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1.
BMC Genomics ; 23(1): 665, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36131263

RESUMO

BACKGROUND: Portal vein ligation (PVL)-induced liver hypertrophy increases future liver remnant (FLR) volume and improves resectability of large hepatic carcinoma. However, the molecular mechanism by which PVL facilitates liver hypertrophy remains poorly understood. METHODS: To gain mechanistic insight, we established a rat PVL model and carried out a comprehensive transcriptome analyses of hepatic lobes preserving portal blood supply at 0, 1, 7, and 14-day after PVL. The differentially expressed (DE) long-non coding RNAs (lncRNAs) and mRNAs were applied to conduct weighted gene co-expression network analysis (WGCNA). LncRNA-mRNA co-expression network was constructed in the most significant module. The modules and genes associated with PVL-induced liver hypertrophy were assessed through quantitative real-time PCR. RESULTS: A total of 4213 DElncRNAs and 6809 DEmRNAs probesets, identified by transcriptome analyses, were used to carry out WGCNA, by which 10 modules were generated. The largest and most significant module (marked in black_M6) was selected for further analysis. Gene Ontology (GO) analysis of the module exhibited several key biological processes associated with liver regeneration such as complement activation, IL-6 production, Wnt signaling pathway, autophagy, etc. Sixteen mRNAs (Notch1, Grb2, IL-4, Cops4, Stxbp1, Khdrbs2, Hdac2, Gnb3, Gng10, Tlr2, Sod1, Gosr2, Rbbp5, Map3k3, Golga2, and Rev3l) and ten lncRNAs (BC092620, AB190508, EF076772, BC088302, BC158675, BC100646, BC089934, L20987, BC091187, and M23890) were identified as hub genes in accordance with gene significance value, module membership value, protein-protein interaction (PPI) and lncRNA-mRNA co-expression network. Furthermore, the overexpression of 3 mRNAs (Notch1, Grb2 and IL-4) and 4 lncRNAs (BC089934, EF076772, BC092620, and BC088302) was validated in hypertrophic liver lobe tissues from PVL rats and patients undergoing hepatectomy after portal vein embolization (PVE). CONCLUSIONS: Microarray and WGCNA analysis revealed that the 3 mRNAs (Notch1, Grb2 and IL-4) and the 4 lncRNAs (BC089934, EF076772, BC092620 and BC088302) may be promising targets for accelerating liver regeneration before extensive hepatectomy.


Assuntos
Neoplasias Hepáticas , RNA Longo não Codificante , Animais , Hepatectomia , Hipertrofia , Interleucina-4 , Interleucina-6 , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/patologia , Regeneração Hepática/genética , Veia Porta/patologia , Veia Porta/cirurgia , RNA Longo não Codificante/genética , RNA Mensageiro/genética , Ratos , Superóxido Dismutase-1 , Receptor 2 Toll-Like
2.
Front Immunol ; 13: 999763, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36119069

RESUMO

Portal vein tumor thrombus (PVTT) is a frequent complication in hepatocellular carcinoma (HCC). HCC patients with PVTT have the characteristics of less treatment tolerance and poor prognosis. Immunotherapy, especially combined immunotherapy, has been successfully used in advanced HCC. However, there are no recognized universally indicators that can predict response or resistance to immunotherapy for HCC. Herein, we reported a 58-year-old HCC patient with PVTT, cirrhosis and chronic viral hepatitis, who achieved complete response (CR) after combined immunotherapy (camrelizumab combined with sorafenib or regorafenib), according to his high enrichment of tumor-infiltrating immune cells and tertiary lymphoid structure (TLS). In this case, we revealed the characteristics of the baseline tumor immune microenvironment (TIME) in a HCC patient who responded well to combined immunotherapy, suggesting that TIME can be used to assist in clinical decision making of immunotherapy for HCC.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trombose , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Humanos , Imunoterapia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Pessoa de Meia-Idade , Veia Porta/patologia , Sorafenibe/uso terapêutico , Trombose/patologia , Microambiente Tumoral
3.
Medicine (Baltimore) ; 101(37): e30475, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36123884

