic access can be an alternative approach without liver graft injury when the superior mesenteric vein branch and inferior mesenteric vein cannot be used as access routes.


Assuntos
Procedimentos Endovasculares/métodos , Transplante de Fígado/métodos , Veia Porta/cirurgia , Veia Esplênica/cirurgia , Trombose Venosa/cirurgia , Humanos , Fígado/irrigação sanguínea , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Trombose Venosa/complicações
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