RESUMO

INTRODUCTION: Portal vein aneurysms (PVA) and intrahepatic portosystemic venous shunts are rarely diagnosed clinically. PATIENT CONCERNS: A 75-year-old female was admitted to our hospital for evaluation of significant weight loss, diabetes, and an irregularly shaped cystic lesion in the left lateral lobe of the liver. DIAGNOSIS: The patient was diagnosed with a portal vein aneurysm combined with an intrahepatic portosystemic venous shunt using multiple imaging techniques. INTERVENTIONS: The patient had no relevant clinical symptoms of PVA with concurrent intrahepatic portosystemic venous shunt; hence, no interventions were performed. Ultrasonography was suggested to be performed every 3 months. OUTCOMES: The patient did not visit the hospital after discharge; however, 4 telephonic follow-up evaluations showed that the patient was well. LESSONS: Multimodal imaging techniques should be used to evaluate the source of blood flow, presence or absence of shunts, and the course, number, and location of the shunts to prevent misdiagnosis of this disease.


Assuntos
Aneurisma , Veia Porta , Idoso , Feminino , Humanos , Fígado/irrigação sanguínea , Imagem Multimodal , Veia Porta/diagnóstico por imagem , Ultrassonografia
4.
Medicine (Baltimore) ; 101(37): e30412, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36123901

RESUMO

Donor anatomy is an essential part of donor selection and operative planning in living donor liver transplantation. In this study, variations of hilar structures, and the effects of variant anatomy on donor and recipient outcomes were evaluated. Living donor liver transplantations in a single center between January 2013 and December 2020 were retrospectively reviewed. In total, 203 liver transplantations were analyzed. Type 1 arterial anatomy, type 1 portal vein anatomy and type 1 bile duct anatomy were observed in 144 (70.9%), 173 (85.2%), and 129 (63.5%) donors, respectively. Variant biliary anatomy was observed more frequent in donors with variant portal vein branching than in those with type 1 portal anatomy (60.0% vs 32.3%, P = .004). The overall survival rates calculated for each hilar structure were similar between recipients receiving grafts with type 1 anatomy and those receiving grafts with variant anatomy. When donors with variant anatomy and donors with type 1 anatomy were compared in terms of hilar structure, no significant difference was observed in the frequency of complications and the frequency of serious complications. Biliary variations are more common in individuals with variant portal vein anatomy. Donor anatomic variations are not risk factors for inferior results of recipient survival or donor morbidity.


Assuntos
Transplante de Fígado , Doadores Vivos , Humanos , Fígado/irrigação sanguínea , Transplante de Fígado/efeitos adversos , Veia Porta/anatomia & histologia , Estudos Retrospectivos
5.
Surg Radiol Anat ; 44(9): 1247-1250, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36068438

RESUMO

PURPOSE: Aberrant left gastric vein is a rare variant and hardly known by surgeons. Its misidentification may lead to accidental bleeding. More importantly, it can also be the root of hypertensive gastropathy in cirrhotic patients and tumor spread in patients with gastric cancer. Here, we describe and provide imaging data of the three patterns of aberrant left gastric veins. METHODS: Over the past 5 years, three cases were noted, each one corresponding to one of the three variants. RESULTS: Aberrant left gastric vein is a rare anatomical entity and has rarely been reported. Its normal anatomy and variants, embryological origins, radiological analysis, and clinical implications are all discussed, bringing light to what surgeons should know when encountering an aberrant left gastric vein. CONCLUSION: Surgeons should be aware of the types of ALGV, its associated arterial variations, the presence of pseudolesion or not, and the potential atrophy of liver segment.


Assuntos
Neoplasias Gástricas , Cirurgiões , Humanos , Fígado/irrigação sanguínea , Veia Porta , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
6.
Lakartidningen ; 1192022 Sep 20.
Artigo em Sueco | MEDLINE | ID: mdl-36125253

RESUMO

Acute mesenteric venous thrombosis causes impaired mesenteric blood supply which may lead to bowel infarction and, in a longer perspective, severe portal hypertension. Early diagnosis, immediate anticoagulation, and active expectancy are critical for the outcome. The patients should be evaluated and treated in a multidisciplinary context, involving gastroenterologists, interventional radiologists, vascular and colorectal surgeons, and consultants in clinical coagulation. Percutaneous thrombectomy, including transjugular intrahepatic portosystemic shunt (TIPS), should be considered in cases with imminent bowel necrosis despite adequate anticoagulation, but can also serve as a complement to surgery. Here we provide a clinical overview of acute mesenteric venous thrombosis, exemplified with authentic patient cases, especially discussing the role for interventional radiology.


Assuntos
Isquemia Mesentérica , Trombose Venosa , Doença Aguda , Anticoagulantes/uso terapêutico , Humanos , Isquemia Mesentérica/complicações , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle
7.
World J Surg Oncol ; 20(1): 278, 2022 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36057621

RESUMO

In this report, we describe a case of highly advanced hepatocellular carcinoma with tumor thrombosis extending into the main portal vein of the pancreas that was successfully treated with adjuvant lenvatinib after right hepatic resection with thrombectomy. A 70-year-old woman was referred from the clinic because of elevated hepatobiliary enzymes. The patient was positive for the hepatitis B virus antigen at our hospital. The tumor markers were highly elevated with alpha-fetoprotein (14.5 U/mL) and protein induced by vitamin K absence (PIVKAII) (1545 ng/mL), suggesting hepatocellular carcinoma. Dynamic abdominal computed tomography showed an early enhanced tumor approximately 6 cm in size and portal vein tumor thrombosis filling the main portal vein, but not extending into the splenic or superior mesenteric vein (SMV). On magnetic resonance imaging 1 week after CT, portal vein tumor thrombosis had extended to the confluence of the splenic vein with the SMV, indicating rapid tumor growth. Thus, we performed emergent right hepatectomy with tumor thrombectomy. Postoperatively, we treated the patient with lenvatinib for a tumor reduction surgery. Fortunately, the patient was alive 2 years postoperatively without recurrence. This case report suggests that a favorable outcome may be achieved with multidisciplinary treatment including resection and postoperative treatment with lenvatinib.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Trombose , Trombose Venosa , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Compostos de Fenilureia , Veia Porta/patologia , Veia Porta/cirurgia , Prognóstico , Quinolinas , Veia Esplênica/patologia , Veia Esplênica/cirurgia , Trombose/etiologia , Trombose/cirurgia , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico
8.
Radiographics ; 42(5): 1562-1576, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35984753

RESUMO

Multiple diseases of the portal system require effective portal vein access for endovascular management. While percutaneous transhepatic and transjugular approaches remain the standard methods of portal vein access, transsplenic access (TSA) has gained recognition as an effective and safe technique to access the portal system in patients with contraindications to traditional approaches. Recently, the utility of percutaneous TSA has grown, with described treatments including recanalization of chronic portal vein occlusion, placement of stents for portal vein stenosis, portal vein embolization of the liver, embolization of gastric varices, placement of complicated transjugular intrahepatic portosystemic shunts, and interventions after liver transplant. The authors provide a review of percutaneous TSA, including indications, a summary of related portal vein diseases, and the different techniques used for access and closure. In addition, an imaging-based review of technical considerations of TSA interventions is presented, with a review of potential procedural complications. With technical success rates that mirror or rival the standard methods and reported low rates of major complications, TSA can be a safe and effective option in clinical scenarios where traditional approaches are not feasible. ©RSNA, 2022.


Assuntos
Embolização Terapêutica , Varizes Esofágicas e Gástricas , Transplante de Fígado , Derivação Portossistêmica Transjugular Intra-Hepática , Cateterismo , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Humanos , Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Resultado do Tratamento
9.
Med Sci Monit ; 28: e937763, 2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36039028

RESUMO

BACKGROUND Portal hypertension associated with liver cirrhosis can be treated by splenectomy. During splenectomy, the gastrosplenic and the splenorenal ligaments that form the hilar splenic pedicle can be surgically divided by several approaches, with the aim to reduce portal vein thrombosis (PVT) and postoperative pancreatic fistula (PPF). This 12-year retrospective study from a single center aimed to evaluate postoperative outcomes following use of a modified method of surgical division of the splenic pedicle (MSDSP) in 719 patients who underwent splenectomy for portal hypertension (PH). MATERIAL AND METHODS From January 2010 to December 2021, 719 consecutive cirrhotic patients with PH and splenomegaly underwent splenectomy in our department. According to different methods of surgical division of the splenic pedicle, patients were divided into a Control Group (n=349) and a Study Group (n=370). The characteristics of the patients, perioperative indicators, postoperative complications (PVT, PPF and abdominal hemorrhage) and follow-up data were compared between the 2 groups. Propensity score matching was conducted to adjust for differences in preoperative characteristics at a 1: 1 ratio, resulting in 260 patients in each group. RESULTS After PSM was conducted, intraoperative blood loss, PVT, PPF, and hospital stay were decreased significantly in the matched Study Group (all P<0.01). Both groups showed similar results concerning recurrent esophagogastric variceal bleeding and overall survival during the follow-up period. CONCLUSIONS Our MSDSP help to reduce postoperative complications and shorten hospital stay.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Trombose Venosa , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Veia Porta , Complicações Pós-Operatórias , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Trombose Venosa/etiologia
10.
A A Pract ; 16(8): e01607, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35952339

RESUMO

The use of intraoperative transesophageal echocardiography (TEE) to assess venous congestion of the liver due to right heart dysfunction is well established, predominately through the Doppler interrogation of the hepatic and portal venous waveforms. Transjugular intrahepatic portosystemic shunts (TIPSs) are artificial intraparenchymal tracts through the liver that are placed to decompress the portal circulation in the setting of portal hypertension, most commonly due to cirrhosis. Herein, we describe the Doppler interrogation of a TIPS using intraoperative TEE, and how changes in the transmitted portal venous waveform were used to assess the severity of tricuspid regurgitation and inform management. (A&A Practice. 2022;16:e01607.).


Assuntos
Fístula , Hipertensão Portal , Derivação Portossistêmica Transjugular Intra-Hepática , Ecocardiografia Transesofagiana , Humanos , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Ultrassonografia Doppler
11.
BMC Surg ; 22(1): 311, 2022 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-35953816

RESUMO

BACKGROUND: Liver transplantation is one of the most effective treatments for end-stage liver disease. Split liver transplantation (SLT) can effectively improve the utilization efficiency of grafts. However, split liver transplantation still faces shortcomings and is not widely used in surgery. How to improve the effective transplantation volume of split liver transplantation and promote the postoperative recovery of patients has important clinical significance. METHODS: In our study, the donor's liver was split into the extended right graft and left lateral sector, and the IV segment occur ischemia. To guarantee the functional graft size, and avoid complications, we reconstructed the IV segment portal vein and left portal vein. And we analyzed the operation time, intraoperative bleeding, liver function, and postoperative complications. RESULTS: In our research, 14 patients underwent IV segment portal vein reconstruction, and 8 patients did not undergo vascular reconstruction. We found that the ischemic area of the IV segment decreased significantly after IV segment portal vein reconstruction. We found that there was no significant difference in operation time and postoperative complications between the patients of the groups. There were significant differences in ALT on the 1st day and albumin on the 6th day after the operation. CONCLUSION: It indicates that IV segment reconstruction in SLT surgery can alleviate the graft ischemic and promote the recovery of liver function after the operation. And, IV segment reconstruction as a novel operating procedure may be widely used in SLT.


Assuntos
Doença Hepática Terminal , Transplante de Fígado , Humanos , Transplante de Fígado/métodos , Doadores Vivos , Veia Porta/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
12.
Am J Case Rep ; 23: e935893, 2022 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-36003007

RESUMO

BACKGROUND Portal vein thrombosis (PVT) is a well-recognized complication in patients with cirrhosis and frequently requires a nuanced approach to treatment. There is a paucity of existing literature and evidence-based recommendations regarding the optimal treatment approach to chronically occluded portal veins. Management options range from observation to anticoagulation and interventional therapies such as transjugular intrahepatic portosystemic shunts (TIPS), thrombolysis, or surgical thrombectomy. For select patients with little success from traditional medical therapies and previously failed TIPS procedures, a direct transhepatic approach to restoring blood flow and resolving variceal bleeding may be appropriate. CASE REPORT A 31-year-old man with a past medical history of portal hypertension, refractory ascites, gastroesophageal varices, and decompensated cirrhosis secondary to alcohol abuse had previously undergone an unsuccessful TIPS placement. Preprocedural imaging demonstrated a cirrhotic liver, splenomegaly, and gastroesophageal varices compatible with portal hypertension. Also noted were focal calcifications in the region of the diminutive main portal vein, medial splenic vein, and superior mesenteric vein, compatible with sequalae of chronic thrombosis. Restoration of flow through the occluded segment of the main portal vein and cessation of variceal bleeding was successfully resolved through the combination of portal vein reconstruction and massive volume embolization of the large coronary vein using a direct, percutaneous approach. CONCLUSIONS A direct, percutaneous approach to main portal vein reconstruction and massive volume embolization after a previously failed TIPS may be a potential alternative approach for select patients.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Trombose , Varizes , Trombose Venosa , Adulto , Vasos Coronários , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/terapia , Cirrose Hepática/complicações , Masculino , Veia Porta/cirurgia , Estudos Retrospectivos , Trombose/complicações , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/terapia
13.
Drug Discov Ther ; 16(4): 200-203, 2022 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-35989282

RESUMO

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired clonal hematopoietic stem cell disorder, characterized by hemolytic anemia, bone marrow failure and thrombosis. Portal vein thrombosis (PVT) is relatively rare in patients with PNH. In this paper, we reported PVT as the first clinical presentation of PNH in a female patient. PVT related symptoms resolved after anticoagulation therapy.


Assuntos
Hemoglobinúria Paroxística , Hepatopatias , Trombose , Trombose Venosa , Anticoagulantes/uso terapêutico , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/diagnóstico , Hemoglobinúria Paroxística/tratamento farmacológico , Humanos , Veia Porta , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia
15.
Radiol Clin North Am ; 60(5): 857-871, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35989049

RESUMO

The liver's unique blood supply facilitates multiple important physiologic roles. Liver vascular disorders have distinct appearances on imaging examinations and may mimic other pathologies. This article reviews the imaging appearances of vascular disorders from a multimodality perspective. Liver vascular pathologies are categorized by how they affect liver inflow, liver outflow, and those with abnormal arterial-venous connections. By understanding the physiologic and pathologic underpinnings of the hepatic vasculature, the radiologist is well positioned to positively affect patient care.


Assuntos
Hepatopatias , Doenças Vasculares , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Veia Porta , Doenças Vasculares/diagnóstico por imagem
16.
Cir Cir ; 90(S1): 61-69, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944117

RESUMO

BACKGROUND: Portal vein occlusion shortly before extended hepatic resections has hepatoprotective properties, but its molecular effects have not been elucidated. We characterized the impact of regenerative preconditioning by portal vein embolization (PVE) on hepatic energy metabolism and cytokine expression. MATERIALS AND METHODS: About 90% hepatectomies were performed in normal pigs (Control) and in pigs that underwent a PVE 24 h before the surgery (n = 10/group). Blood biochemistry and coagulation, liver damage, liver function (ICG), hepatic content of adenine nucleotides, and hepatic expression of inflammatory mediators (RT-PCR and WB) were determined before the hepatectomy, 15 min, and 24 h later. RESULTS: All PVE and hepatectomies were successfully accomplished. The 90% hepatectomy resulted in: Immediate reduction of ATP, leading to persistent decreases of energy load and ATP/ADP ratio up to the 24-h time-point; and pro-inflammatory expression profile of cytokines in the remnant liver. Prior performance of PVE attenuated the bioenergetic alterations and prevented many of the changes in hepatic cytokine expression. CONCLUSIONS: Regenerative preconditioning by PVE improved hepatic energy metabolism and modulated inflammatory mediators in the remnant liver in pigs undergoing major hepatectomies, potentially contributing to its hepatoprotective effects.


INTRODUCCIÓN: la oclusión de la vena porta precoz antes de hepatectomías extendidas tiene propiedades hepatoprotectoras, pero sus efectos moleculares no se han aclarado. Caracterizamos el impacto del preacondicionamiento regenerativo por embolización de la vena porta (PVE) sobre el metabolismo energético hepático y la expresión de citocinas. MATERIALES Y MÉTODOS: Realizamos hepatectomías del 90% en cerdos (Control) y en cerdos sometidos a PVE 24 horas antes de la cirugía (n = 10/grupo). La bioquímica y la coagulación, el daño hepático, la función hepática (ICG), los nucleótidos de adenina y la expresión de mediadores inflamatorios (RT-PCR y WB) fueron determinado antes de la hepatectomía, quince minutos y 24 horas después. RESULTADOS: Las PVE y las hepatectomías se realizaron con éxito. La hepatectomía del 90% resultó en: una reducción del ATP, lo que disminuye la carga energética y la relación ATP/ADP a las 24 horas; y en la expresión de citocinas proinflamatorias. La realización previa de PVE atenuó las alteraciones bioenergéticas y evitó muchos de los cambios en la expresión de citocinas. CONCLUSIONES: El preacondicionamiento regenerativo con PVE mejoró el metabolismo energético y moduló los mediadores inflamatorios en el hígado remanente en cerdos sometidos a hepatectomías subtotales, contribuyendo potencialmente a sus efectos hepatoprotectores.


Assuntos
Embolização Terapêutica , Neoplasias Hepáticas , Trifosfato de Adenosina , Animais , Citocinas , Embolização Terapêutica/métodos , Hepatectomia/métodos , Mediadores da Inflamação , Fígado/cirurgia , Neoplasias Hepáticas/cirurgia , Veia Porta/cirurgia , Suínos , Resultado do Tratamento
17.
Nihon Shokakibyo Gakkai Zasshi ; 119(8): 761-767, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35944994

RESUMO

A 61-year-old man was admitted due to alcoholic liver cirrhosis, portal vein thrombosis, hepatocellular carcinoma, and chronic pancreatitis. The patient's portal vein thrombosis improved with anticoagulant therapy. Serum amylase gradually increased, but there was no abdominal pain. The patient was placed under observation. The pain in both ankle and knee joints appeared on nine days after admission. Multiple osteonecrotic lesions of both elbows, both knees and both ankle joints were examined using 99mTc bone scintigraphic examinations. Magnetic resonance of the right ankle joint showed osteonecrosis. The pain of the right ankle joint improved with a decrease of serum amylase. We report that this is a rare case of multiple osteonecrosis caused by exacerbation of chronic pancreatitis.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Osteonecrose , Pancreatite Crônica , Trombose Venosa , Amilases , Carcinoma Hepatocelular/complicações , Humanos , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem , Dor/complicações , Pancreatite Crônica/complicações , Veia Porta , Trombose Venosa/complicações
20.
BMC Gastroenterol ; 22(1): 398, 2022 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-36008761

RESUMO

BACKGROUND: This study aimed to determine which running pattern of the left gastric vein (LGV) is most frequently ligated in subtotal stomach-preserving pancreatoduodenectomy (SSPPD) and how LGV ligation affects delayed gastric emptying (DGE) after SSPPD. METHODS: We retrospectively analysed 105 patients who underwent SSPPD between January 2016 and September 2021. We classified the running pattern of LGV as follows: type 1 runs dorsal to the common hepatic artery (CHA) or splenic artery (SpA) to join the portal vein (PV), type 2 runs dorsal to the CHA or SpA and joins the splenic vein, type 3 runs ventral to the CHA or SpA and joins the PV, and type 4 runs ventral to the CHA or SpA and joins the SpV. Univariate and multivariate analyses were used to identify differences between patients with and without DGE after SSPPD. RESULTS: Type 1 LGV running pattern was observed in 47 cases (44.8%), type 2 in 23 (21.9%), type 3 in 12 (11.4%), and type 4 in 23 (21.9%). The ligation rate was significantly higher in type 3 (75.0%) LGVs (p < 0.0001). Preoperative obstructive jaundice (p = 0.0306), LGV ligation (p < 0.0001), grade B or C pancreatic fistula (p = 0.0116), and sepsis (p = 0.0123) were risk factors for DGE in the univariate analysis. Multivariate analysis showed that LGV ligation was an independent risk factor for DGE (odds ratio: 13.60, 95% confidence interval: 3.80-48.68, p < 0.0001). CONCLUSION: Type 3 LGVs are often ligated because they impede lymph node dissection; however, LGV preservation may reduce the occurrence of DGE after SSPPD.


Assuntos
Gastroparesia , Pancreaticoduodenectomia , Esvaziamento Gástrico , Gastroparesia/etiologia , Humanos , Pancreaticoduodenectomia/efeitos adversos , Veia Porta , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
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